Diuresis, E28
Which statement made by the nursing student indicates the need for further education on recording intake and output of fluids in patients receiving diuretics? " should check the patient's weight daily." "I should measure the patient's abdominal girth.' "A patient's intake and output should be measured every 4 hours "I should record the degree of edema present in the patient's legs.
"A patient's intake and output should be measured every 4 hours' Rationale The nurse should monitor a patient's intake and output at the end of each shift and total the intake and output every 24 hours, not every 4 hours. The nurse should perform a daily weight check, measure the abdominal girth, and record the degree of edema presentin the patient's legs to assess fluid intake and output.
Which statements made by the nursing student indicate effective learning about the use of triamterene (Dyrenium)? Select all that apply. "I should note any reduction in hearing." "I should check for symptoms of acute gout." "I should ask about any preexisting problems with libido." "I should obtain baseline data such as vital signs and lung sounds." "I should collect data related to the patient's mental status.'
"I should obtain baseline data such as vital signs and lung sounds." "I should collect data related to the patient's mental status.' Rationale The nursing implications for triamterene (Dyrenium) are to obtain baseline data such as vital signs, lung sounds, and data related to the patient's mental status. Noting any reduction in hearing is related to the nursing implications for sulfonamide-type loop diuretics. Checking for symptoms of acute gout is related to effects caused by sulfonamide-type loop diuretics. Asking about any preexisting problems with libido is related to the potential side effects of spironolactone (Aldactone).
Which statement made by the e patient indicates the need for further education about amiloride (Midamor)? "I should initially start taking mg of the drug daily." "I should take the drug with food or milk." "I should take the drug in the midafternoon." "I should increase my dosage by 5-mg increments up to 20 mg a day."
"I should take the drug in the midafternoon." Rationale The patient should not administer amiloride (Midamor) in the midafternoon because this drug may cause nocturia. The patient should initially start with a daily dose of5 mg. The patient should take the medication with food or milk to prevent gastric irritation. The patient should increase the dosage in 5-mg increments up to 20 mg daily while having his or her electrolytes closely monitored as instructed by the healthcare provider.
Which statement by a patient taking furosemide indicates effective learning on ways to prevent xerostomia and oral irritation? " will suck hard candy if experience oral irritation." "I will suck ice chips if l experience oral irritation." "I will use a commercial mouthwash that contains alcohol.' "I will use l tsp of hydrogen peroxide in 200 mL of water as a mouthwash."
"I will use 1 tsp of hydrogen peroxide in 200 mL of water as a mouthwash." Rationale Xerostomia, or dry mouth, and oral irritation are common adverse effects related to furosemide. Regular oral hygiene should be maintained by using a mouthwash that contains l tsp of hydrogen peroxide in 200 ml of water. Sucking hard candies and ice chips may alleviate dry mouth but not irritation. Using commercial mouthwashes that contain alcohol may cause further drying and oral irritation.
Which statement given by a patient indicates the need for further education about a potassium-sparing diuretic? Select all that apply. "I will sit or lie down if I feel faint." "I will take the medication in the morning." "I will weigh myself daily after breakfast." "I will eliminate foods that are high in potassium.' "I will weigh myself daily using the same scale and at the same time."
"I will weigh myself daily after breakfast." "I will eliminate foods that are high in potassium.' Rationale A daily weight measurement should be performed before breakfast, not after it. Foods that are high in potassium should be moderately restricted but not withheld from the diet. Diuretic therapy may produce postural hypotension; therefore the patient should sit or lie down if he or she feels faint. Diuretics should be taken in the morning to avoid nocturia. Weight changes are the best indicators of fluid loss or gain. Therefore weighing oneself daily using the same scale and at the same time will help the patient.
Which instruction would be given to a patient who is taking a thiazide diuretic and reports gastric irritation? "Take the medicine with food or milk." "Take the drug before midafternoon." "It's a common adverse effect." "Reduce the dose of the drug to half the initial dose."
"Take the medicine with food or milk." Rationale The administration of thiazide diuretics with food or milk reduces gastric irritation. To prevent nocturia, the drug should be taken before midafternoon. Gastric irritation is a serious adverse effect. ofa thiazide diuretic, nota common adverse effet. Reducing the dose of the drug by half is not appropriate because this action may not treat the disease effectively.
Which instruction would the nurse give to a patient with renal disease who is concurrently taking furosemide (Lasix) and naproxen (Naprelan)? Select all that apply. "You should discontinue your dose of naproxen (Naprelan).' "Your dose of furosemide (Lasix) should be increased." "Your potassium levels should be checked and monitored closely for hypokalemia.' "You should be tested regularly for early indications of hyperuricemia." "You require close monitoring for dehydration and electrolyte imbalance."
"You should discontinue your dose of naproxen (Naprelan). "Your dose of furosemide (Lasix) should be increased." Rationale Nonsteroidal anti-inflammatory drugs (NSAlDs) such as naproxen (Naprelan) inhibit the diuretic activity of the sulfonamide-type loop diuretics Either the NSAID should be discontinued or the dose of furosemide (Lasix should be increased. The dose of naproxen (Naprelan) should not be increased. When corticosteroids are used with furosemide (Lasix for all patients, potassium levels should be checked and the patient monitored closely for hypokalemia. A patient with previous history of gouty arthritis should be monitored for early indications of hyperuricemia. A patient who is using furosemide (Lasix),a sulfonamide-type loop diuretics, and metolazone concurrently should be closely monitored for dehydration and electrolyte imbalance.
Normal creatinine
0.6-1.2
When a patient is vomiting and has diarrhea, the patient is likely to have which level of serum potassium? 2.5mEq/L 3.8 mEq/L 4.9 mEq/L 5.7mEq/L
2.5mEq/L Rationale A serum potassium level below 3.5 mEq/L indicates hypokalemia, which is s especially likely to occur when a patient exhibits vomiting, diarrhea, or heavy diuresis. Therefore a patient with a serum potassium level of 2.5mEq/Lis hypokalemic. The normal blood potassium level ranges from 3.5to 5.5mEq/L.
What would be the appropriate initial oral dose of ethacrynic acid (Edecrin) per ' day for an 8-year-old patient who weighs 55 pounds? Record your answer using a whole number.
25 Rationale The initial oral dose of ethacrynic acid (Edecrin) for pediatric patients mg/kg once a day. Therefore for an 8-year-old child weighing 55 pounds, the weight would be converted to kilograms:55/2.2=25 kg.' The dose would be lx25 =25mg.
Normal BUN
8-25
A patient is ordered IV furosemide (Lasix). The nurse administers this drug over how many minutes? A. 2 to 4 B. 5 to 7 C. 1 to 2 D. 4 to 5
A
For which adverse effects does the nurse monitor in a patient taking bumetanide (Bumex) and gentamicin (Garamycin)? A. Hearing loss B. Increased potassium loss C. Increased seizure activity D. Increased renal failure
A Rationale Bumetanide (Bumex) with gentamicin (Garamycin) has the potential to increase the risk of ototoxicity. The nurse should monitor the patient for gradual changes in hearing. Observe if the patient is speaking more loudly, asks for statements to be repeated, or turns the TVorradio volume progressively louder. This combination of medications does not increase the incidence of seizures, renal failure, or potassium loss in the urine.
Which nursing orders are found in the care plan for a patient receiving furosemide (Lasix)? (Select all that apply.) A. Rise slowly from a sitting or supine position Correct B. Monitor for signs of hypokalemia C. Administer medication 1 hour before or 2 hours after meals Incorrect D. Perform weekly weights after breakfast E. Provide hard candy or ice to prevent dry mouth
A, B, E Rationale Furosemide may cause hypokalemia because the medication stimulates the conservation of sodium and excretion of potassium. The nurse would monitor the patient for common signs of hypokalemia, including weakness, muscle aches, and changes in heart rhythm. Orthostatic hypotension is a known side effect of furosemide. Teaching the patient to rise slowly from a sitting or supine position will help prevent the patient from becoming dizzy and/or sustaining a fall. Dry mouth is common with furosemide use, so providing the patient with hard candy or ice chips can alleviate this Patients taking furosemide should be weighed daily to monitor fluid status; weekly is not often enough. Furosemide does not need to be taken on an empty stomach. It is more important to administer the dose at the same time every morning.
