NUR 3420 Pharmacology PrepU Chapter 34, Pharm: Chapter 34 therapy for fluid volume, 32: Drug Therapy for Fluid Volume Excess, Chapter 34: Drug Therapy for Fluid Volume Excess, Chapter 34: Drug Therapy for Fluid Volume Excess, 28: Drug Therapy for Hyp…
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
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
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?
"Actually, patients with renal failure usually can't take hydrochlorothiazide." Correct Explanation: Renal disease and severe renal impairment contraindicate the use of hydrochlorothiazide. HCTZ affects the kidneys, not the bladder, and is not administered intravenously.
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?
"Actually, patients with renal failure usually can't take hydrochlorothiazide."- Renal disease and severe renal impairment contraindicate the use of hydrochlorothiazide. HCTZ affects the kidneys, not the bladder, and is not administered intravenously.
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."
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." Explanation: The drug is a potassium sparing diuretic placing the patient at risk for hyperkalemia, especially if the patient consumes foods high in potassium. The patient should take the medication in the morning to prevent interfering with sleep by having to get up at night to void. The patient can take the drug with meals if GI upset occurs. Many salt substitutes contain potassium, which could increase the patient's risk for hyperkalemia.
After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states which of the following? a) "I need to take the drug on an empty stomach." b) "I need to make sure I don't eat too many high potassium foods." c) "I should take the medicine around dinnertime for the best effect." d) "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." Explanation: The drug is a potassium sparing diuretic placing the patient at risk for hyperkalemia, especially if the patient consumes foods high in potassium. The patient should take the medication in the morning to prevent interfering with sleep by having to get up at night to void. The patient can take the drug with meals if GI upset occurs. Many salt substitutes contain potassium, which could increase the patient's risk for hyperkalemia.
A patient who has just been told that they need to go on dialysis asks the nurse what the normal output of urine is per day. What would be the nurse's best response?
2,000 mL
A 10-year-old child has edema caused by a heart defect. The patient is taking furosemide (Lasix). The dosage is 6 mg/kg per day. The child weighs 76 pounds. How many mg does the child receive in each dose? a) 50 mg b) 105 mg c) 210 mg d) 20 mg
210 mg Explanation: The nurse will administer 210 mg per dose of the drug (2.2 lbs : 1 kg = 76 lbs : X kg, 76 divided by 2.2 = 34.5, 35 times 6 = 210 mg).
The kidneys receive approximately what percentage of the cardiac output?
25%
The nurse is administering furosemide IV to a client. How soon after administration does the nurse expect diuretic effects to peak?
30 minutes
You are monitoring serum electrolyte levels in a 55-year-old patient who has been prescribed digoxin and a potassium-sparing diuretic for treatment of heart failure. Which of the following potassium levels would you hope to see for this patient?
4.0 mEq/L Explanation: One goal of treatment is to maintain normal serum potassium levels, which are between 3.5 mEq/L and 5.0 mEq/L. Levels below or above that range are indicative of hypokalemia or hyperkalemia, respectively
A patient receives furosemide intravenously at 9 AM. The nurse would expect to assess peak effects of the drug at which time? a) 9:30 AM b) 9:15 AM c) 10:30 AM d) 10:00 AM
9:30 AM Explanation: Furosemide, when given IV, peaks in 30 minutes; the nurse would see peak drug action at approximately 9:30 AM.
A hospital patient with peripheral edema has been prescribed furosemide (Lasix). How should the nurse best determine the extent of the patient's desired fluid loss? A) Assess the patient's skin turgor on a daily basis. B) Test the osmolarity of the patient's urine regularly. C) Weigh the patient daily. D) Auscultate the patient's chest each morning.
: C) Weigh the patient daily.
A clinic nurse has been assigned to follow up with a group of patients on hydrochlorothiazide therapy. Which patient will the nurse most closely monitor for hyponatremia?
A 71-year-old female who has advanced arteriosclerosis-While patients with diabetes or advanced arteriosclerosis should be monitored closely during hydrochlorothiazide therapy, older patients (over 65 years), especially women, are more at risk for hyponatremia. Older adults and their family members must be advised to report symptoms of hyponatremia such as weakness, nerve disorders, weight loss, salt hunger, cramps, and digestive problems.
