Pharm Unit 2

The amount of fluid excreted as urine each day averages approximately less than how many liters?

Approximately 1% of the filtrate or less than 2 L of fluid is excreted each day in the form of urine.

The nurse is preparing to administer a diuretic to a client. The nurse should question this order if which disorder(s) is noted in the client's history? Select all that apply.

Diuretics are contraindicated in clients with known hypersensitivity to the drugs, electrolyte imbalance (hyponatremia and hypokalemia), severe kidney or liver dysfunction, and anuria. Diuretics are often used in the treatment of hypertension. Some thiazide diuretics contain tartrazine, which can cause an allergic-type reaction or bronchial asthma in individuals who have a hypersensitivity to tartrazine.

The nurse reviews the laboratory results of a client taking digoxin. What finding creates a risk for digoxin toxicity?

Electrolyte abnormalities such as hypokalemia could alter the action potential and change the effects of digoxin. Hypernatremia does not have this effect. Alterations in hemoglobin and chloride levels do not have this effect.

To which client should the nurse anticipate administering mannitol?

Mannitol is a drug of choice to treat increased ICP. Other diuretics are preferred in the treatment of hypertensive crisis, edema, or ascites.

A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered?

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.

In a discussion of heart failure, the nursing instructor is explaining preload and afterload. Which of the following statements regarding preload and afterload is accurate?

Preload is the filling pressure of the ventricle. Afterload is the pressure associated with the ejection of blood from the ventricle.

Sodium ions are actively reabsorbed in which location?

Sodium is filtered through the glomerulus and enters the renal tubule, where it is actively reabsorbed in the proximal convoluted tubule to the peritubular capillaries.

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?

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?

A 35-year-old female has been recently diagnosed with hyperthyroidism. Her health care provider has prescribed propranolol (Inderal) for what effect?

Beta blockers are used to decrease heart rate, decrease cardiac output, and decrease tremors in hyperthyroidism. They are not used to promote bronchodilation, prevent respiratory depression, or to decrease systolic blood pressure.

The nurse is providing education to a 72-year-old client who has been discharged home on a diuretic. What should the nurse include in the discharge instructions?

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 rebound fluid retention when compensatory mechanisms are activated. For most clients, it is unnecessary to monitor intake and output.

A male client has cirrhosis of the liver that has caused ascites. The nurse knows that what condition may occur if diuretics are used to reduce the ascites?

Diuretics are often used to manage edema and ascites in clients with hepatic impairment. These drugs must be used with caution, because diuretic-induced fluid and electrolyte imbalances may precipitate or worsen hepatic encephalopathy and coma.

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 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.

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?

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 with heart failure has developed acute shortness of breath and pulmonary edema. The nurse will prepare for administration of what medication and via what route?

Furosemide is the drug of choice when significant, rapid diuresis is required, such as in cases of pulmonary edema. IV administration achieves the most rapid effect. PO combination medications are used for ongoing therapy rather than immediate intervention. Osmotic diuretics such as mannitol do not achieve sufficient diuresis in cases of pulmonary edema.

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:

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.

"Water follows salt" is a maxim that can guide many aspects of nursing practice. To what mechanism within the pathophysiology of edema does this principle apply?

Increased capillary hydrostatic pressure results from sodium retention. This is the primary mechanism for edema formation in heart failure, pulmonary edema, and renal failure.

When explaining the underlying mechanisms associated with renal failure, which would be most important for the nurse to keep in mind?

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 male client is diagnosed with heart failure. The health care provider orders a loading dose of digoxin. Loading doses are necessary for what reason?

Loading or digitalizing doses are necessary for initiating therapy, because digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading. Loading doses should be used cautiously in clients who have taken digoxin within the previous 2 or 3 weeks.

The nurse is caring for a 68-year-old female client with type 1 diabetes mellitus whose health care provider has ordered hydrochlorothiazide. As a consequence of taking the diuretic, the client may need to:

One adverse effect of potassium-losing diuretics, such as the thiazides, is hyperglycemia. Clients with diabetes mellitus may require larger doses of hypoglycemic agents (e.g., insulin) while taking these diuretics to control blood sugar levels. Decreasing potassium intake is inappropriate for clients taking thiazides because it increases the risk of hypokalemia. Increasing sodium intake would lessen the effectiveness of the diuretic.

A nurse would administer phentolamine cautiously to a client with which condition?

