FUNDAMENTA 102 Diuretics (Pharm2 Exam4) | GRADED A | Questions and Answer solutions | Download To Score An A

Chapter 43: Diuretics MULTIPLE CHOICE 1. Thiazide diuretics are contraindicated if the client has: a. emphysema. b. arteriosclerotic cardiovascular disease. c. renal failure. d . viral infection. ANS: C Renal failure decreases the excretion of the drug, leading to accumulation and electrolyte imbalance. DIF: Cognitive Level: Comprehension REF: p. 640 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 2. Client teaching for a client taking a thiazide diuretic includes which instruction? a. Instruct the client to add salt liberally to his food. b. Instruct the client to decrease intake of potassium-rich foods. c. Instruct the client to check pulse rate if digoxin is taken with hydrochlorothiazide. d. Advise the client to rise slowly from a sitting to a standing position. ANS: D Diuretics can lead to orthostatic hypotension. The client should limit Na intake and ingest K- containing foods. DIF: Cognitive Level: Application REF: p. 647 TOP: Nursing Process: Intervention/Teaching MSC: CONTENT CATEGORY: Physiological Integrity: Pathophysiology 3. A client is taking a thiazide diuretic. The nurse assesses the client’s serum glucose level—the fasting blood glucose level is 150 mg/dl. What is an appropriate response by the nurse? a. Instruct the client to discontinue taking hydrochlorothiazide. Inform the healthcare provider of the glucose level and the possible need for a different b. diuretic. c. Instruct the client to take hydrochlorothiazide every other day. d. Instruct the client to take an antidiabetic drug instead of the diuretic. ANS: B Thiazide diuretics can lead to impaired insulin function and hyperglycemia, warranting changing diuretic agents. DIF: Cognitive Level: Analysis REF: p. 642 TOP: Nursing Process: Intervention MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A nurse is teaching a client about lifestyle changes when taking a potassium-sparing diuretic. Which statement indicates a need for more teaching? a. “I need to have my blood drawn frequently.” b. “I need to call the clinic if I am urinating less than every 2 hours.” c. “I need to be careful when out in the sun.” d. “I need to eat foods like bananas frequently.” ANS: D Eating high-potassium foods with potassium-sparing diuretics can lead to hyperkalemia. DIF: Cognitive Level: Application REF: pp. 649-650 TOP: Nursing Process: Intervention/Teaching MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 5. A client is ordered to receive triamterene (Dyrenium) to decrease her blood pressure. The nurse is evaluating the effectiveness of the medication in returning the blood chemistries to normal. A positive response to the medication is indicated by a(n) K level and a(n) Na level. a. increased; decreased b. increased; increased c. decreased; decreased d. decreased; increased ANS: A The medication is expected to produce an increase in the potassium level and a decrease in the sodium level. DIF: Cognitive Level: Analysis REF: p. 648 TOP: Nursing Process: Evaluation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The client is being treated with furosemide as well as an aminoglycoside. What effect should the nurse expect to see as a result of the interaction of the drugs? a. Blurred vision b. Ototoxicity c. Bone pain d. Blood-tinged urine ANS: B The interaction of furosemide and an aminoglycoside can produce ototoxicity in the client. DIF: Cognitive Level: Application REF: p. 644 TOP: Nursing Process: Evaluation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The client is being treated with furosemide and a steroid drug as well. As a result of the interaction of the drugs, the nurse should expect to see an increased loss of: a. potassium. b. calcium. c. magnesium. d. sodium. ANS: A The interaction of furosemide and a steroid drug can result in an increased loss of potassium. DIF: Cognitive Level: Application REF: p. 644 TOP: Nursing Process: Evaluation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The client is being treated with a thiazide diuretic. The nurse should expect to see an increased serum as a result of treatment with this drug. a. potassium b. sodium d. calcium ANS: D Treatment with a thiazide diuretic will produce an increase in the levels of serum calcium, glucose, and uric acid, and a decrease in the levels of serum potassium, sodium, and magnesium. DIF: Cognitive Level: Application REF: p. 642 TOP: Nursing Process: Evaluation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 9. The client is being treated with chlorthalidone (Hygroton). In determining the proper time to schedule dosages, the nurse recognizes that the duration of action for the medication is up to hours. a. 12 b. 24 c. 48 d. 72 ANS: D The medication will stay in the client’s system for up to 72 hours. DIF: Cognitive Level: Application REF: p. 641 TOP: Nursing Process: Planning MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The client is being treated with a thiazide diuretic. He tells the nurse that he is interested in using herbal preparations and frequently self-medicates with ginkgo. The nurse’s most appropriate response to this information is: a. “Ginkgo can be effectively used with a thiazide diuretic since it decreases blood pressure.” b. “Ginkgo can be used with a thiazide diuretic since it prolongs medication’s action.” c. “Ginkgo should not be used with a thiazide diuretic since it increases blood pressure.” d. “Ginkgo should not be used with a thiazide diuretic since it may cause toxicity.” ANS: C Increased blood pressure can result when ginkgo is used in combination with a thiazide diuretic. DIF: Cognitive Level: Application REF: p. 643 TOP: Nursing Process: Intervention MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 11. The client is being treated with a thiazide diuretic as well as digoxin. He complains to the nurse of experiencing blurred vision. The highest priority nursing intervention is to call the physician because blurred vision: a. is indicative of digoxin toxicity. b. is indicative of an anaphylactic reaction. c. indicates an inadequate dosage of the diuretic. d. indicates an overdose of the diuretic. ANS: A Visual changes are indicative of digoxin toxicity when the drug is combined with a thiazide diuretic. 12. The client is being treated with a thiazide diuretic. The nurse anticipates that the medication will be administered at: a. 8:00 AM. b. 11:30 AM. c. 4:30 PM. d. 9:00 PM. ANS: A The diuretic should be administered in the morning to avoid nocturia. Chapter 28: Diuretic Drugs MULTIPLE CHOICE 1. When monitoring a patient who has diabetes and is receiving a carbonic anhydrase inhibitor for edema, the nurse will monitor for which possible adverse effect? a. Metabolic alkalosis b. Elevated blood glucose c. Hyperkalemia d. Mental alertness ANS: B An undesirable effect of carbonic anhydrase inhibitors is that they elevate the blood glucose level and cause glycosuria in diabetic patients. They induce metabolic acidosis, making their usefulness limited. In addition, hypokalemia and drowsiness may occur. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 461 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of these diuretics? a. hydrochlorothiazide (HydroDIURIL) b. furosemide (Lasix) c. acetazolamide (Diamox) d. spironolactone (Aldactone) ANS: D Spironolactone (Aldactone) is a potassium-sparing diuretic, and patients taking this drug must be monitored for signs of hyperkalemia. The other drugs do not cause hyperkalemia but instead cause hypokalemia. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 465 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. Mannitol (Osmitrol) has been ordered for a patient with acute renal failure. The nurse will administer this drug using which procedure? a. Intravenously, through a filter b. By rapid intravenous bolus c. By mouth in a single morning dose d. Through a gravity intravenous drip with standard tubing ANS: A Mannitol is administered via intravenous infusion through a filter because of possible crystallization. It is not available in oral form. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 465 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. Furosemide (Lasix) is prescribed for a patient who is about to be discharged, and the nurse provides instructions to the patient about the medication. Which statement by the nurse is correct? a. “Take this medication in the evening.” b. “Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and dates.” “If you experience weight gain, such as 5 pounds or more per week, be sure to tell your c. physician during your next routine visit.” “Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent d. dizziness and possible fainting because of blood pressure changes.” ANS: D Orthostatic hypotension is a possible problem with diuretic therapy. Foods high in potassium should be eaten more often, and the drug needs to be taken in the morning so that the diuretic effects do not interfere with sleep. A weight gain of 5 pounds or more per week must be reported immediately. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 471 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. When reviewing the mechanisms of action of diuretics, the nurse knows that which statement is true about loop diuretics? a. They work by inhibiting aldosterone. b. They are very potent, having a diuretic effect that lasts at least 6 hours. c. They have a rapid onset of action and cause rapid diuresis. d. They are not effective when the creatinine clearance decreases below 25 mL/min. ANS: C The loop diuretics have a rapid onset of action; therefore, they are useful when rapid onset is desired. Their effect lasts for about 2 hours, and a distinct advantage they have over thiazide diuretics is that their diuretic action continues even when creatinine clearance decreases below 25 mL/min. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 462 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. When monitoring a patient who is taking hydrochlorothiazide (HydroDIURIL), the nurse notes that which drug is most likely to cause a severe interaction with the diuretic? a. Digitalis b. Penicillin c. Potassium supplements d. Aspirin ANS: A There is an increased risk for digitalis toxicity in the presence of hypokalemia, which may develop with hydrochlorothiazide therapy. Potassium supplements are often prescribed with hydrochlorothiazide therapy to prevent hypokalemia. The other options do not have interactions with hydrochlorothiazide. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 467 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. When a patient is receiving diuretic therapy, which of these assessment measures would best reflect the patient’s fluid volume status? a. Blood pressure and pulse b. Serum potassium and sodium levels c. Intake, output, and daily weight d. Measurements of abdominal girth and calf circumference ANS: C Urinary intake and output and daily weights are the best reflections of a patient’s fluid volume status. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 468 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A patient is being discharged to home on a single daily dose of a diuretic. The nurse instructs the patient to take the dose at which time so it will be least disruptive to the patient’s daily routine? a. In the morning b. At noon c. With supper d. At bedtime ANS: A Take the diuretic medication early in the morning to prevent urination during the night. Taking the diuretic at the other times may cause nighttime urination and disrupt sleep. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 470 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which class is likely to be used initially? a. Loop diuretics b. Osmotic diuretics c. Thiazide diuretics d. Potassium-sparing diuretics ANS: C The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guidelines recommend thiazide diuretics as the first- line treatment for hypertension. The other drug classes are not considered first-line treatments. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 460 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. A patient in the neurologic intensive care unit is being treated for cerebral edema. Which class of diuretic is used to reduce intracranial pressure? a. Loop diuretics b. Osmotic diuretics c. Thiazide diuretics d. Vasodilators ANS: B Mannitol, an osmotic diuretic, is commonly used to reduce intracranial pressure and cerebral edema resulting from head trauma. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 464 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A 79-year-old patient is taking a diuretic for treatment of hypertension. This patient is very independent and wants to continue to live at home. The nurse will know that which teaching point is important for this patient? a. He should take the diuretic with his evening meal. b. He should skip the diuretic dose if he plans to leave the house. c. If he feels dizzy while on this medication, he needs to stop taking it and take potassium supplements instead. He needs to take extra precautions when standing up because of possible orthostatic d. hypotension and resulting injury from falls. ANS: D Caution must be exercised in the administration of diuretics to the elderly because they are more sensitive to the therapeutic effects of these drugs and are more sensitive to the adverse effects of diuretics, such as dehydration, electrolyte loss, dizziness, and syncope. Taking the diuretic with the evening meal may disrupt sleep because of nocturia. Doses should never be skipped or stopped without checking with the prescriber. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 469 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. A patient on diuretic therapy calls the clinic because he’s had the flu, with “terrible vomiting and diarrhea,” and he has not kept anything down for 2 days. He feels weak and extremely tired. Which statement by the nurse is correct? “It’s important to try to stay on your prescribed medication. Try to take it with sips of a. water.” b. “Stop taking the diuretic for a few days, and then restart it when you feel better.” “You will need an increased dosage of the diuretic because of your illness. Let me speak to c. the physician.” d. “Please come into the clinic for an evaluation to make sure there are no complications.” ANS: D diuretic until these problems have stopped. He needs to be checked for possible hypokalemia and dehydration. The other options are incorrect responses. