Chapter 34 Drug Therapy for Fluid Volume Excess

The kidneys receive approximately what percentage of the cardiac output? 40% 5% 25% 15%

25% Explanation: The kidneys receive approximately 25% of the cardiac output.

The nurse admits a client with a high potassium level. Renal attempts at lowering the client's potassium level may cause what assessment finding? Oliguria Edema Pruritus Drowsiness

Edema Explanation: If potassium levels are very high, the retention of sodium in exchange for potassium also leads to retention of water and a dilution of blood volume. Water retention can lead to edema. Hyperkalemia does not necessarily lead to oliguria, even if it has a renal etiology. Pruritus and drowsiness are not associated with hyperkalemia.

After teaching a group of nursing students about diuretics, the instructor determines that the teaching was successful when the group identifies which as a loop diuretic? Furosemide Hydrochlorothiazide Acetazolamide Spironolactone

Furosemide Explanation: Furosemide is an example of a loop diuretic. Hydrochlorothiazide is a thiazide diuretic. Acetazolamide is a carbonic anhydrase inhibitor. Spironolactone is a potassium-sparing diuretic.

A health care provider is considering ordering hydrochlorothiazide for a client. This drug must be used cautiously, if at all, if the client has a history of: • obesity. • stable angina. • hypersensitivity to sulfonamides. • hypertension.

hypersensitivity to sulfonamides. Explanation: Thiazide diuretics, such as hydrochlorothiazide, are chemically related to sulfonamide drugs. Thiazides may be contraindicated in clients allergic to sulfonamides because of cross-sensitivity.

A client who has been taking hydrochlorothiazide arrives at the clinic for his 1-month follow-up appointment. The client tells the nurse that he feels weaker since he began taking the drug. What should the nurse consider as a possible cause of these symptoms? • Hypokalemia • Hypocalcemia • Hyperkalemia • Hypercalcemia

• Hypokalemia Explanation: Thiazides, such as hydrochlorothiazide, are potassium-losing diuretics, and their use can lead to hypokalemia. Symptoms of hypokalemia include muscle weakness, arrhythmia, hypotension, anorexia, and shallow respirations.

The nurse is caring for a client with a severe head injury. An osmotic diuretic is ordered. The nurse understands which drug is an osmotic diuretic? • Mannitol • Spironolactone • Bumetanide • Ethacrynic

• Mannitol Explanation: Mannitol is an osmotic diuretic. Spironolactone is a potassium sparing diuretic. Bumetanide and ethacrynic are loop diuretics.

A health care provider prescribes spironolactone, a potassium-sparing diuretic, for a client with cirrhosis. For which category of clients is the use of potassium-sparing diuretics contraindicated? • liver disease • gout • diabetes • hyperkalemia

• hyperkalemia Explanation: The nurse should know that potassium-sparing diuretics are contraindicated in clients with hyperkalemia and are not recommended for children. Potassium-sparing diuretics should be used cautiously in clients with liver disease, diabetes, or gout, but presence of these conditions does not contraindicate the use of potassium diuretics.

A physician has prescribed triamterene to a client with renal disease. The client informs the nurse that they are taking potassium supplements to address some heart problems. The nurse would be alert for which of the following? • increased risk of bleeding. • decreased diuretic effectiveness. • increased risk of arrhythmias. • increased risk of hyperkalemia.

• increased risk of hyperkalemia. Explanation: The nurse should inform the client about the increased risk of hyperkalemia as the effect of the interaction between triamterene, which is a potassium-sparing diuretic, and potassium supplements. When the client is administered loop diuretics with anticoagulants or thrombolytics, there will be increased risk of bleeding. When the client is administered digitalis with loop diuretics, there is an increased risk of arrhythmias. Decreased diuretic effect, in this case decreased effect of triamterene, will occur when a potassium-sparing diuretic such as triamterene is administered with NSAIDs, salicylates, and anticoagulants.

A group of students are reviewing the function of the kidneys and demonstrate understanding when they identify that the kidneys receive what portion of the cardiac output? • ½ • 1/10 • ¼ • 1/5

• ¼ Explanation: The kidneys receive approximately 25% or ¼ of the cardiac output.

When explaining the underlying mechanisms associated with renal failure, which would be most important for the nurse to keep in mind? • Extensive kidney damage has usually occurred by the time the patient is symptomatic. • Renal failure typically involves some injury to the protective layers of the kidneys. • Nephron damage is not associated with the development of signs and symptoms. • Manifestations occur when a small number of nephrons become nonfunctional.

