CH 59 Renal and Urinary Medications

Bethanechol chloride is prescribed for a client with urinary retention. Which disorder would be a contraindication to the administration of this medication? 1. gastric atony 2. urinary strictures 3. neurogenic atony 4. gastroesophageal reflux

2. urinary strictures Rationale: bethanechol chloride can be hazardous to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could damage or rupture the bladder in clients with these conditions

A client who has a cold is seen in the emergency department with an inability to void, Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client should be questioned about the use of which medication? 1. diuretics 2. antibiotics 3. antilipemics 4. decongestants

4. decongestants Rationale: in the client with benign prostatic hyperplasia, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. These medications lessen the voluntary ability to contract the bladder. The client should be questioned about the use of these medications if he has urinary retention. Diuretics increase urine output. Antibiotics and antlipemics do not affect ability to urinate.

Trimethoprim-sulfamethoxazole is prescribed for a client. The nurse should instruct the client to report which symptom if it develops during the course of this medication therapy? 1. nausea 2. diarrhea 3. headache 4. sore throat

4. sore throat Rationale: clients taking trimethoprim-sulfamethoxazole should be informed about early signs and symptoms of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client should be instructed to notify the HCP if these occur. The other options do not require HCP notification

Tacrolimus is prescribed for a client who underwent a kidney transplant. Which instruction should the nurse include when teaching the client about this medication? 1. eat at frequent intervals to avoid hypoglycemia 2. take the medication with a full glass of grapefruit juice 3. change positions carefully due to risk of orthostatic hypotension 4. take the oral medication every 12 hours at the same times every day

4. take the oral medication every 12 hours at the same times every day Rationale: tacrolimus is a potent immunosuppressant used to prevent organ rejection in transplant clients. It is important that the med be taken at 12 hr intervals to maintain a stable blood level to prevent organ rejection. Adverse effects include hyperglycemia and hypertension, so the client does not eat frequently to avoid hypoglycemia or use precautions to avoid orthostatic hypotension. Tacrolimus is metabolized through the cytochrome P450 system, so grapefruit juice is not allowed

Nitrofurantoin is prescribed for a client with a urinary tract infection. The client contacts the nurse and reports a cough, chills, fever, and difficulty breathing. The nurse should make which interpretation about the client's complaints? 1. the client may have contracted the flu 2. the client is experiencing anaphylaxis 3. the client is experiencing expected effects of the medication 4. the client is experiencing a pulmonary reaction requiring cessation of the medication

4. the client is experiencing a pulmonary reaction requiring cessation of the medication Rationale: Nitrofurantoin can induce 2 kinds of pulmonary reactions: acute and subacute. Acute reactions, which are most common, manifest with dyspnea, chest pain, chills, fever, cough, and alveolar infiltrates. These symptoms resolve 2 to 4 days after discontinuing the med. Acute pulmonary responses are thought to be hypersensitivity reactions. Subacute reactions are rare and occur during prolonged treatment. Symptoms (e.g., dyspnea, cough, malaise) usually regress over weeks to months following nitrofurantoin withdrawal. However, in some clients, permanent lung damage may occur. The remaining options are incorrect interpretations

The nurse receives a call from a client concerned about eliminating brown-colored urine after taking nitrofurantoin for a UTI. The nurse should make which appropriate response? 1. "continue taking the medication; the brown urine occurs and is not harmful" 2. "take magnesium hydroxide with your medication to lighten the urine color" 3. "discontinue taking the medication and make an appointment for a urine culture" 4. "decrease your medication to half the dose, because your urine is too concentrated

1. "continue taking the medication; the brown urine occurs and is not harmful" Rationale: nitrofurantoin imparts a harmless brown color to the urine and the medication should not be discontinued until the prescribed dose is completed. Magnesium hydroxide will not affect urine color. In addition, antacids should be avoided because they interfere with medication effectiveness

A client with chronic kidney disease is receiving epoetin alfa. Which lab result would indicate a therapeutic effect of the medication? 1. Hct 33% 2. platelets 400,000 3. WBC 6000 4. BUN 15

1. Hct 33% Rationale: Epoetin alfa is synthetic erythropoetin, which the kidney produce to stimulate RBC production in the bone marrow. It is used to treat anemia associated with chronic kidney disease. The normal hematocrit level is male 42-52 and female 37-47. Therapeutic effect is seen when the hematocrit reaches between 30 and 33%. The normal platelet count is 150-400,000. The normal BUN is 10-20. The normal WBC count is 5000-10,000. Platelet production, white blood cell production, and BUN do not respond to erythropoetin

A client with a UTI is receiving ciprofloxacin by IV. The nurse appropriately administers the medication by performing which action? 1. infusing slowly over 60 min 2. infusing in a light-protective bag 3. infusing only through a central line 4. infusing rapidly as a direct IV push medication

