Chapter 24 Pharm.pdf

Pharmacology for Nurses, 6e (Adams) Chapter 24 Diuretic Therapy and Drugs for Kidney Failure 1) The nurse has provided client education about the function of the renal system. Which statements made by the client indicate an understanding of the teaching? Note: Credit will be given only if all...

Pharmacology for Nurses, 6e (Adams) Chapter 24 Diuretic Therapy and Drugs for Kidney Failure 1) The nurse has provided client education about the function of the renal system. Which statements made by the client indicate an understanding of the teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Kidneys help the heart by balancing potassium." 2. "Kidneys balance the fluid and electrolytes in my body." 3. "Kidneys keep blood pressure from getting too low." 4. "Kidneys help decrease infections by excreting bacteria." 5. "Kidneys help regulate the oxygen levels in my blood." Answer: 1, 2, 3 Explanation: 1. The kidneys are the primary organs for regulating potassium balance. 2. The kidneys are the primary organs for regulating fluid and electrolyte balance. 3. They secrete renin, which helps to regulate blood pressure. 4. The kidneys do not have any impact on bacterial infections. 5. The kidneys do not affect serum oxygen levels. Page Ref: 322-323 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 24-1 Explain the primary functions of the kidneys. MNL Learning Outcome: 24.1 Identify the anatomy and physiology of the renal system and the effect of chronic kidney disease on pharmacotherapy. 1 Copyright © 2020 Pearson Education, Inc. 2) Which should the nurse recognize are important safety precautions when administering a prescription to a client with renal failure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client will require lower dosages. 2. Some prescriptions increase fluid retention. 3. Measure hourly intake and output. 4. Some prescriptions are nephrotoxic. 5. Some prescriptions are bound to plasma proteins Answer: 1, 3, 4 Explanation: 1. A client with renal failure may require a decreased dosage of the prescription to prevent toxicity. The renal system is impaired and cannot effectively clear the drugs from the client's system. 2. Increased fluid retention affects the cardiovascular system. 3. Ensuring there is adequate output is a primary treatment goal for a client with renal failure. 4. A client with renal failure should not be administered nephrotoxic drugs. 5. Prescriptions that are bound to plasma proteins are unable to pass through the pores of the glomerulus and enter the filtrate; therefore, they will continue to circulate in the blood. This is not a safety precaution for a client with renal failure. Page Ref: 323 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential 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. | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 24-3 Describe the adjustments in pharmacotherapy that must be considered in patients with kidney failure. MNL Learning Outcome: 24.1 Identify the anatomy and physiology of the renal system and the effect of chronic kidney disease on pharmacotherapy. 2 Copyright © 2020 Pearson Education, Inc. 3) Which should the nurse suspect after noting the presence of protein on a routine urinalysis? 1. Acute kidney injury 2. Structural damage 3. Kidney infection 4. Chronic kidney injury Answer: 2 Explanation: 1. A urinalysis is not used to diagnose an acute kidney injury. 2. 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. Proteinuria and albuminuria are the primary measurement for structural kidney damage. 3. Proteinuria is not a diagnosis for a kidney infection. 4. A urinalysis is not used to diagnose a chronic kidney injury. Page Ref: 323 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 2-2 Discuss the role of the U.S. Food and Drug Administration (FDA) in the drug approval process. MNL Learning Outcome: 24.1 Identify the anatomy and physiology of the renal system and the effect of chronic kidney disease on pharmacotherapy. 3 Copyright © 2020 Pearson Education, Inc. 4) Which conditions should the nurse anticipate the healthcare provider to possibly prescribe a diuretic? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Heart failure 2. Cerebrovascular accident 3. Hypertension 4. Acute kidney injury 5. Ketoacidosis Answer: 1, 3, 4 Explanation: 1. A diuretic is a drug that increases the rate of urine flow. The goal of most diuretic therapy is to reverse abnormal fluid retention by the body. Excretion of excess fluid from the body is particularly desirable in clients with heart failure. 2. Diuretics are not necessarily prescribed for a client with a cerebrovascular accident. 3. A diuretic is a drug that increases the rate of urine flow. The goal of most diuretic therapy is to reverse abnormal fluid retention by the body. Excretion of excess fluid from the body is particularly desirable in clients with hypertension. 