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 471 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential MULTIPLE RESPONSE 1. When assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency, which would include what symptoms? (Select all that apply.) a. Dyspnea b. Constipation c. Tinnitus d. Muscle weakness e. Anorexia f. Lethargy ANS: D, E, F Symptoms of hypokalemia include anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension. The other symptoms are not associated with hypokalemia. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 471 TOP: NURSING PROCESS: Evaluation OTHER 1. A patient is to receive hydrochlorothiazide (HydroDIURIL) via a percutaneous endoscopic gastrostomy (PEG) tube. The order reads, “Give hydrochlorothiazide, 25 mg, per PEG tube once daily.” The medication is available in a liquid form, 50 mg/5 mL. How many milliliters will the nurse administer for each dose? ANS: 2.5 mL 50 mg : 5 mL :: 25 mg : x mcg (50 × x) = (5 × 25); 50x = 125; x = 2.5 DIF: COGNITIVE LEVEL: Applying (Application) REF: p. N/A TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The order for a child reads, “Give furosemide (Lasix) 2 mg/kg IV STAT.” The child weighs 33 pounds. How many milligrams will the child receive for this dose? ANS: 30 mg First, convert 33 lb to kg: 33 lb ÷ 2.2 = 15 kg Next, calculate mg/kg: 2 mg/kg × 15 kg = 30 mg Chapter 12: Drugs That Affect Urine Output MULTIPLE CHOICE 1. For which complication does the nurse remain alert when a patient is taking any type of diuretic? a. Loss of appetite b. Bladder spasms c. Hypertension d. Dehydration ANS: D Any type of diuretic increases water loss through urination. This water loss can cause dehydration if a patient’s fluid intake does not keep pace with his or her urine output. REF: p. 207 TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity 2. A patient who has been taking a diuretic for the past 2 weeks now experiences all of the following changes. Which change indicates to the nurse that the diuretic is effective? a. Weight loss of 7 lb b. Heart rate increased from 72 to 80 beats per minute c. Respiratory rate decreased from 20 to 16 breaths per minute d. Morning blood glucose decreased from 142 mg/dL to 110 mg/dL ANS: A Diuretic drugs cause water loss and are often prescribed for edema. One liter of water weighs 2.2 lb. In helping the patient rid the body of excess water, the patient is expected to lose weight. PTS: 1 DIF: Cognitive Level: Applying (Application) or higher TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity 3. A patient prescribed a once-daily diuretic calls the office to report that yesterday’s drug dose was missed. What is the nurse’s best advice? a. “Take today’s dose now and restrict today’s fluid intake to 1 L.” b. “Take yesterday’s dose now and take today’s dose after another 6 hours.” c. “Take today’s dose now and maintain your normal intake of food and fluids.” d. “Skip today’s doses of all your medications and then begin everything fresh tomorrow.” ANS: C Too much time has passed to take both yesterday’s dose and today’s dose. Additional dosing would amount to doubling the dose, which could lead to more side effects and possible complications. PTS: 1 DIF: Cognitive Level: Applying (Application) or higher TOP: Nursing Process Step: Implementation MSC: Client Needs Category: Health Promotion and Maintenance 4. The nurse is teaching a patient about diuretic therapy. Which statement made by the patient indicates that more teaching is needed? a. “I am so thankful that my high blood pressure has been cured by this drug.” b. “I always try to drink just about the same amount of fluid that I urinate each day.” c. “I will call my health care provider if my heart rate is less than 60 beats per minute.” d. “I have been taking this drug early in the day so that I don’t have to get up during the night.” ANS: A Diuretics do not cure high blood pressure (hypertension), they only control the problem. If the patient stops taking the diuretic, blood pressure will increase. PTS: 1 DIF: Cognitive Level: Applying (Application) or higher TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Health Promotion and Maintenance 5. A patient taking a thiazide diuretic has the following blood laboratory values for kidney function. Which value does the nurse report to the prescriber immediately? a. Sodium 136 mEq/L b. Potassium 2.6 mEq/L c. Creatinine 0.9 mg/dL d. Blood urea nitrogen 6 mg/dL ANS: B Normal blood levels of potassium range between 3.5 and 5.0 mEq/L. The value listed here, 2.6 mEq/L, is low (hypokalemia) and can weaken the skeletal muscles of respiration. Most likely, the diuretic therapy caused the kidneys to excrete too much potassium. Although the blood urea nitrogen level also is lower than normal, it does not pose an immediate health threat. PTS: 1 DIF: Cognitive Level: Applying (Application) or higher TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Safe and Effective Care Environment 6. Why does the nurse teach a patient who is prescribed a thiazide diuretic to change positions slowly? a. Moving rapidly from a standing position to a sitting position can raise blood pressure and increase the patient’s risk for a stroke. b. Moving rapidly from a standing position to a sitting position can cause excess body fluids to collect in the feet and ankles increasing the patient’s risk for edema. c. Moving rapidly from a sitting position to a standing position can put pressure on the bladder and increase the patient’s risk for incontinence. d. Moving rapidly from a sitting position to a standing position can cause blood pressure to drop and increase the patient’s risk for falling. ANS: D Diuretics reduce the amount of blood in the circulatory system at any one time, lowering blood pressure. When the patient moves from a sitting position to a standing position too rapidly, blood pressure falls very quickly (orthostatic hypotension), causing too little blood to reach the brain and making the patient dizzy. This can cause the patient to faint or fall. PTS: 1 DIF: Cognitive Level: Understanding (Comprehension) REF: p. 209 TOP: Nursing Process Step: Implementation MSC: Client Needs Category: Safe and Effective Care Environment 7. The nurse administers 20 mg of furosemide (Lasix) to a patient by the intravenous (IV) route. Which action is most important for the nurse to take? a. Give the drug slowly over at least 2 minutes. b. Check the patient carefully for symptoms of low blood glucose levels. c. Mix the drug with potassium chloride to prevent a rapid drop in serum potassium levels. d. Monitor the IV site after giving the drug because furosemide causes severe tissue damage if infiltration occurs. ANS: A Furosemide is ototoxic (can reduce hearing). This effect is more likely to occur when the drug is administered intravenously at a rapid rate (faster than 10 mg/min). PTS: 1 DIF: Cognitive Level: Applying (Application) or higher TOP: Nursing Process Step: Implementation MSC: Client Needs Category: Safe and Effective Care Environment 8. Which side effect is associated only with loop diuretics? a. Dizziness b. Hearing loss c. Urinary frequency d. Increased sun sensitivity ANS: B All loop diuretics are ototoxic (can cause hearing loss). No other class of diuretics is