NCLEX Prep II Renal and Urinary Medications Chapter 59

Propantheline bromide is prescribed for a client with bladder spasms. Which disorder, if noted in the client's record, should alert the nurse to question the prescription for this medication? 1.Glaucoma 2.Myxedema 3.Hypothyroidism 4.Coronary artery disease

1.Glaucoma Rationale: Propantheline bromide is contraindicated in clients with narrow-angle glaucoma, obstructive uropathy, gastrointestinal disease, or ulcerative colitis. The medication decreases bladder muscle spasms.

The home health nurse is caring for a client who is taking probenecid. The client has been instructed to restrict the diet to low-purine foods. Which food item should the nurse instruct the client to avoid? 1.Spinach 2.Scallops 3.Potatoes 4.Ice cream

2.Scallops Rationale: Probenecid is a medication used for clients with gout to inhibit the reabsorption of uric acid by the kidneys and promote excretion of uric acid in the urine. Uric acid is produced when purine is catabolized. Clients are instructed to modify their diets to limit excessive purine intake. High-purine foods to avoid or limit include organ meats, roe, sardines, scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, yeast, wine, and alcohol.

Tamsulosin hydrochloride is prescribed for a client. The nurse should suspect that this medication is prescribed to relieve which condition? 1.Constipation 2.Muscle spasms 3.Urinary obstruction 4.Respiratory congestion

3.Urinary obstruction Rationale: Tamsulosin hydrochloride is used to relieve mild to moderate manifestations that occur in benign prostatic hypertrophy. The medication also improves urinary flow rates. This medication is not used to treat constipation, muscle spasms, or respiratory congestion.

A client is receiving oxybutynin. The nurse should suspect that this medication is prescribed to relieve which condition? 1.Gastritis 2.Renal calculi 3.Ulcerative colitis 4.Overactive bladder

4.Overactive bladder Rationale: When medication therapy for overactive bladder is indicated, anticholinergic agents are the medications generally prescribed. These medications block muscarinic receptors on the bladder detrusor and thereby inhibit bladder contractions and decrease the urge to void. It is not used to treat gastritis. The medication would not be used to treat renal calculi or ulcerative colitis. In fact, it may make those conditions worse.

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 health care provider (HCP) if these occur. The other options do not require HCP notification.

Parenteral bethanechol chloride is prescribed for a client with urinary retention. The nurse should plan to administer this medication by which route? 1.Intravenously 2.Intradermally 3.Intramuscularly 4.Subcutaneously

4.Subcutaneously Rationale: The injectable form of bethanechol chloride is intended for subcutaneous administration only. Bethanechol must never be injected intramuscularly or intravenously because the resulting high medication level can cause severe toxicity, resulting in bloody diarrhea, bradycardia, profound hypotension, and cardiovascular collapse.

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 medication be taken at 12-hour 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 an adult client to treat acute urinary tract infection (UTI). Based on the normal adult dose, how should the nurse instruct the client to take this medication? 1.50 mg every 6 hours 2.150 mg 3 times daily 3.300 mg administered at bedtime 4.1 g distributed evenly throughout the day

1.50 mg every 6 hours Rationale: For treatment of acute UTI, the adult dosage is 50 mg every 6 hours. For prophylaxis of recurrent UTI, low doses are used, such as 50 to 100 mg at bedtime for adults.

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? 1.Hematocrit of 33% (0.33) 2.Platelet count of 400,000 mm3 (400 × 109/L) 3.White blood cell count of 6000 mm3 (6.0 × 109/L) 4.Blood urea nitrogen level of 15 mg/dL (5.25 mmol/L)

1.Hematocrit of 33% (0.33) Rationale: Epoetin alfa is synthetic erythropoietin, which the kidneys produce to stimulate red blood cell production in the bone marrow. It is used to treat anemia associated with chronic kidney disease. The normal hematocrit level is Male: 42% to 52% (0.42 to 0.52); Female: 37% to 47% (0.37 to 0.47). Therapeutic effect is seen when the hematocrit reaches between 30% and 33% (0.30 and 0.33). The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). The normal blood urea nitrogen level is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). The normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L). Platelet production, white blood cell production, and blood urea nitrogen do not respond to erythropoietin.

