Medication Quiz Unit 4 Renal

furosemide (Lasix):

loop diuretic (NCLEX: pinch IV line injection port above and inject slowly over 1-2 minutes) Monitor BP, change positions slowly. *Increase potassium intake* *(tomatoes, bananas, and raisins)* monitor electrolytes.

Bethanechol chloride is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this medication?

urinary strictures. Rationale: Bethanechol chloride can be hazardous to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could damage or rupture the bladder in clients with these conditions.

bethanechol chloride (Urecholine) classification/action:

classification: urinary tract stimulant/cholinergic action: Bladder emptying. Contraction of the urinary bladder.

Nitrofurantoin (Macrodantin) routes of administration:

routes of administration: PO: (Adults) Treatment of active infection-50-100 mg q 6-8 hr or 100 mg q 12 hr as extended-release product. *50mg q 6hr (NCLEX)*

The nurse is preparing a subcutaneous dose of bethanechol prescribed for a client with urinary retention. Before giving the dose, the nurse checks to see that which medication is available on the emergency cart for use if needed?

Atropine sulfate Rationale: Bethanechol is a cholinergic medication. Administration of bethanechol could result in cholinergic overdose. The antidote is atropine (an anticholinergic), which should be readily available for use if overdose occurs. Mucomyst is the antidote for acetaminophen overdose. Protamine sulfate is the antidote for heparin. Vitamin K is the antidote for warfarin.

phenazopyridine (Pyridium) assessment/patient education:

assessment: *Assess patient for urgency, frequency, and pain on urination prior to and throughout therapy. *monitor renal function; LABS: interferes with urine tests based on color reactions (glucose, ketones, bilirubin, steroids, protein). patient education: take as directed. medication is STOPPED once pain or discomfort is relieved, but continue to take antibiotics. *REDDISH-ORANGE discoloration of the urine may stain clothing or bedding* Sanitary nakin may be worn to avoid clothing stains. May also *stain CONTACT LENSES*. Notify HCP if rash, skin discoloration or unusual tenderness occur.

sodium polystyrene sulfonate (Kayexalate) assessment/education:

assessment: *MONITOR ELECTROLYTES* monitor the response of symptoms of hyperkalemia. Monitor I's & O's, and daily weight. Assess for symptoms of *fluid overload. Low sodium diet may be ordered.* If patient is taking digoxin, assess for digoxin toxicity. Assess abdomen, and frequency of stools. education: avoid taking *antacids, or laxatives* during this therapy, unless approved by HCP. It's important to have frequent lab tests to monitor effectiveness of medication.

bethanechol chloride (Urecholine) assessment/patient education:

assessment: *assess for history of asthma; don't give if patient has asthma* monitor vitals before administering and *at least 1 hour after giving subcutaneously.* Monitory I's & O's, *palpate abdomen for bladder distention*. Monitor serum AST, amylase, and lipase concentrations. *give 2hrs after meals* *watch for bradycardia, this can mean the patient is having a cholinergic overdose.* patient education: take as directed, and take missed doses ass soon as possible within 2 hours. *change positions slowly to minimize orthostatic hypotension. *report abdominal discomfort, salivation, sweating, or flushing to HCP.*

trimethoprim/sulfamethoxazole (Bactrim) assessment/patient education:

assessment: assess for infection, obtain specimens for culture and sensitivity, inspect IV site frequently, phlebitis is COMMON, ass for allergy to SULFONAMIDES, monitory I's & O's, maintain a urine output of at least 1200-1500mL daily to prevent crystalluria. Assess for CDIFF, monitor *CBC, and UA, increases potassium, and creatinine, and may cause hypoglycemia.* patient education: *drink 8-10 glasses of water a day* *take each dose with 8oz of water,* report *SORE THROAT* take med around the clock, complete drug as directed. Sharing this med is DANGEROUS. notify HCP if rash occurs. *use sunscreen and protective clothing, to prevent photosensitivity. Notify HCP if rash, SORE THROAT, fever, mouth sores or unusual bleeding occurs*

finasteride (Proscar): assessment/education:

assessment: assess for symptoms of prostatic hyperplasia before and during therapy. digital rectal exams periodically before and during therapy for Benign Prostatic Hyperplasia (BPH). education: take as directed even if feeling better. At least 6-12mo is necessary. There's an increased risk for high grade prostate cancer. *This med poses a risk to male fetus* notify HCP if there's changes in the breast. *The volume of ejaculate may be decreased and erectile dysfunction and decreased libido may occur during and after therapy is complete.*

oxybutynin chloride (Ditropan) assessment/patient education

assessment: monitor voiding patter, and I's & O's. *Assess abdomen for bladder distention* catherterization may be used to assess post-void residual. Geri: assess patients for anticholinergic effects (sedation/weakness) patient education: take as directed, may cause drowsiness, or blurred vision. avoid alcohol, *may cause dry mouth so oral hygiene, sugarless gum or candy, and rinsing of the mouth can decrease dry mouth* if anaphylaxis, or angioedema occur stop med and notify HCP. notify hcp if urinary retention or constipation persist. desired outcome: relief of bladder spasm

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?

bradycardia (cholinergic overdose) 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.

sodium polystyrene sulfonate (Kayexalate) classification/action:

classification: hypokalemicelectrolyte modifiers action: lower potassium levels, excretes it through poop. *Reduction of serum potassium levels.*

The nurse is providing teaching for a client prescribed *ciprofloxacin* for a urinary tract infection. Which statement made by the client indicates that there is a need for further teaching?