An elderly patient with a history of heart failure has presented to the emergency department in respiratory distress. Assessment reveals the presence of pulmonary edema, and an infusion of IV furosemide (Lasix) has been ordered. For the duration of treatment, the nurse should prioritize assessments related to what nursing diagnosis? A) Risk for deficient fluid volume related to diuretic administration B) Risk for decreased cardiac output related to adverse effects of furosemide C) Ineffective health maintenance related to pulmonary edema D) Functional urinary incontinence related to diuretic administration
A) Risk for deficient fluid volume related to diuretic administration
An adult patient with a diagnosis of hypertension has had oral Lasix added to his medication regimen by his primary care provider. The nurse is planning a brief health education session with the patient in light of this change in his treatment plan. What goal should the nurse specify when planning this teaching session? A) The patient will identify strategies for limiting his sodium intake. B) The patient will describe the rationale for increasing his fluid intake. C) The patient will be able to demonstrate correct technique for blood glucose monitoring. D) The patient will accurately describe the basic structure and functions of the kidneys.
A) The patient will identify strategies for limiting his sodium intake.
A patient is switched from furosemide (Lasix) to spironolactone (Aldactone). The patient asks the nurse why she has been switched to a new medicine. What is the nurse's best response? A) "You will lose less potassium with spironolactone than with furosemide." B) "You will have greater potassium losses with spironolactone than with furosemide." C) "You will have greater water losses with spironolactone than with furosemide." D) "You will have greater sodium losses with spironolactone than with furosemide."
A: "You will lose less potassium with spironolactone than with furosemide."
Aldosterone levels would be affected if which gland was dysfunctional?
Adrenal
Some drugs can increase the effects of diuretics. Drugs from what category, when taken concomitantly with some diuretics, increase the risk of hearing loss? a) Oral contraceptives b) Aminoglycoside antibiotics c) Antihypertensive agents d) Corticosteroids
Aminoglycoside antibiotics Explanation: Additive ototoxicity can occur with concomitant use of some diuretics (e.g., ethacrynic acid) and aminoglycoside antibiotics. Concomitant use of antihypertensive agents can cause additive hypotensive effects; concomitant use of corticosteroids can lead to additive hypokalemia. Concomitant use of oral contraceptives can decrease the effects of diuretics, resulting in retention of water and sodium
A nurse is reviewing a newly admitted patient's medication administration record and notes that the patient takes a loop diuretic as well as a thiazide diuretic. The nurse understands what primary rationale for the concurrent use of these two drugs? A) Increased diuretic effect B) Reduced risk of potassium imbalances C) Decreased blood pressure without a risk of bradycardia D) Increased adherence to treatment
Ans: A) Increased diuretic effect
A patient has edema of the lower extremities with crackles in the lung bases. What diuretic is the nurse most likely to administer? A) Hydrochlorothiazide B) Furosemide C) Spironolactone D) Mannitol
Ans: B.) Furosemide
A physician has prescribed a bumetanide drug to a patient with renal insufficiency. The patient has high blood pressure. Which of the following instructions should the nurse include in the teaching plan for this patient? a) Always take the drug before meals. b) Avoid OTC drugs for appetite suppression. c) Omit the drug dose when feeling dizzy. d) Avoid salt substitutes containing potassium.
Avoid OTC drugs for appetite suppression. Explanation: The nurse should instruct the hypertensive patient to avoid medications that increase blood pressure, such as OTC drugs for appetite suppression and cold symptoms. The nurse should instruct patients taking potassium-sparing diuretics to refrain from using salt substitutes containing potassium, and not for patients taking loop diuretics such as bumetanide. The nurse need not instruct the patient to take the drug before meals since doing so will not decrease the patient's blood pressure. The nurse should instruct the patient to observe caution while driving or performing hazardous tasks when dizziness or weakness occurs. In such cases, the nurse instructs the patient to rise slowly from a sitting or lying position, and avoid standing in one place for an extended time.
