PHARM - Renal and Urinary Medications

The nurse is caring for a client diagnosed with Parkinson's disease who is prescribed benztropine mesylate daily. The nurse reinforces instructions to both the client and the spouse regarding the side effects of this medication and the need to report which side effect if it occurs?

Inability to urinate Rationale: Urinary retention is a side effect of benztropine mesylate. The nurse should instruct the client or spouse about the need to monitor for difficulty with urinating, a distended abdomen, infrequent voiding in small amounts, and overflow incontinence.

The nurse prepares to administer sodium polystyrene sulfonate to a client with chronic kidney disease for which laboratory abnormality?

Potassium level of 7.2 mEq/L Rationale: Sodium polystyrene sulfonate is a cation exchange resin used in the treatment of hyperkalemia. The resin either passes through the intestine or is retained in the colon. It releases sodium ions in exchange for primarily potassium ions. The therapeutic effect occurs 2 to 12 hours after oral administration and longer after rectal administration.

Bethanechol chloride is prescribed for a client. When should the nurse tell the client to take the medication?

Two hours after meals Rationale: Administration of bethanechol with meals can cause nausea and vomiting in the client. To avoid this problem, oral doses should be administered 1 hour before meals or 2 hours after meals.

Bethanechol chloride is prescribed for a client with urinary retention. Which disorder should be a contraindication to the administration of this medication?

Urinary strictures Rationale: Bethanechol chloride can be harmful 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 rupture the bladder in clients with these conditions.

Phenazopyridine hydrochloride is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. Which should the nurse reinforce to the client?

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.

In reviewing the admission assessment data and primary health care provider's prescriptions for a client with peptic ulcer disease, the nurse notes that the client has a history of renal disease. Based on this data, the nurse determines that which antacid should be prescribed for this client?

Aluminum hydroxide Rationale: Aluminum hydroxide lowers serum phosphate by binding with dietary phosphorus to form insoluble aluminum phosphate. The phosphate is then excreted in the feces. Aluminum hydroxide will not affect the renal system as much as other antacids. The medications identified in options 1, 3, and 4 are partially excreted by the kidneys; therefore, they may cause a problem in clients with renal disease.

The nurse is caring for a client with kidney failure. The serum phosphate level is reported as 7 mg/dL. Which medication should the nurse plan to administer as prescribed to the client?

Aluminum hydroxide gel Rationale: The normal serum phosphate level is 3 to 4.5 mg/dL. The client in this question is experiencing hyperphosphatemia. Certain medications can be given to increase fecal excretion of phosphorus by binding phosphorus from the food in the gastrointestinal tract. Aluminum hydroxide gel is one such medication. Calcium gluconate and calcium chloride are medications used in the treatment of tetany that occurs from acute hypocalcemia. Calcitonin, a thyroid hormone, decreases the plasma calcium level by increasing the incorporation of calcium into the bones thus keeping it out of the serum.

Following kidney transplantation, cyclosporine is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication?

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 to 1.1 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). Anormal 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 receiving nitrofurantoin calls the primary health care provider's office complaining of side effects related to the medication. Which side effect indicates the need to stop treatment with this medication?

Chest pain Rationale: Gastrointestinal (GI) effects are the most frequent adverse reactions to this medication and can be minimized by administering the medication with milk or meals. Pulmonary reactions manifested as dyspnea, chest pain, chills, fever, cough, and the presence of alveolar infiltrates on the x-ray should indicate the need to stop the treatment. These symptoms resolve in 2 to 4 days following discontinuation of this medication.

The 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 class of medications?

Decongestants Rationale: Episodes of urinary retention can be triggered by certain medications such as decongestants, anticholinergics, and antidepressants. Diuretics, antibiotics, and antitussives generally do not trigger urinary retention. Retention also can be precipitated by other factors such as alcoholic beverages, infection, bed rest, and becoming chilled.

A client has been prescribed allopurinol. The nurse reinforces which information concerning the administration of the medication?

Drink at least 8 glasses of fluid every day. Rationale: Clients taking allopurinol are encouraged to drink 2000 to 3000 mL of fluid a day to prevent the formation of crystals in the urine. Allopurinol is to be given with milk or immediately following meals. If the client develops a rash, irritation of the eyes, or swelling of the lips or mouth, the primary health care provider should be notified because this may indicate hypersensitivity.