Extensive kidney damage has usually occurred by the time the patient is symptomatic. Explanation: It is estimated that only about 25% of the total number of nephrons are necessary to maintain healthy renal function. That means that the renal system is well protected from failure with a large backup system. However, it also means that by the time a patient manifests signs and symptoms suggesting failure of the kidneys, extensive kidney damage has already occurred.

A client has been diagnosed with renal failure and is surprised to learn of the large volume of blood that is filtered by the kidneys. The client asks, "If that much blood gets filtered, why don't people produce more urine than they do?" In response, the nurse should describe what phenomenon? Most of the substances that are removed from urine are recycled. Most urine is processed internally rather than excreted. Electrolytes draw the water from urine back into circulation. A very large majority of filtrate is returned to circulation.

· A very large majority of filtrate is returned to circulation. Explanation: Only 1% of filtrate is excreted as urine, since the majority of the filtrate is physiologically useful. Substances are removed from blood, not from urine. Urine is excreted, not processed internally.

A 10-year-old child has edema caused by a heart defect. The client is taking furosemide. The dosage is 3 mg/kg/d. The child weighs 76 lbs. How many milligrams does the child receive each day? • 20 mg • 50 mg • 105 mg • 210 mg

• 105 mg Explanation: The nurse will administer 105 mg/dose of the drug (76 lbs divided by 2.2 = 34.5 kg, 35 kg times 3 mg = 105 mg).

The nurse has just administered 150 g of mannitol IV to a client with increased intracranial pressure. What assessment related to mediation administration should the nurse prioritizewhen monitoring the client? • Blood pressure • Weight and abdominal girth • Apical heart rate and rhythm • Respiratory rate and oxygen saturation

• Blood pressure Explanation: The most common and potentially dangerous adverse effect related to an osmotic diuretic is the sudden drop in fluid levels, which could result in dangerous hypotension. Weight and abdominal girth may change over time as fluid balance changes, but effects would not be observed as quickly as a drop in blood pressure. The nurse should monitor the client's respiratory status and heart rate because of the client's acute illness, but these are less likely to affect mannitol.

A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route? • Intravenous • Intramuscular • Oral • Subcutaneous

• Oral Explanation: Hydrochlorothiazide is only available as an oral preparation. Only chlorothiazide can be given by intravenous infusion.

A health care provider prescribes diuretic therapy to a client with nephrotic syndrome. The client experiences hyponatremia as an effect of the therapy. Which symptom of hyponatremia should the nurse monitor for in the client? • Paresthesias • Visual hallucination • Tachycardia • Tremors

• Tachycardia Explanation: The nurse should monitor for tachycardia, cold and clammy skin, confusion, and hypotension in the client experiencing hyponatremia. Hyponatremia is excessive loss of sodium, and is a common fluid and electrolyte imbalance associated with diuretic therapy. Tremors, visual hallucinations, and paresthesias are the symptoms of hypomagnesemia and not hyponatremia.

A client began taking hydrochlorothiazide 1 week ago and is reporting occasional dizziness when she stands up quickly from sitting or lying. What is the nurse's best action? • Teach the client about the blood pressure effects of the medication and relevant safety measures. • Tell the client to withhold the next scheduled dose until she can be assessed by the provider. • Arrange for the client's potassium levels to be assessed as soon as possible. • Educate the client about the need for bed rest until her body adjusts to the new medication.

• Teach the client about the blood pressure effects of the medication and relevant safety measures. Explanation: Mild dizziness upon rapid position changes is expected as a result of lowered blood pressure. The nurse should teach the client about this phenomenon and associated falls prevention. This is more likely a result of hypotension than changes in potassium levels. Bed rest would not be necessary and causes many other potential health problems. The nurse should not tell the client to withhold the medication since there is no evidence of severe adverse effects or an emergency.

A physician has prescribed triamterene to a client with renal disease. The client informs the nurse that they are taking potassium supplements to address some heart problems. The nurse would be alert for which of the following? • increased risk of bleeding. • decreased diuretic effectiveness. • increased risk of arrhythmias. • increased risk of hyperkalemia

· Increased risk of hyperkalemia. Explanation: The nurse should inform the client about the increased risk of hyperkalemia as the effect of the interaction between triamterene, which is a potassium-sparing diuretic, and potassium supplements. When the client is administered loop diuretics with anticoagulants or thrombolytics, there will be increased risk of bleeding. When the client is administered digitalis with loop diuretics, there is an increased risk of arrhythmias. Decreased diuretic effect, in this case decreased effect of triamterene, will occur when a potassium-sparing diuretic such as triamterene is administered with NSAIDs, salicylates, and anticoagulants.