A patient is receiving furosemide (Lasix) and a potassium supplement. When monitoring daily laboratory values, what should the potassium level be for this patient? A) 1.5 to 3.0 mEq/L B) 3.5 to 5.0 mEq/L C) 5.0 to 7.5 mEq/L D) 6.0 to 6.5 mEq/L
B) 3.5 to 5.0 mEq/L
A patient is admitted to the hospital with a diagnosis of heart failure. The patient is ordered to receive furosemide (Lasix) 40 mg IV. How soon after administration should the nurse expect to see evidence of diuretic effects? A.)1 minute B.) 5 minutes C.) 30 minutes D.) 2 hours
B.) 5 minutes
A patient has edema of the lower extremities and abdomen. What is the reason for administering a stronger diuretic than a thiazide diuretic to this patient? A.) A thiazide diuretic will reabsorb potassium in the distal tubule. B.) A thiazide diuretic will be ineffective for immediate diuresis. C.) A thiazide diuretic will provide peak effects in 2 hours. D.)A thiazide diuretic will be excreted in more than 72 hours.
B.) A thiazide diuretic will be ineffective for immediate diuresis.
A patient is administered furosemide (Lasix) 20 mg PO every morning. What effect will a diet high in sodium have on the patient? A.) Decreased blood pressure B.) Decreased diuresis C.) Hyperkalemia D.) Hyperglycemia
B.) Decreased dieresis Feedback:
A patient with hypertension has been prescribed a combination diuretic. What is the major purpose in administering a combination diuretic agent? A) It prevents sodium imbalance. B) It is less expensive than two medications. C) It prevents potassium imbalance. D) It prevents allergic reactions.
C) It prevents potassium imbalance.
A patient asks the nurse why she has to take two diuretics when her friend only takes one with a combination medication. The patient takes hydrochlorothiazide 75 mg every day with a potassium-sparing diuretic. What is the nurse's best response? A) "Maybe you should speak with your doctor about the combination." B) "I do not know why your doctor prefers that you take two medications." C) "It could be that you need a larger dose than is available in the combination medications." D) "The combination medications are not as effective as two medications."
C.) "It could be that you need a larger dose than is available in the combination medications."
The physician has ordered the patient hydrochlorothiazide. What assessment should the nurse make before administering the first dose of hydrochlorothiazide? A) Pulse rate B) Hemoglobin level C) Sulfonamide allergy D) Neutrophil level
C.) Sulfonamide allergy
Which statement by a client taking a sulfonamide requires further instruction? a) "I will take all of my medicine even if my symptoms go away." b) "I will take my medicine with my meals like it says on the prescription bottle." c) "I will make sure to use extra sunscreen when I go to the tanning booth." d) "I will be sure to drink a full glass of water every time I take my medicine."
Correct response: "I will make sure to use extra sunscreen when I go to the tanning booth." Explanation: Clients taking sulfonamides should avoid any exposure to sunlight or ultraviolet light, such as tanning beds or sunlamps. Extra sunscreen would not protect the client from the photosensitivity effect of the medication. The client is correct in stating that he would complete the entire course of the medication, would drink a full glass of water with each pill, and would take the medication with meals.
You are caring for a 53-year-old man with a 30-year history of alcohol dependency. He presents with ascites, secondary to cirrhosis. Which mechanism is involved in his fluid shift?
Decreased plasma oncotic pressure may occur with decreased synthesis of plasma proteins caused by liver disease
A physician has prescribed triamterene to a patient with renal disease. The patient informs the nurse that he is taking potassium supplements to overcome cardiovascular problems. What effect of the interaction between these two drugs should the nurse look for in the patient? a) Decreased diuretic effectiveness b) Increased risk of hyperkalemia c) Increased risk of arrhythmias d) Increased risk of bleeding
Correct response: Increased risk of hyperkalemia Explanation: The nurse should inform the patient about the increased risk of hyperkalemia as the effect of the interaction between triamterene, which is a potassium-sparing diuretic, and potassium supplements. When the patient is administered loop diuretics with anticoagulants or thrombolytics, there will be increased risk of bleeding. When the patient is administered digitalis with loop diuretics, there is an increased risk of arrhythmias. Decreased diuretic effect, in this case decreased effect of triamterene, will occur when a potassium-sparing diuretic such as triamterene is administered with NSAIDs, salicylates, and anticoagulants.
A physician is considering ordering hydrochlorothiazide for a patient. This drug must be used cautiously, if at all, if the patient has a history of
Correct response: hypersensativity to sulfonamides. Explanation: Thiazide diuretics, such as hydrochlorothiazide, are chemically related to sulfonamide drugs. Thiazides may be contraindicated in patients allergic to sulfonamides because of cross-sensitivity.
