Week10 GU , Diuretics , F/E ch28,29,34,35

Question 1

The emergency department (ED) nurse is caring for a patient who is experiencing pulmonary edema. patient is treated with furosemide (Lasix). What will the nurse monitor?

a.Sodium levels
b.Bone narrow function
c.Calcium levels
d.Potassium levels

Answer 1

d.Potassium levels

Furosemide is associated with loss of potassium, so that the patient will need to be monitored carefully for low potassium levels, which could cause cardiac arrhythmias and further aggravate pulmonary edema. The nurse would not monitor sodium or calcium levels or bone marrow function because of the effects of the drug during the acute treatment of pulmonary edema.

Question 2

The nurse on the coronary unit is caring for a patient with known coronary artery disease who is being treated with cholestyramine (Questran) and hydrochlorothiazide
(HydroDIURIL). What action will the nurse take?

A) Call the physician and refuse to give the drugs without further orders.
B) Make sure that the drugs are given at least 2 hours apart.
C) Give the patient an antacid with the drugs.
D) Check the patient’s blood glucose level before giving the drugs.

Answer 2

B) Make sure that the drugs are given at least 2 hours apart.

Question 3

The pharmacology instructor is discussing diuretic drugs with the nursing class. What would the instructor cite as an adverse effect of loop diuretics?

A) Hyperkalemia
B. Alkalosis
C. Hypertension
D. Hypercalcemia

Answer 3

B. Alkalosis

Alkalosis is a drop in serum pH to an alkaline state due to bicarbonate loss in urine. Hypokalemia, hypocalcemia, and hypotension are also adverse effect of these drugs. Therefore, the other options are not correct.

Question 4

A 68-year-old patient, who has type 1 diabetes, is to receive hydrochlorothiazide (HydroDIURIL). Before administration of this medication, what information is most important for the nurse to communicate to the patient?

A) His or her insulin dose may need to be increased.
B) His or he insulin dose may need to be decreased.
C) He or she will need to have him or her urine checked for ketones four times a day.
D) He or she will need to have a creatinine clearance done once a month.

Answer 4

A) His or her insulin dose may need to be increased.

Question 5

When evaluating an 82-year-old patient receiving hydrochlorothiazide (HydroDIURIL), what laboratory value deviations may be related to the medication?

A) Elevated uric acid levels
B) Reduced blood urea nitrogen (BUN) levels
C) A serum potassium level of 4.7 mEq/L
D) A hemoglobin A1C of 4.8

Answer 5

A) Elevated uric acid levels

Uric acid excretion is decreased because thiazides interfere with its secretory mechanism. High levels of uric acid can result in a condition called gout. Hydrochlorothiazide does not reduce BUN levels. Thiazide diuretics may lead to hypokalemia and increase blood glucose levels. The potassium and hemoglobin A1C levels are normal and not affected by the medication.

Question 6

The nurse is providing discharge instruction to a patient who has just begun using diuretics. The nurse counsels the patient that it is most important to monitor the intake of foods that contain which element?

A) Calcium
B) Potassium

Answer 6

B) Potassium

Potassium is the most important element to monitor in the diet because diuretics are most likely to lead to hyper- or hypokalemia depending on the diuretic prescribed. Calcium, glucose, and magnesium may need to be monitored in the diet but potassium would be the most important.

Question 7

The nurse is talking with a group of nursing students. What drug would the nurse tell them, when combined with furosemide (Lasix), is likely to cause hearing loss?
A) Codeine
B) Ciprofloxacin (Cipro)
C) Digoxin (Lanoxin)
D) Gentamicin (Garamycin)

Answer 7

D) Gentamicin (Garamycin)

The risk of ototoxicity increases if loop diuretics are combined with aminoglycoside antibiotics (gentamicin) or cisplatin. No known increased risk of ototoxicity exists when furosemide is taken with codeine, ciprofloxacin, or digoxin.

Question 8

A student asks the pharmacy instructor what the difference is between the diuretics spironolactone (Aldactone) and furosemide (Lasix). What would the instructor reply?

A) Potassium losses are lower with spironolactone.
B) Potassium losses are greater with spironolactone.
C) Water losses are greater with spironolactone.
D) Sodium losses are greater with spironolactone.

