NURA 1500 Renal Medications

A nurse is planning care for a group of clients. Which of the following client's should the nurse plan to monitor for signs of nephrotoxicity? 1. A client who is receiving gentamicin for treatment of a wound infection 2. A client who is receiving digoxin for treatment of heart failure 3. A client who is receiving methyl prednisone for treatment of severe asthma 4. A client who is receiving propranolol for treatment of hypertension

1. A client who is receiving gentamicin for treatment of a wound infection Rationale: amino glycoside antibiotics can injure cells of the proximal tubules, causing acute tubular necrosis. The nurse should plan to monitor this client for nephrotoxicity and acute kidney injury. Providers use caution when prescribing digoxin for clients who have renal impairment, but it's use does not cause nephrotoxicity. Methylprednisolone does not cause nephrotoxicity. Providers use caution when prescribing propanolol for clients who have renal impairment, but it's use does not cause nephrotoxicity.

The nurse is reviewing the laboratory results for a client receiving tacrolimus (Prograf). Which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medications? 1. Blood glucose of 200 mg/dL 2. Potassium level of 3.8 mEq/L 3. Platelet count of 300,000 cells/mm3 4. White blood cell count of 6000 cells/mm3

1. Blood glucose of 200 mg/dL Rationale: A blood glucose level of 200 mg/dL is significantly elevated above the normal range of 70 to 110 mg/dL and suggests an adverse effect. Other adverse effects include neurotoxicity evidenced by headache, tremor, and insomnia; gastrointestinal effects such as diarrhea, nausea, and vomiting; hypertension and hyperkalemia.

A client with chronic kidney disease is receiving epoetin alfa (Epogen). Which laboratory result would indicate a therapuetic effect of the medication? 1. Hematocrit of 32% 2. Platelet count of 400,000 cells/mm3 3. Blood urea nitrogen level of 15 mg/dL 4. White blood cell count of 6000 cells/mm3

1. Hematocrit of 32% Rationale: Epoetin alfa is used to reverse anemia associated with chronic kidney disease. Therapeutic effect is seen when the hematocrit is between 30% and 33%. Options 2, 3, and 4 are not associated with the action of this medication.

A client with a urinary tract infection is receiving ciprofloxacin (Cipro) by the intravenous (IV) route. The nurse appropriately administers the medication by performing which action? 1. Infusing slowly over 60 minutes 2. Infusing in a light-protective bag 3. Infusing only through a central line 4. Infusing rapidly as a direct intravenous push medication

1. Infusing slowly over 60 minutes Rationale: Ciprofloxacin (Cipro) is prescribed for treatment of mild, moderate, severe, and complicated infections of the urinary tract, lower respiratory tract, and skin and skin structure. A single dose is administered slowly over 60 minutes to minimize discomfort and vein irritation. Other solutions infusing at the same site need to be temporarily discontinued while the ciprofloxacin is infusing.

Tacrolimus (Prograf) is prescribed for a client. Which disorder, if noted in the client's record, would indicate that the medication needs to be administered with caution? 1. Pancreatitis 2. Ulcerative colitis 3. Diabetes insipidus 4. Coronary artery disease

1. Pancreatitis Rationale: Tacrolimus (Prograf) is used with caution in immunosuppressed clients and in clients with renal, hepatic, or pancreatic function impairment. Tacrolimus is contraindicated in clients with hypersensitivity to this medication or hypersensivity to cyclosporine.

A nurse is caring for a client who has nephrotic syndrome and has been taking prednisone for 3 days. Which of the following adverse effects should the nurse monitor do and report to the provider? 1. Sore throat 2. Frequent stools 3. Drowsiness 4. Tremors

1. Sore throat Rationale: glucocorticoids depress the natural immune system and increases the client's rockslide for infection. A sore throat indicate and infection.

The nurse is providing discharge instructions to a client receiving sulfamethoxazole. Which instruction should be included in the list? 1. Restrict fluid intake 2. Maintain a high fluid intake 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. Maintain a high fluid intake Rationale: Each dose of sulfamethoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfamethoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the HCP.

Bethanechol chloride (Urecholine) 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 aotny 4. Gastroesophageal reflux

2. Urinary strictures Rationale: Bethanechol chloride (Urecholine) can be hazardous to clients with urinary tract obstruction or wekness 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 rupture the bladder in clients with these conditions.

The nurse receives a call from a client concerned about eliminating brown-colored urine after taking nitrofurantoin (Furadantin) for a urinary tract infection. The nurse should make which appropriate response? 1. "Discontinue taking the medication and make an appointment for a urine culture" 2. "Decrease your medication to half the dose because your urine is too concentrated" 3. "Continue taking the medication because the urine is discolored from the medication 4. "Take magnesium hydroxide (Maalox) with your medication to lighten the urine color"

3. "Continue taking the medication because the urine is discolored from the medication Rationale: Nitrofurantoin (Furadantin) imparts a harmless brown color to the urine and the medication should not be discontinued until the prescribed dose is completed. Magnesium hydroxide (Maalox) will not affect urine color. In addition, antacids should be avoided because they interfere with medication effectiveness.

The nurse, who is administering bethanechol chloride (Urecholine), 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 (Urecholine) produces manifestations of excessive muscarine stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Treatment includes supportive measures and the administration of atropine sulfate subcutaneously or intravenously.

The nurse is providing dietary instructions to a client who has been prescribed cyclosporine (Sandimmune). 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 grapefruit juice inhibits metabolism of cyclosporine. As a result, consumption of graprefruit juice can raise cyclosporine levels by 50% to 100%, thereby increasing the risk of toxicity.

