Question 1

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?

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."

"The kidneys help my heart by balancing potassium."
"The kidneys keep blood pressure from getting too low."
"The kidneys balance the fluid and electrolytes in my body."

Accepted Answer

Rationale 1: The kidneys are the primary organs for regulating potassium balance.
Rationale 2: The kidneys do not have any impact on bacterial infections.
Rationale 3: The kidneys secrete renin, which helps to maintain blood pressure.
Rationale 4: The kidneys are the primary organs for regulating fluid and electrolyte balance.
Rationale 5: The kidneys do not affect serum oxygen levels.

Question 2

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?&#10;A) &#34;I am really happy that I can have my cranberry juice.&#34;&#10;B) &#34;I am relieved that I do not have to give up my cabbage and mushrooms.&#34;&#10;C) &#34;Thank goodness I can still have my orange juice and bananas for breakfast.&#34;&#10;D) &#34;I need an apple a day to stay regular. I am glad I can still have this.&#34;&#10;

Accepted Answer

Rationale 1: Cranberries are low in potassium.
Rationale 2: These foods are low in potassium.
Rationale 3: Orange juice and bananas are rich in potassium and should be avoided by persons taking spironolactone (Aldactone), which is a potassium-sparing diuretic.
Rationale 4: Apples are low in potassium.

Question 3

The nurse is caring for a client with a serum sodium level of 110 mEq/L. Which solution will be used to treat this condition?&#10;A) 5% dextrose in 0.2% saline&#10;B) 3% sodium chloride&#10;C) 0.45% sodium chloride&#10;D) 0.9% sodium chloride&#10;

Accepted Answer

Rationale: 1. This is an isotonic solution and would not correct the client's hyponatremia. 
Rationale 2 Normal saline consists of 0.9% NaCl and is used to treat mild hyponatremia. When serum sodium falls below 115 mEq/L, a highly concentrated 3% NaCl solution may be infused.
Rationale 3 This is a hypotonic solution and would not correct the client's hyponatremia
Rationale 4. Normal saline consists of 0.9% NaCl and is used to treat mild hyponatremia. When serum sodium falls below 115 mEq/L, a highly concentrated 3% NaCl solution may be infused.

Question 4

The nurse is caring for a client with a pH of 7.52. Which medications would be appropriate to administer to a client with this condition?&#10;A) Oral bicarbonate&#10;B) Sodium chloride&#10;C) Citrate salts&#10;D) Potassium chloride&#10;E) Ammonium chloride&#10;

Accepted Answer

Rationale 1: Oral bicarbonate is an agent used to treat acidosis.
Rationale 2: Sodium chloride is an agent used to treat alkalosis.
Rationale 3: Citrate salts are an agent used to treat acidosis.
Rationale 4: Potassium chloride is an agent used to treat alkalosis.
Rationale 5: Ammonium chloride is an agent used to treat alkalosis.

Question 5

A client has hypertension and asks the nurse how this condition can lead to heart failure. Which is the best response by the nurse?&#10;A) &#34;Hypertension limits the ability of your heart to stretch before emptying, or afterload; your heart works harder and weakens.&#34;&#10;B) &#34;Hypertension causes resistance in your aorta, or afterload; your heart works harder and weakens.&#34;&#10;C) &#34;Hypertension causes resistance in your blood vessels, or afterload; your heart works harder and weakens.&#34;&#10;D) &#34;Hypertension limits the amount of blood entering your left ventricle, or afterload; your heart works harder and weakens.&#34;&#10;

Accepted Answer

Rationale 1: The ability of the heart to stretch before emptying is known as preload, not afterload.
Rationale 2: Afterload refers to peripheral resistance, not to resistance in the aorta.
Rationale 3: The most common cause of increased afterload is an increase in peripheral resistance due to hypertension.
Rationale 4: Afterload refers to peripheral resistance, not to the amount of blood entering the left ventricle.

