A nurse is administering bumetanide to a client who has ascites. The nurse should recognize that which of the following findings is an expected therapeutic effect of this medication?

Choice A rationale Bumetanide is a potent loop diuretic that acts on the ascending limb of the loop of Henle to inhibit the sodium-potassium-chloride cotransporter (NKCC2). This action prevents the reabsorption of sodium, chloride, and potassium, leading to their increased excretion in the urine. Therefore, a decreased excretion of urine sodium would be an unexpected and contradictory finding to the therapeutic effect of this medication. The opposite, increased excretion, is the goal. Choice B rationale Bumetanide's primary therapeutic effect is to increase urinary output by inhibiting the reabsorption of electrolytes in the loop of Henle. This inhibition leads to a higher concentration of solutes in the renal tubules, which draws water into the urine via osmosis. The resulting diuresis helps to reduce fluid overload in clients with conditions like ascites, which is the accumulation of fluid in the peritoneal cavity. Increased urinary output is a direct measure of its effectiveness. Choice C rationale Bumetanide, like other loop diuretics, can cause hyperglycemia by impairing insulin secretion and increasing hepatic glucose production. While this is a potential side effect, it is not an expected therapeutic effect. A decrease in serum glucose is not a goal of bumetanide therapy, and its effect on blood sugar is typically a negative consequence that requires monitoring. The expected therapeutic effect is on fluid balance. Choice D rationale Bumetanide is an antihypertensive and diuretic medication. Its therapeutic effect is to decrease blood pressure by reducing blood volume through diuresis. An increased blood pressure would indicate that the medication is not working, or that there is a concurrent pathological process. The expected and desired outcome is a reduction in blood volume and a subsequent decrease in systemic and venous pressures, which can indirectly lead to a decrease in blood pressure.