Diuretic/ Fluid and Electrolyte Practice Questions- Pharmacology I

What intervention will the nurse perform when monitoring a patient receiving triamterene? A. Assess potassium levels B. Monitor for hypernatremia C. Assess urinary output every other day D. Monitor for side effects of hypoglycemia

Correct Answer: A Rationale: Triamterene is a potassium-sparing diuretic. The nurse should monitor potassium for potential hyperkalemia. Hypernatremia and hypoglycemia are not common adverse effects of this drug. Urine output should be assessed more frequently than every other day.

The nurse is caring for a patient who has congestive heart failure that resulted from diastolic dysfunction. The patient's medical history indicates that the patient has a history of chronic kidney disease. Which drug does the nurse anticipate will be prescribed for the patient? A. Furosemide B. Metolazone C. Spironolactone D. Hydrochlorothiazide

Correct Answer: A Rationale: All the above drugs are recommended to treat diastolic dysfunction. However, because the patient has chronic kidney disease, the nurse anticipates that the primary health care will prescribe furosemide, which is safe in patients with chronic kidney disease. The use of metolazone, spironolactone, or hydrochlorothiazide is contraindicated in patients with chronic kidney disease.

The primary health care provider orders intravenous fluids containing potassium for a patient who has gastroenteritis and dehydration. Which nursing action is correct before administering the intravenous fluid? A. Assess the patient's urinary output. B. Check the patient's blood pressure. C. Take a saliva sample from the patient. D. Obtain a stool sample from the patient.

Correct Answer: A Rationale: Before administering intravenous fluids with potassium, the nurse should assess the patient's urinary output to know if there is any electrolyte imbalance. The kidneys compensate for any electrolyte imbalance by retaining electrolytes. A higher urinary output indicates loss of potassium, and the nurse will administer potassium supplements as prescribed. Change in blood pressure can be due to multiple factors and is not necessarily due to potassium levels in the body. A saliva sample will also provide information about infection but not potassium levels. A stool sample will provide information about the infection but not about potassium levels.

Which fluid is administered to reduce the risk of deep vein thrombosis? A. Colloids B. Whole blood C. Sodium supplements D. Potassium supplements

Correct Answer: A Rationale: Colloids are the intravenous fluids that increase the colloidal osmotic pressure and also increase the fluid flow from the interstitial compartment to the plasma compartment. They can be used as a prophylactic measure for preventing deep vein thrombosis. Whole blood contains all the components of the blood but is not as effective as colloids for treating deep vein thrombosis. Sodium ions are most abundant in the extracellular fluid and are necessary for the optimal functioning of the body. Sodium has no effect on clotting or plasma volume. Potassium supplements have no effect on the clotting mechanism of the blood.

What is the priority nursing intervention when administering intravenous potassium replacement to a patient? A. Administer the medication in a diluted form. B. Administer potassium as a bolus over 10 minutes. C. Apply heat to the site of intravenous administration. D. Teach the patient and family the signs and symptoms of hypokalemia.

Correct Answer: A Rationale: Intravenous dosage forms of potassium must always be given in a diluted form. There is no use or place for undiluted potassium because undiluted potassium is associated with cardiac arrest. Potassium should not be administered as a bolus or pushed. Heat will not aid the infusion. Unless the patient is prone to constant hypokalemia, teaching the signs and symptoms is not a priority.

Which diuretic is the drug of choice for the prevention of tissue damage after a closed head injury? A. Mannitol B. Metolazone C. Spironolactone D. Hydrochlorothiazide

Correct Answer: A Rationale: Mannitol is the drug of choice to prevent increased intracranial pressure after a closed head injury; although it works along the entire length of the nephron, it reduces intracranial pressure and cerebral edema by reducing cellular edema as an osmotic diuretic. Metolazone is a thiazide-like diuretic, spironolactone is an aldosterone-inhibiting diuretic, and hydrochlorothiazide is a thiazide diuretic; they are of little benefit in reducing cerebral edema.