A client with chronic kidney disease (CKD) who is receiving an antihypertensive medication is experiencing frequent hypotensive episodes. The nurse reviews the client's medication record, knowing that which medication would have the greatest tendency to cause hypotension? 1.Methyldopa 2.Epoetin alfa 3.Levothyroxine 4.Calcium carbonate

1.Methyldopa Rationale: Methyldopa is metabolized by the kidneys and requires careful dosage adjustment according to the client's renal function to prevent hypotension. Calcium carbonate is used in the treatment of calcium deficiency and does not cause hypotension when administered via the oral route. Parenteral administration of calcium may cause hypotension. Levothyroxine does not cause hypotension. Epoetin alfa is an erythropoietin and is more likely to cause hypertension than hypotension.

A client with acute pyelonephritis who was started on antibiotic therapy 24 hours earlier is still complaining of burning with urination. The nurse should anticipate that the health care provider will prescribe which medication? 1.Phenazopyridine 2.Oxybutynin chloride 3.Bethanechol chloride 4.Propantheline bromide

1.Phenazopyridine Rationale: The pain experienced with pyelonephritis usually resolves as antibiotic therapy becomes effective. However, clients may be treated for urinary tract pain with phenazopyridine, which is a urinary analgesic. Oxybutynin chloride and propantheline bromide are antispasmodics that are used to treat bladder spasm. Bethanechol chloride is a cholinergic agent used to treat neurogenic bladder or urinary retention.

A client with chronic kidney disease has a medication prescription for epoetin alfa. The nurse should plan to administer this medication by which method? 1.Subcutaneously 2.Intramuscularly 3.With a full glass of water 4.Diluted in juice to enhance taste

1.Subcutaneously Rationale: Epoetin alfa is erythropoietin that has been manufactured through the use of recombinant DNA technology. It is used to treat anemia in the client with chronic kidney disease. The medication may be administered subcutaneously or intravenously as prescribed.

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

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.

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.

Tamsulosin hydrochloride has been prescribed for a client with benign prostatic hypertrophy (BPH). How should the nurse instruct the client to take the medication? 1.With breakfast 2.With a glass of milk 3.With the lunchtime meal 4.Thirty minutes after a meal

4.Thirty minutes after a meal Rationale: Tamsulosin hydrochloride is a medication that will relieve mild to moderate manifestations of BPH and improve urinary flow rates. The medication should be administered 30 minutes after meals because food decreases the peak plasma concentration and lengthens the time to achieve peak plasma medication concentrations. Therefore, options 1, 2, and 3 are incorrect.

Bethanechol chloride is prescribed for an adult client with postoperative bladder spasms. Based on the normal adult dose, how should the nurse plan to administer this medication? 1.100 mg at bedtime 2.100 mg every 4 hours 3.10 to 50 mg 3 to 4 times a day 4.50 to 100 mg 3 to 4 times a day

3.10 to 50 mg 3 to 4 times a day Rationale: The normal adult dosage of bethanechol chloride ranges from 10 to 50 mg given 3 to 4 times daily. Therefore, the remaining options are incorrect.

The nurse is providing teaching for a client prescribed ciprofloxacin for a urinary tract infection. Which statement made by the client indicates that there is a need for further teaching? 1."I can take the ciprofloxacin with or without food." 2."I'll need to wear sunscreen and protective clothing while taking ciprofloxacin." 3."I'll need to contact my health care provider if I develop any white patches in my mouth." 4."If I develop any tendon pain while taking ciprofloxacin, exercise should help to decrease the pain."

4."If I develop any tendon pain while taking ciprofloxacin, exercise should help to decrease the pain." Rationale: The health care provider should be contacted immediately if the client develops any tendon pain, swelling, or inflammation because of the risk of tendon rupture. Exercise is contraindicated until tendon rupture is ruled out. Fluorquinolones such as ciprofloxacin need to be discontinued at the first sign of any tendon pain, swelling, or inflammation. Ciprofloxacin can be taken with or without food, can cause photosensitivity, and can increase the risk for oral Candida infections.

