Question 1

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?

Accepted Answer

The most important safety precaution with regard to medication administration for a client with acute renal failure is to review the client's medication regimen to identify any nephrotoxic drugs. Nephrotoxic drugs can exacerbate kidney damage and contribute to acute renal failure.

Question 2

The nurse is completing discharge care planning for a client started on enalopril therapy for hypertension and heart failure. Which of the following alterations in serum levels is possible during enalapril therapy?

Accepted Answer

Enalapril, an ACE inhibitor, can lead to increased potassium levels (hyperkalemia) due to its effect on the renin-angiotensin-aldosterone system, which reduces aldosterone secretion and decreases potassium excretion.

Question 3

The nurse is reviewing the diet history of a client prescribed an ACEI for hypertension. Which part of the client's current dietary intake should the nurse teach the patient to alter?

Accepted Answer

ACE inhibitors can increase potassium levels in the blood, so it is important to avoid taking potassium supplements while on this medication. Fish oil and multiple vitamin supplements are not contraindicated with ACE inhibitors. Calcium supplements can be taken with caution, but it is not the top priority to teach the client to alter.

Question 4

Which of the following usual doses of medication will the nurse question for a client with renal failure?

Accepted Answer

The nurse should question the usual dose of digoxin (Lanoxin) for a client with renal failure because it is primarily eliminated through the kidneys and can accumulate in the body, leading to toxicity. The other options do not have significant renal elimination and can generally be given at their usual doses to clients with renal failure.

Question 5

The nurse is caring for clients on a renal failure unit. Which of the following signs and symptoms exhibited by the clients would be indications for diuretic therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

Accepted Answer

Diuretic therapy is indicated for hypertension (high blood pressure) and fluid overload, which can manifest as generalized edema and decreased urine output.

Question 6

A client prescribed bumetanide (Bumex) asks the nurse to describe what the 'loop' means in relation to this new medicine. Which response by the nurse is the most appropriate?

Accepted Answer

Bumetanide is a loop diuretic that works by blocking sodium reabsorption in the thick ascending limb of Henle's loop, which is located in the kidney. The term 'loop' refers to this specific location in the kidney where the medication acts. Option A is incorrect because bumetanide does not reabsorb potassium; it actually increases urinary excretion of potassium. Option B is incorrect because Bowman's capsule is part of the nephron but is not involved in loop diuretics. Option D is incorrect because bumetanide does not work in the proximal tubule, which is located before the loop of Henle.

Question 7

Spironolactone (Aldactone) is prescribed for a client diagnosed with hypertension. What information supports the use of this drug?

Accepted Answer

The answer of Spironolactone (Aldactone) is prescribed for a client...

Question 8

A student is working on the near unit and is caring for a client post head injury. The instructor asks the student to describe how mannitol (Osmitrol) works for this client. What is the best response of the student?

Accepted Answer

Mannitol (Osmitrol) works by increasing serum osmolality, which helps to reduce brain swelling by drawing fluid out of the brain tissue and into the blood vessels. This can also increase urine flow and help to eliminate excess fluid from the body. Choices A, B, and D refer to mechanisms of action for other diuretic medications.

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

Accepted Answer

Amiloride (Midamor) and Spironolactone (Aldactone) are potassium-sparing diuretics, meaning they do not cause the body to lose potassium, unlike other types of diuretics. Therefore, patients taking these medications typically do not need to take potassium supplements.

Question 10

The nurse is caring for a client who is experiencing acute renal failure. Which of the following, usually regulated by the kidneys may be altered? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

Accepted Answer

The kidneys regulate fluid balance, electrolyte composition, the pH of body fluids, and blood pressure. Heart rate is not directly regulated by the kidneys.

Question 11

Which of the following drugs should a nurse question for a client in renal failure?

Accepted Answer

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can cause further damage to the kidneys in clients with renal failure. Therefore, the nurse should question the prescription of ibuprofen for a client in renal failure. Erythromycin and aluminum hydroxide gel may need to be cautiously used in clients with renal failure, but they are not contraindicated and should not be questioned without further assessment. Acetylsalicylic acid at a low dose (81-162 mg) may actually be prescribed to some clients with renal failure for its cardiovascular benefits.

Question 12

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?

Accepted Answer

Amiloride is a potassium-sparing diuretic that can help prevent the excretion of potassium in the urine, making it safe to administer to a client with hypokalemia (low potassium levels). The other options, Chlorothiazide (Diuril), Bumetanide (Burinex), and Ethacrynic acid (Edecrin) are loop and thiazide diuretics that can increase the excretion of potassium, making them unsafe for clients with hypokalemia.

Question 13

Which laboratory values are essential to monitor while a client is being treated with ACE inhibitors and ARBs? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

Accepted Answer

The answer of Which laboratory values are essential to monitor...

Question 14

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

Accepted Answer

Furosemide (Lasix) and Hydrochlorothiazide (Microzide) are both diuretics that can help remove excess fluid from the body, which is important in treating hypervolemia. Epoetin alfa (Procrit) is used to stimulate red blood cell production and would not be helpful in treating hypervolemia. Polystyrene sulfate (Kayexalate) is a medication used to treat high potassium levels in the blood and would not be used to directly treat hypervolemia. Sodium bicarbonate is sometimes used to treat acidosis, but would not directly address the fluid overload seen in hypervolemia.

Question 15

The major difference in adverse effect profile between ACE inhibitors and ARBs is that ARBs do not cause which clinical manifestation?

Accepted Answer

ACE inhibitors are known to cause a persistent, dry cough in some patients due to the accumulation of bradykinin, whereas ARBs do not typically cause this side effect because they do not increase bradykinin levels.

Question 16

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

Accepted Answer

Excess secretion of antidiuretic hormone (ADH) causes fluid retention, leading to fluid volume excess or hyponatremia. ADH promotes water reabsorption in the kidneys, leading to a decrease in urine output and an increase in water retention, which can lead to fluid volume excess. Hyperkalemia (choice B) is not directly related to excess secretion of ADH. Hypernatremia (choice C) is actually the opposite effect of ADH and occurs with decreased secretion of ADH, leading to excessive urine output and dehydration. Therefore, choice A, fluid volume excess, is the correct answer.

Question 17

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?

Accepted Answer

Spironolactone is a potassium-sparing diuretic, which means it can cause potassium levels in the blood to increase. Consuming high-potassium foods like orange juice and bananas while on spironolactone could lead to hyperkalemia (high potassium levels), indicating the client needs further teaching about dietary restrictions.

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?

Accepted Answer

In severe protein malnutrition, there is a decrease in the amount of albumin in the blood, which results in a decrease in the amount of drug that is bound to albumin. This, in turn, leads to an increase in the amount of free drug that is filtered into Bowman's capsule during glomerular filtration. The other options (A, B, and D) are not directly affected by the decrease in protein levels and albumin binding.

Question 19

Which structure does the formation of urine begin?

Accepted Answer

The formation of urine begins in the glomerulus, which is a tiny network of blood vessels located in the renal corpuscle of the kidney.

Question 20

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

Accepted Answer

HCTZ is a diuretic medication that increases urine output and can help manage fluid overload in chronic renal failure. Therefore, it is important for the client to understand the role of the kidneys in fluid and electrolyte balance, as well as blood pressure regulation. Choice B is incorrect because the kidneys do not play a significant role in excreting bacteria from the body, that is the job of the immune system. Choice E is incorrect because while the kidneys do play a role in regulating the acid-base balance of the blood, they do not directly regulate oxygen levels.

Quiz 11: Pharmacology of Alterations in the Cardiovascular System