Which information would a nurse provide a patient who is receiving spironolactone and furosemide

The nurse reviews the laboratory values of a patient receiving furosemide [Lasix]. Which lab result indicates to the nurse that an adverse effect is occurring?

A. Decreased glucose
B. Decreased uric acid
C. Decreased phosphate
D. Decreased magnesium

D

Furosemide [Lasix] increases urinary excretion of magnesium, posing a risk of magnesium deficiency. Hyperglycemia (increased glucose) and hyperuricemia (increased uric acid) are adverse effects. Furosemide [Lasix] does not affect phosphate.

The nurse is teaching a patient who has been prescribed hydrochlorothiazide [Microzide]. Which statement from the patient indicates a correct understanding of the teaching?

A. "I will limit my intake of oats."
B. "I will not eat melons or grapes."
C. "I will take iron supplements every day."
D. "I will take the dose only in the morning."

D

To minimize nocturia, hydrochlorothiazide [Microzide] should not be taken late in the day. Taking the dose only in the morning indicates teaching was successful. Diuretics are to be taken in the morning because they cause urination at night (nocturia) and subsequent loss of sleep when taken late in the afternoon or night. Limiting oats is not necessary for a diuretic. Instructing the patient to not eat melons or grapes is not appropriate for diuretic teaching. Hydrochlorothiazide does not cause anemia; therefore, an iron supplement is not needed.

The nurse observes that a patient's vision is not improving after treatment. Which drug would the nurse anticipate to be prescribed for the patient for reducing intraocular pressure?

A. Mannitol [Osmitrol]

B. Furosemide [Lasix]

C. Amiloride [Midamor]

D. Spironolactone [Aldactone]

A

Mannitol [Osmitrol] can be used to reduce intraocular pressure in patients who are unresponsive to other drug therapies. Furosemide [Lasix] (loop diuretic), amiloride [Midamor] (potassium-sparing diuretic), and spironolactone [Aldactone] (potassium-sparing diuretic) are not used for reducing intraocular pressure.

The nurse is reviewing the home medication list with the patient. The nurse should recognize that hydrochlorothiazide is used primarily for which condition?

A. Edema

B. Hypertension

C. Diabetes insipidus

D. Protection against postmenopausal osteoporosis

B

The primary indication for hydrochlorothiazide is hypertension, a condition for which thiazides are often the drugs of first choice. Hydrochlorothiazides are also used for edema, diabetes insipidus, and protection against postmenopausal osteoporosis, but the primary indication is hypertension.

A patient taking spironolactone [Aldactone] has been taught about the medication. Which menu selection indicates the patient understands teaching related to this medication?

A. Nuts

B. Spinach

C. Chicken

D. Potatoes

C

Spironolactone [Aldactone] is a potassium-sparing diuretic that could potentially cause hyperkalemia. Of the foods listed, chicken is lowest in potassium. Nuts, potatoes, dried fruits, spinach, citrus fruits, and bananas are all known to contain high levels of potassium.

The nurse is working in the emergency department when a patient with a head injury develops increased intracranial pressure. Which drug would the nurse anticipate administering?

A. Mannitol [Osmitrol]

B. Metolazone [Zaroxolyn]

C. Spironolactone [Aldactone]

D. Hydrochlorothiazide [Microzide]

A

Intracranial pressure (ICP) that has been elevated by cerebral edema can be reduced with mannitol [Osmitrol]. The drug lowers ICP because its presence in the blood vessels of the brain creates an osmotic force that draws edematous fluid from the brain into the blood. Metolazone [Zaroxolyn] and hydrochlorothiazide [Microzide] are thiazide-like diuretics; spironolactone [Aldactone] is a potassium-sparing diuretic; they are of little benefit in reducing cerebral edema.

A postmenopausal woman is receiving a diuretic. Which diuretic will the nurse most likely be administering?