Answer 8

A) Potassium losses are lower with spironolactone.

Spironolactone is a potassium sparing diuretic; therefore, it promotes retention of potassium. Furosemide promotes greater water, sodium, and potassium losses than spironolactone.

Question 9

The nurse is caring for a patient with a severe head injury. An osmotic diuretic is ordered. The nurse understands which drug is an osmotic diuretic?
A) Spironolactone (Aldactone)
B) Bumetanide (Bumex)
C) Mannitol (Osmitrol)
D) Ethacrynic (Edecrin)

Answer 9

C) Mannitol (Osmitrol)

Mannitol is an osmotic diuretic. Spironolactone is a potassium sparing diuretic. Bumetanide and ethacrynic are loop diuretics.

Question 10

The staff educator in the ICU is talking with a group of new nurses about osmotic diuretics. The educator would tell the new nurses that osmotic diuretics act on which site in the nephron?
A) Proximal tubule
B) Glomerulus
C) Ascending limb of loop of Henle
D) Collecting tubule

Answer 10

B) Glomerulus

These drugs are freely filtered at the renal glomerulus, poorly reabsorbed by the renal tubule, not secreted by the tubule, and resistant to metabolism.

Question 11

A 91-year-old patient is being discharged on the diuretic spironolactone (Aldactone). What is the major adverse effect of this type of medication?
A) Hypokalemia
B) Hyperkalemia
C) Gastric irritation
D) Hypertension

Answer 11

B) Hyperkalemia

The most common adverse effect of potassium-sparing diuretics is hyperkalemia, which can cause lethargy, confusion, ataxia, muscle cramps, and cardiac arrhythmias. Hypokalemia, gastric irritation, and hypertension are not recognized as adverse effects of spironolactone.

Question 12

The nurse is conducting an admission assessment of a patient who has been prescribed hydrochlorothiazide (HydroDIURIL). Which situation would contraindicate the administration of hydrochlorothiazide (HydroDIURIL)?
A) Allergy to sulfa drugs
B) Allergy to codeine
C) BP 160/96
D) Blood glucose level of 140 mg/dL

Answer 12

A) Allergy to sulfa drugs

Thiazide and thiazide-like diuretics are contraindicated with allergy to thiazides or sulfonamides to prevent hypersensitivity reactions. The other options are not correct.

Question 13

The nurse is caring for a patient who has just been diagnosed with essential hypertension. The nurse is aware that the health care provider will begin therapy with which classification of diuretics?
A) Loop diuretics
B) Carbonic anhydrous inhibitors
C) Thiazide and thiazide-like diuretics
D) potassium-sparing diuretics

Answer 13

C) Thiazide and thiazide-like diuretics

Thiazides are considered to be mild diuretics compared with the more potent loop diuretics. These agents are the first-line drugs used to manage essential hypertension when drug therapy is needed. Loop and potassium-sparing diuretics and carbonic anhydrous inhibitors would be used in combination with or after the thiazide diuretics are no longer effective.

Question 14

A female patient has a history of frequent bladder infections. Which classification of diuretic would not be recommended for this patient?
A) Thiazide and thiazide-like diuretics
B) Loop diuretics
C) potassium-sparing diuretics
D) Osmotic diuretics

Answer 14

A) Thiazide and thiazide-like diuretics

Urine is slightly alkalinized when the thiazides or thiazide-like diuretics are used because they block reabsorption of bicarbonate. This effect can cause problems for patients who are susceptible to bladder

Question 15

A patient has just begun to take a prescribed diuretic. Why would the nurse tell the patient to drink 8 to 10 glasses of water daily (unless it is counterindicated)?
A) To decrease the action of the renin​angiotensin cycle
B) To make more concentrated plasma
C) To dilute the urine
D) To avoid rebound edema

Answer 15

D) To avoid rebound edema

Care must be taken when using diuretics to avoid fluid rebound, which is associated with fluid loss. If a patient stops taking in water and takes the diuretic, the result will be a concentrated plasma of smaller volume. The decreased volume is sensed by the nephrons, which activate the renin-angiotensin cycle. When concentrated blood is sensed by the osmotic center in the brain, antidiuretic hormone (ADH) is released to retain water and dilute the blood. The result can be ​rebound​ edema as fluid is retained. Drinking 8 to 10 glasses of water will not decrease the action of the renin-angiotensin cycle, or make plasma more concentrated. It may produce urine that is dilute but that is not the reason it is recommended.

