Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a client who has heart failure.
The nurse administered furosemide 60 mg IV bolus 30 min earlier. For which of the following findings should the nurse notify the provider?
A. BUN 15 mg/dL.
Choice A is wrong because BUN (blood urea nitrogen) is a measure of kidney function and a normal range is 7 to 20 mg/dL. A BUN of 15 mg/dL is not a cause for concern and does not indicate any adverse effect of furosemide.
B. The client reports difficulty hearing.
Furosemide is a diuretic that is used to treat heart failure by reducing fluid retention and lowering blood pressure. It can cause some side effects, such as increased urination, thirst, dry mouth, headache, dizziness, nausea, and electrolyte imbalance.
C. Potassium 3.8 mEq/L.
Choice C is wrong because potassium is an electrolyte that is important for nerve and muscle function and a normal range is 3.5 to 5.0 mEq/L. Potassium of 3.8 mEq/L is within the normal range and does not indicate any adverse effect of furosemide. However, furosemide can cause low potassium levels (hypokalemia) in some cases, so the nurse should monitor the client’s potassium levels regularly and advise the client to eat foods rich in potassium, such as bananas, oranges, and potatoes.
D. The client reports dizziness upon standing.
Choice D is wrong because dizziness upon standing is a common side effect of furosemide and does not require immediate notification from the provider. However, the nurse should instruct the client to rise slowly from a sitting or lying position to prevent falls and to drink enough fluids to prevent dehydration.
This question is an excerpt from Nurse Dive's nursing test bank - ATI RN Pharmacology 2019 Proctored Exam. Take the full exam now
Full Explanation
Furosemide is a diuretic that is used to treat heart failure by reducing fluid retention and lowering blood pressure. It can cause some side effects, such as increased urination, thirst, dry mouth, headache, dizziness, nausea, and electrolyte imbalance.
Choice A is wrong because BUN (blood urea nitrogen) is a measure of kidney function and a normal range is 7 to 20 mg/dL.
A BUN of 15 mg/dL is not a cause for concern and does not indicate any adverse effect of furosemide.
Choice C is wrong because potassium is an electrolyte that is important for nerve and muscle function and a normal range is 3.5 to 5.0 mEq/L.
Potassium of 3.8 mEq/L is within the normal range and does not indicate any adverse effect of furosemide. However, furosemide can cause low potassium levels (hypokalemia) in some cases, so the nurse should monitor the client’s potassium levels regularly and advise the client to eat foods rich in potassium, such as bananas, oranges, and potatoes.
Choice D is wrong because dizziness upon standing is a common side effect of furosemide and does not require immediate notification of the provider. However, the nurse should instruct the client to rise slowly from a sitting or lying position to prevent falls and to drink enough fluids to prevent dehydration.
Choice B is correct because difficulty hearing or hearing loss is a rare but serious side effect of furosemide that may indicate ototoxicity (damage to the inner ear). This can be irreversible if not treated promptly and may affect the client’s quality of life and safety. The nurse should notify the provider immediately if the client reports difficulty hearing or any other signs of ototoxicity, such as ringing in the ears (tinnitus) or vertigo (a sensation of spinning). The provider may need to adjust the dose of furosemide or switch to another diuretic that is less ototoxic.
Similar Questions
A nurse is providing teaching to a client who has a new prescription for clozapine. Which of the following statements should the nurse include in the teaching?
A. You might experience weight loss while taking this medication.
Choice A is wrong because clozapine can cause weight gain, not weight loss, in some people. This can increase the risk of diabetes, high cholesterol, and heart problems. The nurse should advise the client to monitor their weight regularly and to follow a healthy diet and exercise plan.
B. Ringing in the ears is an expected adverse effect of this medication.
Choice B is wrong because ringing in the ears (tinnitus) is not an expected adverse effect of clozapine. However, clozapine can cause other ear problems, such as otitis media (middle ear infection) or otitis externa (outer ear infection). The nurse should instruct the client to report any ear pain, discharge, or hearing loss to their provider.
C. Notify your provider if you develop a fever while taking this medication.
Clozapine is an antipsychotic medication that is used to treat schizophrenia and other psychotic disorders. It works by affecting the balance of certain chemicals in the brain.
D. Diarrhea is a common adverse effect of this medication.
Choice D is wrong because diarrhoea is not a common adverse effect of clozapine. However, clozapine can cause constipation, which can be severe and lead to bowel obstruction or perforation. The nurse should advise the client to drink plenty of fluids, eat high-fibre foods, and use laxatives as prescribed by their provider.
Full Explanation
Clozapine is an antipsychotic medication that is used to treat schizophrenia and other psychotic disorders. It works by affecting the balance of certain chemicals in the brain.
Choice A is wrong because clozapine can cause weight gain, not weight loss, in some people. This can increase the risk of diabetes, high cholesterol, and heart problems. The nurse should advise the client to monitor their weight regularly and to follow a healthy diet and exercise plan.
Choice B is wrong because ringing in the ears (tinnitus) is not an expected adverse effect of clozapine. However, clozapine can cause other ear problems, such as otitis media (middle ear infection) or otitis externa (outer ear infection). The nurse should instruct the client to report any ear pain, discharge, or hearing loss to their provider.
Choice D is wrong because diarrhoea is not a common adverse effect of clozapine. However, clozapine can cause constipation, which can be severe and lead to bowel obstruction or perforation. The nurse should advise the client to drink plenty of fluids, eat high-fibre foods, and use laxatives as prescribed by their provider.
Choice C is correct because fever is a serious adverse effect of clozapine that may indicate a life-threatening condition called
agranulocytosis. Agranulocytosis is a severe reduction in white blood cells that can impair the immune system and increase the risk of infections. The nurse should instruct the client to notify their provider immediately if they develop a fever or any signs of infection, such as sore throat, cough, or flu-like symptoms. The client should also have regular blood tests to monitor their white blood cell count while taking clozapine.
