A senior nurse is providing instructions to a newly hired nurse about caring for clients who are receiving diuretic therapy to treat heart failure. The senior nurse should explain that which of the following medications puts clients at risk for both hyperkalemia and hyponatremia?
Spironolactone
Furosemide
Hydrochlorothiazide
Metolazone
The Correct Answer is A
A) Spironolactone:
Spironolactone is a potassium-sparing diuretic commonly used in the treatment of heart failure. Unlike other diuretics, spironolactone works by antagonizing aldosterone, a hormone that promotes sodium and water retention and potassium excretion. By blocking aldosterone's action, spironolactone prevents the kidneys from excreting potassium, thus increasing potassium levels in the blood (hyperkalemia). Additionally, spironolactone can lead to hyponatremia (low sodium levels), as it also causes the kidneys to retain sodium and water, diluting sodium levels in the blood.
B) Furosemide:
Furosemide, a loop diuretic, is typically used in heart failure to remove excess fluid. It works by inhibiting the reabsorption of sodium, chloride, and potassium in the loop of Henle, which increases urine output. While furosemide can cause hypokalemia (low potassium levels) due to the increased excretion of potassium, it does not typically cause hyperkalemia.
C) Hydrochlorothiazide:
Hydrochlorothiazide is a thiazide diuretic, which works by inhibiting sodium and chloride reabsorption in the distal convoluted tubule of the kidney, leading to increased urine production. Thiazide diuretics can cause hypokalemia (low potassium levels) and hyponatremia (low sodium levels) due to the enhanced excretion of both electrolytes.
D) Metolazone:
Metolazone is also a thiazide-like diuretic that works similarly to hydrochlorothiazide. It can cause hypokalemia and hyponatremia, but like hydrochlorothiazide, it does not typically cause hyperkalemia. Metolazone is more potent than hydrochlorothiazide but still does not carry the risk of hyperkalemia like spironolactone does.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Prepare for defibrillation: Defibrillation is the priority intervention for ventricular fibrillation, as it is the most effective treatment to terminate this life-threatening arrhythmia. Rapid defibrillation can restore a perfusing rhythm, which is critical for survival in a client who is unresponsive, pulseless, and apneic.
B. Atropine administration: Atropine is used to treat bradycardia or asystole but is not effective for ventricular fibrillation. In this scenario, defibrillation takes precedence over medication administration to restore a normal heart rhythm.
C. Prepare for synchronized cardioversion: Synchronized cardioversion is used for certain tachyarrhythmias when the client has a pulse. Ventricular fibrillation requires immediate unsynchronized defibrillation because the client is pulseless and unresponsive.
D. Amiodarone administration: Amiodarone is an antiarrhythmic drug that can be used after defibrillation and chest compressions to stabilize the heart rhythm. However, it is not the initial action in this emergency; defibrillation must occur first to terminate the arrhythmia and restore circulation.
Correct Answer is A
Explanation
A) Administering oral antibiotics to a client with UTI:
Administering oral antibiotics is an appropriate task to delegate to a licensed practical nurse (LPN). LPNs are trained to administer medications, including oral antibiotics, and to monitor for common side effects or adverse reactions. Since the task is routine and does not require advanced clinical judgment, it can be delegated to the LPN under the nurse’s supervision.
B) Teaching a client with a new order for a renal angiogram:
Teaching a client about a new diagnostic procedure, such as a renal angiogram, requires advanced knowledge and clinical judgment to explain the procedure, its risks, and the necessary pre- and post-procedure care. This task is best performed by a registered nurse (RN) because it involves providing detailed patient education and addressing the patient’s concerns.
C) Evaluate the outflow of peritoneal dialysate:
Evaluating the outflow of peritoneal dialysate is a more complex task that involves assessing the effectiveness of the dialysis process and identifying any potential complications (e.g., infection, leakage). This task requires clinical expertise in dialysis and the ability to interpret changes in the output. Although LPNs may assist in monitoring the process, it is ultimately the RN’s responsibility to evaluate the outcome, interpret any changes, and intervene if necessary.
D) Assess a client with flank pain due to glomerulonephritis:
Assessment of a client with flank pain related to glomerulonephritis requires a thorough evaluation of the client's condition, including understanding the potential causes of pain and monitoring for complications such as renal failure or infection. This type of assessment requires critical thinking and clinical judgment, making it the responsibility of the RN.
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