A patient with a longstanding diagnosis of chronic renal failure has experienced a significant decline in urine output in recent days, prompting him to seek care at a local clinic. A nurse at the clinic has suggested to a colleague that the administration of a diuretic such as hydrochlorothiazide may improve the patient's urine output. How should the colleague bestrespond to this suggestion? • "That would probably help, but we'd have to do blood work first." • "Maybe, but hydrochlorothiazide affects the bladder more than the kidneys." • "That would only work if he could come in twice a day to get it intravenously." • "Actually, patients with renal failure usually can't take hydrochlorothiazide."

• "Actually, patients with renal failure usually can't take hydrochlorothiazide." Explanation: Renal disease and severe renal impairment contraindicate the use of hydrochlorothiazide. HCTZ affects the kidneys, not the bladder, and is not administered intravenously.

After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states: • "I need to make sure I don't eat too many high potassium foods." • "I need to take the drug on an empty stomach." • "I should take the medicine around dinnertime for the best effect." • "I can still use my salt substitute if I want to."

• "I need to make sure I don't eat too many high potassium foods." Explanation: The drug is a potassium sparing diuretic placing the patient at risk for hyperkalemia, especially if the patient consumes foods high in potassium. The patient should take the medication in the morning to prevent interfering with sleep by having to get up at night to void. The patient can take the drug with meals if GI upset occurs. Many salt substitutes contain potassium, which could increase the patient's risk for hyperkalemia.

You are monitoring serum electrolyte levels in a 55-year-old patient who has been prescribed digoxin and a potassium-sparing diuretic for treatment of heart failure. Which of the following potassium levels would you hope to see for this patient? • 2.5 mEq/L • 6.0 mEq/L • 3.0 mEq/L • 4.0 mEq/L

• 4.0 mEq/L Explanation: One goal of treatment is to maintain normal serum potassium levels, which are between 3.5 mEq/L and 5.0 mEq/L. Levels below or above that range are indicative of hypokalemia or hyperkalemia, respectively.

A clinic nurse has been assigned to follow up with a group of patients on hydrochlorothiazide therapy. Which patient will the nurse most closely monitor for hyponatremia? • A 23-year-old male who has diabetes • A 36-year-old female who has diabetes • A 42-year-old male who has advanced arteriosclerosis • A 71-year-old female who has advanced arteriosclerosis

• 71-year-old female who has advanced arteriosclerosis Explanation: While patients with diabetes or advanced arteriosclerosis should be monitored closely during hydrochlorothiazide therapy, older patients (over 65 years), especially women, are more at risk for hyponatremia. Older adults and their family members must be advised to report symptoms of hyponatremia such as weakness, nerve disorders, weight loss, salt hunger, cramps, and digestive problems.

A client has been diagnosed with renal failure and is surprised to learn of the large volume of blood that is filtered by the kidneys. The client asks, "If that much blood gets filtered, why don't people produce more urine than they do?" In response, the nurse should describe what phenomenon? • Electrolytes draw the water from urine back into circulation. • A very large majority of filtrate is returned to circulation. • Most urine is processed internally rather than excreted. • Most of the substances that are removed from urine are recycled.

• A very large majority of filtrate is returned to circulation. Explanation: Only 1% of filtrate is excreted as urine, since the majority of the filtrate is physiologically useful. Substances are removed from blood, not from urine. Urine is excreted, not processed internally.

A nurse is caring for a client with acute renal failure. The health care provider has prescribed a diuretic therapy for the client to promote dieresis. What intervention should the nurse perform to prevent the inconvenience caused by increased urination? • Ask the client to decrease fluid intake. • Gradually increase the drug dosage. • Administer the drug early in the day. • Encourage the client to exercise.

• Administer the drug early in the day. Explanation: The nurse should administer the drug early in the day to prevent any nighttime sleep disturbance caused by increased urination when caring for a client receiving a diuretic therapy for acute renal failure. The nurse need not ask the client to decrease fluid intake, gradually increase the drug dosage, or encourage the client to exercise as these are not appropriate interventions and will not help in reducing the discomfort caused by increased urination.

Aldosterone levels would be affected if which gland was dysfunctional? • Pituitary • Thyroid • Pancreas • Adrenal

• Adrenal Explanation: Aldosterone is a hormone produced by the adrenal gland that causes the distal tubule to retain sodium, and therefore water. A dysfunction adrenal gland would result in the insufficient production of aldosterone.

Which enzyme would a nurse identify as being responsible for the reabsorption of sodium ions? • Angiotensin converting enzyme • Monoamine oxidase • Acetylcholinesterase • Carbonic anhydrase

• Carbonic anhydrase Explanation: Sodium ions are reabsorbed via a transport system that functions under the influence of the catalyst carbonic anhydrase, which speeds the process of carbon dioxide and water combining to form carbonic acid.