A nurse is reviewing the list of current medications for a client who is to start a new prescription for carbamazepine.
The nurse should identify which of the following medications interacts with carbamazepine?
A. Beclomethasone.
Choice A is wrong because beclomethasone is a corticosteroid that is used to treat asthma and allergic rhinitis. It does not interact with carbamazepine.
B. Estrogen-progestin combination.
Carbamazepine is an anticonvulsant medication that is used to treat seizures and nerve pain. It works by reducing the activity of certain nerve cells in the brain.
C. Diphenhydramine.
Choice C is wrong because diphenhydramine is an antihistamine that is used to treat allergies, motion sickness, and insomnia. It does not interact with carbamazepine.
D. Nicotine transdermal system.
Choice D is wrong because nicotine transdermal system is a nicotine replacement therapy that is used to help people quit smoking. It does not interact with carbamazepine.
Full Explanation
Carbamazepine is an anticonvulsant medication that is used to treat seizures and nerve pain. It works by reducing the activity of certain nerve cells in the brain.
Choice A is wrong because beclomethasone is a corticosteroid that is used to treat asthma and allergic rhinitis. It does not interact with carbamazepine.
Choice B is correct because the estrogen-progestin combination is a hormonal contraceptive that is used to prevent pregnancy and regulate menstrual cycles. It interacts with carbamazepine because carbamazepine can increase the breakdown of estrogen and progestin in the body, making them less effective. The nurse should instruct the client to use an alternative or additional method of birth control while taking carbamazepine.
Choice C is wrong because diphenhydramine is an antihistamine that is used to treat allergies, motion sickness, and insomnia. It does not interact with carbamazepine.
Choice D is wrong because the nicotine transdermal system is a nicotine replacement therapy that is used to help people quit smoking. It does not interact with carbamazepine.
A nurse is caring for a client who is taking triamterene.
For which of the following laboratory values should the nurse withhold the medication?
A. Sodium 142 mEq/L.
This is a normal level of sodium in the blood (the normal range is 135 to 145 mEq/L) and does not require withholding triamterene. Triamterene can cause hyponatremia (low sodium) by increasing the excretion of sodium in the urine. The nurse should monitor the sodium level during triamterene therapy and report any signs of low sodium such as confusion, weakness, or seizures.
B. BUN 16 mg/dL.
This is a normal level of blood urea nitrogen (BUN) in the blood (normal range is 7 to 20 mg/dL) and does not require withholding triamterene. BUN is a measure of kidney function and can be elevated in kidney disease or dehydration. Triamterene can cause an increase in BUN by reducing the blood flow to the kidneys or by interacting with other medications that affect the kidneys. The nurse should monitor the BUN level during triamterene therapy and report any signs of kidney impairment such as decreased urine output, swelling, or nausea.
C. Potassium 5.3 mEq/L.
This is a high level of potassium in the blood (the normal range is 3.5 to 5 mEq/L) and can be dangerous for the heart. Triamterene is a potassium-sparing diuretic that prevents the body from losing too much potassium in the urine. It can cause hyperkalemia (high potassium), especially in people with kidney disease, diabetes, or severe illness. The nurse should check the potassium level before giving triamterene and hold the medication if it is above 5 mEq/L.
D. Albumin 4 g/dL.
This is a normal level of albumin in the blood (the normal range is 3.4 to 5.4 g/dL) and does not require withholding triamterene. Albumin is a protein that helps maintain fluid balance and transport substances in the blood. Triamterene does not affect albumin levels directly, but it can cause fluid loss or retention that may alter albumin levels indirectly. The nurse should monitor the albumin level during triamterene therapy and report any signs of fluid imbalance such as weight changes, edema, or shortness of breath.
Full Explanation
This is a high level of potassium in the blood (the normal range is 3.5 to 5 mEq/L) and can be dangerous for the heart.
Triamterene is a potassium-sparing diuretic that prevents the body from losing too much potassium in the urine. It can cause hyperkalemia (high potassium), especially in people with kidney disease, diabetes, or severe illness. The nurse should check the potassium level before giving triamterene and hold the medication if it is above 5 mEq/L.
The other choices are incorrect because:
Choice A: Sodium 142 mEq/L.
This is a normal level of sodium in the blood (the normal range is 135 to 145 mEq/L) and does not require withholding triamterene. Triamterene can cause hyponatremia (low sodium) by increasing the excretion of sodium in the urine. The nurse should monitor the sodium level during triamterene therapy and report any signs of low sodium such as confusion, weakness, or seizures.
Choice B: BUN 16 mg/dL.
This is a normal level of blood urea nitrogen (BUN) in the blood (normal range is 7 to 20 mg/dL) and does not require withholding
triamterene. BUN is a measure of kidney function and can be elevated in kidney disease or dehydration. Triamterene can cause an increase in BUN by reducing the blood flow to the kidneys or by interacting with other medications that affect the kidneys. The nurse should monitor the BUN level during triamterene therapy and report any signs of kidney impairment such as decreased urine output, swelling, or nausea. •
Choice D: Albumin 4 g/dL.
This is a normal level of albumin in the blood (the normal range is 3.4 to 5.4 g/dL) and does not require withholding triamterene. Albumin is a protein that helps maintain fluid balance and transport substances in the blood. Triamterene does not affect albumin levels directly, but it can cause fluid loss or retention that may alter albumin levels indirectly. The nurse should monitor the albumin level during triamterene therapy and report any signs of fluid imbalance such as weight changes, edema, or shortness of breath.