Abrams Clinical Drug Therapy Rationales for Nursing Practice by Geralyn Frandsen -Test Bank

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Abrams Clinical Drug Therapy Rationales for Nursing Practice by Geralyn Frandsen -Test Bank

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Abrams Clinical Drug Therapy Rationales for Nursing Practice by Geralyn Frandsen -Test Bank

chapter 2

1. Which cellular structure stores hormones and other substances and packages these substances into secretory granules?
  A) Golgi apparatus
  B) Endoplasmic reticulum
  C) Mitochondria
  D) Lysosome
  Ans: A
  Feedback:
  The golgi apparatus stores hormones and other substances. The endoplasmic reticulum contains ribosomes, which synthesize proteins, including enzymes that synthesize glycogen, triglycerides, and steroids and those that metabolize drugs and other chemicals. The mitochondria generate energy for cellular activities and require oxygen. Lysosomes are membrane-enclosed vesicles that contain enzymes capable of digesting nutrients (proteins, carbohydrates, fats), damaged cellular structures, foreign substances (bacteria), and the cell itself.

 

 

2. A patient is suffering from a cough associated with an upper respiratory infection. Which oral medication will likely produce the most therapeutic effect?
  A) A tablet
  B) An expectorant
  C) A topical spray
  D) A timed-release tablet
  Ans: B
  Feedback:
  Liquid medications are absorbed faster than tablets or capsules. Expectorants are liquid medications. A tablet is an oral medication that has a slower onset of action than a liquid medication. A topical spray can be sprayed to the back of the throat and provides only a local effect. A timed-release tablet is an oral medication that has a slower onset and longer duration of action.

 

 

3. A patient is administered an oral contraceptive. Which of the following is the process that occurs between the time the drug enters the body and the time that it enters the bloodstream?
  A) Absorption
  B) Distribution
  C) Metabolism
  D) Excretion
  Ans: A
  Feedback:
  Absorption is the process that occurs from the time the drug enters the body to the time it enters the bloodstream to be circulated. Distribution involves the transport of drug molecules within the body. Metabolism is the method by which drugs are inactivated or biotransformed by the body. Excretion refers to elimination of a drug from the body.

 

 

4. Which of the following sites of drug absorption is considered to have an exceptionally large surface area for drug absorption?
  A) Rectum
  B) Fundus of the stomach
  C) Esophagus
  D) Lungs
  Ans: D
  Feedback:
  The lungs have a large surface area for absorption of anesthetic gases and a few other drugs. The rectum absorbs the medication through the mucous membranes and has a smaller surface area than the lungs. The fundus and esophagus have comparatively small surface areas.

 

 

5. A nurse is aware of the importance of adhering to the intended route of a medication. Which of the following drugs are formulated to be absorbed through the skin?
  A) Amoxicillin, tetracycline, and penicillin
  B) Clonidine, fentanyl, and nitroglycerin
  C) Digoxin, lidocaine, and propranolol
  D) Insulin, heparin, and morphine
  Ans: B
  Feedback:
  Some drugs are formulated in adhesive skin patches for absorption through the skin. Clonidine, fentanyl, and nitroglycerin are examples of drugs that are formulated in adhesive skin patch form to be absorbed through the skin. Amoxicillin, tetracycline, and penicillin are administered orally. Digoxin and propranolol are administered orally, and lidocaine can be administered intravenously, subcutaneously, or topically. Insulin and heparin are administered intravenously and subcutaneously. Morphine is administered orally, intramuscularly, and intravenously.

 

 

6. An 85-year-old patient has an elevated serum creatinine level, indicating impaired kidney function. When the patient is administered a medication, this patient is at risk for which of the following medication-related effects?
  A) Toxicity
  B) Increased absorption
  C) Delayed gastric emptying
  D) Idiosyncratic effects
  Ans: A
  Feedback:
  An elevated creatinine level is indicative of diminished kidney function, which will result in serum drug toxicity. The creatinine level indicates kidney function, does not affect absorption, and has no effect on gastric emptying.

 

 

7. Protein binding is an important aspect of pharmacokinetics. Protein binding ultimately has which of the following effects on drug action?
  A) Increases the drugs speed of action
  B) Decreases the drugs speed of action
  C) Increases the rate of excretion
  D) Averts adverse effects
  Ans: B
  Feedback:
  Protein binding allows part of a drug to be stored and released as needed. Drugs that are highly bound to plasma proteins or stored extensively in other tissues have a long duration of action. Protein binding does not increase the speed of action, increase the excretion rate, or avert adverse effects. Protein binding decreases the speed of action by storing the drug to be released when needed.

