A nurse is caring for a client who has hydromorphone toxicity.
The nurse should anticipate a prescription for which of the following medications?

Choice A rationale

Furosemide, a loop diuretic, can cause ototoxicity, particularly with rapid IV administration or high doses. This adverse effect manifests as tinnitus, vertigo, or irreversible hearing loss due to its impact on the hair cells in the organ of Corti within the inner ear. Therefore, reporting any indications of hearing loss is crucial for client safety.

Choice B rationale

Taking the daily dose of furosemide at bedtime is generally not recommended. Furosemide has a rapid onset and relatively short duration of action, typically leading to increased urine production for several hours. Administering it at bedtime can disrupt sleep patterns due to frequent nocturia, making morning administration preferable to minimize nocturnal diuresis.

Choice C rationale

Daily weight monitoring is essential for clients taking furosemide for heart failure. Furosemide promotes diuresis, reducing fluid overload. Daily weight checks (normal variations are within 0.5-1 kg/day) allow for assessment of fluid balance and the effectiveness of the diuretic therapy, helping to identify both fluid excess and dehydration promptly.

Choice D rationale

Furosemide is a potassium-wasting diuretic, meaning it promotes the excretion of potassium from the body. Chronic use can lead to hypokalemia (normal range 3.5-5.0 mEq/L), which can cause muscle weakness, fatigue, and cardiac arrhythmias. Consuming foods high in potassium regularly helps mitigate this electrolyte imbalance and maintain physiological function.

Choice E rationale

Furosemide can cause orthostatic hypotension, a sudden drop in blood pressure upon standing. This occurs due to fluid volume depletion and vasodilation induced by the diuretic effect. Rising slowly from a sitting or lying position allows the cardiovascular system to compensate, reducing the risk of dizziness, syncope, and falls.

Choice A rationale

Laryngeal edema is a severe manifestation of an immediate hypersensitivity (Type I anaphylactic) reaction to penicillin. It involves swelling of the larynx, leading to airway obstruction, stridor, and difficulty breathing. This life-threatening condition requires immediate medical intervention, including epinephrine and airway management, making it the priority to monitor.

Choice B rationale

Urticaria, or hives, is a common cutaneous manifestation of a hypersensitivity reaction to penicillin. It involves transient, itchy wheals on the skin due to histamine release. While uncomfortable and requiring attention, it is typically not life-threatening unless accompanied by systemic symptoms like laryngeal edema or bronchospasm.

Choice C rationale

Epigastric distress, such as stomach upset or pain, is a common gastrointestinal adverse effect of oral penicillin V, often due to direct irritation of the gastric mucosa or altered gut flora. While it can cause discomfort, it is generally not a life-threatening condition and can often be managed with food or dose adjustment.

Choice D rationale

Maculopapular rash is a delayed hypersensitivity reaction to penicillin, usually appearing several days after initiation of therapy. It presents as flat, red areas with small raised bumps. While it indicates a drug allergy, it is generally not immediately life-threatening compared to acute airway compromise and resolves upon discontinuation of the medication.