A nurse is teaching a client who has hypertension and is prescribed nifedipine, a calcium channel blocker, about self-care measures. Which of the following instructions should the nurse include? (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

The client has a blood pressure of 120/78 mm Hg. This indicates that the medication is effective because it lowers the blood pressure below the hypertensive levels.In adults 60 years of age or older, this is typically defined as a systolic pressure below 150 mm Hg and a diastolic pressure below 90 mm Hg.

Choice A is wrong because the client has no edema in the lower extremities. This is not a specific outcome of lisinopril, an angiotensin II receptor blocker (ARB). Edema can be caused by many factors, such as heart failure, kidney disease, or venous insufficiency. Lisinopril does not directly affect fluid retention or edema.

Choice B is wrong because the client has a urine output of 30 mL/hr. This is a low urine output that may indicate dehydration, kidney impairment, or urinary obstruction. Lisinopril is expected to increase urine output by reducing the blood pressure and improving the renal blood flow.

Choice D is wrong because the client has a serum creatinine level of 1.2 mg/dL. This is a high serum creatinine level that may indicate kidney damage or reduced kidney function. Lisinopril is expected to lower the serum creatinine level by preventing the progression of kidney disease and protecting the kidney from further injury.

Normal ranges of urine output, blood pressure, and serum creatinine are:

• Urine output: 800 to 2000 mL/day or 40 to 80 mL/hr

• Blood pressure: less than 120/80 mm Hg for adults

• Serum creatinine: 0.6 to 1.2 mg/dL for males and 0.5 to 1.1 mg/dL for females