NCLEX Prep II Renal and Urinary Medications Chapter
59 (Answered) With Rationale
Parenteral bethanechol chloride is prescribed for a client with urinary retention.
The nurse should plan to administer this medication by which route?
1.Intravenously
2.Intradermally
3.Intramuscularly
4.Subcutaneously
4.Subcutaneously
Rationale:
The injectable form of bethanechol chloride is intended for subcutaneous administration
only. Bethanechol must never be injected intramuscularly or intravenously because the
resulting high medication level can cause severe toxicity, resulting in bloody diarrhea,
bradycardia, profound hypotension, and cardiovascular collapse.
A client taking metronidazole telephones the home health nurse to report dark
discoloration to the urine. The nurse interprets that the client's complaint
warrants which nursing action at this time?
1.Instruct the client to increase fluid intake.
2.Tell the client to discontinue the medication.
3.Instruct the client to call the health care provider (HCP). 4.Tell the client that this
is a harmless medication side effect.
4.Tell the client that this is a harmless medication side effect.
Rationale:
Harmless darkening of the urine may occur, and the client should be told of this effect.
Metronidazole can produce a variety of side effects, but they rarely require termination
of treatment. Increasing fluid intake is a good health measure but will not prevent this
side effect from occurring. It is not necessary to discontinue the medication or call the
HCP.
A client is receiving oxybutynin. The nurse should suspect that this medication is
prescribed to relieve which condition?
1.Gastritis
2.Renal calculi
3.Ulcerative colitis
4.Overactive bladder
4.Overactive bladder
Rationale:
When medication therapy for overactive bladder is indicated, anticholinergic agents are
the medications generally prescribed. These medications block muscarinic receptors on
the bladder detrusor and thereby inhibit bladder contractions and decrease the urge to
void. It is not used to treat gastritis. The medication would not be used to treat renal
calculi or ulcerative colitis. In fact, it may make those conditions worse.
The nurse is taking care of a client receiving oxybutynin. Which finding should
the nurse expect to note if the client develops side or adverse effects of this
medication?
,1.Itching
2.Diarrhea
3.Swelling
4.Dry mouth
4.Dry mouth
Rationale:
Oxybutynin is an anticholinergic. Anticholinergic side effects include dry mouth,
constipation, tachycardia, urinary hesitancy, urinary retention, mydriasis, blurred vision,
and dry eyes. Itching, diarrhea, and swelling are not associated with this medication.
The nurse, who is administering bethanechol chloride, is monitoring for
cholinergic overdose associated with the medication. The nurse should check the
client for which sign of overdose?
1.Dry skin
2.Dry mouth
3.Bradycardia
4.Signs of dehydration
3.Bradycardia
Rationale:
Cholinergic overdose of bethanechol chloride produces manifestations of excessive
muscarinic stimulation such as salivation, sweating, involuntary urination and
defecation, bradycardia, and severe hypotension. Remember that the sympathetic
nervous system speeds the heart rate and the cholinergic (parasympathetic) nervous
system slows the heart rate. Treatment includes supportive measures and the
administration of atropine sulfate (anticholinergic) subcutaneously or intravenously.
Tamsulosin hydrochloride is prescribed for a client. The nurse should suspect
that this medication is prescribed to relieve which condition?
1.Constipation
2.Muscle spasms
3.Urinary obstruction
4.Respiratory congestion
3.Urinary obstruction
Rationale:
Tamsulosin hydrochloride is used to relieve mild to moderate manifestations that occur
in benign prostatic hypertrophy. The medication also improves urinary flow rates. This
medication is not used to treat constipation, muscle spasms, or respiratory congestion.
The nurse is providing discharge instructions to a client receiving trimethoprim-
sulfamethoxazole. Which instruction should be included in the list?
1.Advise that sunscreen is not needed.
2.Drink 8 to 10 glasses of water per day.
3.If the urine turns dark brown, call the health care provider (HCP) immediately.
4.Decrease the dosage when symptoms are improving to prevent an allergic
response.
2.Drink 8 to 10 glasses of water per day.
Rationale:
Each dose of trimethoprim-sulfamethoxazole should be administered with a full glass of
water, and the client should maintain a high fluid intake to avoid crystalluria. The
, medication is more soluble in alkaline urine. The client should not be instructed to taper
or discontinue the dose. Clients should be advised to use sunscreen since the skin
becomes sensitive to the sun. Some forms of trimethoprim-sulfamethoxazole cause
urine to turn dark brown or red. This does not indicate the need to notify the HCP.