A patient is taking spironolactone (Aldactone). When providing patient teaching about this medication, what foods should the patient be instructed to avoid? A) Fish B) Apples C) Crackers D) Bananas
D) Bananas
A patient has been prescribed digoxin (Lanoxin) and furosemide (Lasix) for treatment of congestive heart failure. What is the patient at risk for developing with this combination of medications? A) Hyperkalemia B) Hyperglycemia C) Tachycardia D) Digoxin toxicity
D) Digoxin toxicity
A hospital patient with a diagnosis of liver failure has been prescribed a low dose of spironolactone in order to treat ascites. The nurse who is providing this patient's care should prioritize assessments for the signs and symptoms of what health problem? A) Peritonitis B) Liver cancer C) Cirrhosis D) Hepatic encephalopathy
D) Hepatic encephalopathy
A patient has been taking an ACE inhibitor and a beta-blocker for the treatment of hypertension but has been consistently obtaining blood pressure readings in the vicinity of 145/90 mm Hg. As a result, the patient's primary care provider has prescribed furosemide (Lasix). What order would be most consistent with this patient's health needs? A) Lasix 125 mg PO OD B) Lasix 40 mg IV TID C) Lasix 20 mg IV OD D) Lasix 40 mg PO BID
D) Lasix 40 mg PO BID
A patient is admitted to the emergency department and is unconscious as a result of a head injury. The patient's intracranial pressure is increased. What type of diuretic will the nurse most likely administer to the patient? A) Loop diuretic B) Potassium-sparing diuretic C) Thiazide diuretic D) Osmotic diuretic
D) Osmotic diuretic
An older adult patient has a complex medical history that includes heart failure, type 1 diabetes, and diabetic nephropathy. The nurse has questioned a care provider's order for oral spironolactone because the patient's health problems would contribute to a high risk of A) metabolic acidosis. B) hypocalcemia. C) hemolytic anemia. D) hyperkalemia.
D) hyperkalemia.
Upon her visit to your primary care physician's office, your patient presents with 14 pounds of additional weight since her visit 3 weeks ago. Her lower extremities are quite swollen, and her facial features are puffy. The physician prescribes a diuretic and requests a follow-up visit in 3 days. By what mechanism should the prescribed diuretic decrease the patient's onboard fluid? a) Sodium depletion b) Unknown mechanism c) Increasing plasma volume d) Decreasing plasma volume
Decreasing plasma volume Explanation: In edematous states, diuretics mobilize tissue fluids by decreasing plasma volume.
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?
Descending limb of loop of Henle Explanation: These drugs are freely filtered at the renal glomerulus, poorly reabsorbed by the renal tubule, not secreted by the tubule, and resistant to metabolism. Therefore Options A, C, and D are incorrect.
The pharmacology instructor is discussing the various diuretic agents and their sites of action in the nephron. In what part of the nephron do thiazide diuretics act?
Distal tubule-
When evaluating an 82-year-old patient receiving hydrochlorothiazide (HydroDIURIL), which of the following laboratory value deviations may be related to the medication?
Elevated uric acid levels Explanation: Uric acid excretion also is decreased because the thiazides interfere with its secretory mechanism. High levels of uric acid can result in a condition called gout. Hydrochlorothiazide does not cause reduced BUN levels. Options C and D are normal values.
When explaining the underlying mechanisms associated with renal failure, which would be mostimportant for the nurse to keep in mind?
Extensive kidney damage has usually occurred by the time the patient is symptomatic. Explanation: It is estimated that only about 25% of the total number of nephrons are necessary to maintain healthy renal function. That means that the renal system is well protected from failure with a large backup system. However, it also means that by the time a patient manifests signs and symptoms suggesting failure of the kidneys, extensive kidney damage has already occurred.
What term is used to describe the process that moves fluid and small particles out of the blood through the glomerulus and into the nephron tubule
Filtration
A client is admitted in acute renal failure and prescribed mannitol. The nurse prepares to administer this drug via which route?
Intravenously-Mannitol is administered intravenously. It is not given intramuscularly, subcutaneously, or orally.
