Ch 51: Diuretic Agents
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."
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."
Which instruction would be most appropriate for a client who is taking a diuretic?
"It's okay to take it with food."
The nurse is caring for a client who is receiving mannitol. The nurse knows that it is used to manage oliguria or anuria. The nurse knows that it is also used for what other conditions?
-Reduction of intraocular pressure -Urinary excretion of toxic substances -Reduction of intracranial pressure
A client is receiving hydrochlorothiazide. The nurse would expect this drug to begin acting within which time frame?
2 hours
What is the term for the action of a diuretic in a patient with glaucoma?
osmotic pull
What would contraindicate the use of indapamide?
renal disease
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.
When providing medication teaching to a client who has been prescribed spironolactone, what foods should the nurse instruct the client to avoid?
Bananas
When describing the action of chlorothiazide, what would a nurse include?
Blocking of the chloride pump (Rationale: Chlorothiazide, a thiazide diuretic, blocks the chloride pump. Carbonic anhydrase inhibitors such as acetazolamide block the action of carbonic anhydrase. Spironolactone, a potassium-sparing diuretic, acts as an aldosterone antagonist. Amiloride and triamterene, potassium-sparing diuretics, block potassium secretion through the tubule.)
A client presents with ascites, secondary to cirrhosis. What mechanism is involved in this fluid shift?
Decreased plasma oncotic pressure
What type of diet should a patient taking diuretics have?
Eat potassium-rich or low-potassium diet as appropriate
A nurse is caring for a patient with edema due to congestive heart failure (CHF). The physician has prescribed indapamide to the patient. The patient is also undergoing treatment with digitalis glycoside. Which intervention should the nurse perform when caring for this patient?
Frequently monitor the patient's pulse rate and rhythm
When preparing the teaching plan for a male client who is prescribed spironolactone, the nurse would alert the client to which potential adverse effect?
Gynecomastia
A client who is allergic to sulfonamide would use what diuretic cautiously?
Hydrochlorothiazide There is a known cross-sensitivity of some sulfonamide-allergic clients to sulfonamide nonantibiotics, such as thiazides.
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
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
Which would the nurse expect to find in a client receiving acetazolamide?
Metabolic acidosis Metabolic acidosis is a relatively common and potentially dangerous effect that occurs when bicarbonate is lost due to the action of carbonic anhydrase inhibitors. Metabolic alkalosis would occur if bicarbonate were retained. No respiratory acid-base imbalances are associated with this drug
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 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 For clients with cirrhosis, diuretic therapy should be initiated in a hospital setting, with small doses and careful monitoring. To prevent hypokalemia and metabolic alkalosis, supplemental potassium or spironolactone may be needed.
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.
A patient is receiving acetazolamide in a sustained release form. The nurse would anticipate the onset of drug action in approximately which time frame?
2 hours
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 For hypertension, furosemide is commonly given as 40 mg PO twice daily and gradually increased if necessary.
A male client is prescribed potassium-sparing diuretics to treat his disease process. During his annual visit to the health care provider, he reports experiencing muscle weakness and tingling in his fingers. What does the nurse suspect is wrong with this client?
Hyperkalemia Potassium-sparing diuretics are contraindicated in clients with renal impairment because of the high risk of hyperkalemia
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 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.
Because of the action of methazolamide, the nurse would assess a patient closely for signs and symptoms of which acid-base imbalance?
Metabolic acidosis Rationale: Methazolamide is a carbonic anhydrase inhibitor that can cause metabolic acidosis, not alkalosis, due to the loss of bicarbonate. It is not associated with either respiratory acidosis or alkalosis.
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 preparing to administer a diuretic that antagonizes the action of aldosterone. Which drug would the nurse be most likely to administer?
Spironolactone is a potassium-sparing diuretic that exerts its diuretic effect by antagonizing the action of aldosterone.
A 64-year-old patient is admitted to the emergency department with pulmonary edema. The physician orders furosemide 40 mg IV. If the drug is available in a 100 mg/10 mL preparation, how will the nurse administer it?
The nurse will administer 4 mL over 1 to 2 minutes.
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 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. The client is most likely experiencing muscle cramps due to potassium loss.
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.
A 75-year-old client is diagnosed with atrial fibrillation and chronic congestive heart failure. The health care provider orders a combination of digoxin and diuretics to treat the client's diseases. Recent laboratory results indicate that the client's potassium level is 2 mEq/L. This client is at risk for which problem?
Digoxin toxicity
Which diuretic will most likely be the initial drug of choice when a client demonstrates dyspnea related to pulmonary edema?
Furosemide
What sign is most indicative of dehydration in a patient taking diuretics?
body weight
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 client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route?
oral
A client receives a dose of furosemide intravenously at 8:00 AM. The nurse would expect this drug to exert is peak effects at which time?
8:30 am
A patient receives furosemide intravenously at 9 AM. The nurse would expect to assess peak effects of the drug at which time?
9:30 am
A male client has cirrhosis of the liver that has caused ascites. The nurse knows that what condition may occur if diuretics are used to reduce the ascites?
Hepatic encephalopathy Diuretics are often used to manage edema and ascites in clients with hepatic impairment. These drugs must be used with caution, because diuretic-induced fluid and electrolyte imbalances may precipitate or worsen hepatic encephalopathy and coma.
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
An adult client with a diagnosis of hypertension has been prescribed oral furosemide. What goal should the nurse identify when planning this client's medication teaching session?
The client will identify strategies for limiting sodium intake. The reason for furosemide use should guide client teaching. In most instances, it is necessary to initiate measures to limit sodium intake. Key considerations should include not adding salt to food during preparation or at the dinner table, reading food labels carefully to be aware of hidden sources of sodium, and avoiding processed or high-sodium foods. Blood glucose monitoring is not indicated, and there is no need for increased fluid intake. Renal anatomy and physiology are not priority teaching points.
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
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 client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered
mannitol
A client is admitted to the emergency department with pulmonary edema. What diuretic does the nurse expect the health care provider to prescribe to achieve rapid therapeutic effect?
loop diuretic
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 has been prescribed both digoxin and furosemide. The nurse should monitor the client for development of what adverse effect?
Digoxin toxicity
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.
The pharmacology instructor is discussing the differences among the various diuretic agents. Which would the instructor cite as a difference between spironolactone and hydrochlorothiazide?
Potassium losses are greater with hydrochlorothiazide than with spironolactone. Unlike hydrochlorothiazide, sprionolactone is a potassium-sparing diuretic. To avoid the risk of hyperkalemia, patients receiving potassium-sparing diuretics should not be given supplemental potassium. Both diuretics act in the distal tubule of the nephron.
A nurse demonstrates understanding of diuretics when identifying which medication as exerting its effect by inhibiting the enzyme carbonic anhydrase?
acetazolamide
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
