Diuretics

After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states: -"I should take the medicine around dinnertime for the best effect." -"I need to take the drug on an empty stomach." -"I can still use my salt substitute if I want to." -"I need to make sure I don't eat too many high potassium foods."

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

Where do K+ sparing diuretics exert their effects? -Glomerulus -Thick Ascending Loop of Henle -Proximal Tubule -Meyer's Loop -Collecting Tubule -Inhibits Microtubules

Collecting Tubule These medications work in the cortical collecting tubule, to antagonize aldosterone or Na+ channels.

What mechanism of action or pharmacological action is best associated with spironolactone? Absorbs Calcium and Phosphorus Inhibit Reabsorption of Uric Acid Inhibits Na+-K+-2Cl- Increased Na and water reabsorption Osmotic Diuresis Competitive Aldosterone Receptor Antagonist

Competitive Aldosterone Receptor Antagonist works by competing for intracellular mineralocorticoid receptors in the late distal tubule, or collecting tubule. This decreases the reabsorption of Na+ and water, while decreasing the secretion of K+.

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 upon which site in the nephron? -Collecting tubule -Ascending limb of loop of Henle -Descending limb of loop of Henle -Proximal tubule

Descending limb of loop of Henle

An elderly patient with a history of congestive heart failure has been admitted to hospital with failure to thrive and admission blood work reveals a hemoglobin level of 6.9 g/dL. The care team has consequently administered two units of packed red blood cells, but auscultation of the client's lungs now reveals diffuse crackles. Administration of what drug is likely to resolve the patient's pulmonary edema? -Mannitol -Hydrochlorothiazide -Triamterene -Furosemide

Furosemide

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? -Ethacrynic acid -Bumetanide -Spironolactone -Mannitol

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? -Administration of a thiazide diuretic -Monitoring of CBC and serum albumin -Monitoring of serum electrolytes, creatinine, and BUN -Administration of concurrent potassium

Monitoring of serum electrolytes, creatinine, and BUN

Why would potassium-sparing diuretics be contraindicated for clients experiencing renal failure? -They may cause rebound edema. -They are the strongest form of diuretics. -They promote excretion of potassium. -They may cause hyperkalemia.

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 care provider's prescription for oral spironolactone because the client's health problems would contribute to a high risk of which adverse reaction? -hypocalcemia -hemolytic anemia -hyperkalemia -metabolic acidosis

hyperkalemia

A health care provider has prescribed triamterene to a male client with renal disease. The client informs the nurse that he is taking potassium supplements to address some heart problems. The nurse would be alert for: -increased risk of hyperkalemia. -increased risk of bleeding. -decreased diuretic effectiveness. -increased risk of arrhythmias.

increased risk of hyperkalemia

Which instruction would be most appropriate for a client who is taking a diuretic? -"Limit the amount of fluids you drink." -"Take the daily dose around dinnertime." -"Lie down after taking the drug." -"It's okay to take it with food."

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

A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route? -Subcutaneous -Oral -Intramuscular -Intravenous

-Oral

What mechanism of action or pharmacological action is best associated with amiloride and triamterene? -Blocks Potassium Channels in Beta Cells -Osmotic Diuresis -Inhibits Na+-K+-2Cl- -Inhibits Voltage-Gated Ca2+ channels -Increased Na and water reabsorption -Block Na+ Channels

Block Na+ Channels These medications directly block epithelial Na+ channels (ENaC) to prevent its resorption in the collecting tubule in the kidneys. By blocking this channel, Na+ is not resorbed and K+ is not exchanged or wasted into the collecting tubule lumen.

K+ sparing diuretics are most likely indicated for which of the following conditions? -Cardiac Tamponade -Cystinosis -Renal Tubular Acidosis -Restrictive Cardiomyopathy -Bradyarrhythmias -CHF and Hypertension

CHF and Hypertension K+ sparing diuretics are indicated for CHF and hypertension treatment.

What type of diet should a patient taking diuretics have? -Eat sodium-rich or low-sodium diet as appropriate -Eat potassium-rich or low-potassium diet as appropriate -No effect on diet -Eat low-sodium, low-potassium diet

Eat potassium-rich or low-potassium diet as appropriate

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? -Hydrochlorothiazide -Furosemide -Acetazolamide -Spironolactone

Furosemide

During your assessment of a patient taking K+ sparing diuretics of the following side effects is most likely to be seen? -Arthralgias -Hyperthyroidism -Telangiectasias -Corneal Deposits -Cardiac Toxicity -Gynecomastia

GynecomastiaMan-boobs A side effect of Spironolactone administration is gynecomastia (male breasts), as this drug has antiandrogen effects and weak progesteronic effects (progesterone is linked to breast development).

