32: Drug Therapy for Fluid Volume Excess, Chapter 34: Drug Therapy for Fluid Volume Excess, Chapter 34: Drug Therapy for Fluid Volume Excess, 28: Drug Therapy for Hypertension, Prep U: Chapter 26=Drug Therapy for Hypertension, Prep U Chapter 26: Drug…

A patient with a longstanding diagnosis of chronic renal failure has experienced a significant decline in urine output in recent days, prompting him to seek care at a local clinic. A nurse at the clinic has suggested to a colleague that the administration of a diuretic such as hydrochlorothiazide may improve the patient's urine output. How should the colleague best respond to this suggestion?

"Actually, patients with renal failure usually can't take hydrochlorothiazide."- Renal disease and severe renal impairment contraindicate the use of hydrochlorothiazide. HCTZ affects the kidneys, not the bladder, and is not administered intravenously.

After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states:

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

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

"I need to make sure I don't eat too many high potassium foods." Explanation: The drug is a potassium sparing diuretic placing the patient at risk for hyperkalemia, especially if the patient consumes foods high in potassium. The patient should take the medication in the morning to prevent interfering with sleep by having to get up at night to void. The patient can take the drug with meals if GI upset occurs. Many salt substitutes contain potassium, which could increase the patient's risk for hyperkalemia.

A male client who is an Asian executive visiting the United States presents to the emergency department with a severe headache and an elevated blood pressure. He is admitted to the hospital for treatment and regulation of his medication regimen. The client is concerned because the dosage prescribed for his antihypertensive medication is lower than what he researched on the Internet. What is an accurate response for the nurse to make? "I will contact the provider immediately." "There is an error on the prescription." "People of Asian descent excrete the drugs more rapidly, so the doses prescribed are smaller." "People of Asian descent excrete the drugs more slowly, so the doses prescribed are smaller."

"People of Asian descent excrete the drugs more slowly, so the doses prescribed are smaller." Explanation: In general, people of Asian descent with hypertension require much smaller doses of beta-blockers, because they metabolize and excrete the drugs slowly.

Which of the following questions would be most important for a nurse to ask a female patient who is starting on an angiotensin II receptor blocker for hypertension? a) "Have you always weighed 150 pounds?" b) "When was your last menstrual period?" c) "How much physical exercise do you get?" d) "Do you eat something when you take your medications?"

"When was your last menstrual period?" Explanation: It would be important to know when the patient's LMP occurred and that the patient is not pregnant. These drugs are category C for the first trimester and category D for the second and third trimesters of pregnancy and should not be used in pregnancy unless the benefits outweigh the risks. The other questions provide good assessment information but would provide no specific insights regarding the patient who is beginning angiotensin II receptor blocker therapy.

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?

105 mg- The nurse will administer 105 mg/dose of the drug (76 lbs divided by 2.2 = 34.5 kg, 35 kg times 3 mg = 105 mg).

The nurse is administering furosemide IV to a client. How soon after administration does the nurse expect diuretic effects to peak?

30 minutes

A patient receives furosemide intravenously at 9 AM. The nurse would expect to assess peak effects of the drug at which time? a) 9:30 AM b) 9:15 AM c) 10:30 AM d) 10:00 AM

9:30 AM Explanation: Furosemide, when given IV, peaks in 30 minutes; the nurse would see peak drug action at approximately 9:30 AM.

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 very large majority of filtrate is returned to circulation.

Which question would be most important for a nurse to ask a female client who is starting on an angiotensin II receptor blocker for hypertension? A. "When was your last menstrual period?" B. "Do you eat something when you take your medications?" C. "Have you always weighed 150 pounds?" D. "How much physical exercise do you get?"

A. "When was your last menstrual period?"

A 42-year-old client is seen by the health care provider for follow-up for diabetic nephropathy. The provider prescribed losartan for the treatment of this condition because the medication has been shown to reduce the rate of end-stage renal disease. Which drug class does this drug belong to? A. Angiotensin II receptor blockers B. Calcium channel blockers C. Antihyperlipidemic drugs D. Selective aldosterone blockers

A. Angiotensin II receptor blockers

A staff nurse on a renal unit knows that most patients require treatment for hypertensive disease. What would the nurse expect to assess prior to the beginning of antihypertensive treatment? A. Baseline renal function B. A temporary increase in renal function C. A sustained increase in renal dysfunction D. A sustained decrease in renal function

A. Baseline renal function

The nurse would encourage clients with prehypertension to follow what type of diet? A. DASH diet B. Restricted-calorie diet C. High-sodium diet D. High-protein diet

A. DASH diet

A patient who is prescribed losartan for hypertension has stopped taking the drug immediately after experiencing adverse effects. Which of the following may result when antihypertensives are abruptly discontinued? A. Rebound hypertension B. Anginal attacks C. Breathing difficulty D. Orthostatic hypotension

A. Rebound hypertension

A client with a blood pressure of 165/95 mm Hg would be classified in which stage of hypertension? A. Stage 2 B. Stage 1 C. Normotensive D. Prehypertension

A. Stage 2

Aldosterone levels would be affected if which gland was dysfunctional?

Adrenal

A man who is taking an oral hypoglycemic for management of his type 2 diabetes mellitus begins taking hydrochlorothiazide. The nurse should monitor for which of the following serum laboratory changes? A. hypocalcemia B. hypercalcemia C. hyperglycemia D. hypernatremia

Answer: C Rationale: Hydrochlorothiazide is a thiazide diuretic, that acts to decease reabsorption of sodium, water, chloride and bicarbonate in the distal convoluted tubule. Adverse effects of hydrochlorothiazide include hypersensitivity reactions, hypotension, weakness, dizziness, diarrhea, constipation, electrolyte imbalances (hyponatermia, hypokalemia, hydrochloremia), hyperglycemia, paresthesia and erectile dysfunction.

A client with primary hypertension asks the nurse why the prescriber added another medication to assist with lowering the blood pressure. What is the nurse's best response? A. "You should talk to the prescriber for clarification about the medications. " B. "Many clients require two or more drugs for high blood pressure." C. "Your diet and exercise are not effective and adding another drug is ideal." D. "The prescriber has not read the current guidelines and needs an update."

B. "Many clients require two or more drugs for high blood pressure."

A male client who is an Asian executive visiting the United States presents to the emergency department with a severe headache and an elevated blood pressure. He is admitted to the hospital for treatment and regulation of his medication regimen. The client is concerned because the dosage prescribed for his antihypertensive medication is lower than what he researched on the Internet. What is an accurate response for the nurse to make? A. "I will contact the provider immediately." B. "People of Asian descent excrete the drugs more slowly, so the doses prescribed are smaller." C. "There is an error on the prescription." D. "People of Asian descent excrete the drugs more rapidly, so the doses prescribed are smaller."

B. "People of Asian descent excrete the drugs more slowly, so the doses prescribed are smaller."

A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to help to promote compliance? A. Photosensitivity B. Cough C. GI irritation D. Constipation

B. Cough

A 71-year-old male client has recently been diagnosed with hypertension. Which measurement is a partial indication of effective treatment and management? A. Systolic blood pressure below 160 mm Hg B. Diastolic blood pressure below 90 mm Hg C. Systolic blood pressure above 140 mm Hg D. Diastolic blood pressure below 100 mm Hg

B. Diastolic blood pressure below 90 mm Hg

The client is diagnosed with primary hypertension. The nurse is educating a client about dietary changes that help decrease blood pressure. Which menu selection indicates the need for further client education? A. Baked fish, broccoli, and oranges B. Ham sandwich with mustard, carrots and cheesy dip C. Salad with a grilled chicken; unsweetened tea D. Turkey sandwich on whole wheat with lettuce and tomato; sweetened tea

B. Ham sandwich with mustard, carrots and cheesy dip

A client with hypertension has been started on losartan. After 6 weeks of therapy, the healthcare provider decides that the losartan alone is not controlling the client's hypertension. What does the nurse anticipate will be added to the losartan regimen for better control of this client's hypertension? A. Antidiuretic hormone (ADH) B. Hydrochlorothiazide C. Candesartan D. Captopril

B. Hydrochlorothiazide

A 48-year-old client with a blood pressure of 198/112 mm Hg reports severe headache and drowsiness. The nurse notes that the client is disoriented and has begun to vomit. What is the primary nursing goal for this client experiencing a hypertensive emergency? A. Assess the level of head pain. B. Implement interventions to lower blood pressure. C. Administer antiemetic medication. D. Monitor the client's level of consciousness.

B. Implement interventions to lower blood pressure.

The patient has been placed on a nitroprusside drip for the treatment of a hypertensive crisis. Which mechanism of action does the nurse know is true for nitroprusside? A. It inhibits the movement of calcium ions across cell membranes. B. It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins. C. It blocks the action of angiotensin II from all the different pathways where it is formed, not just the single substrate altered by ACE inhibitors. D. It binds selectively to the mineralocorticoid receptors.

B. It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins.

A nurse is presenting a class for patients newly diagnosed with hypertension. What factor would the nurse tell the class has the greatest effect on diastolic blood pressure? A. Force of myocardial contraction B. Peripheral vascular resistance C. Pulse pressure D. Renal function

B. Peripheral vascular resistance

A client, newly diagnosed with hypertension is started on captopril, an ACE inhibitor. The client should be informed of the possibility of what adverse effect? A. Sweating B. Persistent cough C. Hypokalemia D. Sedation

B. Persistent cough

A client with a long history of hypertension has just been prescribed an alpha1-adrenergic receptor blocker. To reduce this client's risk of orthostatic hypotension and falls, the nurse should encourage the client to implement what intervention? A. Increase fluid intake for 48 hours before taking the first dose. B. Take the medication at bedtime. C. Start with a low dose and increase gradually over 2 to 3 weeks. D. Take the medication with a high-fat meal.

B. Take the medication at bedtime.

A 26-year-old white male client has been prescribed captopril for hypertension. A nurse has been assigned to the client to provide education regarding the use of this drug. The nurse will advise the client that: A. the first dose of the medication should be taken at breakfast. B. a persistent, dry cough may occur; however, it is not serious. C. if sore throat, fever, and swollen hands or feet occur, do not be alarmed. These manifestations will subside. D. he should use a salt substitute containing potassium to avoid hypokalemia.

B. a persistent, dry cough may occur; however, it is not serious.

When the cardiac workload is increased from secondary hypertension, the client is at risk for developing what associated condition? A. increased venous tone B. myocardial hypertrophy C. arterial lumen dilation D. hepatic damage

B. myocardial hypertrophy

A staff nurse on a renal unit knows that most patients require treatment for hypertensive disease. What would the nurse expect to assess prior to the beginning of antihypertensive treatment? Baseline renal function A temporary increase in renal function A sustained decrease in renal function A sustained increase in renal dysfunction

Baseline renal function Explanation: Antihypertensive drugs are frequently required by patients with renal impairment ranging from mild insufficiency to end-stage failure. It would be necessary to assess baseline renal function in these patients prior to beginning antihypertensive therapy.

A client experienced an MI 10 years ago. He is a 48-year-old man who has frequent episodes of angina. He is tachycardic. What is the first drug of choice for treatment of his condition? ARBs Calcium channel blockers Antiadrenergics Beta-blockers

Beta-blockers Explanation: Beta adrenergic blockers are the drugs of first choice for clients younger than 50 years of age with high-renin hypertension, tachycardia, angina pectoris, myocardial infarction, or left ventricular hypertrophy.

A nurse is educating a patient with hypertension who is prescribed losartan on the mechanism of action of the drug. Which mode of action helps losartan to bring about its antihypertensive effect? By preventing the conversion of angiotensin I By blocking the aldosterone receptors By preventing renin secretion By blocking the angiotensin II receptors

By blocking the angiotensin II receptors Explanation: Losartan brings about an antihypertensive effect by blocking the angiotensin II receptors. Losartan is an angiotensin II receptor antagonist. By blocking the angiotensin II receptor, the renin-angiotensin system is stopped and consequently blood pressure is reduced. Drugs such as captopril prevent the conversion of angiotensin I. Losartan does not prevent renin secretion. Losartan does not block aldosterone receptors.

Key behavioral determinants of blood pressure are related to what factor? A. Dietary consumption of sugars and fat B. Minimal body mass C. Dietary consumption of calories and salt D. Comorbidities

C. Dietary consumption of calories and salt

After receiving the results of an echocardiogram, a client has many questions regarding the results and their impact on the client's lifestyle. The client is a 57-year-old Hispanic man with a 10-year history of hypertension. The client would like to know what effect hypertension has on the heart. What is the nurse's best reply? A. Decreased risk of thrombosis B. Arterial lumen dilation C. Myocardium hypertrophy D. Increased risk for hepatic damage

C. Myocardium hypertrophy

Which enzyme would a nurse identify as being responsible for the reabsorption of sodium ions?

Carbonic anhydrase

What statement should underlie the nurse's response when asked if ACE inhibitor therapy can be continued during pregnancy? Since ACE inhibitors cross the placenta, dosage during pregnancy should be reduced. There is no research to support discontinuation of ACE inhibitor therapy during pregnancy. ACE inhibitors are contraindicated during pregnancy because they are teratogenic. ACE inhibitors will exacerbate the fluid overload that commonly accompanies pregnancy.

Correct response: ACE inhibitors are contraindicated during pregnancy because they are teratogenic. Explanation: It is important to instruct women of childbearing age to take measures to prevent pregnancy while taking captopril or other ACE inhibitors because the drugs are teratogenic. This therapy must be discontinued if pregnancy occurs.

A 48-year-old client with a blood pressure of 198/112 mm Hg reports severe headache and drowsiness. The nurse notes that the client is disoriented and has begun to vomit. What is the primary nursing goal for this client experiencing a hypertensive emergency? Implement interventions to lower blood pressure. Assess the level of head pain. Administer antiemetic medication. Monitor the client's level of consciousness.

Correct response: Implement interventions to lower blood pressure. Explanation: Hypertensive emergencies require immediate blood pressure reduction with parenteral antihypertensive drugs to limit damage to target organs. While appropriate, none of the other options have priority over decreasing the blood pressure.

How does captopril contribute to a reduction of a client's blood pressure? dilating peripheral arteries and relaxing vascular smooth muscle blocking the conversion of angiotensin I to angiotensin II increasing rebel excretion of sodium and water blocking the blood pressure-raising effects of angiotensin II

Correct response: blocking the conversion of angiotensin I to angiotensin II Explanation: ACE inhibitors such as captopril block the enzyme that normally converts angiotensin I to the potent vasoconstrictor angiotensin II. Calcium channel blockers dilate peripheral arteries and relax vascular smooth muscle. Angiotensin II receptor blockers mitigate the hypertensive effects of angiotensin II and diuretics increase water excretion.

When the cardiac workload is increased from secondary hypertension, the client is at risk for developing what associated condition? hepatic damage arterial lumen dilation increased venous tone myocardial hypertrophy

Correct response: myocardial hypertrophy Explanation: Hypertension profoundly alters cardiovascular function by increasing the workload of the heart and causing thickening and sclerosis of arterial walls. The increased cardiac workload leads to myocardial hypertrophy as a compensatory mechanism, with eventual heart failure. Because of endothelial dysfunction and arterial changes (vascular remodeling), the arterial lumen narrows. Renal damage is associated with hypertension, while increased venous tone is a compensatory mechanism for hypotension.