ototoxic. PTS: 1 DIF: Cognitive Level: Understanding (Comprehension) REF: p. 211 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A 9. Which diuretic may cause an adverse effect of a higher than normal serum potassium level? a. spironolactone (Aldactone) b. bumetanide (Bumex) c. chlorothiazide (Diuril) d. furosemide (Lasix) ANS: A Spironolactone (Aldactone) is a potassium-sparing diuretic which reduces the amount of potassium excreted by the kidneys. As a result, serum potassium levels can become higher than normal. PTS: 1 DIF: Cognitive Level: Understanding (Comprehension) REF: p. 214 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A 10. A patient is prescribed spironolactone (Aldactone). Why does the nurse advise the patient to avoid the use of salt substitutes? a. They may cause the patient to be at risk for a high potassium level. b. They can increase the patient’s risk for hypertension. c. They may lead to hypokalemia. d. They can cause water retention. ANS: A Most salt substitutes are made by replacing sodium with potassium. Use of salt substitutes at the same time as potassium-sparing diuretics such as spironolactone increases the patient’s risk of a high potassium level (hyperkalemia). PTS: 1 DIF: Cognitive Level: Understanding (Comprehension) REF: pp. 213-214 TOP: Nursing Process Step: Implementation MSC: Client Needs Category: Health Promotion and Maintenance 11. A patient who has been taking amiloride (Midamor) for the past 3 months reports that she must shave her legs more frequently. What is the nurse’s best action? a. Hold the next dose and notify the prescriber immediately. b. Instruct the patient to stop taking oral contraceptives while she is taking this drug. c. Document the response and reassure the patient that this is an expected side effect. d. Ask the patient whether she has noticed any changes in the thickness of her scalp hair. ANS: C A common and nonharmful side effect of amiloride and other potassium-sparing diuretics is an increase in body hair (hirsutism) in women. It is not necessary to stop taking this drug. PTS: 1 DIF: Cognitive Level: Applying (Application) or higher TOP: Nursing Process Step: Implementation MSC: Client Needs Category: Health Promotion and Maintenance 12. The nurse prepares to give a second dose of furosemide (Lasix) to a patient by intravenous (IV) push. Before the injection is started, the patient reports having chest pain ever since the last dose of the drug. What is the nurse’s best action? a. Assist the patient to lay flat and encourage him or her to take slow, deep breaths. b. Document the report as the only action for this expected side effect. c. Slow the IV drip rate and examine the infusion site for infiltration. d. Hold the dose and notify the prescriber immediately. ANS: D Chest pain is a serious side effect or adverse reaction to furosemide and can indicate that the patient is having a heart attack. Another dose could cause a more severe response. The prescriber should be notified about this response immediately for preventive action. PTS: 1 DIF: Cognitive Level: Applying (Application) or higher TOP: Nursing Process Step: Evaluation/Implementation MSC: Client Needs Category: Safe and Effective Care Environment | Client Needs Category: Physiological Integrity 13. A patient with overactive bladder has been prescribed tolterodine (Detrol). While assessing the patient, the nurse discovers the presence of the following health problems. Which problem causes the nurse to contact the prescriber and question the drug order? a. Asthma b. Glaucoma c. Hypotension d. Diabetes mellitus ANS: B Tolterodine (Detrol) is an anticholinergic drug that can close the angle of the iris of the eye and decrease the outflow of aqueous fluid in the eye. For people who have closed angle glaucoma, the intraocular pressure can become even higher and the risk for blindness increases. PTS: 1 DIF: Cognitive Level: Understanding (Comprehension) REF: p. 216 TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Safe and Effective Care Environment 14. A patient is prescribed an extended-release drug for overactive bladder. Which precaution is most important for the nurse to teach the patient? a. “Avoid taking this drug at bedtime.” b. “Drink at least 3 L of fluid daily.” c. “Swallow the tablet or capsule whole.” d. “Perform a home pregnancy test monthly.” ANS: C Extended-release tablets or capsules are meant to release a drug at a relatively even dose throughout the day. Chewing or crushing the drug ruins the timed-release feature and allows most of the drug dose to be absorbed at once. This can cause more side effects and limits how long the drug will be effective. PTS: 1 DIF: Cognitive Level: Applying (Application) or higher TOP: Nursing Process Step: Implementation MSC: Client Needs Category: Health Promotion and Maintenance 15. A patient is prescribed a drug for overactive bladder. Which instruction does the nurse provide to prevent a serious complication? a. “Be sure to let your prescriber know if your symptoms do not improve.” b. “When using the patch, press it firmly to make sure it stays in place.” c. “Use alcohol in moderation while taking this drug.” d. “Avoid becoming overheated or dehydrated.” ANS: D Urinary antispasmodic drugs decrease the sweating response, increasing the risk for heat stroke. Patients can reduce this risk by ensuring that they keep themselves well hydrated during exercise or when in hot environments. PTS: 1 DIF: Cognitive Level: Applying (Application) or higher TOP: Nursing Process Step: Implementation MSC: Client Needs Category: Health Promotion and Maintenance 16. Which laboratory value is always checked before giving a dose of furosemide (Lasix)? a. Calcium b. Magnesium c. Creatinine d. Potassium ANS: D Blood levels of potassium often decrease when furosemide (a loop diuretic) is administered, causing dry mouth, increased thirst, irregular heartbeat, mental and mood changes, muscle cramps or muscle pain, nausea and vomiting, tiredness, weakness, and weak pulses. PTS: 1 DIF: Cognitive Level: Understanding (Comprehension) REF: p. 212 TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity 17. What must the nurse teach a patient who is taking a diuretic drug? a. Avoid foods that are rich in potassium such as bananas and broccoli. b. Sit on the side of the bed for 1 to 2 minutes before getting out of bed. c. Notify the prescriber if the heart rate is less than 70 beats per minute. d. Keep a record of dietary intake for a few weeks. ANS: B A common side effect of diuretics is hypotension and patients should be advised to change positions slowly. Patients should also be taught the signs of hypotension such as dizziness and light-headedness. PTS: 1 DIF: Cognitive Level: Applying (Application) or higher TOP: Nursing Process Step: Implementation MSC: Client Needs Category: Safe and Effective Care Environment 18. What is the most common side effect of drugs used for benign prostate hypertrophy (BPH)? a. Low blood pressure b. Decreased libido c. Light-headedness d. Hair loss ANS: B Side effects of drugs used for BPH also include erectile dysfunction, decreased seminal fluid, and reduced fertility. The most common side effect of these drugs is a decreased interest in sexual activity. PTS: 1 DIF: Cognitive Level: Remembering (Knowledge) REF: p. 219 TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity 19. An 82-year-old-man is prescribed a dihydrotestosterone (DHT) inhibitor to treat benign prostatic hypertrophy (BPH). Which health promotion activity is most important for the nurse to teach this patient? a. Have vision and glaucoma checks yearly. b. Participate in yearly prostate cancer screening. c. Avoid both alcohol and caffeine while on the drug. d. Avoid donating blood when taking the drug and for at least 6 months after drug therapy has stopped. ANS: B The symptoms of BPH and prostate cancer are the same. Prostate cancer is the most common cancer type in older men. DHT inhibitors improve the symptoms of obstruction, which can mask the presence of prostate cancer. Although younger men should be cautioned not to donate blood during therapy and for 6 months after therapy (because the drug in the blood could cause birth defects if a pregnant woman received the blood), most blood centers do not permit people older than 75 years to donate blood. PTS: 1 DIF: Cognitive Level: Applying (Application) or higher TOP: Nursing Process Step: Implementation MSC: Client Needs Category: Health Promotion and Maintenance 20. A patient has received furosemide (Lasix), 40 mg orally, 30 minutes ago. To prevent injury to the patient, what does the nurse do? a. Assist the patient to the bathroom b. Keep the patient on bed rest c. Place all four side rails in the elevated position d. Ask the patient to get out of bed rapidly ANS: A An expected action of diuretic drugs is loss of excess fluid. This can lead to hypovolemia with signs of decreased volume including dizziness and lightheadedness. To provide a safe environment for the patient, the nurse should ensure that the patient has assistance when getting out of bed. PTS: 1 DIF: Cognitive Level: Applying (Application) or higher TOP: Nursing Process Step: Implementation MSC: Client Needs Category: Safe and Effective Care Environment 21. A patient who is prescribed hydrochlorothiazide (HCTZ) informs the nurse that she plans to become pregnant. What does the nurse include in a care plan for the patient about this drug? a. This drug is safe for use during pregnancy and breastfeeding. b. The prescriber will most likely decrease your dose while you are pregnant. c. You may take this drug during pregnancy, but should not use it if you plan to breastfeed. d. This drug should be avoided during pregnancy and breastfeeding. ANS: D Thiazide diuretics should be avoided during pregnancy because they may cause side effects in the newborn, including jaundice and low potassium levels. Thiazide diuretics should also be avoided during breastfeeding because they pass into breast milk. The action of these drugs may decrease the flow of breast milk. PTS: 1 DIF: Cognitive Level: Understanding (Comprehension) REF: p. 210 TOP: Nursing Process Step: Planning MSC: Client Needs Category: Physiological Integrity 22. A patient taking tolterodine (Detrol) reports decreased urination, ankle swelling, and a weight gain of 5 pounds over the past 2 days. What does the nurse do next? a. Holds the dose and notifies the prescriber b. Checks the patient’s blood pressure and heart rate c. Gives the dose as prescribed d. Documents the finding as the only action ANS: A Adverse effects of drugs for overactive bladder include chest pain, fast or irregular heart rate, shortness of breath, swelling (edema) and rapid weight gain, confusion, and hallucinations. Additionally, these drugs may cause decreased urination or no urine output, and painful or difficult urination. The dose should be held and the prescriber notified. PTS: 1 DIF: Cognitive Level: Applying (Application) or higher TOP: Nursing Process Step: Implementation MSC: Client Needs Category: Safe and Effective Care Environment 23. A patient taking tamsulosin (Flomax) asks the nurse how the drug works. What is the nurse’s best response? a. “This drug works on your prostate gland to decrease its size.” b. “This drug signals the cells in your prostate gland not to grow.” c. “This drug works by relaxing the detrusor muscle of your bladder.” d. “This drug relaxes muscle around your urethra to improve urine flow.” ANS: D Tamsulosin is a selective alpha-1 blocker that acts to relax smooth muscle tissue in the prostate gland, the neck of the bladder, and in the urethra. When these receptors are bound with selective alpha-1 blockers, the smooth muscle relaxes, placing less pressure on the urethra and improving urine flow. PTS: 1 DIF: Cognitive Level: Understanding (Comprehension) REF: p. 218 TOP: Nursing Process Step: Implementation MSC: Client Needs Category: Health Promotion and Maintenance 24. Which test or examination does a patient receive before taking any drug for benign prostate hypertrophy (BPH)? a. Digital rectal examination b. 24-hour urinalysis c. Kidney function test d. Urine culture ANS: A The signs and symptoms of BPH are the same as for prostate cancer. Before a drug for BPH is taken, the patient should have a digital rectal examination by his prescriber and have his blood tested for prostate specific antigen levels to rule out prostate cancer. PTS: 1 DIF: Cognitive Level: Remembering (Knowledge) REF: p. 219 TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Safe and Effective Care Environment 25. A patient taking finasteride (Proscar) informs the nurse that he is also taking the herbal supplement saw palmetto. What is the nurse’s best response? a. “You should not take finasteride and saw palmetto at the same time.” b. “Finasteride and saw palmetto taken together increase your risk of bleeding.” c. “Be sure to notify your prescriber if you notice any unusual side effects.” d. “Avoid people with viral infections while taking these two substances.” ANS: C Some common herbal preparations, including saw palmetto and soy isoflavones, have an action similar to DHT inhibitors. It is possible that a man taking a DHT inhibitor such as finasteride with one of these herbs could increase effects, including increased side effects. PTS: 1 DIF: Cognitive Level: Applying (Application) or higher TOP: Nursing Process Step: Implementation MSC: Client Needs Category: Health Promotion and Maintenance SEQUENCING 1. The nurse is teaching a patient about the patch form of a drug to treat overactive bladder. List the correct order in which the patient should perform the steps of drug administration. (Number 1 is the first step and number 7 is the last step.) A. Examine the skin under the old patch for redness, irritation, or open areas. B. Press the patch firmly and hold in place for at least 15 seconds. C. Remove the old patch after it has been on for 3 to 4 days. D. Remove the adhesive backing on the patch. E. Carefully clean and dry the new site. F. Apply the patch sticky side down. G. Select a new site. ANS: 1. C 2. A 3. G 4. E 5. D 6. F 7. B The first step is to remove the old patch because there may still be some drug left in it, and when added to the drug in the new patch, could cause the dose released to be too high. Anything present on the skin for 3 to 4 days could cause skin irritation. The patient should check the site to determine whether the skin is irritated in any way. If skin irritation occurs, especially if an open area is present, the patient