A. Furosemide [Lasix]

B. Bumetanide [Bumex]

C. Ethacrynic acid [Edecrin]

D. Hydrochlorothiazide [Microzide]

D

Thiazides promote tubular reabsorption of calcium and may thereby decrease the risk of osteoporosis in postmenopausal women. Since thiazides promote renal calcium retention, they may counteract the calcium loss associated with menopause and may thereby help preserve bone integrity. Loop diuretics (furosemide [Lasix], bumetanide [Bumex], and ethacrynic acid [Edecrin]) are not as effective for this.

What is the best information for the nurse to provide to a patient who is receiving spironolactone and furosemide therapy?

A. "This combination prevents dehydration and loss of fluid volume."

B. "This combination promotes urine output but decreases the risk of low potassium."

C. "Using two drugs increases the osmolality of plasma and the glomerular filtration rate."

D. "Moderate doses of two different diuretics are more effective than a large dose of one."

B

Spironolactone [Aldactone] is a potassium-sparing diuretic; furosemide [Lasix] causes potassium loss. Giving these together minimizes electrolyte imbalance. It is not accurate to state that the drug combination prevents dehydration and loss of fluid volume or that it increases the osmolality of plasma and the glomerular filtration rate. Stating that giving two different diuretics is more effective than a large dose of one is not accurate.

The nurse is caring for a patient with heart failure who needs a diuretic. Which agent is likely to be chosen, because it has been shown to greatly reduce mortality in patients with heart failure?

A. Mannitol [Osmitrol]

B. Furosemide [Lasix]

C. Spironolactone [Aldactone]

D. Hydrochlorothiazide [HydroDIURIL]

C

Spironolactone [Aldactone] is a potassium-sparing diuretic used to treat both hypertension and edema. It is a preferred drug in mild heart failure, because it has been shown to have a cardioprotective effect, reducing mortality in patients with heart failure.

Which patient receiving mannitol [Osmitrol] should the nurse assess first?

A. A patient with anuria

B. A patient with dehydration

C. A patient with a head injury

D. A patient with diabetes mellitus

A

If urine flow declines to a very low rate (oliguria) or ceases entirely (anuria), the infusion should be stopped. Mannitol [Osmitrol] is safe to use with diabetic patients and those with head injuries, and it may function as a prophylaxis against renal failure in patients with dehydration.

A patient asks the nurse about taking potassium supplements while taking triamterene [Direnium]. What is the nurse's best response?

A. "You will need to discuss this important issue with your physician."

B. "You are correct about potassium. I will make sure that you get some right away."

C. "Your potassium level was normal in this morning's laboratory report, so no supplement is needed."

D. "You are on a diuretic that is potassium-sparing, so there is no need for extra potassium."

D

Triamterene [Direnium] is a potassium-sparing diuretic. It causes sodium and water to be excreted while potassium is retained. Patients undergoing triamterene therapy do not need potassium supplements and thus do need to discuss potassium supplements with the physician. Potassium supplementation is not based upon the patient's laboratory results when the patient is on a potassium-sparing diuretic.

The healthcare provider orders mannitol [Osmitrol] 72 gm infusion over 24 hours. The nurse should plan to set the infusion pump for how many grams per hour?

A. 1 gm

B. 2 gm

C. 3 gm

D. 4 gm

C

To infuse 72 grams over 24 hours, divide 72 by 24 for the total per hour. 72 divided by 24 equals 3 grams per hour.

What should the nurse assess within an hour after administering a diuretic? Select all that apply.

A. Weight

B. Heart rate

C. Urinary output

D. Blood pressure

E. Neurologic status

C, D

The nurse should assess urinary output and blood pressure within an hour after administering a diuretic. Neurologic status should not change. Weight is not the best way to monitor a diuretic given for hypertension. Heart rate is not a measure of diuretic effectiveness.

A patient has been prescribed hydrochlorothiazide [Microzide]. After reviewing the patient's laboratory report, the nurse informs the provider that the patient has hypokalemia. Which drug would the nurse expect to be included in the patient's prescription?

