What is a key nursing consideration when initiating diuretic therapy?

• A. Monitor BP and orthostatic BP; hold if SBP < 90
• B. Monitor daily weights and report a weight gain or loss exceeding 2 pounds in 24 hours
• C. Monitor electrolytes, especially K+ and Na+ and kidney function
• D. Monitor for S&S of hyper- and hypokalemia

Answer: (A)

Initiating diuretic therapy primarily raises the risk of a rapid drop in intravascular volume, which can lead to hypotension, including orthostatic changes. The key nursing action is to closely monitor blood pressure, both sitting and standing, to detect any drop after dosing. If systolic blood pressure falls below 90 mmHg, the dose should be held and reassessed before continuing. This safety step helps prevent dizziness, fainting, and potential injury from falls while the body adjusts to the diuretic.

Electrolyte shifts and kidney function are important to monitor as ongoing concerns with diuretics, and daily weights help gauge volume status, but the most immediate safety focus during initiation is ensuring stable blood pressure and preventing orthostatic intolerance.