Chapter 34: Drug Therapy for Fluid Volume Excess PREPU

eat potassium-rich foods.

A 49-year-old client reports frequent muscle cramps while on hydrochlorothiazide therapy. The nurse would advise the client to do which? take calcium supplements. drink plenty of fluids. include high-sodium foods in her diet. eat potassium-rich foods.

Teach the client about the blood pressure effects of the medication and relevant safety measures.

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.

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? Educate the client about the need for bed rest until her body adjusts to the new medication. Teach the client about the blood pressure effects of the medication and relevant safety measures. Tell the client to withhold the next scheduled dose until she can be assessed by the provider. Arrange for the client's potassium levels to be assessed as soon as possible.

Thiazide diuretics

A client has a history of frequent bladder infections. What classification of diuretic would be contraindicated for this client? Potassium-sparing diuretics Osmotic diuretics Loop diuretics Thiazide diuretics

A very large majority of filtrate is returned to circulation.

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? Electrolytes draw the water from urine back into circulation. Most of the substances that are removed from urine are recycled. Most urine is processed internally rather than excreted. A very large majority of filtrate is returned to circulation.

Intravenously

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

Mannitol

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

Oral

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

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? Hypokalemia Hypocalcemia Hypercalcemia Hyperkalemia

Response of pupils to light

A client with cerebral edema is prescribed mannitol. Which assessment should the nurse prioritize during the ongoing assessment? Joint pain Response of pupils to light Blood pressure every 4 hours Serum uric acid concentrations

Potassium losses are lower with spironolactone than with furosemide.

A client with hypertension has been prescribed spironolactone. The client's previous diuretic, furosemide, has been discontinued. The nurse should explain what benefit of this change? The diuretic effect is greater with spironolactone than with furosemide. Unlike furosemide, spironolactone can be taken on an outpatient basis. Sodium losses are greater with spironolactone. Potassium losses are lower with spironolactone than with furosemide.

Monitoring of serum electrolytes, creatinine, and BUN

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 CBC and serum albumin Administration of a thiazide diuretic Monitoring of serum electrolytes, creatinine, and BUN Administration of concurrent potassium

A 71-year-old female who has advanced arteriosclerosis

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 A 23-year-old male who has diabetes A 36-year-old female who has diabetes A 42-year-old male who has advanced arteriosclerosis

¼

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? 1/5 1/10 ½ ¼

Nephron

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? Bowman's capsule Nephron Convoluted tubule Glomerulus

Increased blood glucose levels

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? Sudden increase in weight Occurrence of gout attacks Sudden pain in the joints Increased blood glucose levels

hypersensitivity to sulfonamides.

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: obesity. hypersensitivity to sulfonamides. stable angina. hypertension.

Tachycardia

A health care provider prescribes diuretic therapy to a client with nephrotic syndrome. The client experiences hyponatremia as an effect of the therapy. Which symptom of hyponatremia should the nurse monitor for in the client? Paresthesias Tremors Tachycardia Visual hallucination

He is consuming excessive salty foods at the games.

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 developing comorbidities. He is anxious about his team. He has become a vegetarian until his team wins the championship. He is consuming excessive salty foods at the games.

Check response of pupils to light.

A nurse is caring for a client with increased intracranial pressure caused by cerebral edema. The health care provider has prescribed mannitol. What assessment should the nurse perform after administering the drug to the client? Monitor blood pressure every four hours. Monitor serum uric acid concentrations. Check response of pupils to light. Monitor client for joint pain.

Hyperkalemia

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 Diabetes Gout Liver disease

Torsemide. Ethacrynic acid. Bumetanide.

A nurse is teaching a colleague about loop diuretics. What drugs should the nurse address? Select all that apply. Mannitol Acetazolamide Torsemide Bumetanide Ethacrynic acid

"Actually, patients with renal failure usually can't take hydrochlorothiazide."

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? "Maybe, but hydrochlorothiazide affects the bladder more than the kidneys." "That would only work if he could come in twice a day to get it intravenously." "That would probably help, but we'd have to do blood work first." "Actually, patients with renal failure usually can't take hydrochlorothiazide."