A nurse is caring for a client with increased intracranial pressure caused by cerebral edema. The health care provider has prescribed mannitol. What assessment should the nurse perform after administering the drug to the client? • Monitor blood pressure every four hours. • Monitor serum uric acid concentrations. • Monitor client for joint pain. • Check response of pupils to light.

• Check response of pupils to light. Explanation: When caring for a client who has been administered mannitol for intracranial pressure, the nurse should perform neurological assessments such as vital signs, response of the pupils to light, level of consciousness, or response to a painful stimulus at the time intervals ordered by the primary health care provider. The nurse monitors the client for joint pain and other discomforts when the client is administered thiazide diuretics for renal impairment. When caring for clients taking thiazide diuretics, the nurse also monitors the serum uric acid concentrations because these drugs may precipitate an acute attack of gout. The nurse needs to monitor the client's blood pressure every 30 to 60 minutes when caring for a client receiving the osmotic diuretic mannitol or urea for the treatment of increased intracranial pressure caused by cerebral edema

A patient is prescribed a thiazide diuretic that is to be administered intravenously. Which agent would this most likely be? • Hydrochlorothiazide • Methyclothiazide • Chlorothiazide • Bendroflumethiazide

• Chlorothiazide Explanation: Chlorothiazide is administered orally or intravenously. Hydrochlorothiazide, Bendroflumethiazide, and methyclothiazide are administered orally only.

The pharmacology instructor is discussing the various diuretic agents and their sites of action in the nephron. In what part of the nephron do thiazide diuretics act? • Descending limb of the loop of Henle • Distal tubule • Ascending limb of the loop of Henle • Proximal tubule

• Distal tubule Explanation: Thiazide diuretics act in the nephron's distal tubule.

A 49-year-old client reports frequent muscle cramps while on hydrochlorothiazide therapy. The nurse would advise the client to do which? • take calcium supplements. • eat potassium-rich foods. • drink plenty of fluids. • include high-sodium foods in her diet.

• Eat potassium-rich foods. Explanation: The client is most likely experiencing muscle cramps due to potassium loss. Therefore, the nurse should advise the client to include potassium supplements in the diet. Drinking plenty of fluids or using calcium supplements will not reduce the occurrence of cramps. It is important to caution the client to avoid foods high in sodium because they could counteract the effects of drug therapy.

The nurse admits a client with a high potassium level. Renal attempts at lowering the client's potassium level may cause what assessment finding? • Pruritus • Drowsiness • Edema • Oliguria

• Edema Explanation: If potassium levels are very high, the retention of sodium in exchange for potassium also leads to retention of water and a dilution of blood volume. Water retention can lead to edema. Hyperkalemia does not necessarily lead to oliguria, even if it has a renal etiology. Pruritus and drowsiness are not associated with hyperkalemia.

The nurse is evaluating an 82-year-old client's medical record. The client is receiving hydrochlorothiazide. What abnormal laboratory result is related to the medication? • Elevated serum potassium levels • Reduced blood glucose levels • Elevated uric acid levels • Elevated serum magnesium levels

• Elevated uric acid levels Explanation: Use of thiazides can result in hyperuricemia (i.e., elevated uric acid level). Other adverse effects of this diuretic class include hypokalemia, hypomagnesemia, and hyperglycemia.

When explaining the underlying mechanisms associated with renal failure, which would be most important for the nurse to keep in mind? • Nephron damage is not associated with the development of signs and symptoms. • Renal failure typically involves some injury to the protective layers of the kidneys. • Manifestations occur when a small number of nephrons become nonfunctional. • Extensive kidney damage has usually occurred by the time the patient is symptomatic.

• Extensive kidney damage has usually occurred by the time the patient is symptomatic. Explanation: It is estimated that only about 25% of the total number of nephrons are necessary to maintain healthy renal function. That means that the renal system is well protected from failure with a large backup system. However, it also means that by the time a patient manifests signs and symptoms suggesting failure of the kidneys, extensive kidney damage has already occurred.

What term is used to describe the process that moves fluid and small particles out of the blood through the glomerulus and into the nephron tubule • Filtration • Secretion • Reabsorption • Excretion

• Filtration Explanation: Filtration is the term used to describe the passage of fluid and small components of the blood through the glomerulus into the nephron tubule. None of the other options are terms used to describe this process.

After teaching a group of nursing students about diuretics, the instructor determines that the teaching was successful when the group identifies which as a loop diuretic? • Furosemide • Acetazolamide • Hydrochlorothiazide • Spironolactone

• Furosemide Explanation: Furosemide is an example of a loop diuretic. Hydrochlorothiazide is a thiazide diuretic. Acetazolamide is a carbonic anhydrase inhibitor. Spironolactone is a potassium-sparing diuretic.

