A nurse is providing instruction to a new nurse about caring for clients who are receiving diuretic therapy to treat heart failure. The nurse should explain that which of the following medications puts clients at risk for both hyperkalemia and hyponatremia?

A. Furosemide is a loop diuretic that increases sodium and water excretion. It can cause hypokalemia but does not typically lead to both hyperkalemia and hyponatremia. B. Hydrochlorothiazide is a thiazide diuretic that can cause hypokalemia and hypercalcemia but is not known to put clients at risk for both hyperkalemia and hyponatremia. C. Metolazone is a thiazide-like diuretic that can also cause hypokalemia but does not generally cause both hyperkalemia and hyponatremia. D. Spironolactone is a potassium-sparing diuretic that can increase potassium levels (leading to hyperkalemia) while also causing the retention of water, which can dilute sodium levels, leading to hyponatremia.