Pharm Unit 3

The pharmacology instructor is discussing the differences among the various diuretic agents. Which would the instructor cite as a difference between spironolactone and hydrochlorothiazide?

Potassium losses are greater with hydrochlorothiazide than with spironolactone.

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?

Potassium losses are lower with spironolactone than with furosemide

A client has a nursing diagnosis of activity intolerance related to fatigue and weakness. Which action(s) would be appropriate for the nurse to include in the client's plan of care?

Promoting rest periods throughout the day as necessary; encouraging ambulation as tolerated

A client, diagnosed with left-sided heart failure, should be taught to recognize the signs and symptoms of the onset of what classic manifestation of this condition?

Pulmonary edema

A client with cerebral edema is prescribed mannitol. Which assessment should the nurse prioritize during the ongoing assessment?

Response of pupils to light

A male client has cirrhosis and is receiving diuretic therapy. The nurse knows that what drug will help prevent metabolic alkalosis or hypokalemia in this client?

Spironolactone

The nurse is caring for a client with hyperaldosteronism. For which diuretic would the nurse prepare teaching for the client?

Spironolactone

The client has been prescribed amlodipine for hypertension. The client's blood pressure upon a revisit remains elevated. The nurse inquiries about the use of which alternative therapy?

St. John's Wort

On several occasions, the nurse checks a client's blood pressure. The readings are 130/79 mm Hg, 136/78 mm Hg, and 128/88 mm Hg. What term would the nurse use to document the client's blood pressure?

Stage 1 hypertension

A client began taking hydrochlorothiazide 1 week ago and is reporting occasional dizziness when standing 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 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?

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

After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states:

"I need to make sure I don't eat too many high potassium foods"

The nurse provides drug teaching to the client prescribed captopril. What statement made by the client does the nurse interpret to mean teaching has been effective?

"I will call my doctor if I bruise easily or become extremely tired"

A client with heart failure is prescribed a loop diuretic. Which client statement indicates that teaching provided by the nurse about this medication was effective?

"I will change positions slowly if I feel dizzy"

The nurse is teaching a 62-year-old client about hydrochlorothiazide, which the health care provider has prescribed for treatment of hypertension. What statement, made by the client, suggests that the client understands the teaching?

"I will need to stand slowly."

A client with a history of gout and congestive heart failure has been prescribed captopril for treatment of hypertension. What assessment questions should the nurse ask the client when assessing for potential interactions? Select all that apply.

"Is your heart failure treated with digoxin?";"Do you take iron supplements?";"What medication are you prescribed for management of gout?";"Have you ever been prescribed spironolactone?"

A client, prescribed amlodipine, asks how this drug works. What is the nurse's best response?

"It inhibits the influx of calcium ions across cardiac and smooth muscle, dilating the coronary arteries"

A client with primary hypertension asks the nurse why the prescriber added another medication to assist with lowering the blood pressure. What is the nurse's best response?

"Many clients require two or more drugs for high blood pressure"

A male client who is an Asian executive visiting the United States presents to the emergency department with a severe headache and an elevated blood pressure. He is admitted to the hospital for treatment and regulation of his medication regimen. The client is concerned because the dosage prescribed for his antihypertensive medication is lower than what he researched on the Internet. What is an accurate response for the nurse to make?

"People of Asian descent excrete the drugs more slowly, so the doses prescribed are smaller"

The nurse is teaching a client who has been diagnosed with orthostatic hypotension about the role of renin in maintaining blood pressure. What process should the nurse describe?

"Renin is directly involved in the control of arterial blood pressure and it is essential for proper functioning of the glomerulus"

A client with kidney disease asks why there is blood in the urine. Which process will the nurse explain to the client?

"The glomerulus in the kidney is scarred or damaged, permitting blood cells to escape in the urine"

What is the nurse's priority assessment question before administering an angiotensin II-receptor blocker (ARB) to a female client?

"When was your last menstrual period (LMP)?"

Which question would be most important for a nurse to ask a female client who is starting on an angiotensin II receptor blocker for hypertension?

"When was your last menstrual period?"

An 8-year-old client weighing 57 lb. is prescribed furosemide 5 mg/kg/day. Calculate the amount of medication the nurse will provide to the client. Round your answer to the nearest whole number.

130 mg

A client with diabetes also has hypertension. The nurse would expect that the blood pressure goal for the client would be which of the following?

130/80 mmHg

The amount of fluid excreted as urine each day averages approximately less than how many liters?

2 L

A client is receiving hydrochlorothiazide. The nurse would expect this drug to begin acting within which time frame?

2 hours

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?

4.0 mEq/L

A client is prescribed clonidine as a transdermal patch. After instructing the client about this drug, the nurse determines that the teaching was successful when the client states that the patch should remain in place for how long?

7 days

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?" In response, the nurse should describe what phenomenon?

A very large majority of filtrate is returned to circulation

Some drugs can increase the effects of diuretics. Drugs from what category, when taken concomitantly with some diuretics, increase the risk of hearing loss?

Aminoglycoside antibiotics

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?

At breakfast and midafternoon

The nurse is teaching a client with hypertension about losartan which the health care provider has prescribed. The nurse can explain that losartan exerts which action on the body?

Blocks angiotensin II receptors

What sign is most indicative of dehydration in a patient taking diuretics?

Body weight

A nurse is educating a patient with hypertension who is prescribed losartan on the mechanism of action of the drug. Which mode of action helps losartan to bring about its antihypertensive effect?

By blocking the angiotensin II receptors

A 46-year-old client with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension after serial blood pressure readings. The clinician has opted to begin the client on captopril (Capoten). The nurse should recognize that the therapeutic effect of this drug is achieved in what way?