 

 

8. A patient is taking a medication that is metabolized by the CYP enzymes. Which of the following medications inhibits several of the CYP enzymes?
  A) Cisplatin
  B) Acebutolol hydrochloride
  C) Cimetidine
  D) Dicloxacillin sodium
  Ans: C
  Feedback:
  Cimetidine is a gastric acid suppressor that inhibits several CYP enzymes and can greatly decrease drug metabolism. The other listed drugs do not have this specific effect.

 

 

9. A nurse is aware that the dosing scheduling of a patients new medication takes into account the serum half-life of the drug. What is the serum half-life of a medication?
  A) The time required for IV medications to penetrate the brain tissue
  B) The time needed for the serum level to fall by 50%
  C) The safest margin to prevent toxicity
  D) The dose adjustment that reduces the risk of adverse effects by one half
  Ans: B
  Feedback:
  Serum half-life is the time required for the serum concentration of a drug to decrease by 50%. Although many IV medications penetrate the brain tissue, this action does not describe the half-life. The safest margin to prevent toxicity depends on the rate of metabolism and excretion. The half-life of the medication does not relate directly to a specific reduction in adverse effects.

 

 

10. A patient has increased intracranial pressure and is ordered to receive a diuretic. Which of the following diuretics does not act on receptor sites to produce diuresis?
  A) Furosemide (Lasix)
  B) Hydrochlorothiazide (HCTZ)
  C) Spironolactone (Aldactone)
  D) Mannitol (Osmitrol)
  Ans: D
  Feedback:
  Mannitol (Osmitrol) is an osmotic diuretic that increases the osmolarity of plasma and pulls water out of the tissues into the bloodstream. It does not act on receptor sites. Furosemide (Lasix) is a loop diuretic that inhibits the reabsorption of sodium and chloride in the loop of Henle. Hydrochlorothiazide is associated with drug interference with absorption of sodium ions across the distal renal tubule. Spironolactone acts by competing with aldosterone for cellular receptor sites.

 

 

11. A patient older than 65 years is more likely to experience drug reaction than a much younger patient. Which of the following factors accounts for this variation?
  A) Drugs more readily crossing the bloodbrain barrier in older people
  B) Age-related physiologic changes
  C) Increased drug-metabolizing enzymes in older people
  D) Diminished immune response
  Ans: B
  Feedback:
  In older adults (65 years and older), physiologic changes may alter all pharmacokinetic processes. Although drugs crossing the bloodbrain barrier affect drug reaction, this factor is important in all ages. Increased drug-metabolizing enzymes are key in all ages and do not relate to age variations. A diminished immune response is important in all ages and does not affect all medications.

 

 

12. A patient who is 6 feet tall and weighs 280 pounds will require which of the following doses?
  A) Higher dose than a patient who weighs 180 pounds
  B) Lower dose than a patient who weighs 180 pounds
  C) Same dose as a patient who weighs 180 pounds
  D) A parenteral rather than oral dose
  Ans: A
  Feedback:
  In general, people heavier than average may need larger doses, provided their renal, hepatic, and cardiovascular functions are adequate.

 

 

13. A nurse has provided an oral dose of morphine, an opioid agonist, to a woman in early labor. The nurse should be aware of what characteristic of agonists?
  A) Agonists alter the normal processes of distribution and metabolism.
  B) Agonists counteract the action of specific neurotransmitters.
  C) Agonists block the action of specific neurotransmitters.
  D) Agonists bind to receptors and cause a physiological effect.
  Ans: D
  Feedback:
  Agonists are drugs that produce effects similar to those produced by naturally occurring hormones, neurotransmitters, and other substances by activating (not blocking or counteracting) a receptor. Classification of a drug as an agonist does not denote a change to metabolism or distribution.

 

 

14. A nurse is preparing to simultaneously administer two drugs to a patient. The nurse knows that the drugs have been ordered to be given together because of their synergistic effect. This means that
  A) the adverse effects of one of the drugs are nullified by the other drug.
  B) the combined effects are greater than the effects of either one of the drugs alone.
  C) one of the drugs enhances metabolism, while the other drug enhances either distribution or absorption.
  D) both drugs are toxic in isolation but therapeutic when administered together.
  Ans: B
  Feedback:
  Synergism occurs when two drugs with different sites or mechanisms of action produce greater effects when taken together. This does not mean that potential toxicity or adverse effects are canceled out. The two drugs would not individually affect different aspects of pharmacokinetics.