should notify the prescriber. It may be possible that the patient’s skin is too sensitive to use the transdermal route of the drug. A new area should be selected; placing a new patch on the same area increases the risk for skin irritation to occur. The new patch is more likely to stick to the skin if the skin area selected is both clean and dry. Usually, the sticky side of the patch is covered with a protective seal, which must be removed before the patch can stick and release the drug into the skin. Applying some pressure to the patch and holding it in place for about 15 seconds helps the patch adhere better to the skin. Chapter 51- Diuretic Agents The class of diuretics that act to block the chloride pump in the distal convoluted tubules 1. and leads to a loss of sodium and potassium and a minor loss of water is what? A) Carbonic anhydrase inhibitors B) Osmotic diuretics C) Potassium-sparing diuretics D) Thiazide diuretics Ans: D Feedback: Thiazide diuretics work to block the chloride pump, which leads to a loss of sodium, potassium, and some water. They are considered mild diuretics. Carbonic anhydrase inhibitors work to block the formation of carbonic acid and bicarbonate in the renal tubules. Osmotic diuretics use hypertonic pull to remove fluid from the intravascular spaces and to deliver large amounts of water into the renal tubules. Potassium-sparing diuretics are mild and act to spare potassium in exchange for the loss of sodium and water. The nurse is providing discharge instructions to a 72-year-old patient who has been discharged home on a diuretic. What would the patient’s instructions regarding the use of 2. a diuretic at home include? A) Measuring intake and output of urine To weigh themselves on the same scale, at the same time of day, in the same B) clothing Restrict fluids to 500 mL/d to limit the need to urinate C) D) Decrease exercise to conserve energy Ans: B Feedback: Patients taking a diuretic at home need to learn to weigh themselves every day, at the same time, and in the same clothes to monitor for loss or retention of fluid. They should not be asked to measure urine output or to decrease activity. Restricting fluids can lead to a rebound fluid retention when compensatory mechanisms are activated. The emergency department (ED) nurse is caring for a patient who is experiencing pulmonary edema. The patient is treated with furosemide (Lasix). What will the nurse 3. monitor? A) Sodium levels B) Bone narrow function C) Calcium levels D) Potassium levels Ans: D Feedback: Furosemide is associated with loss of potassium, so that the patient will need to be monitored carefully for low potassium levels, which could cause cardiac arrhythmias and further aggravate pulmonary edema. The nurse would not monitor sodium or calcium levels or bone marrow function because of the effects of the drug during the acute treatment of pulmonary edema. The nurse on the coronary unit is caring for a patient with known coronary artery disease who is being treated with cholestyramine (Questran) and hydrochlorothiazide 4. (HydroDIURIL). What action will the nurse take? A) Call the physician and refuse to give the drugs without further orders. B) Make sure that the drugs are given at least 2 hours apart. C) Give the patient an antacid with the drugs. D) Check the patient’s blood glucose level before giving the drugs. Ans: B Feedback: Because of its effects in the GI tract, cholestyramine should be taken at least 2 hours earlier or later than hydrochlorothiazide to ensure the absorption of hydrochlorothiazide. This combination of drugs can be used effectively. An antacid would further aggravate drug absorption and would not be recommended. Blood glucose levels would not be affected by either of these drugs. The pharmacology instructor is discussing diuretic drugs with the nursing class. What 5. would the instructor cite as an adverse effect of loop diuretics? A) Hyperkalemia B) Alkalosis C) Hypertension D) Hypercalcemia Ans: B Feedback: Alkalosis is a drop in serum pH to an alkaline state due to bicarbonate loss in urine. Hypokalemia, hypocalcemia, and hypotension are also adverse effect of these drugs. Therefore, the other options are not correct. A patient with glaucoma has been prescribed a diuretic as treatment of his or her disease 6. process. What drug does the nurse suspect that the patient will be prescribed? A) Acetazolamide (Diamox) B) Spironolactone (Aldactone) C) Chlorthalidone (Hygroton) D) Bendroflumethiazide (Naturetin) Ans: A Feedback: Acetazolamide is used to treat glaucoma. The inhibition of carbonic anhydrase results in decreased secretion of aqueous humor of the eye. Spironolactone is a potassium-sparing diuretic used to treat edema caused by congestive heart failure, liver disease, hypertension, hyperkalemia, and hyperaldosterone. Chlorthalidone is a thiazide-like diuretic and bendroflumethiazide, a thiazide diuretic, are used to treat edema caused by congestive heart failure, liver disease, kidney disease, and as adjunct treatment of hypertension. A patient comes to the clinic for a 1-month follow-up appointment. The patient tells the nurse he or she has been taking chlorothiazide (Diruil) for a month and now has leg cramps and feels tired all the time. What will the nurse consider as the cause of the 7. patient’s symptoms? Hypercalcemia A) C) Hyperkalemia D) Hypokalemia Ans: D Feedback: Hypokalemia results from the loss of potassium in the distal tubule and causes muscle weakness, fatigue, and arrhythmias. Hyperkalemia presents with cardiac arrhythmias and occasionally muscle weakness. Hypercalcemia is characterized by fatigue, depression, mental confusion, nausea, vomiting, and constipation. Hypocalcemia presents with muscle spasms, facial grimacing, possible convulsions, irritability, and depression. A patient has been prescribed furosemide (Lasix). Because this drug causes potassium 8. loss, what will the nurse instruct the patient to eat? A) Peaches B) Apples Pears C) Ans: A Feedback: Peaches, as well as bananas, oranges, raisins, and other fruits, spices, and vegetables are high in potassium and consuming them should be encouraged when taking furosemide. Apples, pears, and pineapple, however, do not replace potassium in the body. A 10-year-old child has edema caused by a heart defect. The patient is taking furosemide (Lasix). The dosage is 6 mg/kg/d. The child weighs 76 pounds. How many mg does the 9. child receive in each dose? A) 20 mg B) 50 mg C) 105 mg D) 210 mg Ans: D Feedback: The nurse will administer 210 mg/dose of the drug (2.2 pounds: 1 kg = 76 pounds: × kg, 76 divided by 2.2 = 34.5, 35 times 6 = 210 mg). The nurse is caring for a patient who is taking acetazolamide (Diamox) for treatment of glaucoma. What drug, if taken with acetazolamide (Diamox), would cause the nurse to 10. contact the physician? A) Indomethacin (Indocin) B) Colestipol (Colestid) C) Lithium (Eskalith) D) Ibuprofen (Motrin) Ans: C Feedback: An increase in the excretion of lithium can occur when taken with acetazolamide, so that special monitoring or a dosage adjustment may be necessary. Indomethacin, colestipol, and ibuprofen do not produce drug-to-drug interactions when given with acetazolamide. A 68-year-old patient, who has type 1 diabetes, is to receive hydrochlorothiazide 