"If I develop any tendon pain while taking ciprofloxacin, exercise should help to decrease the pain." Rationale: The health care provider should be contacted immediately if the client develops any tendon pain, swelling, or inflammation because of the risk of tendon rupture. Exercise is contraindicated until tendon rupture is ruled out. Fluorquinolones such as ciprofloxacin need to be discontinued at the first sign of any tendon pain, swelling, or inflammation. Ciprofloxacin can be taken with or without food, can cause photosensitivity, and can increase the risk for oral Candida infections.

Ciprofloxacin (Cipro) adverse reaction side effects & interactions.

-adverse reaction/side effects: *diarrhea, nausea, cdiff associated diarrhea (CDAD), seizures, suicidal thoughts, intracranial pressure, hepatotoxicity.* -interactions: tizanidine, *theophylline*, phenytoin, warfarin.

Ciprofloxacin (Cipro) classification/action:

-classification: anti-infective -action: inhibits *bacterial* DNA synthesis by inhibiting DNA gyrase enzyme.

A client is prescribed trimethoprim-sulfamethoxazole for a recurrent urinary tract infection (UTI). The nurse should give the client which instruction regarding this medication?

Take each dose with 8 oz (235 mL) of water, and drink extra water each day. Rationale: Trimethoprim-sulfamethoxazole is a combination medication. The client takes each dose with 8 oz (235 mL) of water and drinks several extra glasses of water each day. The client should space doses evenly around the clock for stable blood levels and should take the medication for the full course of therapy. The client should report rashes or other skin changes, which could indicate an allergy to sulfa.

Nitrofurantoin is prescribed for a client with a urinary tract infection. The client contacts the nurse and reports a cough, chills, fever, and difficulty breathing. The nurse should make which interpretation about the client's complaints?

The client is experiencing a pulmonary reaction requiring cessation of the medication.

spironolactone (Aldactone) adverse side effects/interactions:

adverse side effects: *HYPERKALEMIA*, drug rash with eosinophilia, and systemic symptoms (DRESS), Stevens Johnson syndrome, epidermal necrolysis. interactions: eplerenone, decreased lithium excretion, NSAIDS, potassium supplements, potassium sparing diuretics. Cholestyramine.

NItrofurantoin (Macrodantin) Assessment/patient education:

assessment: *assess lung sounds*, monitor I's & O's, obtain specimen culture for sensitivity, assess for UTI, monitor for CDIFF, *assess for s/s of pulmonary reactions*, Monitor CBC routinely, Monitor liver function tests, May cause ↑ serum glucose, bilirubin, alkaline phosphatase, BUN, and creatinine. If hepatotoxicity occurs, discontinue therapy. Monitor renal function periodically during therapy. patient education: *take WITH MEALS, expect BROWN urine.* take medication around the clock, as directed. Take missed doses as soon as remembered and space next dose 2-4 hr apart. *Medication may cause a rust-yellow to brown discoloration of urine, which is not significant.* notify HCP if fever and diarrhea develop, especially if stool contains blood, pus, or mucus.

A client being admitted to the nursing unit has been taking bethanechol chloride at home. During the admission assessment, the nurse gives special attention to assessing the client for which side and adverse effect of this medication?

bradycardia Rationale: Bethanechol chloride is a direct-acting muscarinic agonist (cholinergic medication). It can cause hypotension secondary to vasodilation and bradycardia. It also can cause excessive salivation, increased secretion of gastric acid, abdominal cramps, and diarrhea. Higher doses can cause involuntary defecation.

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?

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.

trimethoprim/sulfamethoxazole (Bactrim) classification and action:

classification: anti-infective action: Combination *inhibits the metabolism of folic acid in bacteria at two different points.*

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?

