Chapter 51: Diuretic Agents

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

"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 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? 8:15 AM 8:30 AM 8:45 AM 9:00 AM

8:30 Furosemide, when given intravenously, begins to act in 5 minutes, reaching peak effects in 30 minutes. In this case, this would be 8:30 AM.

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? Furosemide Hydrochlorothiazide Mannitol Triamterene

Furosemide 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 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? Ammonia absorption Subtherapeutic drug levels Hepatic encephalopathy Hepatomegaly

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 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 Hyperkalemia Hypokalemia

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.

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

Loop of Henle Bumetanide is a loop diuretic that blocks the chloride pump in the ascending loop of Henle. It also has a similar effect in the descending loop and in the distal convoluted tubule.

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 client will describe the rationale for increasing fluid intake. * The client will be able to demonstrate correct technique for blood glucose monitoring. *The client will accurately describe the basic structure and functions of the kidneys.

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.

An elderly client 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 has been prescribed. For the duration of treatment, the nurse should prioritize assessments related to which expected age-related dysfunctions? Select all that apply. cardiac function cognitive function respiratory function renal function hepatic functio

cardiac function renal function hepatic function In general, dose selection for the older adults requires caution reflecting the increased likelihood that older adults have decreased cardiac, renal, or hepatic function. This medication therapy has a lower risk for effecting respirations or cognition.

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 care provider has prescribed furosemide. What order would be most consistent with this client's health needs? furosemide 125 mg PO OD furosemide 40 mg IV TID furosemide 20 mg IV OD furosemide 40 mg PO BID

furosemide 40 mg PO BID For hypertension, furosemide is commonly given as 40 mg PO twice daily and gradually increased if necessary.

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 liver disease gout diabetes

hyperkalemia 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 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. The nurse should inform the client 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 client is administered loop diuretics with anticoagulants or thrombolytics, there will be increased risk of bleeding. When the client 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.

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." "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." 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 client has edema of the lower extremities and abdomen. What is the reason to administer a stronger diuretic than a thiazide diuretic to this client? *A thiazide diuretic will reabsorb potassium in the distal tubule. *A thiazide diuretic will be ineffective when immediate diuresis is needed. *A thiazide diuretic will provide peak effects in 2 hours. *A thiazide diuretic will be excreted in more than 72 hours.

A thiazide diuretic will be ineffective when immediate diuresis is needed. Thiazide diuretics are ineffective when immediate diuresis is required. A thiazide diuretic acts to reabsorb sodium, not potassium, in the distal convoluted tubule. A thiazide diuretic reaches its peak in 4 to 6 hours. A thiazide diuretic is excreted in 72 hours maximum.

The client is receiving triamterene. The nurse instructs the client to avoid what foods? (Select all that apply.) Bananas Prunes Lettuce Broccoli Apples

Prunes Broccoli Bananas Foods high in potassium should be avoided. These would include bananas, prunes, and broccoli.

A client, prescribed digoxin and furosemide, is at risk for developing which adverse effect? * hyperkalemia *hyperglycemia *tachycardia *digoxin toxicity

digoxin toxicity When digoxin and diuretics are used concomitantly, the risk of digoxin toxicity is increased. The client is at risk for hypokalemia, not hyperkalemia. The client is not at risk for hyperglycemia or tachycardia

A hospital client 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 client's care should prioritize assessments for the signs and symptoms of what health problem? peritonitis liver cancer cirrhosis hepatic encephalopathy

hepatic encephalopathy Spironolactone is used in the treatment of ascites. However, it should be used cautiously and carefully monitored in clients with significant hepatic impairment because a rapid change in fluid and electrolyte balance may lead to hepatic coma. It is important to monitor susceptible clients carefully for signs and symptoms of hepatic encephalopathy. There is no risk for liver cancer, cirrhosis, or peritonitis that results directly from the use of spironolactone.