The nurse is taking care of a client receiving oxybutynin. Which finding should the nurse expect to note if the client develops side or adverse effects of this medication? 1.Itching 2.Diarrhea 3.Swelling 4.Dry mouth

4.Dry mouth Rationale: Oxybutynin is an anticholinergic. Anticholinergic side effects include dry mouth, constipation, tachycardia, urinary hesitancy, urinary retention, mydriasis, blurred vision, and dry eyes. Itching, diarrhea, and swelling are not associated with this medication.

The nurse receives a call from a client concerned about eliminating brown-colored urine after taking nitrofurantoin for a urinary tract infection. 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.

Epoetin alfa is prescribed for a client diagnosed with chronic kidney disease. The client asks the nurse about the purpose of the medication. Which response by the nurse is most appropriate? 1."It is used to treat anemia." 2."It is used to lower your blood pressure." 3."It will help to increase the potassium level in your body." 4."It is an anticonvulsant medication given to all clients after dialysis to prevent seizure activity."

1."It is used to treat anemia." Rationale: Epoetin alfa is a medication that is used to treat anemia. It does not lower blood pressure or increase potassium. It is also not given after a dialysis treatment to prevent seizure activity. Hypertension is a side effect. Hyperkalemia and seizures are adverse effects of the medication.

The nurse has a prescription to administer bethanechol chloride subcutaneously. Before giving this medication, the nurse checks to ensure that which condition is not noted in the client's history? 1.Asthma 2.Lung infection 3.Hypothyroidism 4.Urinary retention

1.Asthma Rationale: Bethanechol chloride is a cholinergic medication that is used for urinary retention. This medication should not be used for clients with asthma because it can precipitate bronchoconstriction by activating muscarinic receptors. Other conditions this medication should not be used with include hypotension, bradycardia, gastric ulcers, intestinal obstruction, urinary tract obstruction, and hyperthyroidism.

The nurse is administering a dose of a prescribed diuretic to an assigned client. The nurse should monitor the client for hypokalemia as a side effect of therapy if the client has been receiving which medication? 1.Bumetanide 2.Triamterene 3.Amiloride HCl 4.Spironolactone

1.Bumetanide Rationale: Bumetanide is a loop diuretic that places the client at risk for hypokalemia. The nurse would monitor this client carefully for signs of hypokalemia, monitor serum potassium levels, and encourage intake of high-potassium foods. The other medications listed are potassium-retaining diuretics.

Laboratory analysis of a urine sample for culture and sensitivity reveals a bacterial infection, and the client is diagnosed with cystitis. Nitrofurantoin is prescribed for the client. Which is the priority nursing assessment before administering this medication? 1.Checking lung sounds 2.Checking the blood pressure 3.Checking the apical heart rate 4.Checking the bowel sounds in all 4 quadrants

1.Checking lung sounds Rationale: Nitrofurantoin is an antibacterial used to treat urinary tract infections. Although rare, the medication can cause an asthmatic exacerbation in those with a history of asthma. Therefore, the priority baseline assessment should include questioning the client about a history of asthma and checking lung sounds. The assessments in the remaining options may be done but are unrelated to this medication and are not a priority.

A client with a urinary tract infection is receiving ciprofloxacin 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 IV push medication

1.Infusing slowly over 60 minutes Rationale: Ciprofloxacin 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. Ciprofloxacin is not light-sensitive, may be infused through a peripheral IV access, and is not given by IV push method.

A client who has had a prostatectomy is complaining of pain from bladder spasms. The nurse checks the health care provider's prescription sheet and expects to see which medication prescribed to treat the problem? 1.Oxybutynin 2.Hydromorphone 3.Morphine sulfate 4.Meperidine hydrochloride

1.Oxybutynin Rationale: Bladder spasms after prostatectomy are treated with antispasmodic medications, such as oxybutynin. Opioid analgesics such as morphine sulfate, hydromorphone, and meperidine hydrochloride usually are not effective in treating pain caused by spasms.

A client being admitted to the nursing unit has been taking bethanechol chloride at home. During the admission assessment, the nurse gives special attention to assessing the client for which side and adverse effect of this medication? 1.Dry mouth 2.Bradycardia 3.Constipation 4.Hypertension

2.Bradycardia Rationale: Bethanechol chloride is a direct-acting muscarinic agonist (cholinergic medication). It can cause hypotension secondary to vasodilation and bradycardia. It also can cause excessive salivation, increased secretion of gastric acid, abdominal cramps, and diarrhea. Higher doses can cause involuntary defecation.

