Block sodium the distal and proximal loops

Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E
Chapter 24
Question 1
Type: MCMA
The patient has been diagnosed with chronic renal failure and is receiving hydrochlorothiazide (HCTZ). The nurse has taught the patient about the importance of kidney function and evaluates that learning has occurred when the patient makes which statements?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Rationale 4: The kidneys do not have any impact on bacterial infections.

Rationale 5: The kidneys do not affect serum oxygen levels.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 24-1 Explain the primary functions of the kidneys.

The nurse is managing care for a group of patients on a renal failure unit. What does the nurse recognize as the

most important patient safety precaution with regard to medication administration?

Correct Answer: 1

Rationale 1: Administering the "average" dose of medication to a patient in severe renal failure can have mortal consequences. The consequences of recognizing that renal patients will require less-than-average doses of medications cannot be overemphasized.

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Question 3

Type: MCSA

3. There could be a mistake with the results; the patient should have another test done.

4. The results probably mean nothing if the amount of protein is very small.

Rationale 4: Any amount of protein in the kidney is considered abnormal. There is no evidence that this patient is in acute renal failure.

Global Rationale: When filtrate passes through Bowman's capsule, its composition is similar to plasma. Plasma proteins are too large to pass through the filter, and if they appear in the filtrate or urine, this indicates kidney pathology. There is no evidence to support a mistake with the results of the urinalysis. Any amount of protein in the kidney is considered abnormal. There is no evidence that this patient is in acute renal failure.

MNL Learning Outcome: 13.4.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 343

Rationale 2: Confusion and ataxia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here.

Rationale 3: Diuretics are indicated for the treatment of renal failure, hypertension, and for the removal of edema fluid.

Client Need Sub: Pharmacological and Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

Question 5

Type: MCSA

3. Serum sodium level of 160 and headaches

4. Mental confusion and dependent edema

Rationale 4: Mental confusion and dependent edema are not side effects of diuretic therapy.

Global Rationale: Hypokalemia and hypotension are serious side effects of diuretic therapy. Hypernatremia and headaches are not side effects of diuretic therapy. Ataxia and frequent diarrhea are not side effects of diuretic therapy. Mental confusion and dependent edema are not side effects of diuretic therapy.

MNL Learning Outcome: 13.4.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 349

1. "This medication reabsorbs potassium in the loop of Henle in your kidney. It is safer than other diuretics."

2. "This is a loop diuretic, which means it works in the proximal loop of your kidney. Not all diuretics work the same way."

Rationale 2: Bumetanide (Bumex) works in the loop of Henle, not the proximal loop.

Rationale 3: Bumetanide (Bumex) is called a loop diuretic because it acts by preventing the reabsorption of sodium in the loop of Henle.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Type: MCSA

The physician has ordered hydrochlorothiazide (HCTZ) for the patient in chronic renal failure. The nurse suspects

3. Assessing the skin for moisture and turgor

4. Auscultating breath sounds for wheezes

Rationale 4: Wheezes are commonly auscultated with pulmonary edema, which can occur with chronic renal failure and fluid retention. This is a priority because pulmonary edema affects the patient's oxygenation.

Global Rationale: Wheezes are commonly auscultated with pulmonary edema, which can occur with chronic renal failure and fluid retention. This is a priority because pulmonary edema affects the patient's oxygenation. Skin assessment is important but is not the priority here. Vital sign assessment is important but is not the priority here. Reviewing lab work is important but is not the priority here.

MNL Learning Outcome: 13.4.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 352

1. "I am really happy that I can have my cranberry juice."

2. "Thank goodness I can still have my orange juice and bananas for breakfast."

Rationale 2: Orange juice and bananas are high in potassium and are contraindicated with a potassium-sparing diuretic.

Rationale 3: Apples are low in potassium and are not contraindicated with a potassium-sparing diuretic.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Type: MCSA

The elderly patient is receiving chlorothiazide (Diuril). What does the best teaching by the nurse include with this

4. "Take the medication on an empty stomach."

Correct Answer: 1

Global Rationale: Elderly patients should take diuretics early in the morning to avoid nocturia. Absorption of chlorothiazide (Diuril) is decreased when taken on an empty stomach. Chlorothiazide (Diuril) is a potassium-excreting drug, and foods high in potassium should be encouraged. Alcohol can potentiate the hypotensive effects of chlorothiazide (Diuril) and should be avoided, especially in the elderly.

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and Parenteral Therapies
QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience.

Page Number: 354

Question 10

2. "Any kind of fluid is okay, but avoid alcohol."