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 Bell peppers Mushrooms Fresh pineapple

Fresh pineapple The nurse will advise the patient to avoid foods high in potassium, which include apricots, avocados, bananas, cantaloupe, fish, honeydew, kiwi, meat, milk, oranges, potatoes, poultry, prunes, spinach, sweet potatoes, tomatoes, winter squash, and yams. Triamterene achieves its diuretic effect by inhibiting transport of sodium in the distal tubules independent of aldosterone. This mechanism causes increased loss of sodium, water, bicarbonate, and calcium and promotes retention of potassium and magnesium. Hyperkalemia can be a serious adverse effect of the drug. Reference:

A nurse understands that loop diuretics are considered high ceiling diuretics because they: cause a greater diuresis. are associated with more adverse effects. cause a greater loss of potassium. require large doses to achieve effect.

High ceiling diuretics are those that cause a greater degree of diuresis than other diuretics.

patient is receiving bumetanide. The nurse would instruct the patient to be alert for what issues? (Select all that apply.) Hypotension Dizziness Weakness Muscle cramps Irreversible hearing loss

Hypotension Dizziness Weakness Muscle cramps Bumetanide may cause hypotension and dizziness due to the rapid fluid loss, reversible hearing loss, and signs and symptoms of hypokalemia, such as weakness and muscle cramps.

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? Spironolactone Bumetanide Mannitol Ethacrynic acid

Mannitol is an osmotic diuretic used frequently in cases of increased ICP. Bumetanide and ethacrynic acid are loop diuretics, and spironolactone is a potassium-sparing diuretic.

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 best answer that will provide patient education regarding the change? "You will lose less potassium with spironolactone than with furosemide." "You will have greater potassium losses with spironolactone than with furosemide." "You will have greater water 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 Spironolactone promotes retention of sodium and water and excretion of potassium by stimulating the sodium-potassium exchange mechanism in the distal tubule. The patient will not have greater potassium losses, water losses, or sodium losses with spironolactone rather than furosemide.

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

furosemide Loop diuretics, like furosemide, are the diuretics of choice when rapid effects are required since they produce extensive diuresis for short periods, after which the kidney tubules regain their ability to reabsorb sodium. Thiazide diuretics, like hydrochlorothiazide, are the drugs of choice for most clients who require diuretic therapy, especially for long-term management of heart failure and hypertension. In clients with heart failure and inadequate renal function, the addition of spironolactone, a potassium-sparing diuretic, allows smaller doses of loop diuretics and potassium supplements to be administered as spironolactone reduces urinary potassium loss. Osmotic diuretics, like mannitol, are useful in managing oliguria or anuria, and it may prevent acute renal failure (ARF) during prolonged surgery, trauma, or infusion of cisplatin, an an

When preparing the teaching plan for a male client who is prescribed spironolactone, the nurse would alert the client to the possibility of which of the following? Gynecomastia Erectile dysfunction Priapism Alopecia

gynecomastia The nurse should advise male clients taking spironolactone that gynecomastia may occur. Erectile dysfunction, priapism, and alopecia are not associated with the drug.

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 spironolactone than with hydrochlorothiazide. *Potassium losses are greater with hydrochlorothiazide than with spironolactone. *Spironolactone is more likely to be taken with a potassium supplement. *The two diuretics act in different parts of the nephron

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.

Upon her visit to the primary care provider's office, a female client 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 provider prescribes a diuretic and requests a follow-up visit in 3 days. Two days later, the client contacts the office and is so dyspneic that 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? Loop diuretic Thiazide Potassium-sparing diuretic Osmotic diuretic

Loop diuretics Loop diuretics are the diuretics of choice when rapid effects are required.

Ms. Crampton is prescribed furosemide for chronic heart failure. The nurse knows that furosemide can cause electrolyte imbalances and what other serious side effect? Metabolic alkalosis Metabolic acidosis Compensated respiratory alkalosis Compensated respiratory acidosis

Metabolic alkalosis 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.

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

"It's okay to take it with food." Instructions for a client taking a diuretic include taking the drug with food or meals if gastrointestinal upset occurs, taking the dose early in the morning to prevent interfering with sleep, implementing safety precautions if dizziness or weakness is a problem, and ensuring adequate fluid intake to prevent fluid rebound. It is not necessary to lie down after taking the drug.

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 *Increased blood glucose levels *Occurrence of gout attacks *Sudden increase in weight

Increased blood glucose levels The nurse should monitor for increased blood glucose levels in the diabetic client receiving a loop diuretic. The blood glucometer test results for these clients may be elevated, 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 client will not cause this effect. Reference: