Fluid and Electrolytes + 4 Categories of Diuretics

CCB: Verapamil [Calan] The nurse provides discharge instructions to a patient prescribed verapamil [Calan] SR 120 mg PO daily for essential hypertension. Which statement by the patient indicates understanding of the medication? 1 "I must make sure I swallow the pill whole." 2 "I'll need to reduce the amount of fiber in my diet." 3 "I will take the medication with grapefruit juice each morning." 4 "I should expect occasional loose stools from this medication."

"SR" indicates that the drug is sustained release; therefore, the patient must swallow the pill intact, without chewing or crushing, which would result in a bolus effect. Grapefruit juice should be avoided, because it can inhibit intestinal and hepatic metabolism of the drug, thereby raising the drug level. Constipation, not loose stools, is a common side effect of verapamil [Calan]; increasing fluids and dietary fiber can help prevent this adverse effect.

Compare/contrast ACE inhibitors and ARB's

**ACE:see photo **ARB's: see next flash

Diuretic: Hydrochlorothiazide After reviewing the chart, which information would cause the nurse to notify the provider for a patient taking hydrochlorothiazide [Microzide]? 1 History of gout 2 Potassium 4.0 mEq/L 3 Urine output 40 mL/hr 4 Output more than intake

The provider should be notified because the patient has a history of gout. Hydrochlorothiazide [Microzide] is a thiazide diuretic, which can cause an increase in uric acid level, leading to a gout attack. A potassium of 4.0 is normal; the provider should be called when the potassium is below 3.5 mEq/L or above 5 mEq/L. The provider should be called when the urine output is less than 25 mL/hr; the patient's output is 40 mL/hr. When a patient is taking a diuretic, the output should be more than the intake because it causes diuresis.

ACE inhibitor: lisinopril [Prinivil] A patient is prescribed lisinopril [Prinivil] 40 mg by mouth once a day for hypertension. For which therapeutic effect should the nurse monitor? 1 Slowing of the heart rate 2 Decrease in blood pressure 3 Symptoms such as dizziness and fainting 4 Pulse oximetry oxygen saturation of 100%

The therapeutic effect of angiotensin-converting enzyme (ACE) inhibitors is to reduce blood pressure in patients with hypertension. ACE inhibitors do not affect patients' heart rate. Dizziness and fainting are symptoms of hypotension. ACE inhibitors do not affect oxygen saturation.

CCB: patient education The nurse is teaching a patient about the reason for the administration of calcium channel blockers (CCBs). Which information should be included in the teaching plan? 1 This medication will help you to get rid of sodium. 2 This medication will work to cause you to get rid of fluid. 3 This medication will lower your blood pressure by promoting weight loss. 4 This medication will enlarge the blood vessels to lower your blood pressure.

This medication causes vasodilation (widening) and is used in hypertension to lower blood pressure. It causes direct vasodilation by blocking calcium influx in smooth muscles in the blood vessels. This medication class does not help to rid fluids, decrease sodium, or lose weight.

Math: Diuretics: Osmotic diuretics: mannitol [Osmitrol] The healthcare provider orders mannitol [Osmitrol] 72 gm infusion over 24 hours. The nurse should plan to set the infusion pump for how many grams per hour? 1 1 gm 2 2 gm 3 3 gm

To infuse 72 grams over 24 hours, divide 72 by 24 for the total per hour. 72 divided by 24 equals 3 grams per hour.

Hypokalemia: PO KCl: Patient education A patient is hypokalemic and taking sustained release oral potassium chloride. What should the nurse teach about taking this drug? 1 Take with meals. 2 Take with calcium. 3 Take with bicarbonate. 4 Take with sips of water.

To minimize gastrointestinal effects, oral potassium chloride should be taken with meals or a full glass of water, not sips. It is not taken with calcium or bicarbonate.

Diuretic: Hydrochlorothiazide: PE The nurse is teaching a patient who has been prescribed hydrochlorothiazide [Microzide]. Which statement from the patient indicates a correct understanding of the teaching? 1 "I will limit my intake of oats." 2 "I will not eat melons or grapes." 3 "I will take iron supplements every day." 4 "I will take the dose only in the morning."

To minimize nocturia, hydrochlorothiazide [Microzide] should not be taken late in the day. Taking the dose only in the morning indicates teaching was successful. Diuretics are to be taken in the morning because they cause urination at night (nocturia) and subsequent loss of sleep when taken late in the afternoon or night. Limiting oats is not necessary for a diuretic. Instructing the patient to not eat melons or grapes is not appropriate for diuretic teaching. Hydrochlorothiazide does not cause anemia; therefore, an iron supplement is not needed.

Diuretic: Hydrochlorothiazide: _______(type?) The nurse is teaching a patient who has been prescribed hydrochlorothiazide [Microzide]. Which statement from the patient indicates a correct understanding of the teaching? 1 "I will limit my intake of oats." 2 "I will not eat melons or grapes." 3 "I will take iron supplements every day." 4 "I will take the dose only in the morning."

To minimize nocturia, hydrochlorothiazide [Microzide] should not be taken late in the day. Taking the dose only in the morning indicates teaching was successful. Diuretics are to be taken in the morning because they cause urination at night (nocturia) and subsequent loss of sleep when taken late in the afternoon or night. Limiting oats is not necessary for a diuretic. Instructing the patient to not eat melons or grapes is not appropriate for diuretic teaching. Hydrochlorothiazide does not cause anemia; therefore, an iron supplement is not needed.

K+A patient asks the nurse about taking potassium supplements while taking triamterene [Direnium]. What is the nurse's best response? 1 "You will need to discuss this important issue with your physician." 2 "You are correct about potassium. I will make sure that you get some right away." 3 "Your potassium level was normal in this morning's laboratory report, so no supplement is needed." 4 "You are on a diuretic that is potassium-sparing, so there is no need for extra potassium.

Triamterene [Direnium] is a potassium-sparing diuretic. It causes sodium and water to be excreted while potassium is retained. Patients undergoing triamterene therapy do not need potassium supplements and thus do need to discuss potassium supplements with the physician. Potassium supplementation is not based upon the patient's laboratory results when the patient is on a potassium-sparing diuretic.

Antihypertensives The nurse is administering several medications at 8 AM. Which medication will decrease blood pressure by blocking angiotensin II receptor sites? 1 Enalapril 2 Furosemide 3 Eplerenone [Inspra] 4 Valsartan [Exforge]

Valsartan [Exforge] is an angiotensin II receptor blocker (ARB) that is indicated for management of hypertension. Furosemide is a loop diuretic. Eplerenone [Inspra] is an aldosterone antagonist. Enalapril is an angiotensin-converting enzyme (ACE) inhibitor.

