chapter 24

The nurse is managing care for a group of patients on a renal failure unit. What does the nurse recognize as the most important patient safety precaution with regard to medication administration? 1. Know that patients will require less-than-average doses of medications. 2. Know which drugs will increase fluid retention. 3. Ensure that each patient's intake and output is measured precisely. 4. Be aware of what drugs are nephrotoxic.

Correct Answer: 1 Rationale 1: Administering the "average" dose of medication to a patient in severe renal failure can have mortal consequences. The consequences of recognizing that renal patients will require less-than-average doses of medications cannot be overemphasized. Rationale 2: Knowing which drugs will increase fluid retention is important but not as important as recognizing another precaution. Rationale 3: Ensuring that each patient's intake and output is measured precisely is important but not as important as another precaution. Rationale 4: Recognizing which drugs are nephrotoxic is important but not as important as another precaution.

The elderly patient is receiving chlorothiazide (Diuril). What does the best teaching by the nurse include with this medication? 1. "Take the medication early in the morning." 2. "Avoid foods that are high in potassium." 3. "It is alright to have a glass of wine with this medication." 4. "Take the medication on an empty stomach."

Correct Answer: 1 Rationale 1: Elderly patients should take diuretics early in the morning to avoid nocturia. Rationale 2: Chlorothiazide (Diuril) is a potassium-excreting drug, and foods high in potassium should be encouraged. Rationale 3: Alcohol can potentiate the hypotensive effects of chlorothiazide (Diuril) and should be avoided, especially in the elderly. Rationale 4: Absorption of chlorothiazide (Diuril) is decreased when taken on an empty stomach.

Loop diuretics 1. inhibit reabsorption of sodium and chloride in the loop of Henle. 2. block sodium in the distal and proximal loops. 3. block aldosterone. 4. promote excretion of water by adding sodium to the filtrate.

Correct Answer: 1 Rationale 1: Loop diuretics inhibit sodium in the loop of Henle and increase urine output. Rationale 2: Thiazide diuretics block sodium in the distal tubule and nephron. Rationale 3: Potassium-sparing diuretics block aldosterone. Rationale 4: Some miscellaneous diuretics have this mechanism.

Which substances enter the filtrate by active secretion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Hydrogen 2. Potassium 3. Phosphate 4. Chloride 5. Sodium

Correct Answer: 1,2,3 Rationale 1: Hydrogen is pumped into filtrate by molecular pumps. Rationale 2: Potassium is pumped into filtrate by molecular pumps. Rationale 3: Phosphate is pumped into filtrate by molecular pumps. Rationale 4: Chloride does not enter filtrate by active secretion. Rationale 5: Sodium does not enter filtrate by active secretion.

The patient has been diagnosed with chronic renal failure and is receiving hydrochlorothiazide (HCTZ). The nurse has taught the patient about the importance of kidney function and evaluates that learning has occurred when the patient makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Kidneys help my heart by balancing potassium." 2. "Kidneys balance the fluid and electrolytes in my body." 3. "Kidneys keep blood pressure from getting too low." 4. "Kidneys help decrease infections by excreting bacteria." 5. "Kidneys help regulate the oxygen levels in my blood."

Correct Answer: 1,2,3 Rationale 1: The kidneys are the primary organs for regulating potassium balance. Rationale 2: The kidneys are the primary organs for regulating fluid and electrolyte balance. Rationale 3: They secrete renin, which helps to regulate blood pressure. Rationale 4: The kidneys do not have any impact on bacterial infections. Rationale 5: The kidneys do not affect serum oxygen levels.

The nurse is caring for a patient who is experiencing acute renal failure. The nurse knows that this patient may experience problems regulating Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. fluid balance. 2. electrolyte composition. 3. the pH of body fluids. 4. heart rate. 5. blood pressure.

Correct Answer: 1,2,3,5 Rationale 1: The kidneys are the primary organs for regulating fluid balance through filtration and urine output. Rationale 2: The kidneys are the primary organs for regulating electrolyte composition through filtration and urine output. Rationale 3: The kidneys are the primary organ for regulating the pH of body fluids through filtration and urine output. Rationale 4: The kidneys do not play a role in regulating heart rate. Rationale 5: The kidneys play a role in regulating blood pressure through the secretion of renin.