The nurse is caring for a 42-year-old peri-menopausal client recently diagnosed with hypertension and prescribed benazepril. The client also takes over-the-counter ibuprofen for headaches. The nurse would provide which important points when educating the client on taking the new medication? Select all that apply. Taking ibuprofen can make the drug more potent and decrease your blood pressure more, so take acetaminophen instead. Use barrier contraceptives while taking benazepril to prevent pregnancy, as it may cause severe birth defects. A dry cough may develop when taking benazepril and it is not harmful, but if it is bothersome tell the primary care provider. If swelling of the face, throat, or extremities occurs, hold the next dose and call the primary care provider immediately. Take the medication one hour before meals or two hours after meals to enhance absorption of antihypertensives.

Correct response: Use barrier contraceptives while taking benazepril to prevent pregnancy, as it may cause severe birth defects. If swelling of the face, throat, or extremities occurs, hold the next dose and call the primary care provider immediately. A dry cough may develop when taking benazepril and it is not harmful, but if it is bothersome tell the primary care provider. Explanation: A reliable birth control method, such as barrier contraception, should be used by a peri-menopausal woman to prevent severe birth defects while taking the angiotensin converting inhibitor (ACEI). Before the woman received the prescription, a negative pregnancy test should have been performed. Only captopril and moexipril must be administered 1 hour before or 2 hours after a meal to enhance absorption. Benazepril may be taken with or without food. The client beginning an ACEI needs to be taught about the symptoms of angioedema and to not take the next dose, but call the primary care provider (PCP) immediately for further instructions. If the client would have problems breathing, the PCP would instruct the client to call "911". The client taking ACEIs should not take NSAIDs, such as ibuprofen, because they decrease the effectiveness of the ACEI. A side effect of ACEIs is a dry cough, which if bothersome may be treated by the PCP with agents such as cromolyn or a local anesthetic.

Which statement by a client taking a sulfonamide requires further instruction? a) "I will take all of my medicine even if my symptoms go away." b) "I will take my medicine with my meals like it says on the prescription bottle." c) "I will make sure to use extra sunscreen when I go to the tanning booth." d) "I will be sure to drink a full glass of water every time I take my medicine."

Correct response: "I will make sure to use extra sunscreen when I go to the tanning booth." Explanation: Clients taking sulfonamides should avoid any exposure to sunlight or ultraviolet light, such as tanning beds or sunlamps. Extra sunscreen would not protect the client from the photosensitivity effect of the medication. The client is correct in stating that he would complete the entire course of the medication, would drink a full glass of water with each pill, and would take the medication with meals.

A physician is considering ordering hydrochlorothiazide for a patient. This drug must be used cautiously, if at all, if the patient has a history of

Correct response: hypersensativity to sulfonamides. Explanation: Thiazide diuretics, such as hydrochlorothiazide, are chemically related to sulfonamide drugs. Thiazides may be contraindicated in patients allergic to sulfonamides because of cross-sensitivity.

A nurse is educating a patient with hypertension who is prescribed losartan on the mechanism of action of the drug. Which mode of action helps losartan to bring about its antihypertensive effect? A. By preventing the conversion of angiotensin I B. By blocking the aldosterone receptors C. By preventing renin secretion D. By blocking the angiotensin II receptors

D. By blocking the angiotensin II receptors

A 46-year-old client with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension after serial blood pressure readings. The clinician has opted to begin the client on captopril (Capoten). The nurse should recognize that the therapeutic effect of this drug is achieved in what way? A. By directly relaxing vascular smooth muscle B. By blocking the movement of calcium ions into arterial smooth muscles C. By blocking aldosterone from binding to mineralocorticoid receptors D. By inhibiting the transformation of angiotensin I to angiotensin II

D. By inhibiting the transformation of angiotensin I to angiotensin II

The client has been started on an ACE inhibitor for hypertension. The client also takes spironolactone (Aldactone) daily. The nurse would evaluate the client for which of the following? A. Hypokalemia B. Hypocalcemia C. Hypercalcemia D. Hyperkalemia

D. Hyperkalemia

The nurse is providing drug teaching for a client who is prescribed enalapril. What drug-specific adverse effect will the nurse include in the drug teaching? A. Hypersensitivity reaction B. Sedation C. Hepatic dysfunction D. Persistent cough

D. Persistent cough

On several occasions, the nurse checks a client's blood pressure. The readings are 130/79 mm Hg, 136/78 mm Hg, and 128/88 mm Hg. What term would the nurse use to document the client's blood pressure? A. Stage 2 hypertension B. Elevated C. Normal D. Stage 1 hypertension

D. Stage 1 hypertension

A client has been diagnosed with primary hypertension. Which medications are used to treat primary hypertension? A. Loop diuretics B. C. Beta adrenergic antagonists D. Thiazide diuretics E. Angiotensin receptor blockers (ARBs) F. Angiotensin converting enzymes (ACEs)

D. Thiazide diuretics E. Angiotensin receptor blockers (ARBs) F. Angiotensin converting enzymes (ACEs)

The nurse should inform the client of the possibility of developing what common adverse effect of captopril therapy? A. photosensitivity B. rhinitis C. rash to the trunk and extremities D. dry cough

D. dry cough

The goal of therapy for a client taking antihypertensive medication is to maintain: A. a fluid volume balance. B. compliance. C. homeostasis. D. the blood pressure within normal limits.

D. the blood pressure within normal limits.

The nurse would encourage clients with prehypertension to follow what type of diet? High-sodium diet High-protein diet DASH diet Restricted-calorie diet

DASH diet Explanation: It is recommended that client with early or prehypertension should follow the Dietary Approaches to Stop Hypertension (DASH) diet, which encourages the client to eat a diet abundant in fresh fruits and vegetables and low-fat dairy products. Most clients with hypertension are encouraged to eat food low in sodium. A restricted-calorie diet is only recommended if the client is overweight. A high-protein diet is not recommended because of the effect on the kidneys.

You are caring for a 53-year-old man with a 30-year history of alcohol dependency. He presents with ascites, secondary to cirrhosis. Which mechanism is involved in his fluid shift?

Decreased plasma oncotic pressure may occur with decreased synthesis of plasma proteins caused by liver disease

Upon her visit to your primary care physician's office, your patient presents with 14 pounds of additional weight since her visit 3 weeks ago. Her lower extremities are quite swollen, and her facial features are puffy. The physician prescribes a diuretic and requests a follow-up visit in 3 days. By what mechanism should the prescribed diuretic decrease the patient's onboard fluid? a) Sodium depletion b) Unknown mechanism c) Increasing plasma volume d) Decreasing plasma volume

Decreasing plasma volume Explanation: In edematous states, diuretics mobilize tissue fluids by decreasing plasma volume.

A 71-year-old male client has recently been diagnosed with hypertension. Which measurement is a partial indication of effective treatment and management? Diastolic blood pressure below 100 mm Hg Systolic blood pressure above 140 mm Hg Systolic blood pressure below 160 mm Hg Diastolic blood pressure below 90 mm Hg

Diastolic blood pressure below 90 mm Hg Explanation: Successful treatment involves reducing blood pressure below hypertensive levels. In adults, this is typically defined as a systolic pressure below 140 mm Hg and a diastolic pressure below 90 mm Hg.

Key behavioral determinants of blood pressure are related to what factor? Minimal body mass Dietary consumption of sugars and fat Comorbidities Dietary consumption of calories and salt

Dietary consumption of calories and salt Explanation: Key behavioral determinants of blood pressure are related to dietary consumption of calories and salt; the prevalence of hypertension rises proportionally to average body mass index.

