The nurse is teaching a 68-year-old client with heart failure about taking Furosemide at home. Which statement by the client indicates a correct understanding of when to take this medication?

A. Drugs with strong first-pass metabolism are best administered via an enteral route: Drugs that undergo extensive first-pass metabolism are often less effective when given enterally, as much of the drug is inactivated by the liver before reaching systemic circulation. Non-enteral routes (e.g., sublingual, IV) are preferred to bypass the liver initially.
B. Metabolism alters medications so that they can be excreted from the body: The liver uses enzymatic processes to convert drugs into more water-soluble forms, facilitating their elimination through the kidneys or bile. This process can either activate, inactivate, or detoxify substances depending on the drug.
C. The first-pass effect increases the bioavailability of orally administered drugs: The first-pass effect reduces, not increases, the bioavailability of orally administered drugs. It refers to the initial metabolism in the liver that significantly reduces the active concentration of a drug before it reaches systemic circulation.
D. Metabolism primarily occurs in the kidneys: While the kidneys are essential for drug excretion, metabolism primarily occurs in the liver. Hepatic enzymes, especially those of the cytochrome P-450 system, play the central role in drug biotransformation.

A. "Limit your fluid intake to meal times.": Fluid restriction is not a standard recommendation for patients taking Verapamil unless they have another condition like heart failure. Adequate hydration is important, especially to counter constipation, a known side effect of the drug.
B. "You can expect swelling of the ankles while taking this medication.": While peripheral edema is a known side effect of Verapamil, it is not something patients should expect or accept without reporting. Significant swelling may require dose adjustment or switching medications.
C. "This medication will not affect your heart rate": Verapamil is a calcium channel blocker that slows AV node conduction and reduces heart rate. It is used for conditions like hypertension, angina, and arrhythmias, and can cause bradycardia, especially in high doses.
D. "Increase your daily intake of dietary fiber.": Verapamil frequently causes constipation by decreasing gastrointestinal motility. Increasing dietary fiber, fluid intake, and physical activity are recommended to minimize this side effect and promote regular bowel movements.