 

 

15. A patient has been brought to the emergency department by ambulance, and his friend states that he has overdosed on methadone, a long-acting opioid. The care team is preparing to administer the appropriate antidote, naloxone, which has a shorter half-life than methadone. What are the implications of this aspect of pharmacokinetics?
  A) Repeated doses of naloxone will likely be necessary.
  B) A different antidote will be required after the serum level of naloxone decreases.
  C) An increased dose of naloxone will be required.
  D) The antidote is unlikely to have a therapeutic effect on the patients symptoms.
  Ans: A
  Feedback:
  When an antidote is used, its half-life relative to the toxins half-life must be considered. For example, the half-life of naloxone, a narcotic antagonist, is relatively short compared with the half-life of the longer-acting opioids such as methadone, and repeated doses may be needed to prevent recurrence of the toxic state.

 

 

16. A patient tells the nurse, I took my sleeping pill yesterday evening, but it didnt seem to work for me like it usually does. The nurse should consider which of the following variables that can affect drug absorption? Select all that apply.
  A) GI function
  B) Blood flow to the site of administration
  C) The presence of other drugs
  D) Route of administration
  E) The presence of receptor agonists
  Ans: A, B, C, D
  Feedback:
  Numerous factors affect the rate and extent of drug absorption, including dosage form, route of administration, blood flow to the site of administration, GI function, the presence of food or other drugs, and other variables. Agonist activity is a relevant variable, but this is not an aspect of absorption.

 

 

17. A nurse has administered a dose of a drug that is known to be highly protein bound. What are the implications of this characteristic?
  A) The patient must consume adequate protein in order to achieve a therapeutic effect.
  B) The molecules of the drug that are bound to protein are inactive.
  C) Increased levels of serum protein will increase the effect of the drug.
  D) Each molecule of the drug must bind to a protein molecule to become effective.
  Ans: B
  Feedback:
  Drug molecules bound to plasma proteins are pharmacologically inactive because the large size of the complex prevents their leaving the bloodstream through the small openings in capillary walls and reaching their sites of action, metabolism, and excretion. Only the free or unbound portion of a drug acts on body cells. The patients protein intake or levels of protein are not normally relevant.

 

 

18. A patient requires a high dose of his new antihypertensive medication because the new medication has a significant first-pass effect. This means that the drug
  A) must pass through the patients bloodstream several times to generate a therapeutic effect.
  B) passes through the renal tubules and is excreted in large amounts.
  C) is extensively metabolized in the patients liver.
  D) is ineffective following the first dose and increasingly effective with each subsequent dose.
  Ans: C
  Feedback:
  Some drugs are extensively metabolized in the liver, with only part of a drug dose reaching the systemic circulation for distribution to sites of action. This is called the first-pass effect or presystemic metabolism. The first-pass effect is not related to renal function or the need to pass through the bloodstream multiple times.

 

 

19. A patient with a diagnosis of bipolar disorder has begun lithium therapy, and the nurse has explained the need for regular monitoring of the patients serum drug levels. What is the primary rationale for the nurses instruction?
  A) It is necessary to regularly test for blooddrug incompatibilities that may develop during treatment.
  B) It is necessary to ensure that the patients drug levels are therapeutic but not toxic.
  C) It is needed to determine if additional medications will be needed to potentiate the effects of lithium.
  D) It is needed in order to confirm the patients adherence to the drug regimen.
  Ans: B
  Feedback:
  Measuring serum drug levels is useful when drugs with a narrow margin of safety are given, because their therapeutic doses are close to their toxic doses. This is the case during lithium therapy. Serum levels are not commonly taken to monitor adherence to treatment. Blooddrug incompatibilities are not a relevant consideration.

 

 

20. A patient in cardiovascular collapse requires pharmacological interventions involving a rapid drug action and response. What route of administration is most likely appropriate?
  A) Intravenous
  B) Oral
  C) Rectal
  D) Topical
  Ans: A
  Feedback:
  For rapid drug action and response, the IV route is most effective because the drug is injected directly into the bloodstream.

