NCLEX Prep II Renal and Urinary Medications Chapter 59 (Answered) With Rationale

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 prescribed for the client. Which is the priority nursing assessment before administering this medication? 1.Checking lung sounds 2.Checking the blood pressure 3.Checking the apical heart rate 4.Checking the bowel sounds in all 4 quadrants 1.Checking lung sounds Rationale: Nitrofurantoin is an antibacterial used to treat urinary tract infections. Although rare, the medication can cause an asthmatic exacerbation in those with a history of asthma. Therefore, the priority baseline assessment should include questioning the client about a history of asthma and checking lung sounds. The assessments in the remaining options may be done but are unrelated to this medication and are not a priority. Phenazopyridine is prescribed for a client with a urinary tract infection. The nurse evaluates that the medication is effective based on which observation? 1.Urine is clear amber. 2.Urination is not painful. 3.Urge incontinence is not present. 4.A reddish-orange discoloration of the urine is present. 2.Urination is not painful. Rationale: Phenazopyridine is a urinary analgesic. It is effective when it eliminates pain and burning with urination. It does not eliminate the bacteria causing the infection, so it would not make the urine clear amber. It does not treat urge incontinence. It will cause the client to have reddish-orange discoloration of urine but this is a side effect of the medication, not the desired effect. Epoetin alfa is prescribed for a client diagnosed with chronic kidney disease. The client asks the nurse about the purpose of the medication. Which response by the nurse is most appropriate? 1."It is used to treat anemia." 2."It is used to lower your blood pressure." 3."It will help to increase the potassium level in your body." 4."It is an anticonvulsant medication given to all clients after dialysis to prevent seizure activity." 1."It is used to treat anemia." Rationale: Epoetin alfa is a medication that is used to treat anemia. It does not lower blood pressure or increase potassium. It is also not given after a dialysis treatment to prevent seizure activity. Hypertension is a side effect. Hyperkalemia and seizures are adverse effects of the medication. A client who has had a prostatectomy is complaining of pain from bladder spasms. The nurse checks the health care provider's prescription sheet and expects to see which medication prescribed to treat the problem? 1.Oxybutynin 2.Hydromorphone 3.Morphine sulfate