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? a) Hydrochlorothiazide b) Furosemide c) Mannitol d) Triamterene
Furosemide Explanation: Furosemide can be given intravenously to provide rapid relief from pulmonary edema. Mannitol is not normally used to treat pulmonary edema and neither HCTZ nor triamterene is used in the acute treatment of pulmonary edema.
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? a) Triamterene b) Hydrochlorothiazide c) Mannitol d) Furosemide
Furosemide Explanation: Furosemide can be given intravenously to provide rapid relief from pulmonary edema. Mannitol is not normally used to treat pulmonary edema and neither HCTZ nor triamterene is used in the acute treatment of pulmonary edema.
A male client is excited because it is football season. He has season tickets and attends most games with his friends. At his latest appointment, the client's blood pressure is elevated. What does the nurse suspect is the cause?
He is consuming excessive salty foods at the games.-Excessive table salt and salty foods (e.g., ham, packaged sandwich meats, potato chips, dill pickles, most canned soups) may aggravate edema or hypertension.
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?
Hypokalemia
A 91-year-old patient is being discharged on the diuretic spironolactone (Aldactone). What is the major adverse effect of this type of medication?
Hyperkalemia
Your 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) Hypertension d) Gastric irritation
Hyperkalemia Explanation: The most common adverse effect of potassium-sparing diuretics is hyperkalemia, which can cause lethargy, confusion, ataxia, muscle cramps, and cardiac arrhythmias. This makes Options A, C, and D incorrect.
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 major adverse effect of potassium-sparing diuretics such as spironolactone is hyperkalemia. Clients receiving these drugs should not be given potassium supplements and should not be encouraged to eat foods high in potassium.
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-The nurse should know that potassium-sparing diuretics are contraindicated in clients with hyperkalemia and are not recommended for children. Potassium-sparing diuretics should be used cautiously in clients with liver disease, diabetes, or gout.
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? a) Hypocalcemia b) Hyperkalemia c) Hypokalemia d) Hypercalcemia
Hypokalemia Explanation: Thiazides, such as hydrochlorothiazide, are potassium-losing diuretics, and their use can lead to hypokalemia. Symptoms of hypokalemia include muscle weakness, dysrhythmia, hypotension, anorexia, and and shallow respirations.
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 physician has prescribed a loop diuretic for a patient with hypertension. The patient also has diabetes mellitus. What condition should the nurse monitor for in this patient after administering the prescribed drug? a) Sudden increase in weight b) Sudden pain in the joints c) Increased blood glucose levels d) Occurrence of gout attacks
Increased blood glucose levels Explanation: The nurse should monitor for increased blood glucose levels in the diabetic patient receiving a loop diuretic. The blood glucometer test results for glucose for these patients may be elevated (blood) or urine may test positive for glucose. Thiazide diuretic agents may cause gout attacks and sudden joint pain. The nurse need not monitor for a sudden increase in weight as the administration of loop diuretics to a diabetic patient will not cause this effect.
Hydrochlorothiazide works by what mechanism of action?
Increasing the excretion of sodium and chloride in the distal tubule Explanation: Hydrochlorothiazide acts in the distal tubule and possibly in the diluting segment of the ascending loop of Henle. It increases the excretion of sodium and chloride in the distal convoluted tubule by slightly inhibiting the ion pumps that work in sodium and chloride reabsorption. This action also inhibits water reabsorption.
Hydrochlorothiazide works by what mechanism of action? a) Increasing the excretion of sodium and chloride in the distal tubule b) Decreasing sodium absorption in the loop of Henle c) Increasing water reabsorption in the ascending loop of Henle d) Promoting increased chloride concentrations in the urine
Increasing the excretion of sodium and chloride in the distal tubule Explanation: Hydrochlorothiazide acts in the distal tubule and possibly in the diluting segment of the ascending loop of Henle. It increases the excretion of sodium and chloride in the distal convoluted tubule by slightly inhibiting the ion pumps that work in sodium and chloride reabsorption. This action also inhibits water reabsorption.