The nurse is caring for a client suspected of having renal dysfunction. The presence of what substances in the client's urine would be considered pathological? • Potassium and sodium • Glucose and protein • Bicarbonate and urea • Creatinine and chloride

• Glucose and protein Explanation: The various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. Glucose scarring or swelling of or damage to the semipermeable membrane leads to the escape of larger plasma components such as blood cells or protein into the filtrate. A clinical sign of renal damage is the presence of blood cells or protein in the urine.

A male client is excited because it is football season. He has season tickets and attends most games with his friends. At his latest appointment, the client's blood pressure is elevated. What does the nurse suspect is the cause? • He is anxious about his team. • He has become a vegetarian until his team wins the championship. • He is developing comorbidities. • He is consuming excessive salty foods at the games.

• He is consuming excessive salty foods at the games. Explanation: Excessive table salt and salty foods (e.g., ham, packaged sandwich meats, potato chips, dill pickles, most canned soups) may aggravate edema or hypertension.

A 91-year-old client, who is being prepared for discharge, has been prescribed the diuretic spironolactone. While teaching the client about the drug, what major adverse effect should the nurse be sure to mention? • Hypokalemia • Hypertension • Hyperkalemia • Angina

• Hyperkalemia Explanation: The major adverse effect of potassium-sparing diuretics such as spironolactone is hyperkalemia. Clients receiving these drugs should not be given potassium supplements and should not be encouraged to eat foods high in potassium.

A client presents to the clinic for a 1-month follow-up appointment. The client tells the nurse he or she has been taking chlorothiazide for a month and now has leg cramps and "feels tired all the time." What will the nurse consider as the most likely cause of the client's symptoms? • Hypercalcemia • Hyperkalemia • Hypokalemia • Hypocalcemia

• Hypokalemia Explanation: 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 male client has been ordered spironolactone (Aldactone) for hypertension. Which statement by the client indicates a need for further education? • "I do not need to increase my potassium intake with this medication." • "I will weigh myself daily." • "I will take the medication when my blood pressure is elevated." • "I may experience breast enlargement."

• I will take the medication when my blood pressure is elevated." Explanation: Spironolactone (Aldactone) should be taken daily to decrease blood pressure, not only when blood pressure is elevated. Spironolactone (Aldactone) is a potassium-sparing diuretic; therefore, no additional potassium is needed. Adverse reactions include gynecomastia, headache, diarrhea, and cramping. It is important that the client weigh himself daily.

The nurse is preparing to hang an intermittent infusion of furosemide. To prevent accelerated degradation of furosemide, the nurse knows that the medication should be mixed in what IV solution? • D5W • D51/4 NS • Lactated Ringer's solution • D51/2 NS

• Lactated Ringer's solution Explanation: For continuous infusion, furosemide should be mixed with normal saline or lactated Ringer's solution, because D5W may accelerate degradation of furosemide.

A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered? • Amiloride • Bumetanide • Furosemide • Mannitol

• Mannitol Explanation: Mannitol is a powerful osmotic diuretic that is used to treat increased intracranial pressure. It is given intravenously and begins to work in 30 to 60 minutes. Furosemide, amiloride, and bumetanide are not indicated for the treatment of increased intracranial pressure.

A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered? • Bumetanide • Mannitol • Furosemide • Amiloride

• Mannitol Explanation: Mannitol is a powerful osmotic diuretic that is used to treat increased intracranial pressure. It is given intravenously and begins to work in 30 to 60 minutes. Furosemide, amiloride, and bumetanide are not indicated for the treatment of increased intracranial pressure.

The nurse is caring for a client who is experiencing elevated intracranial pressure following neurosurgery. The health care provider orders an osmotic diuretic to reduce pressure. Which medication would the nurse expect to be ordered? • Ethacrynic acid • Bumetanide • Mannitol • Spironolactone

• Mannitol Explanation: Mannitol is an osmotic diuretic used frequently in cases of increased ICP. Bumetanide and ethacrynic acid are loop diuretics, and spironolactone is a potassium-sparing diuretic.

A group of students are reviewing the structure and function of the renal system. The students demonstrate understanding when they identify what as the functional unit? • Bowman's capsule • Nephron • Convoluted tubule • Glomerulus

• Nephron Explanation: The nephron is the functional unit of the kidney that begins at Bowman's capsule and becomes the proximal and distal convoluted tubule.

A group of students are reviewing the structure and function of the renal system. The students demonstrate understanding when they identify what as the functional unit? • Nephron • Convoluted tubule • Bowman's capsule • Glomerulus

• Nephron Explanation: The nephron is the functional unit of the kidney that begins at Bowman's capsule and becomes the proximal and distal convoluted tubule.

