A home health nurse is visiting a client who has heart failure and a prescription for furosemide. The nurse identifies that the client has gained 2.5 kg (5 lb) since the last visit 2 days ago. Which of the following actions should the nurse take first?

A. Determine medication adherence by the client: A rapid weight gain of 2.5 kg (5 lb) in 2 days suggests fluid retention and worsening heart failure. The nurse’s first priority is to assess whether the client has been taking furosemide as prescribed since nonadherence can lead to ineffective fluid removal and worsening symptoms. B. Notify the provider of the client's weight gain: The provider must be informed, but doing so before assessing medication adherence limits the nurse’s ability to provide complete information necessary for treatment adjustments. C. Encourage the client to dangle the legs while sitting in a chair: Dangling the legs may temporarily reduce peripheral swelling, but it does not correct the underlying problem of fluid overload associated with heart failure. D. Teach the client about foods low in sodium: Although sodium restriction is an important preventive measure, client teaching is not the immediate priority in an acute fluid retention situation. The nurse should first assess adherence to diuretic therapy to identify the cause of the weight gain.