The client with coronary artery disease asks the nurse, "Why do I get this chest pain?" Which would be the most appropriate response?

Choice A reason: Withholding the dose and reassessing the blood pressure in 30 minutes is not the most appropriate action at this time. Furosemide is a drug that reduces fluid retention and swelling by increasing the urine output. ¹ The client has pulmonary congestion, which means that there is excess fluid in the lungs, causing difficulty breathing and low oxygen levels. ² Delaying the administration of furosemide may worsen the client's condition and increase the risk of complications, such as pulmonary edema or heart failure.

Choice B reason: Calling the healthcare provider to obtain an order for oral furosemide is not the most appropriate action at this time. Oral furosemide is a tablet that is swallowed and absorbed by the digestive system. ¹ It takes longer to act than intravenous (IV) furosemide, which is injected directly into the bloodstream. ¹ The client has pulmonary congestion, which requires immediate treatment to relieve the fluid accumulation in the lungs. Switching to oral furosemide may delay the therapeutic effect and compromise the client's outcome.

Choice C reason: Administering the medication and notifying the healthcare provider of the blood pressure is the most appropriate action at this time. Furosemide is a drug that reduces fluid retention and swelling by increasing the urine output. ¹ The client has pulmonary congestion, which means that there is excess fluid in the lungs, causing difficulty breathing and low oxygen levels. ² Administering IV furosemide can help remove the excess fluid from the lungs and improve the client's breathing and oxygenation. However, furosemide can also lower the blood pressure by reducing the volume of fluid in the blood vessels. ¹ The client already has low blood pressure, which can cause dizziness, fainting, or shock. The nurse should notify the healthcare provider of the blood pressure and monitor the client for any signs of hypotension or adverse reactions.

Choice D reason: Administering the dose and continuing to monitor the vital signs is not the most appropriate action at this time. Furosemide is a drug that reduces fluid retention and swelling by increasing the urine output. ¹ The client has pulmonary congestion, which means that there is excess fluid in the lungs, causing difficulty breathing and low oxygen levels. ² Administering IV furosemide can help remove the excess fluid from the lungs and improve the client's breathing and oxygenation. However, furosemide can also lower the blood pressure by reducing the volume of fluid in the blood vessels. ¹ The client already has low blood pressure, which can cause dizziness, fainting, or shock. The nurse should not only monitor the vital signs, but also notify the healthcare provider of the blood pressure and report any changes or concerns.

Choice A reason: Limiting the intake of citrus juices is not related to the teaching about hydrochlorothiazide. Citrus juices are rich in vitamin C, which has no significant interaction with hydrochlorothiazide. The client does not need to avoid or limit citrus juices unless they have other medical conditions that require dietary restrictions.

Choice B reason: Eating bananas daily to lower the potassium level is a wrong statement. Bananas are high in potassium, which is a mineral that hydrochlorothiazide can deplete from the body. The client may need to increase their potassium intake or take a potassium supplement to prevent hypokalemia, a condition of low potassium level that can cause muscle weakness, cramps, and arrhythmias.

Choice C reason: Taking the pill each day in the morning is the correct statement. Hydrochlorothiazide is a diuretic that increases the urine output and reduces the blood volume and pressure. The client should take the pill in the morning to avoid nocturia, which is frequent urination at night that can disrupt the sleep quality and increase the risk of falls.

Choice D reason: Taking the pill each day after dinner is not the best statement. Hydrochlorothiazide can cause diuresis, which is increased urine production and excretion. Taking the pill after dinner can lead to nocturia, which is frequent urination at night that can interfere with the sleep cycle and cause fatigue and irritability. The client should take the pill in the morning to prevent nocturia and its complications.