EXAM 3: Ch. 8 HOGAN

3 Rationale: The nurse should be most concerned with the low serum potassium result (normal 3.5-5.1 mEq/L) because bumetanide is a potassium-wasting diuretic. The blood urea nitrogen is within normal limits (8-22 mg/dL) and is not of concern. The blood glucose is only slightly elevated (normal 70-110 mg/dL) so it is not the priority and is not related to therapy with bumetanide. The calcium level is within normal limits (8.5-11 mg/dL).

A client was started on drug therapy with bumetanide 1 month ago. At a follow-up health visit, the nurse should be most concerned with which most recent laboratory test result? 1. Blood urea nitrogen 22 mg/dL 2. Blood glucose 130 mg/dL 3. Potassium 3.1 mEq/L 4. Calcium 9.5 mEq/L

1 Rationale: If the nurse is to advise the client appropriately, knowledge of pharmacokinetics is necessary. For example onset: 20-60 minutes; peak: 60-70 minutes; duration: 2 hrs; elimination: 50% every 24hrs. Since clients may not respond as expected, the client should ingest the drug as early as possible to prevent nocturia that could disrupt the client's sleep. Therefore, 0800 is best answer. While 12 noon is a more a more appropriate time than 1800 or bedtime, it is not the best time. Since 50% will remain in the body for each 24-hr period, a cumulative effect could disrupt the client's sleep-rest pattern. An onset of 20-60 mins would result in a direct interruption of the sleep- rest pattern.

A client who is starting medication therapy with furosemide 20 mg PO daily asks the nurse what would be the best time of the day to take the pill. What time should the nurse recommend? 1. 8:00 a.m. 2. 12 noon 3. 6:00 p.m. 4. At bedtime

3 Rationale: A BP decrease when standing up from a lying or sitting position is called orthostatic hypotension. This can occur when a diuretic such as amiloride is added to antihypertensive drug therapy with hydralazine. An increase in urine output is an intended drug effect of a diuretic such as amiloride, but it is not an interactive drug effect. The pulse rate should not decrease with the addition of a diuretic to the client's medication list. A change in oxygen saturation is not expected with the addition of amiloride a diuretic to the pt medication list

A client who is taking hydralazine has also been started on drug therapy with amiloride. Which change in client data should the nurse attribute to the interactive effects of these medications? 1. Urine output increases from 40-75 mL/hr 2. Pulse rate decrease from 100/min- 85/min 3. Blood pressure decrease from 140-120 mmHg when standing 4. Oxygen saturation increase from 90%- 95% on room air

2 Rationale: Indapamide is a thiazide diuretic that may cause hypokalemia. Because the function of potassium involves the action potential of smooth muscles such as arteries, hypokalemia can result in irregular muscle contractions. Hence, muscle weakness and leg cramps can occur. Since the cause of the signs and symptoms is manageable and the problems do not significantly impact the client's health, terminating the drug is not necessary. Furosemide is a loop diuretic that can also result of hypokalemia, a nonsteriodal anti-inflammatory drug (NSAID) is not the appropriate treatment for the symptom.

A 45-year-old female has been taking indapamide 2.5 mg daily. She reported to the clinic today with leg cramps and a blood pressure of 126/70. The nurse should consult with the prescriber to do which of the following? 1. Stop the indapamide 2. Evaluate the electrolytes 3. Change prescription to furosemide 4. Change prescription to a nonsteroidal anti-inflammatory drug.

1,3,4,5 rationale: Nitrofurantoin does cause a harmless brown discoloration to the urine. Pts should be made aware of this so it does not cause them concern. The client should continues to monitor for signs and symptoms of urinary tract infection, which can include cloudy or foul-smelling urine, in addition to classic symptoms of frequency, urgency, and dysuria. Muscle weakness, tingling, and numbness can be signs of neuropathy, which can be severe and irreversible. For this reason, these symptoms should be reported immediately to the prescriber. Nausea is a common side effect of this medication, although it can be reduced by using the macrocrystal form of nitrofuantoin. The pt should maintain adequate fluid intake, but fluids are not generally "forced" or increased to high levels durging chronic therapy

A client has been started on medication therapy with nitrogurantoin as chronic suppressive therapy for urinary tract infection. What statements should the nurse include when teaching the client about this medication? SATA 1 "This medication causes a harmless brown color to the urine." 2 "You should greatly increase your daily fluid intake to about 3 L/day." 3 "Monitor your urine for cloudiness or foul smell." 4 "Promptly report muscle weakness, tingling, or numbness to the prescriber." 5 "Nausea can be a common side effect of this medication."

