Deck 32: Diuretic Therapy and the Pharmacotherapy of Renal Failure

Question 1

The nurse is caring for four clients on a renal failure unit and recognizes which drug as safe to administer to a client with hypokalemia?

A)Amiloride (Midamor)
B)Chlorothiazide (Diuril)
C)Bumetanide (Bumex)
D)Ethacrynic acid (Edecrin)

Answer 1

Amiloride (Midamor)

Question 2

A client prescribed bumetanide (Bumex)asks the nurse,"What is all this about 'loops' in my medicine?" Which response by the nurse is the most appropriate?

A)"This medication reabsorbs potassium in Henle's loop in your kidney."
B)"This medication blocks sodium reabsorption in what is known as Bowman's capsule."
C)"This is a loop diuretic,which refers to the location where it acts in your kidneys."
D)"This is a loop diuretic,which means it works in the proximal tubule of your kidney."

Answer 2

"This is a loop diuretic,which refers to the location where it acts in your kidneys."

Question 3

The nurse is caring for a client with a brain tumor who is prescribed mannitol (Osmitrol)IV.Which laboratory finding represents a potential adverse effect of this drug?

A)Serum cholesterol 300 mg/dL
B)Serum albumin 29 mg/dL
C)Serum sodium 104 mEq/L
D)Serum amylase 820 mg/dL

Answer 3

Serum sodium 104 mEq/L

Question 4

The nurse is reviewing results of a routine urinalysis that indicate the presence of protein in the urine.How does the nurse interpret this finding?

A)The client probably has kidney damage.
B)The results are probably insignificant if the amount of protein is very small.
C)There is likely a mistake with the results,and the client should have another test done.
D)The client is in acute renal failure,and should be hospitalized.

Question 5

The nurse is teaching a client about spironolactone (Aldactone),and recognizes which statement as an indication that the client needs further teaching about this drug?

A)"I am really happy that I can have my cranberry juice."
B)"I am relieved that I do not have to give up my cabbage and mushrooms."
C)"Thank goodness I can still have my orange juice and bananas for breakfast."
D)"I need an apple a day to stay regular.I am glad I can still have this."

Question 6

A client with cancer is secreting excessive amounts of antidiuretic hormone.The nurse will monitor the client for which consequence of excess antidiuretic hormone secretion?

A)Fluid volume excess
B)Hyperkalemia
C)Hypernatremia
D)Dehydration

Question 7

A client is diagnosed with chronic renal failure and is receiving hydrochlorothiazide (HCTZ).The nurse has taught the client about the importance of kidney function and evaluates that learning has occurred when the client makes which statements?
Select all that apply.

A)"The kidneys help my heart by balancing potassium."
B)"The kidneys help decrease infections by excreting bacteria."
C)"The kidneys keep blood pressure from getting too low."
D)"The kidneys balance the fluid and electrolytes in my body."
E)"The kidneys help regulate the oxygen levels in my blood."

Question 8

The nurse is preparing to administer furosemide (Lasix)40 mg IV to a client on complete bed rest who has renal failure and pulmonary edema.Which action is most appropriate prior to administering furosemide (Lasix)to this client?

A)Measure the client's urine output.
B)Monitor apical heart rate and rhythm.
C)Auscultate bowel sounds.
D)Lower the head of the bed.

Question 9

The nurse is instructing a client on the importance of eating foods rich in potassium while taking a diuretic that causes hypokalemia.Which diuretics do not require potassium supplements?
Select all that apply.

A)Furosemide (Lasix)
B)Chlorothiazide (Diuril)
C)Amiloride (Midamor)
D)Mannitol (Osmitrol)
E)Spironolactone (Aldactone)

Question 10

The nurse caring for a client with renal failure will the use of a usual dose of which medication?

A)Digoxin (Lanoxin)
B)Cholestyramine (Questran)
C)Fluvastatin (Lescol)
D)Benzylpenicillin (penicillin G)

Question 11

Which substances enter the filtrate by active secretion?
Select all that apply.

A)Hydrogen
B)Potassium
C)Phosphate
D)Chloride
E)Sodium

Question 12

The nurse is caring for a client admitted to the medical-surgical unit with hypervolemia that has resulted from renal failure.Which medications does the nurse anticipate will be prescribed for this client based on the diagnosis?
Select all that apply.

A)Furosemide (Lasix)
B)Hydrochlorothiazide (Microzide)
C)Epoetin alfa (Procrit)
D)Polystyrene sulfate (Kayexalate)
E)Sodium bicarbonate

Question 13

The nurse caring for a client in renal failure should an order for which drug?

A)Ibuprofen (Advil)800 mg three times daily
B)Erythromycin (E-Mycin)500 mg four times daily
C)Aluminum hydroxide gel 30 mL every 4 hours as needed
D)Acetylsalicylic acid (aspirin)162 mg daily

Question 14

The nurse is managing care for a client diagnosed with acute renal failure.What does the nurse recognize as the most important safety precaution with regard to medication administration?

A)Review the client's medication regimen to identify any nephrotoxic drugs.
B)Ensure that the client's fluid intake and output are measured precisely.
C)Review the client's medication regimen to identify any drugs that increase fluid retention.
D)Plan to administer less-than-average doses of all medications prescribed for the client.

