A nurse is caring for a client with a history of kidney injury who is receiving diuretic therapy.
The nurse should recognize that which of the following medications places the client at risk for hyperkalemia?
Hydrochlorothiazide.
Furosemide.
Mannitol.
Spironolactone.
The Correct Answer is D
Choice A rationale
Hydrochlorothiazide is a thiazide diuretic that works by inhibiting sodium and chloride reabsorption in the distal convoluted tubule. This mechanism causes increased excretion of both water and potassium, making the client susceptible to hypokalemia (serum potassium <3.5 mEq/L), not hyperkalemia, thereby requiring regular electrolyte monitoring.
Choice B rationale
Furosemide is a potent loop diuretic that acts on the ascending limb of the loop of Henle, blocking the reabsorption of sodium, chloride, and potassium. Its high efficacy in causing diuresis leads to significant renal loss of potassium, which places the client at a high risk for developing hypokalemia (serum potassium <3.5 mEq/L), not the elevated levels of hyperkalemia.
Choice C rationale
Mannitol is an osmotic diuretic that acts primarily by increasing the osmotic pressure of the glomerular filtrate, which inhibits the reabsorption of water. It is predominantly used for reducing cerebral edema and intraocular pressure; it does not significantly interfere with the renal tubular handling of potassium, so it poses little risk for hyperkalemia.
Choice D rationale
Spironolactone is a potassium-sparing diuretic that functions as an aldosterone receptor antagonist in the distal nephron. By blocking aldosterone's effects, it promotes sodium and water excretion while retaining potassium, which, especially in clients with impaired kidney function, significantly elevates the risk for life-threatening hyperkalemia (serum potassium >5.0 mEq/L). 80mm.5pt.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Epinephrine is an adrenergic agonist and a potent vasoconstrictor, primarily used to treat severe allergic reactions (anaphylaxis) and cardiac arrest by stimulating alpha and beta receptors. It would not reverse the anticoagulant effects of warfarin, which acts by inhibiting vitamin K epoxide reductase in the coagulation cascade. Its mechanism of action is unrelated to reversing excessive anticoagulation.
Choice B rationale
Protamine sulfate is the specific antidote for heparin overdose, not warfarin. Protamine is a highly basic protein that forms a stable, inactive complex with the highly acidic heparin molecule, thereby neutralizing its anticoagulant effect. It has no effect on the mechanism of action of warfarin, which interferes with vitamin K-dependent clotting factors synthesis.
Choice C rationale
Atropine is an anticholinergic (parasympatholytic) agent used to increase heart rate in cases of symptomatic bradycardia by blocking the effects of acetylcholine at muscarinic receptors. It does not interact with the clotting cascade or the pharmacodynamics of warfarin, which requires replacement of the necessary clotting factors or its cofactor.
Choice D rationale
Vitamin K (Phytonadione) is the essential cofactor for the synthesis of coagulation factors II, VII, IX, and X in the liver, which are inhibited by warfarin. Administering Vitamin K bypasses the warfarin-induced block, promoting the production of functional clotting factors and thus reversing excessive anticoagulation, which is reflected by a prolonged International Normalized Ratio (INR) (therapeutic range 2.0-3.0).
Correct Answer is A
Explanation
Choice A rationale
The recommended first-line treatment for uncomplicated gonorrhea is typically a single 500 mg intramuscular (IM) injection of Ceftriaxone, a third-generation cephalosporin. This regimen is highly effective because Ceftriaxone achieves high, sustained serum and tissue levels and addresses the increasing rates of antimicrobial resistance seen in Neisseria gonorrhoeae, providing a reliable, single-dose cure to both the client and their partner.
Choice B rationale
Doxycycline is primarily used to treat Chlamydia trachomatis infection, which frequently co-occurs with gonorrhea. While it may be administered alongside Ceftriaxone for dual coverage if chlamydia hasn't been ruled out, it is not the monotherapy for gonorrhea, which requires the higher efficacy of a cephalosporin like Ceftriaxone due to resistance patterns.
Choice C rationale
Penicillin is no longer the standard treatment for gonorrhea because Neisseria gonorrhoeae has developed widespread resistance to penicillins and many other older antibiotics through plasmid-mediated β-lactamase production and chromosomal mutations. Using a single dose of Penicillin would likely result in treatment failure and the progression of the infection, thus necessitating the use of the more potent Ceftriaxone.
Choice D rationale
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae and is a serious sexually transmitted infection (STI) that requires prompt antibiotic treatment. It does not typically resolve on its own. Untreated infection can lead to severe complications, including pelvic inflammatory disease (PID) in women, epididymitis in men, and potentially disseminated gonococcal infection (DGI), highlighting the necessity of effective treatment.
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