Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
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.
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
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.
Similar Questions
A client who has Graves’ disease is prescribed methimazole.
Which of the following effects should the nurse expect to see after the client has taken the medication for 2 months?
A. Weight loss.
Choice A is wrong because weight loss is a symptom of hyperthyroidism, not a result of methimazole treatment. Methimazole should lower the thyroid hormone levels and help the client gain weight.
B. Increase in pulse rate.
Choice B is wrong because an increase in pulse rate is also a symptom of hyperthyroidism, not a result of methimazole treatment. Methimazole should lower the heart rate and blood pressure by reducing the thyroid hormone levels.
C. Increased sleeping.
Methimazole is an antithyroid medication that blocks the thyroid from making thyroid hormone. It is used to treat hyperthyroidism caused by Graves’ disease, which is an autoimmune disorder that stimulates the thyroid gland to produce excess hormones. After taking methimazole for 2 months, the client should expect to see a reduction in the symptoms of hyperthyroidism, such as weight loss, increased pulse rate, and heat intolerance. Increased sleeping is a sign of improved thyroid function, as hyperthyroidism can cause insomnia and restlessness.
D. Warmer skin.
Choice D is wrong because warmer skin is another symptom of hyperthyroidism, not a result of methimazole treatment. Methimazole should improve the client’s heat tolerance and make the skin cooler and less sweaty.
Full Explanation
Methimazole is an antithyroid medication that blocks the thyroid from making thyroid hormones. It is used to treat hyperthyroidism caused by Graves’ disease, which is an autoimmune disorder that stimulates the thyroid gland to produce excess hormones. After taking methimazole for 2 months, the client should expect to see a reduction in the symptoms of hyperthyroidism, such as weight loss, increased pulse rate, and heat intolerance. Increased sleeping is a sign of improved thyroid function, as hyperthyroidism can cause insomnia and restlessness.
Choice A is wrong because weight loss is a symptom of hyperthyroidism, not a result of methimazole treatment. Methimazole should lower the thyroid hormone levels and help the client gain weight.
Choice B is wrong because an increase in pulse rate is also a symptom of hyperthyroidism, not a result of methimazole treatment. Methimazole should lower the heart rate and blood pressure by reducing thyroid hormone levels.
Choice D is wrong because warmer skin is another symptom of hyperthyroidism, not a result of methimazole treatment. Methimazole should improve the client’s heat tolerance and make the skin cooler and less sweaty.
A nurse is caring for a client who develops an anaphylactic reaction to IV antibiotic administration.
After assessing the client’s respiratory status and stopping the medication infusion, which of the following actions should the nurse take next?
A. Administer epinephrine IM.
Epinephrine (adrenaline) is the first-line treatment for anaphylaxis, a severe and potentially life-threatening allergic reaction. Epinephrine works by reducing the body’s allergic response and improving the breathing and circulation of the client. Epinephrine should be given as soon as possible after the onset of anaphylaxis symptoms, using an auto-injector device if available.
B. Replace the infusion with 0.9% sodium chloride.
Choice B is wrong because replacing the infusion with 0.9% sodium chloride (normal saline) is not enough to treat anaphylaxis. Normal saline can help maintain the blood pressure and hydration of the client, but it does not reverse the allergic reaction or improve the breathing of the client. Normal saline can be given after epinephrine, but not before or instead of it.
C. Give diphenhydramine IM.
Choice C is wrong because giving diphenhydramine IM is not enough to treat anaphylaxis. Diphenhydramine is an antihistamine that can help relieve some of the symptoms of anaphylaxis, such as itching and hives, but it works too slowly and does not address the more serious effects of anaphylaxis on the breathing and circulation of the client. Diphenhydramine can be given after epinephrine, but not before or instead of it.
D. Elevate the clients legs and feet.
Choice D is wrong because elevating the clients legs and feet is not enough to treat anaphylaxis. Elevating the legs and feet can help increase the blood flow to the vital organs, but it does not reverse the allergic reaction or improve the breathing of the client. Elevating the legs and feet can be done after epinephrine, but not before or instead of it.
