A nurse is caring for a client in an outpatient clinic. For each provider prescription, click to specify if the order is indicated or not indicated for the client. There must be at least 1 selection in every row. There does not need to be a selection in every column.

This client has newly diagnosed heart failure and worsening symptoms of fluid overload, including dyspnea, crackles, edema, elevated BNP, and decreased oxygen saturation. Heart failure management aims to reduce preload and afterload, improve cardiac output, and prevent fluid retention. Medication selection and monitoring are critical, especially regarding renal function and electrolyte balance. Nursing care must align with standard heart failure pharmacologic therapy and avoid interventions that worsen fluid retention or electrolyte disturbances. Rationale: • Spironolactone 50 mg PO once daily: Spironolactone is a potassium-sparing diuretic and aldosterone antagonist used in heart failure to reduce fluid overload and cardiac remodeling. It helps decrease mortality in patients with symptomatic heart failure. The client shows signs of volume overload, including edema, crackles, and elevated BNP. Therefore, this medication is appropriate for managing fluid retention and improving outcomes. • Obtain BUN and creatinine: Renal function must be monitored closely in heart failure due to the risk of impaired perfusion and medication effects on the kidneys. Diuretics and ACE inhibitors can alter renal function and electrolyte balance. Elevated fluid status and decreased cardiac output can further compromise kidney perfusion. Monitoring BUN and creatinine is essential for safe treatment planning. • Enalapril 2.5 mg PO twice daily: Enalapril is an ACE inhibitor that reduces afterload, improves cardiac output, and decreases progression of heart failure. It also helps reduce mortality and hospitalizations in heart failure clients. The client demonstrates elevated blood pressure and symptoms of worsening heart failure, making ACE inhibitor therapy appropriate. It is a first-line medication in this condition. • Albuterol dry powder inhaler, inhale 2 puffs every 4 to 6 hr PRN shortness of breath: Albuterol is a bronchodilator used primarily for obstructive airway diseases such as asthma or COPD, not heart failure. The client’s respiratory symptoms are due to pulmonary congestion, not bronchospasm. Using albuterol would not address the underlying fluid overload and may cause tachycardia, worsening cardiac workload. • Fluid restriction of 0.5 L per day: A fluid restriction of 0.5 L (500 mL) per day is excessively restrictive and unsafe for most heart failure clients. While fluid restriction may be necessary, typical limits are individualized and generally higher (e.g., 1.5–2 L/day depending on severity). Severe restriction can lead to dehydration, renal impairment, and electrolyte imbalance. • Potassium 20 mEq PO twice daily: Potassium supplementation is not indicated because the client’s potassium level is normal (4.5 mEq/L). Additionally, the client is prescribed spironolactone and an ACE inhibitor, both of which increase potassium levels and raise the risk of hyperkalemia. Adding potassium supplementation could lead to dangerous cardiac dysrhythmias. Therefore, this prescription is contraindicated.