Prep U:Chapter 34=Drug Therapy for Fluid Volume Excess

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. A 42-year-old male who has advanced arteriosclerosis B. A 71-year-old female who has advanced arteriosclerosis C. A 23-year-old male who has diabetes D. A 36-year-old female who has diabetes

B. A 71-year-old female who has advanced arteriosclerosis

Aldosterone levels would be affected if which gland was dysfunctional? A. Adrenal B. Pituitary C. Pancreas D. Thyroid

A. Adrenal

When describing the action of spironolactone, the nurse would explain that this drug acts by: A. Blocking aldosterone in the distal tubule B. Blocking the chloride pump C. Slowing the movement of hydrogen ions D. Blocking potassium secretion through the tubule

A. Blocking aldosterone in the distal tubule

A 75-year-old client is diagnosed with atrial fibrillation and chronic congestive heart failure. The health care provider orders a combination of digoxin and diuretics to treat the client's diseases. Recent laboratory results indicate that the client's potassium level is 2 mEq/L. This client is at risk for which problem? A. Digoxin toxicity B. Exacerbation of the atrial fibrillation C. Congestive heart failure D. Subtherapeutic levels of serum digoxin

A. Digoxin toxicity

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 A. Filtration B. Reabsorption C. Excretion D. Secretion

A. Filtration

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? A. Furosemide B. Spironolactone C. Hydrochlorothiazide D. Acetazolamide

A. Furosemide

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? A. He is consuming excessive salty foods at the games. B. He is anxious about his team. C. He has become a vegetarian until his team wins the championship. D. He is developing comorbidities.

A. He is consuming excessive salty foods at the games.

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? A. Hyperkalemia B. Hypertension C. Angina D> Hypokalemia

A. Hyperkalemia

When teaching a class about diuretics, a nursing instructor describes a class of drugs that increases the density of the filtrate in the glomerulus. Which medication would the instructor cite as an example? A. Mannitol B. Metolazone C. Triamterene D. Furosemide

A. Mannitol

A health care provider has prescribed triamterene to a male client with renal disease. The client informs the nurse that he is taking potassium supplements to address some heart problems. The nurse would be alert for: A. increased risk of hyperkalemia. B. increased risk of bleeding. C. increased risk of arrhythmias. D. decreased diuretic effectiveness.

A. increased risk of hyperkalemia.

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

B. Edema

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? A. Spironolactone B. Mannitol C. Bumetanide D. Ethacrynic acid

B. Mannitol

The nurse is teaching a client with orthostatic hypotension about the role of renin in maintaining blood pressure. What process should the nurse describe? A. "Renin is directly involved in the control of arterial blood pressure and the flow of blood through the pyramids of the kidney." B. "Renin is directly involved in the control of arterial blood pressure and it is essential for proper functioning of the glomerulus." C. "Renin is involved in venous blood pressure and controls the flow of blood through the tubules." D. "Renin is involved in venous blood pressure and it is essential for proper functioning of the glomerulus."

B. "Renin is directly involved in the control of arterial blood pressure and it is essential for proper functioning of the glomerulus."

The amount of fluid excreted as urine each day averages approximately less than how many liters? A. 1 L B. 2 L C. 3 L D. 4 L

B. 2 L

The kidneys receive approximately what percentage of the cardiac output? A. 15% B. 25% C. 40% D. 5%

B. 25%

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? A. Bicarbonate and urea B. Potassium and sodium C. Glucose and protein D. Creatinine and chloride

C. Glucose and protein

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? A. Decrease exercise to conserve energy B. To weigh themselves on the same scale, at the same time of day, in the same clothing C. Measuring intake and output of urine D. Restrict fluids to 500 mL/day to limit the need to urinate

B. To weigh themselves on the same scale, at the same time of day, in the same clothing

The nurse is conducting an admission assessment of a client who has been prescribed hydrochlorothiazide. The nurse should contact the provider because of the client's: A. allergy to codeine. B. allergy to sulfa drugs. C. recent BP of 160/96 mm Hg. D. recent blood glucose level of 140 mg/dL.

B. allergy to sulfa drugs.

An allergy to sulfonamides would contraindicate the use of what diuretic? Select all that apply. A. mannitol B. hydrochlorothiazide C. furosemide D. spironolactone E. chlorothiazide

B. hydrochlorothiazide C. furosemide E. chlorothiazide

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

C. "I need to make sure I don't eat too many high potassium foods."

Aldosterone levels would be affected if which gland was dysfunctional? A. Thyroid B. Pancreas C. Adrenal D. Pituitary

C. Adrenal

Where is the majority of potassium that is filtered at the glomerulus reabsorbed? A. Ascending loop of Henle B. Distal convoluted tubule C. Bowman's capsule D. Descending loop of Henle

C. Bowman's capsule

A 91-year-old client is being discharged on the diuretic spironolactone. What assessment finding would the nurse attribute to adverse effects of this medication? A. Blood pressure of 160/109 mm Hg B. Polyuria and polyphagia C. Confusion and irregular heart rate D. Diarrhea and positive stool for occult blood (FOB) test

C. Confusion and irregular heart rate

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? A. Hypokalemia B. Hypertension C. Hyperkalemia D. Angina

C. Hyperkalemia

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

C. Mannitol

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? A. Calcium levels B. Bone narrow function C. Potassium levels D. Sodium levels

C. Potassium levels

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? A. Sodium losses are greater with spironolactone. B. The diuretic effect is greater with spironolactone than with furosemide. C. Potassium losses are lower with spironolactone than with furosemide. D. Unlike furosemide, spironolactone can be taken on an outpatient basis.

C. Potassium losses are lower with spironolactone than with furosemide.

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

C. The renal pelvises drain urine into the ureters.

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: A. stable angina. B. hypertension. C. hypersensitivity to sulfonamides. D. obesity.

C. hypersensitivity to sulfonamides.

A health care provider has prescribed triamterene to a male client with renal disease. The client informs the nurse that he is taking potassium supplements to address some heart problems. The nurse would be alert for: A. decreased diuretic effectiveness. B. increased risk of arrhythmias. C. increased risk of hyperkalemia. D. increased risk of bleeding.

C. increased risk of hyperkalemia.

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? A. 1/10 B. ½ C. ¼ D. 1/5

C. ¼

A nurse is caring for a 78-year-old patient with renal insufficiency and chronic heart failure who is receiving rapid infusions of high-dose furosemide. It will be a priority for the nurse to monitor for: A. dehydration. B. hepatic encephalopathy. C. vascular thrombosis. D. ototoxicity.

D. ototoxicity.

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? A. 20 mg B. 50 mg C. 210 mg D. 105 mg

D. 105 mg

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? A. Most of the substances that are removed from urine are recycled. B. Electrolytes draw the water from urine back into circulation. C. Most urine is processed internally rather than excreted. D. A very large majority of filtrate is returned to circulation.

D. A very large majority of filtrate is returned to circulation.

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

D. Extensive kidney damage has usually occurred by the time the patient is symptomatic.

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? A. Spironolactone B. Ethacrynic acid C. Bumetanide D. Mannitol

D. Mannitol

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

D. Oral

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: A. hypertension. B. obesity. C. stable angina. D. hypersensitivity to sulfonamides.

D. hypersensitivity to sulfonamides.

Why would potassium-sparing diuretics be contraindicated for clients experiencing renal failure?

They may cause hyperkalemia.