RENAL & URINARY DRUGS
Acetazolamide is prescribed for a client with glaucoma. What is the primary therapeutic effect?
A. Increase aqueous humor production
B. Decrease intraocular pressure
C. Increase urine sodium retention
D. Increase systemic blood pressure
Answer: B. Decrease intraocular pressure
Rationale: Acetazolamide inhibits carbonic anhydrase, reducing aqueous humor secretion and decreasing intraocular pressure.
Which electrolyte imbalance should the nurse monitor for in a client receiving furosemide?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B. Hypokalemia
Rationale: Furosemide can cause significant electrolyte losses, including hypokalemia, hyponatremia, hypocalcemia, and hypomagnesemia.
Which medication is considered a first-line oral medication for type 2 diabetes?
A. Metformin
B. Desmopressin
C. Methimazole
D. Furosemide
Answer: A. Metformin
Rationale: Metformin is a first-line oral medication for type 2 diabetes. It decreases hepatic glucose production and increases peripheral insulin sensitivity.
Which insulin should the nurse recognize as having a rapid onset and being administered within approximately 15–20 minutes of a meal?
A. NPH
B. Glargine
C. Lispro
D. Regular
Answer: C. Lispro
Rationale: Lispro is rapid-acting insulin and is administered within approximately 15–20 minutes of a meal.
A client with central diabetes insipidus is prescribed desmopressin (DDAVP). Which finding best indicates that the medication is having the desired therapeutic effect?
A. Increased urine output
B. Decreased urine specific gravity
C. Decreased excessive thirst and urine output
D. Increased serum sodium level
Answer: C. Decreased excessive thirst and urine output
Rationale: Central DI occurs because of inadequate ADH, causing excessive dilute urine production and thirst. Desmopressin acts as synthetic ADH and promotes water reabsorption, decreasing polyuria and polydipsia.
A client taking tamsulosin for BPH reports dizziness when standing. Which instruction should the nurse provide?
A. Change positions slowly.
B. Stop drinking fluids.
C. Take an extra dose at bedtime.
D. Increase sodium intake significantly.
Answer: A. Change positions slowly.
Rationale: Alpha-1 blockers such as tamsulosin can cause orthostatic hypotension and dizziness. Changing positions slowly helps reduce the risk of falls.
Which laboratory value is most important for the nurse to monitor in a client receiving spironolactone?
A. Potassium
B. Calcium
C. Hemoglobin
D. Platelets
Answer: A. Potassium
Rationale: Spironolactone is potassium-sparing. The major concern is hyperkalemia, which can cause life-threatening cardiac dysrhythmias.
A client taking metformin is scheduled for a procedure involving iodinated radiocontrast. Which action is appropriate?
A. Give the medication immediately before the procedure.
B. Continue metformin without interruption.
C. Hold metformin before or at the time of the procedure.
D. Double the metformin dose after the procedure.
Answer: C. Hold metformin before or at the time of the procedure.
Rationale: Metformin should be discontinued before or at the time of iodinated contrast administration and withheld for 48 hours afterward. Renal function should be reassessed before restarting it because renal impairment can increase the risk of lactic acidosis.
Which insulin is the only type listed in the study material as safe for IV infusion during acute crises?
A. NPH
B. Regular
C. Glargine
D. Lispro
Answer: B. Regular
Rationale: Regular insulin is short-acting and is the insulin used for IV infusion during acute crises such as DKA.
The nurse is caring for a client receiving desmopressin. Which finding requires the nurse's priority intervention?
A. Urine output of 2,000 mL/day
B. Mild nasal irritation
C. Serum sodium of 128 mEq/L with confusion
D. Urine specific gravity of 1.020
Answer: C. Serum sodium of 128 mEq/L with confusion
Rationale: Desmopressin can cause serious water retention and life-threatening hyponatremia. Confusion is a concerning neurologic manifestation. The medication should be discontinued if hyponatremia occurs.
Which statement by a client taking finasteride requires further teaching?
A. "This medication can take several months to shrink my prostate."
B. "I may experience sexual side effects."
C. "My pregnant wife can safely handle my crushed tablets."
D. "This medication blocks conversion of testosterone to DHT."
Answer: C. "My pregnant wife can safely handle my crushed tablets."
Rationale: Finasteride is teratogenic. Pregnant women should not handle crushed or broken tablets because exposure can harm a developing male fetus.
A client receives mannitol to decrease intracranial pressure. Which finding requires the nurse's immediate attention?
A. Increased urine output
B. Mild thirst
C. New crackles and shortness of breath
D. Decreased intracranial pressure
Answer: C. New crackles and shortness of breath
Rationale: Mannitol rapidly increases intravascular volume as fluid shifts into the vascular space. This can cause pulmonary edema and worsen heart failure.
A client taking an oral antidiabetic medication reports using several herbal supplements. Which concern should the nurse prioritize?
A. Herbal products can increase blood glucose.
B. Herbal products can dramatically increase hypoglycemia risk.
C. Herbal products prevent insulin absorption.
D. Herbal products always cause hypertension.
Answer: B. Herbal products can dramatically increase hypoglycemia risk.
Rationale: Several herbs, including cinnamon, ginseng, garlic, fenugreek, and aloe vera, have hypoglycemic effects and can potentiate antidiabetic medications.
The nurse is preparing to mix regular insulin and NPH insulin in the same syringe. Which action is correct?