Which medication is a potassium sparing diuretic? a. Acetazolamide (Diamox) b. Spironolactone (Aldactone) c. Furosemide (Lasix) d. Bumetanide (Bumex)
ANS: B Spironolactone is a potassium sparing diuretic that blocks the sodium retaining and potassium and magnesium excreting properties of aldosterone. This results in loss of water, with increased sodium excretion and retention of potassium. Acetazolamide is a carbonic anhydrase inhibitor and does not spare potassium. Furosemide is a loop diuretic. Bumetanide is a loop diuretic and does not spare potassium
How soon will diuresis be expected to occur after the nurse has administered 20 mg of furosemide (Lasix) intravenously (IV) to a patient with heart failure? a. As soon as injected b. Within 10 minutes c. After 2 hours d. After 4 hours
ANS: B The onset of diuresis following IV furosemide administration is 5 to 10 minutes after administration. The diuretic effect peaks within 30 minutes and lasts approximately 2 hours
Which foods will the nurse recommend for a patient taking loop diuretics? a. Protein-rich foods such as poultry, whole grains, and fish b. Fiber-rich foods such as yellow vegetables, nuts, and lentils c. Potassium-rich foods such as raisins, figs, and bananas d. Sodium-rich foods such as canned vegetables and processed foods
ANS: C Loop diuretics deplete potassium. Potassium-rich foods include raisins, figs, bananas, peaches, kiwis, dates, apricots, oranges, prunes, melons, broccoli, and potatoes. Protein- and fiber-rich foods are not needed in increased amounts by patients taking loop diuretics. Because of high sodium content, canned foods are restricted for patients on diuretic therapy.
What would the nurse anticipate if a patient with a history of type 2 diabetes is prescribed a thiazide diuretic? a. No change in the antidiabetic regimen b. Decreased need for antidiabetic medication c. Increased blood sugar levels d. Less frequent monitoring of blood sugar level
ANS: C The thiazides may induce hyperglycemia and aggravate cases of preexisting diabetes mellitus. Regular assessment for glycosuria is indicated. Dosages of oral hypoglycemics and insulin may need adjustment in patients with diabetes mellitus. Thiazides affect glucose metabolism, and the patient should change her regimen to accommodate this. Thiazides have the opposite effect on glucose metabolism. More frequent monitoring is warranted when the patient is being treated with thiazide diuretics.
When teaching a patient who is taking thiazide diuretics, the nurse will encourage the patient to increase the intake of which electrolyte? a. Calcium b. Sodium c. Potassium d. Magnesium
ANS: C Thiazide diuretics cause a decrease in the level of potassium. The patient taking thiazide diuretics does not need to increase calcium or magnesium intake. Although sodium levels are altered in patients taking thiazide diuretics, patients do not need to increase sodium intake
On admission, a patient with a history of cardiac insufficiency complains of shortness of breath. The nurse auscultates the lungs and notes bilateral crackles throughout both fields. In addition, there is bilateral +2 edema of the lower extremities. Which medication does the nurse anticipate that the healthcare provider will prescribe? a. Allopurinol (Zyloprim) b. Diphenhydramine (Benadryl) c. Mannitol d. Furosemide (Lasix)
ANS: D Diuretics, such as furosemide, are the mainstay of treatment in heart failure and hypertension. Allopurinol is used to treat gout. Diphenhydramine is an antihistamine and is not used for diuresis. Mannitol is used mainly to treat cerebral edema
Which diuretic is used to reduce intraocular pressure associated with glaucoma? Furosemide (Lasix) Mannitol (Osmitrol) Acetazolamide (Diamox) Spironolactone (Aldactone)
Acetazolamide Rationale Acetazolamide (Diamox) is used to reduce intraocular pressure associated with glaucoma. Furosemide (Lasix) is used to trea: t edema and hypercalcemia. Mannitol (Osmitrol) is used to reduce e cerebral edema Spironolactone (Aldactone) is prescribed to reduce ascites associated with liver disease.