You are caring for a 53-year-old man with a 30-year history of alcohol dependency. He presents with ascites, secondary to cirrhosis, with weeping edema of his lower extremities. To decrease his onboard fluid, combination diuretic therapy is used. When his urine output doesn't meet the physician's expectations, what would you expect the physician to do with the low diuretic dosage? a) Decrease the dose b) Discontinue the diuretics c) Increase the dose d) Leave the dose the same
Leave the dose the same Explanation: In liver disease, small doses of all diuretics are usually indicated because diuretic-induced electrolyte imbalances may precipitate or aggravate hepatic coma. The physician may add additional diuretic drugs, but they would be low doses
Upon her visit to your primary care physician's office, your patient presents with 14 pounds of additional weight since her visit 3 weeks ago. Her lower extremities are quite swollen, and her facial features are puffy. The physician prescribes a diuretic and requests a follow-up visit in 3 days. Two days later, the patient contacts the office so dyspneic she is hard to understand over the phone. An ambulance is dispatched, and she is admitted to the hospital for rapid diuresing. Which diuretic will most likely be the initial drug of choice? a) Thiazide b) Loop diuretic c) Osmotic diuretic d) Potassium-sparing diuretic
Loop diuretic Correct Explanation: Loop diuretics are the diuretics of choice when rapid effects are required.
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
Ms. Crampton is prescribed furosemide for chronic heart failure. The nurse knows that furosemide can cause electrolyte imbalances and what other serious side effect? a) Compensated respiratory acidosis b) Metabolic alkalosis c) Compensated respiratory alkalosis d) Metabolic acidosis
Metabolic alkalosis Explanation: Most of furosemide's adverse effects relate to fluid or electrolyte imbalance. Electrolyte imbalances, which are most likely to occur within the first 2 weeks of therapy, include hyponatremia, hypokalemia, hypochloridemia, and hypocalcemia. Loss of hydrogen ions can also lead to metabolic alkalosis.
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
A group of students are reviewing the structure and function of the renal system. The students demonstrate understanding when they identify what as the functional unit?
Nephron
A patient has just been diagnosed with acute renal failure. The patient asks for information about the kidneys' functional unit. What would the nurse reply?
Nephron Explanation: The functional unit of the kidney is the nephron. There are about 2.4 million nephrons in an adult. These structures filter fluid and make urine. The glomerulus is a tuft of blood vessels with a capillary-like endothelium that allows easy passage of fluid and waste products. The renal pelvises are in a region of the kidney that drains urine into the ureters. The renal capsule is a protective layer, which is made up of the fiber layer, a peri-renal or brown fat layer, and the renal parietal layer.
The client has just been diagnosed with acute renal failure. The client asks the nurse what functional units of the kidneys are involved. What would the nurse reply?
Nephrons
A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route?
Oral-Hydrochlorothiazide is only available as an oral preparation. Only chlorothiazide can be given by intravenous infusion.
A nurse is caring for a 78-year-old patient with renal insufficiency and chronic heart failure who is receiving rapid infusions of high-dose furosemide. It will be a priority for the nurse to monitor for a) dehydration. b) vascular thrombosis. c) ototoxicity. d) hepatic encephalopathy.
Ototoxicity can occur with rapid intravenous administration, especially in patients with poor renal function and in those receiving high doses of furosemide. Although usually transient, ototoxicity may result in permanent damage. Rapid infusions of high-dose furosemide would not place the patient at risk for hepatic encephalopathy. Excessive diuresis from furosemide can result in dehydration and vascular thrombosis, but they would not be the priority in this case.
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 greater with spironolactone b) Water losses are greater with spironolactone c) Sodium losses are greater with spironolactone d) Potassium losses are less with spironolactone
Potassium losses are less with spironolactone Correct Explanation: The potassium-sparing diuretics are not as powerful as the loop diuretics, but they retain potassium instead of wasting it. Therefore Options B, C, and D are incorrect.
A clinical nurse educator on a nephrology and dialysis unit is reviewing renal physiology with a nursing student who is completing a preceptorship on the unit. The student should be aware that a majority of reabsorption takes place in what anatomical location? A) Ureters B) Proximal tubule C) Efferent arteriole D) Afferent arteriole
Proximal tubule
About 80% of water, sodium, potassium, and other substances is reabsorbed during renal processing; the remaining 20% enters the loop of Henle. What substance is reabsorbed in the ascending limb of the loop of Henle? a) Amino acids b) Sodium c) Glucose d) Water
Sodium Explanation: In the ascending limb of the loop of Henle, sodium is reabsorbed.