4. A diuretic is a drug that increases the rate of urine flow. The goal of most diuretic therapy is to reverse abnormal fluid retention by the body. Excretion of excess fluid from the body is particularly desirable in clients with acute kidney injury (AKI). 5. Diuretics are not prescribed for a client with ketoacidosis; this client requires fluid replacement. Page Ref: 324 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 24-4 Identify indications for diuretics. MNL Learning Outcome: 24.3 Examine the pharmacologic profiles and uses of prototype diuretic drugs presented. 4 Copyright © 2020 Pearson Education, Inc. 5) The nurse suspects a client receiving chlorothiazide (Diuril) is experiencing side effects from the prescription. Which assessment finding supports the nurse's suspicion? 1. Ataxia and frequent diarrhea 2. Serum potassium level of 3.0 mEq/L and low blood pressure 3. Serum sodium level of 160 mEq/L and headaches 4. Mental confusion and dependent edema Answer: 2 Explanation: 1. Ataxia and frequent diarrhea are not side effects of diuretic therapy. 2. The normal lab value for potassium is 3.5-5.0 mEq/L. Hypokalemia and hypotension are serious side effects of diuretic therapy. 3. The normal lab value for sodium is 135-145 mEq/L. Hypernatremia and headaches are not side effects of diuretic therapy. 4. Mental confusion and dependent edema are not side effects of diuretic therapy. Page Ref: 327 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 24-5 Describe the general adverse effects of diuretic pharmacotherapy. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 5 Copyright © 2020 Pearson Education, Inc. 6) A client prescribed bumetanide (Bumex) asks the nurse how the drug works. Which response should the nurse provide the client? 1. "This prescription causes your kidneys to reabsorb potassium." 2. "This prescription causes your kidneys to block the reabsorption of sodium." 3. "This prescription causes your kidneys to reabsorb calcium." 4. "This prescription causes your kidneys to reabsorb chloride." Answer: 3 Explanation: 1. Bumetanide is a potassium-excreting drug. 2. Bumetanide blocks reabsorption of sodium. 3. Bumetanide does not reabsorb calcium. 4. Bumetanide does not affect chloride levels. Page Ref: 326 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-6 Compare and contrast the loop, thiazide, and potassium-sparing diuretics. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 6 Copyright © 2020 Pearson Education, Inc. 7) The healthcare provider has prescribed hydrochlorothiazide (HCTZ) for a client with chronic renal failure. Which assessment finding indicates the treatment is ineffective? 1. Weak pulses 2. Hypotension 3. Poor skin turgor 4. Wheezing Answer: 4 Explanation: 1. The diuretic is prescribed to treat fluid retention. Findings associated with ineffective treatment would include bounding pulses. 2. The diuretic is prescribed to treat fluid retention. Findings associated with ineffective treatment would include hypertension. 3. The diuretic is prescribed to treat fluid retention. Findings associated with ineffective treatment do not include poor skin turgor. 4. Wheezes are commonly auscultated with pulmonary edema, which can occur with chronic renal failure and fluid retention. Page Ref: 326-328 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition of care. | AACN Essential 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: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 24-7 Describe the nurse's role in the pharmacologic management of kidney failure and in diuretic therapy. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 7 Copyright © 2020 Pearson Education, Inc. 8) The nurse has completed the dietary teaching for a client prescribed spironolactone (Aldactone). Which statement made by the client indicates further teaching is required? 1. "I am really happy that I can have my cranberry juice." 2. "I can still have my orange juice and bananas for breakfast." 3. "I usually eat an apple a day to stay regular." 4. "I love to eat eggs and toast in the morning." Answer: 2 Explanation: 1. Cranberries are low in potassium and are not contraindicated with a potassium-sparing diuretic. 2. Orange juice and bananas are high in potassium and are contraindicated with a potassium-sparing diuretic. 3. Apples are low in potassium and are not contraindicated with a potassium-sparing diuretic. 4. Eggs and toast are low in potassium and are not contraindicated with a potassium- sparing diuretic. Page Ref: 329-330 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essential 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. | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 24-9 Use the nursing process to care for patients who are receiving pharmacotherapy with diuretics. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 8 Copyright © 2020 Pearson Education, Inc. 9) Which information should the nurse include when providing education for an older client prescribed chlorothiazide (Diuril)? 1. "Take the medication early in the morning." 2. "Avoid foods that are high in potassium." 3. "It is alright to have a glass of wine with this medication." 4. "Take the medication on an empty stomach." Answer: 1 Explanation: 1. Elderly patients should take diuretics early in the morning to avoid nocturia. 2. Chlorothiazide (Diuril) is a potassium-excreting drug, and foods high in potassium should be encouraged. 3. Alcohol can potentiate the hypotensive effects of chlorothiazide (Diuril) and should be avoided, especially in the elderly. 4. Absorption of chlorothiazide (Diuril) is decreased when taken on an empty stomach. Page Ref: 327-328 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essential 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. | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 24-9 Use the nursing process to care for patients who are receiving pharmacotherapy with diuretics. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 9 Copyright © 2020 Pearson Education, Inc. 10) A client prescribed spironolactone (Aldactone) asks the nurse which fluids they should drink to prevent dehydration. Which response should the nurse provide? 1. "Citrus juices are very good for rehydration." 2. "Any kind of fluid is okay, but avoid alcohol." 3. "Plain water is really the best." 4. "Electrolyte-replacement drinks like sports drinks." Answer: 3 Explanation: 1. Citrus juices contain potassium, which should be avoided by those taking potassium- sparing diuretics. 2. "Any kind of fluid" is not a correct answer as some fluids are better than others. 3. Plain water is the best fluid for the patient to consume while receiving diuretic therapy. 4. Electrolyte-replacement drinks like Gatorade are not as good as plain water in avoiding dehydration. Page Ref: 330 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. | AACN Essential 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. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-8 For each of the classes shown in Drugs at a Glance, know representative drugs, and explain the mechanism of drug action, primary actions, and important adverse effects. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 10 Copyright © 2020 Pearson Education, Inc. 11) A patient receiving chlorothiazide (Diuril) has developed hypokalemia. Which assessment findings support the diagnosis? 1. Hyperglycemia 2. Heart palpitations 3. Increased urine output 4. Diarrhea Answer: 2 Explanation: 1. Hypoglycemia is associated with hypokalemia. 2. Heart palpitations is a symptom of hypokalemia. 3. Increased urine output is not a symptom of hypokalemia. 4. Diarrhea is not a symptom of hypokalemia. Page Ref: 328 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essential 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. | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 24-9 Use the nursing process to care for patients who are receiving pharmacotherapy with diuretics. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 11 Copyright © 2020 Pearson Education, Inc. 12) Which prescription is nephrotoxic if an overdose occurs? 1. Lorazepam (Ativan) 2. Amitriptyline (Elavil) 3. Ibuprofen (Advil) 4. Quetiapine (Seroquel) Answer: 3 Explanation: 1. An overdose of lorazepam (Ativan) will result in CNS depression, not nephrotoxicity. 2. Amitriptyline (Elavil) is cardiotoxic. 3. NSAIDs, such as ibuprofen, are nephrotoxic drugs. 4. An overdose of quetiapine (Seroquel) will result in CNS depression, not nephrotoxicity. Page Ref: 323 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition of care. | AACN Essential 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: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 24-8 For each of the classes shown in Drugs at a Glance, know representative drugs, and explain the mechanism of drug action, primary actions, and important adverse effects. MNL Learning Outcome: 24.3 Examine the pharmacologic profiles and uses of prototype diuretic drugs presented. 12 Copyright © 2020 Pearson Education, Inc. 13) The nurse is preparing the education for a client prescribed chlorothiazide (Diuril). Which information should the nurse include in the teaching? 1. Consumption of foods high in potassium 2. Assessment of blood glucose daily 3. Daily weights with a report of a gain of more than 1 pound in 24 hours 4. Report change in hearing Answer: 1 Explanation: 1. Patients receiving thiazide diuretics should consume foods high in potassium. 2. Although chlorothiazide can cause hyperglycemia, there is no indication to assess the blood glucose daily because the client is not a diabetic. 