Question 16

A patient has just been prescribed furosemide (Lasix). After reviewing the patient’s medication history, what drug would cause the nurse concern when taken with furosemide (Lasix)?
A) Acetaminophen
B) Ferrous sulfate (Feosol)
C) Naproxen sodium (Naprosyn)
D) Ampicillin

Answer 16

C) Naproxen sodium (Naprosyn)

Naproxen sodium is a nonsteroidal antiinflammatory drug. There may also be a decreased loss of sodium and decreased antihypertensive effects if these drugs are combined with indomethacin, ibuprofen, salicylates, or other nonsteroidal antiinflammatory drugs. The patient receiving this combination should be monitored closely and appropriate dosage adjustments should be made. There is no contraindication to the intercurrent use of acetaminophen, ferrous sulfate, or ampicillin.

Question 17

A patient who was recently prescribed spironolactone calls the clinic and complains that he is not urinating as much as he did when he first started taking this medication. What would be an appropriate question for the nurse to ask this patient?

A) ​Are you taking a salicylate?​
B) ​Are you taking acetaminophen?​
C) ​Are you taking ibuprofen?​
D) ​Are you using a lot of salt?​

Answer 17

A) ​Are you taking a salicylate?​

The diuretic effect decreases if potassium-sparing diuretics are combined with salicylates. Dosage adjustment may be necessary to achieve therapeutic effects. There is no decrease in effect when spironolactone is combined with acetaminophen, ibuprofen, and increased sodium intake.

Question 18

The nurse is writing a plan of care for a patient who is taking a diuretic. What would be an appropriate nursing diagnosis for this patient?
A) Impaired urinary elimination
B) Monitor the patient response to the drug
C) Imbalanced nutrition: More than body requirements
D) Risk for fluid volume overload

Answer 18

A) Impaired urinary elimination

Nursing diagnoses related to drug therapy may include impaired urinary elimination related to drug effect. Options B, C, and D would not be appropriate nursing diagnoses.

Question 19

A patient has been prescribed hydrochlorothiazide (HydroDIURIL) and the nurse is preparing to give the patient discharge instructions. Which adverse effects may this patient experience while taking this medication? (Select all that apply.)
A) Constipation
B) Dizziness
C) Polyphagia
D) Nocturia
E) Muscle Cramps

Answer 19

B) Dizziness
D) Nocturia
E) Muscle Cramps

The adverse effects associated with hydrochlorothiazide are dizziness, vertigo, orthostatic hypotension, nausea, anorexia, vomiting, dry mouth, diarrhea, polyuria, nocturia, muscle cramps, and spasms. The patient would not experience polyphagia (great hunger) and constipation.

Question 20

The nurse is caring for a patient with edema who has just begun taking a diuretic. What will the nurse use to evaluate the effectiveness of this medication? (Select all that apply.)
A) Daily weight
B) Decrease in edema
C) Increase in blood pressure
D) Increase in urinary output
E) Increase in pulse

Answer 20

A) Daily weight
B) Decrease in edema
D) Increase in urinary output

Question 21

The nurse has just administered 150 g of mannitol IV to a patient with increased intracranial pressure. What is most important for the nurse to monitor in the hour after administration?
A) Weight of patient
B) Blood pressure of patient
C) Pulse of patient
D) Respiratory rate of patient

Answer 21

B) Blood pressure of patient

The most common and potentially dangerous adverse effect related to an osmotic diuretic is the sudden drop in fluid levels. Mannitol peaks 1 hour after administration, therefore, it would be most important to monitor blood pressure. Weight is the best indicator over time but would not be as effective in indicating a dangerous fluid drop as the blood pressure. Respiratory and pulse rates would also not be as effective as blood pressure in evaluating dangerous fluid drops.