The nurse is preparing to administer a transfusion of a blood product. What is the most appropriate intravenous fluid to hang as a maintenance infusion? A. Normal saline B. Ringer solution C. Lactated Ringer D. 5% dextrose and water

Correct Answer: A Rationale: Of the intravenous solutions listed, the only one that is compatible with blood products is saline.

Which class of diuretic drugs act at the descending loop of Henle? A. Osmotic diuretics B. Thiazide diuretics C. Potassium-sparing diuretics D. Carbonic anhydrase inhibitors

Correct Answer: A Rationale: Osmotic diuretics act at the proximal tubule and the descending loop of Henle, increasing the osmotic pressure in the glomerular filtrate and increasing the reabsorption of water into the renal tubules. Thiazide diuretics inhibit the reabsorption of sodium and chloride ions from the distal convoluted tubule. Potassium-sparing diuretics prevent sodium reabsorption in the distal convoluted tubule. Carbonic anhydrase inhibitors prevent the reabsorption of sodium ions by inhibiting the action of carbonic anhydrase enzyme in the proximal convoluted tubule.

A patient taking spironolactone has been taught about the medication. Which menu selection indicates that the patient understands teaching related to this medication? A. Carrots B. Potatoes C. Lima beans D. Tomato juice

Correct Answer: A Rationale: Spironolactone is a potassium-sparing diuretic that potentially could cause hyperkalemia. Carrots are the only appropriate choice out of the foods listed because they are lower in potassium. Potatoes, lima beans, and tomato juice are all known to contain high levels of potassium.

On reviewing a patient's laboratory reports, the nurse finds that the patient has a total protein level of 4.5 g/dL. What will the nurse expect the primary health care provider to prescribe? A. Albumin B. Tolvaptan C. Conivaptan D. Sodium polystyrene sulfonate

Correct Answer: A Rationale: The normal total protein level in the body is 7.4 g/dL. If the level falls below 5.3 g/dL, colloid replacement therapy is suggested to the patient. The total level of protein in the patient is 4.5 g/dL (below 5.3 g/dL). Therefore, the nurse would expect the primary health care provider to prescribe albumin, a natural protein. Tolvaptan, conivaptan, and sodium polystyrene sulfonate are not used to restore the patient's protein level. Tolvaptan and conivaptan are nonpeptide dual arginine vasopressins used to restore sodium levels in the body. Sodium polystyrene sulfonate is used to restore potassium levels in the body.

The health care provider has ordered 5% dextrose in water as a maintenance fluid for the patient. The nurse is assessing the patient at the beginning of the shift and observes the fluid hanging to be 5% dextrose in normal saline (D5NS). Which is the highest priority nursing action? A. Stop the infusion. B. Complete an occurrence report. C. Find out which nurse hung the D5NS. D. Notify the health care provider of the error.

Correct Answer: A Rationale: The patient's safety is always the primary concern; the fluid should be stopped and the correct fluid hung before other measures are taken, such as notifying the health care provider. The patient should be treated first before completing any paperwork such as an occurrence report and before investigating which nurse hung the incorrect solution.

What is the correct pediatric dose of furosemide? A. 1 to 2 mg/kg B. 2 to 3 mg/kg C. 3 to 4 mg/kg D. 4 to 5 mg/kg

Correct Answer: A Rationale: The pediatric dose of furosemide is 1 to 2 mg/kg of body weight. Doses of 2 to 3 mg/kg, 3 to 4 mg/kg, and 4 to 5 mg/kg are all considered too high for children. They may lead to disturbance in the normal electrolytic balance in the child.

Which product is preferred in patients with extreme blood loss of over 25%? A. Whole blood B. Fresh frozen plasma (FFP) C. Plasma protein fraction (PPF) D. Packed red blood cells (PRBCs)

Correct Answer: A Rationale: Whole blood is more beneficial in patients who undergo extreme blood loss of over 25% because whole blood also contains plasma, which is the chief fluid volume of the blood. FFP is given to patients who show demonstrated deficiency of clotting factor. PPF is used to manage acute bleeding. PRBCs are used to increase the oxygen-carrying capacity in patients.