Which drug acts by inhibiting the enzyme carbonic anhydrase in the kidney? Amiloride (Midamor) Acetazolamide (Diamox) Ethacrynic acid (Edecrin) Benzothiadiazides
Acetazolamide (Diamox) Rationale Acetazolamide (Diamox) is a weak diuretic that inhibits the enzyme carbonic anhydrase in the kidneys. Amiloride (Midamor) is a potassium-sparing diuretic that also has weak antihypertensive activity. Its mechanism of action is unknown. Ethacrynic acid (Edecrin)is a diuretic that acts on the ascending limb of the loop of Henle and on the proximal and distal tubules to prevent sodium and chloride reabsorption. Benzothiadiazides act primarily on the distal tubules of the kidney to block the reabsorption of sodium and chloride ions from the tubule.
Which drug does the nurse anticipate will be prescribed by y a healthcare provider for a patient taking furosemide (Lasix) who develops hyperuricemia? Bumetanide (Bumex') Allopurinol (Zyloprim') Prednisone Ethacrynic acid (Edecrin')
Allopurinol (Zyloprim Rationale Furosemide (Lasix) may inhibit the excretion of uric acid, which may result in hyperuricemia. Allopurinol (Zyloprim) is used to treat hyperuricemia. Bumetanide (Bumex) and l ethacrynic acid (Edecrin) are diuretics used to treat edema resulting from heart failure. Prednisone does not decrease the hyperuricemia experienced by this patient.
The nurse administering IV furosemide (Lasix) to a patient anticipates that diuresis will occur in how many minutes? A. 10 to 15 B. 5 to 10 C. 1 to 5 D. 15 to 20
B
When planning the administration of ethacrynic acid (Edecrin), which factor must the nurse consider? A. Maintenance doses need to be given between 7:00 AM and 7:00 PM. B. During IV administration, narrowed pulse pressure must be reported. C. For intravenous (IV) administration, the drug must be mixed with 0.9% saline only. D. Oral doses must be given on an empty stomach.
B
Which drug would be beneficial for a pregnant patient who complains of edema in her legs? Furosemide Lasix; Amiloride Midamor; Ethacrynic acid Edecrin' Benzothiadiazides
Benzothiadiazides Rationale Benzothiadiazides are thiazide diuretics used to treat edemain pregnant patients. Furosemide (Lasix) is used to treat edema associated with heart failure. Amiloride (Midamor) is used in combination with other diuretics for patients with hypertension or heart failure. Ethacrynic acid (Edecrin) is used to treat edema resulting from heart failure, cirrhosis of the liver, renal disease, and malignancy and for hospitalised pediatric patients with congenital heart disease.
For which medication is orthostatic hypotension an adverse effect? Select all that apply. Bumetanide (Bumex') Amiloride (Midamor) Triamterene (Dyrenium) Ethacrynic acid (Edecrin) Spironolactone (Aldactone)
Bumetanide (Bumex' Ethacrynic acid (Edecrin) Rationale Bumetanide (Bumex) and ethacrynic acid (Edecrin are sulfonamide-type loop diuretics. When used to treat edema resulting from hypertension, these drugs may lead to orthostatic hypotension. Amiloride (Midamor) is a potassium-sparing diuretic that has weak antihypertensive activity. Anorexia and nausea are adverse effects of this drug Triamterene (Dyrenium) is a potassium-sparing diuretic that may cause hives and pruritus. Spironolactone (Aldactone' )is a potassium-sparing diuretic that may cause mental confusion and headaches.
Which drug acts by increasing renal blood flow into the glomeruli and inhibiting electrolyte absorption in the proximal tubule? Amiloride (Midamor) Bumetanide (Bumex) Acetazolamide (Diamox) Ethacrynic acid (Edecrin)
Bumetanide (Bumex) Rationale Bumetanide (Bumex) acts by increasing renal blood flow into the glomeruli and inhibiting electrolyte absorption in the proximal tubule. Amiloride (Midamor) is a potassium-sparing diuretic that also has weak antihypertensive activity. Its mechanism of action is unknown. Acetazolamide (Diamox)is a weak diuretic that inhibits the enzyme carbonic anhydrase in the kidneys . Ethacrynic acid (Edecrin) is a diuretic that acts primarily on the ascending limb of the loop of Henle but also on the proximal and distal tubules to prevent sodium and chloride reabsorption.