Question 22

LILLY - DIURETICS
When monitoring a patient who has diabetes and is receiving a carbonic anhydrase inhibitor for edema, the nurse will monitor for which possible adverse effect?
a. Metabolic alkalosis
b. Elevated blood glucose
c. Hyperkalemia
d. Mental alertness

Answer 22

b. Elevated blood glucose

An undesirable effect of carbonic anhydrase inhibitors is that they elevate the blood glucose level and cause glycosuria in diabetic patients. They induce metabolic acidosis, making their effectiveness diminishes in 2 to 4 days. In addition, hypokalemia and drowsiness may occur.

Question 23

The nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of these diuretics?
a. Hydrochlorothiazide (HydroDIURIL)
b. Furosemide (Lasix)
c. Acetazolamide (Diamox)
d. Spironolactone (Aldactone)

Answer 23

d. Spironolactone (Aldactone)

Spironolactone (Aldactone) is a potassium-sparing diuretic, and patients taking this drug must be monitored for signs of hyperkalemia. The other drugs do not cause hyperkalemia but instead cause hypokalemia.

Question 24

Mannitol (Osmitrol) has been ordered for a patient with acute renal failure. The nurse will administer this drug using which procedure?
a. Intravenously, through a filter
b. By rapid intravenous bolus
c. By mouth in a single morning dose
d. Through a gravity intravenous drip with standard tubing

Answer 24

a. Intravenously, through a filter

Mannitol is administered via intravenous infusion through a filter because of possible crystallization. It is not available in oral form. The other options are incorrect.

Question 25

Furosemide (Lasix) is prescribed for a patient who is about to be discharged, and the nurse provides instructions to the patient about the medication. Which statement by the nurse is correct? a. “Take this medication in the evening.” b. “Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and dates.” c. “If you experience weight gain, such as 5 pounds or more per week, be sure to tell your physician during your next routine visit.” d. “Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes.”

Answer 25

d. “Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes.” Orthostatic hypotension is a possible problem with diuretic therapy. Foods high in potassium should be eaten more often, and the drug needs to be taken in the morning so that the diuretic effects do not interfere with sleep. A weight gain of 5 pounds or more per week must be reported immediately.

Question 26

When reviewing the mechanisms of action of diuretics, the nurse knows that which statement is true about loop diuretics? a. They work by inhibiting aldosterone. b. They are very potent, having a diuretic effect that lasts at least 6 hours. c. They have a rapid onset of action and cause rapid diuresis. d. They are not effective when the creatinine clearance decreases below 25 mL/min.

Answer 26

c. They have a rapid onset of action and cause rapid diuresis. The loop diuretics have a rapid onset of action; therefore, they are useful when rapid onset is desired. Their effect lasts for about 2 hours, and a distinct advantage they have over thiazide diuretics is that their diuretic action continues even when creatinine clearance decreases below 25 mL/min.

Question 27

When a patient is receiving diuretic therapy, which of these assessment measures would best reflect the patient’s fluid volume status? a. Blood pressure and pulse b. Serum potassium and sodium levels c. Intake, output, and daily weight d. Measurements of abdominal girth and calf circumference

Answer 27

c. Intake, output, and daily weight Urinary intake and output and daily weights are the best reflections of a patient’s fluid volume status.

Question 28

A patient is being discharged to home on a single daily dose of a diuretic. The nurse instructs the patient to take the dose at which time so it will be least disruptive to the patient’s daily routine? a. In the morning b. At noon c. With supper d. At bedtime

Answer 28

a. In the morning It is better to take the diuretic medication early in the morning to prevent urination during the night. Taking the diuretic at the other times may cause nighttime urination and disrupt sleep.

Question 29

A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which class is likely to be used initially? a. Loop diuretics b. Osmotic diuretics c. Thiazide diuretics d. Potassium-sparing diuretics

Answer 29

c. Thiazide diuretics The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8) guidelines reaffirmed the role of thiazide diuretics as among the first-line drugs in the treatment hypertension. The other drug classes are not considered first-line treatments.

Question 30

A patient in the neurologic intensive care unit is being treated for cerebral edema. Which class of diuretic is used to reduce intracranial pressure? a. Loop diuretics b. Osmotic diuretics c. Thiazide diuretics d. Vasodilators

Answer 30

b. Osmotic diuretics Mannitol, an osmotic diuretic, is commonly used to reduce intracranial pressure and cerebral edema resulting from head trauma.