A patient with congestive heart failure is prescribed furosemide and amiloride. However, while assessing the patient's medical record, the nurse observes that the patient is on therapy with lithium carbonate to treat bipolar disorder. How should the nurse respond in this situation? A. Instruct the patient to stop taking lithium carbonate during diuretic therapy. B. Report to the health care provider about the patient's lithium carbonate therapy. C. Report to the health care provider about the patient's bipolar disorder. D. Instruct the patient to take lithium carbonate 1 hour before administering the diuretics.

Correct Answer: B Rationale: Amiloride is a potassium-sparing diuretic. Concurrent use of a potassium-sparing diuretic with lithium will cause lithium toxicity. Therefore, the nurse should report to the health care provider about the patient's lithium therapy. The nurse should not tell the patient to stop taking lithium carbonate, because this is out of the scope of nursing practice. Reporting to the provider about the patient's bipolar disorder will not help change the medications used in diuretic therapy. The nurse should not instruct the patient to take lithium carbonate 1 hour before administering the diuretics, because concurrent use of these two medications leads to lithium toxicity and because this is out of the scope of nursing practice.

The nurse is caring for a patient who has a deficiency in clotting factor. Which product is used in such a patient? A. Hetastarch B. Fresh frozen plasma (FFP) C. Plasma protein fraction (PPF) D. Packed red blood cells (PRBCs)

Correct Answer: B Rationale: FFP is used to increase the clotting factor in patients who show demonstrated deficiency in clotting factor. Hetastarch is used as a nonprotein plasma expander to increase the blood volume in patients with decreased blood levels. PPF is used to manage acute bleeding. PRBCs are used to increase the oxygen-carrying capacity in patients with anemia, in patients with hemoglobin deficit, and in patients with blood loss up to 25%.

The primary health care provider instructs the nurse to administer a 20% solution of mannitol to a patient who has cerebral edema. What does the nurse recall before administering the drug to the patient? A. To administer potassium supplements B. To maintain normal room temperature C. To store the drug in a brightly lit room D. To give oral rehydration salts with the drug

Correct Answer: B Rationale: Mannitol is an osmotic diuretic that is used in the treatment of cerebral edema that may occur due to head injuries. Mannitol is more likely to crystallize at low temperatures when its concentration exceeds 15%. Therefore, to avoid crystallization of the 20% solution of mannitol, the nurse should maintain normal room temperature before administering the drug. Because mannitol is an osmotic, diuretic potassium is not lost, and supplements are not needed. Exposure of mannitol to light can cause the chemicals in the medication to break down. The nurse should not administer oral rehydration salts to the patient, because they do not prevent the crystallization of mannitol.

A patient with hypokalemia is ordered to receive an intravenous (IV) dose of potassium chloride (KCl) 15 mEq in 250 mL of 0.9% saline to infuse over 1 hour. What action will the nurse take prior to starting the infusion? A. Place an ice pack over the IV site. B. Review the electrocardiogram (ECG). C. Ensure that the IV cannula is securely taped. D. Review the previous 24-hour intake and output.

Correct Answer: B Rationale: Potassium infusions are used to treat patients with severe hypokalemia. The most concentrated solutions used are 60 mEq/L, with a rate not more than 40 mEq/hour. Hence, cardiac monitoring is indicated when concentrated potassium chloride is administered intravenously. An ice pack is placed over the IV site to relieve the burning after or during the therapy. The IV cannula is used for the implementation of antineoplastic drugs. The nurse needs to assess the serum potassium concentrations to evaluate for toxicity, not the 24-hour intake and output.

A patient with severe trauma has received 5000 mL normal saline intravenously. The patient now has peripheral edema but remains hypotensive. Which agent will help in correction of the fluid balance? A. 3% saline B. Hetastarch C. Lactose-free milk D. Packed red cells (PRCs)

Correct Answer: B Rationale: The patient needs to increase intravascular fluid volume. Hetastarch is a colloid, which will increase osmotic pull from the extravascular spaces to the intravascular area. The use of 3% saline is not preferred because of the risk of hypernatremia. PRCs are red blood cell replacements, not volume expanders. Lactose-free milk is used to induce sleep.