 

 

chapter 16

1. A patient is administered penicillin V orally for a strep throat. What is the mechanism of action of this medication?
  A) It inhibits protein synthesis.
  B) It lowers the pH of cellular contents.
  C) It causes mutations.
  D) It inhibits cell wall synthesis.
  Ans: D
  Feedback:
  Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. Penicillin V does not inhibit protein synthesis, cause mutations, or lower the pH of a bacteriums cellular contents.

 

 

2. A patient previously experienced an anaphylactic reaction to penicillin G. Which of the following medications should not be administered to this patient due to the potential for cross-sensitivity?
  A) Lactulose (Chronulac)
  B) Ketoconazole (Nizoral)
  C) Kanamycin (Kantrex)
  D) Cefadroxil (Duricef)
  Ans: D
  Feedback:
  Cefadroxil (Duricef) is a cephalosporin. Administration of cephalosporins or carbapenems should be avoided if possible in people with life-threatening allergic reactions to penicillin. Lactulose reduces blood ammonia by resident intestinal bacteria. It is not contraindicated in the event of penicillin anaphylaxis. Ketoconazole is an antifungal and does not possess cross-sensitivity to penicillin. Kanamycin is an aminoglycoside and does not possess cross-sensitivity to penicillin.

 

 

3. An adult patient has a history of rheumatic fever. Which of the following medications should be administered as prophylaxis for rheumatic fever?
  A) Cyclacillin (Cyclapen)
  B) Amoxicillin (Augmentin)
  C) Dicloxacillin
  D) Penicillin G benzathine (Bicillin LA)
  Ans: D
  Feedback:
  Penicillin G benzathine (Bicillin LA) is administered as prophylaxis for rheumatic fever. Cyclacillin, amoxicillin, and dicloxacillin are not routinely administered for prophylaxis of rheumatic fever.

 

 

4. A patient has been prescribed an oral penicillin for an infection caused by gram-negative bacilli. When conducting health education for this patient, the nurse should emphasize which of the following?
  A) The need to take the medication on an empty stomach
  B) The fact that a mild rash frequently follows the first few doses
  C) The need to increase fluid intake for the duration of treatment
  D) The fact that the drug should be discontinued once symptoms subside
  Ans: A
  Feedback:
  Most penicillins should be best taken on an empty stomach. Increased fluid intake is not normally necessary. A rash is an unexpected finding that should be reported promptly. The patient should take the full course of antibiotics.

 

 

5. Unasyn is being administered to a patient with an infection caused by Staphylococcus aureus. What type of anti-infective is Unasyn?
  A) Extended-spectrum antipseudomonal penicillin
  B) Penicillinbeta-lactamase inhibitor combination
  C) Cephalosporin
  D) Aminopenicillin
  Ans: B
  Feedback:
  Unasyn is a penicillinbeta-lactamase inhibitor combination. It is ampicillin and sulbactam. Unasyn is not classified as an extended-spectrum antipseudomonal penicillin, cephalosporin, or aminopenicillin.

 

 

6. A patient is administered Augmentin (amoxicillin and clavulanate potassium) to treat otitis media. How does a beta-lactamase inhibitor agent achieve a therapeutic effect?
  A) It extends the spectrum of antibacterial activity of penicillin.
  B) It extends the spectrum of the beta-lactamase inhibitor.
  C) It decreases the side effects of high-dose penicillin.
  D) It increases the absorption of the penicillin.
  Ans: A
  Feedback:
  When combined with a penicillin, the beta-lactamase inhibitor protects the penicillin from destruction by the enzymes and extends the penicillins spectrum of antimicrobial activity. Augmentin does not extend the spectrum of beta-lactamase inhibitor. Augmentin does not decrease the side effects of high-dose penicillin. Augmentin does not increase the absorption of penicillin.

 

 

7. A patient is administered a third-generation cephalosporin. Which of the following microorganisms are cephalosporins most effective in treating?
  A) Gram-positive
  B) Gram-negative
  C) Fungi
  D) Virus
  Ans: B
  Feedback:
  Cephalosporins are broad-spectrum agents with activity against both gram-positive and gram-negative bacteria. Compared with penicillins, they are, in general, less active against gram-positive organisms but more active against gram-negative ones. Cephalosporins are not effective against fungi or viruses.

