Renal
Following kidney transplantation, cyclosporine is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication?
1. Hemoglobin level of 14.0 g/dL (140 mmol/L)
2. Creatinine level of 0.6 mg/dL (53 mcmol/L)
3. Blood urea nitrogen level of 25 mg/dL (8.8 mmol/L)
4. Fasting blood glucose level of 99 mg/dL (5.5 mmol/L)
3
Cyclosporine is an immunosuppressant. Nephrotoxicity can occur from the use of cyclosporine. Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels. The normal blood urea nitrogen level is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). The normal creatinine level for a male is 0.6 to 1.2 mg/dL (53 to 106 mcmol/L) and for a female is 0.5 to 1.1 mg/dL (44 to 97 mcmol/L). Cyclosporine can lower complete blood cell count levels. A normal hemoglobin is 14 to 18 g/dL (140 to 180 mmol/L) for a male and 12 to 16 g/dL (120 to 160 mmol/L) for a female. A normal hemoglobin is not an adverse effect. Cyclosporine does affect the glucose level. The normal fasting glucose is 70 to 99 mg/dL (3.9–5.5 mmol/L).
*ALSO AVOID GRAPEFRUIT*
A client is prescribed spironolactone for management of hypertension and fluid retention. Which dietary instruction should the nurse include in the client's discharge teaching?
A. Increase daily consumption of bananas, oranges, and dark leafy greens.
B. Strictly eliminate all forms of dietary sodium intake.
C. Avoid using commercial salt substitutes that contain potassium chloride.
D. Double your daily water consumption to at least 3,000 mL.
C
Salt substitutes are often packed with potassium chloride instead of sodium chloride. Spironolactone retains potassium, so using these substitutes can easily trigger dangerous hyperkalemia.
The nurse provides discharge instructions to a client with atrial fibrillation who is taking warfarin sodium. Which statement, by the client, reflects the need for further teaching?
1. "I will avoid alcohol consumption."
2. "I will take my pills every day at the same time."
3. "I have already called my family to pick up a MedicAlert bracelet."
4. "I will take coated aspirin for my headaches because it will coat my stomach."
4.
Aspirin-containing products need to be avoided when a client is taking this medication. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking the prescribed medication at the same time each day increases client compliance. The MedicAlert bracelet provides health care personnel with emergency information.
A client taking an angiotensin-converting enzyme (ACE) inhibitor to treat hypertension calls the clinic nurse and reports that he has a dry, nonproductive cough that is very bothersome. The nurse should respond by making which statement?
1. "The medication may need to be changed."
2. "The cough must be the start of a respiratory infection."
3. "The medication needs to be taken with large amounts of water to prevent the cough."
4. "This sometimes happens, and you will need to take a cough medication with each dose of medication."
1.
An ACE inhibitor is used to treat hypertension or heart failure. A side effect of ACE inhibitors is a characteristic dry, nonproductive cough. This can be quite bothersome to a client, and the medication may need to be changed. The cough is reversible with discontinuation of therapy. The remaining options are incorrect.
A client with heart failure is scheduled to be discharged to home with digoxin and furosemide as daily prescribed medications. The nurse tells the client to report which finding as an indication that the medications are not having the intended effect?
1. Sudden increase in appetite
2. Weight gain of 2 to 3 lb in a few days
3. Increased urine output during the day
4. Cough accompanied by other signs of respiratory infection
2.
Clients with heart failure should immediately report weight gain, loss of appetite, shortness of breath with activity, edema, persistent cough, and nocturia. An increase in urine output during the day is expected with diuretic therapy. A cough resulting from respiratory infection does not necessarily indicate that heart failure is worsening.
You're educating a group of new nurse graduates about loop diuretics. One topic you discuss is ototoxicity. You ask the new nurses to explain how to prevent this adverse side effect in a patient prescribed a loop diuretic. Which response by one of the new nurses is correct?*
A. "Always administer intravenous loop diuretics slowly."
B. "Monitor for signs and symptoms of low potassium levels because this increases the risk of inner ear damage while taking loop diuretics."