Which diuretic can cause a rash? Select all that apply. Amiloride (Midamor) Bumetanide (Bumex) Triamterene (Dyrenium) Ethacrynic acid (Edecrin) Spironolactone (Aldactone)
Bumetanide (Bumex) Triamterene (Dyrenium) Rationale Bumetanide (Bumex) is a sulfonamide-type loop diuretic used to treat edema resulting from heart failure and renal disease. the rash may appear on the skin as a result of hypersensitivity to the drug. Triamterene (Dyrenium) is a potassium-sparing diuretic used in combination with other diuretics. A rash is one of the adverse effects of this drug. Amiloride (Midamor) is a potassium-sparing diuretic used in combination with other diuretics. Anorexia is one of the adverse effects of this drug Ethacrynic acid (Edecrin) is a sulfonamide-type loop diuretic used to treat edema associated with heart failure. Orthostatic hypotension is one of the adverse effects of this drug Spironolactone (Aldactone) is a potassium-sparing diuretic that relieves edema and ascites. Mental confusion is one of the adverse effects of this drug.
A patient who is being treated for ascites resulting from liver disease is admitted. Which medication does the nurse anticipate will be ordered for this patient? A. Furosemide (Lasix) B. Mannitol (Osmitrol) C. Spironolactone (Aldactone) D. Acetazolamide (Diamox)
C
For what therapeutic effect does the nurse assess in a patient taking acetazolamide (Diamox)? A. Increased urine osmolality B. Decreased intracranial pressure C. Decreased intraocular pressure D. Decreased serum glucose levels
C
The nurse teaches a patient to take a potassium-sparing diuretic to avoid ingesting which item? A. Additional salt in food B. Orange juice C. Salt substitute D. Black pepper
C
What concerns the nurse about a patient taking a nonsteroidal anti-inflammatory drug (NSAID) concurrently with a diuretic? A. Increased potential for electrolyte imbalances B. Increased potential for ototoxicity C. Higher doses of the diuretic will be required to be effective D. NSAIDs increase the potential for renal failure
C Rationale An NSAID will inhibit diuretic activity. Either the diuretic dosage should be increased or the NSAID should be discontinued. An NSAlD does not increase the potential for renal failure when taken with a diuretic. Taking NSAIDs and diuretics will not cause an increased risk for ototoxicity and does not affect the reabsorption or secretion of electrolytes.
What does the nurse suggest to a patient taking diuretics to decrease the effects of dry mouth? A. Increase fluid intake B. Use a commercial mouthwash at least three times a day Incorrect C. Suck on hard candy or ice chips D. Purchase lemon and glycerin swabs to suck on or swab the mouth
C Rationale Sucking on hard candy or ice chips will help decrease oral irritation and dryness. Many commercial types of mouthwash contain alcohol that causes further drying and oral irritation. Increasing fluid intake may decrease mouth dryness, but because the patient is taking a diuretic, this would not be the best suggestion. Lemon and glycerin swabs contain alcohol and will cause further oral irritation and dryness.
For which side effect should a nurse closely monitor a patient who is taking a benzothiadiazide and digoxin for heart failure? Lethargy Fine tremors Hyperreflexia Colored vision disturbances
Colored vision disturbances Rationale Benzothiadiazides are thiazide diuretics used to treat edema associated with heart failure. Digoxin (Lanoxin) is a cardiac glycoside used to treat congestive heart failure. When the patients have prescribed a benzothiadiazide along with digoxin, the nurse should monitor for signs of digitalis toxicity, which include colored vision disturbances. Thiazide diuretics induce lithium toxicity. lf the patient is taking lithium and a thiazide diuretic concurrently, the nurse should monitor the patient for signs of lithium toxicity, which include lethargy, fine tremors, and hyperreflexia
What is the significant sign of dehydration in a patient with diuresis? Crusted lips Distended neck veins Increased abdominal girth An increased circumference of medial malleolus
Crusted lips Rationale Crusted lips are a significant sign of dehydration in a patient with diuresis. Distended neck veins, increased abdominal girth, and an increased circumference of medial malleolus are signs of overhydration.