Which is the fluid of choice in a patient who has lost 15% of blood volume slowly? A. Dextran B. Crystalloids C. Whole blood D. Plasma protein fraction (PPF)

Correct Answer: B Rationale: When a patient has lost about 15% of the blood slowly, crystalloids are the fluid of choice. Dextran is a nonprotein plasma expander and is given to patients who have lost about 20% to 50% of blood slowly. Whole blood is given to patients who have lost over 50% of blood slowly or 20% of blood rapidly. PPF is given to control acute bleeding in patients.

A patient reveals that he or she is taking daily ibuprofen for chronic back pain. On reviewing the patient's medical history, the nurse learns that the patient is also taking furosemide for high blood pressure. What does the nurse anticipate that the primary health care provider will prescribe? A. Decreased dose of ibuprofen B. Increased dose of furosemide C. Alternating doses of both medications D. STAT venipuncture for serum calcium

Correct Answer: B Rationale: When furosemide is used with nonsteroidal antiinflammatory drugs (NSAIDs), the diuretic activity of the drug is decreased due to the inhibition of the renal prostaglandins. The nurse can expect the primary health care provider to increase the dose of furosemide to have effective diuresis. Decreasing the dose of ibuprofen may not be effective in relieving the patient's pain. The primary health care provider does not alternate the doses of the two medications, because the patient will neither achieve effective pain relief nor receive the full effect of the diuretic. When furosemide is given with an NSAID, there is no impact on the serum calcium level.

A patient is found to have low levels of clotting factors. Which treatment will the provider order for this patient? A. Dextran 70 B. Conivaptan C. Fresh frozen plasma (FFP) D. Packed Red Blood Cells (PRBCs)

Correct Answer: C Rationale: Administration of FFP is useful to treat the patient with low levels of clotting factors, because it increases clotting factors and promotes the clotting function. Dextran 70 is used in colloid replacement therapy and does not increase clotting factor levels. Conivaptan is a vaptan used to treat hyponatremia but it is not used in cases of clotting factor deficiency. PRBCs are useful for patients suffering from anemia but does not help increase clotting factor levels.

A patient is prescribed chlorthalidone. What information will the nurse teach the patient? A. "Take this medication on an empty stomach." B. "Take this medication before bed each night." C. "Wear protective clothing and sunscreen while taking this medication." D. "Do not drink more than 10 ounces of fluid a day while on this medication."

Correct Answer: C Rationale: Adverse effects associated with chlorthalidone include photosensitivity. The nurse should teach the patient about sun protection when out in the sun. The thiazide-like diuretics can cause gastrointestinal distress, so it is advised that they be taken with food. Diuretics taken late in the afternoon or evening may lead to nocturia, so they are usually scheduled for morning dosing. Fluids should be increased while taking diuretics to avoid the side effect of constipation.

A patient is hospitalized due to euvolemic hyponatremia. Which drug is useful for treating the patient? A. Hetastarch B. Dextran 70 C. Conivaptan D. Acetazolamide

Correct Answer: C Rationale: Conivaptan is a nonpeptide dual arginine vasopressin (AVP) V1A and V2 receptor antagonist that is used to treat euvolemic hyponatremia. Hetastarch, Dextran 70, and acetazolamide are not indicated for the treatment of euvolemic hyponatremia. Hetastarch and Dextran 70 are used in colloid replacement therapy. Acetazolamide is a diuretic that is used to correct metabolic acid-base imbalance.

A patient is taking hydrochlorothiazide. On assessment, the nurse notices the patient has muscle weakness and hypotension. What is the nurse's first intervention? A. Reduce salt in the patient's food B. Administer calcium supplements C. Assess the serum potassium level D. Give a lower dose of the medication

Correct Answer: C Rationale: Hydrochlorothiazide overdose leads to hypokalemic symptoms, which are characterized by muscle weakness and hypotension. The nurse should immediately assess the patient's serum potassium level to determine the course of action. Decreasing the salt intake would further reduce the patient's blood pressure and cause sodium deficiency. Giving calcium supplements alone does not reduce the symptoms caused by potassium deficiency. Reducing the dose of the medication will not help restore the electrolyte balance.