Question 31

A 79-year-old patient is taking a diuretic for treatment of hypertension. This patient is very independent and wants to continue to live at home. The nurse will know that which teaching point is important for this patient? a. He should take the diuretic with his evening meal. b. He should skip the diuretic dose if he plans to leave the house. c. If he feels dizzy while on this medication, he needs to stop taking it and take potassium supplements instead. d. He needs to take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls.

Answer 31

d. He needs to take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls. Caution must be exercised in the administration of diuretics to the older adults because they are more sensitive to the therapeutic effects of these drugs and are more sensitive to the adverse effects of diuretics, such as dehydration, electrolyte loss, dizziness, and syncope. Taking the diuretic with the evening meal may disrupt sleep because of nocturia. Doses should never be skipped or stopped without checking with the prescriber.

Question 32

KARCH Oxybutinin The nurse is assessing a patient who is taking oxybutynin (Ditropan). What would be the priority nursing assessment for this patient? A) Skin condition B) Cardiac arrhythmia C) Vision changes D) Mental status

Answer 32

C) Vision changes The nurse should assess for vision changes and recommend an ophthalmologic examination during treatment to evaluate drug effects on intraocular pressure so that the drug can be stopped if intraocular pressure increases. A rash and changes in cardiac rhythm and rate are possible adverse effects. Also, disorientation (mental status) could be a concern. However, these effects can be treated and may not necessitate stopping the medication.

Question 33

A small group of nursing students are giving an oral presentation to their classmates about urinary tract infections (UTIs). What is a measure that can be used to encourage patients to use to reduce the risk of recurrent urinary tract infections? a.increase alkaline foods in your diet. b.Take tub baths, soaking 15 minutes daily. c.Use sterile gauze pads to cleanse after urinating. d.Drink 2,000 to 3,000 mL of fluid daily.

Answer 33

d.Drink 2,000 to 3,000 mL of fluid daily.

Question 34

LILLY oxybutinin A patient has a prescription for oxybutynin (Ditropan), an anticholinergic drug. When reviewing the patient’s medical history, which condition, if present, would be considered a contraindication to therapy with this drug? a. Diarrhea b. Hypertension c. Neurogenic bladder d. Uncontrolled angle-closure glaucoma

Answer 34

d. Uncontrolled angle-closure glaucoma Contraindications include drug allergy, urinary or gastric retention, and uncontrolled angle-closure glaucoma. Neurogenic bladder is an indication for oxybutynin. The other options are incorrect.

Question 35

The nurse is reviewing the use of anticholinergic drugs. Anticholinergic drugs block the effects of which nervous system? a. Central nervous system b. Somatic nervous system c. Sympathetic nervous system d. Parasympathetic nervous system

Answer 35

d. Parasympathetic nervous system Anticholinergic drugs block or inhibit the actions of acetylcholine in the parasympathetic nervous system. The other options are incorrect.

Question 36

A 72-year-old man has a new prescription for an anticholinergic drug. He is an active man and enjoys outdoor activities, such as golfing and doing his own yard work. What will the nurse emphasize to him during the teaching session about his drug therapy? a. Drowsiness may interfere with his outdoor activities. b. Increased salivation may occur during exercise and outside activities. c. Fluid loss may occur as a result of an increased incidence of diarrhea. d. He will need to take measures to reduce the occurrence of heat stroke during his

Answer 36

d. He will need to take measures to reduce the occurrence of heat stroke during his activities Elderly patients who take an anticholinergic drug need to be reminded that they are at a greater risk for suffering heat stroke because of decreased sweating and loss of normal heat-regulating mechanisms.

Question 37

The nurse will monitor for which adverse effect when administering an anticholinergic drug? a. Excessive urination b. Diaphoresis c. Dry mouth d. Pupillary constriction

Answer 37

c. Dry mouth Anticholinergic drugs commonly cause the adverse effects of dry mouth, blurred vision, constipation, and urinary retention. They also cause mydriasis (pupillary dilation).