2,3,4 Rationale: Tolterodine is an antimuscarinic type of anticholinergic agent used to control symptoms of overactive bladder. It helps to control symptoms such as urinary frequency, urgency, and leakage of urine. Tolterodine does not treat conditions leading to decreased urine output. Tolterodine does not treat urinary infection or other conditions associated with hematuria

A client has been started on medication therapy with tolterodine. The home health nurse making a follow up visit should assess for resolution of which symptoms? SATA 1. Reduced urine output 2. Urinary urgency 3. Urinary frequency 4. Leakage of urine 5. Hematuria

1,2,4,5 Rationale: Potassium can be irritating to the GI tract so the client should take the dose with meals. Because hyperkalemia is a risk if there is excessive potssium supplementation, the client should report signs of hyperkalemia such as irregular pulse, fatigue, or weakness in legs. Soluble tablets should be dissolved in at least 4 ounces of liquid, while whole tablets should be taken with a large glass of liquid ( if allowed). The client should avoid the use of salt substitutes while taking potassium chloride because salt substitutes are high in potassium and could lead to hyperkalemia. Diarrhea and vomiting are not expected side effects and should be reported.

A client has received a prescription for supplemental potassium chloride. Which client teaching points should the nurse include in a discussion with the client? SATA 1. Take supplement with meals to reduce GI upset 2. Report irregular pulse, fatigue, or weakness in legs 3. Expect diarrhea or vomiting as side effects 4. Dissolve soluble tablet in at least 120 mL (4 oz) of water of juice 5. Avoid use of salt substitutes while taking potassium

10 Rationale: because rapid administration of K chloride can lead to cardiac dysrhythmias and cardiac arrest, the recommended IV infusion rate should not exceed 10 mEq/hr

A client is admitted with muscle cramps and frequent premature ventricular contractions associated with hypokalemia. When the client is prescribed a continuous IV infusion containing potassium chloride, the nurse should verify that the infusion rate does not exceed how many milliequivalents (mEq) of potassium per hour?

2 Rationale: Trimethoprim can cause serious adverse effects on the hematologic system, decreasing the RBC, WBC, and platelet count. These changes can be detected by a complete blood count. A K level would most commonly be of concern with drugs such as diuretics or digoxin. A uric acid level would be useful to detect side effects of thiazide diuretics or to detect gout. A serum osmolality would be useful in determining fluid volume status, such as for clients who have increased intracranial pressure.

A client is prescribed trimethoprim. The nurse should assess for changes in which laboratory test to determine possible adverse effects of the drug? 1 Potassium level 2 White blood cell count 3 Uric acid level 4 Serum osmolality

1,2,5 Rationale: Spironolactone is a potassium-sparing diuretic, so the client should avoid excessive intake of foods high in potassium. Bananas, cantaloupe (and other melons), and spinach are high in potassium and should be avoided or limited while taking spironolactone. Grapes and green or wax beans are lower in potassium and may be eaten regularly while taking spironolactone.

A client will be starting drug therapy with spironolactone to manage edema associated with cirrhosis of the liver. The nurse should encourage the client to avoid excessive amounts of which foods? SATA 1. Bananas 2. Cantaloupe 3. Grapes 4. Green beans 5. Spinach

3 Rationale: The pt's BP may increase during early therapy as the hematocrit rises. The nurse should monitor the trend in this VS and alert the HP if there is significant increase, which could warrant a dosage reduction. Epoetin alfa does not cause a rise or drop in body temperature. The pt's PR is not expected to change significantly during drug therapy w/ epoetin alfa. A change in oxygen saturation is not an adverse drug effect of epoetin alfa.

A client with chronic renal failure is beginning drug therapy with epoetin alfa. The nurse should monitor the trend of which vital sign to detect an adverse effect of this medication? 1 Temperature 2 Pulse 3 Blood pressure 4 Oxygen saturation

1 rationale: hyperuricemia is a side effect of thiazide diuretics such as hydrochlorothiazide, and this could lead to symptoms resembling gout ( such as an enlarged, painful great toe ). An increase in liver enzymes such as alanine aminotransferase (ALT) is not associated with thiazide diuretics. Clients may experience hyperglycemia, but this is more likely related to the comorbidity of diabetes mellitus than to a drug side effect, and pain from diabetic neuropathy ( if present ) is not likely to occur in the toe. The drug is more likely to cause hypokalemia than a change in Na level.

A client with hypertension and diabetes mellitus is taking hydrochlorothiazide. The client reports onset of an enlarged, red, painful right great toe soon after beginning therapy with this medication. The home health nurse should request a prescription from the healthcare provider for which serum laboratory test? 1. Uric acid level 2. Alanine aminotransferase 3. Serum glucose 4. Serum sodium

3,4,5 Rationale: Therapeutic outcomes of tamsulosin would include decreased urethral obstruction, increased urine flow, and decreased urinary frequency. Hypotension and syncope are adverse effects of tamsulosin.

A nurse administering tamsulosin to a client would expect to note which therapeutic outcomes of drug therapy? SATA 1. Hypotension 2. Syncope 3. Decreased urethral obstruction 4. Increased urine flow 5. Decreased urinary frequency

1 Rationale: Methenamine is a urinary tract anti-infective that is useful in treating urinary tract infections. Some types of bladder incontinence may be treated with drugs that reduce bladder spasms. Methenamine is not useful in treating acute kidney injury, which would be characterized by a sudden drop in urine output. Methenamine would not counteract the effects of chronic renal failure, which is an irreversible health problem.