Diuretics can either block the reabsorption of components of the urine, or they can 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 diuretics? a) The amount of sodium and chloride reabsorption that it blocks b) The amount of sodium and chloride that it excretes through the kidney c) The amount of water reabsorption back into the body d) The amount of water excreted by the body
The amount of sodium and chloride reabsorption that it blocks Explanation: The increase in urine flow that a diuretic produces is related to the amount of sodium and chloride reabsorption that it blocks. The other answers are not correct.
What best describes the structure of the kidneys?
The renal pelvises drain urine into the ureters.
A nurse understands that loop diuretics are considered high ceiling diuretics because of which of the following? a) They require large doses to achieve effect. b) They are associated with more adverse effects. c) They cause a greater diuresis. d) They cause a greater loss of potassium.
They cause a greater diuresis. Explanation: High ceiling diuretics are those that cause a greater degree of diuresis than other diuretics.
Why would potassium-sparing diuretics be contraindicated for clients experiencing renal failure?
They may cause hyperkalemia. Explanation: Potassium-sparing diuretics are contraindicated in the presence of renal insufficiency because their use may cause hyperkalemia because of the kidneys' ineffective filtration abilities. The remaining options would not result from impaired renal failure.
The class of diuretics that act to block the chloride pump in the distal convoluted tubules and leads to a loss of sodium and potassium and a minor loss of water is what? a) Carbonic anhydrase inhibitors b) Osmotic diuretics c) Thiazide diuretics d) Potassium-sparing diuretics
Thiazide diuretics Correct Explanation: Thiazide diuretics work to block the chloride pump, which leads to a loss of sodium and potassium and some water. They are considered mild diuretics. Carbonic anhydrase inhibitors work to block the formation of carbonic acid and bicarbonate in the renal tubules. Osmotic diuretics use hypertonic pull to remove fluid from the intravascular spaces and to deliver large amounts of water into the renal tubules. Potassium-sparing diuretics are mild and act to spare potassium in exchange for the loss of sodium and water
Your 92-year-old patient is being seen for follow-up after her latest hospital discharge in her 15-year history of HF. To decrease her cardiac workload, what type of diuretic has she most likely been using in the management of her long-term HF? a) Potassium-sparing diuretic b) Osmotic diuretic c) Thiazide d) Loop diuretic
Thiazides and related diuretics are frequently prescribed in the long-term management of heart failure and hypertension.
When describing the process of tubular reabsorption, which substances would the instructor include as being reabsorbed regularly?
With tubular reabsorption, about 99% of the water is reabsorbed along with vitamins, glucose, electrolytes, sodium bicarbonate, and sodium chloride.
Aldosterone levels would be affected if which gland was dysfunctional?
adrenal
The nurse, who works in the emergency department, is aware that the renin-angiotensin-aldosterone system works to maintain blood flow in the kidneys. What vital sign would signify the initiation of this system in a trauma client?
decreased Explanation: The renin-angiotensin-aldosterone system is initiated in response to changes in blood volume, so that a decrease in blood pressure would be most likely to initiate this system. An increase in temperature, a decrease in pulse, and a pain level of 3 would not affect blood volume.
A female patient reports that she has frequent muscle cramps while on hydrochlorothiazide therapy. The nurse will advise her to a) take calcium supplements. b) eat potassium-rich foods. c) include high-sodium foods in her diet. d) drink plenty of fluids.
eat potassium-rich foods. Explanation: The patient is most likely experiencing muscle cramps due to potassium loss. Therefore, the nurse should advise her to include potassium supplements in her diet. Drinking plenty of fluids or using calcium supplements will not reduce the occurrence of cramps. It is important to caution the patient to avoid foods high in sodium because they could counteract the effects of drug therapy
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 Explanation: Furosemide is less powerful than bumetanide and torsemide and therefore has a larger margin of safety for home use (see the Critical Thinking Scenario in this chapter for additional information about using furosemide in heart failure). Ethacrynic acid is used less frequently in the clinical setting because of the improved potency and reliability of the newer drugs.
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 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 Explanation: The major adverse effect of potassium-sparing diuretics such as spironolactone is hyperkalemia. Clients receiving these drugs should not be given potassium supplements and should not be encouraged to eat foods high in potassium.