A client with a urinary tract infection with dysuria is given a prescription for phenazopyridine hydrochloride for symptom relief. Which should the nurse reinforce instructing the client about this medication?

Expect the urine to become reddish orange. Rationale: Phenazopyridine hydrochloride is a urinary tract analgesic with no antimicrobial properties. It can cause a reddish orange discoloration of urine and tears and can stain undergarments and soft contact lenses. 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 notifying the primary health care provider.

The nurse is reinforcing discharge instructions to a client receiving sulfadiazine. Which should be included in the list of instructions?

Maintain a high fluid intake. Rationale: Each dose of sulfadiazine 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 sulfadiazine cause urine to turn dark brown or red. This does not indicate the need to notify the PHCP.

The nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. Which should be included in the plan of care for instructions?

Maintain a high fluid intake. Rationale: Each dose of sulfisoxazole 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 sulfisoxazole cause the urine to turn dark brown or red. This does not indicate the need to notify the primary health care provider.

Trimethoprim-sulfamethoxazole is prescribed for a client. The nurse should instruct the client to report which symptom if it developed during the course of this medication therapy?

Sore throat Rationale: Clients taking trimethoprim-sulfamethoxazole should be informed about early signs 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 PHCP if these symptoms occur. The other options do not require PHCP notification.

The nurse is reinforcing dietary instructions to a client who is currently prescribed probenecid. Which food should the nurse encourage the client to continue to eat?

Spinach Rationale: Probenecid inhibits the reabsorption of uric acid by the kidneys and promotes excretion of uric acid in the urine. Clients taking this medication are instructed to limit excessive purine intake. High-purine foods to avoid or limit include organ meats, sardines, scallops, anchovies, broth, mincemeat, herring, shrimp, mackerel, gravy, and yeast. Spinach is not a high-purine food.

A sulfonamide is prescribed for a client with a urinary tract infection. During review of the client's record, the nurse notes that the client is taking warfarin sodium daily. Which prescription should the nurse anticipate for this client?

A decrease in the warfarin sodium dosage Rationale: Sulfonamides can potentiate the effects of warfarin sodium, phenytoin, and orally administered hypoglycemics such as tolbutamide. When an oral anticoagulant is combined with a sulfonamide, a decrease in the anticoagulant dosage may be needed.

The nurse is preparing a subcutaneous dose of bethanechol chloride 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?

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

The nurse who is administering bethanechol chloride is monitoring for acute toxicity associated with the medication. The nurse should check the client for which sign of toxicity?

Bradycardia Rationale: Toxicity (overdose) produces manifestations of excessive muscarinic 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.

Propantheline bromide is prescribed for a client with bladder spasms. Which disorder, noted in the client's record, alerts the nurse to question the prescription for this medication?

Glaucoma Rationale: Propantheline bromide is contraindicated in clients with narrow-angle glaucoma, obstructive uropathy, gastrointestinal disease, or ulcerative colitis. Options 2, 3, and 4 are not contraindications to the use of this medication.

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication?

Hematocrit of 32% Rationale: Epoetin alfa is used to reverse anemia associated with chronic kidney disease. A therapeutic effect is seen when the hematocrit is between 30% and 33%. The laboratory tests noted in the other options are unrelated to the use of this medication.

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication?

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.

The nurse caring for a client taking tamsulosin determines that which finding indicates the need for follow-up?

Pulse rate of 120 beats per minute Rationale: Tamsulosin is classified as benign prostatic hyperplasia agent and acts by relaxing smooth muscle and increasing urinary flow. An adverse effect of this medication is first-dose syncope, which usually occurs within the first 30 to 90 minutes of the initial dose. This is commonly preceded by tachycardia (pulse of 120 to 160 beats per minute). Side effects of this medication include dizziness, drowsiness, nasal congestion, and vertigo.

Oxybutynin chloride is prescribed for a client with neurogenic bladder. Which sign would indicate a possible toxic effect related to this medication?

Restlessness Rationale: Toxicity (overdose) of this medication 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 overdose.

Bethanechol is prescribed for the client with urinary retention, and an injectable form of bethanechol is available for use as prescribed. The nurse informs the client of the primary health care provider's prescription, knowing that the medication will be administered by which injectable route?

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

A urinary analgesic is prescribed for a client with a urinary tract infection. When should the nurse tell the client that it is best to take the medication?

With meals Rationale: A urinary antiseptic is administered with meals to decrease gastrointestinal side effects.