A client is taking furosemide for the management of early chronic kidney disease (CKD). To assess the therapeutic effect of the medication, what action of the nurse is best?

Palpate the client’s abdomen.

Assess the client's diet history.

Auscultate heart and breath sounds.

Obtain daily weights of the client.

Answer and Explanation

The Correct Answer is D

Furosemide is a potent loop diuretic that inhibits the sodium-potassium-chloride symporter in the thick ascending limb of the loop of Henle. By preventing the reabsorption of these electrolytes, it promotes osmotic diuresis, effectively reducing intravascular volume and systemic edema. In chronic kidney disease, monitoring the balance between fluid intake and excretion is vital to prevent circulatory overload and worsening renal tension.

Rationale:

A. Palpating the abdomen is not an effective method for assessing the therapeutic response to a diuretic. While the nurse might check for ascites in advanced liver or renal failure, abdominal palpation does not provide quantifiable data regarding fluid loss. Daily weights and intake/output measurements provide the objective evidence needed to evaluate the success of pharmacological volume reduction.

B. Assessing diet history is important for managing sodium and fluid intake in renal patients, but it does not measure the actual effectiveness of furosemide. While a high-sodium diet can counteract the drug's effects, the diet history is a record of input rather than a measure of the drug's output and therapeutic impact on the patient's current fluid status.

C. Auscultating heart and breath sounds is a necessary assessment to detect complications of fluid volume excess, such as pulmonary edema or S3 gallops. However, while these findings provide a "snapshot" of current status, they are less sensitive for daily titration compared to weight. Improvements in lung sounds are secondary to the primary goal of actual fluid mass reduction.

D. Obtaining daily weights is the most accurate and "best" action to assess the therapeutic effect of furosemide. Since 1 liter of fluid equals 1 kilogram of body mass, weight changes are the most sensitive indicator of fluid volume fluctuations. This provides the nurse and provider with objective, daily data to ensure the medication is successfully mobilizing excess extracellular fluid.

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Correct Answer is C

Explanation

Exogenous corticosteroidslike prednisone provide negative feedback to the hypothalamic-pituitary-adrenal (HPA) axis. Long-term use leads to the atrophy of the adrenal cortex and the suppression of endogenous cortisolproduction. A gradual taper is mandatory to allow the adrenal glands to resume natural function and prevent a life-threatening adrenal crisis.

Rationale:

A.While prednisone does suppress the immune system, the purpose of a taper is not to prevent "allergic reactions" from the immune system starting too quickly. The immune system's recovery is generally desired. The primary physiological danger of stopping prednisone abruptly is metabolic and endocrine collapse rather than an overactive allergic response or immediate hypersensitivity.

B.While a recurrence of the underlying disease is possible, this is not the most critical physiological reason for a medical taper. The taper is specifically designed to manage the endocrine response of the HPA axis. Focusing on disease recurrence misses the urgent safety education regarding the risk of secondary adrenal insufficiency and cardiovascular collapse.

C.This statement correctly explains that long-term prednisone use causes adrenal suppression. When exogenous steroids are supplied, the adrenal glands stop producing endogenous cortisol. A slow taper is essential because it provides time for the adrenal cortex to regain its secretory capacity, ensuring the body can produce enough cortisol to maintain blood pressure and glucose levels.

D.Corticosteroids are hormones, but they are not always required for the rest of a patient's life. Unlike primary Addison's disease, the adrenal suppression caused by prednisone therapy is often reversible if managed with a proper taper. The goal of the taper is to successfully transition the patient back to endogenous hormone production, not lifelong dependence.

A. Monitor the client's intake and output. B. Check the client's temperature C. Evaluate the client's skin integrity. D. Ensure the client increases intake to make up for nutrients lost. E. Ambulate the client a minimum of two times a day.

Correct Answer is ["A","B","C"]

Explanation

An acute exacerbation of Crohn's diseaseinvolves intensified transmural inflammation, leading to ulceration and bleeding. The presence of blood and mucus in the stool indicates active mucosal injury. Nursing priorities center on assessing for systemic complications such as dehydration, sepsis, and localized tissue breakdown, as these patients are at high risk for electrolyte imbalancesand infection during a flare.

Rationale:

A.Monitoring intake and output is a priority because the client is experiencing diarrhea. Frequent liquid stools can lead to rapid dehydration and significant electrolyte depletion. Accurately tracking fluid balance is essential for determining the need for intravenous fluid replacement and for monitoring the patient's overall hemodynamic and renal status during the exacerbation.

B.Checking the client's temperature is a priority to screen for sepsisor abscess formation. Crohn's disease can lead to intestinal perforations or fistulas that introduce bacteria into the peritoneum or bloodstream. An elevated temperature often indicates an acute infection that requires immediate medical intervention with antibiotics and further diagnostic imaging.

C.Evaluating skin integrity is a priority because frequent diarrhea and the presence of blood or mucus are highly irritating to the perianal skin. The moisture and enzymes in the stool can cause rapid skin breakdown and excoriation. Early intervention with barrier creams and meticulous hygiene is necessary to prevent painful ulcers and secondary localized infections.

D.Encouraging the client to increase intake during an acute flare may be counterproductive. Often, the bowel needs to be placed at rest (NPO status)to reduce inflammation and decrease the frequency of painful bowel movements. Nutritional needs are important, but during an acute phase, aggressive oral feeding can worsen abdominal pain and diarrhea.

E.Ambulating the client is not a priority during an acute inflammatory flare. While general mobility is good for preventing venous stasis, a patient with severe diarrhea and abdominal pain needs rest to conserve energy and reduce intestinal motility. The focus must be on physical stabilization and symptom management rather than forced physical activity.

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A client is taking furosemide for the management of early chronic kidney disease (CKD). To assess the therapeutic effect of the medication, what action of the nurse is best?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is providing education for a client who is now on a prednisone taper after long-term treatment of systemic vasculitis. What statement will the nurse include in the teaching?

Correct Answer is C

Explanation

A client with a history of Crohn's disease presents to the outpatient clinic complaining of abdominal pain and diarrhea. The client reports passing stools with blood and mucus. Which interventions should the nurse prioritize? Select all that apply

Correct Answer is ["A","B","C"]

Explanation

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