ch 51 PreU

A patient with a longstanding diagnosis of chronic renal failure has experienced a significant decline in urine output in recent days, prompting him to seek care at a local clinic. A nurse at the clinic has suggested to a colleague that the administration of a diuretic such as hydrochlorothiazide may improve the patient's urine output. How should the colleague bestrespond to this suggestion?

"Actually, patients with renal failure usually can't take hydrochlorothiazide."

An older adult client with hypertension has recently been prescribed a beta-adrenergic blocker and a thiazide diuretic. When educating the client about preventing and managing adverse effects, the nurse will provide which instruction?

"Change positions slowly to prevent lightheadedness or dizziness."

A client asks, "Why is my prescription being switched from furosemide to spironolactone?" What is the nurse's best response?

"You will lose less potassium with spironolactone than with furosemide."

Your 55-year-old patient is receiving both digoxin and potassium supplements along with hydrochlorothiazide. When monitoring daily laboratory values, you know it is important for your patient to maintain which serum potassium level?

3.5-5.0 mEq/L

The health care provider orders furosemide for a pediatric client. The nurse knows that the established dose of the drug should not exceed how many milligrams per kilogram of body weight per day?

6

The nurse is teaching a client about the prescribed metolazone and providing suggestions for foods to eat which will help increase potassium consumption. The nurse determines the teaching is successful after the client correctly chooses which food(s)? Select all that apply.

Bananas Asparagus Salmon Peanuts

A 91-year-old client, who is being prepared for discharge, has been prescribed the diuretic spironolactone. While teaching the client about the drug, what major adverse effect should the nurse be sure to mention?

Hyperkalemia

The health care provider has prescribed spironolactone for a client. The nurse is prepared to carefully monitor the client's potassium level if the client is also administered which drug?

Lisinopril

The nurse is preparing to administer bumetanide to the client. The nurse should question this order after noting which drug(s) are currently being administered? Select all that apply.

Lithium Gentamicin Warfarin Digoxin

When describing where bumetanide acts, what would the nurse include?

Loop of Henle

The nurse is caring for a client who is experiencing elevated intracranial pressure following neurosurgery. The health care provider orders an osmotic diuretic to reduce pressure. Which medication would the nurse expect to be ordered?

Mannitol

A client with renal impairment is in need of a diuretic. Because of the renal problem, potassium-sparing diuretics are contraindicated but may be used if there is no other option. If they are used at all, what nursing intervention would be most important for this client?

Monitoring of serum electrolytes, creatinine, and BUN

What would contraindicate the use of indapamide?

Renal disease

A male client has cirrhosis and is receiving diuretic therapy. The nurse knows that what drug will help prevent metabolic alkalosis or hypokalemia in this client?

Spironolactone

A client is prescribed a carbonic anhydrase inhibitor. Which medication would the nurse withhold giving to the client with the diuretic?

aspirin

A 49-year-old client reports frequent muscle cramps while on hydrochlorothiazide therapy. The nurse would advise the client to do which?

eat potassium-rich foods.

A client with heart failure has developed acute shortness of breath and pulmonary edema. The nurse will prepare for administration of what medication and via what route?

furosemide IV

A client with a history of allergy to sulfonamides is identified as a candidate for diuretic therapy. What diuretics would be contraindicated by the allergy? Select all that apply.

hydrochlorothiazide furosemide chlorothiazide

A health care provider prescribes spironolactone, a potassium-sparing diuretic, for a client with cirrhosis. For which category of clients is the use of potassium-sparing diuretics contraindicated?

hyperkalemia

A physician has prescribed triamterene to a client with renal disease. The client informs the nurse that they are taking potassium supplements to address some heart problems. The nurse would be alert for which of the following?

increased risk of hyperkalemia.

The nurse is caring for a client with increased intracranial pressure. Which diuretic would the nurse anticipate being prescribed for this client?

mannitol

The nurse is caring for a client with hyperaldosteronism. For which diuretic would the nurse prepare teaching for the client?

spironolactone

To which client should the nurse anticipate administering mannitol?

the client with increased intracranial pressure secondary to a subarachnoid hemorrhage

After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states:

"I need to make sure I don't eat too many high potassium foods."

A client with heart failure is prescribed a loop diuretic. Which client statement indicates that teaching provided by the nurse about this medication was effective?

"I will change positions slowly if I feel dizzy."

Which instruction would be most appropriate for a client who is taking a diuretic?

"It's okay to take it with food."

What information should the nurse discuss with the client considering pregnancy regarding the use of a diuretic during pregnancy?

"Typically, women on diuretics prior to becoming pregnant can remain on the medication during their pregnancy."

A nurse is preparing a teaching plan for a client with edema who is prescribed a diuretic. Which teaching should the nurse prioritize?

Administer early in the day.

After teaching a group of nursing students about diuretics, the instructor determines that the teaching was successful when the group identifies which as a loop diuretic?

Furosemide

After teaching a group of students about loop diuretics, the instructor determines that the teaching has been successful when the students identify which agent as the safest for use in the home?

Furosemide

Which is an example of a loop diuretic?

Furosemide (Lasix)

A nurse is preparing to administer spironolactone to a client. The nurse would question this order if which disorder is noted in the client's history?

Hyperkalemia

A client with heart failure has been prescribed furosemide 40 mg orally once per day. Which dietary measure(s) will the nurse recommend when teaching the client about this new medication? Select all that apply.

Incorporate high-potassium foods into the diet. Avoid high-sodium foods and adding salt to meals.

A client is admitted in acute renal failure and prescribed mannitol. The nurse prepares to administer this drug via which route?

Intravenously

A nurse is caring for a client with acute renal failure. The health care provider has prescribed a diuretic therapy for the client to promote dieresis. What intervention should the nurse perform to prevent the inconvenience caused by increased urination?

Administer the drug early in the day.

The nurse has finished a teaching session with a client who is prescribed a diuretic to be taken twice a day. The nurse determines the session is successful when the client correctly chooses which times to take the drug?

At breakfast and midafternoon

A client prescribed both an ACE inhibitor and a beta-blocker for the treatment of hypertension has been consistently obtaining blood pressure readings in the vicinity of 145/90 mm Hg. As a result, the client's primary health care provider has prescribed furosemide. What order would be mostconsistent with this client's health needs?

Furosemide 40 mg PO BID

A health care provider has prescribed a loop diuretic for a client with hypertension. The client also has diabetes mellitus. What condition should the nurse monitor for in this client after administering the prescribed drug?

Increased blood glucose levels

A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered?

Mannitol

A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route?

Oral

A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed?

Osmotic diuretic

An ED nurse is caring for a patient who is receiving furosemide for treatment of pulmonary edema. What will the nurse monitor to observe for adverse effects of the drug?

Potassium levels

A client with cerebral edema is prescribed mannitol. Which assessment should the nurse prioritize during the ongoing assessment?

Response of pupils to light

The health care provider indicates that a client experiencing renal failure is not a candidate for therapy with potassium-sparing diuretics. How will the nurse respond when the client's family member asks why this is the case?

They may cause hyperkalemia.

An older adult client has a complex medical history that includes heart failure, type 1 diabetes, and diabetic nephropathy. The nurse has questioned a health care provider's prescription for oral spironolactone because the client's health problems would contribute to a high risk of which adverse reaction?

Hyperkalemia

A primary health care provider has prescribed a loop diuretic for hypertension in a client with diabetes mellitus. Which assessment should the nurse prioritize?

Increased blood glucose levels