3. The client should be instructed to weigh themselves daily and report a weight gain of greater than 2 lbs in 24 hours. 4. Chlorothiazide is not ototoxic. Page Ref: 327, 332 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essential 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. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-9 Use the nursing process to care for patients who are receiving pharmacotherapy with diuretics. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 13 Copyright © 2020 Pearson Education, Inc. 14) An older adult receiving ethacrynic acid (Edecrin) tells the nurse he or she doesn't hear as well as he or she used to. Which statement should the nurse include in the response? 1. "You may be dehydrated; are you drinking enough fluid?" 2. "I will let your healthcare provider know about this; it could be a side effect of your medication." 3. "How long have you been having difficulty hearing?" 4. "I will schedule a hearing exam; this could be a side effect of your medication." Answer: 2 Explanation: 1. Ototoxicity is not related to dehydration. 2. Loop diuretics are ototoxic. Instruct the patient to report ringing in the ears or becoming "hard of hearing" and notify the healthcare provider. 3. Asking the patient about how long he or she has had the hearing loss is a good question, but the nurse must always report suspected side effects to the healthcare provider. 4. It is inappropriate to schedule a hearing exam unless drug toxicity has been ruled out. Page Ref: 326 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition of care. | AACN Essential 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: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-5 Describe the general adverse effects of diuretic pharmacotherapy. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 14 Copyright © 2020 Pearson Education, Inc. 15) Which is the client at risk for that is receiving spironolactone (Aldactone)? 1. Pancytopenia 2. Aplastic anemia 3. Hyperkalemia 4. Hyponatremia Answer: 3 Explanation: 1. Spironolactone does not place the client at risk for pancytopenia. 2. Spironolactone does not place the client at risk for aplastic anemia. 3. Spironolactone predisposes the patient to the risk of hyperkalemia. 4. Spironolactone does not place the client at risk for hyponatremia. Page Ref: 328 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. | AACN Essential 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. | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 24-8 For each of the classes shown in Drugs at a Glance, know representative drugs, and explain the mechanism of drug action, primary actions, and important adverse effects. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 15 Copyright © 2020 Pearson Education, Inc. 16) Which is the primary functional unit of the kidney? 1. Loop of Henle 2. Bowman's capsule 3. Nephron 4. Distal tubule Answer: 3 Explanation: 1. The loop of Henle filters ions. 2. The Bowman's capsule filters the blood. 3. The nephron is the functional unit, which initially receives blood through the large renal arteries. 4. The distal tubule passes filtrate. Page Ref: 322-323 Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 24-2 Explain the processes that change the composition of filtrate as it travels through the nephron. MNL Learning Outcome: 24.1 Identify the anatomy and physiology of the renal system and the effect of chronic kidney disease on pharmacotherapy. 16 Copyright © 2020 Pearson Education, Inc. 17) Which is the most appropriate food for the nurse to recommend to a client to eat that is prescribed a loop diuretic? 1. Meat 2. Bananas 3. Cheese 4. Yogurt Answer: 2 Explanation: 1. Meat provides protein but not much potassium. 2. Bananas are great source of potassium. Other foods high in potassium include green leafy vegetables. 3. Cheese is a good source of calcium. 4. Yogurt is a good source of calcium. Page Ref: 326 Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Nutrition and Oral Hydration Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 24-9 Use the nursing process to care for patients who are receiving pharmacotherapy with diuretics. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 17 Copyright © 2020 Pearson Education, Inc. 18) Which general adverse effect is associated with the use of diuretics? 1. Constipation 2. Orthostatic hypotension 3. Weight gain 4. Hypertension Answer: 2 Explanation: 1. Diarrhea can occur as a result of the use of diuretics. 2. Orthostatic hypotension is a common adverse effect of all the prototype drugs. 3. Weight loss will occur with the use of diuretics. 