C. "Administer the medication with meals."
D. "Avoid administering loop diuretics with a tetracycline."
A
Pushing meds too fast can be ototoxic- ALWAYS give loop diuretics slowly
The nurse is educating a nursing student about how colloids work to expand the plasma volume. Which statements by the nursing student indicate the student understands how these solutions work? Select all that apply:
A. "These fluids work by pulling water into the intravascular space through oncotic pressure."
B. "Colloids push water from the intravascular space into the interstitial space."
C. "Colloids are able to increase the plasma volume because their large molecules do not cross the capillary wall but stay in the intravascular space longer."
D. "Colloids work to increase filtration by hydrostatic pressure."
A. "These fluids work by pulling water into the intravascular space through oncotic pressure."
C. "Colloids are able to increase the plasma volume because their large molecules do not cross the capillary wall but stay in the intravascular space longer."
A client is diagnosed with an ST segment elevation myocardial infarction (STEMI) and is receiving a tissue plasminogen activator, alteplase. Which action is a priority nursing intervention?
1. Monitor for kidney failure.
2. Monitor psychosocial status.
3. Monitor for signs of bleeding.
4. Have heparin sodium available
3.
ABCs and hemorrhage are priorities!
Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin may be administered after thrombolytic therapy, but the question is not asking about follow-up medications.
A client is being treated with procainamide for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take first?
1. Obtain a 12-lead electrocardiogram.
2. Check the client's fingerstick blood glucose level.
3. Auscultate the client's apical pulse and blood pressure.
4. Measure the QRS interval duration on the rhythm strip.
3.
Signs of toxicity from procainamide include confusion, dizziness, drowsiness, decreased urination, nausea, vomiting, and tachydysrhythmias. If the client complains of dizziness, the nurse should assess the vital signs first. Although measuring the QRS duration on the rhythm strip and obtaining a 12-lead electrocardiogram may be interventions, these would be done after the vital signs are taken. Dizziness directly following the procainamide indicates that the medication was the likely cause and should be addressed before assessing for other possible causes such as hypoglycemia.
The nurse is monitoring a client with hypertension who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this medication?
1. Report of infrequent insomnia
2. Development of expiratory wheezes
3. A baseline blood pressure of 150/80 mm Hg after 2 doses of the medication
4. A baseline resting heart rate of 88 beats per minute followed by a resting heart rate of 72 beats per minute after 2 doses of the medication
2.
Remember ABCs
Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. Beta blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.
Your patient is ordered a loop diuretic at 1000. Which finding below would require you to hold the dose and notify the physician for further orders?
A. Calcium level 9 mg/L
B. Potassium level 2.5 mEq/L
C. Blood pressure 102/78
D. Sodium level 144
B
Remember that loop diuretics DROP potassium, so if potassium is already low, loop diuretics will make it worse.
The nurse is monitoring a client for adverse effects of medications. Which findings are characteristic of adverse effects of hydrochlorothiazide? Select all that apply.
1. Sulfa allergy
2. Osteoporosis
3. Hypokalemia
4. Hypouricemia
5. Hyperglycemia
6. Hypercalcemia
1, 3, 5, 6
Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.
Intravenous heparin therapy is prescribed for a client with atrial fibrillation. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit?
1. Vitamin K
2. Protamine sulfate
3. Potassium chloride
4. Aminocaproic acid
2.
The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin sodium. Potassium chloride is administered for a potassium deficit. Aminocaproic acid is the antidote for thrombolytic therapy.
A client with chronic atrial fibrillation is being started on quinidine sulfate as maintenance therapy for dysrhythmia suppression, and the nurse provides instructions to the client about the medication. Which statement by the client indicates a need for further instruction?
1. "I will avoid chewing the tablets."
2. "I will take the dose at the same time each day."
3. "I will take the medication with food if my stomach becomes upset."