The client presents to the health care provider with a new onset of bradycardia. The nurse recognizes that which of the following antihypertensives can cause bradycardia? a) Labetalol b) Clonidine c) Diltiazem d) Enalapril

Diltiazem Explanation: Diltiazem is a calcium channel blocker that can cause atrioventricular block and bradycardia. Labetalol's adverse reactions include fatigue, drowsiness, insomnia, and hypotension. Clonidine's adverse reactions include drowsiness, dizziness, dry mouth, and constipation. Clients on enalapril can experience headache and dizziness

The client presents to the health care provider with a new onset of bradycardia. The nurse recognizes that which of the following antihypertensives can cause bradycardia? a) Diltiazem b) Labetalol c) Clonidine d) Enalapril

Diltiazem Explanation: Diltiazem is a calcium channel blocker that can cause atrioventricular block and bradycardia. Labetalol's adverse reactions include fatigue, drowsiness, insomnia, and hypotension. Clonidine's adverse reactions include drowsiness, dizziness, dry mouth, and constipation. Clients on enalapril can experience headache and dizziness.

What drug is a safe and effective calcium channel blocker only if given as sustained-release or extended-release preparations to treat hypertension? a) Diltiazem (Cardizem) b) Metoprolol (Lopressor) c) Aliskiren (Tekturna) d) Atenolol (Tenormin)

Diltiazem (Cardizem)The calciumchannel blockers available in immediate-release and sustained-release forms that are used in treating hypertension include amlodipine (Norvasc), felodipine (Plendil), isradipine (DynaCirc, DynaCirc CR), and nicardipine (Cardene, Cardene SR). Other calcium channel blockers are safe and effective for this use only if they are given as sustained-release or extended-release preparations. These include diltiazem (Cardizem, Dilacor CR), nifedipine (Procardia XL), nisoldipine (Sular), and verapamil (Calan SR). Aliskiren (Tekturna) is a rennin inhibitor. Atenolol (Tenormin) and Metoprolol (Lopressor) are beta blockers, not calcium channel blocker.

The pharmacology instructor is discussing the various diuretic agents and their sites of action in the nephron. In what part of the nephron do thiazide diuretics act?

Distal tubule-

When evaluating an 82-year-old patient receiving hydrochlorothiazide (HydroDIURIL), which of the following laboratory value deviations may be related to the medication?

Elevated uric acid levels Explanation: Uric acid excretion also is decreased because the thiazides interfere with its secretory mechanism. High levels of uric acid can result in a condition called gout. Hydrochlorothiazide does not cause reduced BUN levels. Options C and D are normal values.

What term is used to describe the process that moves fluid and small particles out of the blood through the glomerulus and into the nephron tubule

Filtration

A deficiency in antidiuretic hormone (ADH) would be primarily associated with which condition?

Fluid imbalance-Antidiuretic hormone (ADH)is important in maintaining fluid balance.

A patient has been advised to use a transdermal patch of clonidine for hypertension. For which of the following time periods should the nurse ensure that the patch is intact? For three weeks For four weeks For two weeks For one week

For one week Explanation: The nurse should ensure that the transdermal patch is intact for a period of one week. A clonidine transdermal patch should be applied to a hairless area over the torso for one week. If the patch loosens before seven days, it has to be reinforced. The nurse has to mark the date of placement and the date of removal of the patch on the surface of the patch.

A patient has been advised to use a transdermal patch of clonidine for hypertension. For which of the following time periods should the nurse ensure that the patch is intact? a) For three weeks b) For four weeks c) For two weeks d) For one week

For one week Explanation: The nurse should ensure that the transdermal patch is intact for a period of one week. A clonidine transdermal patch should be applied to a hairless area over the torso for one week. If the patch loosens before seven days, it has to be reinforced. The nurse has to mark the date of placement and the date of removal of the patch on the surface of the patch.

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?

Glucose and protein

The client is diagnosed with primary hypertension. The nurse is educating a client about dietary changes that help decrease blood pressure. Which menu selection indicates the need for further client education? Baked fish, broccoli, and oranges Salad with a grilled chicken; unsweetened tea Ham sandwich with mustard, carrots and cheesy dip Turkey sandwich on whole wheat with lettuce and tomato; sweetened tea

Ham sandwich with mustard, carrots and cheesy dip Explanation: A ham sandwich with mustard and a cheesy dip has increased fat and sodium. The DASH diet includes whole grains, poultry, fish, and nuts and has reduced amounts of fats, red meats, sweets, and sugared beverages.

The client has been started on an ACE inhibitor for hypertension. The client also takes spironolactone (Aldactone) daily. The nurse would evaluate the client for which of the following? a) Hypercalcemia b) Hypocalcemia c) Hyperkalemia d) Hypokalemia

Hyperkalemia Explanation: When ACE inhibitors are combined with potassium-sparing diuretics, the client is at risk for elevated potassium levels. Therefore, hyperkalemia, not hypokalemia, is the risk. Calcium levels are not affected.

A nurse is preparing to administer spironolactone to a client. The nurse would question this order if which disorder is noted in the client's history?

Hyperkalemia-The nurse should know that potassium-sparing diuretics are contraindicated in clients with hyperkalemia and are not recommended for children. Potassium-sparing diuretics should be used cautiously in clients with liver disease, diabetes, or gout.

A health care provider has prescribed a loop diuretic for a client with hypertension. The client also has diabetes mellitus. What condition should the nurse monitor for in this client after administering the prescribed drug?

Increased blood glucose levels

Once a client develops primary hypertension, therapy should last for how long? (Choose one) a) 5 years b) One year c) Until blood pressure is 120/80 mmHg d) Lifelong

Lifelong Explanation: Once primary hypertension develops, management of the disorder becomes a lifetime task.

Ms. Crampton is prescribed furosemide for chronic heart failure. The nurse knows that furosemide can cause electrolyte imbalances and what other serious side effect? a) Compensated respiratory acidosis b) Metabolic alkalosis c) Compensated respiratory alkalosis d) Metabolic acidosis

Metabolic alkalosis Explanation: Most of furosemide's adverse effects relate to fluid or electrolyte imbalance. Electrolyte imbalances, which are most likely to occur within the first 2 weeks of therapy, include hyponatremia, hypokalemia, hypochloridemia, and hypocalcemia. Loss of hydrogen ions can also lead to metabolic alkalosis.

The client is to start on lisinopril for hypertension. Prior to administration of the medication, the blood pressure is 112/76 mm Hg. What is the nurse's most appropriate action? a) Administer the medication. b) Retake the blood pressure in 30 minutes. c) Hold the medication. d) Notify the health care provider.

Notify the health care provider. Explanation: The client's blood pressure is within the normal range. It is important that the nurse notify the provider of the client's blood pressure so that the need can be further evaluated. The nurse should not hold the medication; the provider must determine the best course of action.

A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route?

Oral-Hydrochlorothiazide is only available as an oral preparation. Only chlorothiazide can be given by intravenous infusion.

A client is started on trandolapril (Mavik). The client should be instructed that what is a common adverse effect of ACE inhibitor therapy? Persistent cough Rash Sedation Tachycardia

Persistent cough Explanation: A persistent cough develops in approximately 10% to 20% of clients and may lead to stopping the drug.

A client is started on trandolapril (Mavik). The client should be instructed that which of the following is a common adverse effect of ACE inhibitor therapy? a) Rash b) Sedation c) Tachycardia d) Persistent cough

Persistent cough Explanation: A persistent cough develops in approximately 10% to 20% of clients and may lead to stopping the drug.

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?

Potassium levels

A student asks the pharmacy instructor what the difference is between the diuretics spironolactone (Aldactone) and furosemide (Lasix). What would the instructor reply? a) Potassium losses are greater with spironolactone b) Water losses are greater with spironolactone c) Sodium losses are greater with spironolactone d) Potassium losses are less with spironolactone

Potassium losses are less with spironolactone Correct Explanation: The potassium-sparing diuretics are not as powerful as the loop diuretics, but they retain potassium instead of wasting it. Therefore Options B, C, and D are incorrect.