The client has just been diagnosed with acute renal failure. The client asks the nurse what functional units of the kidneys are involved. What would the nurse reply? • Glomeruli • Renal pelves • Renal capsules • Nephrons

• Nephrons Explanation: The functional unit of the kidney is the nephron. There are about 2.4 million nephrons in an adult. These structures filter fluid and make urine. The glomerulus is a tuft of blood vessels with a capillary-like endothelium that allows easy passage of fluid and waste products. The renal pelves are in a region of the kidney that drains urine into the ureters. The renal capsule is a protective layer, which is made up of the fiber layer, a perirenal or brown fat layer, and the renal parietal layer.

The client has just been diagnosed with acute renal failure. The client asks the nurse what functional units of the kidneys are involved. What would the nurse reply? • Nephrons • Glomeruli • Renal pelves • Renal capsules

• Nephrons Explanation: The functional unit of the kidney is the nephron. There are about 2.4 million nephrons in an adult. These structures filter fluid and make urine. The glomerulus is a tuft of blood vessels with a capillary-like endothelium that allows easy passage of fluid and waste products. The renal pelves are in a region of the kidney that drains urine into the ureters. The renal capsule is a protective layer, which is made up of the fiber layer, a perirenal or brown fat layer, and the renal parietal layer.

The client has just been diagnosed with acute renal failure. The client asks the nurse what functional units of the kidneys are involved. What would the nurse reply? • Nephrons • Renal pelves • Glomeruli • Renal capsules

• Nephrons Explanation: The functional unit of the kidney is the nephron. There are about 2.4 million nephrons in an adult. These structures filter fluid and make urine. The glomerulus is a tuft of blood vessels with a capillary-like endothelium that allows easy passage of fluid and waste products. The renal pelves are in a region of the kidney that drains urine into the ureters. The renal capsule is a protective layer, which is made up of the fiber layer, a perirenal or brown fat layer, and the renal parietal layer.

A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route? • Subcutaneous • Intravenous • Oral • Intramuscular

• Oral Explanation: Hydrochlorothiazide is only available as an oral preparation. Only chlorothiazide can be given by intravenous infusion.

The emergency department (ED) nurse is caring for a client who is experiencing pulmonary edema. The client is treated with furosemide. What will the nurse monitor most closely? • Potassium levels • Calcium levels • Bone narrow function • Sodium levels

• Potassium levels Explanation: Furosemide is associated with loss of potassium, so that the client 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 emergency department (ED) nurse is caring for a client who is experiencing pulmonary edema. The client is treated with furosemide. What will the nurse monitor most closely? • Sodium levels • Potassium levels • Calcium levels • Bone narrow function

• Potassium levels Explanation: Furosemide is associated with loss of potassium, so that the client 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 emergency department (ED) nurse is caring for a client who is experiencing pulmonary edema. The client is treated with furosemide. What will the nurse monitor most closely? • Potassium levels • Sodium levels • Calcium levels • Bone narrow function

• Potassium levels Explanation: Furosemide is associated with loss of potassium, so that the client 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 emergency department (ED) nurse is caring for a client who is experiencing pulmonary edema. The client is treated with furosemide. What will the nurse monitor most closely? • Sodium levels • Bone narrow function • Potassium levels • Calcium levels

• Potassium levels Explanation: Furosemide is associated with loss of potassium, so that the client 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.

A client with hypertension has been prescribed spironolactone. The client's previous diuretic, furosemide, has been discontinued. The nurse should explain what benefit of this change? • Potassium losses are lower with spironolactone than with furosemide. • The diuretic effect is greater with spironolactone than with furosemide. • Unlike furosemide, spironolactone can be taken on an outpatient basis. • Sodium losses are greater with spironolactone.

• Potassium losses are lower with spironolactone than with furosemide. Explanation: Spironolactone is a potassium-sparing diuretic; therefore, it promotes retention of potassium. Furosemide promotes greater water, sodium, and potassium losses than spironolactone. Both medications can be safely taken on an outpatient basis with adequate follow-up

A male client has cirrhosis and is receiving diuretic therapy. The nurse knows that what drug will help prevent metabolic alkalosis or hypokalemia in this client? • Bumetanide • Dyazide • Hydrochlorothiazide • Spironolactone

• Spironolactone Explanation: For clients with cirrhosis, diuretic therapy should be initiated in a hospital setting, with small doses and careful monitoring. To prevent hypokalemia and metabolic alkalosis, supplemental potassium or spironolactone may be needed.