Question 6

A client comes to the emergency department complaining of coughing and difficulty breathing. The diagnosis is heart failure. The client asks the nurse how difficulty breathing could be a heart problem. Which response by the nurse is the most appropriate?

A) "The right side of your heart has enlarged, and cannot effectively pump blood."
B) "What you have is called congestive heart failure."
C) "The left side of your heart is weak, and pumps blood too quickly."
D) "The right side of your heart has weakened and blood has entered your lungs."
E) "The left side of your heart has weakened and blood backs up into your lungs."

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Accepted Answer

Rationale 1: Right-sided heart failure results in peripheral edema, not pulmonary congestion.
Rationale 2: Left-sided heart failure is sometimes called congestive heart failure, because it causes pulmonary edema (congestion).
Rationale 3: Some heart failure is the result of the heart pumping so quickly that it is not able to fully relax and fill up with blood (reducing preload), but there is no indication in the question that this client's heart failure has this particular pathophysiology.
Rationale 4: Left-sided, not right-sided, heart failure is associated with pulmonary edema (congestion). Right-sided heart failure results in peripheral edema.
Rationale 5: When the left ventricle cannot compensate for increased preload, blood backs up into the lungs, resulting in cough and shortness of breath.

Question 7

The nurse is caring for a client who is prescribed digoxin (Lanoxin) for a cardiac dysrhythmia. The nurse teaches the client about digoxin (Lanoxin) toxicity and determines that learning has occurred when the client makes which statements?

A) "It is okay to keep taking my ginseng."
B) "I can drink orange juice every morning."
C) "If I have nausea I will notify my health care provider."
D) "I must check my pulse, and not take the medication if it is less than 60."
E) "I should limit my fluids while taking this medication."

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Accepted Answer

Rationale 1: Ginseng can increase the risk of digoxin (Lanoxin) toxicity.
Rationale 2: Orange juice is a source of potassium, which will minimize the risk for digoxin (Lanoxin) toxicity.
Rationale 3: Nausea can be an expected side effect or it can indicate digoxin (Lanoxin) toxicity. The client should notify the health care provider for further investigation.
Rationale 4: Sixty beats per minute is the generally accepted limit for withholding digoxin (Lanoxin).
Rationale 5: Dehydration can increase the risk for digoxin (Lanoxin) toxicity; the client must not limit fluids.

Question 8

A client admitted with heart failure overhears the health care provider discussing plans to "digitalize" the client and asks the nurse what this means. Which response by the nurse is the most appropriate?

A) "The dose of digoxin gradually is increased until the heart tissue is saturated and symptoms of heart failure subside."
B) "You will be given a series of digoxin injections over the next few days."
C) "You will be given increasing doses of digoxin until you reach a toxic level, and then the drug will be stopped."
D) "You are given twice the usual dose of digoxin every day until therapeutic results are seen."

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Accepted Answer

Rationale 1: Digitalization is the process in which the dose of digoxin gradually is increased until the heart tissue is saturated and symptoms of heart failure subside.
Rationale 2: Although the doses would be given over the next few days, the answer is not specific enough.
Rationale 3: The doses are not increased to toxic levels.
Rationale 4: Twice the normal dose is not given.

Question 9

A student nurse is planning on administering a diuretic to a client with heart failure. Her instructor asks her to describe the action diuretics have on heart failure. What is the best response of the student?

A) Diuretics cause venodilation, this reduces preload and cardiac workload.
B) Diuretics relieve symptoms of HF by reducing fluid volume and decreasing blood pressure
C) Diuretics increase the force of contraction and cause vasodilation
D) Diuretics slowing the heart rate and decrease blood pressure.

Accepted Answer

Rationale 1 This is the action of vasodilators
Rationale 2 Diuretics increase urine flow, thereby reducing blood volume and cardiac workload. They are widely used in the treatment of cardiovascular disease.
Rationale 3 This is the action of a phosphodiesterase inhibitor.
Rationale 4 This is the action of a beta blocker.

Deck 20: Diuretic Therapy and Pharmacotherapy of Renal Failure