Vasodilators pt education The nurse is caring for patients receiving vasodilators. Which instruction should the nurse give the patients to combat a common adverse effect? 1 Wear a hat when outdoors. 2 Avoid taking with grapefruit juice. 3 Drink the oral solution through a straw. 4 Rise slowly from a sitting to standing position

Vasodilators place patients at increased risk of falls. Patients should also be taught that they can minimize postural (orthostatic) hypotension by avoiding abrupt transitions from a supine or seated position to an upright position. Grapefruit does not affect the metabolism of vasodilators. Wearing hats and using a straw are not necessary with vasodilators.

Verapamil and digoxin What is the most appropriate nursing consideration for a patient who is prescribed verapamil [Calan] and digoxin [Lanoxin]? 1 Restrict intake of oral fluids and high-fiber food. 2 Take an apical pulse for 30 seconds before administration. 3 Notify the healthcare provider of nausea, vomiting, and visual changes. 4 Hold the medications if the heart rate is greater than 110 beats per minute

Verapamil [Calan] can raise digoxin blood serum levels, increasing the risk of digoxin toxicity. Symptoms of digoxin toxicity may include nausea, vomiting, and visual changes. Increase intake of oral fluids and high-fiber food to decrease the adverse effect of constipation. An apical pulse should be taken for a full minute prior to administering digoxin. Verapamil [Calan] and digoxin [Lanoxin] can cause bradycardia, not tachycardia.

AE: KCl: PO The nurse is caring for a patient receiving oral potassium chloride. Which symptom indicates a common adverse effect of this medication? 1 Wheezing 2 Headache 3 Loose stools 4 Urinary retention

We know: *Moderate HYPOKALEMIA is treated with potassium choloride sustained release tablets (ch 42). IV is given in severe cases. Diarrhea is a common side effect of oral potassium chloride. Other adverse effects can include abdominal discomfort, nausea, vomiting, and potential severe intestinal injury. Headache, wheezing, and urinary retention are not common adverse effects of this medication.

Thiocyanate toxicity: The nurse is caring for a patient who has been receiving intravenous sodium nitroprusside [Nitropress] for 3 days. Which assessement data indicate the patient may be experiencing thiocyanate toxicity? 1 Sudden confusion 2 Difficulty breathing 3 Erythematous rash 4 Gastrointestinal bleeding

When nitroprusside [Nitropress] is given for several days, thiocyanate may accumulate, which can cause adverse effects. These effects, which involve the central nervous system (CNS), include disorientation, psychotic behavior, and delirium. Difficulty breathing, erythematous rash, and gastrointestinal bleeding are not adverse effects related to thiocyanate toxicity.

Angina: Nitroglycerine: nitroprusside [Nitropress] The nurse is caring for a patient who has been receiving intravenous sodium nitroprusside [Nitropress] for 3 days. Which assessement data indicate the patient may be experiencing thiocyanate toxicity? 1 Sudden confusion 2 Difficulty breathing 3 Erythematous rash 4 Gastrointestinal bleeding

When nitroprusside [Nitropress] is given for several days, thiocyanate may accumulate, which can cause adverse effects. These effects, which involve the central nervous system (CNS), include disorientation, psychotic behavior, and delirium. Difficulty breathing, erythematous rash, and gastrointestinal bleeding are not adverse effects related to thiocyanate toxicity.

S/S: Irregular heartbeat, muscle weakness in the legs, and mild confusion An elderly patient reports a feeling of irregular heartbeat, muscle weakness in the legs, and mild confusion. Which question should the nurse ask the patient? 1 "Have you had an anxiety attack?" 2 "Have you had a respiratory infection recently?" 3 "Have you been taking potassium supplements?" 4 "Have you been having normal bowel movements?"

When the patient reports an irregular heartbeat and muscle weakness in the legs and mild confusion, the nurse should suspect hyperkalemia. Hyperkalemia may be caused by potassium supplements. An anxiety attack would lead to respiratory alkalosis before hyperkalemia. A respiratory infection would lead to respiratory alkalosis or acidosis before hyperkalemia. Bowel movements would be assessed to understand the extent of fluid loss rather than potassium loss or gain.

Oliguria

urine output less than 25 mL/hr

ACE inhibitor: Enalapril Which comment by a patient indicates correct understanding about the use of enalapril? 1 "If I feel tired, I should double the dose." 2 "I cannot go out in the sun while on this therapy." 3 "I should stop the drug if I have ringing in my ears." 4 "If I develop a chronic cough, I need to notify my provider."

A patient on therapy with an angiotensin-converting enzyme (ACE) inhibitor such as enalapril should report a nonproductive chronic cough, as this is a potential side effect. There is no treatment other than to change the medication therapy. The patient should not double the dose of an antihypertensive. Ringing in the ears in not a concern for ACE inhibitors and the patient need not avoid the sun.

A patient is taking minoxidil [Rogaine] and develops hypertrichosis. Which area should the nurse assess first? 1 Face 2 Heart 3 Lungs 4 Ankles

About 80% of patients taking minoxidil [Rogaine] for 4 weeks or more develop hypertrichosis (excessive growth of hair). Hair growth begins on the face and later develops on the arms, legs, and back. If the patient developed sodium and water retention, the lungs and ankles would be assessed. If the patient developed pericardial effusion or cardiac tamponade, the nurse should assess the heart.

Antihypertensive: The nurse is caring for a patient prescribed aliskiren [Tekturna]. How does this medication lower blood pressure? 1 It prevents angiotensin II from binding to its receptors. 2 It selectively blocks aldosterone receptors in the kidneys. 3 It blocks the conversion of angiotensin I to angiotensin II. 4 It inhibits the conversion of angiotensinogen to angiotensin I

Aliskiren [Tekturna] was the first direct renin inhibitor on the market. It binds with renin and thus inhibits the conversion of angiotensinogen to angiotensin I. The other items describe ACE inhibitors, ARBs, and selective aldosterone receptor blockers.

Antihypertensives The nurse is caring for a patient prescribed aliskiren [Tekturna]. How does this medication lower blood pressure? 1 It prevents angiotensin II from binding to its receptors. 2 It selectively blocks aldosterone receptors in the kidneys. 3 It blocks the conversion of angiotensin I to angiotensin II. 4 It inhibits the conversion of angiotensinogen to angiotensin I

Aliskiren [Tekturna] was the first direct renin inhibitor on the market. It binds with renin and thus inhibits the conversion of angiotensinogen to angiotensin I. The other items describe ACE inhibitors, ARBs, and selective aldosterone receptor blockers.