The nurse is caring for a patient who has diarrhea and vomiting. During a review of the patient's medical history, the nurse finds that the patient is taking phenytoin for seizures. What crystalloid mix will be ineffective in this patient? A. Saline mixed with lactose B. Saline mixed with sodium C. Saline mixed with dextrose D. Saline mixed with potassium

Correct Answer: C Rationale: In the presence of dextrose, phenytoin gets precipitated, which may cause the phenytoin to be ineffective. Therefore, the primary health care provider will not prescribe dextrose. Lactose is a sugar molecule found in milk that does not react with phenytoin. Therefore, lactose can also be prescribed by the primary health care provider. Neither sodium nor potassium precipitates phenytoin. Therefore, sodium or potassium can be prescribed to a patient on phenytoin.

A primary health care provider orders potassium supplements for a patient who is lethargic and dehydrated. After assessing the laboratory reports, the nurse finds the patient's potassium levels are 4 mEq/L. For what does the nurse monitor in the patient? A. Complaints of nausea B. A decrease in hemoglobin C. Complaints of chest discomfort D. A decrease in white blood cells (WBC)

Correct Answer: C Rationale: Normal potassium levels range from 3.5 to 5.0 mEq/L. Therefore, a potassium level of 4 mEq/L indicates normal potassium concentration. When administered extra potassium supplements, the patient may develop symptoms of hyperkalemia; therefore, the nurse should monitor the patient for chest discomfort caused by irregular cardiac activity due to hyperkalemia. Hypokalemia may cause nausea, but hyperkalemia does not manifest as nausea. A decrease in hemoglobin causes anemia and is evident by hemoglobin levels. A decrease in WBC is observed with infections but is not caused by administering potassium.

A patient is prescribed an isotonic intravenous fluid. Which intravenous fluid is most likely to be ordered by the health care provider? A. 3% NaCl B. 0.25% NaCl C. Normal saline D. 0.45% NaCl/D5W

Correct Answer: C Rationale: Of the fluids listed, the only one that is isotonic is normal saline. 3% NaCl is considered to be a hypertonic solution; 0.25% NaCl and 0.45% NaCl/D5W are considered to be hypotonic solutions.

The nurse is assessing a patient who has been diagnosed with jaundice. The patient has a total protein level of 4.5 g/dL. What will the nurse expect the primary health care provider to prescribe? A. Dextran 70 B. Conivaptan C. 5% albumin D. Lactated Ringer solution

Correct Answer: C Rationale: On assessment, the nurse finds that the patient has hypoproteinemia along with jaundice. Therefore; the treatment should include a colloid that restores the protein level and also does not affect the patient's liver. Albumin is metabolized by the reticuloendothelial system and excreted by the liver. Therefore, administration of 5% albumin would be the most suitable treatment. Dextran 70 is also a colloid, but it is metabolized in the liver, so it is not as effective as 5% albumin. Conivaptan is a vaptan used to treat hyponatremia but not hypoproteinemia. Lactated Ringer solution is a crystalloid solution and is not used for colloidal replacement therapy.

Which blood product is administered to anemic patients? A. Cryoprecipitate B. Fresh frozen plasma C. Packed red blood cells D. Plasma protein fraction

Correct Answer: C Rationale: Packed red blood cells are useful in anemic patients to increase oxygen-carrying capacity. Cryoprecipitate is useful for arresting acute bleeding and for facilitating quick clotting. Fresh frozen plasma is useful for patients with low levels of clotting factors. It doesn't increase the oxygen-carrying capacity of the blood. Plasma protein fraction provides clotting factors and is used in cases of acute bleeding to arrest the bleeding. It doesn't help increase oxygen-carrying capacity.