Question 38

The nurse working in a preoperative admitting unit administers an anticholinergic medication to a patient before surgery . What is the purpose of this drug in the preoperative setting? a. Reduce pain b. Relax the patient c. Reduce urinary frequency d. Reduce oral and gastrointestinal secretions

Answer 38

d. Reduce oral and gastrointestinal secretions Anticholinergic drugs are given preoperatively to control oral and gastrointestinal secretions during surgery. The other options are incorrect.

Question 39

FLUID AND ELECTROLYTES When reviewing the health history of a patient, the nurse will note that a potential contraindication to potassium supplements exists if the patient has which problem? a. Burns b. Diarrhea c. Renal disease d. Cardiac tachydysrhythmias

Answer 39

c. Renal disease Potassium supplements are contraindicated in the presence of renal disease; the other conditions listed may be treated with potassium supplements.

Question 40

During a blood transfusion, the patient begins to have chills and back pain. What is the nurse’s priority action? a. Observe for other symptoms. b. Slow the infusion rate of the blood. c. Discontinue the infusion immediately, and notify the prescriber. d. Tell the patient that these symptoms are a normal reaction to the blood product.

Answer 40

c. Discontinue the infusion immediately, and notify the prescriber. Because of the possibility of a transfusion reaction, the infusion should be discontinued immediately and the prescriber notified. The intravenous line should be kept patent with isotonic normal saline solution infusing at a slow rate, and the health care facility’s protocol for transfusion reactions should always be followed. The other options are inappropriate actions.

Question 41

The nurse is working with a graduate nurse to prepare an intravenous dose of potassium for a patient on a regular medical-surgical unit. Which statement by the graduate nurse reflects a need for further teaching? a. “We will need to monitor this infusion closely.” b. “The infusion rate needs to infuse at 10 mEq/hr.” c. “The intravenous potassium will be diluted before we give it.” d. “The intravenous potassium dose will be given undiluted.”

Answer 41

d. “The intravenous potassium dose will be given undiluted.” When giving intravenous potassium, the medication must always be given in a diluted form and administered slowly. Intravenous bolus or undiluted forms may cause cardiac arrest. Intravenous rates are not to exceed 10 mEq/hr unless the patient is on a cardiac monitor. Oral forms should be mixed with juice or water or taken according to instructions.

Question 42

A patient is in an urgent care center and is receiving treatment for mild hyponatremia after spending several hours doing gardening work in the heat of the day. The nurse expects that which drug therapy will be used to treat this condition? a. Oral supplementation of fluids b. Intravenous bolus of lactated Ringer’s solution c. Normal saline infusion, administered slowly d. Oral administration of sodium chloride tablets

Answer 42

c. Normal saline infusion, administered slowly Mild hyponatremia is usually treated by oral administration of sodium chloride tablets. Pronounced sodium depletion is treated by intravenous normal saline or lactated Ringer’s solution.

Question 43

When monitoring a patient for signs of hypokalemia, the nurse looks for what early sign? a. Seizures b. Cardiac dysrhythmias c. Diarrhea d. Muscle weakness

Answer 43

d. Muscle weakness Muscle weakness is an early symptom of hypokalemia, as are hypotension, lethargy, mental confusion, and nausea. Cardiac dysrhythmias are a late symptom of hypokalemia. The other options are incorrect.

Question 44

The nurse is preparing to transfuse a patient with a unit of packed red blood cells (PRBCs). Which intravenous solution is correct for use with the PRBC transfusion? a. 5% dextrose in water (D5W) b. 0.9% sodium chloride (NS) c. 5% dextrose in 0.45% sodium chloride (D5NS) d. 5% dextrose in lactated Ringer’s solution (D5LR)

Answer 44

b. 0.9% sodium chloride (NS) Blood products should be given only with normal saline 0.9% because D5W will also cause hemolysis of the blood product.

Question 45

The nurse is preparing to give a potassium supplement. Which laboratory test should be checked before the patient receives a dose of potassium? a. Complete blood count b. Serum potassium level c. Serum sodium level d. Liver function studies

Answer 45

b. Serum potassium level Contraindications to potassium replacement products include hyperkalemia from any cause. It is important to know the patient’s electrolyte levels before beginning any electrolyte replacement therapy. Giving potassium supplements to a patient whose serum potassium levels are already high may cause worsening of the hyperkalemia if it is present. The other options are incorrect.