Hypertension: Aliskiren (Tekturna) For which purpose should the nurse administer aliskiren to a patient with hypertension? 1 To prevent stroke 2 To reduce blood pressure 3 To reduce diabetic nephropathy 4 To prevent myocardial infarction

Aliskiren is approved only for hypertension. Aliskiren does not prevent stroke or myocardial infarction, nor does it reduce diabetic nephropathy.

ARB: candesartan [Atacand] The nurse administers candesartan [Atacand] to a patient. Which assessment finding should the nurse use as a clinical indicator of the therapeutic effectiveness of the medication? 1 Blood pressure reduction 2 Serum potassium retention 3 Peripheral perfusion reduction 4 Pulmonary congestion retention

All angiotensin receptor blockers (ARBs), such as candesartan [Atacand], are approved for hypertension. Reduction in blood pressure equals those seen with angiotensin-converting enzyme (ACE) inhibitors. ARBs will decrease pulmonary congestion. Because ARBs promote vasodilation, the nurse expects the patient's extremities to be warm and pink from increased perfusion. In contrast to ACE inhibitors, ARBs do not cause clinically significant hyperkalemia.

IV fluids: 3% sodium chloride infusion The nurse is caring for a patient receiving intravenous (IV) therapy with a 3% sodium chloride infusion at 75 mL/hr. The nurse should closely monitor for which adverse effect of treatment? 1 Sodium level of 140 mEq/L 2 Blood urea nitrogen of 22 mg/dL 3 Distended neck veins and ankle edema 4 Tenting of the skin and dry mucous membranes

An intravenous (IV) solution of 3% sodium chloride is hypertonic and may cause fluid overload. Signs of volume overload include distended neck veins and ankle edema. T he blood urea nitrogen level and sodium level are normal values. Tenting of the skin and dry mucous membranes indicate volume contraction, which would not be a likely adverse effect of this therapy.

ARB's

Angiotensin Receptor Blockers. These lower blood pressure. Blocks angiotensin II access to receptors on blood vessels- not affect bradykinin!!

ACE inhibitor The nurse is caring for a patient who takes an angiotensin-converting enzyme (ACE) inhibitor. If the patient develops a persistent nonproductive cough, what should the nurse do? 1 Notify the provider of the new development. 2 Tell the patient that the cough will subside in a few days. 3 Assess the patient for other symptoms of upper respiratory infection. 4 Instruct the patient to take antitussive medication until the symptoms subside

Angiotensin-converting enzyme (ACE) inhibitors prevent the breakdown of bradykinins, frequently causing a nonproductive cough. The patient should be switched to a different medication if the side effect cannot be tolerated. The cough will NOT subside in a few days. This is NOT a sign of infection but is a known side effect of ACE inhibitors. Medications will NOT make the cough subside.

CHF: ACE inhibitors: Lisinopryl (prinvil) A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug? 1 Jugular vein distention 2 Potassium level of 3.5 mEq/L 3 + 2 edema of the lower extremities 4 Crackles in the lungs are no longer heard

Because angiotensin-converting enzyme (ACE) inhibitors promote venous dilation, they provide the therapeutic effect of reducing pulmonary congestion and peripheral edema. Absence of previously heard crackles would be an indicator of effectiveness. Edema and jugular vein distention are manifestations of heart failure. A potassium level of 3.5 mEq/L is a normal value.

The nurse is preparing to administer minoxidil [Loniten] 5 mg orally. What is the only cardiovascular indication for this mediacation? 1 Heart failure 2 Angina pectoris 3 Myocardial infarction 4 Severe hypertension

Because of its serious adverse effects, minoxidil [Loniten] is reserved for patients who have failed to respond to safer drugs. The only cardiovascular indication for minoxidil is severe hypertension.

Antihypertensive: lisinopryl A patient is admitted to the hospital for an intestinal obstruction and has been placed on strict nil per os (NPO) status. The nurse is reconciling the patient's at-home medications and notes that the patient's daily dose of the antihypertensive lisinopril [Prinivil] has not been prescribed by the healthcare provider. The patient's blood pressure is 160/100 mm Hg. Which action should the nurse take? 1 Address hypertensive episodes only when they arise. 2 Obtain a prescription to administer the lisinopril [Prinivil] intravenously. 3 Obtain a prescription for the daily lisinopril [Prinivil] and give with a sip of water. 4 Collaborate with the healthcare provider to determine whether intravenous enalapril [Vasotec] can be ordered

Because the patient has an intestinal obstruction and must maintain strict nil per os (NPO) status, a parenteral form of an angiotensin-converting enzyme (ACE) inhibitor is needed to keep the patient's blood pressure under control. Enalapril [Vasotec] is the only ACE inhibitor that is available in parenteral form. All medications should be reconciled on admission, so collaboration with the healthcare provider is essential.

CCB: MOA A staff member asks how calcium channel blockers (CCBs) work. Which response should the nurse provide? 1 CCBs increase arterial pressure. 2 CCBs block reabsorption of sodium. 3 CCBs relax vascular smooth muscle. 4 CCBs have a positive inotropic effect.

By blocking calcium channels, CCBs inhibit muscle contraction in the coronary arteries and peripheral arteries, resulting in relaxed vascular smooth muscle (vasodilation). CCBs have a negative inotropic effect by blocking calcium entry, which decreases the force of contractions. CCBs have no direct role in sodium activity. Vasodilation from CCBs decrease arterial pressure.

CCB Which patient assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker (CCB)? 1 Absence of dizziness 2 Absence of chest pain 3 Decreased swelling in the ankles 4 Decreased eczematous eruptions

Calcium channel blockers (CCBs) are given for angina, so an absence of chest pain is a therapeutic effect as is decreased blood pressure and dysrhythmias. Dizziness may be a side effect of the medication. Decreased swelling is not a therapeutic effect of CCBs; in fact, some may cause peripheral edema. Eczematous eruptions are an adverse effect of CCBs in older patients.

CCB: MOA The nurse is teaching the staff about the effects of calcium channel blockers (CCBs). Which describes actions of CCBs? Select all that apply. A Increase the heart rate B Reduce force of heart contraction C Constrict peripheral venules and veins D Dilate peripheral arterioles and arteries E Suppress conduction through the AV node

Calcium channel blockers (CCBs) reduce force of contraction, slow heart rate, and suppress conduction through the atrioventricular (AV) node. At therapeutic doses, CCBs act selectively on peripheral arterioles and arteries and arterioles of the heart. CCBs have no significant effect on veins.