 

 

8. A patient is diagnosed with infective endocarditis. Which of the following medications is most effective in treating this patient?
  A) Dicloxacillin
  B) Ampicillin
  C) Nafcillin
  D) Oxacillin
  Ans: B
  Feedback:
  Health care providers use ampicillin in the treatment or prophylaxis of infective endocarditis. Dicloxacillin, nafcillin, and oxacillin are typically used to treat methicillin-resistant Staphylococcus aureus.

 

 

9. A patient with septicemia is administered cefotaxime sodium (Claforan), a second-generation cephalosporin. How is this medication excreted?
  A) It is excreted by the lungs.
  B) It is excreted by the liver.
  C) It is excreted by the kidneys.
  D) It is excreted through the GI tract.
  Ans: C
  Feedback:
  Cefotaxime sodium, like all cephalosporins, is excreted by the kidneys. Cefotaxime is not excreted by the lungs, liver, or GI tract.

 

 

10. A patient is scheduled for a vaginal hysterectomy. Which of the following medications is the drug of choice for surgical prophylaxis?
  A) Cefadroxil (Duricef)
  B) Cefazolin sodium (Ancef)
  C) Cephalexin (Keflex)
  D) Cephradine (Velosef)
  Ans: B
  Feedback:
  Cefazolin sodium (Ancef) is the drug of choice for surgical prophylaxis in most surgical procedures. Cefadroxil, cephalexin, and cephradine are all first-generation cephalosporins, but they are not utilized as the drug of choice for surgical prophylaxis.

 

 

11. A patient is diagnosed with B. fragilis, an anaerobic organism resistant to most drugs. What is the drug of choice to treat this microorganism?
  A) Cefaclor (Ceclor)
  B) Cefamandole nafate (Mandol)
  C) Cefoxitin (Mefoxin)
  D) Cefuroxime sodium (Zinacef)
  Ans: C
  Feedback:
  Cefoxitin (Mefoxin) is active against B. fragilis, an anaerobic organism resistant to most drugs. Cefaclor, cefamandole nafate, and cefuroxime sodium are all second-generation cephalosporins but not the drug of choice for B. fragilis.

 

 

12. A patient is to receive imipenemcilastatin (Primaxin) IM to treat P. aeruginosa. What should imipenemcilastatin be mixed with prior to administering intramuscularly?
  A) Meropenem (Merrem)
  B) Gentamicin (Garamycin)
  C) Lidocaine
  D) Epinephrine
  Ans: C
  Feedback:
  When preparing imipenemcilastatin for IM injection, lidocaine is added to decrease pain. Meropenem, gentamicin, and epinephrine are not added to imipenemcilastatin.

 

 

13. A patient is administered imipenemcilastatin for the treatment of an E. coli infection. The nurse should be aware that cilastatin is combined with the imipenem for what purpose?
  A) To eliminate adverse effects of imipenem administration
  B) To inhibit the destruction of imipenem
  C) To potentiate the therapeutic effects of imipenem
  D) To allow imipenem to cross the bloodbrain barrier
  Ans: B
  Feedback:
  Cilastatin inhibits the destruction of imipenem, increasing the urinary concentration of imipenem and reducing its potential renal toxicity. It does not allow the drug to cross the bloodbrain barrier, and cilastatin does not eliminate all adverse effects.

 

 

14. A patient is administered aztreonam (Azactam). What is the major advantage of this monobactam over the aminoglycosides in treating P. aeruginosa?
  A) It is a lower-cost medication.
  B) It is administered orally.
  C) It causes less GI distress.
  D) It has lower risk for hearing loss.
  Ans: D
  Feedback:
  Aztreonam is effective against gram-negative bacteria similar to aminoglycosides, but the drug does not cause kidney damage or hearing loss. Aztreonam is not a lower-cost medication. Aztreonam is not administered orally. Aztreonam does not cause less GI upset.

 

 

15. A 71-year-old man with a history of osteoarthritis is scheduled for hip replacement surgery, and the surgeon has ordered a first-generation cephalosporin to be administered before and after surgery as prophylaxis. Which of the following drugs is a first-generation cephalosporin?
  A) Cefotetan (Cefotan)
  B) Cefoxitin (Mefoxin)
  C) Ceftriaxone (Rocephin)
  D) Cefazolin (Ancef)
  Ans: D
  Feedback:
  Cefazolin (Ancef) is a first-generation cephalosporin. Cefotetan (Cefotan) and cefoxitin (Mefoxin) belong to the second generation, and ceftriaxone (Rocephin) is a third-generation cephalosporin.