A home care nurse is instructing a patient with congestive heart failure on daily self-monitoring between home care visits. The nurse should instruct the patient to monitor and record Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. weight. 2. pulse. 3. temperature. 4. blood pressure. 5. respiratory rate.

Correct Answer: 1,2,4 Rationale 1: It is essential that the patient measure and record weight daily to monitor for fluid loss or retention. Rationale 2: It is essential that the patient measure and record the pulse daily to determine the effectiveness of the medication therapy. Rationale 3: There is no need for the patient to measure and record a daily temperature while taking a diuretic. Rationale 4: It is essential that the patient measure and record daily blood pressure to determine the effectiveness of the medication therapy. Rationale 5: There is no need for the patient to measure and record a daily respiratory rate while taking a diuretic.

The nurse is preparing to discharge a patient who has been placed on a loop diuretic for the treatment of congestive heart failure. Which foods should the nurse encourage the patient to consume to prevent serious adverse effects associated with the medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Bananas 2. Red meat 3. Oranges 4. Dried dates 5. Green, leafy vegetables

Correct Answer: 1,3,4 Rationale 1: Bananas are a potassium-rich food. Patients on loop diuretics should eat foods rich in potassium. Rationale 2: Red meats are high in iron and would not be a good source of potassium for this patient. Rationale 3: Citrus fruits are a good source of potassium. Patients on loop diuretics should eat foods rich in potassium. Rationale 4: Dried dates are a good source of potassium. Patients on loop diuretics should eat foods rich in potassium. Rationale 5: Green, leafy vegetables are a good source of iron but not of potassium. Patients on loop diuretics should eat foods rich in potassium.

The patient is receiving chlorothiazide (Diuril). The nurse suspects the patient is exhibiting side effects to the medication. What will the best assessment of the nurse include? 1. Ataxia and frequent diarrhea 2. Serum potassium level of 3.0 and low blood pressure 3. Serum sodium level of 160 and headaches 4. Mental confusion and dependent edema

Correct Answer: 2 Rationale 1: Ataxia and frequent diarrhea are not side effects of diuretic therapy. Rationale 2: Hypokalemia and hypotension are serious side effects of diuretic therapy. Rationale 3: Hypernatremia and headaches are not side effects of diuretic therapy. Rationale 4: Mental confusion and dependent edema are not side effects of diuretic therapy.

The patient is receiving chlorothiazide (Diuril). The nurse assesses the patient for hypokalemia. What does the best assessment include? 1. Confusion and decreased urine output 2. Palpitations 3. General irritability and increased urine output 4. Diarrhea and projectile vomiting

Correct Answer: 2 Rationale 1: Confusion and decreased urine output are not signs of hypokalemia. Rationale 2: Palpitations are indications of hypokalemia. Rationale 3: General irritability and increased urine output are not signs of hypokalemia. Rationale 4: Diarrhea and projectile vomiting are not signs of hypokalemia.

The patient is receiving spironolactone (Aldactone). The nurse has completed dietary education and evaluates that the patient needs additional education when the patient makes which statement? 1. "I am really happy that I can have my cranberry juice." 2. "Thank goodness I can still have my orange juice and bananas for breakfast." 3. "I need an apple a day to stay regular; I'm glad I can still have this." 4. "I am German, so I could not give up my cabbage and mushrooms."

Correct Answer: 2 Rationale 1: Cranberries are low in potassium and are not contraindicated with a potassium-sparing diuretic. Rationale 2: Orange juice and bananas are high in potassium and are contraindicated with a potassium-sparing diuretic. Rationale 3: Apples are low in potassium and are not contraindicated with a potassium-sparing diuretic. Rationale 4: Cabbage and mushrooms are low in potassium and are not contraindicated with a potassium-sparing diuretic.

Pharmacotherapy with diuretics can cause which general adverse effect? 1. Constipation 2. Orthostatic hypotension 3. Weight gain 4. Hypertension

Correct Answer: 2 Rationale 1: Diarrhea, not constipation, might be a problem. Rationale 2: Orthostatic hypotension is a common adverse effect of all the prototype drugs. Rationale 3: Weight loss, not weight gain, will occur. Rationale 4: Hypertension usually does not occur.