A male client has cirrhosis and is receiving diuretic therapy. The nurse knows that what drug will help prevent metabolic alkalosis or hypokalemia in this client? • Bumetanide • Hydrochlorothiazide • Spironolactone • Dyazide

• Spironolactone Explanation: For clients with cirrhosis, diuretic therapy should be initiated in a hospital setting, with small doses and careful monitoring. To prevent hypokalemia and metabolic alkalosis, supplemental potassium or spironolactone may be needed.

A client began taking hydrochlorothiazide 1 week ago and is reporting occasional dizziness when she stands up quickly from sitting or lying. What is the nurse's best action? • Arrange for the client's potassium levels to be assessed as soon as possible. • Tell the client to withhold the next scheduled dose until she can be assessed by the provider. • Educate the client about the need for bed rest until her body adjusts to the new medication. • Teach the client about the blood pressure effects of the medication and relevant safety measures.

• Teach the client about the blood pressure effects of the medication and relevant safety measures. Explanation: Mild dizziness upon rapid position changes is expected as a result of lowered blood pressure. The nurse should teach the client about this phenomenon and associated falls prevention. This is more likely a result of hypotension than changes in potassium levels. Bed rest would not be necessary and causes many other potential health problems. The nurse should not tell the client to withhold the medication since there is no evidence of severe adverse effects or an emergency.

A client began taking hydrochlorothiazide 1 week ago and is reporting occasional dizziness when she stands up quickly from sitting or lying. What is the nurse's best action? • Teach the client about the blood pressure effects of the medication and relevant safety measures. • Educate the client about the need for bed rest until her body adjusts to the new medication. • Tell the client to withhold the next scheduled dose until she can be assessed by the provider. • Arrange for the client's potassium levels to be assessed as soon as possible.

• Teach the client about the blood pressure effects of the medication and relevant safety measures. Explanation: Mild dizziness upon rapid position changes is expected as a result of lowered blood pressure. The nurse should teach the client about this phenomenon and associated falls prevention. This is more likely a result of hypotension than changes in potassium levels. Bed rest would not be necessary and causes many other potential health problems. The nurse should not tell the client to withhold the medication since there is no evidence of severe adverse effects or an emergency.

A client has sought care because of a gradual onset of oliguria. After diagnostic testing, the client has been diagnosed with early-stage renal failure. The nurse should identify what implication of this client's diagnosis? • The client should be monitored closely for signs and symptoms of hypokalemia. • Early intervention will allow the client to begin regenerating nephrons. • The client has likely lost around three-quarters of his or her nephrons. • The client's renal function has dropped by at least 10%.

• The client has likely lost around three-quarters of his or her nephrons. Explanation: Only 25% of the total number of nephrons is necessary to maintain healthy renal function, so most clients must have experienced nephron loss of at least 75% to have signs and symptoms of kidney failure. Nephrons cannot regenerate. Renal failure typically causes hyperkalemia, not hypokalemia.

What best describes the structure of the kidneys? • The renal pelvises drain urine into the ureters. • The renal arteries arise from the renal cortex. • The glomerulus produces erythropoietin. • The cortical nephrons concentrate urine

• The renal pelvises drain urine into the ureters. Explanation: The renal pelvises drain the urine into the ureters. All nephrons filter and make urine, but only the medullary nephrons can concentrate or dilute urine. The renal arteries come directly off the aorta. Erythropoietin is produced by a small group of cells called the juxtaglomerular apparatus.

The health care provider indicates that a client experiencing renal failure is not a candidate for therapy with potassium-sparing diuretics. How will the nurse respond when the client's family member asks why this is the case? • They may cause hyperkalemia. • They promote excretion of potassium. • They may cause rebound edema. •They are the strongest form of diuretics.

• They may cause hyperkalemia. Explanation: Potassium-sparing diuretics accumulate in renal insufficiency and present the risk for hyperkalemia. For this reason, health care practitioners typically avoid the drug in this population. Potassium-sparing diuretics decrease potassium excretion, and, by themselves, they are weak diuretics. Rebound edema may be a concern when a diuretic is discontinued, but it is not the reason this client is a poor candidate for a potassium-sparing diuretic.

The health care provider indicates that a client experiencing renal failure is not a candidate for therapy with potassium-sparing diuretics. How will the nurse respond when the client's family member asks why this is the case? • They promote excretion of potassium. • They may cause hyperkalemia. • They may cause rebound edema. • They are the strongest form of diuretics.

• They may cause hyperkalemia. Explanation: Potassium-sparing diuretics accumulate in renal insufficiency and present the risk for hyperkalemia. For this reason, health care practitioners typically avoid the drug in this population. Potassium-sparing diuretics decrease potassium excretion, and, by themselves, they are weak diuretics. Rebound edema may be a concern when a diuretic is discontinued, but it is not the reason this client is a poor candidate for a potassium-sparing diuretic.