What is an advantage of using ethacrynic acid (Edecrin) over furosemide (Lasix) in patients with significant renal failure? A. Ethacrynic acid conserves more calcium than furosemide. Incorrect B. Ethacrynic acid conserves more magnesium than furosemide. C. Ethacrynic acid conserves more potassium than furosemide. D. Ethacrynic acid inhibits the reabsorption of sodium to a greater degree than furosemide.
D
A patient is prescribed amiloride (Midamor). The nurse monitors the patient for which adverse effect? A. Anorexia B. Constipation C. Hyperglycemia D. Hyperkalemia
D. Hyperkalemia Rationale Amiloride is a potassium-sparing ( diuretic, and hyperkalemia is most likely to occur with its s use. Hyperuricemia can occur in patients taking furosemide. Diarrhea, not constipation, is an adverse effect of amiloride. Hyperglycemiais an adverse effect ofthiazide and sulfonamide-type loop diuretics.
Which adverse effects can occur if a patient is administered ethacrynic acid (Edecrin) intravenously? Select all that apply. Diarrhea Deafness Dark, tarry stools Electrolyte imbalance Coffee-ground vomitus
Dark, tarry stools Coffee-ground vomitus Rationale Gastrointestinal bleeding is a serious adverse effect associated with IVethacrynic acid (Edecrin) This condition is manifested as coffee-ground vomitus or dark, tarry stools. Diarrhea can be severe;however, this may not occur because of IVethacrynic acid (Edecrin use only. Deafness and electrolyte imbalance may occur, but adverse effects are specifically related to the IVadministration of the edrug.
Which is a serious adverse gastrointestinal effect of spironolactone (Aldactone)? Nausea Vomiting Diarrhea Anorexia
Diarrhea Rationale Diarrhea is a serious adverse gastrointestinal ( effect of spironolactone (Aldactone) Nausea, vomiting, and anorexia are ( common side effects of amiloride (Midamor).
Which drug when given with a benzothiadiazide may cause blurred vision? Digoxin (Digitek) Lithium (Lithobid) Indomethacin (Indocin) Gentamicin (Garamycin)
Digoxin (Digitek) Rationale Benzothiadiazides are thiazide diuretics. Thiazide diuretics may cause excessive excretion of potassium, resulting in hypokalemia.if the patient is also receiving digoxin (Digitek), there may be a chance of digitalis toxicity, which manifests as a low heart rate and blurred vision. Thiazide diuretics may induce lithium toxicity when lithium (Lithobid) is taken concurrently. Lithium toxicity is manifested by nausea, persistent vomiting, profuse diarrhea, and fine tremors. Indomethacin (Indocin) is an NSAlD, which inhibits the diuretic activity of benzothiadiazides. combination of gentamicin (Garamycin) and benzothiadiazides will not cause hypokalemia.
Increase the flow of urine to increase net loss of water
Diuretics
What are the 6 cardinal signs of cardiovascular disease?
Dyspnea, fatigue, syncopy, edema, palpitations, chest pain
Which diuretic drug acts on the ascending limb of the loop of Henle and the proximal and distal tubules? Furosemide (Lasix) Amiloride (Midamor) Ethacrynic acid (Edecrin) Hydrochlorothiazide (HydroDiuril)
Ethacrynic acid (Edecrin) Rationale Ethacrynic acid (Edecrin) acts primarily on the ascending limb of the loop of Henle and the proximal and distal tubules to prevent sodium and chloride reabsorption. Furosemide Lasix) acts by inhibiting sodium and chloride reabsorption from the ascending limb of the loop of Henle. Amiloride (Midamor) and hydrochlorothiazide (HydroDiuril) acts primarily on the distal tubules of the kidney to block the reabsorption of sodium and chloride ions from the tubule.