The most appropriate food for the patient taking loop diuretics is 1. meat. 2. bananas. 3. cheese. 4. yogurt.

Correct Answer: 2 Rationale 1: Meat provides protein but not much potassium. Rationale 2: Bananas are great source of potassium. Other foods high in potassium are green leafy vegetables. Rationale 3: Cheese is a good source of calcium. Rationale 4: yogurt is a good source of calcium.

The older adult is receiving ethacrynic acid (Edecrin) and tells the nurse he doesn't hear as well as he used to. What is the best response by the nurse? 1. "You may be dehydrated; are you drinking enough fluid?" 2. "I will let your doctor know about this; it could be a side effect of your medication." 3. "How long have you been having difficulty hearing?" 4. "I will schedule a hearing exam; this could be a side effect of your medication."

Correct Answer: 2 Rationale 1: Ototoxicity is not related to dehydration. Rationale 2: Loop diuretics are ototoxic. Instruct the patient to report ringing in the ears or becoming "hard of hearing" and notify the physician. Rationale 3: Asking the patient about how long he has had the hearing loss is a good question, but the nurse must always report suspected side effects to the physician. Rationale 4: It is inappropriate to schedule a hearing exam unless drug toxicity has been ruled out.

The patient is receiving chlorothiazide (Diuril). What is the best medication education by the nurse? 1. "Avoid foods high in potassium, such as bananas." 2. "Weigh yourself and report a gain of more than 2 pounds in 24 hours." 3. "Weigh yourself and report a gain of more than 0.5 pound in 24 hours." 4. "Report signs of hypokalemia, such as vomiting and diarrhea."

Correct Answer: 2 Rationale 1: Patients receiving thiazide diuretics should consume foods high in potassium. Rationale 2: Patients receiving thiazide diuretics should check weight daily and report a weight gain of 2 or more pounds in 24 hours. Rationale 3: A weight gain of 0.5 pound in 24 hours is not significant. Rationale 4: Vomiting and diarrhea are not signs of hypokalemia.

A patient with chronic kidney failure is taking a loop diuretic. The nurse will advise the patient to take the drug 1. with food. 2. in the morning. 3. at bedtime. 4. in the late afternoon.

Correct Answer: 2 Rationale 1: The medication does not need to be given with food. Rationale 2: It is best to take loop diuretics in the morning, since they increase urine flow, which could lead to sleep disruption. Rationale 3: Taking a loop diuretic at bedtime will cause nighttime urination and interfere with sleep. Rationale 4: Late afternoon is too late, since the drug will increase urine flow.

The patient has a routine urinalysis done, and the results show protein in the urine. What does the nurse correctly conclude about this result? 1. The patient is in acute renal failure and needs to be hospitalized. 2. The patient probably has kidney damage; protein should not be present in the urine. 3. There could be a mistake with the results; the patient should have another test done. 4. The results probably mean nothing if the amount of protein is very small.

Correct Answer: 2 Rationale 1: There is no evidence that this patient is in acute renal failure. Rationale 2: When filtrate passes through Bowman's capsule, its composition is similar to plasma. Plasma proteins are too large to pass through the filter, and if they appear in the filtrate or urine, this indicates kidney pathology. Rationale 3: There is no evidence to support a mistake with the results of the urinalysis. Rationale 4: Any amount of protein in the kidney is considered abnormal. There is no evidence that this patient is in acute renal failure.

A patient states, "My ankles swell at the end of the day. My neighbor takes furosemide (Lasix) for her swelling. Would that work for me?" Which information is important for the nurse to consider when formulating a response to this question? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The patient is 55-years-old. 2. The patient takes lithium to control bipolar disorder. 3. The patient is allergic to sulfa drugs. 4. The patient gets a rash if given penicillin. 5. The patient uses salt substitutes.

Correct Answer: 2,3 Rationale 1: Being 55-years-old is not a contraindication to use of furosemide (Lasix). Rationale 2: Concurrent use of furosemide (Lasix) and lithium may result in lithium toxicity. Rationale 3: Persons who are allergic to sulfa drugs should not take furosemide (Lasix). Rationale 4: There is no allergic cross-sensitivity between furosemide (Lasix) and penicillin. Rationale 5: Use of salt substitutes is not contraindicated when taking furosemide (Lasix).