Phenazopyridine (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. The nurse should provide the client with which information regarding this medication? 1. Take the medication at bedtime 2. Take the medication before meals 3. Discontinue the medication if a headache occurs 4. A reddish orange discoloration of the urine may occur

4. A reddish orange discoloration of the urine may occur Rationale: The nurse should instruct the client that a reddish-orange discoloration of urine may occur. The nurse also should instruct the client that this discoloration can stain fabric. The medication should be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication.

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. Antitussives 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. The client whould be questioned about the use of these medications if the client has urinary retention. Retention also can be precipitated by other factors, such as alcoholic beverages, infection, bed rest, and becoming chilled.

Following kidney transplantation, cyclosporine (Sandimmune) is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1. Normal hemoglobin level 2. Decreased creatinine level 3. Decreased white blood cell count 4. Elevated blood urea nitrogen level

4. Elevated blood urea nitrogen level Rationale: Nephrotoxicity can occur from the use of cyclosporine (Sandimmune). Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels. Cyclosporine does not depress the bone marrow.

Oxybutynin chloride (Ditropan XL) is prescribed for a client with a neurogenic bladder. 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 frewuent side effect of the medication but does not indicate overdosage.

Trimethoprim-sulfamethoxazole (TMP-SMZ; Bactrim) is precribed 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 rimethoprim-sulfamethoxazole (TMP-SMZ) should be informed about early signs/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.

Nitrofurantoin (Macrodantin) 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 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 two 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 medication. 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.

Wilm's Tumor meds daktinomycin (Actinomycin D) vincristine (Vincasar)

Actinomycin D, vincristine, doxorubin, cyclophosphadmide Antineoplastics, antitumor antibiotics Inhibits RNA synthesis by forming a complex with DNA (cell cycle phase-nonspecific) Death of rapidly replicating cells, particularly malignant ones Antineoplastics - binds to proteins of mitotic spindle, causing metaphase arrest Cell replication is stopped as a result

Struvite meds

Antibiotics to control infection

Medications that can affect incontinence Anticholinergics - oxybutynin (Ditropan) Effects - reduced bladder contractility Side effects - constipation, urinary retention, dry mouth, increases ocular pressure (ask if pt has glaucoma)

Anticolinergics - medications that "block" the effects of acetylcholine - blocks muscarine receptors at the detrusor muscle, thus reducing bladded contractility (the neurotransmitter for the parasympathetic nervous system) on bladder/sphincter function. Reduces incontinence by causing bladder muscle relaxation and suppressing the urge to void (overactive bladder tx - decreases incontinence by delaying desire to void)

Enuresis meds imipramine (Tofranil) Enuresis meds desmopressin (DDAVP) Enuresis meds oxybutynin (Ditropan)

Antidepressant, used to treat enuresis as well, anticholinergic, mostly metabolized by liver Hormone, antidiuretic, analogue of naturally occurring vasopressin (antidiuretic hormone); primary action is enhanced reabsorption of water in kidneys; prevention of nocturnal enuresis Urinary tract antispasmodics, treats neurogenic bladder symptoms (frequent urination, urgency, nocturia, urge continence) Inhibits action of acetylcholine at postganglionic receptors, increased bladder capacity, delayed desire to void

Three most common medications to treat BPH Doxazosin Terazosin Tamulosin - antiadrenergic

Antihypertensives that work to decrease contractions in smooth muscle of prostate capsule and increase urine flow

Medications that can affect incontinence Cholinergics - bethanechol (Urecholine) Effects - Increased bladder contractility Sympathomimetic/Adrenergic - pseudoephedrine (Sudafed) Effects - Increased urethral resistance (contraction of the smooth muscle fibers within the proximal urethral/bladder neck); a secondary effect is relaxation of the bladder wall

Cholinergics - medications that mimic the effects of acetylcholine (the neurotransmitter for parasympathetic nervouse system) on bladder/sphincter function (increases bladder emptying, increases bladder contractions - urinary tract stimulant used with urinary retention) Sympathomimetic/Adrenergic - medications that mimic the effect of the sympathetic nervous system on bladder and sphincter function

tamsulosin (Flomax) - treat BPH Assess for symptoms of prostatic hyperplasia, first dose orthostatic hypotension, monitor I&O and daily weight, edema,

Decrease symptoms of prostatic hyperplasia (urinary urgency, hesitancy, nocturia) Decreases contractions in smooth muscle of the prostate capsule by binding alpha 1 receptors Metabolized by liver 14 hr half life Contraindicated in hypersensitivity Use cautiously in prostate carcinoma, cattaract surgery, sulfa allergy Can cause dizziness, headache, rhinitis, orthostatic hypotension, retrograde ejaculation

Calcium oxalate meds

In addition to calcium phosphate meds, Allopurinal (Zyloprim), vitamin B6 (pyridoxine)

Calcium phosphate medications

Thiazide diuretics to increase calcium absorption Orthophosphates to decrease urine saturation of calcium oxalate Sodium cellulose phosphate to decrease intestinal absorption of calcium

BPH meds

To improve urine flow: Finasteride (Proscar) Tamsulosin (Flomax)

Uric acid meds

allopurinal (Zyloprim) to prevent formation of uric acid Potassium or sodium citrate or sodium bicarbonate to alkalinize the urine

Cystine meds

apha mercapto propionyglycine (AMPG) to lower urine cystine captopril (Capoten)