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 health care provider (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 medication 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.

Trimethoprim-sulfamethoxazole is prescribed to be administered by intravenous infusion to a client with a recurrent urinary tract infection. How should the nurse administer this medication? 1.Over 30 minutes 2.Over 60 to 90 minutes 3.Piggybacked into the peripheral line containing parenteral nutrition 4.Piggybacked into the existing infusion of normal saline and potassium chloride

2.Over 60 to 90 minutes Rationale: Trimethoprim-sulfamethoxazole may be administered by intravenous infusion but should not be mixed with any other medications or solutions. Trimethoprim-sulfamethoxazole is infused over 60 to 90 minutes, and bolus infusions or rapid infusions must be avoided.

A client is prescribed sulfamethoxazole for treatment of urinary tract infection. Identification of which other medication noted on the client's medical record requires further collaboration with the health care provider (HCP)? 1.Insulin 2.Phenytoin 3.Metoprolol 4.Propranolol

2.Phenytoin Rationale:Sulfonamides can intensify the effects of warfarin, phenytoin, and sulfonylurea-type oral hypoglycemics (e.g., glipizide, glyburide). The principal mechanism is inhibition of hepatic metabolism. When combined with sulfonamides, these medications may require a reduction in dosage to prevent toxicity. Therefore, the nurse should collaborate with the HCP regarding dose adjustment of phenytoin.

A client is receiving levofloxacin for treatment of urinary tract infection. Which finding warrants an immediate call to the health care provider (HCP)? 1.Client complaint of constipation 2.Prolonged QT interval on electrocardiogram 3.Client will not take the levofloxacin without food 4.The client's culture shows Staphylococcus aureus

2.Prolonged QT interval on electrocardiogram Rationale:Levofloxacin can prolong the client's QT interval, which would be noted on electrocardiogram. This warrants a call to the HCP because a prolongation in the QT interval can lead to torsades de pointes, a lethal dysrhythmia. The client may complain of diarrhea, not constipation, as a side or adverse effect. The medication can be taken with or without food and is effective against Staphylococcus aureus.

Nitrofurantoin is prescribed for the client. The nurse checks the client's record, knowing that this medication is contraindicated in which disorder? 1.Heart failure 2.Renal disease 3.Hepatic disease 4.Diabetes insipidus

2.Renal disease Rationale: Nitrofurantoin is contraindicated in clients with renal impairment. The disorders in the other options are not a concern with the use of this medication.

Oral bethanechol chloride is prescribed for the client. The nurse should instruct the client to take this medication at which time? 1.With meals 2.Two hours after meals 3.With a snack in the afternoon 4.At bedtime with crackers and cheese

2.Two hours after meals Rationale: Administration of bethanechol chloride with food can cause nausea and vomiting. To avoid this problem, oral doses should be administered 1 hour before meals or 2 hours after meals. Therefore, all other options are incorrect.

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.

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.

Nitrofurantoin is prescribed for a client with urinary tract infection. The nurse is instructing the client regarding the administration of the medication. Which information about the best time to take this medication should be included in the client's education? 1.At bedtime 2.With meals 3.One hour before the dinner meal 4.In the morning 2 hours after breakfast

2.With meals Rationale: Nitrofurantoin is an antibacterial used to treat urinary tract infections. The nurse would instruct the client to take the medication with food to reduce any gastrointestinal upset that the medication can cause. Therefore, the best time to take the medication is with meals.

Aluminum hydroxide is prescribed for a client with chronic kidney disease (CKD). The nurse should instruct the client to take this medication at what time? 1.At bedtime 2.With meals 3.On an empty stomach 4.In the morning on arising

2.With meals Rationale: The client who is receiving aluminum hydroxide should take the medication with meals. The phosphate-binding effect of this medication is most effective when it is taken with food. If tablets are used, they should be chewed well before swallowing.

The nurse provides instructions regarding the administration of liquid oral cyclosporine solution to a client. Which statement, if made by the client, would indicate the need for further teaching? 1."I need to mix the concentrate well and drink it immediately." 2."I will mix the concentrate with orange juice to improve the taste." 3."I will purchase a dropper from the pharmacy to calibrate the amount of medication that I need." 4."After taking the medication, I need to rinse the container with diluent and drink it to ensure that I have taken the complete dose."