The nurse is assessing a patient prior to the administration of a diuretic. The nurse knows it is essential to assess which vital signs at this time? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Temperature 2. Pulse 3. Respirations 4. Blood pressure 5. Pain

Correct Answer: 2,4 Rationale 1: It is not necessary to assess temperature prior to administering a diuretic. Rationale 2: The nurse must assess the patient's pulse prior to administering a diuretic. Rationale 3: It is not necessary to assess respirations prior to administering a diuretic. Rationale 4: The nurse must assess the patient's blood pressure prior to administering a diuretic. Rationale 5: It is not necessary to assess the patient's pain prior to administering a diuretic.

Four patients arrive at the emergency department. All have attempted suicide by overdosing on medication. Which patient will the nurse plan to transfer to the renal failure unit? 1. The patient who overdosed on lorazepam (Ativan) 2. The patient who overdosed on amitriptyline (Elavil) 3. The patient who overdosed on ibuprofen (Advil) 4. The patient who overdosed on quetiapine (Seroquel)

Correct Answer: 3 Rationale 1: An overdose of lorazepam (Ativan) will result in CNS depression, not nephrotoxicity. Rationale 2: Amitriptyline (Elavil) is cardiotoxic, not nephrotoxic. Rationale 3: NSAIDs, such as ibuprofen, are nephrotoxic drugs. Rationale 4: An overdose of quetiapine (Seroquel) will result in CNS depression, not nephrotoxicity.

The patient is receiving bumetanide (Bumex) and asks the nurse, "What is all this about 'loops' in my medicine?" What is the best response by the nurse? 1. "This medication reabsorbs potassium in the loop of Henle in your kidney. It is safer than other diuretics." 2. "This is a loop diuretic, which means it works in the proximal loop of your kidney. Not all diuretics work the same way." 3. "This is a loop diuretic, which refers to where it acts in your kidney. Not all diuretics work the same way." 4. "This medication blocks sodium reabsorption in what is known as Bowman's capsule. Not all diuretics work the same way."

Correct Answer: 3 Rationale 1: Bumetanide (Bumex) is a potassium-excreting drug; it does not reabsorb potassium. Rationale 2: Bumetanide (Bumex) works in the loop of Henle, not the proximal loop. Rationale 3: Bumetanide (Bumex) is called a loop diuretic because it acts by preventing the reabsorption of sodium in the loop of Henle. Rationale 4: Bumetanide (Bumex) blocks reabsorption of sodium in the loop of Henle, not in Bowman's capsule.

The patient is receiving spironolactone (Aldactone). The patient asks the nurse what the best fluid to drink to avoid dehydration is. What is the best response by the nurse? 1. "Citrus juices are very good for rehydration." 2. "Any kind of fluid is okay, but avoid alcohol." 3. "Plain water is really the best." 4. "Electrolyte-replacement drinks like Gatorade."

Correct Answer: 3 Rationale 1: Citrus juices contain potassium, which should be avoided by those taking potassium-sparing diuretics. Rationale 2: "Any kind of fluid" is not a correct answer as some fluids are better than others. Rationale 3: Plain water is the best fluid for the patient to consume while receiving diuretic therapy. Rationale 4: Electrolyte-replacement drinks like Gatorade are not as good as plain water in avoiding dehydration.

The hospitalized patient is receiving spironolactone (Aldactone). A consulting physician sees the patient and orders lisinopril (Prinivil). What will be the primary assessment by the nurse? 1. Decreased effect of spironolactone (Aldactone) 2. Hypokalemia 3. Hyperkalemia 4. Decreased effect of lisinopril (Prinivil)

Correct Answer: 3 Rationale 1: Spironolactone (Aldactone) does not decrease the effect of spironolactone (Aldactone). Rationale 2: The patient will not be at risk for hypokalemia. Rationale 3: Concurrent use of spironolactone (Aldactone) and ACE inhibitors such as lisinopril (Prinivil) may predispose the patient to hyperkalemia. Rationale 4: (Aldactone) does not decrease the effect of lisinopril (Prinivil).