11. (HydroDIURIL). Before administration of this medication, what information is most important for the nurse to communicate to the patient? A) His or her insulin dose may need to be increased. B) His or he insulin dose may need to be decreased. C) He or she will need to have him or her urine checked for ketones four times a day. D) He or she will need to have a creatinine clearance done once a month. Ans: A Feedback: Caution should be used with the following conditions, which include systemic lupus erythematosus (SLE), which frequently causes glomerular changes and renal dysfunction that could precipitate renal failure in some cases; glucose tolerance abnormalities or diabetes mellitus, which is worsened by the glucose-elevating effects of many diuretics; and gout, which reflects an abnormality in normal tubule reabsorption and secretion. There would be no reason to check ketones four times daily or to have a creatinine clearance once a month. When evaluating an 82-year-old patient receiving hydrochlorothiazide (HydroDIURIL), 12. what laboratory value deviations may be related to the medication? A) Elevated uric acid levels B) Reduced blood urea nitrogen (BUN) levels C) A serum potassium level of 4.7 mEq/L D) A hemoglobin A1C of 4.8 Ans: A Feedback: Uric acid excretion is decreased because thiazides interfere with its secretory mechanism. High levels of uric acid can result in a condition called gout.Hydrochlorothiazide does not reduce BUN levels. Thiazide diuretics may lead to hypokalemia and increase blood glucose levels. The potassium and hemoglobin A1Clevels are normal and not affected by the medication. What statement by the 62-year-old patient indicates that the patient understand the nurse’s 13. teaching about diuretics? A) I will weigh myself daily and report significant changes. B) I will have to limit my high sugar foods. C) If my leg gets swollen again, I’ll take an additional pill. I will take my medication before bedtime on an empty stomach. D) Ans: A Feedback: Daily weights and blood pressures should be monitored at home in a patient taking diuretics. Options B, C, and D would indicate that further teaching is needed. The nurse is providing discharge instruction to a patient who has just begun using diuretics. The nurse counsels the patient that it is most important to monitor the intake of 14. foods that contain which element? A) Calcium B) Potassium C) Glucose D) Magnesium Ans: B Feedback: Potassium is the most important element to monitor in the diet because diuretics are most likely to lead to hyper- or hypokalemia depending on the diuretic prescribed. Calcium, glucose, and magnesium may need to be monitored in the diet but potassium would be the most important. The nurse is talking with a group of nursing students. What drug would the nurse tell 15. them, when combined with furosemide (Lasix), is likely to cause hearing loss? A) Codeine B) Ciprofloxacin (Cipro) C) Digoxin (Lanoxin) D) Gentamicin (Garamycin) Ans: D Feedback: The risk of ototoxicity increases if loop diuretics are combined with aminoglycoside antibiotics (gentamicin) or cisplatin. No known increased risk of ototoxicity exists when furosemide is taken with codeine, ciprofloxacin, or digoxin. A student asks the pharmacy instructor what the difference is between the diuretics 16. spironolactone (Aldactone) and furosemide (Lasix). What would the instructor reply? A) Potassium losses are lower with spironolactone. B) Potassium losses are greater with spironolactone. C) Water losses are greater with spironolactone. D) Sodium losses are greater with spironolactone. Ans: A Feedback: Spironolactone is a potassium sparing diuretic; therefore, it promotes retention of potassium. Furosemide promotes greater water, sodium, and potassium losses than spironolactone. The nurse is caring for a patient with a severe head injury. An osmotic diuretic is ordered. 17. The nurse understands which drug is an osmotic diuretic? A) Spironolactone (Aldactone) B) Bumetanide (Bumex) C) Mannitol (Osmitrol) D) Ethacrynic (Edecrin) Ans: C Feedback: Mannitol is an osmotic diuretic. Spironolactone is a potassium sparing diuretic. Bumetanide and ethacrynic are loop diuretics. The staff educator in the ICU is talking with a group of new nurses about osmotic diuretics. The educator would tell the new nurses that osmotic diuretics act on which site 18. in the nephron? A) Proximal tubule B) Glomerulus C) Ascending limb of loop of Henle D) Collecting tubule Ans: B Feedback: These drugs are freely filtered at the renal glomerulus, poorly reabsorbed by the renal tubule, not secreted by the tubule, and resistant to metabolism. Therefore, options A, C, and D are not correct. A 64-year-old patient in hypertensive crisis is to receive furosemide (Lasix) 40 mg IV. 19. Lasix comes in 100 mg/10 mL containers. How will the nurse administer the medication? A) Give 4 mL over 1 to 2 minutes IV. B) Give 4 mL over 10 minutes. C) Flush the line with normal saline, give 1 mL/min, flush again when finished. D) Fix 10 mL in an IV piggyback and deliver it over 30 minutes. Ans: A Feedback: Administer furosemide (Lasix) 40 mg over 1 to 2 minutes IV. The other options are not correct. A 91-year-old patient is being discharged on the diuretic spironolactone (Aldactone). 20. What is the major adverse effect of this type of medication? A) Hypokalemia B) Hyperkalemia C) Gastric irritation D) Hypertension Ans: B Feedback: The most common adverse effect of potassium-sparing diuretics is hyperkalemia, which can cause lethargy, confusion, ataxia, muscle cramps, and cardiac arrhythmias. Hypokalemia, gastric irritation, and hypertension are not recognized as adverse effects of spironolactone. The nurse is conducting an admission assessment of a patient who has been prescribed hydrochlorothiazide (HydroDIURIL). Which situation would contraindicate the 21. administration of hydrochlorothiazide (HydroDIURIL)? A) Allergy to sulfa drugs B) Allergy to codeine C) BP 160/96 D) Blood glucose level of 140 mg/dL Ans: A Feedback: Thiazide and thiazide-like diuretics are contraindicated with allergy to thiazides or sulfonamides to prevent hypersensitivity reactions. The other options are not correct. The nurse is caring for a patient who has just been diagnosed with essential hypertension. 22. The nurse is aware that the health care provider will begin therapy with which classification of diuretics? A) Loop diuretics B) Carbonic anhydrous inhibitors C) Thiazide and thiazide-like diuretics D) potassium-sparing diuretics Ans: C Feedback: Thiazides are considered to be mild diuretics compared with the more potent loop diuretics. These agents are the first-line drugs used to manage essential hypertension when drug therapy is needed. Loop and potassium-sparing diuretics and carbonic anhydrous inhibitors would be used in combination with or after the thiazide diuretics are no longer effective. A female patient has a history of frequent bladder infections. Which classification of 23. diuretic would not be recommended for this patient? A) Thiazide and thiazide-like diuretics Loop diuretics B) C) potassium-sparing diuretics D) Osmotic diuretics Ans: A Feedback: Urine is slightly alkalinized when the thiazides or thiazide-like diuretics are used because they block reabsorption of bicarbonate. This effect can cause problems for patients who are susceptible to bladder infections. Loop, potassium sparing, and osmotic diuretics do not have this effect. 