You are a clinic nurse who is assessing a new patient prior to their seeing the physician. The patient has a history of hypertension and tells you they are taking benazepril (Lotensin) to control their disease process. A priority nursing assessment in this patient would be to assess them for a history of what? a) Hepatic disease b) Peptic ulcer disease c) Mental illness d) Renal disease

Renal disease Explanation: Benazepril is an ACE inhibitor and these drugs are contraindicated in the presence of impaired renal function. Mental illness, hepatic, or peptic ulcer disease is not a contraindication with this drug.

During a routine check up of a 45-year-old patient with renal disease, the nurse observes an increase in the patient's blood pressure. Which is the most likely consequence of renal impairment? Secondary hypertension Essential hypertension Rebound hypertension Hypertensive emergency

Secondary hypertension Explanation: Secondary hypertension results as a consequence of renal impairment. In secondary hypertension there is usually a known cause for the development of hypertension. Renal disease is one of the causes of secondary hypertension. When there is no known cause of hypertension it is called essential hypertension. Rebound hypertension occurs when a patient abruptly stops taking antihypertensive medication. Hypertensive emergency is a high blood pressure state that has to be lowered immediately.

About 80% of water, sodium, potassium, and other substances is reabsorbed during renal processing; the remaining 20% enters the loop of Henle. What substance is reabsorbed in the ascending limb of the loop of Henle? a) Amino acids b) Sodium c) Glucose d) Water

Sodium Explanation: In the ascending limb of the loop of Henle, sodium is reabsorbed.

A male client has cirrhosis and is receiving diuretic therapy. The nurse knows that what drug will help prevent metabolic alkalosis or hypokalemia in this client?

Spironolactone-For clients with cirrhosis, diuretic therapy should be initiated in a hospital setting, with small doses and careful monitoring. To prevent hypokalemia and metabolic alkalosis, supplemental potassium or spironolactone may be needed.

A client with a blood pressure of 165/95 mmHg would be in classified as which stage of hypertension? Stage 1 Prehypertension Stage 2 Normotensive Hypertensive urgency

Stage 2 Explanation: A client is diagnosed with stage 2 hypertension when their systolic blood pressure is greater than or equal to 160 or their diastolic blood pressure is greater than or equal to 100.

The client has a blood pressure of 165/100 mmHg. The nurse knows that this client would be in classified as which stage of hypertension? a) Normotensive b) Stage 1 c) Stage 2 d) Prehypertension

Stage 2 Explanation: A client is diagnosed with Stage 2 hypertension when his or her systolic blood pressure is greater than or equal to 160 mm Hg OR the diastolic blood pressure is greater than or equal to 100 mm Hg.

A client has been prescribed hydrochlorothiazide, and the nurse is preparing to give the client discharge instructions. Which adverse effects should the nurse caution the client about?

The adverse effects associated with hydrochlorothiazide are dizziness, vertigo, orthostatic hypotension, nausea, anorexia, vomiting, dry mouth, diarrhea, constipation, polyuria, nocturia, muscle cramps, and spasms

A nurse understands that loop diuretics are considered high ceiling diuretics because of which of the following? a) They require large doses to achieve effect. b) They are associated with more adverse effects. c) They cause a greater diuresis. d) They cause a greater loss of potassium.

They cause a greater diuresis. Explanation: High ceiling diuretics are those that cause a greater degree of diuresis than other diuretics.

The health care provider indicates that a client experiencing renal failure is not a candidate for therapy with potassium-sparing diuretics. How will the nurse respond when the client's family member asks why this is the case?

They may cause hyperkalemia- Potassium-sparing diuretics accumulate in renal insufficiency and present the risk for hyperkalemia. For this reason, health care practitioners typically avoid the drug in this population. Potassium-sparing diuretics decrease potassium excretion, and, by themselves, they are weak diuretics. Rebound edema may be a concern when a diuretic is discontinued, but it is not the reason this client is a poor candidate for a potassium-sparing diuretic.

A 26-year-old white male client has been prescribed captopril for hypertension. A nurse has been assigned to the client to provide education regarding the use of this drug. The nurse will advise the client that: he should use a salt substitute containing potassium to avoid hypokalemia. a persistent, dry cough may occur; however, it is not serious. if sore throat, fever, and swollen hands or feet occur, do not be alarmed. These manifestations will subside. the first dose of the medication should be taken at breakfast.

a persistent, dry cough may occur; however, it is not serious. Explanation: The nurse will advise the client that the captopril may produce a persistent, dry cough that is not serious. Clients may want to discontinue therapy because of the cough, but the nurse should encourage the client to continue therapy and help the client minimize the cough. However, if the cough becomes intolerable, the client should contact the prescriber. The client should be instructed to take the first dose at bedtime to minimize the possibilities of injury from first-dose hypotension. The client should be advised to notify the prescriber promptly if sore throat; fever; swollen hands or feet; irregular heartbeat; chest pain; swollen face, eyes, lips and tongue; difficulty breathing; or hoarseness occur. These effects could indicate angioedema, which can be life threatening. If the client normally uses a salt substitute containing potassium or a potassium supplement, these substances may need to be discontinued to avoid possible hyperkalemia. Hypokalemia is not a concern.

The nurse should inform the client of the possibility of developing what common adverse effect of captopril therapy? dry cough photosensitivity rhinitis rash to the trunk and extremities

dry cough Explanation: A persistent cough develops in a significant number of clients taking captopril, and this problem may lead to discontinuation of the drug. Photosensitivity, rhinitis, and rash are not common adverse effects of ACE inhibitors.

A female patient reports that she has frequent muscle cramps while on hydrochlorothiazide therapy. The nurse will advise her to a) take calcium supplements. b) eat potassium-rich foods. c) include high-sodium foods in her diet. d) drink plenty of fluids.

eat potassium-rich foods. Explanation: The patient is most likely experiencing muscle cramps due to potassium loss. Therefore, the nurse should advise her to include potassium supplements in her diet. Drinking plenty of fluids or using calcium supplements will not reduce the occurrence of cramps. It is important to caution the patient to avoid foods high in sodium because they could counteract the effects of drug therapy

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:

hypersensitivity to sulfonamides.

A physician has prescribed triamterene to a client with renal disease. The client informs the nurse that they are taking potassium supplements to address some heart problems. The nurse would be alert for which of the following?

increased risk of hyperkalemia.-

The students are studying the male reproductive system. The instructor tells the students that in the male, the urethra leaves the urinary bladder and passes through the:

prostate gland.

A clinic nurse is assessing a new client prior to the client seeing the health care provider. The client has a history of hypertension and takes benazepril (Lotensin) to control the disease process. A priority nursing assessment in this client would be to assess the client for a history of: peptic ulcer disease. hepatic disease. renal disease. mental illness.

renal disease. Explanation: Benazepril is an ACE inhibitor and these drugs are contraindicated in the presence of impaired renal function. Mental illness, hepatic, or peptic ulcer disease is not a contraindication with this drug.

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?

¼-The kidneys receive approximately 25% or ¼ of the cardiac output.

Choice Multiple question - Select all answer choices that apply. Which of the following drugs cause diuresis by inhibiting re-absorption of sodium and chloride ions in the distal and proximal tubules and in the loop of Henle? Select all that apply: a) Spironolactone (Aldactone) b) Furosemide (Lasix) c) Chlorothiazide (Diuril) d) Mannitol (Osmitrol) e) Bumetanide (Bumex)

• Furosemide (Lasix) • Bumetanide (Bumex) Explanation: Loop diuretics, like furosemide (Lasix) and bumetanide (Bumex), cause diuresis by inhibiting re-absorption of sodium and chloride ions in the distal and proximal tubules and in the loop of Henle.

The client has been taking hydrochlorothiazide for hypertension. Which of the following manifestations would lead the nurse to believe the client is experiencing hyponatremia?

• Hypotension • Confusion • Tachycardia Explanation: Symptoms of hyponatremia include irritability, hypotension (not hypertension), tachycardia, and confusion. Lethargy is not related to hyponatremia

A client is admitted in acute renal failure and prescribed mannitol. The nurse prepares to administer this drug via which route?

