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 C

Explanation

A) Go to the emergency department:
An immediate trip to the emergency department is generally not required for a peak expiratory flow rate (PEFR) of 82%. The PEFR of 82% indicates that the client’s airflow is reduced, but it is not necessarily an emergency. PEFR readings are typically classified into zones: green (80-100% of personal best), yellow (50-79% of personal best), and red (below 50% of personal best). A reading of 82% is in the yellow zone, which suggests that the client is experiencing some degree of airway obstruction or worsening asthma symptoms

B) Continue to use salmeterol and fluticasone as prescribed:
While salmeterol (a long-acting beta agonist) and fluticasone (a corticosteroid) are important for long-term asthma control, continuing their use without additional intervention is not the most appropriate action when the PEFR is 82%. A PEFR of 82% indicates that the client’s asthma is not well controlled at the moment, and the nurse should recommend additional short-acting relief to help open the airways (e.g., a rescue inhaler like albuterol.

C) Administer an additional rescue dose of Albuterol:
The correct immediate action is to administer a rescue dose of albuterol. Albuterol is a short-acting beta-agonist that helps open the airways quickly during an asthma exacerbation. A PEFR of 82% falls in the yellow zone, suggesting some obstruction but not an emergency situation. In this case, administering an additional rescue dose of albuterol can help improve airflow and bring the PEFR closer to normal.

D) Call the physician:
While it may be necessary to call the physician if the client’s asthma symptoms do not improve after using a rescue inhaler or if there is a significant decline in symptoms, the first immediate action should be to use a rescue medication like albuterol. Calling the physician may be appropriate after assessing the response to the rescue medication, but it is not the first step in managing a PEFR of 82%.

A. The time between ventricular depolarization and repolarization (diastole) B. Time taken for impulse to spread to the point immediately preceding ventricular contraction C. Time taken for depolarization (contraction) of both ventricles (systole) D. Passage of electrical impulse through the atrium causing atrial depolarization

Correct Answer is D

Explanation

A) The time between ventricular depolarization and repolarization (diastole):
This refers to the period between ventricular depolarization and repolarization, which is associated with the QT interval on the EKG, not the P wave. The P wave specifically relates to atrial depolarization, not the ventricular activity. Diastole refers to the relaxation phase of the heart cycle, and it’s not directly linked to the P wave, which represents atrial contraction.

B) Time taken for impulse to spread to the point immediately preceding ventricular contraction:

The P wave represents the depolarization (or contraction) of the atria, not the time taken for the impulse to spread to the ventricles. The time taken for the impulse to spread through the atria, across the AV node, and down to the ventricles is better represented by the PR interval, not the P wave itself.

C) Time taken for depolarization (contraction) of both ventricles (systole):
This describes the QRS complex, which represents the depolarization (contraction) of the ventricles during systole, not the P wave. The QRS complex shows the electrical activity of the ventricles as they contract, while the P wave relates to atrial depolarization, which occurs before ventricular contraction.

D) Passage of electrical impulse through the atrium causing atrial depolarization:
The P wave represents the passage of the electrical impulse through the atria, leading to atrial depolarization. Depolarization of the atria results in the contraction of the atria, pushing blood into the ventricles. The P wave is the first part of the cardiac cycle on the EKG and reflects the electrical activity that causes atrial contraction.

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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

Naxlex Comprehensive Predictor Exams

A nurse instructs a 60-year-old client diagnosed with asthma about using a peak expiratory flow meter. Which immediate action should the nurse recommend to the client that obtains a reading of 82% on their peak flow meter?

Correct Answer is C

Explanation

The patient asks the nurse what the P Wave indicates on an EKG strip. The nurse informs the patient that the P Wave represents:

Correct Answer is D

Explanation

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