Which diuretic can cause hearing loss? Furosemide (Lasix) Torsemide (Demadex) Ethacrynic acid (Edecrin) Spironolactone (Aldactone)
Ethacrynic acid (Edecrin) Rationale Ethacrynic acid (Edecrin) is a sulfonamide-type loop diuretic used to treat edema associated with heart failure and renal failure. Deafness is one of the serious adverse effects of this drug. Oral irritation is one of the adverse effects of furosemide (Lasix) and torsemide (Demade) Mental confusion is one of the adverse effects of spironolactone (Aldactone).
Which diuretic should be used to treat edema in a hospitalized pediatric patient with congenital heart disease? Furosemide (Lasix) Bumetanide (Bumex) Torsemide (Demadex) Ethacrynic acid (Edecrin)
Ethacrynic acid (Edecrin) Rationale Ethacrynic acid (Edecrin) is a sulfonamide-type loop diuretic used to treat pediatric patients suffering from edema associated with congenital heart disease. Furosemide (Lasix), bumetanide (Bumex), and torsemide (Demadex) are sulfonamide-type loop diuretics used to treat edema resulting from heart failure and renal disease.
Which adverse effect may occur in a patient who is concurrently taking a thiazide diuretic and prednisone? Increased diuretic activity Decreased loss of calcium Excessive excretion of potassium Increased toxicity
Excessive excretion of potassium Rationale Corticosteroids such as prednisone may enhance the loss of potassium when taken concurrently with thiazide diuretics. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the diuretic activity of thiazide diuretics. Prednisone does; not alter the loss of calcium nor does it induce toxicity.
Which drug is used in combination with 0.9% sodium chloride infusions to enhance the excretion of calcium in patients with hypercalcemia? Select all that apply. Bumetanide (Bumex) Torsemide (Demadex) Acetazolamide (Diamox) Ethacrynic acid (Edecrin)
Furosemide (Lasix) Ethacrynic acid (Edecrin) Rationale Furosemide (Lasix) and ethacrynic acid (Edecrin) are used in combination with 0.9% sodium chloride infusions to enhance the excretion of calcium in patients with hypercalcemia. Bumetanide (Bumex) and torsemide (Demadex)are used to treat edema resulting from heart failure. Acetazolamide (Diamox) is not frequently used as a diuretic because of the availability of more effective medications.
Which drugs may be responsible for severe itching in a patient being treated for renal disease? Select all that apply. Furosemide (Lasix) Amiloride (Midamor, Ethacrynic acid (Edecrin) Spironolactone (Aldactone) Benzothiadiazides
Furosemide (Lasix) Benzothiadiazides Rationale Furosemide (Lasix) and benzothiadiazides are used to treat edema associated with renal disease. Pruritus (severe itching) is an adverse effect of these e drugs. Anorexia is an adverse effect ofamiloride (Midamor). Orthostatic hypotension is an adverse effect of ethacrynic acid (Edecrin) Mental confusion is a side effect of spironolactone (Aldactone).
Which drug used concurrently with furosemide may y lead to hearing loss? Digoxin Gentamicin Prednisone Indomethacin
Gentamicin Rationale Administering aminoglycosides like gentamicin concurrently with furosemide increases the potential for hearing loss Digoxin use may lead to digitalis toxicity. Prednisone may enhance the loss of potassium but may not cause loss of hearing. Indomethacin, a nonsteroidal antinfammatory drug (NSAlD), can decrease the effectiveness of the diuretic but is not associated with hearing loss.
Which statements are true regarding spironolactone? Select all that apply. When given concurrently with lithium, spironolactone can cause lithium toxicity. The action of nonsteroidal anti-inflammatory drugs (NSAlDs) is blocked when taken with spironolactone. Gynecomastia and reduced libido are known adverse effects of spironolactone. Spironolactone causes increased amounts of sodium and water to be excreted, but potassium is retained. When spironolactone and angiotensin-converting enzyme (ACE) inhibitors are taken concurrently, there is a reduction in mortality of patients with heart failure.
