The nurse is reviewing the discharge instructions with a patient who has heart failure and is prescribed losartan (Cozaar). Which of the following statements by the patient indicates understanding of the teaching? (Select all that apply.)

The nurse should monitor the client’s serum potassium level closely because furosemide is a loop diuretic that can cause hypokalemia, which increases the risk of cardiac arrhythmias and digitalis toxicity. The nurse should also monitor the client’s fluid status, blood pressure, and renal function.

Choice B is wrong because Serum calcium is wrong because furosemide does not affect calcium levels significantly. Calcium levels are more likely to be affected by thiazide diuretics, which can cause hypercalcemia.

Choice C is wrong because Serum albumin is wrong because furosemide does not affect albumin levels significantly. Albumin levels are more likely to be affected by liver disease, malnutrition, or nephrotic syndrome.

Choice D is wrong because Serum glucose is wrong because furosemide does not affect glucose levels significantly. Glucose levels are more likely to be affected by diabetes mellitus, corticosteroids, or stress.

Normal ranges for the laboratory values are:

• Serum potassium: 3.5-5.0 mEq/L

• Serum calcium: 8.5-10.5 mg/dL

• Serum albumin: 3.5-5.0 g/dL

• Serum glucose: 70-110 mg/dL

This is because metoprolol is a beta blocker, which can block the beta-2 receptors in the lungs and cause constriction of the airways.This can lead to breathing problems such as shortness of breath, cough, and wheezing. Bronchospasm is more likely to occur in people who have asthma or chronic obstructive pulmonary disease (COPD).

Choice A is wrong because tachycardia, or fast heart rate, is not an adverse effect of metoprolol. In fact, metoprolol can lower the heart rate by blocking the beta-1 receptors in the heart.A normal resting heart rate for adults ranges from 60 to 100 beats per minute (bpm).Metoprolol can cause bradycardia, or slow heart rate, which can be a serious side effect if it is too low.

Choice B is wrong because hyperglycemia, or high blood sugar, is not an adverse effect of metoprolol. Metoprolol does not affect the insulin secretion or glucose metabolism in the body.A normal blood sugar level for adults without diabetes is less than 140 mg/dL (7.8 mmol/L) two hours after eating. Metoprolol can cause hypoglycemia, or low blood sugar, in people who have diabetes and take insulin or other glucose-lowering medications.This is because metoprolol can mask the symptoms of hypoglycemia, such as palpitations and tremors.

Choice D is wrong because hyperkalemia, or high potassium, is not an adverse effect of metoprolol. Metoprolol does not affect the potassium balance in the body.

A normal blood potassium level for adults is 3.6 to 5.2 millimoles per liter (mmol/L)