The nurse is administering a dose of a prescribed diuretic to an assigned client.
The nurse should monitor the client for hypokalemia as a side effect of therapy if
the client has been receiving which medication?
1.Bumetanide
2.Triamterene
3.Amiloride HCl
4.Spironolactone
1.Bumetanide
Rationale:
Bumetanide is a loop diuretic that places the client at risk for hypokalemia. The nurse
would monitor this client carefully for signs of hypokalemia, monitor serum potassium
levels, and encourage intake of high-potassium foods. The other medications listed are
potassium-retaining diuretics.
Trimethoprim-sulfamethoxazole is prescribed to be administered by intravenous
infusion to a client with a recurrent urinary tract infection. How should the nurse
administer this medication?
1.Over 30 minutes 2.Over 60 to 90 minutes 3.Piggybacked into the peripheral line
containing parenteral nutrition 4.Piggybacked into the existing infusion of normal
saline and potassium chloride
2.Over 60 to 90 minutes
Rationale:
Trimethoprim-sulfamethoxazole may be administered by intravenous infusion but should
not be mixed with any other medications or solutions. Trimethoprim-sulfamethoxazole is
infused over 60 to 90 minutes, and bolus infusions or rapid infusions must be avoided.
The home health nurse is caring for a client who is taking probenecid. The client
has been instructed to restrict the diet to low-purine foods. Which food item
should the nurse instruct the client to avoid?
1.Spinach
2.Scallops
3.Potatoes
4.Ice cream
2.Scallops
Rationale:
Probenecid is a medication used for clients with gout to inhibit the reabsorption of uric
acid by the kidneys and promote excretion of uric acid in the urine. Uric acid is produced
when purine is catabolized. Clients are instructed to modify their diets to limit excessive
purine intake. High-purine foods to avoid or limit include organ meats, roe, sardines,
scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, yeast, wine,
and alcohol.
Laboratory analysis of a urine sample for culture and sensitivity reveals a
bacterial infection, and the client is diagnosed with cystitis. Nitrofurantoin is
59 (Answered) With Rationale
Parenteral bethanechol chloride is prescribed for a client with urinary retention.
The nurse should plan to administer this medication by which route?
1.Intravenously
2.Intradermally
3.Intramuscularly
4.Subcutaneously
4.Subcutaneously
Rationale:
The injectable form of bethanechol chloride is intended for subcutaneous administration
only. Bethanechol must never be injected intramuscularly or intravenously because the
resulting high medication level can cause severe toxicity, resulting in bloody diarrhea,
bradycardia, profound hypotension, and cardiovascular collapse.
A client taking metronidazole telephones the home health nurse to report dark
discoloration to the urine. The nurse interprets that the client's complaint
warrants which nursing action at this time?
1.Instruct the client to increase fluid intake.
2.Tell the client to discontinue the medication.
3.Instruct the client to call the health care provider (HCP). 4.Tell the client that this
is a harmless medication side effect.
4.Tell the client that this is a harmless medication side effect.
Rationale:
Harmless darkening of the urine may occur, and the client should be told of this effect.
Metronidazole can produce a variety of side effects, but they rarely require termination
of treatment. Increasing fluid intake is a good health measure but will not prevent this
side effect from occurring. It is not necessary to discontinue the medication or call the
HCP.
A client is receiving oxybutynin. The nurse should suspect that this medication is
prescribed to relieve which condition?
1.Gastritis
2.Renal calculi
3.Ulcerative colitis
4.Overactive bladder
4.Overactive bladder
Rationale:
When medication therapy for overactive bladder is indicated, anticholinergic agents are
the medications generally prescribed. These medications block muscarinic receptors on
the bladder detrusor and thereby inhibit bladder contractions and decrease the urge to
void. It is not used to treat gastritis. The medication would not be used to treat renal
calculi or ulcerative colitis. In fact, it may make those conditions worse.
The nurse is taking care of a client receiving oxybutynin. Which finding should
the nurse expect to note if the client develops side or adverse effects of this
medication?
