A nurse is caring for a client who is crying after receiving a terminal cancer diagnosis. Which of the following responses should the nurse make?

Rationale:

A. Ecchymosis on the inner left thigh: Bruising can occur as a result of trauma or surgery and is expected after cast placement. While it should be monitored, it is not the most urgent concern unless it worsens or is accompanied by signs of active bleeding or compartment syndrome.

B. Diminished pulses on the affected extremity: Reduced or absent pulses indicate compromised circulation, which may be a sign of compartment syndrome or vascular injury. This is the highest priority because it threatens tissue viability and requires immediate intervention to prevent permanent damage.

C. One fingerbreadth of space between the cast and the skin: This indicates appropriate cast fit and allows for some swelling. It is not a cause for concern and confirms that the cast is not overly tight, helping to prevent pressure injuries or circulatory compromise.

D. Client report of muscle spasms of the left leg: Muscle spasms can occur from immobilization or injury and may cause discomfort, but they do not immediately endanger the limb. Pain relief and repositioning may help, but this is not the priority over vascular assessment.

Rationale:

A. Arterial blood gases: While ABGs assess respiratory and metabolic balance, they are not routinely monitored for clients on furosemide. This test is more relevant for clients with severe respiratory or acid-base disorders, not as a direct indicator of diuretic therapy effects.

B. Blood urea nitrogen: Furosemide is a loop diuretic that can affect kidney function by reducing circulating blood volume. Monitoring BUN helps assess renal perfusion and detect early signs of dehydration or nephrotoxicity associated with diuretic use.

C. Prothrombin time: PT evaluates coagulation status, typically in clients taking anticoagulants like warfarin. Furosemide does not affect clotting pathways, so PT monitoring is unnecessary in this context unless the client is on anticoagulants for another condition.

D. Thyroid stimulating hormone: TSH measures thyroid function but is not influenced by furosemide. There is no established link between furosemide and thyroid activity that would necessitate routine TSH monitoring for clients taking this medication.