The primary functional unit of the kidney is the 1. loop of Henle. 2. Bowman's capsule. 3. nephron. 4. distal tubule.

Correct Answer: 3 Rationale 1: The loop of Henle filters. Rationale 2: The Bowman's capsule filters the blood. Rationale 3: The nephron is the functional unit, which receives blood. Rationale 4: The distal tubule passes filtrate.

Which change is a common adverse effect of furosemide (Lasix)? 1. Weight gain 2. Bradycardia 3. Hypotension 4. Vomiting

Correct Answer: 3 Rationale 1: Weight loss is the desired effect, and weight gain should not occur. Rationale 2: Tachycardia when dehydrated is the cardiac system's response to fluid loss. Rationale 3: Hypotension results from large amounts of fluid being excreted. Rationale 4: Vomiting is not a common adverse effect.

Several patients have been seen in the acute-care clinic. The nurse will plan to administer diuretic therapy to which patients? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The patient experiencing visual and auditory hallucinations 2. The patient with confusion and ataxia 3. The patient with a blood pressure of 200/98 mmHg 4. The patient with generalized edema and decreased urine output 5. The patient with pinpoint pupils and extreme paranoia

Correct Answer: 3,4 Rationale 1: Visual and auditory hallucinations could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here. Rationale 2: Confusion and ataxia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here. Rationale 3: Diuretics are indicated for the treatment of renal failure, hypertension, and for the removal of edema fluid. Rationale 4: Diuretics are indicated for the treatment of renal failure, hypertension, and for the removal of edema fluid. Rationale 5: Pinpoint pupils and extreme paranoia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here.

The nurse is instructing a patient on the importance of eating foods rich in potassium while taking a diuretic that causes hypokalemia. Which diuretics do not require potassium supplements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Furosemide (Lasix) 2. Chlorothiazide (Diuril) 3. Amiloride (Midamor) 4. Mannitol (Osmitrol) 5. Spironolactone (Aldactone)

Correct Answer: 3,5 Rationale 1: Furosemide (Lasix) is a loop diuretic that often causes hypokalemia. Patients taking furosemide are encouraged to eat foods high in potassium or take a potassium supplement. Rationale 2: Chlorothiazide (Diuril) is a thiazide diuretic that often causes hypokalemia. Patients taking chlorothiazide are encouraged to eat foods high in potassium or take a potassium supplement. Rationale 3: Amiloride (Midamor) is a potassium-sparing diuretic; therefore, patients do not need to eat foods high in potassium or take a potassium supplement while on this medication. Rationale 4: Mannitol (Osmitrol) is an osmotic diuretic that causes hypokalemia. A patient should be instructed to take a potassium supplement. Rationale 5: Spironolactone (Aldactone) is a potassium-sparing diuretic. Patients on this medication are not required to eat foods high in potassium or take a potassium supplement.

The diuretic drug that will most likely be used to reduce mortality in heart failure is 1. chlorothiazide (Diuril). 2. acetazolamide (Diamox). 3. furosemide (Lasix). 4. spironolactone (Aldactone).

Correct Answer: 4 Rationale 1: Chlorothiazide is a thiazide diuretic used primarily for hypertension. Rationale 2: Acetazolamide is a carbonic anhydrase inhibitor used primarily for patients with glaucoma. Rationale 3: Furosemide is used for hypertension and reduction of edema. Rationale 4: Spironolactone is used to reduce mortality in heart failure patients.

The physician has ordered hydrochlorothiazide (HCTZ) for the patient in chronic renal failure. The nurse suspects the patient is experiencing an ineffective response to the medication. Which assessment is a priority for this patient? 1. Reviewing the lab work for hypokalemia and hyponatremia 2. Assessing the vital signs for hypertension 3. Assessing the skin for moisture and turgor 4. Auscultating breath sounds for wheezes

Correct Answer: 4 Rationale 1: Reviewing lab work is important but is not the priority here. Rationale 2: Vital sign assessment is important but is not the priority here. Rationale 3: Skin assessment is important but is not the priority here. Rationale 4: Wheezes are commonly auscultated with pulmonary edema, which can occur with chronic renal failure and fluid retention. This is a priority because pulmonary edema affects the patient's oxygenation.