Hypertension: A patient is admitted to the hospital with a diagnosis of hypertension. The nurse should understand that which medication works by preventing angiotensin II from binding with its receptor sites? 1 Quinapril [Accupril] 2 Aliskiren [Tekturna] 3 Eplerenone [Inspra] 4 Candesartan [Atacand]

Candesartan [Atacand] is an angiotensin II receptor blocker (ARB) and thus prevents the binding of angiotensin II at its receptor sites. Quinapril [Accupril] is an angiotensin-converting enzyme (ACE) inhibitor; aliskiren [Tekturna] is a direct renin inhibitor (DRI), and eplerenone [Inspra] is a selective aldosterone receptor blocker

AE: hydrochlorothiazide The nurse should monitor for which adverse effect after administering hydrochlorothiazide [HydroDIURIL] and digoxin [Lanoxin] to a patient? 1 Digoxin toxicity 2 Dehydration 3 Heart failure 4 Decreased diuretic effect

Digoxin levels have an inverse relationship with potassium levels. Because hydrochlorothiazide [HydroDIURIL] can lower potassium levels, combined use of hydrochlorothiazide [HydroDIURIL] and digoxin [Lanoxin] poses a risk for elevated digoxin levels and ensuing digoxin toxicity.

digoxin toxicity

EKG changes, nausea/vomiting, yellow-green visual disturbances Verapamil [Calan] can raise digoxin blood serum levels, increasing the risk of digoxin toxicity. Symptoms of digoxin toxicity may include nausea, vomiting, and visual changes. Increase intake of oral fluids and high-fiber food to decrease the adverse effect of constipation. An apical pulse should be taken for a full minute prior to administering digoxin. Verapamil [Calan] and digoxin [Lanoxin] can cause bradycardia, not tachycardia.

K+ The nurse is assessing a patient's laboratory reports and discovers that the serum pH indicates the patient is in acidosis. The nurse is scheduled to administer a potassium-sparing diuretic. Which action should the nurse take? 1 Hold the drug 2 Discontinue the drug 3 Offer with a full glass of water 4 Give with low potassium food

Extracellular acidosis promotes the exit of potassium from cells, thereby causing extracellular hyperkalemia. Potassium-sparing diuretics will make this condition worse and should be held for the nurse to notify the provider. A nurse cannot discontinue a drug; that is a provider's responsibility. Giving the drug with water or food would make the situation worse.

Diuretic: _______(type): furosemide [Lasix] Which assessment findings indicate the patient is experiencing adverse effects from furosemide [Lasix]? Select all that apply. A Oliguria B Dry mouth C Clear lungs D Unusual thirst E Clear yellow urine

Furosemide [Lasix] can produce dehydration. Signs of evolving dehydration include dry mouth, unusual thirst, and oliguria (urine output less than 25 mL/hr). Therapeutic effects of furosemide Furosemide [Lasix] include clear lungs and an increased amount of clear yellow urine.

Diuretic: _______(type?) furosemide [Lasix] The nurse reviews the laboratory values of a patient receiving furosemide [Lasix]. Which lab result indicates to the nurse that an adverse effect is occurring? 1 Decreased glucose 2 Decreased uric acid 3 Decreased phosphate 4 Decreased magnesium

Furosemide [Lasix] increases urinary excretion of magnesium, posing a risk of magnesium deficiency. Hyperglycemia (increased glucose) and hyperuricemia (increased uric acid) are adverse effects. Furosemide [Lasix] does not affect phosphate.

Diuretics: Lasix The nurse reviews the laboratory values of a patient receiving furosemide [Lasix]. Which lab result indicates to the nurse that an adverse effect is occurring? 1 Decreased glucose 2 Decreased uric acid 3 Decreased phosphate 4 Decreased magnesium

Furosemide [Lasix] increases urinary excretion of magnesium, posing a risk of magnesium deficiency. Hyperglycemia (increased glucose) and hyperuricemia (increased uric acid) are adverse effects. Furosemide [Lasix] does not affect phosphate.

Diuretics: efficacy The nurse is administering several different diuretics. Which drug will produce the most diuresis in a patient? 1 Furosemide [Lasix] 2 Triamterene [Dyrenium] 3 Spironolactone [Aldactone] 4 Hydrochlorothiazide [Microzide]

Furosemide [Lasix] is the most potent diuretic. Drugs that act early in the nephron have the opportunity to block the greatest amount of solute reabsorption. Furosemide [Lasix] works at the loop of Henle; as a result, furosemide [Lasix] produces the greatest diuresis. Hydrochlorothiazide [Microzide] works on the early distal convoluted tubule so does not have the capacity to excrete as much sodium and water as a loop diuretic and is less effective. Triamterene [Dyrenium] and spironolactone [Aldactone] work at the distal nephron so do not have the ability to excrete as much sodium and water as loop diuretics.

Hydralazine (apresoline) The nurse is administering hydralazine [Apresoline] with a beta blocker. What is the rationale for the nurse's action? 1 To prevent reflex tachycardia 2 To prevent blood volume expansion 3 To reduce sodium and water retention 4 To prevent systemic lupus erythematosus-like syndrome

Hydralazine [Apresoline] can be combined with a beta blocker to protect against reflex tachycardia and with a diuretic to prevent sodium and water retention and expansion of blood volume. Doses kept below 200 mg/day will help reduce the incidence of systemic lupus erythematosus-like syndrome.

Hydralazine + propranolol The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. A drug such as propranolol is often combined with hydralazine for what purpose? 1 To prevent heart failure 2 To reduce the risk of headache 3 To improve hypotensive effects 4 To protect against reflex tachycardia

Hydralazine [Apresoline] is a vasodilator that lowers blood pressure, but it can also trigger reflex tachycardia. Beta blockers, such as propranolol [Inderal], are often added to the regimen to normalize the heart rate.

Diuretics: Thiazide diuretics: hydrochlorothiazide [Microzide] A patient is taking hydrochlorothiazide [Microzide]. On assessment, the nurse notes that the patient has muscle weakness, cramping, and leg discomfort. What should be the nurse's first intervention? 1 Reduce salt in the patient's diet 2 Administer calcium supplements 3 Assess the serum potassium level 4 Give a lower dose of the medication

Hydrochlorothiazide [Microzide] can cause hypokalemia, characterized by muscle weakness, cramping, and leg discomfort. The nurse should immediately assess the patient's serum potassium level to determine the course of action. Giving calcium supplements does not reduce the symptoms caused by potassium deficiency. The patient is experiencing hypokalemia, not hypernatremia; reducing salt is for hypernatremia. Reducing the dose of the medication will not help restore the electrolyte balance.

Thiazide diuretics-Prototype drug?

