A nurse is teaching a client who has a diagnosis of heart failure about furosemide.
Which of the following instructions should the nurse include in the teaching about this medication? Select all that apply.

Choice A rationale

Amiodarone is known to cause various adverse effects, but ototoxicity leading to hearing impairment is not a commonly reported or significant side effect. The primary concerns with amiodarone involve pulmonary, thyroid, hepatic, and ocular toxicities. Therefore, routine hearing screenings are not a standard intervention in the care plan for clients on amiodarone.

Choice B rationale

An increase in appetite is not a recognized or common adverse effect associated with amiodarone. Amiodarone can cause gastrointestinal side effects such as nausea, vomiting, and anorexia, but an increased appetite is not typically observed. Monitoring for such a symptom would not be a priority in the client's plan of care.

Choice C rationale

Amiodarone is extensively metabolized by the liver and is known to cause hepatotoxicity, ranging from asymptomatic transaminase elevation to severe hepatitis and cirrhosis. Therefore, periodic monitoring of liver enzyme levels (e.g., AST, ALT, alkaline phosphatase) is crucial to detect early signs of liver injury and adjust treatment if necessary. Normal AST levels are typically 10-40 U/L, and ALT levels are 7-56 U/L.

Choice D rationale

While some medications can cause psychiatric disturbances, manic behavior is not a commonly reported or characteristic adverse effect of amiodarone. The central nervous system effects of amiodarone are more likely to include peripheral neuropathy, ataxia, and tremors. Monitoring for manic behavior is not a standard intervention for clients on amiodarone therapy.

• conditions. The client has dyspnea, tachycardia, and low oxygen saturation, suggesting acute illness or cardiovascular instability.
• Bumetanide, a loop diuretic, is contraindicated here as it may worsen hypovolemia and electrolyte imbalance. The client’s blood pressure is high but he is already showing signs of dehydration and electrolyte abnormalities (hypokalemia). Diuretics may exacerbate hypokalemia and hypotension later.
• Labetalol is anticipated for managing the acute hypertension (BP 160/98 mm Hg), especially with the client’s tachycardia and hypertensive urgency signs. It acts by blocking alpha and beta receptors to lower blood pressure safely.
• Oxygen is anticipated because the client’s oxygen saturation is 92% on room air with dyspnea and tachypnea; supplemental oxygen will improve tissue oxygenation and reduce hypoxia.
• Midodrine is contraindicated because it raises blood pressure via alpha-1 agonism; given the client’s elevated BP, it would worsen hypertension and increase cardiovascular risk.
• Calcium gluconate is contraindicated because the client’s calcium is within normal limits (10.3 mg/dL) and giving calcium unnecessarily can cause hypercalcemia or arrhythmias.
• Potassium supplementation is anticipated as the client has hypokalemia (2.8 mEq/L) on Day 2, which can cause arrhythmias and muscle weakness, requiring prompt correction.