Increased blood glucose levels

A primary health care provider has prescribed a loop diuretic for hypertension in a client with diabetes mellitus. Which assessment should the nurse prioritize? Sudden increase in weight Increased blood glucose levels Sudden pain in the joints Occurrence of gout attacks

"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: "I should take the medicine around dinnertime for the best effect." "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." "I need to take the drug on an empty stomach."

Adrenal

Aldosterone levels would be affected if which gland was dysfunctional? Pancreas Thyroid Pituitary Adrenal

Active movement of substances from the blood into the renal tubule

An instructor is reviewing the process of tubular secretion. Which would the nurse include? Activity to create a more concentrated or diluted urine Movement of fluid and small components through the glomerulus into the tubule Movement of substances from the tubule back into the vascular system Active movement of substances from the blood into the renal tubule

Increasing the excretion of sodium and chloride in the distal tubule

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

2 L

The amount of fluid excreted as urine each day averages approximately less than how many liters? 1 L 2 L 3 L 4 L

Nephrons

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 Renal capsules Renal pelves Glomeruli

Potassium levels

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? Calcium levels Bone narrow function Potassium levels Sodium levels

Lisinopril

The health care provider has prescribed spironolactone for a client. The nurse is prepared to carefully monitor the client's potassium level if the client is also administered which drug? Lisinopril Terazosin Metoprolol Diltiazem

They may cause hyperkalemia.

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 are the strongest form of diuretics. They promote excretion of potassium. They may cause rebound edema. They may cause hyperkalemia.

25%

The kidneys receive approximately what percentage of the cardiac output? 25% 5% 40% 15%

At breakfast and midafternoon

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? Midmorning and before dinner In the early morning and at bedtime After lunch and dinner At breakfast and midafternoon

Glucose and protein

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? Bicarbonate and urea Potassium and sodium Glucose and protein Creatinine and chloride

Mannitol

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? Ethacrynic acid Mannitol Bumetanide Spironolactone

Decreased hemoglobin

The nurse is caring for a client who is in renal failure. When reviewing the client's laboratory values, what would the nurse expect to find? Increased hematocrit Decreased hemoglobin Increased white blood cell count Increased platelet count

Mannitol

The nurse is caring for a client with a severe head injury. An osmotic diuretic is ordered. The nurse understands which drug is an osmotic diuretic? Bumetanide Ethacrynic Mannitol Spironolactone

Avoid over-the-counter drugs for cold symptoms.

The nurse is preparing to teach a client with renal insufficiency about the recently prescribed bumetanide for hypertension. Which instruction should the nurse prioritize for this client?

prostate gland.

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. vas deferens. renal cortex. renal calyx.

The renal pelvises drain urine into the ureters.

What best describes the structure of the kidneys? The renal arteries arise from the renal cortex. The glomerulus produces erythropoietin. The renal pelvises drain urine into the ureters. The cortical nephrons concentrate urine.

The filtration of fluid from the blood into the kidney's nephron tubule is impaired

What is the expected outcome when the glomerular membrane is damaged? The kidney's ability to regulate the concentration of urine is impaired The reabsorption of substances from the renal tubule back into the vascular system is altered The chemical reaction that results in the formation of sodium bicarbonate is impaired The filtration of fluid from the blood into the kidney's nephron tubule is impaired

Filtration

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 Excretion Secretion Filtration Reabsorption

Extensive kidney damage has usually occurred by the time the patient is symptomatic.

When explaining the underlying mechanisms associated with renal failure, which would be most important for the nurse to keep in mind? Renal failure typically involves some injury to the protective layers of the kidneys. Extensive kidney damage has usually occurred by the time the patient is symptomatic. Manifestations occur when a small number of nephrons become nonfunctional. Nephron damage is not associated with the development of signs and symptoms.

Mannitol

When teaching a class about diuretics, a nursing instructor describes a class of drugs that increases the density of the filtrate in the glomerulus. Which medication would the instructor cite as an example? Triamterene Mannitol Metolazone Furosemide

Water

Which substances are moved from the glomerulus into the tubule due to hydrostatic pressure? Water Proteins Blood cells Lipids

4.0 mEq/L

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? 2.5 mEq/L 6.0 mEq/L 4.0 mEq/L 3.0 mEq/L