The nurse observes that a patient with an increased sodium level has an increase in weight, a heart rate of 90 beats/min, and a blood pressure of 170/90 mm Hg. The patient reports reduced urine output. Which instruction will the nurse expect from the primary health care provider? A. Reduce salt content in the patient's diet. B. Suggest that the patient exercise regularly. C. Administer 5% dextrose in water to the patient. D. Infuse intravenous (IV) potassium at a rate of 15 mEq/hr.

Correct Answer: C Rationale: The patient had an increase in weight due to edema (fluid retention) and decreased urine output. In addition, the patient's heart rate is 90 beats/min (increased heart rate), and the patient's blood pressure is 170/90 mm Hg (hypertension). So, the primary health care provider asks the nurse to administer 5% dextrose in water, because it will cause intravascular sodium dilution and enhance urine volume output. Reducing salt intake in the patient's diet would reduce sodium levels, but it does not increase urine output. Physical exercise may not help reduce the high sodium levels. The patient's symptoms are due to increased sodium levels, so infusing IV potassium at a rate of 15 mEq/hr would not reduce sodium levels.

Which drug can be prescribed for the treatment of idiopathic hypercalciuria? A. Mannitol B. Amiloride C. Metolazone D. Furosemide

Correct Answer: C Rationale: Thiazide diuretics are used to treat idiopathic hypercalciuria. Metolazone is a thiazide diuretic drug that is useful in the treatment of idiopathic hypercalciuria. Mannitol, amiloride, and furosemide are not used to treat idiopathic hypercalciuria. Mannitol is an osmotic diuretic that is used for the treatment of cerebral edema and acute renal failure. Amiloride is a potassium-sparing diuretic that is used in the management of heart failure and metabolic alkalosis. Furosemide is a loop diuretic that is used in the treatment of pulmonary edema and the edema associated with heart failure, liver disease, nephrotic syndrome, and ascites.

Which class of diuretics is indicated for the treatment of glaucoma? A. Loop diuretics B. Thiazide diuretics C. Potassium-sparing diuretics D. Carbonic anhydrase inhibitors

Correct Answer: D Rationale: Carbonic anhydrase inhibitors increase the outflow of aqueous humor. Therefore, they are used in the long-term management of open-angle glaucoma. Loop diuretics are used to manage edema associated with heart failure and/or renal diseases. Thiazide diuretics are used to manage edema associated with various origins. Potassium-sparing diuretics are used in the management of hyperaldosteronism and hypertension.

. For what signs and symptoms of overdose does the nurse monitor after administering a hypertonic saline solution to a patient who has severe hyponatremia? A. Vomiting and diarrhea B. Confusion and seizures C. Lethargy and hypotension D. Flushed skin and increased thirst

Correct Answer: D Rationale: An overdose of hypertonic saline leads to sodium excess, which may cause red, flushed skin and increased thirst. Vomiting, diarrhea, lethargy, and hypotension are direct adverse effects of hyponatremia. Confusion and seizures are the symptoms of hypokalemia

What acts to increase the reabsorption of water? A. Aldosterone B. Hypernatremia C. Glomerular filtration D. Antidiuretic hormon

Correct Answer: D Rationale: Antidiuretic hormone (ADH), known as the water-conserving hormone, acts on the collecting duct to regulate conservation of water by increasing the water permeability of the collecting ducts; this increases the amount of water reabsorbed into the bloodstream. Aldosterone is a mineralocorticoid steroid hormone produced by the adrenal cortex that regulates sodium and water balance. Hypernatremia is a condition in which an abnormally high sodium concentration is present in the blood. It may be due to defective renal excretion but is more commonly caused by excessive dietary sodium or replacement therapy. Glomerular filtration is the first step in urine formation. It removes solutes and water from the arterial blood; hence glomerular filtrate is not diluted.

A patient diagnosed with congestive heart failure is prescribed a combination of furosemide and amiloride. Which outcome indicates the effectiveness of the therapy? A. The patient's pulse rate is between 110 and 150 beats/min. B. The patient reports dizziness, lightheadedness, and palpitations. C. The patient's laboratory reports show increased specific gravity of urine. D. The patient has strong pedal pulses and warm, pink extremities with rapid capillary refill.