 

 

16. Oral ampicillin has been ordered for a female patient whose urinary tract infection will be treated in a home setting. When teaching this patient about her antibiotic, the nurse should instruct the patient to do which of the following?
  A) Take the first dose together with diphenhydramine to reduce the chance of an allergic reaction.
  B) Take the drug immediately before a meal, unless the meal will contain large amounts of fat.
  C) Drink a full glass of water when taking a dose of the drug.
  D) Taper off the drug rather than abruptly stopping it.
  Ans: C
  Feedback:
  Patients taking penicillins should take oral doses with a full glass of water. The drugs should otherwise be taken on an empty stomach. Tapering is unnecessary, and it is not advised to take the drug with diphenhydramine in an effort to reduce the allergy risk.

 

 

17. An older adult patient has just been diagnosed with community-acquired pneumonia and aztreonam (Azactam) has been ordered. What action should the nurse perform before administering the first dose?
  A) Administer a 500 mL bolus of normal saline.
  B) Confirm the patients allergy status.
  C) Swab the patients nares for the presence of MRSA.
  D) Teach the patient to expect discolored urine during treatment.
  Ans: B
  Feedback:
  As with all antibiotics, it is important to assess the patients allergy status prior to drug administration. This is especially important before the initial dose. An IV bolus is unnecessary, and discoloration of urine is not expected. MRSA testing is not relevant to aztreonam administration.

 

 

18. An intensive care unit (ICU) nurse is preparing to administer an intravenous dose of imipenemcilastatin to a patient who is being treated for sepsis. What aspect of this patients history would contraindicate the use of this drug?
  A) The patient has a history of type 1 diabetes mellitus.
  B) The patient is showing signs and symptoms of fluid volume excess.
  C) The patients most recent creatinine level was 140 mmol/L (high).
  D) The patient has a documented allergy to penicillin.
  Ans: D
  Feedback:
  It is important to avoid administering imipenemcilastatin and the other carbapenems to people with life-threatening allergic reactions to penicillin. Diabetes, slightly increased creatinine levels, and fluid overload do not necessarily contraindicate the use of imipenemcilastatin.

 

 

19. A nurse has established intravenous access in a patient whose infection necessitates treatment with IV cefazolin. What potential adverse reaction is most likely during this patients course of treat?
  A) Gastrointestinal upset
  B) Dry skin and pruritus
  C) Drowsiness
  D) Orthostatic hypotension
  Ans: A
  Feedback:
  Adverse effects to cefazolin and the other cephalosporins are similar to those of most other antibiotics: abdominal pain, diarrhea, gastritis, nausea, and vomiting. Integumentary, neurological, and blood pressure changes are atypical.

 

 

20. A 69-year-old female responded well to inpatient treatment with a third-generation cephalosporin. After being largely symptom free for 48 hours, the woman has developed a fever of 38.6C and an elevated white cell count. What phenomenon may account for this patients current clinical presentation?
  A) The patient may be infected with microorganisms that were resistant to the cephalosporin.
  B) The patient may be experiencing a delayed (type IV) hypersensitivity reaction to the cephalosporin.
  C) The patient may be developing glomerulonephritis secondary to the nephrotoxic cephalosporin.
  D) The cephalosporin may have initially caused leukopenia and made the patient susceptible to secondary infection.
  Ans: A
  Feedback:
  Patients treated with cephalosporins may be vulnerable to superinfections (infection after a previous infection, typically caused by microorganisms that are resistant to the antibiotics used earlier). Delayed hypersensitivity and renal involvement are highly unlikely. Antibiotics do not cause leukopenia.

 

 

chapter 32

1. The physician has ordered the patient hydrochlorothiazide. What assessment should the nurse make before administering the first dose of hydrochlorothiazide?
  A) Pulse rate
  B) Hemoglobin level
  C) Sulfonamide allergy
  D) Neutrophil level
  Ans: C
  Feedback:
  Thiazide diuretics must be used cautiously in patients allergic to sulfonamide drugs because there is a known cross-sensitivity of some sulfonamide-allergic patients to sulfonamide nonantibiotic. It is not imperative to assess pulse, hemoglobin, or neutrophil levels.