Hydrochlorothizide **Specific Nursing Interventions: -NEVER for kidney failure pt -Primary for Diabetis Insipidous -Doesn't work as well as LOOP=requires higher dose ** Similar Nursing Interventions: -Check BP -Check electrolytes -Monitor I/O -Teach your pt to take in AM --Monitor for s/s of dehydration ---s/s decreased potassium ~See above question~

K+ The nurse is preparing to administer intravenous (IV) potassium to a patient with hypokalemia. Which prescription is the most appropriate? 1 Potassium chloride 10 mEq IV push over 1 minute 2 Potassium chloride 30 mEq in 100 mL IV over 1 hour 3 Potassium chloride 10 mEq in 100 mL IV over 1 hour 4 Potassium chloride 10 mEq in 100 mL IV over 30 minutes

IV potassium must be diluted (never given IV push) and infused slowly, at a rate no faster than 10 mEq/hr. Faster infusions of potassium can lead to cardiac toxicity.

Diuretic: __________(type): spironolactone [Aldactone] A patient with hypertension is receiving spironolactone [Aldactone] therapy. The nurse notes that the patient's serum potassium level is 6.2 mEq/L. What would the nurse anticipate to be prescribed for the patient? 1 Insulin [Humulin] 2 Mannitol [Osmitrol] 3 Amiloride [Midamor] 4 Triamterene [Maxzide]

If serum potassium rises above 5 mEq/L, or if signs of hyperkalemia develop (eg, abnormal heart rhythm), spironolactone [Aldactone] should be discontinued and potassium intake restricted. Injection of insulin [Humulin] can help lower potassium levels by promoting potassium uptake into cells. Amiloride [Midamor] and triamterene [Maxzide] are potassium-sparing diuretics which, on administration, may cause further increase in the serum potassium levels. Mannitol [Osmitrol] is an osmotic diuretic, which does not show any significant effect on potassium levels.

CCB: diltiazem [Cardizem] Which behavior by a patient indicates more teaching is needed about taking diltiazem [Cardizem]? 1 Takes with tea 2 Takes with lemonade 3 Takes with apple juice 4 Takes with grapefruit juice

If the patient consumes grapefruit juice, it can raise the levels of diltiazem [Cardizem] and verapamil [Calan]. The other drinks (tea, apple juice, lemonade) can be used by the patient when taking diltiazem [Calan] as they have no significant interaction.

NaCl + KCl The nurse administers sodium chloride plus potassium chloride. Which patient should receive this type of treatment? 1 A patient with metabolic acidosis 2 A patient with metabolic alkalosis 3 A patient with respiratory acidosis 4 A patient with respiratory alkalosis

In most cases, metabolic alkalosis can be corrected by infusing a solution of sodium chloride plus potassium chloride. This facilitates renal excretion of bicarbonate and thereby promotes normalization of plasma pH. Treat respiratory or metabolic acidosis with sodium bicarbonate. Treat respiratory alkalosis by having patients inhale 5% CO2 or rebreathe their expired air.

Hypertonic contraction The nurse is preparing to administer the initial treatment for a patient with hypertonic contraction. Which action should the nurse take? 1 Offer water to drink 2 Offer a paper bag to breathe in 3 Start an IV of 3% sodium chloride 4 Start an IV of sodium bicarbonate

Initial therapy for hypertonic contraction may consist simply of drinking water. A paper bag is treatment for respiratory alkalosis. 3% sodium chloride is treatment for hypotonic contraction. Sodium bicarbonate is treatment for any type of acidosis.

Diuretic: Osmotic Diuretic: mannitol [Osmitrol] Which assessment indicates to the nurse that a therapeutic effect of mannitol [Osmitrol] has been achieved? 1 Increased calcium 2 Decreased potassium 3 Increased intraocular pressure (IOP) 4 Decreased intracranial pressure (ICP)

Intracranial pressure (ICP) that has been elevated by cerebral edema can be reduced with mannitol [Osmitrol]. The drug lowers ICP because its presence in the blood vessels of the brain creates an osmotic force that draws edematous fluid from the brain into the blood. Mannitol [Osmitrol] has no significant effect on the excretion of potassium and other electrolytes. Mannitol [Osmitrol] will decrease intraocular pressure (IOP).

Hypertensive emergency A patient with a hypertensive emergency is admitted to the hospital. Which medication should the nurse be prepared to administer to this patient? 1 Minoxidil [Loniten] 2 Hydralazine [Apresoline] 3 Sodium nitroprusside [Nipride] 4 Hydralazine and isosorbide dinitrate [BiDil]

Intravenous sodium nitroprusside [Nipride] has an immediate effect and is the drug of choice for hypertensive emergencies. Minoxidil [Loniten] and hydralazine [Apresoline] are used for blood pressure control.

Isotonic volume contraction Which intravenous (IV) fluid would be most appropriate for treating isotonic volume contraction? 1 0.9% sodium chloride 2 5% dextrose and water 3 0.225% sodium chloride 4 3% sodium chloride and water

Isotonic volume contraction occurs when sodium and water are lost in isotonic proportions. It may be caused by vomiting, diarrhea, kidney disease, and/or misuse of diuretics. In this situation, volume is replenished with isotonic solutions, such as normal saline (0.9% sodium chloride).

Antihypertensive and Lithium The nurse is caring for a patient with bipolar disorder treated with lithium [Eskalith]. The patient has a new prescription for captopril [Capoten] for hypertension. The combination of these two drugs makes which assessment particularly important? 1 Lithium level 2 Blood pressure 3 Potassium level 4 Creatinine level

Lithium levels should be monitored on a regular basis. Angiotensin-converting enzyme (ACE) inhibitors, such as captopril [Capoten], can cause lithium accumulation. ACE inhibitors can cause hyperkalemia, renal insufficiency in some patients, and hypotension. However, the combination of lithium [Eskalith] and captopril [Capoten] would not increase the risk of these effects.

Which patient receiving losartan [Cozaar] should be monitored closely while receiving this therapy? 1 The patient with constipation 2 The patient with an elevated creatinine level 3 The patient with a heart rate of 90 beats/min 4 The patient with a potassium level of 3.4 mEq/L

Losartan [Cozaar] has been shown to be beneficial in patients with hypertension and heart failure. Patients with renal or hepatic dysfunction should be assessed carefully due to the potential for toxicity and increased side effects. An elevated creatinine level is an indication of renal dysfunction. The other findings are not.

Electrolytes:A patient has hypomagnesemia. Which drug should the patient learn about in a teaching session with the nurse? 1 Calcium salt 2 Magnesium oxide 3 Calcium gluconate 4 Magnesium sulfate

Magnesium sulfate intramuscularly (IM) or intravenously (IV) is the preferred treatment for hypomagnesemia. Tablets of magnesium oxide may be taken as supplements to dietary magnesium to help prevent hypomagnesemia. Calcium gluconate or calcium salt is given for hypermagnesemia.