Correct Answer: D Rationale: In a patient with congestive heart failure, the primary goal of diuretic therapy is to maintain a balanced cardiac output. Strong pedal pulses and warm, pink extremities with rapid capillary refill indicate that the cardiac output is restored. When the patient's pulse rate is between 60 and 100 beats/min, this indicates that the cardiac output is restored. If a patient no longer reports dizziness, lightheadedness, and palpitations, it indicates that the patient is no longer experiencing hypotensive episodes. If the patient's laboratory report shows normal specific gravity of urine, it indicates that the patient has regained balanced fluid volume status.

The nurse is caring for a patient who is undergoing diuretic therapy to relieve hypertension. Which is the best intervention by the nurse to assess hypotensive episodes? A. Check the serum sodium levels. B. Monitor the pedal pulses of the patient periodically. C. Check the elasticity and flexibility of the patient's skin. D. Ask the patient about signs like tingling of fingers and dizziness.

Correct Answer: D Rationale: It is important for the nurse to monitor a patient undergoing diuretic therapy because excessive use of diuretics can result in hypotension. Tingling of fingers and dizziness are some of the symptoms of hypotension. Checking the serum sodium levels will help assess the fluid volume status of a patient. Monitoring the pedal pulses helps assess the cardiac output of the patient. The fluid volume status in a patient is assessed by checking the elasticity and flexibility of the patient's skin.

At which concentration is the intravenous injection of mannitol most likely to crystallize? A. 5% B. 10% C. 15% D. 20%

Correct Answer: D Rationale: Mannitol is more likely to crystallize at 20% concentration (above 15%). At 5%, mannitol solution is in a liquid state. At a concentration of 10%, it is also stable in a liquid state without any crystallization. A 15% solution is likely in a liquid state as long as the solution is not stored at a low temperature.

Which drug may cause melena as a side effect? A. Mannitol B. Furosemide C. Metolazone D. Acetazolamide

Correct Answer: D Rationale: Melena and photosensitivity are the adverse effects of acetazolamide. Mannitol causes thrombophlebitis, convulsions, and pulmonary congestion. Furosemide doesn't cause melena as an adverse effect. Photosensitivity and thrombocytopenia are adverse effects of thiazide and thiazide-like diuretics such as metolazone.

The nurse will expect to administer which diuretic medication to treat a patient diagnosed with primary hyperaldosteronism? A. Mannitol B. Metolazone C. Furosemide D. Spironolactone

Correct Answer: D Rationale: Spironolactone is the direct antagonist for aldosterone. Spironolactone is used to treat hyperaldosteronism to reverse the potassium loss caused by potassium-wasting diuretics such as loop diuretics. Mannitol is an osmotic diuretic, metolazone is a thiazide and thiazide-like diuretic, and furosemide is a loop diuretic. These are not administered to treat hyperaldosteronism.

A patient who has just undergone surgery exhibits tachycardia and a hemoglobin level of 9 g/100 mL. Which fluid therapy will the nurse expect to administer? A. 50 mL of 5% albumin B. 450 mL of whole blood C. 100 mL of fresh frozen plasma D. 250 mL of packed red blood cells

Correct Answer: D Rationale: The nurse should administer the red blood cells (RBCs) to increase the patient's oxygen-carrying capacity. The patient has anemia, so this therapy should help alleviate tachycardia because, in this case, tachycardia is a result of sympathetic nervous system (SNS) activation in response to hypoxemia. As the tissues receive more oxygenated blood from the infusion of additional hemoglobin, the SNS stimulation should subside, and improved tissue oxygenation should help improve healing. The patient needs hemoglobin, so albumin and plasma are improper therapy because they do not provide hemoglobin. Whole blood can help replenish hemoglobin, but because whole blood contains more fluid than RBCs, it increases the risk of fluid volume overload and is not indicated.

The nurse is administering hypertonic saline solution to treat a patient with severe hyponatremia. Which nursing action is the priority? A. Monitor temperature B. Monitor urinary output C. Administer antiemetic D. Assess level of consciousness

Correct Answer: D Rationale: The nurse should be alert to signs of hypernatremia when administering hypertonic saline solutions. Flushed skin, increased thirst, elevated temperature, and decreased urinary output are signs and symptoms of hypernatremia. However these signs are not as high a priority as decreased level of consciousness and confusion, which are signs of severe hypernatremia.