A. Mannitol [Osmitrol]

B. Furosemide [Lasix]

C. Amiloride [Midamor]

D. Torsemide [Demadex

C

Although it can be employed alone as a diuretic, amiloride [Midamor] is used primarily to counteract potassium loss caused by more powerful diuretics (thiazides, loop diuretics). Furosemide [Lasix] and torsemide [Demadex] are loop diuretics and would make the hypokalemia worse. Mannitol [Osmitrol] is an osmotic diuretic that does not have an effect on potassium levels. Therefore, these medications will not be included in the patient's prescription.

What should the nurse teach patients taking rifampin and isoniazid prophylactically secondary to tuberculosis exposure?

A. "These drugs only need to be taken for 7 to 10 days."

B. "Isoniazid may decrease serum glucose in susceptible people."

C. "Oral contraceptives become ineffective when given with rifampin."

D. "Tanning beds may be used to counteract the pale skin tone caused by these medications."

C

Women taking oral contraceptives who are prescribed rifampin must be switched to another form of birth control because oral contraceptives become ineffective when given with rifampin. Rifampin and isoniazid must be taken long-term because the mycobacterium is slow growing. They can cause photosensitivity, necessitating the use of sunscreen, not tanning beds. Finally, isoniazid may increase, not decrease, serum glucose levels.

What should the nurse teach a patient who is taking isoniazid?

A. "You will need to take vitamin C to potentiate the action of isoniazid."

B. "You should not be on that drug. I will check with the healthcare provider."

C. "Multidrug therapy is necessary to prevent the occurrence of resistant bacteria."

D. "Pyridoxine (vitamin B6) will prevent numbness and tingling that can occur when taking isoniazid."

D

Isoniazid can cause neurotoxicity resulting in numbness and tingling of the legs. Pyridoxine (vitamin B6) is the drug of choice to prevent this adverse reaction. It is not an antiinfective agent and thus will work to destroy the mycobacterium or prevent drug resistance. Vitamin C is not taken with this drug. The drug is appropriate for most patients; Isoniazid with pyridoxine is not multidrug therapy.

The nurse has administered ethambutol [Myambutol] to a patient for the treatment of tuberculosis. Which side effect associated with ethambutol [Myambutol] use should the nurse observe for in the patient?

A. Neutropenia

B. Optic neuritis

C. Hyperuricemia

D. Hyperglycemia

B

Ethambutol [Myambutol] is a first-line bacteriostatic drug used in the treatment of tuberculosis. It is associated with side effects such as optic neuritis, a condition in which inflammation of the optic nerve occurs. It may cause a complete or partial loss of vision. Neutropenia, hyperglycemia, and hyperuricemia are not side effects of ethambutol [Myambutol]. Neutropenia is a side effect of rifabutin [Mycobutin]. Hyperglycemia is a side effect of isoniazid. Hyperuricemia is a side effect of pyrazinamide.

The nurse anticipates an order for vitamin supplementation for a patient who is receiving isoniazid therapy. What vitamin supplement is usually used with isoniazid?

A. Folate

B. Calcium

C. Vitamin E

D. Vitamin B6

D

The neurologic side effects occur secondary to vitamin B6 deficiency caused by isoniazid. Pyridoxine (vitamin B6) is typically ordered to assist in prevention of the neurologic side effects of isoniazid by raising levels to normal ranges. Folate, vitamin E, and calcium will not assist in prevention of the neurologic side effects of isoniazid.

The nurse develops a care plan for a patient in the continuation phase of treatment for active tuberculosis (TB). The care plan includes teaching about which medication regimen?