Full Explanation
Epinephrine (adrenaline) is the first-line treatment for anaphylaxis, a severe and potentially life-threatening allergic reaction. Epinephrine works by reducing the body’s allergic response and improving the breathing and circulation of the client. Epinephrine should be given as soon as possible after the onset of anaphylaxis symptoms, using an auto-injector device if available.
Choice B is wrong because replacing the infusion with 0.9% sodium chloride (normal saline) is not enough to treat anaphylaxis. Normal saline can help maintain the blood pressure and hydration of the client, but it does not reverse the allergic reaction or improve the breathing of the client. Normal saline can be given after epinephrine, but not before or instead of it.
Choice C is wrong because giving diphenhydramine IM is not enough to treat anaphylaxis. Diphenhydramine is an antihistamine that can help relieve some of the symptoms of anaphylaxis, such as itching and hives, but it works too slowly and does not address the more serious effects of anaphylaxis on the breathing and circulation of the client. Diphenhydramine can be given after epinephrine, but not before or instead of it.
Choice D is wrong because elevating the client's legs and feet is not enough to treat anaphylaxis. Elevating the legs and feet can help increase the blood flow to the vital organs, but it does not reverse the allergic reaction or improve the breathing of the client. Elevating the legs and feet can be done after epinephrine, but not before or instead of it.
A nurse is teaching a guardian of a school-age child who has a new prescription for a fluticasone metered-dose inhaler.
Which of the following information should the nurse include in the teaching? (Select all that apply)
A. Rinse your child’s mouth following administration.
Fluticasone is an inhaled steroid that prevents the symptoms of asthma by decreasing inflammation in the airways. It is not used to treat a sudden asthma attack.
B. A spacer will make it easier to use the device.
Fluticasone is an inhaled steroid that prevents the symptoms of asthma by decreasing inflammation in the airways. It is not used to treat a sudden asthma attack.
C. Soak the inhaler in water after use.
Choice C is wrong because soaking the inhaler in water after use can damage the device and affect its performance.
D. Have your child take one inhalation as needed for shortness of breath.
Choice D is wrong because fluticasone is not a rescue inhaler that can be used as needed for shortness of breath.It is a controller inhaler that should be used regularly as prescribed by the doctor.
E. Shake the device prior to administration.
Choice E is wrong because shaking the device prior to administration is not necessary for a fluticasone metered-dose inhaler (MDI). However, it is recommended for fluticasone inhalation powder (Flovent Diskus). Some normal ranges that may be applicable are: The usual dose of fluticasone MDI for adults and children 12 years and older is 55 to 232 mcg twice a day. The usual dose of fluticasone MDI for children 4 to 11 years old is 30 mcg twice a day. The maximum dose of fluticasone MDI for adults and children 12 years and older is 1000 mcg twice a day.
Full Explanation
Fluticasone is an inhaled steroid that prevents the symptoms of asthma by decreasing inflammation in the airways. It is not used to treat a sudden asthma attack.
Some additional information to explain why the other choices are wrong are:
Choice C is wrong because soaking the inhaler in water after use can damage the device and affect its performance.
Choice D is wrong because fluticasone is not a rescue inhaler that can be used as needed for shortness of breath. It is a controller inhaler that should be used regularly as prescribed by the doctor.
Choice E is wrong because shaking the device prior to administration is not necessary for a fluticasone metered-dose inhaler (MDI). However, it is recommended for fluticasone inhalation powder (Flovent Diskus). Some normal ranges that may be applicable are:
The usual dose of fluticasone MDI for adults and children 12 years and older is 55 to 232 mcg twice a day. The usual dose of fluticasone MDI for children 4 to 11 years old is 30 mcg twice a day. The maximum dose of fluticasone MDI for adults and children 12 years and older is 1000 mcg twice a day.