A. Withdraw NPH before regular insulin.
B. Withdraw regular insulin before NPH insulin.
C. Mix glargine with NPH.
D. Shake both vials before withdrawing the medication.
Answer: B. Withdraw regular insulin before NPH insulin.
Rationale: The rule is clear before cloudy. Regular insulin is clear and should be withdrawn before cloudy NPH to prevent contamination of the regular insulin vial.
A client receiving octreotide reports several new symptoms. Which finding should the nurse recognize as a potential adverse effect of this medication?
A. Severe hypocalcemia
B. Gallstone formation
C. Increased thyroid hormone production
D. Severe urinary retention
Answer: B. Gallstone formation
Rationale: Octreotide can cause gastrointestinal effects and has a high incidence of gallstone formation. It can also cause glucose dysregulation, hypothyroidism, bradycardia, and other cardiovascular effects.
The nurse is teaching a client who is taking a urinary anti-infective. Which instruction is appropriate?
A. Restrict fluid intake.
B. Increase fluid intake as directed.
C. Stop the medication when symptoms improve.
D. Take the medication only when pain occurs.
Answer: B. Increase fluid intake as directed.
Rationale: The study material recommends encouraging high fluid intake for clients receiving urinary anti-infectives.
A client with hypertension is prescribed hydrochlorothiazide. Which laboratory finding should the nurse anticipate?
A. Hyperkalemia
B. Hypercalcemia
C. Severe hypoglycemia
D. Decreased uric acid
Answer: B. Hypercalcemia
Rationale: Thiazide diuretics can cause hypokalemia, hyponatremia, hypercalcemia, hyperuricemia, hyperglycemia, and hyperlipidemia.
A client with type 2 diabetes is admitted for surgery. Which medication does the nurse anticipate may be used to manage blood glucose during the perioperative period?
A. Oral antidiabetic medication only
B. Short-acting or regular insulin
C. Desmopressin
D. Methimazole
Answer: B. Short-acting or regular insulin
Rationale: Surgery and acute illness increase stress hormones and insulin resistance. Oral antidiabetic agents are generally withheld, while short-acting or regular insulin may be used for glucose control.
A client with diabetic ketoacidosis is admitted to the emergency department. Which prescription should the nurse anticipate?
A. IV regular insulin infusion
B. Subcutaneous NPH insulin only
C. Oral metformin
D. Inhaled insulin
Answer: A. IV regular insulin infusion
Rationale: DKA requires IV regular insulin through a continuous IV pump along with fluid replacement and close electrolyte monitoring.
A client with acromegaly is prescribed octreotide. The nurse understands that the medication is being used primarily to:
A. Increase growth hormone secretion
B. Stimulate thyroid hormone production
C. Inhibit growth hormone release
D. Increase insulin secretion
Answer: C. Inhibit growth hormone release
Rationale: Acromegaly results from excessive growth hormone secretion after epiphyseal closure. Octreotide is a somatostatin analogue that inhibits GH release.
The nurse is caring for four clients. Which finding requires the priority follow-up?
A. Client taking finasteride reports decreased libido.
B. Client taking tamsulosin reports mild nasal congestion.
C. Client taking spironolactone has an elevated potassium level.
D. Client taking acetazolamide reports mild tingling in the fingers.
Answer: C. Client taking spironolactone has an elevated potassium level.
Rationale: Hyperkalemia is the major potentially life-threatening adverse effect of spironolactone because it can cause fatal cardiac dysrhythmias.
A client receiving IV furosemide reports ringing in the ears and difficulty hearing. Which action should the nurse take?
A. Administer the next dose early.
B. Recognize this as possible ototoxicity and notify the provider.
C. Encourage the client to increase sodium intake.
D. Document the finding as an expected therapeutic effect.
Answer: B. Recognize this as possible ototoxicity and notify the provider.
Rationale: Furosemide can cause ototoxicity, particularly when administered rapidly IV. Hearing changes require prompt attention.
The nurse receives report on four clients. Which client should the nurse assess first?
A. Client taking metformin with a glucose of 145 mg/dL
B. Client taking NPH insulin with a glucose of 180 mg/dL
C. Client receiving desmopressin with confusion and sodium of 128 mEq/L
D. Client taking repaglinide who reports mild nausea
Answer: C. Client receiving desmopressin with confusion and sodium of 128 mEq/L
Rationale: This client has manifestations of potentially life-threatening hyponatremia associated with desmopressin. Neurologic changes such as confusion require immediate attention.
A client with DKA is receiving IV regular insulin. The client's blood glucose decreases to approximately 250 mg/dL. What should the nurse anticipate?
A. Discontinuing all IV fluids
B. Adding dextrose to the IV fluids
C. Giving long-acting insulin only
D. Restricting all fluids
Answer: B. Adding dextrose to the IV fluids
Rationale: Once glucose reaches approximately 250 mg/dL, dextrose is added to the IV fluids while insulin continues to address ketosis and prevent overly rapid glucose reduction.
The nurse is caring for a child receiving somatropin for growth hormone deficiency. Which finding requires close monitoring?
A. Hypoglycemia
B. Hyperglycemia and insulin resistance
C. Decreased growth
D. Increased serum sodium
Answer: B. Hyperglycemia and insulin resistance
Rationale: Somatropin can cause hyperglycemia and insulin resistance. The nurse should also monitor thyroid function, injection sites, and epiphyseal development.