1. infusing slowly over 60 min Rationale: ciprofloxacin is prescribed for treatment of mild, moderate, severe, and complicated infections of the urinary tract, lower respiratory tract, and skin structure. A single dose is administered slowly over 60 min to minimize discomfort and vein irritation. Ciprofloxacin is not light sensitive, may be infused thru a peripheral IV, an is not given by IV push method

The nurse is providing discharge instructions to a client receiving trimethoprim-sulfamethoxazole. Which instruction should be included in the list? 1. advise that sunscreen is not needed 2. drink 8 to 10 glasses of water per day 3. if the urine turns dark brown, call the HCP immediately 4. decrease the dosage when symptoms are improving to prevent an allergic response

2. drink 8 to 10 glasses of water per day Rationale: each dose of trimethoprim-sulfamethoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake to avoid crystalluria. The med is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Clients should be advised to use sunscreen since the skin becomes sensitive to the sun. Some forms of trimethoprim-sulfamethoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the HCP

Phenazopyridine is prescribed for a client with a urinary tract infection. The nurse evaluates that the medication is effective based on which observation? 1. urine is clear amber 2. urination is not painful 3. urge incontinence is not present 4. a reddish-orange discoloration of the urine is present

2. urination is not painful Rationale: phenazopyridine is a urinary analgesic. It is effective when it eliminates pain and burning with urination. It does not eliminate the bacteria causing the infection, so it would not make the urine clear amber. It does not treat urge incontinence. It will cause the client to have reddish-orange discoloration of urine but this is a side effect of the medication, not the desired effect

Following kidney transplantation, cyclosporine is prescribed for a client. Which lab result would indicate an adverse effect from the use of this medication? 1. hemoglobin level of 14 g/dL 2. creatinine level of 0.6 mg/dL 3. blood urea nitrogen level of 25 mg/dL 4. fasting blood glucose level of 99 mg/dL

3. blood urea nitrogen level of 25 mg/dL Rationale: cyclosporine is an immunosuppressant. Nephrotoxicity can occur from the use of cyclosporine. Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels. The normal BUN level is 10-20. The normal creatinine level for male is 0.6-1.2 and for female is 0.5-1.1. Cyclosporine can lower complete blood cell count levels. A normal hemoglobin is 14-18 (male) and 12-16 (female). A normal hemoglobin is not an adverse effect. Cyclosporine does affect the glucose level. The normal fasting glucose is 70-110

The nurse, who is administering bethanechol chloride, is monitoring for cholinergic overdose associated with the medication. The nurse should check the client for which sign of overdose? 1. dry skin 2. dry mouth 3. bradycardia 4. signs of dehydration

3. bradycardia Rationale: cholinergic overdose of bethanechol chloride produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Remember that the sympathetic nervous system speeds the heart rate and the cholinergic (parasympathetic) nervous system slows the heart rate. Treatment includes supportive measures and the administration of atropine sulfate (anticholinergic) subcutaneously or intravenously

The nurse is reviewing the lab results for a client receiving tacrolimus. Which lab result would indicate to the nurse that the client is experiencing an adverse effect of the medications? 1. potassium level of 3.8 mEq/L 2. platelet count of 300,000 3. fasting blood glucose of 200 mg/dL 4. WBC count of 6000

3. fasting blood glucose of 200 mg/dL Rationale: a fasting blood glucose level of 200 is significantly elevated above the normal range of 70-110 and suggests an adverse effect. Recall that fasting blood glucose levels are sometimes based on HCP preference. Other adverse effects include neurotoxicity evidenced by headache, tremor, and insomnia; GI effects such as diarrhea, nausea, and vomiting; hypertension; and hyperkalemia. The remaining options identify normal reference levels. The normal potassium level is 3.5-5.0. The normal platelet count is 150-400. The normal WBC count is 5000-10000

The nurse is providing dietary instructions to a client who has been prescribed cyclosporine. Which food item should the nurse instruct the client to exclude from the diet? 1. red meats 2. orange juice 3. grapefruit juice 4. green leafy vegetables

3. grapefruit juice Rationale: a compound present in grapefuit juice inhibits metabolism of cyclosporine through the cytochrome P450 system. As a result, consumption of grapefruit juice can raise cyclosporine levels by 50-100%, thereby greatly increasing the risk of toxicity. Red meats, orange juice, and green leafy vegetables do not interact with the cytochrome P450 system

Oxybutynin chloride is prescribed for a client with urge incontinence. Which sign would indicate a possible toxic effect related to this medication? 1. pallor 2. drowsiness 3. bradycardia 4. restlessness

4. restlessness Rationale: toxicity (overdosage) of oxybutynin produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a frequent side effect of the medication but does not indicate overdosage