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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Free Nursing Study Resources

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

Explanation

A. Pneumococcal vaccine:

The pneumococcal vaccine is recommended for older adults to protect against Streptococcus pneumoniae, a common cause of pneumonia and other invasive diseases. Individuals over 65 years of age are at increased risk for pneumococcal infections, making this vaccine essential for their health.

B. Influenza vaccine:

The influenza vaccine is recommended annually for older adults, as they are at high risk for severe complications from influenza due to age-related immune system decline. Preventing influenza reduces the risk of secondary infections, such as pneumonia.

C. COVID-19 vaccine:

COVID-19 vaccines are strongly recommended for older adults because they are at higher risk for severe illness and complications from COVID-19. Staying up to date with booster doses further reduces the risk of hospitalization and death.

D. HIB vaccine:

The Haemophilus influenzae type b (HIB) vaccine is not routinely recommended for adults unless they have specific medical conditions, such as asplenia or immunodeficiencies. This vaccine is primarily targeted for infants and young children.

E. Rotavirus vaccine:

The rotavirus vaccine is not recommended for adults. It is specifically designed to prevent rotavirus gastroenteritis in infants and young children. There is no clinical indication for its use in the older adult population.

A. Unstable Supraventricular tachycardia B. Unstable Bradycardia C. Ventricular Fibrillation D. Ventricular tachycardia with NO pulse E. Unstable Atrial Flutter

Correct Answer is {"A":{"answers":"C"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"B"},"E":{"answers":"C"}}

Explanation

Dysrhythmias	Transcutaneous Pacing	Defibrillation	Synchronized cardioversion
Unstable Supraventricular tachycardia			✔️
Unstable Bradycardia	✔️
Ventricular Fibrillation		✔️
Ventricular tachycardia with NO pulse		✔️
Unstable Atrial Flutter			✔️

Unstable Supraventricular Tachycardia: Synchronized Cardioversion

Unstable Bradycardia: Transcutaneous Pacing

Ventricular Fibrillation: Defibrillation

Ventricular Tachycardia with No Pulse: Defibrillation

Unstable Atrial Flutter: Synchronized Cardioversion

Rationales:

Unstable Supraventricular Tachycardia – Synchronized Cardioversion:

Synchronized cardioversion delivers a timed electrical shock to the heart during the R wave, avoiding the vulnerable T wave, which minimizes the risk of inducing ventricular fibrillation. This intervention is preferred for unstable SVT unresponsive to medications, as it restores normal sinus rhythm effectively.

Unstable Bradycardia – Transcutaneous Pacing:

Transcutaneous pacing provides electrical impulses to stimulate the heart when intrinsic conduction is insufficient. It is the recommended treatment for symptomatic bradycardia that does not respond to medications, ensuring adequate cardiac output while awaiting more definitive treatment.

Ventricular Fibrillation – Defibrillation:

Defibrillation delivers an unsynchronized shock to depolarize the entire myocardium, allowing the heart to reset and resume an organized rhythm. It is the first-line intervention for ventricular fibrillation, as the chaotic electrical activity makes the heart incapable of pumping blood.

Ventricular Tachycardia with No Pulse – Defibrillation:

Pulseless ventricular tachycardia requires defibrillation, as the rhythm is life-threatening and the absence of a pulse indicates the heart is not effectively pumping. This unsynchronized shock interrupts the abnormal rhythm, allowing normal sinus rhythm to potentially resume.

Unstable Atrial Flutter – Synchronized Cardioversion:

Synchronized cardioversion is used for unstable atrial flutter to restore sinus rhythm by delivering a precisely timed electrical shock. It is effective when pharmacological measures have not worked or are inappropriate, especially in cases of hemodynamic instability.

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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

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

Explanation

Correct Answer is {"A":{"answers":"C"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"B"},"E":{"answers":"C"}}

Explanation

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