Intravenously-Mannitol is administered intravenously. It is not given intramuscularly, subcutaneously, or orally.

A patient with a longstanding diagnosis of chronic renal failure has experienced a significant decline in urine output in recent days, prompting him to seek care at a local clinic. A nurse at the clinic has suggested to a colleague that the administration of a diuretic such as hydrochlorothiazide may improve the patient's urine output. How should the colleague best respond to this suggestion?

"Actually, patients with renal failure usually can't take hydrochlorothiazide." Correct Explanation: Renal disease and severe renal impairment contraindicate the use of hydrochlorothiazide. HCTZ affects the kidneys, not the bladder, and is not administered intravenously.

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

2 L

A 10-year-old child has edema caused by a heart defect. The patient is taking furosemide (Lasix). The dosage is 6 mg/kg per day. The child weighs 76 pounds. How many mg does the child receive in each dose? a) 50 mg b) 105 mg c) 210 mg d) 20 mg

210 mg Explanation: The nurse will administer 210 mg per dose of the drug (2.2 lbs : 1 kg = 76 lbs : X kg, 76 divided by 2.2 = 34.5, 35 times 6 = 210 mg).

You are monitoring serum electrolyte levels in a 55-year-old patient who has been prescribed digoxin and a potassium-sparing diuretic for treatment of heart failure. Which of the following potassium levels would you hope to see for this patient?

4.0 mEq/L Explanation: One goal of treatment is to maintain normal serum potassium levels, which are between 3.5 mEq/L and 5.0 mEq/L. Levels below or above that range are indicative of hypokalemia or hyperkalemia, respectively

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 71-year-old female who has advanced arteriosclerosis-While patients with diabetes or advanced arteriosclerosis should be monitored closely during hydrochlorothiazide therapy, older patients (over 65 years), especially women, are more at risk for hyponatremia. Older adults and their family members must be advised to report symptoms of hyponatremia such as weakness, nerve disorders, weight loss, salt hunger, cramps, and digestive problems.

Some drugs can increase the effects of diuretics. Drugs from what category, when taken concomitantly with some diuretics, increase the risk of hearing loss? a) Oral contraceptives b) Aminoglycoside antibiotics c) Antihypertensive agents d) Corticosteroids

Aminoglycoside antibiotics Explanation: Additive ototoxicity can occur with concomitant use of some diuretics (e.g., ethacrynic acid) and aminoglycoside antibiotics. Concomitant use of antihypertensive agents can cause additive hypotensive effects; concomitant use of corticosteroids can lead to additive hypokalemia. Concomitant use of oral contraceptives can decrease the effects of diuretics, resulting in retention of water and sodium

Mr. Emmeott is seen by the physician for follow-up for diabetic nephropathy. The physician prescribed losartan for the treatment of this condition because the medication has been shown to reduce the rate of end-stage renal disease. Which drug class does this drug belong to? a) Angiotensin II receptor blockers b) Selective aldosterone blockers c) Calcium channel blockers d) Antihyperlipidemic drugs

Angiotensin II receptor blockers Explanation: Losartan is an angiotensin II receptor blocker (ARB) and is recommended for patients with diabetic renal disease because ARBs have been shown to reduce the rate of end-stage renal disease.

What assessment finding in a patient with heart failure receiving furosemide would indicate an improvement in fluid volume status? A. absence of crackles on auscultation of lungs B. complaints of proximal nocturnal dyspnea C. bounding radial pulse D. decrease in hematocrit

Answer: A Rationale: The nurses assesses for decreased or absent edema, increased urine output, and decreased blood pressure. In patients with heart failure or acute pulmonary edema, it is necessary to observe for decreased dyspnea, crackles, cyanosis and cough.

A patient reports a drug allergy to sulfonamides. Which diuretic drug class should the nurse question if ordered for the patient? A. loop diuretics B. thiazides C. potassium-sparing diuretics D. osmotic diuretics

Answer: B Rationale: It is essential to use thiazide diuretics and related drugs cautiously in patients who are allergic to sulfonamide drugs because there is a known cross-sensitivity of some sulfonamide-allergic patients to a sulfonamide non-antibiotic.

Mrs. Conley, age 53, has had hypertension for 10 years and admits that she does not comply with her prescribed antihypertensive therapy. Recently, she has begun to experience shortness of breath and ankle swelling. A workup reveals the presence of chronic renal insufficiency. What classification of diuretic is the first drug of choice for the nurse practitioner to prescribe? A. thiazide B. loop C. osmotic D. potassium sparing

Answer: B Rationale: Loop diuretics are the diuretics of choice when rapid effects are required (pulmonary edema) and when renal function is impaired (creatinine clearance less than 30 mL/min). Furosemide (loop diuretic) is useful when given alone or in combination with other antihypertensive agents to treat hypertension. Uses also include management of acute pulmonary edema, heart failure, as well as hepatic and renal disease.

A nurse is instructing a patient on dietary considerations while taking spironolactone (Aldactone). Which of the following statements made by the patient indicates that further teaching is necessary? A. "I should not eat foods high in potassium while taking this medication." B. "I should use a salt substitute instead of regular salt." C. "I should call my nurse practitioner if I have any significant adverse effects from my medications." D. "I should not take large amounts of potassium chloride supplements."

Answer: B Rationale: The patient teaching for spironolactone consists of the need for routine blood pressure readings, potential side effects (dizziness or drowsiness), and avoid activities that require mental alertness (driving, operating machinery). It is essential that patients receiving potassium-sparing diuretics do not receive potassium supplements and do not eat foods high in potassium or use salt substitutes.

A patient receives intravenous (IV) furosemide 80 mg for symptoms of severe heart failure. The nurse recognizes that administering the drug slowly by IV push reduces the likelihood of which of the following adverse effects of drug therapy? A. hyponatremia B. hypokalemia C. fluid volume deficit D. ototoxicity

Answer: D Rationale: The nurse gives IV injections of furosemide over 1 to 2 minutes and administers high-dose furosemide continuous IV infusions at a rate of 4 mg/min or less. This decreased or avoids high peak serum levels, which increases the risk of adverse effects, hyponatremia, hypokalemia, fluid volume deficit and ototoxicity. It is usually possible to avoid ototoxicity, which is associated with high plasma drug levels (greater than 50 mcg/mL), by dividing oral doses and by slow injection or continuous infusion of IV doses.

The nurse has finished a teaching session with a client who is prescribed a diuretic to be taken twice a day. The nurse determines the session is successful when the client correctly chooses which times to take the drug?

At breakfast and midafternoon-Twice-a-day dosing should be administered early in the morning (e.g., 0700) and early afternoon (e.g., 1400) to prevent the drug from interfering with the client's sleep.

A physician has prescribed a bumetanide drug to a patient with renal insufficiency. The patient has high blood pressure. Which of the following instructions should the nurse include in the teaching plan for this patient? a) Always take the drug before meals. b) Avoid OTC drugs for appetite suppression. c) Omit the drug dose when feeling dizzy. d) Avoid salt substitutes containing potassium.

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

A 46-year-old man with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension by his primary care provider after serial blood pressure readings. The clinician has opted to begin the patient on captopril (Capoten). The patient's nurse should recognize that the therapeutic effect of this drug is achieved in what way? a) By blocking aldosterone from binding to mineralocorticoid receptors b) By inhibiting the transformation of angiotensin I to angiotensin II c) By directly relaxing vascular smooth muscle d) By blocking the movement of calcium ions into arterial smooth muscles

By inhibiting the transformation of angiotensin I to angiotensin II Explanation: Captopril inhibits the ACE needed to change the inactive angiotensin I to the active form angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, thus preventing sodium and water retention. Captopril therefore decreases peripheral vascular resistance and lowers blood pressure. Calcium channel blockers such as verapamil block the movement of calcium ions into arterial smooth muscles and aldosterone blockers such as Eplerenone (Inspra) inhibit aldosterone from binding to mineralocorticoid receptors. ACE inhibitors do not have a direct effect on vascular smooth muscle.