A. Isoniazid and rifampin

B. Rifampin and ethambutol

C. Ethambutol and isoniazid

D. Pyrazinamide and ethambutol

A

If drug resistance is not a factor, treatment for active TB consists of a four-drug induction phase and a two-drug continuation phase. The continuation phase lasts at least 4 months, and therapy consists of two drugs: isoniazid and rifampin. Pyrazinamide and ethambutol, ethambutol and isoniazid, and rifampin and ethambutol are not the preferred regimens for the continuation phase.

The patient who has tuberculosis is treated with isoniazid. The nurse should monitor for which symptoms that could indicate a vitamin B6 deficiency caused by the medication?

A. Dry skin and brittle nails

B. Alopecia and flaking scalp

C. Oral ulcers and tongue fissures

D. Numbness and tingling in the fingers and toes

D

Dose-related peripheral neuropathy is the most common adverse effect of isoniazid. It results from a vitamin B6 deficiency, which is corrected by taking oral supplements. Symptoms include numbness and tingling in the fingers and toes. Alopecia and flaking scalp, oral ulcers and tongue fissures, and dry skin and brittle nails are not adverse effects of isoniazid-induced vitamin B6 deficiency.

The nurse is caring for a patient who has tuberculosis. The patient has been treated with isoniazid and then with rifampin and isoniazid combination therapy with no improvement in symptoms despite adherence to the medication regimen. Which should the nurse suspect?

A. The patient has a severe tuberculosis infection.

B. The patient has multidrug-resistant tuberculosis.

C. The patient has a Mycobacterium bovis infection.

D. The patient has extensively drug-resistant tuberculosis.

B

The patient has multidrug-resistant tuberculosis. Tuberculosis that is resistant to both isoniazid and rifampin combination therapy is called multidrug-resistant tuberculosis. Therefore, neither isoniazid nor rifampin combination therapy show any effect on the patient. Isoniazid and rifampin combination therapy is useful in treating severe tuberculosis infection. Isoniazid and rifampin combination therapy consists of drugs that are also useful in treating Mycobacterium bovis infection. Extensively drug-resistant tuberculosis is resistant to almost all drugs used to treat tuberculosis. The patient does not have extensively drug-resistant tuberculosis; the patient has resistance to isoniazid and rifampin combination therapy, not all drugs.

Which information should the nurse provide to a patient receiving rifampin?

A. "Oral contraception is the preferred method of birth control when using rifampin."

B. "The patient will only need to take this medication for the prescribed 14-day period."

C. "A nonharmful side effect of the drug is red-orange discoloration of urine, sweat, and tears."

D. "Peripheral neuropathy is an expected side effect, and the patient should report any numbness or tingling of the extremities."

C

Red-orange discoloration of body fluids is a common side effect of rifampin, but it is not harmful. Rifampin does not cause peripheral neuropathies (isoniazid does), but it does interfere with the effectiveness of oral contraceptives. All antitubercular drugs need to be taken long-term in order to eradicate the slow-growing mycobacterium lying deep within the tissues.

Which statement by a patient taking ethambutol [Myambutol] indicates understanding of adverse effects of the drug?

A. "I will get up slowly when sitting to prevent me from getting dizzy."

B. "I'll increase the fiber and liquids in my diet to prevent constipation."

C. "I'll immediately report any red-orange urine to my healthcare provider."

D. "I'll report any problems with blurred vision or being able to determine colors."

D

Ethambutol can cause optic neuritis resulting in disturbance of color discrimination and blurred vision. Symptoms resolve when the medication is discontinued. Orthostatic hypotension, constipation, and discoloration of urine are not known adverse effects of ethambutol.

A primary healthcare provider orders a tuberculin skin test (TST) for a patient with symptoms of tuberculosis. Which action should the nurse take while conducting the TST?