A nurse notes that a client has methenamine on the list of prescribed medications. The nurse should suspect that the client has a diagnosis of which health problem? 1. Urinary tract infection 2. Bladder incontinence 3. Acute kidney injury 4. Chronic renal failure

4 Rationale: Phenazopyridine is a urinary tract analgesic that may be prescribed alone or may be combined with an antibiotic appropriate for urinary tract infections. Yellow-tinged skin is a sign of drug accumulation R/T renal impairment. This sign should be reported to the prescriber, if noted. Although it may be manufactured in combination with an antibiotic, it could also be discontinued after pain with urination is relieved, often after 1-2 days of antibiotic therapy. Any drug that is used long term would require follow-up, but this drug during breastfeeding is unsubstantiated.

After phenazopyridine is prescribed for a client, the nurse teaches the client which of the following items of information? 1. Continue taking drug until infection is resolved. 2. Long-term use of drug requires no follow-up. 3. With appropriate hydration, it is safe to breastfeed. 4. Report sign of yellow-tinged skin of sclera.

1 Rationale: Finasteride is an androgen inhibitor that may be used to treat enlarged prostate. It reduces the serum levels of testosterone, resulting in decreased prostate gland size and indirectly improving the flow of urine during voiding. Because of the risk of abnormalities to the fetus, pregnant women or women of childbearing age should not be exposed to semen fluid of a male taking finasteride. The decreased serum level of testosterone may result in decreased libido, but is not as relevant as the risk to the developing fetus. Because of urinary stasis that accompanies enlarged prostate, the pt should increase fluid intake to prevent infection. Once again however, this is not as relevant as the health of a developing fetus. It may take 6-12 months to reach full therapeutic effectiveness so 3 wks is too short a time frame.

Because finasteride was prescribed for a 45 yr old man, the nurse should include which priority instruction during a teaching session about the medication? 1 Use a contraceptive barrier during sexual intercourse 2 Sexual performance level may decrease 3 Increase daiky fluid intake 4 Take the drug for 1 month

4 Rationale: Oxybutynin is an antispasmodic used for urinary incontinence and bladder spasms. It causes anticholinergic side effects such as dry mouth, constipation, urinary hesitancy, and decreased gastroenteritis motility. For this reason the client needs to use measures to counteract dry mouth. Wearing protection is an appropriate action for urinary incontinence, but retention and hesitancy is associated with this drug. The drug has no effect on the clotting process so there is no unusual risk of injury. The anticholinergic actions are more likely to cause constipation than diarrhea.

The healthcare provider prescribed oxybutynin for a 65-year-old female with urinary frequency and urgency. The nurse should include which instruction to manage a primary side effect when providing medication instruction? 1 Wear protective underwear 2 Avoid activities that may cause injury or bleeding 3 Carry an OTC antidiarrheal agent when traveling 4 Rinse your mouth or use sugarless hard candy frequently

2 Rationale: Early signs of hypersensitivity require immediate intervention, so the client should report sudden onset of fever, pruritis, or malaise. Checking the urine pH decreases the potential for stone formation, a very painful but not life-threatening problem. Fluid intake should produce 1,500 mL/day, and the client needs to take in at least 2 L of fluid per day. The medication is more soluble in alkaline urine, but attending to a hypersensitive reaction takes priority.

The nurse is providing information to a client who has started drug therapy with sulfisoxazole. Which instruction would be the highest priority of the nurse to provide? 1. Check the urine pH to prevent crystals from forming in the urine. 2. Report sudden onset of fever, pruritus, and malaise. 3. Restrict your oral fluid intake to an amount between 500 and 1,000 mL/day. 4. Keep your urine at an alkaline level.

2 Rationale: Acetazolamide is a carbonic anhydrase inhibitor that has uses as a diuretic and antiglaucoma agent. The nurse should anticipate that the client has open-angle glaucoma as part of the health history. Addison disease or other adrenocortical insufficiency would be a contraindication to the use of acetazolamide. Acetazolamide is contraindicated for use in severe liver disease. Diuretics such as loop diuretics or thiazide diuretics are commonly used to treat HF

The nurse notes that the diuretic acetazolamide is listed on the client's medication reconciliation sheet. The nurse should check the client's health history for which anticipated health problem? 1. Addison disease 2. Open-angle glaucoma 3. Liver cirrhosis 4. Heart Failure

2,4 Rationale: Mannitol may be prescribed for clients with increased intracranial pressure or increased intraocular pressure by causing diuresis. It would not be prescribed for the clients with pancreatitis, diarrhea, and congestive heart failure. Clients with pancreatitis wold not experience a benefit from a drug that promotes diuresis. Mannitol is known to precipitate pulmonary edema and HF because of its osmotic action.

The nurse should anticipate that mannitol may be prescribed to reduce symptoms in clients recently admitted to the unit with which conditions? SATA 1 Pancreatitis 2 Increased intracranial pressure 3 Diarrhea 4 Increased intraocular pressure 5 Congestive heart failure