Silvestri Ch 59 Renal and Urinary Medications Practice Questions

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 2. Platelet count of 300,000 mm 3. Fasting blood glucose of 200 mg/dl 4. White blood cell count of 6000mm

3 A fasting blood glucose level of 200 mg/dl is significantly elevated above the normal range. Other adverse effects are nephrotoxicity, tremor, insomnia, GI effects such as diarrhea, nausea, vomiting, hypertension, and hyperkalemia.

Trimethoprim-sulfamethoxazole is prescribed for a client. The nurse should instruct the client to report which symptom if it develops during the coarse of this medication therapy? 1.Nausea 2. Diarrhea 3. Headache 4. Sore throat

4 Clients should be informed about early signs and symptoms of blood disorders that can occur from this medication. Includes sore throat, fever, pallor, should be instructed to notify HCP about these symptoms.

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 each day

4 Potent immunosuppressant used to prevent organ rejection in transplant clients. Medication should be taken at 12 hour intervals to maintain stable blood level to prevent organ rejection. Adverse effects are hyperglycemia and hypertension. Grapefruit juice is not allowed.

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 Toxicity (overdose) of oxybutin produces central nervous system excitement., such as nervousness, restlessness, hallucinations, and irritability. Other signs include hypotension, hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a side effect of the 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 Imparts a harmless brown color to the urine and the medication should not be discontinued until prescribed dose is completed. Antacids should be avoided because they interfere with medication effectiveness.

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% 2. Platelet count of 400,000 mm 3. White blood cell count of 6000mm 4. Blood urea nitrogen level of 15 mg/dl

1 Synthetic erythropoietin, which the kidneys produce to stimulate red blood cell production in the bone marrow. Used to treat anemia in chronic kidney disease. Normal hematocrit is 42-52 % for males. 37-47% for females. Therapeutic effect is seen when the hematocrit reaches between 30-33%. Normal platelet count is 150,000-400,000. Normal white count is 5000-10,000.

A client with a urinary tract infection is receiving ciprofloxacin by the (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 ciprofloxacin is prescribed for treatment of mild, moderate, severe, and complicated infections of the tract, and skin and skin structure. A single dose is administered over 60 minutes to minimise discomfort and vein irritation. It is not light sensitive, may be infused through peripheral IV access, and is not given by IV push method.

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 Can be hazardous to clients with urinary tract obstruction or weakness of the bladder wall. Elevation of pressure within the urinary tract can damage or rupture the bladder in clients with these conditions

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 8-10 glasses of water per day 3. If the urine turns dark brown, call the HCP immediately 4. Decrease the dosage when symptoms are improving to prevent an allergic response

2 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. Should not be instructed to discontinue dose. Use sunscreen. Can cause urine to turn dark brown or red.

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 Is a urinary tract analgesic. Eliminates pain and burning with urination. It will cause the client o have a reddish-orange discoloration, but this is the side effect of the medication, not the desired effect.

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 A compound in grapefruit juice inhibits metabolism of cyclosporine. Grapefruit juice can raise cyclosporine levels by 50-100 % increasing the risk of toxicity. Other options do not interact with cyclosporine.

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 Produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and serve hypotension. Treatment includes supportive measures and the administration of atropine sulfate

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 2. Creatinine level of 0.6mg/dl 3. Blood urea nitrogen level of 25 mg/dl 4. Fasting blood glucose level of 99 mg/dl

3 The medication is a immunosuppressant. Nephrotoxicity can occur from the use of cyclosporine. Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen levels and serum creatinine levels. Normal blood urea nitrogen is 10-20 mg/dl. Normal creatinine is 0.6-1.2 mg/dl for male and 0.5-1.1 for female. Cyclosporine does not effect blood glucose level.

A client who has a cold is seen in the emergency department with the 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 In a client with BPH, 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 antilipemics do not affect ability to urinate.

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 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 2-4 days after discontinuing the medication. Acute pulmonary responses are thought to be hypersensitivity reactions. Subacute reactions are rare and occur during prolonged treatment. Symptoms are dyspnea, cough, malaise usually regress over weeks to months following withdrawal. However, in some cases, permanent lung damage may occur.