A. Administer an inactivated strain of Mycobacterium bovis.

B. Inject 5 tuberculin units of purified protein derivative (PPD) intradermally.

C. Report the test to be positive because of erythema at the site of administration.

D. Give 0.1 mL of bacilli Calmette-Guérin to the patient by the subcutaneous route.

B

The tuberculin skin test is used to diagnose tuberculosis, using a purified protein derivative (PPD). Five tuberculin units of PPD are injected via the intradermal route to detect the presence of Mycobacterium. Bacilli Calmette- Guérin consists of an inactivated strain of Mycobacterium. It is administered to prevent infection, not for diagnosing tuberculosis. An induration at the site of injection, rather than erythema, would indicate a positive test.

A patient is taking rifampin [Rifadin] for active tuberculosis. Which assessment does the nurse identify as an adverse effect of the drug?

A. Jaundice

B. Moon face

C. Absent deep tendon reflexes

D. Blood glucose level of 60 mg/dL

A

Rifampin is toxic to the liver, which increases the patient's risk of hepatitis. Jaundice is a sign of liver dysfunction and should be monitored. Rifampin has no effect on the blood glucose level or deep tendon reflexes, nor does it cause a moon face.

Which is a first-line antitubercular drug?

A. Isoniazid

B. Amikacin [Amikin]

C. Cycloserine [Seromycin]

D. Capreomycin [Capastat Sulfate]

A

Isoniazid is a first-line and primary antitubercular drug. It is most widely used. It can be administered either as the sole drug in the prophylaxis of tuberculosis or in combination with other antitubercular drugs in the treatment of tuberculosis. Amikacin [Amikin], cycloserine [Seromycin], and capreomycin [Capastat Sulfate] are second-line antitubercular drugs.

A patient is prescribed rifampin [Rifadin] for the treatment of tuberculosis. While checking the patient's history, the nurse finds that the patient is taking oral contraceptive therapy. What should the nurse advise the patient concerning the safe use of rifampin [Rifadin]?

A. "Use other forms of birth control."

B. "Take a lower dose of rifampin [Rifadin]."

C. "Use a double dose of the oral contraceptive."

D. "Take an initial half dose of rifampin [Rifadin]."

A

Rifampin [Rifadin] comes under the class of rifamycin antibiotic. It blocks the activity of oral contraceptives. As a result, contraception failure occurs. Therefore, the nurse should advise the patient to use other forms of birth control. A lower dose or initial half dose of rifampin [Rifadin] do not give the desired therapeutic effect; thus, the nurse should not advise this. Taking a double dose of the oral contraceptive would be ineffective in this situation and may cause adverse effects for the patient.

A primary healthcare provider has prescribed isoniazid and pyridoxine (vitamin B6) for a patient who has tuberculosis. What is the purpose of administering pyridoxine?

A. To prevent peripheral neuropathy

B. To prevent cardiovascular complication

C. To prevent gastrointestinal disturbances

D. To prevent the metabolic rate from raising

A

Isoniazid is most widely used for the treatment of tuberculosis. It may be given either as a single drug for prophylaxis or in combination with other antitubercular drugs for the treatment of active tuberculosis. Isoniazid causes a pyridoxine deficiency in the patient. It also produces isoniazid-induced peripheral neuropathy. Pyridoxine (vitamin B6) is administered to the patient to prevent this nerve damage. Pyridoxine does not increase metabolism or prevent cardiovascular complications or gastrointestinal disturbances. It does not produce an effect on the metabolic system, cardiovascular system, or gastrointestinal system.

Which is the most common site for infection caused by Mycobacterium tuberculosis?

A. Lung

B. Liver

C. Kidney

D. Spleen

A

Infections may be limited to the lungs or may become disseminated. The lungs are infected by inhaling infected sputum that has been aerosolized, usually by coughing or sneezing. Once in the lungs, tubercle bacilli are taken up by phagocytic cells (macrophages and neutrophils). Infection can spread from the lungs to other organs via the lymphatic and circulatory systems.

How does spironolactone and furosemide work together?

What do you monitor when taking furosemide?

Which side effect is associated with furosemide?

Which side effect would the nurse include when teaching a patient who is beginning loop diuretic?