3. "Plain water is really the best."

Rationale 3: Plain water is the best fluid for the patient to consume while receiving diuretic therapy.

Rationale 4: Electrolyte-replacement drinks like Gatorade are not as good as plain water in avoiding dehydration.

Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 24-8 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects.

MNL Learning Outcome: 13.4.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

best assessment include?

1. Confusion and decreased urine output

Rationale 1: Confusion and decreased urine output are not signs of hypokalemia.

Rationale 2: Palpitations are indications of hypokalemia.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Type: MCSA

Four patients arrive at the emergency department. All have attempted suicide by overdosing on medication. Which

4. The patient who overdosed on quetiapine (Seroquel)

Correct Answer: 3

Global Rationale: NSAIDs, such as ibuprofen, are nephrotoxic drugs. Amitriptyline (Elavil) is cardiotoxic, not nephrotoxic. An overdose of lorazepam (Ativan) will result in CNS depression, not nephrotoxicity. An overdose of quetiapine (Seroquel) will result in CNS depression, not nephrotoxicity.

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and Parenteral Therapies
QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care.

Page Number: 345

Question 13

3. "Weigh yourself and report a gain of more than 0.5 pound in 24 hours."

4. "Report signs of hypokalemia, such as vomiting and diarrhea."

Rationale 4: Vomiting and diarrhea are not signs of hypokalemia.

Global Rationale: Patients receiving thiazide diuretics should check weight daily and report a weight gain of 2 or more pounds in 24 hours. Patients receiving thiazide diuretics should consume foods high in potassium. Vomiting and diarrhea are not signs of hypokalemia. A weight gain of more than 2, not 0.5, pounds in 24 hours is considered the "gold standard" for fluid overload.

MNL Learning Outcome: 13.4.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 353

1. "You may be dehydrated; are you drinking enough fluid?"

2. "I will let your doctor know about this; it could be a side effect of your medication."

Rationale 2: Loop diuretics are ototoxic. Instruct the patient to report ringing in the ears or becoming "hard of hearing" and notify the physician.

Rationale 3: Asking the patient about how long he has had the hearing loss is a good question, but the nurse must always report suspected side effects to the physician.

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 24-7 Describe the nurse’s role in the pharmacologic management of renal failure and in diuretic therapy.

The hospitalized patient is receiving spironolactone (Aldactone). A consulting physician sees the patient and

orders lisinopril (Prinivil). What will be the primary assessment by the nurse?

Correct Answer: 3

Rationale 1: Spironolactone (Aldactone) does not decrease the effect of spironolactone (Aldactone).

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and Parenteral Therapies
QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care.

Question 16

Type: MCSA

4. distal tubule.

Correct Answer: 3

Global Rationale: The nephron is the functional unit, which receives blood. The loop of Henle filters. The Bowman's capsule filters the blood. The distal tubule passes filtrate.

Cognitive Level: Remembering

MNL Learning Outcome: 13.4.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 343

2. bananas.

3. cheese.

Rationale 3: Cheese is a good source of calcium.

Rationale 4: yogurt is a good source of calcium.

Page Number: 354

Question 18

3. Weight gain

4. Hypertension

Rationale 4: Hypertension usually does not occur.

Global Rationale: Orthostatic hypotension is a common adverse effect of all the prototype drugs. Diarrhea, not constipation, might be a problem. Weight loss, not weight gain, will occur. Hypertension usually does not occur.

MNL Learning Outcome: 13.4.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 348

2. in the morning.

3. at bedtime.

Rationale 3: Taking a loop diuretic at bedtime will cause nighttime urination and interfere with sleep.

Rationale 4: Late afternoon is too late, since the drug will increase urine flow.

Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 24-7 Describe the nurse’s role in the pharmacologic management of renal failure and in diuretic therapy.

MNL Learning Outcome: 13.4.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

1. Weight gain

2. Bradycardia

Rationale 2: Tachycardia when dehydrated is the cardiac system's response to fluid loss.

Rationale 3: Hypotension results from large amounts of fluid being excreted.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 24-8 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects.

The diuretic drug that will most likely be used to reduce mortality in heart failure is

1. chlorothiazide (Diuril).

Rationale 2: Acetazolamide is a carbonic anhydrase inhibitor used primarily for patients with glaucoma. Rationale 3: Furosemide is used for hypertension and reduction of edema.

Rationale 4: Spironolactone is used to reduce mortality in heart failure patients.

Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 24-8 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects.

MNL Learning Outcome: 13.4.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

3. block aldosterone.

4. promote excretion of water by adding sodium to the filtrate.