A nurse is teaching a client who has a diagnosis of heart failure about furosemide. Which of the following instructions should the nurse include in the teaching about this medication? Select all that apply.

Choice A rationale Furosemide, a loop diuretic, can cause ototoxicity, particularly with rapid IV administration or high doses. This adverse effect manifests as tinnitus, vertigo, or irreversible hearing loss due to its impact on the hair cells in the organ of Corti within the inner ear. Therefore, reporting any indications of hearing loss is crucial for client safety. Choice B rationale Taking the daily dose of furosemide at bedtime is generally not recommended. Furosemide has a rapid onset and relatively short duration of action, typically leading to increased urine production for several hours. Administering it at bedtime can disrupt sleep patterns due to frequent nocturia, making morning administration preferable to minimize nocturnal diuresis. Choice C rationale Daily weight monitoring is essential for clients taking furosemide for heart failure. Furosemide promotes diuresis, reducing fluid overload. Daily weight checks (normal variations are within 0.5-1 kg/day) allow for assessment of fluid balance and the effectiveness of the diuretic therapy, helping to identify both fluid excess and dehydration promptly. Choice D rationale Furosemide is a potassium-wasting diuretic, meaning it promotes the excretion of potassium from the body. Chronic use can lead to hypokalemia (normal range 3.5-5.0 mEq/L), which can cause muscle weakness, fatigue, and cardiac arrhythmias. Consuming foods high in potassium regularly helps mitigate this electrolyte imbalance and maintain physiological function. Choice E rationale Furosemide can cause orthostatic hypotension, a sudden drop in blood pressure upon standing. This occurs due to fluid volume depletion and vasodilation induced by the diuretic effect. Rising slowly from a sitting or lying position allows the cardiovascular system to compensate, reducing the risk of dizziness, syncope, and falls.