Acid-Base imbalance Which acid-base imbalance is characterized by increases in both the pH and bicarbonate content of plasma? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

Metabolic alkalosis is characterized by increases in both the pH and bicarbonate content of plasma. Causes include excessive loss of gastric acid (through vomiting or suctioning) and administration of alkalinizing salts (eg, sodium bicarbonate).

CCB: diltiazem [Cardizem] The healthcare provider prescribes an intravenous dose of diltiazem [Cardizem] for treatment of a patient with atrial fibrillation. What is the priority nursing intervention? 1 Assist with cardioversion. 2 Monitor electrocardiogram. 3 Obtain baseline coagulation studies. 4 Assess for increased urinary output

Monitor the electrocardiogram (ECG) continuously during intravenous (IV) administration of diltiazem [Cardizem] for atrioventricular (AV) block, sudden reduction in heart rate, and prolongation of the PR or QT interval. Cardioversion is not necessary; however, the nurse should have equipment for cardioversion available. Baseline laboratory studies are needed for liver and kidney function. Increased urinary output is not an adverse effect of diltiazem [Cardizem].

Diuretics: The nurse knows that diuretics mostly affect which function of the kidneys? 1 Excretion of metabolic waste 2 Elimination of foreign substances 3 Maintenance of acid-base balance 4 Maintenance of extracellular fluid volume

Most diuretics block sodium and chloride reabsorption, thus affecting maintenance of extracellular fluid volume.

S/A: constipation Which medication is most likely to cause the side effect of constipation? 1 Nifedipine [Adalat] 2 Diltiazem [Cardizem] 3 Isradipine [DynaCirc] 4 Amlodipine [Norvasc]

Nifedipine [Adalat], amlodipine [Norvasc], and isradipine [DynaCirc], which are dihydropyridine calcium channel blockers, cause less risk of constipation than diltiazem [Cardizem] and verapamil.

Nitroprusside (nipride) with furosemide (ladies) The nurse is caring for a patient receiving a nitroprusside [Nipride] intravenous (IV) infusion. The patient's wife asks why furosemide [Lasix] is being prescribed along with this drug. The nurse's response should be based on which concept? 1 Furosemide will help reduce reflex tachycardia. 2 Many vasodilators cause retention of sodium and water. 3 Vasodilators can cause serious orthostatic hypotension. 4 Thiocyanate may accumulate in patients receiving nitroprusside.

Nitroprusside [Nipride] is a potent vasodilator that can cause retention of sodium and water. Furosemide [Lasix], a diuretic, is often combined with nitroprusside to reduce the risk of edema and fluid retention. Furosemide does not reduce reflex tachycardia. Thiocyanate can accumulate in patients receiving nitroprusside, but furosemide does not help prevent or treat that. Vasodilators can cause serious orthostatic hypotension, but that is not the rationale for adding furosemide to the regimen.

Hypertonic fluid Based on the condition of the patient, a hypertonic fluid is needed. Which intravenous fluid is most likely to be ordered by the provider? 1 3% sodium chloride 2 0.9% sodium chloride 3 0.45% sodium chloride 4 0.25% sodium chloride

Of the fluids listed, the only one that is hypertonic is 3% sodium chloride. Normal saline is isotonic, and both 0.25% and 0.45% sodium chloride are considered to be hypotonic.

Hypertension: losartan [Cozaar] A patient with hypertension and left ventricular hypertrophy takes losartan [Cozaar] 50 mg daily. What is a benefit of this therapy for a patient with hypertension? 1 This medication has no side effects. 2 This medication decreases the risk of stroke. 3 This medication is less expensive than others. 4 This medication decreases blood pressure more effectively than others

One angiotensin receptor blocker (ARB), Losartan [Cozaar], is approved for reducing stroke in patients with left ventricular hypertrophy and hypertension.

Hypertonic saline solution Which sign should the nurse monitor for after administering a hypertonic saline solution to a patient who has severe hypotonic contraction? 1 Tetany 2 Weakness 3 Hypotension 4 Distention of neck veins

Patients should be monitored for signs of fluid overload (distention of neck veins, peripheral or pulmonary edema). Tetany is a sign of hypomagnesemia. Weakness is a sign of hypokalemia. Hypotension is a sign of hypermagnesemia.

CCB: nifedipine A patient is receiving nifedipine [Adalat CC]. Which adverse effect should the nurse monitor for in this patient? 1 Pallor 2 Diarrhea 3 Backache 4 Ankle edema

Peripheral edema is an adverse effect of nifedipine [Adalat CC]. Headache is an adverse effect, not backache. Diarrhea is not an adverse effect of nifedipine [Adalat CC]. Flushing occurs, not pallor.

Hypotension: A patient develops hypotension after administration of verapamil. Which intervention is appropriate? 1 Administer atropine. 2 Perform gastric lavage. 3 Assist with cardioversion. 4 Place in modified Trendelenburg's position

Placing the patient in modified Trendelenburg's position (legs elevated) and administering intravenous (IV) fluids may help with treatment of hypotension. Atropine is administered for bradycardia and atrioventricular (AV) block, not hypotension. Overdoses can be removed from the gastrointestinal (GI) tract with gastric lavage followed by activated charcoal; however, hypotension can occur in the absence of overdose. Hypotension is not treated with cardioversion.

Hypotension: Verapamil A patient develops hypotension after administration of verapamil. Which intervention is appropriate? 1 Administer atropine. 2 Perform gastric lavage. 3 Assist with cardioversion. 4 Place in modified Trendelenburg's position.

Placing the patient in modified Trendelenburg's position (legs elevated) and administering intravenous (IV) fluids may help with treatment of hypotension. Atropine is administered for bradycardia and atrioventricular (AV) block, not hypotension. Overdoses can be removed from the gastrointestinal (GI) tract with gastric lavage followed by activated charcoal; however, hypotension can occur in the absence of overdose. Hypotension is not treated with cardioversion.

Acid-base imbalance Which acid-base imbalance is caused by chronic renal failure, loss of bicarbonate during severe diarrhea, or metabolic disorders that result in overproduction of lactic acid? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

Principal causes of metabolic acidosis are chronic renal failure, loss of bicarbonate during severe diarrhea, and metabolic disorders that result in overproduction of lactic acid (lactic acidosis) or ketoacids (ketoacidosis). Metabolic acidosis may also result from poisoning by methanol and certain medications (eg, aspirin and other salicylates). Kidney="Metabolic" Loss of Bicarb (base)=becoming acidotic

Hypokalemia A patient with hypokalemia is ordered to receive an intravenous (IV) dose of potassium chloride. Which action should the nurse take? 1 Administer the medication IV push. 2 Administer the medication undiluted. 3 Review the patient's urinary output before administering. 4 Review the patient's serum calcium level before administering.