A health care provider is considering ordering hydrochlorothiazide for a client. This drug must be used cautiously, if at all, if the client has a history of:
hypersensitivity to sulfonamides.
A client comes to the clinic for a 1-month follow-up appointment. The client states taking chlorothiazide (Diruil) for the month it has been prescribed and now has leg cramps and "feels tired all the time." What will the nurse consider as the cause of the patient's symptoms?
hypokalemia Explanation: Hypokalemia is caused by the loss of potassium in the distal tubule and causes muscle weakness, fatigue, and arrhythmias. Hyperkalemia presents with cardiac arrhythmias and occasionally muscle weakness. Hypercalcemia is characterized by fatigue, depression mental confusion, nausea, vomiting, and constipation. Hypocalcemia presents with muscle spasms, facial grimacing, possible convulsions, irritability, and depression.
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
A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route?
oral Explanation: Hydrochlorothiazide is only available as an oral preparation. Only chlorothiazide can be given by intravenous infusion.
The students are studying the male reproductive system. The instructor tells the students that in the male, the urethra leaves the urinary bladder and passes through the:
prostate gland.
A nurse obtains an allergy history from a client based on the understanding that which class is associated with a cross-sensitivity reaction with sulfonamides?
thiazide diuretics
Aldosterone acts on the renal tubules to retain sodium and water.
true
During ongoing assessment of clients taking metolazone (Zaroxolyn), the nurse monitors for signs of hypokalemia. Which of the following are signs of hypokalemia? Select all that apply: a) Depression b) Anorexia c) Diarrhea d) Drowsiness e) Hypoglycemia
• Anorexia • Depression • Drowsiness Explanation: The following are signs of hypokalemia: anorexia, nausea, vomiting, depression, confusion, cardiac arrhythmias, impaired thought process, and drowsiness.
(see full question) Clients with an allergy to sulfamethoxazole/trimethoprim (Septra) may have cross-sensitivity reactions with which of the following diuretics?
• Chlorothiazide (Diuril) • Chlorthalidone (Thalitone) • Metolazone (Zaroxolyn) Explanation: A cross-sensitivity reaction may occur with the thiazides (chlorothiazide, chlorthalidone, and metolazone) and sulfonamides (sulfamethoxazole).
Which of the following clients are at the highest risk of developing hyperkalemia with the use of amiloride (Midamor)?
• Clients with diabetes • Clients with renal disease Explanation: Hyperkalemia is most likely to occur in clients with an inadequate fluid intake and urine output, those with diabetes or renal disease, the elderly, and those who are severely ill
Choice Multiple question - Select all answer choices that apply. Which of the following drugs cause diuresis by inhibiting re-absorption of sodium and chloride ions in the distal and proximal tubules and in the loop of Henle? Select all that apply: a) Spironolactone (Aldactone) b) Furosemide (Lasix) c) Chlorothiazide (Diuril) d) Mannitol (Osmitrol) e) Bumetanide (Bumex)
• Furosemide (Lasix) • Bumetanide (Bumex) Explanation: Loop diuretics, like furosemide (Lasix) and bumetanide (Bumex), cause diuresis by inhibiting re-absorption of sodium and chloride ions in the distal and proximal tubules and in the loop of Henle.
The client has been taking hydrochlorothiazide for hypertension. Which of the following manifestations would lead the nurse to believe the client is experiencing hyponatremia?
• Hypotension • Confusion • Tachycardia Explanation: Symptoms of hyponatremia include irritability, hypotension (not hypertension), tachycardia, and confusion. Lethargy is not related to hyponatremia
Choice Multiple question - Select all answer choices that apply. The nurse understands that the action of most diuretics typically results in which of the following? Select all that apply. a) Retention of sodium b) Retention of potassium c) Loss of chloride d) Loss of calcium e) Loss of water
• Loss of water • Loss of chloride Explanation: Most diuretics result in the loss of water, sodium, and chloride along with the sodium. Potassium may or may not be lost depending on the type of diuretic used. Calcium typically is not affected by diuretics.
The nurse understands that the action of most diuretics typically results in which of the following?
• Loss of water • Loss of chloride Explanation: Most diuretics result in the loss of water, sodium, and chloride along with the sodium. Potassium may or may not be lost depending on the type of diuretic used. Calcium typically is not affected by diuretics.