3."I will purchase a dropper from the pharmacy to calibrate the amount of medication that I need." Rationale: The client needs to be instructed to dispense the oral liquid into a glass container using a specially calibrated pipette. The client should not use any other type of dropper to calibrate the amount of prescribed medication. The remaining options identify correct procedure for administering this medication.

A client with a urinary tract infection (UTI) is given a prescription for levofloxacin. The nurse should provide the client with which information about this medication? 1."You may experience altered taste." 2."You may get dizzy, so move around slowly." 3."Pain in the back of the leg should be reported." 4."Your urine may become dark and if it does, you should call your health care provider."

3."Pain in the back of the leg should be reported." Rationale: Levofloxacin is a fluoroquinolone antibiotic and is used for a variety of infections, including UTI. Adverse effects include peripheral neuropathy, rhabdomyolysis, tendonitis, tendon rupture, Clostridium difficile infection, muscle weakness in clients with myasthenia gravis, and photosensitivity. Levofloxacin can also prolong the client's QT interval, leading to dysrhythmias. Pain in the back of the leg could be indicative of tendonitis and therefore risk for tendon rupture. The other adverse effects are associated with gemifloxacin, not levofloxacin.

The nurse is preparing a subcutaneous dose of bethanechol prescribed for a client with urinary retention. Before giving the dose, the nurse checks to see that which medication is available on the emergency cart for use if needed? 1.Vitamin K 2.Mucomyst 3.Atropine sulfate 4.Protamine sulfate

3.Atropine sulfate Rationale: Bethanechol is a cholinergic medication. Administration of bethanechol could result in cholinergic overdose. The antidote is atropine (an anticholinergic), which should be readily available for use if overdose occurs. Mucomyst is the antidote for acetaminophen overdose. Protamine sulfate is the antidote for heparin. Vitamin K is the antidote for warfarin.

Following kidney transplantation, cyclosporine is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1.Hemoglobin level of 14.0 g/dL (140 mmol/L) 2.Creatinine level of 0.6 mg/dL (53 mcmol/L) 3.Blood urea nitrogen level of 25 mg/dL (8.8 mmol/L) 4.Fasting blood glucose level of 99 mg/dL (5.5 mmol/L)

3.Blood urea nitrogen level of 25 mg/dL (8.8 mmol/L) 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 blood urea nitrogen level is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). The normal creatinine level for a male is 0.6 to 1.2 mg/dL (53 to 106 mcmol/L) and for a female 0.5 to1.1 mg/dL (44 to 97 mcmol/L). Cyclosporine can lower complete blood cell count levels. A normal hemoglobin is Male: 14 to 18 g/dL (140 to 180 mmol/L); Female: 12 to 16 g/dL (120 to 160 mmol/L). A normal hemoglobin is not an adverse effect. Cyclosporine does affect the glucose level. The normal fasting glucose is 70 to 110 mg/dL (4 to 6 mmol/L).

A client is prescribed dutasteride. Which outcome indicates that the medication is effective? 1.Improved erectile function 2.A reduction in blood pressure 3.Decreased obstruction to outflow of urine through the urethra 4.Decreased low-density lipoproteins and increased high-density lipoproteins

3.Decreased obstruction to outflow of urine through the urethra Rationale: Dutasteride promotes regression of prostate epithelial tissue and thereby decreases mechanical obstruction of the urethra. Because the percentage of epithelial tissue is highest in very large prostates, it is most effective in men whose prostates are very enlarged. This medication does not treat erectile dysfunction or have an effect of lipoprotein metabolism. It does not affect blood pressure.