During your assessment of a patient taking K+ sparing diuretics which of the following side effects is most likely to be seen? -Hypoglycemia -Hypertension -Hypocalciuria -Hypokalemia -Hypercalcemia -Hyperkalemia

Hyperkalemia These medications have the potential to cause hyperkalemia, as they prevent its secretion in the cortical collecting tubule. Hyperkalemia can lead to muscle weakness and fatal arrhythmias.

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? -Sudden pain in the joints -Sudden increase in weight -Occurrence of gout attacks -Increased blood glucose levels

Increased blood glucose levels

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 BEST respond to this suggestion? -"That would only work if he could come in twice a day to get it intravenously." -"Actually, patients with renal failure usually can't take hydrochlorothiazide." -"Maybe, but hydrochlorothiazide affects the bladder more than the kidneys." -"That would probably help, but we'd have to do blood work first."

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

The nurse should be aware that diuresis will peak how long after furosemide is administered? -60 to 75 minutes -5 to 10 minutes -15 minutes -30 minutes

30 minutes

Which of the following medications is/are classified as a K+ sparing diuretic(s)? -Hydrochlorthiazide and Triamterene -Mannitol and Furosemide -DDAVP (Desmopressin Acetate) -Lubiprostone (Amitiza) -Finasteride and Spironolactone -Amiloride and Triamterene

Amiloride and Triamterene are K+ sparing diuretics which act in the distal tubule or collecting tubule to decrease K+ loss by exerting their actions on epithelial sodium channels (ENaC).

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? -liver disease -diabetes -hyperkalemia -gout

hyperkalemia

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? -Encourage the client to exercise. -Gradually increase the drug dosage. -Ask the client to decrease fluid intake. -Administer the drug early in the day.

Administer the drug early in the day.

K+ sparing diuretics are most likely indicated for which of the following conditions? -Hypermagnesemia -Cardiac Tamponade -Hyperaldosteronism -Hypomagnesemia -Pheochromocytoma -Hyponatremia

Hyperaldosteronism The K+ sparing diuretic spironolactone is often used in hyperaldosteronism, as it is a competitive aldosterone receptor antagonist.

When describing where bumetanide acts, what would the nurse include? -Loop of Henle -Collecting tubule -Glomerulus -Proximal convoluted tubule

Loop of Henle

A client asks, "Why is my prescription is being switched from furosemide to spironolactone?" What is the nurse's best response? -"You will have greater potassium losses with spironolactone than with furosemide." -"You will have greater sodium losses with spironolactone than with furosemide." -"You will lose less potassium with spironolactone than with furosemide." -"You will have greater water losses with spironolactone than with furosemide."

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

A client who has been taking hydrochlorothiazide arrives at the clinic for his 1-month follow-up appointment. The client tells the nurse that he feels weaker since he began taking the drug. What should the nurse consider as a possible cause of these symptoms? -Hypercalcemia -Hypocalcemia -Hypokalemia -Hyperkalemia

Hypokalemia

K+ sparing diuretics are most likely indicated for which of the following conditions? -Huntington's Disease -Cystinosis -Hypokalemia -Pheochromocytoma -Renal Tubular Acidosis -Increased ICP

Hypokalemia These diuretics are typically combined with loop diuretics (or others), which tend to decrease body K+ to dangerously low levels. Using K+ sparing diuretics with these other K+ wasting drugs tends to keep a normal potassium reference range.

What would contraindicate the use of indapamide? -Systemic lupus erythematosus -Diabetes -Hypokalemia -Gout

IMAGE Hypokalemia

Which of the following medications is classified as a K+ sparing diuretic? Acebutolol Hydrochlorothiazide HCTZ Lubiprostone (Amitiza) Mannitol (Osmitrol) Spironolactone Cholestyramine

Spironolactone is a drug used for heart failure, ascites, hypertension, hypokalemia and hyperaldosteronism. This drug is also used as an antiandrogenic medication, as it blocks androgen binding through various mechanisms. Eplerenone is a very similar drug to Spironolactone

Diuretics can either block the reabsorption of components of the urine or block the reabsorption of water back into the body. What does the increase in urine flow from the body depend on with a patient on loop diuretics? -The amount of water excreted by the body -The amount of sodium and chloride that it excretes through the kidney -The amount of water reabsorption back into the body -The amount of sodium and chloride reabsorption that it blocks

The amount of sodium and chloride reabsorption that it blocks

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? -Auscultate the client's chest each morning. -Test the osmolarity of the client's urine regularly. -Assess the client's skin turgor on a daily basis. -Weigh the client daily.

Weigh the client daily.

A 49-year-old client reports frequent muscle cramps while on hydrochlorothiazide therapy. The nurse would advise the client to do which? -include high-sodium foods in her diet. -drink plenty of fluids. -take calcium supplements. -eat potassium-rich foods.

eat potassium-rich foods

A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client MOST likely be prescribed? -thiazide diuretic -potassium-sparing diuretic -loop diuretic -osmotic diuretic

osmotic diuretic