Ch 38 Evolve

Which patient would the nurse need to assess first if the patient is receiving mannitol (Osmitrol)? A 67-year-old patient with type 1 diabetes mellitus A 21-year-old patient with a head injury A 47-year-old patient with anuria A 55-year-old patient receiving cisplatin to treat ovarian cancer

A 47-year-old patient with anuria Mannitol (Osmitrol) is not metabolized but excreted unchanged by the kidneys. Potential water intoxication could occur if mannitol is given to a patient with anuria. Mannitol is safe to use with diabetic patients and those with head injuries, and it may function as a nephroprotectant when cisplatin is being used.

A nurse is caring for a patient receiving acetazolamide (Diamox). Which assessment finding will require immediate nursing intervention? A decrease in bicarbonate level An increase in urinary output A decrease in arterial pH An increase in PaO2

A decrease in arterial pH Acetazolamide (Diamox) causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat metabolic alkalosis, edema, seizures, and acute glaucoma. A decrease in blood pH would indicate that the patient was becoming more acidotic.

A patient is ordered furosemide (Lasix) to be given via intravenous push. Which interventions will the nurse perform? (Select all that apply.) Administer at a rate no faster than 20 mg/min. Assess lung sounds before and after administration. Assess blood pressure before and after administration. Maintain accurate intake and output record. Monitor ECG continuously. Insert an arterial line for continuous blood pressure monitoring.

Administer at a rate no faster than 20 mg/min. Assess lung sounds before and after administration. Assess blood pressure before and after administration. Maintain accurate intake and output record.

Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide? Sodium level of 140 mEq/L Fasting blood glucose level of 140 mg/dL Calcium level of 9 mg/dL Chloride level of 100 mEq/L

Fasting blood glucose level of 140 mg/dL Correct

What is the best information for the nurse to provide to the patient who is receiving spironolactone (Aldactone) and furosemide (Lasix) therapy? "Moderate doses of two different diuretics are more effective than a large dose of one." "This combination promotes diuresis but decreases the risk of hypokalemia." "This combination prevents dehydration and hypovolemia." "Using two drugs increases the osmolality of plasma and the glomerular filtration rate."

"This combination promotes diuresis but decreases the risk of hypokalemia." Spironolactone is a potassium-sparing diuretic; furosemide causes potassium loss. Giving these together minimizes electrolyte imbalance. It is not accurate to state that the drug combination prevents dehydration and hypovolemia or that it increases the osmolality of plasma and the glomerular filtration rate. Stating that giving two different diuretics is more effective is not specific enough information for the patient.

A patient is prescribed chlorthalidone (Thalitone). What is the most important information the nurse will teach the patient? "Do not drink more than 10 ounces of fluid a day while on this medication." "Take this medication on an empty stomach." "Take this medication before bed each night." "Wear protective clothing and sunscreen while taking this medication."

"Wear protective clothing and sunscreen while taking this medication." Adverse effects associated with chlorthalidone include photosensitivity. The nurse should teach the patient to protect himself when out in the sun. There is no evidence that fluid should be restricted while taking the medication, that it should be taken on an empty stomach, or that it should only be taken at bedtime.

The nurse is assessing a patient who is taking furosemide (Lasix). The patient's potassium level is 3.4 mEq/L; chloride is 90 mmol/L, and sodium is 140 mEq/L. Based on the nurse's understanding of the laboratory results, what prescribed therapy can the nurse anticipate administering? Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly. Administer sodium polystyrene sulfonate. Administer 2 mEq potassium chloride per kilogram per day IV. Administer calcium acetate, two tablets three times per day.

Administer 2 mEq potassium chloride per kilogram per day IV. Furosemide is a potent loop diuretic, resulting in the loss of potassium as well as water, sodium, and chloride. The patient needs chloride replacement. Normal potassium level is 3.5 to 5.2 mEq/L; normal sodium level is 135 to 147 mEq/L, and normal chloride level is 95 to 107 mEq/L. Potassium is never given by rapid infusion.

What intervention will the nurse perform when monitoring a patient receiving triamterene (Dyrenium)? Assess urinary output every other day. Monitor for side effect of hypoglycemia. Assess potassium levels. Monitor for hypernatremia.

Assess potassium levels. Triamterene (Dyrenium) is a potassium-sparing diuretic. The nurse should monitor potassium for potential hyperkalemia.

A patient taking spironolactone (Aldactone) has been taught about the medication. Which menu selection indicates that the patient understands teaching related to this medication? Potatoes Lima beans Chicken Strawberries

Chicken Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Chicken is the only appropriate choice of the foods listed because it is lower in potassium. Potatoes, lima beans, and strawberries are all known to contain high levels of potassium.

Which assessment indicates to the nurse a therapeutic effect of mannitol (Osmitrol) has been achieved? Decreased intracranial pressure Decreased potassium Increased urine osmolality Decreased serum osmolality

Decreased intracranial pressure Correct Mannitol (Osmitrol) is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This will decrease intracranial pressure, increase excretion of medications, decrease urine osmolality, and increase serum osmolality.

A patient with acute pulmonary edema is receiving furosemide (Lasix). What assessment finding indicates to the nurse that the intervention is working? Potassium level decreased from 4.5 to 3.5 mEq/L Improvement in mental status Lungs clear Output 30 mL/hr

Lungs clear Furosemide (Lasix) is a potent, rapid-acting diuretic that would be the drug of choice to treat acute pulmonary edema. Furosemide should not cause a drastic change in output or decrease in potassium level, and there is no evidence that it will create any change in mental status.