1. A patient with chronic heart failure is admitted to the hospital with

signs of fluid overload. The nurse expects to administer which of the

following medications to reduce the excess fluid volume?

a) Furosemide (Lasix)

b) Spironolactone (Aldactone)

c) Hydrochlorothiazide (HydroDIURIL)

d) Mannitol (Osmitrol)

*Answer: a) Furosemide (Lasix)*

Rationale: Furosemide is a loop diuretic that inhibits sodium and water

reabsorption in the ascending loop of Henle, resulting in increased urine

output and decreased fluid volume. Spironolactone is a potassium-sparing

diuretic that has a weaker diuretic effect than furosemide and may cause

hyperkalemia. Hydrochlorothiazide is a thiazide diuretic that is less

effective than furosemide in treating fluid overload and may also cause

hypokalemia. Mannitol is an osmotic diuretic that is used to treat cerebral

edema and increased intracranial pressure, not fluid overload.

2. A patient with diabetic ketoacidosis (DKA) has a blood glucose level of

600 mg/dL, a serum bicarbonate level of 10 mEq/L, and a blood pH of

7.25. The nurse anticipates that the patient will receive which of the

following intravenous fluids to correct the acid-base imbalance?

a) 0.9% sodium chloride

b) 0.45% sodium chloride

c) Lactated Ringer's solution

d) 5?xtrose in water

*Answer: b) 0.45% sodium chloride*

Rationale: 0.45% sodium chloride is a hypotonic solution that provides

free water to dilute the high serum glucose and sodium levels, as well as

to replace the fluid losses from osmotic diuresis. It also helps to restore the

intracellular fluid volume and prevent cellular dehydration. Lactated

Ringer's solution is an isotonic solution that contains lactate, which can be

converted to bicarbonate in the liver and increase the serum bicarbonate

level, but it may also worsen the hyperglycemia and fluid overload. 0.9%

sodium chloride is an isotonic solution that does not provide free water or

bicarbonate, and may increase the serum sodium level and fluid volume.

5?xtrose in water is a hypertonic solution that will further increase the

serum glucose level and fluid volume, and may cause cerebral edema.