Chapter 32

The nurse is teaching a 62-year-old client about hydrochlorothiazide, which the health care provider has prescribed for treatment of hypertension. What statement, made by the client, suggests that the client understands the teaching?

"I will need to stand slowly."

A male client has been ordered spironolactone (Aldactone) for hypertension. Which statement by the client indicates a need for further education?

"I will take the medication when my blood pressure is elevated."

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."

A 10-year-old child has edema caused by a heart defect. The client is taking furosemide. The dosage is 3 mg/kg/d. The child weighs 76 lbs. How many milligrams does the child receive each day?

105 mg

A client is receiving digoxin and a potassium supplement. When monitoring daily laboratory values, what should the potassium level be for this client?

3.5-5.0 mEq/L

A patient has been prescribed a daily dosage of 20 mg of torsemide for the treatment of acute pulmonary edema. The drug is available in the form of 10 mg tablets. How many tablets should the nurse get for the course of 4 days?

8

A client with glaucoma has been prescribed a diuretic. What drug does the nurse suspect that the client will be prescribed?

Acetazolamide

A client who was recently prescribed spironolactone calls the clinic and reports 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 client?

Are you taking a salicylate?

A nurse is providing patient teaching for a 62-year-old woman who is taking triamterene. The nurse will teach the patient to avoid what in her diet?

Avocados

Diuretics increase the production and output of urine. Which statement helps explain how diuretics achieve these effects?

Diuretics reduce the reabsorption of water in the kidneys.

A client has been prescribed hydrochlorothiazide, and the nurse is preparing to give the client discharge instructions. Which adverse effects should the nurse caution the client about? Select all that apply.

Dizziness Nocturia Muscle cramps

What type of diet should a patient taking diuretics have?

Eat potassium-rich or low-potassium diet as appropriate

A nurse encourages a patient who is receiving a diuretic to maintain his fluid intake to prevent the risk for developing:

Fluid rebound

Which is an example of a loop diuretic?

Furosemide (Lasix)

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 most consistent with this client's health needs?

Furosemide 40 mg PO BID

A client presents to the clinic for a 1-month follow-up appointment. The client tells the nurse he or she has been taking chlorothiazide for a month and now has leg cramps and "feels tired all the time." What will the nurse consider as the most likely cause of the client's symptoms?

Hypokalemia

A nurse notes that a newly admitted client is currently prescribed both a loop diuretic as well as a thiazide diuretic. The nurse understands what primary rationale for the concurrent use of these two drugs?

Increased diuretic effect

A nurse has been assigned to patient who receives hydrochlorothiazide each morning for the treatment of primary hypertension. Which of the following components of the patient's morning blood work should prompt the nurse to temporarily hold the drug this morning and consult with the physician?

K+ 3.0 mEq/L

Following a referral from the client's optometrist, a client has been assessed and diagnosed with open-angle glaucoma. When administering the client's subsequent medications, the nurse should prioritize what action?

Monitor the client's potassium levels.

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

Osmotic diuretic

A nurse is caring for a client receiving diuretic therapy for the treatment of ascites due to malignancy. The nurse suspects that the client is developing hypomagnesemia based on which of the following? Select all that apply.

Paresthesias Tachycardia Tremors

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

Potassium levels

A client with hypertension has been prescribed spironolactone. The client's previous diuretic, furosemide, has been discontinued. The nurse should explain what benefit of this change?

Potassium losses are lower with spironolactone than with furosemide.

A client began taking hydrochlorothiazide 1 week ago and is reporting occasional dizziness when she stands up quickly from sitting or lying. What is the nurse's best action?

Teach the client about the blood pressure effects of the medication and relevant safety measures.

A client has been prescribed furosemide. What medication education should the nurse provide this client? (Select all that apply.)

The medication will cause you to urinate larger amounts of urine than you are accustom to. You should try to avoid excessive intake of salt. Be aware that standing up quickly can cause you to be dizzy. Notify your health care provider if you have more than a 3-pound weight change in one day.

The nurse is providing discharge instructions to a 72-year-old client who has been discharged home on a diuretic. What should the nurse include when providing discharge instructions regarding the use of a diuretic at home?

To weigh themselves on the same scale, at the same time of day, in the same clothing

A nurse is providing care to a client who is to receive acetazolamide for epilepsy. Before administering this drug, the nurse would assess which of the following?

Vital signs and weight

The nurse is conducting an admission assessment of a client who has been prescribed hydrochlorothiazide. The nurse should contact the provider because of the client's:

allergy to sulfa drugs.

A 91-year-old client is being discharged on the diuretic spironolactone. What assessment finding would the nurse attribute to adverse effects of this medication?

confusion and irregular heart rate

The nurse is caring for an older adult client who receives furosemide on a regular basis. The nurse should prioritize assessments related to what health problem?

dehydration

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.

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

Which diuretic will most likely be the initial drug of choice when a client demonstrates dyspnea related to pulmonary edema?

furosemide

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 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

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

The nurse is caring for a 68-year-old female client with type 1 diabetes mellitus whose health care provider has ordered hydrochlorothiazide. As a consequence of taking the diuretic, the client may need to:

increase her insulin dose.

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 a severe head injury. An osmotic diuretic is ordered. The nurse understands which drug is an osmotic diuretic?

mannitol

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

osmotic diuretic

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

potassium levels

An adult client with multiple chronic health problems has been prescribed furosemide in the management of hypertension. When reviewing this client's current medication administration record, what drug should signal the nurse to a potentially increased risk of hypokalemia?

prednisone

What substance is reabsorbed in the ascending limb of the loop of Henle?

sodium

A nurse is caring for a patient who is receiving mannitol. The nurse should be aware that the ongoing mannitol administration should be withheld if

the urine output is less than 30 mL/hour after the test dose.

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

A hospital client demonstrating peripheral edema has been prescribed furosemide. How should the nurse best determine the extent of the client's desired fluid loss?

weigh the client daily