The nurse is assessing a patient's laboratory reports and finds that the serum pH is less than 7. Which drug may be contraindicated in this patient? A. Laxatives B. Loop diuretics C. Sodium bicarbonate D. Potassium-sparing diuretics

Correct Answer: D Rationale: The pH level of less than 7 indicates metabolic acidosis, which is treated by administering bicarbonates. Metabolic acidosis causes an increase in potassium concentration; hence, patients with metabolic acidosis are not administered potassium-sparing diuretics, because they cause hyperkalemia. Laxatives are not contraindicated in patients with metabolic acidosis, because they do not cause hyperkalemia. Loop diuretics are preferred to induce diuresis in patients with metabolic acidosis, and sodium bicarbonate is one effective drug used to treat acidosis. It does not cause hyperkalemia, but is used to treat hyperkalemia

A 10-year-old child who has congestive heart failure has been prescribed furosemide. Which instruction does the nurse give to the child's parents to prevent adverse effects of the medication? A. "Administer the medication on an empty stomach." B. "Do not give oral rehydration drinks to your child." C. "Give the medication to your child before bedtime." D. "Protect your child from excessive sunlight exposure."

Correct Answer: D Rationale: The parents should be instructed to prevent the child from being exposed to sunlight. Exposure to excessive sunlight may cause loss of fluids and electrolytes in the child and result in dehydration. Furosemide should be given with meals or with milk to prevent gastrointestinal irritation. Therefore, the nurse should not instruct the parents to give the medication on an empty stomach. Oral rehydration supplements may be given in case of excessive loss of fluids. The diuretic medication needs to be taken early in the morning with food or milk at the same time every day. Medication at night causes nocturia in the child.

Which fluid is given to increase the oxygen-carrying capacity in patients? A. 5% albumin B. Fresh frozen plasma (FFP) C. Plasma protein fraction (PPF) D. Packed red blood cells (PRBCs)

Correct Answer: D Rationale: To increase the oxygen-carrying capacity in patients, PRBCs are given. Albumin is given to increase the blood volume through colloid oncotic pressure. FFP is given to increase the clotting factor levels in patients with a demonstrated deficiency. PPF is given to manage acute bleeding.

What information will the nurse obtain prior to administering furosemide to a patient? Select all that apply. A. The patient's allergies B. The patient's serum potassium level C. The patient's level of consciousness D. The patient's baseline renal function E. The patient's fluid intake and urine output

Correct Answers: A, B, D, E Rationale: The nurse should verify if the patient is allergic to sulfonamides, because there is a cross-allergy to loop diuretics. Before administering a loop diuretic such as furosemide to a patient, the nurse should assess the patient's serum potassium level. A major side effect of loop diuretics is hypokalemia. If the patient's potassium level is not within normal limits, the dose should not be given, and the primary health care provider should be notified. The nurse should also assess the patient's baseline renal function, because loop diuretics should not be administered to patients with end-stage renal disease, in which the nephrons are not functioning. The nurse should also assess the patient's fluid intake and urine output. A loop diuretic pulls off excess fluid, so if the output is greater than the intake, the medication is effective. The patient's level of consciousness would be assessed if an osmotic diuretic was administered for cerebral edema.

Which physiologic change will be observed in a patient after administering diuretics? Select all that apply. A. Increased plasma volume B. Decreased cardiac output C. Decreased blood pressure D. Increased extracellular fluid volume E. Increased peripheral vascular resistance

Correct Answers: B and C Rationale: Diuretics cause direct arterial dilation, which decreases cardiac output. The decreased cardiac output also decreases the blood pressure of the patient. Due to loss of sodium and water, there is a decrease in plasma volume and the extracellular fluid volume after administering diuretics. Due to direct arterial dilation, the peripheral vascular resistance decreases after administering diuretics.