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 C
Explanation
Choice A rationale
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae, not a virus, and it is curable with appropriate antibiotic therapy, such as ceftriaxone. Informing the client that it is a virus and incurable provides false and misleading information, which could lead to non-adherence to treatment and continued transmission of the infection to sexual partners.
Choice B rationale
The presence of a chancre, or primary lesion, is the hallmark clinical manifestation of primary syphilis, an infection caused by the spirochete Treponema pallidum. Although both are sexually transmitted infections, gonorrhea typically presents with urethritis, cervicitis, or pharyngeal infection, not a chancre, which makes this assessment finding irrelevant to a diagnosis of gonorrhea.
Choice C rationale
Public health mandates and ethical responsibilities require the nurse to conduct thorough contact tracing for sexually transmitted infections like gonorrhea. Obtaining information about the client's recent sexual partners is vital so that they can be notified, tested, and treated, preventing further disease propagation and potential long-term complications, such as pelvic inflammatory disease.
Choice D rationale
A diaphragm is a barrier method primarily used for contraception and offers minimal protection against sexually transmitted infections like gonorrhea because it does not cover the external genitalia. The nurse should instruct the client on the consistent and correct use of condoms (male or female) as the most effective barrier method for preventing reinfection and transmission. 80mm.5pt.
Correct Answer is B
Explanation
Choice A rationale
Following a Transurethral Resection of the Prostate (TURP), the continuous bladder irrigation is intended to flush out blood and prevent clot formation. The presence of small blood clots is common and expected as a result of surgical trauma and is not typically an immediate priority unless they cause obstruction.
Choice B rationale
The presence of bright red urine (frank hematuria) or dark clots suggests active arterial bleeding in the prostatic bed, which is a significant and potentially life-threatening complication following a TURP. Maintaining continuous bladder irrigation and notifying the healthcare provider immediately is the priority to prevent hemorrhage, potential hypovolemic shock, and ensure proper clot evacuation.
Choice C rationale
A continuous urge to void (bladder spasms) is a common, though uncomfortable, finding post-TURP due to the irritation of the bladder mucosa from the catheter balloon or the surgical procedure itself. While it requires intervention (e.g., antispasmodic medication), it is not a direct threat to life or organ function and is therefore a lower priority than active bleeding.
Choice D rationale
Burning around the urinary catheter insertion site can indicate localized irritation, inflammation, or a potential urinary tract infection (UTI). Although requiring assessment and intervention, signs of local irritation or potential infection are less immediately life-threatening than active arterial hemorrhage, making it a lower priority than bright red urine.
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