Phentolamine is an alpha-adrenergic blocker that should be used cautiously in clients who are pregnant or lactating, had a recent MI, or have renal failure or Raynaud disease. Beta-blockers and alpha/beta-adrenergic blockers are used cautiously in clients with diabetes. Clients with hepatic failure should be administered alpha/beta adrenergic blocking agents and centrally acting antiadrenergic agents cautiously. Elderly individuals with peripheral artery disease should receive beta-adrenergic blocking agents cautiously.

A client with renal impairment is in need of a diuretic. Because of the renal problem, potassium-sparing diuretics are contraindicated but may be used if there is no other option. If they are used at all, what nursing intervention would be most important for this client?

Potassium-sparing diuretics are contraindicated in clients with renal impairment because of the high risk of hyperkalemia. If they are used at all, frequent monitoring of serum electrolytes, creatinine, and BUN is needed.

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 best respond to this suggestion?

Renal disease and severe renal impairment contraindicate the use of hydrochlorothiazide. HCTZ affects the kidneys, not the bladder, and is not administered intravenously.

The nurse is caring for a client with hyperaldosteronism. For which diuretic would the nurse prepare teaching for the client?

Spironolactone, the most frequently prescribed potassium-sparing diuretic, is the drug of choice for treating hyperaldosteronism, a condition seen in cirrhosis of the liver and nephrotic syndrome of excessive output of aldosterone from the adrenal gland, leading to increased sodium and water retention and loss of potassium. Neither amiloride, eplerenone, nor triamterene are identified as being the drug of choice to treat hyperaldosteronism.

After administering an intravenous (IV) dose of digoxin to a client, the nurse would expect to see effects within what period of time?

The drug has a rapid onset of action and rapid absorption (30 to 120 minutes when taken orally, 5 to 30 minutes when given IV).

A client with kidney disease asks why there is blood in the urine. Which process will the nurse explain to the client?

The glomerulus acts as an ultrafine filter for all of the blood that flows into it. The semipermeable membrane keeps blood cells, proteins, and lipids inside the vessel, while hydrostatic pressure from the blood pushes water and smaller components of the plasma into the tubule. Scarring or swelling of or damage to the semipermeable membrane leads to the escape of larger plasma components, such as blood cells, into the filtrate. The large size of these components prevents them from being reabsorbed by the tubule, and they are lost in the urine. Thus, a clinical sign of renal damage is the presence of blood cells or protein in the urine. Blood in the urine does not indicate a malfunction in the fluid transport system in the kidney. The epithelial cells in the renal tubule remove electrolytes, drugs and drug metabolites, and uric acid and secrete them into the filtrate. Hormones from the glands that sit on the kidneys do not promote blood to be in the urine.

Which substances are moved from the glomerulus into the tubule due to hydrostatic pressure?

The glomerulus acts as an ultrafine filter for all of the blood that flows into it. The semipermeable membrane keeps lipids, proteins, and blood cells inside the vessel, whereas the hydrostatic pressure from the blood pushes water and smaller components of the plasma into the tubule.

A patient is being digitalized for atrial fibrillation. The first dose has been administered. How frequently should the nurse administer digoxin?

The nurse should administer digoxin every six to eight hours. After the administration of the first dose, the additional doses are given every six to eight hours.

The nurse is preparing to teach a client with renal insufficiency about the recently prescribed bumetanide for hypertension. Which instruction should the nurse prioritize for this client?

The nurse should instruct the client to avoid medications that increase blood pressure, such as OTC drugs for appetite suppression and cold symptoms. The nurse should instruct clients taking potassium-sparing diuretics, not loop diuretics such as bumetanide, to refrain from using salt substitutes containing potassium. The nurse need not instruct the client to take the drug before meals since doing so will not decrease the client's blood pressure. The nurse should instruct the client to observe caution while driving or performing hazardous tasks when dizziness or weakness occurs. In such cases, the nurse instructs the client to rise slowly from a sitting or lying position and avoid standing in one place for an extended time.

An elderly client is prescribed metoprolol. Which assessment finding should the nurse prioritize?

The nurse should observe elderly clients taking metoprolol for confusion, heart failure, worsening angina, shortness of breath, and peripheral vascular insufficiency. Hyperglycemia is a general adverse reaction which can occur at any age and not just the elderly.

What best describes the structure of the kidneys?

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.

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?

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.

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?

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.