The nurse is reviewing the laboratory results for a client receiving tacrolimus. Which laboratory result would indicate to the nurse that the client is experiencing an adverse effect of the medication? 1.Potassium level of 3.8 mEq/L (3.8 mmol/L) 2.Platelet count of 300,000 mm3 (300 × 109/L) 3.Fasting blood glucose of 200 mg/dL (11.1 mmol/L) 4.White blood cell count of 6000 mm3 (6.0 × 109/L)

3.Fasting blood glucose of 200 mg/dL (11.1 mmol/L) Rationale:A fasting blood glucose level of 200 mg/dL (11.1 mmol/L) is significantly elevated above the normal range of 70 to 110 mg/dL (4 to 6 mmol/L) and suggests an adverse effect. Recall that fasting blood glucose levels are sometimes based on health care provider preference. Other adverse effects include neurotoxicity evidenced by headache, tremor, and insomnia; gastrointestinal effects such as diarrhea, nausea, and vomiting; hypertension; and hyperkalemia. The remaining options identify normal reference levels. The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). The normal white blood cell count is 5000 to 10,000 mm3 (5 to 10 × 109/L).

Ciprofloxacin is prescribed for a client with a Pseudomonas aeruginosa infection of the urinary tract. The health care provider (HCP) should be questioned by the nurse about the prescription if which underlying condition is noted in the client's record? 1.Osteoarthritis 2.Diabetes mellitus 3.Myasthenia gravis 4.Chronic obstructive pulmonary disease (COPD)

3.Myasthenia gravis Rationale: Ciprofloxacin and other fluorquinolones can exacerbate muscle weakness in clients with myasthenia gravis. Accordingly, clients with a history of myasthenia gravis should not receive these medications. History of the remaining disease processes does not pose a problem.

The nurse is planning to administer furosemide 40 mg by intravenous push (IVP) through an existing intravenous (IV) line. To deliver this medication safely, the nurse should perform which action? 1.Give the medication rapidly over 10 seconds. 2.Give the medication slowly, diluted in 100 mL of 5% dextrose in water. 3.Pinch the IV tubing above the injection port, and inject slowly over 1 to 2 minutes. 4.Pinch the IV tubing below the injection port, and inject slowly over 1 to 2 minutes.

3.Pinch the IV tubing above the injection port, and inject slowly over 1 to 2 minutes. Rationale:To administer medication by IVP, the IV tubing must be pinched above the injection port so that the medication does not go back up the tubing during injection. Most IVP medications should be injected slowly. Considering the need for and action of the medication, it is not diluted unless prescribed.

The ambulatory care nurse is providing instructions to a client with a urinary tract infection (UTI) being started on nitrofurantoin. The nurse should provide the client with which information? 1.It can cause urinary retention. 2.It will cause the urine to become clear. 3.The sun should be avoided because it is a sulfa-based medication. 4.If taken with meals, it will help decrease the risk for gastrointestinal (GI) upset.

4.If taken with meals, it will help decrease the risk for gastrointestinal (GI) upset. Rationale: Nitrofurantoin is a urinary antiseptic (not a sulfa-based medication) and should be taken with meals to decrease the incidence of GI side effects. Food or milk decreases the GI upset. The medication could cause the urine to turn rust yellow or brown. It does not cause urinary retention.

A client is prescribed trimethoprim-sulfamethoxazole for a recurrent urinary tract infection (UTI). The nurse should give the client which instruction regarding this medication? 1.Expect rashes or skin changes as a result of therapy. 2.Discontinue the medication when symptoms subside. 3.Take most doses early in the day when fluid intake is greatest. 4.Take each dose with 8 oz (235 mL) of water, and drink extra water each day.

4.Take each dose with 8 oz (235 mL) of water, and drink extra water each day. Rationale: Trimethoprim-sulfamethoxazole is a combination medication. The client takes each dose with 8 oz (235 mL) of water and drinks several extra glasses of water each day. The client should space doses evenly around the clock for stable blood levels and should take the medication for the full course of therapy. The client should report rashes or other skin changes, which could indicate an allergy to sulfa.

A client taking metronidazole telephones the home health nurse to report dark discoloration to the urine. The nurse interprets that the client's complaint warrants which nursing action at this time? 1.Instruct the client to increase fluid intake. 2.Tell the client to discontinue the medication. 3.Instruct the client to call the health care provider (HCP). 4.Tell the client that this is a harmless medication side effect.

4.Tell the client that this is a harmless medication side effect. Rationale: Harmless darkening of the urine may occur, and the client should be told of this effect. Metronidazole can produce a variety of side effects, but they rarely require termination of treatment. Increasing fluid intake is a good health measure but will not prevent this side effect from occurring. It is not necessary to discontinue the medication or call the HCP.

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 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.