A 46-year-old man with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension by his primary care provider after serial blood pressure readings. The clinician has opted to begin the patient on captopril (Capoten). The patient's nurse should recognize that the therapeutic effect of this drug is achieved in what way? a) By blocking the movement of calcium ions into arterial smooth muscles b) By blocking aldosterone from binding to mineralocorticoid receptors c) By inhibiting the transformation of angiotensin I to angiotensin II d) By directly relaxing vascular smooth muscle

By inhibiting the transformation of angiotensin I to angiotensin II Explanation: Captopril inhibits the ACE needed to change the inactive angiotensin I to the active form angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, thus preventing sodium and water retention. Captopril therefore decreases peripheral vascular resistance and lowers blood pressure. Calcium channel blockers such as verapamil block the movement of calcium ions into arterial smooth muscles and aldosterone blockers such as Eplerenone (Inspra) inhibit aldosterone from binding to mineralocorticoid receptors. ACE inhibitors do not have a direct effect on vascular smooth muscle.

When deciding which drug to use to treat a patient with hypertension, the physician may choose to order an ARB (angiotensin II receptor blocker) over an ACE inhibitor. The rationale for this choice of drug therapy may be based on the fact that an ARB is less likely to cause what adverse effects? a) Palpitations b) Bradycardia c) Orthostatic hypotension d) Hyperkalemia

Correct response: Hyperkalemia Explanation: ARBs are less likely to cause hyperkalemia than ACE inhibitors. They are not generally less likely to cause orthostatic hypotension, palpitations, or bradycardia.

A physician has prescribed triamterene to a patient with renal disease. The patient informs the nurse that he is taking potassium supplements to overcome cardiovascular problems. What effect of the interaction between these two drugs should the nurse look for in the patient? a) Decreased diuretic effectiveness b) Increased risk of hyperkalemia c) Increased risk of arrhythmias d) Increased risk of bleeding

Correct response: Increased risk of hyperkalemia Explanation: The nurse should inform the patient about the increased risk of hyperkalemia as the effect of the interaction between triamterene, which is a potassium-sparing diuretic, and potassium supplements. When the patient is administered loop diuretics with anticoagulants or thrombolytics, there will be increased risk of bleeding. When the patient is administered digitalis with loop diuretics, there is an increased risk of arrhythmias. Decreased diuretic effect, in this case decreased effect of triamterene, will occur when a potassium-sparing diuretic such as triamterene is administered with NSAIDs, salicylates, and anticoagulants.

The staff educator in the ICU is talking with a group of new nurses about osmotic diuretics. The educator would tell the new nurses that osmotic diuretics act upon which site in the nephron?

Descending limb of loop of Henle Explanation: These drugs are freely filtered at the renal glomerulus, poorly reabsorbed by the renal tubule, not secreted by the tubule, and resistant to metabolism. Therefore Options A, C, and D are incorrect.

An elderly patient with a history of congestive heart failure has been admitted to hospital with failure to thrive and admission blood work reveals a hemoglobin level of 6.9 g/dL. The care team has consequently administered two units of packed red blood cells, but auscultation of the client's lungs now reveals diffuse crackles. Administration of what drug is likely to resolve the patient's pulmonary edema? a) Hydrochlorothiazide b) Furosemide c) Mannitol d) Triamterene

Furosemide Explanation: Furosemide can be given intravenously to provide rapid relief from pulmonary edema. Mannitol is not normally used to treat pulmonary edema and neither HCTZ nor triamterene is used in the acute treatment of pulmonary edema.

An elderly patient with a history of congestive heart failure has been admitted to hospital with failure to thrive and admission blood work reveals a hemoglobin level of 6.9 g/dL. The care team has consequently administered two units of packed red blood cells, but auscultation of the client's lungs now reveals diffuse crackles. Administration of what drug is likely to resolve the patient's pulmonary edema? a) Triamterene b) Hydrochlorothiazide c) Mannitol d) Furosemide

Furosemide Explanation: Furosemide can be given intravenously to provide rapid relief from pulmonary edema. Mannitol is not normally used to treat pulmonary edema and neither HCTZ nor triamterene is used in the acute treatment of pulmonary edema.

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?

He is consuming excessive salty foods at the games.-Excessive table salt and salty foods (e.g., ham, packaged sandwich meats, potato chips, dill pickles, most canned soups) may aggravate edema or hypertension.

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?

Hyperkalemia

Your 91-year-old patient is being discharged on the diuretic spironolactone (Aldactone). What is the major adverse effect of this type of medication? a) Hypokalemia b) Hyperkalemia c) Hypertension d) Gastric irritation

Hyperkalemia Explanation: The most common adverse effect of potassium-sparing diuretics is hyperkalemia, which can cause lethargy, confusion, ataxia, muscle cramps, and cardiac arrhythmias. This makes Options A, C, and D incorrect.

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?

Hyperkalemia-The major adverse effect of potassium-sparing diuretics such as spironolactone is hyperkalemia. Clients receiving these drugs should not be given potassium supplements and should not be encouraged to eat foods high in potassium.

A client who has been taking hydrochlorothiazide arrives at the clinic for his 1-month follow-up appointment. The client tells the nurse that he feels weaker since he began taking the drug. What should the nurse consider as a possible cause of these symptoms?

Hypokalemia

A client who has been taking hydrochlorothiazide arrives at the clinic for his 1-month follow-up appointment. The client tells the nurse that he feels weaker since he began taking the drug. What should the nurse consider as a possible cause of these symptoms? a) Hypocalcemia b) Hyperkalemia c) Hypokalemia d) Hypercalcemia

Hypokalemia Explanation: Thiazides, such as hydrochlorothiazide, are potassium-losing diuretics, and their use can lead to hypokalemia. Symptoms of hypokalemia include muscle weakness, dysrhythmia, hypotension, anorexia, and and shallow respirations.

A physician has prescribed a loop diuretic for a patient with hypertension. The patient also has diabetes mellitus. What condition should the nurse monitor for in this patient after administering the prescribed drug? a) Sudden increase in weight b) Sudden pain in the joints c) Increased blood glucose levels d) Occurrence of gout attacks

Increased blood glucose levels Explanation: The nurse should monitor for increased blood glucose levels in the diabetic patient receiving a loop diuretic. The blood glucometer test results for glucose for these patients may be elevated (blood) or urine may test positive for glucose. Thiazide diuretic agents may cause gout attacks and sudden joint pain. The nurse need not monitor for a sudden increase in weight as the administration of loop diuretics to a diabetic patient will not cause this effect.

Hydrochlorothiazide works by what mechanism of action? a) Increasing the excretion of sodium and chloride in the distal tubule b) Decreasing sodium absorption in the loop of Henle c) Increasing water reabsorption in the ascending loop of Henle d) Promoting increased chloride concentrations in the urine

Increasing the excretion of sodium and chloride in the distal tubule Explanation: Hydrochlorothiazide acts in the distal tubule and possibly in the diluting segment of the ascending loop of Henle. It increases the excretion of sodium and chloride in the distal convoluted tubule by slightly inhibiting the ion pumps that work in sodium and chloride reabsorption. This action also inhibits water reabsorption.

