A patient with a known history of angina was walking his dog and developed chest pain.

The patient immediately stops walking and sits down.

He continues to experience chest pain when sitting down.
When should he call 911?

Choice A rationale

Serum sodium levels are important to monitor, as furosemide can cause hyponatremia (normal range 135-145 mEq/L). However, muscle weakness and dizziness are more classic signs of hypokalemia, as potassium plays a crucial role in nerve and muscle function. Therefore, potassium is the more critical value to check initially.

Choice B rationale

Furosemide is a loop diuretic that inhibits the reabsorption of sodium and chloride in the loop of Henle, leading to increased excretion of water, sodium, potassium, and chloride. The patient's symptoms of muscle weakness and dizziness are classic manifestations of hypokalemia (normal range 3.5-5.0 mEq/L), making serum potassium the most important lab value to check.

Choice C rationale

While loop diuretics can sometimes affect blood glucose levels, leading to hyperglycemia, this is not a primary concern for the immediate symptoms of muscle weakness and dizziness. These symptoms are much more indicative of an electrolyte imbalance, specifically potassium, which is directly affected by furosemide's mechanism of action.

Choice D rationale

Serum calcium levels can also be affected by furosemide, which can cause hypocalcemia. While hypocalcemia can present with muscle cramps and weakness, hypokalemia is a more common and prominent side effect of loop diuretics. Thus, checking potassium levels is the priority given the reported symptoms.

Choice A rationale

Anorexiants, such as phentermine, are often taken in the morning or early afternoon to avoid the side effect of insomnia. Taking the medication with the evening meal could lead to sleep disturbances, which is a common and undesirable side effect of these stimulant drugs.

Choice B rationale

Most anorexiants are approved for short-term use, typically for a few weeks to a few months, and not for a duration of two years. Long-term use is associated with a higher risk of adverse effects, including cardiovascular complications and the potential for drug dependence.

Choice C rationale

A dry mouth is a very common and expected adverse effect of many anorexiant medications. It is not an indication to immediately stop the drug. The nurse should advise the patient on strategies to manage this symptom, such as using sugar-free gum or lozenges.

Choice D rationale

Anorexiants often have a stimulating effect on the central nervous system. Combining them with other stimulants, such as caffeine, can potentiate these effects, increasing the risk of adverse cardiovascular events like tachycardia, palpitations, and elevated blood pressure.