Nokea
A nurse is assessing a client after administering a diuretic. Which of the following would lead the nurse to suspect that the client is experiencing a fluid and electrolyte imbalance? Select all that apply.
- A. Dry mouth
- B. Diaphoresis
- C. Muscle cramps
- D. Hypertension
- E. Tachycardia
Correct Answer: A,C,E
Rationale: Warning signs of a fluid and electrolyte imbalance include dry mouth, thirst, lethargy, weakness, drowsiness, restlessness, muscle pain or cramps, confusion, GI disturbances, hypotension, oliguria, tachycardia, and seizures.
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A nurse is administering acetazolamide to a client. The nurse understands that this drug leads to excretion of which of the following? Select all that apply.
- A. Sodium
- B. Magnesium
- C. Potassium
- D. Bicarbonate
- E. Chloride
Correct Answer: A,C,D
Rationale: Carbonic anhydrase inhibitors, like acetazolamide, result in the excretion of sodium, potassium, bicarbonate, and water.
A client is prescribed amiloride. The nurse would administer this drug cautiously if the client had a history of which of the following? Select all that apply.
- A. Gout
- B. Asthma
- C. Diabetes
- D. HIV
- E. Hepatic disease
Correct Answer: A,C,E
Rationale: Potassium-sparing diuretics, like amiloride, should be used cautiously in clients with gout, diabetes, and hepatic disease.
A client who is receiving diuretic therapy comes to the clinic for a follow-up visit. The client states that his mouth is often dry and that he is 'urinating like there is no tomorrow.' Assessment reveals dry mucous membranes and decreased skin turgor. Which nursing diagnosis would the nurse most likely identify?
- A. Risk for Injury
- B. Risk for Deficient Fluid Volume
- C. Impaired Urinary Elimination
- D. Deficient Knowledge
Correct Answer: B
Rationale: Based on the client's report and assessment findings, a nursing diagnosis of Risk for Deficient Fluid Volume would be most appropriate.
A nurse suspects that a client who is receiving acetazolamide is developing hyponatremia based on assessment of which of the following? Select all that apply.
- A. Bradycardia
- B. Anorexia
- C. Hypotension
- D. Hypoglycemia
- E. Decreased skin turgor
Correct Answer: C,E
Rationale: The following are signs of hyponatremia: cold, clammy skin; decreased skin turgor; confusion; hypotension; irritability; and tachycardia.
A client is prescribed a diuretic that is to be taken twice a day. When instructing the client about the schedule for administration, the nurse would suggest that the client take the drug at which times?
- A. In the early morning and at bedtime
- B. After lunch and dinner
- C. At breakfast and midafternoon
- D. Midmorning and before dinner
Correct Answer: C
Rationale: Twice-a-day dosing should be administered early in the morning (e.g., 7 a.m.) and early afternoon (e.g., 2 p.m.) to prevent the drug from interfering with the client's sleep.