24. What is the term for the action of a diuretic in a patient with glaucoma? A) Intraocular pressure (IOP) B) Osmotic pull C) Diuresis D) Potassium sparing Ans: B Feedback: Glaucoma is an eye disease characterized by increased pressure in the eye known as intraocular pressure (IOP)which can cause optic nerve atrophy and blindness. Diuretics are used to provide osmotic pull to remove some of the fluid from the eye, which decreases IOP, or as adjunctive therapy to reduce fluid volume and pressure in the cardiovascular system, which also decreases pressure in the eye somewhat. Potassium sparing refers to a class of diuretics that help to retainpotassium. A patient has just begun to take a prescribed diuretic. Why would the nurse tell the patient 25. to drink 8 to 10 glasses of water daily (unless it is counterindicated)? A) To decrease the action of the reninangiotensin cycle B) To make more concentrated plasma C) To dilute the urine D) To avoid rebound edema Ans: D Feedback: Care must be taken when using diuretics to avoid fluid rebound, which is associated with fluid loss. If a patient stops taking in water and takes the diuretic, the result will be a concentrated plasma of smaller volume. The decreased volume is sensed by the nephrons, which activate the renin-angiotensin cycle. When concentrated blood is sensed by the osmotic center in the brain, antidiuretic hormone (ADH) is released to retain water and dilute the blood. The result can be rebound edema as fluid is retained. Drinking 8 to 10 glasses of water will not decrease the action of the renin-angiotensin cycle, or make plasma more concentrated. It may produce urine that is dilute but that is not the reason it is recommended. A patient has just been prescribed furosemide (Lasix). After reviewing the patient’s medication history, what drug would cause the nurse concern when taken with furosemide 26. (Lasix)? A) Acetaminophen B) Ferrous sulfate (Feosol) C) Naproxen sodium (Naprosyn) D) Ampicillin Ans: C Feedback: Naproxen sodium is a nonsteroidal antiinflammatory drug. There may also be a decreased loss of sodium and decreased antihypertensive effects if these drugs are combined with indomethacin, ibuprofen, salicylates, or other nonsteroidal antiinflammatory drugs. The patient receiving this combination should be monitored closely and appropriate dosage adjustments should be made. There is no contraindication to the intercurrent use of acetaminophen, ferrous sulfate, or ampicillin. A patient with glaucoma has been prescribed acetazolamide (Diamox). What adverse 27. effects would the nurse caution the patient about? (Select all that apply.) A) Paresthesia B) Confusion C) Drowsiness D) Vomiting E) Hyperkalemia Ans: A, B, C Feedback: Metabolic acidosis is a relatively common and potentially dangerous adverse effect that occurs when bicarbonate is lost. Hypokalemia is also common. Patients also complain of paresthesias of the extremities, confusion, and drowsiness. Vomiting and hyperkalemia are not common adverse effects A patient who was recently prescribed spironolactone calls the clinic and complains that he is not urinating as much as he did when he first started taking this medication. What 28. would be an appropriate question for the nurse to ask this patient? A) Are you taking a salicylate? B) Are you taking acetaminophen? C) Are you taking ibuprofen? D) Are you using a lot of salt? Ans: A Feedback: The diuretic effect decreases if potassium-sparing diuretics are combined with salicylates. Dosage adjustment may be necessary to achieve therapeutic effects. There is no decrease in effect when spironolactone is combined with acetaminophen, ibuprofen, and increased 29. A) sodium intake. The nurse is writing a plan of care for a patient who is taking a diuretic. What would be an appropriate nursing diagnosis for this patient? Impaired urinary elimination B) Monitor the patient response to the drug C) Imbalanced nutrition: More than body requirements D) Risk for fluid volume overload Ans: A Feedback: Nursing diagnoses related to drug therapy may include impaired urinary elimination related to drug effect. Options B, C, and D would not be appropriate nursing diagnoses. A patient has been prescribed hydrochlorothiazide (HydroDIURIL) and the nurse is preparing to give the patient discharge instructions. Which adverse effects may this 30. patient experience while taking this medication? (Select all that apply.) A) Constipation B) Dizziness C) Polyphagia D) Nocturia E) Muscle cramps Ans: B, D, E Feedback: The adverse effects associated with hydrochlorothiazide are dizziness, vertigo, orthostatic hypotension, nausea, anorexia, vomiting, dry mouth, diarrhea, polyuria, nocturia, muscle cramps, and spasms. The patient would not experience polyphagia (great hunger) and constipation. A patient has just begun therapy with furosemide (Lasix), and the nurse is instructing the patient about the need to include foods high in potassium in the diet. Which foods would 31. be appropriate for this patient to choose? (Select all that apply.) A) Prunes B) Apples C) Watermelon D) Lima beans E) Rice Ans: A, C, D Feedback: Foods high in potassium include avocados, bananas, broccoli, cantaloupe, dried fruits, grapefruit, lima beans, nuts, navy beans, oranges, peaches, potatoes, prunes, rhubarb, Sanka coffee, sunflower seeds, spinach, tomatoes, and watermelon. Apples and rice are not potassium-rich foods. A nursing instructor is teaching a group of students about loop diuretics. Which would be 32. included in this classification? (Select all that apply.) A) Acetazolamide B) Torsemide C) Ethacrynic acid D) Mannitol E) Bumetanide Ans: B, C, E Feedback: Torsemide, ethacrynic acid, and bumetanide are examples of loop diuretics. Acetazolamide is a carbonic anhydrous inhibitor and mannitol is an osmotic diuretic. The nurse is caring for a patient with edema who has just begun taking a diuretic. What 33. will the nurse use to evaluate the effectiveness of this medication? (Select all that apply.) A) Daily weight B) Decrease in edema C) Increase in blood pressure D) Increase in urinary output E) Increase in pulse Ans: A, B, D Feedback: Responsiveness to the use of a diuretic can be measured by daily weights, increased urinary output, decrease in edema, decrease in blood pressure and pulse rate. Options C and E are not correct. The nurse has just administered 150 g of mannitol IV to a patient with increased intracranial pressure. What is most important for the nurse to monitor in the hour after 34. administration? A) Weight of patient B) Blood pressure of patient C) Pulse of patient D) Respiratory rate of patient Ans: B Feedback: The most common and potentially dangerous adverse effect related to an osmotic diuretic is the sudden drop in fluid levels. Mannitol peaks 1 hour after administration, therefore, it would be most important to monitor blood pressure. Weight is the best indicator over time but would not be as effective in indicating a dangerous fluid drop as the blood pressure. Respiratory and pulse rates would also not be as effective as blood pressure in evaluating dangerous fluid drops. Show Less