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

Answer and Explanation

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.

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Correct Answer is A

Explanation

A) Respiratory rate of 8 bpm:
This a sign of respiratory depression, which can occur in patients with chronic obstructive pulmonary disease (COPD) who are receiving high-flow oxygen. In COPD patients, particularly those with chronic hypercapnia (elevated carbon dioxide), the body may become less sensitive to CO2 buildup and more reliant on low oxygen levels to trigger the respiratory drive. If oxygen is administered at high flow rate, it can reduce the stimulus for breathing, leading to hypoventilation or even respiratory arrest.

B) A large barrel chest:
A barrel chest is a common physical finding in patients with chronic COPD due to the hyperinflation of the lungs. This is a result of air trapping, which is a hallmark of COPD. While it indicates the long-term effects of COPD, it does not require immediate intervention. It is a chronic sign and not an acute or urgent concern unless accompanied by other signs of acute respiratory distress.

C) Fine crackles:
Fine crackles (or rales) on auscultation can be indicative of fluid in the lungs and may suggest conditions such as pulmonary edema, heart failure, or pneumonia. While crackles could be concerning, they are not as immediately life-threatening as a respiratory rate of 8 bpm. In a patient with COPD, crackles might indicate worsening of their condition, possibly due to an infection or fluid overload, but the priority would still be to assess the patient's breathing and ventilation status first.

D) The patient assumes the orthopneic position:
The orthopneic position (sitting upright or leaning forward) is a common way for patients with COPD to relieve shortness of breath. It is a compensatory action to help improve lung expansion and facilitate breathing. While it is a sign of respiratory distress, it is not an immediate emergency. Many COPD patients use this position to cope with chronic difficulty breathing.

A. Assess the client's potassium level. B. Check the client's temperature. C. Increase the client's oxygen flow rate to 15 L/min. D. Encourage the client to perform pursed-lip breathing.

Correct Answer is D

Explanation

A) Assess the client's potassium level:
While electrolyte imbalances, including low potassium, can contribute to symptoms like restlessness or muscle weakness, it is not the first priority in a client with COPD who suddenly becomes restless and anxious. Restlessness and anxiety in this context are more likely to be due to hypoxia (low oxygen levels), hypercapnia (high carbon dioxide levels), or respiratory distress.

B) Check the client's temperature:
An elevated temperature may indicate an infection, such as pneumonia or a respiratory tract infection, which can exacerbate COPD symptoms. However, in the context of sudden restlessness and anxiety, this is less likely to be the most immediate cause. The primary concern should be addressing the potential respiratory issues, such as hypoxia or acute exacerbation, rather than focusing on fever, unless other signs of infection are present.

C) Increase the client's oxygen flow rate to 15 L/min:
While it is important to ensure adequate oxygenation in a client with COPD, increasing the oxygen flow rate to 15 L/min may not be appropriate, as COPD patients are typically at risk for oxygen-induced hypercapnia. These patients often rely on low levels of oxygen to stimulate breathing, and administering high-flow oxygen can suppress their respiratory drive, potentially worsening carbon dioxide retention.

D) Encourage the client to perform pursed-lip breathing:
Pursed-lip breathing is a highly effective technique for COPD patients to help increase oxygenation and decrease the work of breathing. This technique involves the client breathing in through the nose and exhaling slowly through pursed lips, which helps to keep the airways open longer and facilitates the removal of trapped air in the lungs.

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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?

Nursing Test Bank

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Correct Answer is A

Explanation

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Correct Answer is D

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