 

 

2. A patient has edema of the lower extremities and abdomen. What is the reason for administering a stronger diuretic than a thiazide diuretic to this patient?
  A) A thiazide diuretic will reabsorb potassium in the distal tubule.
  B) A thiazide diuretic will be ineffective for immediate diuresis.
  C) A thiazide diuretic will provide peak effects in 2 hours.
  D) A thiazide diuretic will be excreted in more than 72 hours.
  Ans: B
  Feedback:
  Thiazide diuretics are ineffective when immediate diuresis is required. A thiazide diuretic acts to reabsorb sodium, not potassium, in the distal convoluted tubule. A thiazide diuretic reaches its peak in 4 to 6 hours. A thiazide diuretic is excreted in 72 hours maximum.

 

 

3. A patient is admitted to the hospital with a diagnosis of heart failure. The patient is ordered to receive furosemide (Lasix) 40 mg IV. How soon after administration should the nurse expect to see evidence of diuretic effects?
  A) 1 minute
  B) 5 minutes
  C) 30 minutes
  D) 2 hours
  Ans: B
  Feedback:
  After IV administration, diuretic effects occur within 5 minutes. The diuretic effect is not seen in 1 minute. The peak of the action occurs in 30 minutes, not the onset of action. The duration of action is 2 hours, not the onset of action.

 

 

4. A patient is administered furosemide (Lasix) 20 mg PO every morning. What effect will a diet high in sodium have on the patient?
  A) Decreased blood pressure
  B) Decreased diuresis
  C) Hyperkalemia
  D) Hyperglycemia
  Ans: B
  Feedback:
  A high dietary intake of sodium can cause sodium retention and reduce or cancel the diuretic-induced sodium loss. A high dietary intake of sodium will not increase diuresis. A high dietary intake of sodium will not cause hyperkalemia. A high dietary intake of sodium will not cause hyperglycemia.

 

 

5. A patient is switched from furosemide (Lasix) to spironolactone (Aldactone). The patient asks the nurse why she has been switched to a new medicine. What is the nurses best response?
  A) You will lose less potassium with spironolactone than with furosemide.
  B) You will have greater potassium losses with spironolactone than with furosemide.
  C) You will have greater water losses with spironolactone than with furosemide.
  D) You will have greater sodium losses with spironolactone than with furosemide.
  Ans: A
  Feedback:
  Spironolactone promotes retention of sodium and water and excretion of potassium by stimulating the sodiumpotassium exchange mechanism in the distal tubule. The patient will not have greater potassium losses, water losses, or sodium losses with spironolactone rather than furosemide.

 

 

6. A patient is taking spironolactone (Aldactone). When providing patient teaching about this medication, what foods should the patient be instructed to avoid?
  A) Fish
  B) Apples
  C) Crackers
  D) Bananas
  Ans: D
  Feedback:
  Bananas are high in potassium and should be avoided with potassium-sparing diuretics. It is acceptable for the patient to eat fish, apples, and crackers.

 

 

7. A patient is admitted to the emergency department and is unconscious as a result of a head injury. The patients intracranial pressure is increased. What type of diuretic will the nurse most likely administer to the patient?
  A) Loop diuretic
  B) Potassium-sparing diuretic
  C) Thiazide diuretic
  D) Osmotic diuretic
  Ans: D
  Feedback:
  An osmotic diuretic is used to reduce intracranial pressure related to a head injury. Loop diuretics, potassium-sparing diuretics, and thiazide diuretics do not reduce intracranial pressure.

 

 

8. A patient with hypertension has been prescribed a combination diuretic. What is the major purpose in administering a combination diuretic agent?
  A) It prevents sodium imbalance.
  B) It is less expensive than two medications.
  C) It prevents potassium imbalance.
  D) It prevents allergic reactions.
  Ans: C
  Feedback:
  The major purpose of the diuretic combinations is to prevent potassium imbalances. The combination products do not prevent sodium imbalance. The combination products are not less expensive than taking two medications. The combination products do not prevent allergic reactions.

 

 

9. A patient asks the nurse why she has to take two diuretics when her friend only takes one with a combination medication. The patient takes hydrochlorothiazide 75 mg every day with a potassium-sparing diuretic. What is the nurses best response?
  A) Maybe you should speak with your doctor about the combination.
  B) I do not know why your doctor prefers that you take two medications.
  C) It could be that you need a larger dose than is available in the combination medications.
  D) The combination medications are not as effective as two medications.
  Ans: C
  Feedback:
  The fixed-dose combination of hydrochlorothiazide and a potassium-sparing diuretic contains 50 mg of hydrochlorothiazide, and this patient requires 75 mg of hydrochloro

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