4. "I will stop taking the prescribed anticoagulant after starting this new medication."
4.
Medication-specific teaching points for quinidine sulfate include to take the medication exactly as prescribed, not to chew the tablets, to take with food if stomach upset occurs, to wear a medical identification (e.g., MedicAlert) bracelet or tag, and to have periodic checks of heart rhythm and blood counts. The client should not stop taking a prescribed medication unless specifically told to do so by the primary health care provider.
The nurse is monitoring a client with heart failure who is taking digoxin. Which findings are characteristic of digoxin toxicity? Select all that apply.
1. Tremors
2. Diarrhea
3. Irritability
4. Blurred vision
5. Nausea and vomiting
2, 4, 5
Digoxin is a cardiac glycoside. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea. Subsequent manifestations include headache; visual disturbances such as diplopia, blurred vision, yellow-green halos, and photophobia; drowsiness; fatigue; and weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. The optimal therapeutic range for digoxin is 0.5 to 2.0 ng/mL (0.63 to 2.56 nmol/L).
Select all the medications below that are considered loop diuretics:
A. Chlorothiazide
B. Bumetanide
C. Triamterene
D. Spironolactone
E. Furosemide
F. Torsemide
G. Hydrochlorothiazide
B, E, F
Potassium chloride intravenously is prescribed for a client with heart failure experiencing hypokalemia. Which actions should the nurse take to plan for preparation and administration of the potassium? Select all that apply.
1. Obtain an intravenous (IV) infusion pump.
2. Monitor urine output during administration.
3. Prepare the medication for bolus administration.
4. Monitor the IV site for signs of infiltration or phlebitis.
5. Ensure that the medication is diluted in the appropriate volume of fluid.
6. Ensure that the bag is labeled so that it reads the volume of potassium in the solution.
1, 2, 4, 5, 6
Potassium chloride administered intravenously must always be diluted in IV fluid and infused via an infusion pump. Potassium chloride is never given by bolus (IV push). Giving potassium chloride by IV push can result in cardiac arrest. The nurse should ensure that the potassium is diluted in the appropriate amount of diluent or fluid. The IV bag containing the potassium chloride should always be labeled with the volume of potassium it contains. The IV site is monitored closely, because potassium chloride is irritating to the veins and there is risk of phlebitis. In addition, the nurse should monitor for infiltration. The nurse monitors urinary output during administration and contacts the primary health care provider if the urinary output is less than 30 mL/hr.
The nurse is providing discharge instructions to a client taking warfarin sodium. Which statement, based on primary health care provider (PHCP) permission, is appropriate to include in client teaching for this medication?
1. "Alcohol can be consumed as long as it is in small amounts."
2. "You need to check with your doctor about what can be taken for headaches."
3. "It doesn't matter what time the daily dose is taken as long as it is taken each day."
4. "It is all right to take over-the-counter medications as long as they do not contain vitamin K."
2.
Warfarin sodium is an anticoagulant that prevents further extension of formed existing clots and also prevents new clot formation and secondary thromboembolic complications. Because the medication places the client at risk for bleeding, the client is instructed to avoid salicylates (acetylsalicylic acid, or aspirin) and alcohol. The medication should be taken exactly as prescribed and at the same time daily. The client needs to avoid all over-the-counter medications and needs to consult with the PHCP before taking any other medications because of the risk for medication interactions.
A patient is prescribed an additional once-daily antidysrhythmic drug to control persistent atrial fibrillation. What instructions should the nurse provide for this patient?