Question 15

A client diagnosed with chronic renal failure and has gained 4 pounds in the past 24 hours.The nurse anticipates that the client will receive which diuretic?

A)Triamterene (Dyrenium)
B)Ethacrynic acid (Edecrin)
C)Mannitol (Osmitrol)
D)Hydrochlorothiazide (HCTZ)

Question 16

The nurse is caring for a client who is experiencing acute renal failure.The nurse knows that this client may experience problems regulating which items?
Select all that apply.

A)Fluid balance
B)Electrolyte composition
C)The pH of body fluids
D)Heart rate
E)Blood pressure

Question 17

The formation of urine begins at which structure?

A)Glomerulus
B)Ureter
C)Collecting duct
D)Henle's loop

Question 18

A client has severe protein malnutrition and is taking a drug that is 99% bound to albumin.Which alteration of drug concentration in the urinary filtrate will occur?

A)An increase in the amount of drug actively secreted across the walls of the renal tubule
B)A decrease in the amount of drug reabsorbed across the walls of the renal tubule
C)An increase in the amount of drug filtered into Bowman's capsule
D)An increase in the amount of drug passively secreted across the walls of the renal tubule

Question 19

Spironolactone (Aldactone)is prescribed for a client diagnosed with hypertension.The nurse recognizes which information as providing the most support for the use of this drug?

A)Diagnosis of hepatic failure
B)Insufficient therapeutic response to hydrochlorothiazide
C)Insufficient therapeutic response to furosemide (Lasix)
D)Diagnosis of renal failure

Question 20

The nurse is caring for clients on a renal failure unit and recognizes which are indications for diuretic therapy?
Select all that apply.

A)Confusion and ataxia
B)Visual and auditory hallucinations
C)Blood pressure of 200/98 mmHg
D)Generalized edema and decreased urine output
E)Pinpoint pupils and extreme paranoia

Question 21

An older adult reports ringing in the ears while the nurse is administering a dose of ethacrynic acid (Edecrin)intravenously.Which intervention is the priority for the nurse?

A)Schedule a hearing test.
B)Stop infusion of the drug and notify the prescriber.
C)Question the client about recent history of hearing loss.
D)Review the client's fluid intake and assess fluid status.

Question 22

The health care provider prescribes hydrochlorothiazide (HCTZ)for a client in chronic renal failure.The nurse suspects the client is experiencing an ineffective response to the medication.Which clinical manifestation would be the most significant?

A)Hyponatremia
B)Excessive skin moisture
C)Rales
D)Hypertension

Question 23

The nurse is assessing a client prior to the administration of a diuretic.The nurse knows it is essential to assess which vital signs at this time?
Select all that apply.

A)Temperature
B)Pulse
C)Respirations
D)Blood pressure
E)Pain

Question 24

The nurse administers a dose of hydrochlorothiazide (HCTZ)to a client who needs assistance walking.When does the nurse plan to assist the client to the bathroom?

A)1 hour after administration.
B)2 hours after administration.
C)6 hours after administration.
D)30 minutes after administration.

Question 25

The nurse is preparing to discharge a client who is prescribed a loop diuretic for the treatment of congestive heart failure.Which foods should the nurse encourage the client to consume to prevent serious adverse effects associated with the medication?
Select all that apply.

A)Bananas
B)Red meat
C)Oranges
D)Dried dates
E)Green leafy vegetables

Question 26

A client is prescribed acetazolamide (Diamox)to treat absence seizures.Which finding indicates that the next dose of this drug should be withheld?

A)Elevated serum pH
B)Decreased serum potassium
C)Increased seizure frequency
D)Nausea and dizziness

Question 27

Mannitol (Osmitrol)IV is prescribed to a client.The nurse will the order for this drug if which manifestation is noted upon assessment?

A)Mental confusion and elevated blood pressure
B)Fatigue and dizziness
C)Urinary output of 68 mL over 2 hours following administration of a test dose of mannitol (Osmitrol)
D)Urinary output of 45 mL over the previous 24 hours

Question 28

A client diagnosed with chronic renal failure is prescribed hydrochlorothiazide (HCTZ).The client asks the nurse which is the best fluid to drink to avoid dehydration.Which is the best response by the nurse?

A)"Iced tea or coffee is good."
B)"You may drink alcohol in moderation."
C)"Plain water is best."
D)"Electrolyte-replacement fluids like Gatorade are excellent."

Question 29

Which instruction will the nurse include when teaching a client newly prescribed chlorothiazide (Diuril)?

A)"It is all right to have a glass of wine with this medication."
B)"Avoid foods high in potassium while you are taking this medication."
C)"Be sure to include lots of salt in your diet."
D)"Take the medication early in the morning."

Question 30

The nurse is assessing a client prescribed chlorothiazide (Diuril).Which clinical manifestation found upon assessment is an indication of hypokalemia?

A)Confusion and decreased urine output
B)General irritability and increased urine output
C)Muscle weakness or cramps
D)Diarrhea and projectile vomiting

Question 31

A home care nurse is instructing a client diagnosed with congestive heart failure on daily self-monitoring between home care visits.The nurse should instruct the client to monitor and record which items?
Select all that apply.

A)Weight
B)Pulse
C)Temperature
D)Blood pressure
E)Respiratory rate