Renal function should be assessed before and during treatment to ensure adequate output of urine. If renal failure develops, the infusion should be stopped immediately. Potassium chloride must never be administered by IV push. IV potassium chloride should be diluted before administering. The patient's potassium level should be checked, not calcium.

KCl (IV) A patient with hypokalemia is ordered to receive an intravenous (IV) dose of potassium chloride. Which action should the nurse take? 1 Administer the medication IV push. 2 Administer the medication undiluted. 3 Review the patient's urinary output before administering. 4 Review the patient's serum calcium level before administering

Renal function should be assessed before and during treatment to ensure adequate output of urine. If renal failure develops, the infusion should be stopped immediately. Potassium chloride must never be administered by IV push. IV potassium chloride should be diluted before administering. The patient's potassium level should be checked, not calcium.

Acid-Base imbalance: Which acid-base imbalance is caused by retention of CO2 secondary to hypoventilation? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

Respiratory acidosis results from retention of CO2 secondary to hypoventilation. Reduced CO2 exhalation raises plasma pCO2, which in turn causes plasma pH to fall. Retention of CO2 secondary to hypoventilation does not cause respiratory alkalosis, metabolic acidosis, or metabolic alkalosis.

A-ace inhibitor and Arbs-Prototype drug?

SPECIFIC nursing interventions: -Skills: --PO administration= check BP 1 hour before and 2 hr after eating. Educate patient. --DO NOT give to LIVER disease patient *Pt Education: -Common side effect is persistant dry non-productive COUGH. This will not go away. Use cough drops or water. -Photosensitivity-sunglasses General Nursing Intervention: -check BP -check Apical pulse for 1 FULL minute -check BP trends -In general: --If SBP <90 hold med --If HR >60 hold med *Pt education: -FATIGUE is expected it should resolve in 2-3 weeks. Do not stop taking the medication abruptly. Pt needs to monitor their BP, and HR at home. Check pt should demonstrate skills.

The nurse is evaluating the teaching done with a patient who has a new prescription for fosinopril [Monopril]. Which statement by the patient indicates a need for further teaching? 1 "I will call if I develop a bothersome cough." 2 "I will call if I notice a rash or wheals on my skin." 3 "I will use a salt substitute to lower my sodium intake." 4 "I can take this medicine with breakfast each morning.

Salt substitutes contain potassium and may increase the risk of hyperkalemia with angiotensin-converting enzyme (ACE) inhibitors, such as fosinopril [Monopril]. The patient should not take potassium supplements or use salt substitutes. The other statements are appropriate for this patient.

K+ A patient is prescribed a sodium polystyrene sulfonate enema. The nurse is reviewing the patient's laboratory reports. What would the nurse expect the patient's potassium level to be? 1 2.3 mEq/L 2 3.5 mEq/L 3 4.2 mEq/L 4 5.9 mEq/L

Sodium polystyrene sulfonate is given to patients with hyperkalemia. The normal range of serum potassium level is 3.5 to 5 mEq/L. Therefore, the nurse would expect to find the serum potassium level of the patient to be 5.9 mEq/L. A serum potassium level of 3.5 mEq/L or 4.2 mEq/L is considered in the normal range, so the enema would not be required. A serum potassium level of 2.3 mEq/L is considered a low potassium level. If sodium polystyrene sulfonate were administered to a patient with hypokalemia, the potassium level would further decrease.

Diuretic: Spironolactone (Adactone) _____(type?) A patient taking spironolactone [Aldactone] has been taught about the medication. Which menu selection indicates the patient understands teaching related to this medication? 1 Nuts 2 Spinach 3 Chicken 4 Potatoes

Spironolactone [Aldactone] is a potassium-sparing diuretic that could potentially cause hyperkalemia. Of the foods listed, chicken is lowest in potassium. Nuts, potatoes, dried fruits, spinach, citrus fruits, and bananas are all known to contain high levels of potassium.

Diuretics: Potassium sparing + Loop Diuretics: spironolactone and furosemide What is the best information for the nurse to provide to a patient who is receiving spironolactone and furosemide (lasix) therapy? 1 "This combination prevents dehydration and loss of fluid volume." 2 "This combination promotes urine output but decreases the risk of low potassium." 3 "Using two drugs increases the osmolality of plasma and the glomerular filtration rate." 4 "Moderate doses of two different diuretics are more effective than a large dose of one."

Spironolactone [Aldactone] is a potassium-sparing diuretic; furosemide [Lasix] causes potassium loss. Giving these together minimizes electrolyte imbalance. It is not accurate to state that the drug combination prevents dehydration and loss of fluid volume or that it increases the osmolality of plasma and the glomerular filtration rate. Stating that giving two different diuretics is more effective than a large dose of one is not accurate.

Diuretic: Spiranolactone The nurse is teaching a patient who has a new prescription for spironolactone [Aldactone]. Which statement by the patient indicates that the teaching was effective? 1 "I will take this medication at bedtime each evening." 2 "I will use salt substitutes to lower my sodium intake." 3 "I will call my doctor if I begin having menstrual irregularities." 4 "I will increase my intake of foods that are high in potassium."

Spironolactone [Aldactone] is a potassium-sparing, aldosterone-blocking diuretic. As such, it can cause endocrine effects, such as gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of the voice. Patients taking spironolactone [Aldactone] should avoid salt substitutes because they contain potassium, and high-potassium foods should be avoided with this drug. Ideally, all diuretics should be taken in the morning to prevent nocturia.

Fluid volume and osmolality The nurse knows that which organ is primarily responsible for maintaining fluid volume and osmolality? 1 Liver 2 Heart 3 Kidneys 4 Blood vessels

The kidneys are responsible for maintaining and regulating volume and osmolality. This is not the responsibility of the liver, blood vessels, or heart.

Hyerkalemia The nurse is caring for a patient with hyperkalemia. Which assessment is priority? 1 Lung 2 Kidney 3 Cardiac 4 Abdomen

The most serious consequence of hyperkalemia is disruption of the electrical activity of the heart. Because hyperkalemia alters the generation and conduction of cardiac impulses, alterations in the electrocardiogram (ECG) and cardiac rhythm are usually the earliest signs that potassium levels are growing dangerously high. Assessments of lung, kidney, and abdomen are not as critical for hyperkalemia.