1. Take your first dose of this new medication before you go to bed tonight.
2. Do not eat or drink anything for 2 hours after taking the new medication.
3. Before you get out of bed in the morning, sit up on the side of the bed for a few minutes.
4. Plan to return to the clinic to have your electrolytes checked in 2 weeks.
5. Contact the clinic if you notice any loss of hair from your head.
1, 3, 4
A client is ordered furosemide (Lasix) to be given via intravenous push. What interventions should the nurse perform? (Select all that apply.)
a. Administer at a rate no faster than 20 mg/min.
b. Assess lung sounds before and after administration.
c. Assess blood pressure before and after administration.
d. Maintain accurate intake and output record.
e. Monitor ECG continuously.
f. Insert an arterial line for continuous blood pressure monitoring.
b. Assess lung sounds before and after administration.
c. Assess blood pressure before and after administration.
d. Maintain accurate intake and output record.
You're developing a plan of care for a patient with fluid volume overload related to heart failure exacerbation. The physician has prescribed an IV loop diuretic. What nursing interventions will you include in the patient's plan of care? Select all that apply:*
A. Perform and assess daily weights.
B. Educate the patient about consuming a low potassium diet.
C. Strict measuring of the patient's daily intake and output.
D. Encourage the patient to drink 2 L of fluids per day.
E. Assess lung sounds every shift.
A, C, E
Intake and outputs need to be monitored
Loop diuretics drain potassium
Dehydration can make diuretics worse
Lungs can have fluid
What electrolyte imbalances would the nurse monitor for in the patient who is taking a loop diuretic? Select all that apply:
A. Hyperkalemia
B. Hypocalcemia
C. Hypernatremia
D. Hypokalemia
E. Hypomagnesemia
B, D, E
loop diuretics drain- so low calcium, low potassium, low magnesium
A nurse has provided discharge instructions to a client being placed on long-term anticoagulant therapy with warfarin sodium. Adequate learning would be evident if the client makes which statements? Select all that apply.
1. "I may take over-the-counter medications as needed."
2. "I will inform my dentist that I am taking this medication."
3. "I should alternate the timing of my daily dose of this medication."
4. "I should use a firm-bristled toothbrush to prevent the side effects of this medication."
5. "I will have my blood levels checked as prescribed by my primary health care provider (PHCP)."
6. "I will report any signs of blood in my urine or stool to my primary health care provider (PHCP)."
2, 5, 6
Clients need to notify all primary health care providers (PHCPs) that they are on warfarin sodium therapy. Dental procedures may put the client at risk for increased bleeding, so this should direct you to option 2. Knowing that the effectiveness of warfarin sodium is based on maintaining a therapeutic blood level will direct you to select option 5. Awareness of bleeding as a primary complication will direct you to option 6.
The nurse is providing information for a patient who will self-administer a twice-daily antidysrhythmic medication at home. The nurse would provide additional education if the patient makes which statement? Select all that apply.
1. "If I get the flu, I should stop taking the medication until my fever goes down."
2. "I should take my doses as close to 12 hours apart as I can."
3. "If I forget a dose of medication I should take two pills for the next dose."
4. "If I can't take the medication for a couple of days because I am sick, I should call the clinic for advice."
5. "I should get my prescription refilled before I am completely out of medicine."
1, 3
Never miss doses/ skip
A hospitalized client with coronary artery disease complains of substernal chest pain. After assessing the client's heart rate and blood pressure, the nurse administers nitroglycerin, 0.4 mg sublingually. After 5 minutes the client states, "My chest still hurts." Which actions should the nurse take? Select all that apply.
1. Call a Code Blue.
2. Contact the client's family.
3. Assess the client's pain level.
4. Check the client's blood pressure.
5. Contact the primary health care provider (PHCP).
6. Administer a second nitroglycerin, 0.4 mg sublingually.
3, 4, 6
The usual guidelines for administering nitroglycerin tablets for chest pain to a hospitalized client include administering 1 tablet every 5 minutes PRN (as needed) for chest pain, for a total dose of 3 tablets. If the client does not obtain relief after taking a third dose of nitroglycerin, the PHCP is notified. Because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would assess the client's pain level and check the client's blood pressure before administering each nitroglycerin dose. There are no data in the question that indicate the need to call a Code Blue. In addition, it is not necessary to contact the client's family unless he or she has requested this.