A nurse is caring for a client diagnosed with chronic renal disease. The nurse should recognize that which of the following medications is contraindicated for clients with chronic renal disease?

A. Incompetence: Incompetence refers to a lack of skill or ability to perform a task effectively. It is not a desirable quality in a leader and would hinder rather than facilitate the implementation of new processes.

B. Integrity: Integrity is essential for a leader but is not specifically related to implementing new suggestions or initiatives. Integrity involves honesty, ethics, and adherence to moral principles.

C. Initiative: Initiative refers to the ability to take action and drive forward new ideas or projects. A leader with initiative is proactive and encourages innovation and improvement within the organization. Implementing suggestions for streamlining processes requires initiative to initiate change and drive improvement.

D. Fear: Fear is not a desirable quality in a leader when it comes to implementing changes or new initiatives. Leaders need to be confident, decisive, and willing to take calculated risks to drive positive change and improvement. Fear can inhibit innovation and progress.

Condition Most Likely Experiencing: Heart failure.

The client presents with signs and symptoms consistent with heart failure, including cardiomegaly, bibasilar pleural congestion on chest x-ray, elevated BNP level, and vital signs indicating hypertension (BP 146/98 mm Hg), tachycardia (pulse rate 106/min), and tachypnea (respirations 24/min). Additionally, the client is prescribed medications commonly used to manage heart failure, such as digoxin and carvedilol, and is receiving a diuretic (furosemide) to address fluid overload associated with heart failure.
Action to Take:

Elevate the head of the bed: Elevating the head of the bed helps reduce venous return to the heart, decreasing preload and potentially alleviating symptoms of heart failure, such as dyspnea and orthopnea. It can also help prevent aspiration in clients with compromised cardiac function. Encourage intake of a low-sodium diet: A low-sodium diet is essential in managing heart failure as it helps reduce fluid retention and edema by decreasing fluid volume overload. Sodium restriction helps minimize fluid accumulation, which is crucial in preventing exacerbations of heart failure.
Parameter to Monitor:

Urinary output: Monitoring urinary output is important in assessing fluid balance and response to diuretic therapy in clients with heart failure. Decreased urinary output may indicate worsening heart failure or inadequate response to diuretic therapy, whereas increased output may suggest over-diuresis or improvement in heart failure symptoms.
Blood pressure: Monitoring blood pressure helps assess the effectiveness of treatment in managing heart failure and controlling hypertension, a common comorbidity. Hypertension can exacerbate heart failure, so monitoring blood pressure trends helps guide adjustments in medication therapy to achieve optimal blood pressure control and improve cardiac function.