Hypertensive emergency The patient is admitted for the management of a hypertensive emergency. The healthcare provider prescribes sodium nitroprusside [Nipride] drug therapy. What is the priority nursing action during this treatment? 1 Observe for respiratory depression. 2 Monitor the electrocardiogram for tachycardia. 3 Initiate oxygen therapy via nasal cannula at 2 L/min. 4 Adjust the intravenous (IV) infusion rate to the blood pressure response

The nurse should adjust the rate of infusion based on the patient's blood pressure. Respiratory depression is not associated with administion of this drug. Oxygen therapy is not necessary, and nitroprusside [Nipride] causes very little tachycardia.

Hypertension: sodium nitroprusside [Nipride] The patient is admitted for the management of a hypertensive emergency. The healthcare provider prescribes sodium nitroprusside [Nipride] drug therapy. What is the priority nursing action during this treatment? 1 Observe for respiratory depression. 2 Monitor the electrocardiogram for tachycardia. 3 Initiate oxygen therapy via nasal cannula at 2 L/min. 4 Adjust the intravenous (IV) infusion rate to the blood pressure response.

The nurse should adjust the rate of infusion based on the patient's blood pressure. (Standing order would be required) Respiratory depression is not associated with administion of this drug. Oxygen therapy is not necessary, and nitroprusside [Nipride] causes very little tachycardia.

After reviewing the chart, which findings would cause the nurse to notify the provider? 1 Hypouricemia and edema 2 Digoxin [Lanoxin] and hypokalemia 3 Hypocalcemia and the patient lives alone 4 Furosemide [Lasix] and spironolactone [Aldactone

The nurse should notify the provider when hypokalemia and a prescription for digoxin [Lanoxin] occur together. Loss of potassium is of special concern for patients taking digoxin [Lanoxin], a drug for heart failure. By lowering potassium levels, loop diuretics increase the risk of fatal dysrhythmias from digoxin [Lanoxin]. Hypouricemia and edema are not a concern; hyperuricemia is. There is no adverse interaction between hypocalcemia and living alone. Furosemide [Lasix] and spironolactone [Aldactone]can be given together, so this is not a concern.

Digoxin (see photo) After reviewing the chart, which findings would cause the nurse to notify the provider? 1 Hypouricemia and edema 2 Digoxin [Lanoxin] and hypokalemia 3 Hypocalcemia and the patient lives alone 4 Furosemide [Lasix] and spironolactone [Aldactone]

The nurse should notify the provider when hypokalemia and a prescription for digoxin [Lanoxin] occur together. Loss of potassium is of special concern for patients taking digoxin [Lanoxin], a drug for heart failure. By lowering potassium levels, loop diuretics increase the risk of fatal dysrhythmias from digoxin [Lanoxin]. Hypouricemia and edema are not a concern; hyperuricemia is. There is no adverse interaction between hypocalcemia and living alone. Furosemide [Lasix] and spironolactone [Aldactone]can be given together, so this is not a concern.

Diuretic: Furosemide (lasix) The nurse caring for a patient taking furosemide [Lasix] is reviewing the patient's most recent laboratory results, which are sodium, 136 mEq/L; potassium, 3.2 mEq/L; chloride, 100 mEq/L; and blood urea nitrogen, 15 mg/dL. What would be the nurse's best action? 1 Begin a 24-hour urine collection. 2 Place the patient on a cardiac monitor. 3 Administer furosemide [Lasix] as ordered. 4 Hold the furosemide [Lasix] and notify the physician.

The nurse's best action is to hold the furosemide [Lasix] and notify the physician. Loop diuretics, such as furosemide, can cause significant potassium loss. Normal potassium level is 3.5 to 5 mEq/L. The other listed electrolyte levels are normal. Administering the furosemide [Lasix] could result in a critically low potassium level. Effects of low potassium include cardiac dysrhythmias. Placing a patient on a cardiac monitor requires a physician's order and would warrant further assessment first, such as taking vital signs and asking the patient whether he or she is having any cardiac-related symptoms. Collecting a 24-hour urine specimen is not appropriate in this case.

Diuretic: NI The nurse caring for a patient taking furosemide [Lasix] is reviewing the patient's most recent laboratory results, which are sodium, 136 mEq/L; potassium, 3.2 mEq/L; chloride, 100 mEq/L; and blood urea nitrogen, 15 mg/dL. What would be the nurse's best action? 1 Begin a 24-hour urine collection. 2 Place the patient on a cardiac monitor. 3 Administer furosemide [Lasix] as ordered. 4 Hold the furosemide [Lasix] and notify the physician

The nurse's best action is to hold the furosemide [Lasix] and notify the physician. Loop diuretics, such as furosemide, can cause significant potassium loss. Normal potassium level is 3.5 to 5 mEq/L. The other listed electrolyte levels are normal. Administering the furosemide [Lasix] could result in a critically low potassium level. Effects of low potassium include cardiac dysrhythmias. Placing a patient on a cardiac monitor requires a physician's order and would warrant further assessment first, such as taking vital signs and asking the patient whether he or she is having any cardiac-related symptoms. Collecting a 24-hour urine specimen is not appropriate in this case.

Minoxidil (Rogaine) The nurse is administering minoxidil [Rogaine] to a patient. The nurse is caring for which patient? 1 One with heart failure 2 One with prehypertension 3 One with cardiac tamponade 4 One with severe hypertension

The only cardiovascular indication for minoxidil [Rogaine] is severe hypertension. Hydralazine [Apresoline], not minoxidil [Rogaine], can treat heart failure. Minoxidil [Rogaine] is not for treatment of prehypertension. Cardiac tamponade can be an adverse effect of minoxidil [Rogaine].

Excretion The nurse is teaching about the production of urine. In which order should the nurse place the structures to demonstrate how urine is produced in the nephron? 1. Glomerulus 2. Collecting duct 3. Loop of Henle 4. Proximal convoluted tubule 5. Distal convoluted tubule

The production of urine involves these structures in the following order: glomerulus, proximal convoluted tubule, loop of Henle, distal convoluted tubule, and collecting ducts.

Diuretic: hydrochlorothiazide [Microzide] ________(type?) After reviewing the chart, which information would cause the nurse to notify the provider for a patient taking hydrochlorothiazide [Microzide]? 1 History of gout 2 Potassium 4.0 mEq/L 3 Urine output 40 mL/hr 4 Output more than intake

The provider should be notified because the patient has a history of gout. Hydrochlorothiazide [Microzide] is a thiazide diuretic, which can cause an increase in uric acid level, leading to a gout attack. A potassium of 4.0 is normal; the provider should be called when the potassium is below 3.5 mEq/L or above 5 mEq/L. The provider should be called when the urine output is less than 25 mL/hr; the patient's output is 40 mL/hr. When a patient is taking a diuretic, the output should be more than the intake because it causes diuresis.