By inhibiting the transformation of angiotensin I to angiotensin II

A nurse understands that loop diuretics are considered high ceiling diuretics because they:

Cause a greater diuresis

Which risk factors increase a client's risk for the development of hypertension? Select all that apply:

Cigarette smoking, family history, chronic alcohol consumption, advancing age

The nurse is educating a group of clients on the major functions of the renal system. Which functions will the nurse include in the education? Select all that apply.

Concentrating urine, clearing nitrogenous wasted from protein metabolism, regulating red blood cell production, regulating blood pressure

A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to help to promote compliance?

Cough

The nurse knows that electrolytes are maintained in the body by actions within the kidney. Where within the kidney will the nurse explain to a client the level of potassium is adjusted?

Distal convoluted tubule

A client with hypertension is prescribed atenolol. Which assessment finding(s) on the ongoing assessment should the nurse evaluate first? Select all that apply.

Dizziness; bradycardia

A 49-year-old client reports frequent muscle cramps while on hydrochlorothiazide therapy. The nurse would advise the client to do which?

Eat potassium-rich foods

What type of diet should a patient taking diuretics have?

Eat potassium-rich or low-potassium diet as appropriate

The nurse admits a client with a high potassium level. Renal attempts at lowering the client's potassium level may cause what assessment finding?

Edema

An adult client presents with a blood pressure of 128/86 mm Hg. The client exercises regularly, is weight-appropriate for height, and indicates no use of tobacco or alcohol. How would the client's blood pressure be classified?

Elevated

A client has been prescribed ramipril 5 mg PO daily with the scheduled dose due at 08:00. After reviewing the client's most recent blood work, the nurse should consider withholding the dose because of what laboratory finding?

Elevated potassium levels

The nurse is reviewing the client's laboratory results and notes the potassium level is 6 mEq/L. The nurse should question the continued administration of which drug(s) if noted in the client's record? Select all that apply.

Eplerenone; aliskiren

Which would a nurse identify as responsible for causing the release of antidiuretic hormone?

Falling blood volume

A patient has been advised to use a transdermal patch of clonidine for hypertension. For which of the following time periods should the nurse ensure that the patch is intact?

For one week

A 55-year-old man's hypertension has not responded adequately to his current medication regimen consisting of an ACE inhibitor, a beta-blocker and a thiazide diuretic. As a result, he will soon begin taking hydralazine (Apresoline) in addition to his existing antihypertensives. The addition of this medication to his regimen means that the nurse must prioritize which nursing action?

Frequent assessment of the patient's cardiac status

After teaching a group of nursing students about diuretics, the instructor determines that the teaching was successful when the group identifies which as a loop diuretic?

Furosemide

Which diuretic will most likely be the initial drug of choice when a client demonstrates dyspnea related to pulmonary edema?

Furosemide

The client is diagnosed with primary hypertension. The nurse is educating a client about dietary changes that help decrease blood pressure. Which menu selection indicates the need for further client education?

Ham sandwich with mustard, carrots and cheesy dip

A client has come to the clinic for the past 7 months with elevated blood pressure. The client has now been prescribed three different antihypertensives as well as a diuretic. The nurse knows that what other factors may be contributing to the client's consistent hypertension? (Select all that apply.)

Herbal supplement, OTC appetite suppressant, nasal decongestant

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

An adult client with hypertension is being treated with combination therapy that includes trandolapril and spironolactone. The nurse should prioritize assessments related to which adverse effect?

Hyperkalemia

The client has been started on an ACE inhibitor for hypertension. The client also takes spironolactone (Aldactone) daily. The nurse would evaluate the client for which of the following?

Hyperkalemia

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:

Hypersensitivity to sulfonamides

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

A 48-year-old client with a blood pressure of 198/112 mm Hg reports severe headache and drowsiness. The nurse notes that the client is disoriented and has begun to vomit. What is the primary nursing goal for this client experiencing a hypertensive emergency?

Implement interventions to lower blood pressure

A primary health care provider has prescribed a loop diuretic for hypertension in a client with diabetes mellitus. Which assessment should the nurse prioritize?

Increased blood glucose levels

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

Intravenously

The patient has been placed on a nitroprusside drip for the treatment of a hypertensive crisis. Which mechanism of action does the nurse know is true for nitroprusside?

It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins

A group of students are reviewing the various antihypertensive agents. The students demonstrate understanding of the information when they identify what as an example of an angiotensin II receptor blocker?

Losartan

A nursing instructor determines that a class discussion on antihypertensive drugs was successful when the students identify which medication as lowering blood pressure by blocking the binding of angiotensin II at receptor sites in the vascular smooth muscle and adrenal glands? Select all that apply.

Losartan; Olmesartan

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

Mannitol

The nurse is caring for a client with a severe head injury. An osmotic diuretic is prescribed. The nurse understands which drug is an osmotic diuretic?

Mannitol

What best describes the structure of the kidneys?

The renal pelvises drain urine into the ureters

A nurse obtains an allergy history from a client based on the understanding that which class is associated with a cross-sensitivity reaction with sulfonamides?

Thiazide diuretics

A nurse administers chlorothiazide to a client with renal compromise. Which action should the nurse prioritize after noting the BUN level is rising?

Withhold the next dose of the drug

Losartan focuses on what aspect of the cardiac process to address the pathophysiology of heart failure?

lowering blood pressure

A clinic nurse has been assigned a 49-year-old female client who has a history of diabetes. A recent diagnosis of hypertension has been made, and the client has been prescribed a thiazide diuretic and labetalol. The client will be scheduled to return to the clinic once a month for the next 6 months. A priority action by the nurse will be to:

monitor the client's blood pressure.

The nurse is assessing a client with renal disease and discovers the client's blood pressure has increased since the last visit. The nurse suspects the client has developed which concern?

secondary hypertension