The nurse is providing discharge instructions to a 72-year-old client who has been discharged home on a diuretic. What should the nurse include when providing discharge instructions regarding the use of a diuretic at home? • Decrease exercise to conserve energy • To weigh themselves on the same scale, at the same time of day, in the same clothing • Measuring intake and output of urine • Restrict fluids to 500 mL/day to limit the need to urinate

• To weigh themselves on the same scale, at the same time of day, in the same clothing Explanation: Clients 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 decrease activity. Restricting fluids can lead to a rebound fluid retention when compensatory mechanisms are activated. For most clients, it is unnecessary to monitor intake and output.

A physician has prescribed triamterene to a client with renal disease. The client informs the nurse that they are taking potassium supplements to address some heart problems. The nurse would be alert for which of the following? • decreased diuretic effectiveness. • increased risk of arrhythmias. • increased risk of hyperkalemia. • increased risk of bleeding.

• increased risk of hyperkalemia. Explanation: The nurse should inform the client about the increased risk of hyperkalemia as the effect of the interaction between triamterene, which is a potassium-sparing diuretic, and potassium supplements. When the client is administered loop diuretics with anticoagulants or thrombolytics, there will be increased risk of bleeding. When the client is administered digitalis with loop diuretics, there is an increased risk of arrhythmias. Decreased diuretic effect, in this case decreased effect of triamterene, will occur when a potassium-sparing diuretic such as triamterene is administered with NSAIDs, salicylates, and anticoagulants.

The students are studying the male reproductive system. The instructor tells the students that in the male, the urethra leaves the urinary bladder and passes through the: • renal calyx. • prostate gland. • renal cortex. • vas deferens.

• prostate gland. Explanation: In the male, the urethra leaves the urinary bladder and passes through the prostate gland. The renal calyx and cortex are located in the kidney and the urethra does not pass through the kidney. The vas deferens delivers the sperm from the testicles to the urethra.

The students are studying the male reproductive system. The instructor tells the students that in the male, the urethra leaves the urinary bladder and passes through the: • renal calyx. • vas deferens. • prostate gland. • renal cortex.

• prostate gland. Explanation: In the male, the urethra leaves the urinary bladder and passes through the prostate gland. The renal calyx and cortex are located in the kidney and the urethra does not pass through the kidney. The vas deferens delivers the sperm from the testicles to the urethra.

The students are studying the male reproductive system. The instructor tells the students that in the male, the urethra leaves the urinary bladder and passes through the: • renal cortex. • prostate gland. • renal calyx. • vas deferens

• prostate gland. Explanation: In the male, the urethra leaves the urinary bladder and passes through the prostate gland. The renal calyx and cortex are located in the kidney and the urethra does not pass through the kidney. The vas deferens delivers the sperm from the testicles to the urethra.

The nurse is caring for a client whose potassium level is 5.9 mmol/L (5.9 mg/dL). The client's kidneys will respond to this potassium level by: • inactivating aldosterone. • blocking the reabsorption of potassium in Bowman's capsules. • removing more potassium in the distal convoluted tubule. • increasing the excretion of hydrogen ions, causing increased potassium excretion.

• removing more potassium in the distal convoluted tubule. Explanation: The fine-tuning of potassium levels occurs in the distal convoluted tubule, where aldosterone activates the sodium-potassium exchange, leading to a loss of potassium. Inactivating aldosterone would further increase the client's potassium level. About 65% of the potassium that is filtered at the glomerulus is reabsorbed at Bowman's capsule and the proximal convoluted tubule, but this is not the site where potassium levels are adjusted. Hydrogen ions do not directly affect potassium levels.

A client began taking hydrochlorothiazide 1 week ago and is reporting occasional dizziness when she stands up quickly from sitting or lying. What is the nurse's best action? •Teach the client about the blood pressure effects of the medication and relevant safety measures. •Tell the client to withhold the next scheduled dose until she can be assessed by the provider. • Educate the client about the need for bed rest until her body adjusts to the new medication. • Arrange for the client's potassium levels to be assessed as soon as possible. .

•Teach the client about the blood pressure effects of the medication and relevant safety measures Explanation: Mild dizziness upon rapid position changes is expected as a result of lowered blood pressure. The nurse should teach the client about this phenomenon and associated falls prevention. This is more likely a result of hypotension than changes in potassium levels. Bed rest would not be necessary and causes many other potential health problems. The nurse should not tell the client to withhold the medication since there is no evidence of severe adverse effects or an emergency.