You are caring for a 53-year-old man with a 30-year history of alcohol dependency. He presents with ascites, secondary to cirrhosis, with weeping edema of his lower extremities. To decrease his onboard fluid, combination diuretic therapy is used. When his urine output doesn't meet the physician's expectations, what would you expect the physician to do with the low diuretic dosage? a) Decrease the dose b) Discontinue the diuretics c) Increase the dose d) Leave the dose the same

Leave the dose the same Explanation: In liver disease, small doses of all diuretics are usually indicated because diuretic-induced electrolyte imbalances may precipitate or aggravate hepatic coma. The physician may add additional diuretic drugs, but they would be low doses

Upon her visit to your primary care physician's office, your patient presents with 14 pounds of additional weight since her visit 3 weeks ago. Her lower extremities are quite swollen, and her facial features are puffy. The physician prescribes a diuretic and requests a follow-up visit in 3 days. Two days later, the patient contacts the office so dyspneic she is hard to understand over the phone. An ambulance is dispatched, and she is admitted to the hospital for rapid diuresing. Which diuretic will most likely be the initial drug of choice? a) Thiazide b) Loop diuretic c) Osmotic diuretic d) Potassium-sparing diuretic

Loop diuretic Correct Explanation: Loop diuretics are the diuretics of choice when rapid effects are required.

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?

Mannitol

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

Mannitol-Mannitol is a powerful osmotic diuretic that is used to treat increased intracranial pressure. It is given intravenously and begins to work in 30 to 60 minutes. Furosemide, amiloride, and bumetanide are not indicated for the treatment of increased intracranial pressure.

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

Monitoring of serum electrolytes, creatinine, and BUN

A group of students are reviewing the structure and function of the renal system. The students demonstrate understanding when they identify what as the functional unit?

Nephron

The client has just been diagnosed with acute renal failure. The client asks the nurse what functional units of the kidneys are involved. What would the nurse reply?

Nephrons

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) vascular thrombosis. c) ototoxicity. d) hepatic encephalopathy.

Ototoxicity can occur with rapid intravenous administration, especially in patients with poor renal function and in those receiving high doses of furosemide. Although usually transient, ototoxicity may result in permanent damage. Rapid infusions of high-dose furosemide would not place the patient at risk for hepatic encephalopathy. Excessive diuresis from furosemide can result in dehydration and vascular thrombosis, but they would not be the priority in this case.

Your 71-year-old male patient has recently been diagnosed with hypertension. Which of the following measurements is a partial indication of effective treatment and management? a) Systolic blood pressure above 140 mm Hg b) Diastolic blood pressure below 100 mm Hg c) Systolic blood pressure below 160 mm Hg d) Diastolic blood pressure below 90 mm Hg

Successful treatment involves reducing blood pressure below hypertensive levels. In adults, this is typically defined as a systolic pressure below 140 mm Hg and a diastolic pressure below 90 mm Hg.

A client began taking hydrochlorothiazide 1 week ago and is reporting occasional dizziness when she stands up quickly from sitting or lying. What is the nurse's best action?

Teach the client about the blood pressure effects of the medication and relevant safety measures.- Mild dizziness upon rapid position changes is expected as a result of lowered blood pressure. The nurse should teach the client about this phenomenon and associated falls prevention. This is more likely a result of hypotension than changes in potassium levels. Bed rest would not be necessary and causes many other potential health problems. The nurse should not tell the client to withhold the medication since there is no evidence of severe adverse effects or an emergency.

When describing the process of tubular reabsorption, which substances would the instructor include as being reabsorbed regularly?

With tubular reabsorption, about 99% of the water is reabsorbed along with vitamins, glucose, electrolytes, sodium bicarbonate, and sodium chloride.

Diuretics can either block the reabsorption of components of the urine, or they can block the reabsorption of water back into the body. What does the increase in urine flow from the body depend on with a patient on diuretics? a) The amount of sodium and chloride reabsorption that it blocks b) The amount of sodium and chloride that it excretes through the kidney c) The amount of water reabsorption back into the body d) The amount of water excreted by the body

The amount of sodium and chloride reabsorption that it blocks Explanation: The increase in urine flow that a diuretic produces is related to the amount of sodium and chloride reabsorption that it blocks. The other answers are not correct.

The class of diuretics that act to block the chloride pump in the distal convoluted tubules and leads to a loss of sodium and potassium and a minor loss of water is what? a) Carbonic anhydrase inhibitors b) Osmotic diuretics c) Thiazide diuretics d) Potassium-sparing diuretics

Thiazide diuretics Correct Explanation: Thiazide diuretics work to block the chloride pump, which leads to a loss of sodium and potassium and some water. They are considered mild diuretics. Carbonic anhydrase inhibitors work to block the formation of carbonic acid and bicarbonate in the renal tubules. Osmotic diuretics use hypertonic pull to remove fluid from the intravascular spaces and to deliver large amounts of water into the renal tubules. Potassium-sparing diuretics are mild and act to spare potassium in exchange for the loss of sodium and water

Your 92-year-old patient is being seen for follow-up after her latest hospital discharge in her 15-year history of HF. To decrease her cardiac workload, what type of diuretic has she most likely been using in the management of her long-term HF? a) Potassium-sparing diuretic b) Osmotic diuretic c) Thiazide d) Loop diuretic

Thiazides and related diuretics are frequently prescribed in the long-term management of heart failure and hypertension.

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?

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

During ongoing assessment of clients taking metolazone (Zaroxolyn), the nurse monitors for signs of hypokalemia. Which of the following are signs of hypokalemia? Select all that apply: a) Depression b) Anorexia c) Diarrhea d) Drowsiness e) Hypoglycemia

• Anorexia • Depression • Drowsiness Explanation: The following are signs of hypokalemia: anorexia, nausea, vomiting, depression, confusion, cardiac arrhythmias, impaired thought process, and drowsiness.

(see full question) Clients with an allergy to sulfamethoxazole/trimethoprim (Septra) may have cross-sensitivity reactions with which of the following diuretics?

• Chlorothiazide (Diuril) • Chlorthalidone (Thalitone) • Metolazone (Zaroxolyn) Explanation: A cross-sensitivity reaction may occur with the thiazides (chlorothiazide, chlorthalidone, and metolazone) and sulfonamides (sulfamethoxazole).

Which of the following clients are at the highest risk of developing hyperkalemia with the use of amiloride (Midamor)?

• Clients with diabetes • Clients with renal disease Explanation: Hyperkalemia is most likely to occur in clients with an inadequate fluid intake and urine output, those with diabetes or renal disease, the elderly, and those who are severely ill

Choice Multiple question - Select all answer choices that apply. A nurse is caring for a client experiencing a hypertensive emergency. If blood pressure is not lowered immediately which of the following can occur? Select all that apply: a) Damage to the pancreas b) Damage to the kidneys c) Damage to the gall bladder d) Damage to the eyes e) Damage to the heart

• Damage to the heart • Damage to the kidneys • Damage to the eyes Explanation: A hypertensive emergency if not recognized and treated quickly can result in damage to target organs including the heart, kidneys, and eyes.

Choice Multiple question - Select all answer choices that apply. The nurse understands that the action of most diuretics typically results in which of the following? Select all that apply. a) Retention of sodium b) Retention of potassium c) Loss of chloride d) Loss of calcium e) Loss of water

• Loss of water • Loss of chloride Explanation: Most diuretics result in the loss of water, sodium, and chloride along with the sodium. Potassium may or may not be lost depending on the type of diuretic used. Calcium typically is not affected by diuretics.

The nurse understands that the action of most diuretics typically results in which of the following?

• Loss of water • Loss of chloride Explanation: Most diuretics result in the loss of water, sodium, and chloride along with the sodium. Potassium may or may not be lost depending on the type of diuretic used. Calcium typically is not affected by diuretics.

Choice Multiple question - Select all answer choices that apply. The nurse should notify the physician when any of the following occur while a client is receiving an antihypertensive. Select all that apply: a) Headache b) Edema c) Insomnia d) Weight gain of 2 lb or more per day. e) Sedation

• Weight gain of 2 lb or more per day. • Edema Explanation: The nurse should notify the physician if a client has a 2 lb or more weight gain per day or edema of the hands, fingers, feet, legs, or sacral area.