,1.Itching
2.Diarrhea
3.Swelling
4.Dry mouth
4.Dry mouth
Rationale:
Oxybutynin is an anticholinergic. Anticholinergic side effects include dry mouth,
constipation, tachycardia, urinary hesitancy, urinary retention, mydriasis, blurred vision,
and dry eyes. Itching, diarrhea, and swelling are not associated with this medication.
The nurse, who is administering bethanechol chloride, is monitoring for
cholinergic overdose associated with the medication. The nurse should check the
client for which sign of overdose?
1.Dry skin
2.Dry mouth
3.Bradycardia
4.Signs of dehydration
3.Bradycardia
Rationale:
Cholinergic overdose of bethanechol chloride produces manifestations of excessive
muscarinic stimulation such as salivation, sweating, involuntary urination and
defecation, bradycardia, and severe hypotension. Remember that the sympathetic
nervous system speeds the heart rate and the cholinergic (parasympathetic) nervous
system slows the heart rate. Treatment includes supportive measures and the
administration of atropine sulfate (anticholinergic) subcutaneously or intravenously.
Tamsulosin hydrochloride is prescribed for a client. The nurse should suspect
that this medication is prescribed to relieve which condition?
1.Constipation
2.Muscle spasms
3.Urinary obstruction
4.Respiratory congestion
3.Urinary obstruction
Rationale:
Tamsulosin hydrochloride is used to relieve mild to moderate manifestations that occur
in benign prostatic hypertrophy. The medication also improves urinary flow rates. This
medication is not used to treat constipation, muscle spasms, or respiratory congestion.
The nurse is providing discharge instructions to a client receiving trimethoprim-
sulfamethoxazole. Which instruction should be included in the list?
1.Advise that sunscreen is not needed.
2.Drink 8 to 10 glasses of water per day.
3.If the urine turns dark brown, call the health care provider (HCP) immediately.
4.Decrease the dosage when symptoms are improving to prevent an allergic
response.
2.Drink 8 to 10 glasses of water per day.
Rationale:
Each dose of trimethoprim-sulfamethoxazole should be administered with a full glass of
water, and the client should maintain a high fluid intake to avoid crystalluria. The
, medication is more soluble in alkaline urine. The client should not be instructed to taper
or discontinue the dose. Clients should be advised to use sunscreen since the skin
becomes sensitive to the sun. Some forms of trimethoprim-sulfamethoxazole cause
urine to turn dark brown or red. This does not indicate the need to notify the HCP.
The nurse is administering a dose of a prescribed diuretic to an assigned client.
The nurse should monitor the client for hypokalemia as a side effect of therapy if
the client has been receiving which medication?
1.Bumetanide
2.Triamterene
3.Amiloride HCl
4.Spironolactone
1.Bumetanide
Rationale:
Bumetanide is a loop diuretic that places the client at risk for hypokalemia. The nurse
would monitor this client carefully for signs of hypokalemia, monitor serum potassium
levels, and encourage intake of high-potassium foods. The other medications listed are
potassium-retaining diuretics.
Trimethoprim-sulfamethoxazole is prescribed to be administered by intravenous
infusion to a client with a recurrent urinary tract infection. How should the nurse
administer this medication?
1.Over 30 minutes 2.Over 60 to 90 minutes 3.Piggybacked into the peripheral line
containing parenteral nutrition 4.Piggybacked into the existing infusion of normal
saline and potassium chloride
2.Over 60 to 90 minutes
Rationale:
Trimethoprim-sulfamethoxazole may be administered by intravenous infusion but should
not be mixed with any other medications or solutions. Trimethoprim-sulfamethoxazole is
infused over 60 to 90 minutes, and bolus infusions or rapid infusions must be avoided.
The home health nurse is caring for a client who is taking probenecid. The client
has been instructed to restrict the diet to low-purine foods. Which food item
should the nurse instruct the client to avoid?
1.Spinach
2.Scallops
3.Potatoes
4.Ice cream
2.Scallops
Rationale:
Probenecid is a medication used for clients with gout to inhibit the reabsorption of uric
acid by the kidneys and promote excretion of uric acid in the urine. Uric acid is produced
when purine is catabolized. Clients are instructed to modify their diets to limit excessive
purine intake. High-purine foods to avoid or limit include organ meats, roe, sardines,
scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, yeast, wine,
and alcohol.
Laboratory analysis of a urine sample for culture and sensitivity reveals a
bacterial infection, and the client is diagnosed with cystitis. Nitrofurantoin is