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.

bethanechol chloride (Urecholine) route/dosage:

route dosage: SC: (Adults) 5 mg 3-4 times daily. Dose may be determined by administering 2.5 mg q 15-30 min until response is obtained or total of 4 doses administered.

tamsulosin (Flomax) route/dosage:

route/dosage: PO (Adults): 0.4mg once daily AFTER meal, may be increased after 2-4 wk to 0.8mg/day.

sodium polystyrene sulfonate (Kayexalate) route/dosage:

route/dosage: PO: (Adults) 15 g 1-4 times daily in water (up to 40 g 4 times daily). Rect: (Adults) 30-50 g as a retention enema; repeat as needed q 6 hr.

oxybutynin chloride (Ditropan) route/dosage:

route/dosage: Immediate-release tablets-5 mg 2-3 times daily (not to exceed 5 mg 4 times daily) (may start with 2.5 mg 2-3 times daily in elderly). Extended-release tablets-5-10 mg once daily; may ↑, as needed (in 5-mg increments) up to maximum dose of 30 mg/day.

phenazopyridine (Pyridium) route/dosage:

route/dosage: PO: (Adults) 200 mg 3 times daily for 2 days.

phenazopyridine (Pyridium) classification/action:

classification: nonopioid analgesic/ urinary tract analgesic action: used for burning urination (just to help with the pain)

Nitrofurantoin is prescribed for the client. The nurse checks the client's record, knowing that this medication is contraindicated in which disorder?

Renal disease Rationale: Nitrofurantoin is contraindicated in clients with renal impairment.

spironolactone (Aldactone) route/dosage

route dosage: PO: (Adults) 25-400 mg/day as a single dose or 2 divided doses. HF-25-50 mg/day.

finasteride (Proscar) route/dosage:

route/dosage: PO (Adults): 5mg once daily

Parenteral bethanechol chloride is prescribed for a client with urinary retention. The nurse should plan to administer this medication by which route?

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.

Oral bethanechol chloride is prescribed for the client. The nurse should instruct the client to take this medication at which time?

two hours after meals Rationale: Administration of bethanechol chloride with food can cause nausea and vomiting. To avoid this problem, oral doses should be administered 1 hour before meals or 2 hours after meals.

A client with a urinary tract infection (UTI) is given a prescription for levofloxacin. The nurse should provide the client with which information about this medication?

"Pain in the back of the leg should be reported."

Ciprofloxacin (Cipro) assessment/pt education:

-*assessment*: assess for infection before, during and after therapy. Observe for s/s of *anaphylaxis*. Obtain specimen culture for sensitivity. Monitor bowel function. *Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of Clostridium difficile-associated diarrhea (CDAD).* -*patient education*: notify HCP if taking *theophylline*; maintain a fluid intake of at least *1500-2000 mL/day* to prevent *crystalluria.*; report signs of superinfection (*furry overgrowth on the tongue*, vaginal itching or discharge, loose or foul-smelling stools).; use *sunscreen and protective clothing to prevent phototoxicity reactions during and for 5 days after therapy*. *notify HCP if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting HCP. Instruct patient to notify HCP immediately of signs and symptoms of hepatotoxicity. *

Ciprofloxacin (Cipro) route/administration:

-route/administration: PO: (Adults) Complicated urinary tract infection or acute pyelonephritis-250-500 mg every 12 hr for 7-14 days. (NCLEX said to administer over 60min).

The nurse has a prescription to administer bethanechol chloride subcutaneously. Before giving this medication, the nurse checks to ensure that which condition is not noted in the client's history?

Asthma Rationale: Bethanechol chloride is a cholinergic medication that is used for urinary retention. This medication should not be used for clients with asthma because it can precipitate bronchoconstriction by activating muscarinic receptors. Other conditions this medication should not be used with include hypotension, bradycardia, gastric ulcers, intestinal obstruction, urinary tract obstruction, and hyperthyroidism.

Oxybutynin chloride is prescribed for a client with urge incontinence. Which sign would indicate a possible toxic effect related to this medication?

Restlessness Rationale: Toxicity (overdosage) of oxybutynin produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a frequent side effect of the medication but does not indicate overdosage.

tamsulosin (Flomax) classification/action:

classification: none assigned/peripherally acting antiadrenergics action: Decreases contractions in smooth muscle of the prostatic capsule by preferentially binding to alpha1-adrenergic receptors. *GIVEN FOR URINARY OBSTRUCTION*

spironolactone (Aldactone) classification/action:

classification: potassium SPARING diuretic. action: Causes loss of sodium bicarbonate and calcium while saving potassium and hydrogen ions by antagonizing aldosterone.

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?

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.

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?

oxybutynin Rationale: Bladder spasms after prostatectomy are treated with antispasmodic medications, such as oxybutynin. Opioid analgesics such as morphine sulfate, hydromorphone, and meperidine hydrochloride usually are not effective in treating pain caused by spasms.

trimethoprim/sulfamethoxazole (Bactrim) route/dosage:

route/dosage: administer over 60-90 minutes. (NCLEX) PO: (Adults) Urinary tract infection/chronic bronchitis-1 double strength tablet (160 mg TMP/800 mg SMX) q 12 hr for 10-14 days.

bethanechol chloride (Urecholine) adverse side effects/interactions

adverse side effects: heart block, syncope, abdominal discomfort, diarrhea, nausea, salivation, vomiting, urgency, flushing, sweating. *contraindicated in URINARY STRICTURES* interactions: quinidine, proainamide, *anticholinergics.*

sodium polystyrene sulfonate (Kayexalate) adverse side effects/interactions:

adverse side effects: interstinal necrosis, constipation, fecal impaction, hypokalemia, sodium retention. interactions: magnesium containing antacids, sorbitol, calcium.

Nitrofurantoin (Macrodantin) adverse side effects/interactions:

adverse side effects: HEPATOTOXICITY, CLOSTRIDIUM DIFFICILE-ASSOCIATED DIARRHEA (CDAD), anorexia, nausea, vomiting, *hypersensitivity reactions*, *PNEUMONITIS*. interactions: Probenecid contraindicated: *IN RENAL DISEASE*

finasteride (Proscar) adverse side effects/interactions:

adverse side effects: angioedema, breast cancer, prostate cancer. interactions: NONE NOTED

tamulosin (Flomax) assessment/education:

assessment: *assess for symptoms of BPH (urinary hesitancy, incomplete bladder emptying, dysuria) before and during therapy* assess for orthostatic hypotension, syncope. Monitor I's and O's and daily weight and assess for *edema daily*, *rectal exams prior to and throughout therapy to assess prostate size are recommended.* education: *take 30 minutes after meals*. take as directed, avoid driving, change positions slowly, follow up exams are VITAL .

trimethoprim/sulfamethoxazole (Bactrim) adverse side effects/interactions:

adverse side effects: nausea, vomiting, rash, IV site phlebitis, CDIFF, hepatic necrosis, erythema muliforme, stevens johnson syndrome, aplastic anemia. interactions: *phenytoin*, digoxin, warfarin, thiazide diuretics, ace inhibitors increase the risk of *HYPERKALEMIA.*

phenazopyridine (Pyridium) adverse side effects/interactions:

adverse side effects: bright orange urine, renal failure interactions: NONE

oxybutynin chloride (Ditropan) adverse side effects/interactions:

adverse side effects: dizziness, drowsiness, constipation, *dry mouth*, nausea, urinary retention, anaphylaxis, angioedema. (NCLEX: toxic effect = restlessness) interactions: antidepressants, antihistamines, ketoconazole.

tamsulosin (Flomax) adverse side effects/interactions:

adverse side effects: dizziness, headache, orthostatic hypotension interactions: cimetidine, doxazosin, prazosin, terazosin.

Nitrofurantoin (Macrodantin) classification/action:

classification: anti-infective action: interferes with bacterial enzymes.

finasteride (Proscar) classification/action:

classification: hair regrowth stimulants action: Decrease in urinary symptoms of benign prostatic hyperplasia.

*Trimethoprim-sulfamethoxazole* (Bactrim) is prescribed for a client. The nurse should instruct the client to report which symptom if it develops during the course of this medication therapy?

sore throat. Rationale: Clients taking trimethoprim-sulfamethoxazole should be informed about early signs and symptoms of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client should be instructed to notify the health care provider (HCP) if these occur. The other options do not require HCP notification.

Tamsulosin hydrochloride has been prescribed for a client with benign prostatic hypertrophy (BPH). How should the nurse instruct the client to take the medication?

thirty minutes after a meal Rationale: Tamsulosin hydrochloride is a medication that will relieve mild to moderate manifestations of BPH and improve urinary flow rates. The medication should be administered 30 minutes after meals because food decreases the peak plasma concentration and lengthens the time to achieve peak plasma medication concentrations. Therefore, options 1, 2, and 3 are incorrect.

*Nitrofurantoin* MACROBID is prescribed for a client with urinary tract infection. The nurse is instructing the client regarding the administration of the medication. Which information about the best time to take this medication should be included in the client's education?

with meals. Rationale: Nitrofurantoin is an antibacterial used to treat urinary tract infections. The nurse would instruct the client to take the medication with food to reduce any gastrointestinal upset that the medication can cause. Therefore, the best time to take the medication is with meals.

oxybutynin chloride (Ditropan) classifcation/action:

classification: urinary tract antispasmodics/antichlonergic action: used to treat overactive bladder

spironolactone (Aldactone) assessment/education:

assessment: *monitor I's & O's, and daily weight* periodic ECGs are recommended in patients receiving prolonged therapy. Assess patient for hyperkalemia (muscle weakness, fatigue, dyspnea, confusion, paresthesia). Assess for skin rash. Evaluate potassium levels, monitor BUN , creatinine, and electrolytes. education: notify HCP if rash occur, follow up exams are vital. Continue to take med as directed. *Avoid salt substitutes, and foods that contain high levels of potassium.*