4. The development of hypertension is not associated with the use of diuretics. Page Ref: 332 Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. | AACN Essential 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. | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 24-8 For each of the classes shown in Drugs at a Glance, know representative drugs, and explain the mechanism of drug action, primary actions, and important adverse effects. MNL Learning Outcome: 24.3 Examine the pharmacologic profiles and uses of prototype diuretic drugs presented. 18 Copyright © 2020 Pearson Education, Inc. 19) The nurse is reviewing the medical history of a client prescribed hydrochlorothiazide (Microzide). Which condition should the nurse be concerned about? 1. Hypertension 2. Asthma 3. Gout 4. Hypothyroidism Answer: 1 Explanation: 1. Hydrochlorothiazide is the most widely prescribed drug for hypertension. 2. The use of hydrochlorothiazide is not contraindicated for a client with asthma. 3. The use of hydrochlorothiazide may precipitate gout attacks due to its tendency to cause hyperuricemia. 4. The use of hydrochlorothiazide is not contraindicated for a client with hyperthyroidism. Page Ref: 328 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition of care. | AACN Essential 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: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 24-7 Describe the nurse's role in the pharmacologic management of kidney failure and in diuretic therapy. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 19 Copyright © 2020 Pearson Education, Inc. 20) Which initial treatment prescribed should the nurse anticipate for the client that has overdosed on hydrochlorothiazide? 1. Electrolyte replacement 2. Intravenous normal saline 3. Vasopressor 4. Furosemide (Lasix) Answer: 3 Explanation: 1. Electrolyte replacement is not the initial treatment for a client that has overdosed on hydrochlorothiazide. 2. An overdose is manifested as electrolyte depletion, which is initially treated with an infusion of normal saline. Infusion of fluids will also prevent dehydration and hypotension. 3. A vasopressor such as norepinephrine may be necessary to administer for an overdose of furosemide (Lasix) or spironolactone (Aldactone). 4. Furosemide (Lasix) is a loop diuretic that if administered for an overdose of hydrochlorothiazide would worsen the client's condition. Page Ref: 326, 329 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. | AACN Essential 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. | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 24-8 For each of the classes shown in Drugs at a Glance, know representative drugs, and explain the mechanism of drug action, primary actions, and important adverse effects. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 20 Copyright © 2020 Pearson Education, Inc. 21) Which diuretic is most effective in reducing the mortality of a client with heart failure? 1. Chlorothiazide (Diuril) 2. Acetazolamide (Diamox) 3. Furosemide (Lasix) 4. Spironolactone (Aldactone) Answer: 4 Explanation: 1. Chlorothiazide is a thiazide diuretic used primarily for hypertension. 2. Acetazolamide is a carbonic anhydrase inhibitor used primarily for patients with glaucoma. 3. Furosemide is used for hypertension and reduction of edema. 4. Spironolactone has been found to significantly reduce mortality in clients with heart failure. Page Ref: 329 Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. | AACN Essential 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. | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 24-8 For each of the classes shown in Drugs at a Glance, know representative drugs, and explain the mechanism of drug action, primary actions, and important adverse effects. MNL Learning Outcome: 24.2 Differentiate between the types of diuretics 21 Copyright © 2020 Pearson Education, Inc. 22) The nurse has provided education for a client with diabetes type I prescribed hydrochlorothiazide (Microzide). Which statement made by the client indicates an understanding of the information? 1. "I expect my blood glucose to be elevated." 2. "I anticipate to monitor my blood glucose more frequently." 3. "I can expect my hemoglobin A1C to be elevated." 4. "I expect I will need more insulin to help control my glucose." Answer: 1 Explanation: 1. Blood glucose elevation is an adverse effect of hydrochlorothiazide. Consistent elevation should be reported to the healthcare provider. 2. Blood glucose should be monitored more frequently. 3. Hydrochlorothiazide does not affect the hemoglobin A1C. 4. The healthcare provider will evaluate the adverse effect of the elevated glucose and collaborate with the client to determine the safest treatment. Page Ref: 329, 332 Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 24-7 Describe the nurse's role in the pharmacologic management of kidney failure and in diuretic therapy. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 22 Copyright © 2020 Pearson Education, Inc. 23) Which should the nurse recognize a client with acute renal failure cannot effectively regulate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fluid balance 2. Electrolyte balance 3. The pH of body fluids 4. Heart rate 5. Blood pressure Answer: 1, 2, 3, 5 Explanation: 1. The kidneys are the primary organs for regulating fluid balance through filtration and urine output. 2. The kidneys are the primary organs for regulating electrolyte composition through filtration and urine output. 3. The kidneys are the primary organ for regulating the pH of body fluids through filtration and urine output. 4. The kidneys do not play a direct role in regulating the heart rate. 5. The kidneys play a role in regulating blood pressure through the secretion of renin. Page Ref: 322-323 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 24-1 Explain the primary functions of the kidneys. MNL Learning Outcome: 24.1 Identify the anatomy and physiology of the renal system and the effect of chronic kidney disease on pharmacotherapy. 23 Copyright © 2020 Pearson Education, Inc. 24) Which should the nurse recognize is associated with chronic kidney disease (CKD)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Hypertension 2. Inflammation 3. Diabetes 4. Hypoperfusion 5. Sepsis Answer: 1, 3 Explanation: 1. Chronic kidney disease (CKD) develops over a period of months or years. Over half of the patients with CKD have a medical history of longstanding hypertension or diabetes mellitus. 2. Acute kidney injury (AKI) can result from inflammation. 3. Longstanding diabetes is associated with (CKD). 4. The most frequent cause of acute kidney injury (AKI) is renal hypoperfusion, the lack of sufficient blood flow through the kidneys. 5. Acute kidney injury (AKI) can result from sepsis. Page Ref: 323 Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 24-2 Explain the processes that change the composition of filtrate as it travels through the nephron. MNL Learning Outcome: 24.1 Identify the anatomy and physiology of the renal system and the effect of chronic kidney disease on pharmacotherapy. 24 Copyright © 2020 Pearson Education, Inc. 25) The educator is preparing to review the diuretics that do not require potassium supplements with a nurse. Which diuretics should the educator include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Furosemide (Lasix) 2. Chlorothiazide (Diuril) 3. Amiloride (Midamor) 4. Mannitol (Osmitrol) 5. Spironolactone (Aldactone) Answer: 3, 5 Explanation: 1. Furosemide (Lasix) is a loop diuretic that often causes hypokalemia. Clients taking furosemide are encouraged to eat foods high in potassium or take a potassium supplement. 2. Chlorothiazide (Diuril) is a thiazide diuretic that often causes hypokalemia. Clients taking chlorothiazide are encouraged to eat foods high in potassium or take a potassium supplement. 3. Amiloride (Midamor) is a potassium-sparing diuretic; therefore, clients do not need to eat foods high in potassium or take a potassium supplement while on this medication. 4. Mannitol (Osmitrol) is an osmotic diuretic that causes hypokalemia. A client should be instructed to take a potassium supplement. 5. Spironolactone (Aldactone) is a potassium-sparing diuretic. Clients on this medication are not required to eat foods high in potassium or take a potassium supplement. Page Ref: 326 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 24-6 Compare and contrast the loop, thiazide, and potassium-sparing diuretics. MNL Learning Outcome: 24.2 Differentiate between the types of diuretics 25 Copyright © 2020 Pearson Education, Inc. 26) The nurse has provided dietary education for a client prescribed furosemide (Lasix). Which statement made by the client indicates an understanding of the information? 1. "I will increase my consumption of green, leafy vegetables." 2. "I will increase my consumption of poultry." 3. "I will try and eat an orange daily." 4. "I will try and incorporate more grains in my diet." Answer: 3 Explanation: 1. Loop diuretics place the client at risk for hypokalemia. Green, leafy vegetables are a good source of iron but not of potassium. 2. Loop diuretics place the client at risk for hypokalemia. Poultry is not a good source of potassium. 3. Loop diuretics place the client at risk for hypokalemia. Citrus fruits are a good source of potassium. 4. Loop diuretics place the client at risk for hypokalemia. Dried grains are a great source of fiber, but are not high in potassium. Page Ref: 326 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Nutrition and Oral Hydration Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essential 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. | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 24-9 Use the nursing process to care for patients who are receiving pharmacotherapy with diuretics. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 26 Copyright © 2020 Pearson Education, Inc. 27) Which vital signs should the nurse assess prior to the administration of a diuretic? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Temperature 2. Pulse 3. Respirations 4. Blood pressure 5. Pain Answer: 2, 4 Explanation: 1. It is not necessary to assess temperature prior to administering a diuretic. 2. The nurse must assess the patient's pulse prior to administering a diuretic. 3. It is not necessary to assess respirations prior to administering a diuretic. 4. The nurse must assess the patient's blood pressure prior to administering a diuretic. 5. It is not necessary to assess the patient's pain prior to administering a diuretic. Page Ref: 324-325, 331 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essential 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. | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 24-9 Use the nursing process to care for patients who are receiving pharmacotherapy with diuretics. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 27 Copyright © 2020 Pearson Education, Inc. 28) The nurse is preparing to provide education on daily self-monitoring for a client with congestive heart failure prescribed a diuretic. Which information should the nurse plan to include in the teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Weight 2. Pulse 3. Temperature 4. Blood pressure 5. Respiratory rate Answer: 1, 2, 4 Explanation: 1. It is essential that the patient measure and record weight daily to monitor for fluid loss or retention. 2. It is essential that the patient measure and record the pulse daily to determine the effectiveness of the medication therapy. 3. There is no need for the patient to measure and record a daily temperature while taking a diuretic. 4. It is essential that the patient measure and record daily blood pressure to determine the effectiveness of the medication therapy. 5. There is no need for the patient to measure and record a daily respiratory rate while taking a diuretic. Page Ref: 331—332 Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essential 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. | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 24-9 Use the nursing process to care for patients who are receiving pharmacotherapy with diuretics. MNL Learning Outcome: 24.4 Utilize the nursing process in the care of patients receiving diuretics. 28 Copyright © 2020 Pearson Education, Inc. 29) The educator is reviewing the physiology of the renal system with a nurse. Which statement made by the nurse indicates further teaching is required? 1. "The kidneys stimulate white blood cell production." 2. "The kidneys help regulate blood pressure." 3. "The kidneys regulate the acid-base balance of body fluids." 4. "The kidneys produce the active form of vitamin D." Answer: 1 Explanation: 1. The kidneys do not stimulate white blood cell production; however, they secrete erythropoietin which stimulates red blood cell production. 2. The kidneys secrete the enzyme renin which helps regulate the blood pressure. 3. The kidneys regulate the acid base balance of body fluids. 4. The kidneys produce calcitriol, the active form of vitamin D. Page Ref: 322 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 24-1 Explain the primary functions of the kidneys. MNL Learning Outcome: 24.1 Identify the anatomy and physiology of the renal system and the effect of chronic kidney disease on pharmacotherapy. 29 Copyright © 2020 Pearson Education, Inc. 30) The nurse is reviewing the laboratory reports for a client with chronic kidney failure. Which lab should the nurse understand reflects the progression of the kidney disease? 1. Glomerular filtration rate (GFR) 2. Serum creatinine 3. Blood urea nitrogen (BUN) 4. Urinalysis Answer: 1 Explanation: 1. The GFR reflects the decline in nephrons and is used to predict the onset and progression of the kidney disease. 2. The serum creatinine reflects the buildup of nitrogen waste products in the blood. 3. The BUN reflects the buildup of nitrogen waste products in the blood. 4. A urinalysis is an assessment of the urine for the presence of blood cells, proteins, pH, specific gravity, ketones, glucose, and microorganisms. Page Ref: 323 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. | AACN Essential 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. | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 24-2 Explain the processes that change the composition of filtrate as it travels through the nephron. MNL Learning Outcome: 24.1 Identify the anatomy and physiology of the renal system and the effect of chronic kidney disease on pharmacotherapy. 30 Copyright © 2020 Pearson Education, Inc.