Gynecomastia and reduced libido are known adverse effects of spironolactone. Spironolactone causes increased amounts of sodium and water to be excreted, but potassium is retained. When spironolactone and an angiotensin-converting enzyme (ACE) inhibitor are taken concurrently, there is a reduction in mortality of patients with heart failure. Rationale Spironolactone is a potassium-sparing diuretic. Gynecomastia and reduced libido are adverse effects related to this drug. It causes increased amounts of sodium and water to be excreted. This medication is also used to reduce mortality in patients with heart failure who are also being treated with an ACE inhibitor. Lithium toxicity is not associated with spironolactone. The activity of the diuretic drug spironolactone is inhibited by concurrent use of NSAlDs.
For which side effect should a nurse monitor a patient taking amiloride? Hyperuricemia Constipation Hyperkalemia Hyperglycemia
Hyperkalemia Rationale Amiloride is a potassium-sparing diuretic, and hyperkalemia is most likely to occur with its use. Hyperuricemia can occur in patients taking furosemide. Diarrhea, not constipation is an adverse effect of amiloride. Hyperglycemia is an adverse effect of thiazide and sulfonamide-type loop diuretics.
What are the serious adverse effects of furosemide (Lasix)? Select all that apply. Pruritus Deafness Dry mouth Hyperuricemia Orthostatic hypotension
Hyperuricemia Pruritus Rationale Pruritus is a serious adverse effect of furosemide (Lasix) Hyperuricemia is also a serious adverse effect associated with furosemide (Lasix).I Deafness is a serious adverse effect of ethacrynic acid (Edecrin). Dry mouth and orthostatic hypotension are common adverse effects of furosemide (Lasix).
What are the common adverse effects of the combination diuretics spironolactone (Aldactone) and hydrochlorothiazide (HydroDIURUIL)? Select all that apply. Hyperkalemia Hyperglycemia Hyponatremia Hyperuricemia Orthostatic hypotension
Hyponatremia Hyperkalemia Rationale Hyperkalemia and hyponatremia are common adverse effects of combination diuretics such as spironolactone (Aldactone) and hydrochlorothiazide (HydroDlURUIL). Hyperglycemia is an adverse effect of furosemide (Lasix), benzothiadiazides, (Amiodarone hydrochloride) and ethacrynic acid (Edecrin) . Hyperuricemia is an adverse effect of furosemide (Lasix) and ethacrynic acid (Edecrin) Orthostatic hypotension is an adverse effect of ethacrynic acid (Edecrin) and furosemide (Lasix).
The healthcare provider prescribes hydrochlorothiazide to a patient with heart failure. During a follow-up visit, the healthcare provider observes that the patient's symptoms have not subsided. Which another medication in the patient's medication history is responsible for this condition? Ibuprofen Digoxin Lithium Prednisone
Ibuprofen Rationale ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID. When ibuprofen is taken with hydrochlorothiazide, the thiazide diuretic's efficacyis reduced. Digoxin may cause excessive potassium excretion, but it may not reduce the efficacy of thiazide diuretics. Lithium will cause lithium toxicity. Prednisone may enhance the loss of potassium.
Which drug inhibits the diuretic activity of ethacrynic acid? Digoxin Indomethacin Prednisone Gentamicin
Indomethacin Rationale Indomethacin is a nonsteroidal antiinflammatory drug (NSAID) that inhibits the diuretic activity of ethacrynic acid. If the patient is receiving digoxin along with ethacrynic acid, the patient may have digitalis toxicity. Prednisone is a corticosteroid; when it is given along with ethacrynic acid, the patient should be monitored for hypokalemia. Gentamicin is an aminoglycoside that may increase the potential for ototoxicity when administered concurrently with ethacrynic acid.
By which action does a sulfonamide-type diuretic promote diuresis? Retention of potassium and excretion of sodium in the distal renal tubule Prevention of sodium and chloride reabsorption in the proximal and distal tubules Blocking the reabsorption of sodium and chloride ions in the distal tubules Inhibiting sodium and chloride reabsorption in the ascending loop of Henle.
Inhibiting sodium and chloride reabsorption in the ascending loop of Henle. Rationale Sulfonamide-type diuretics promote diuresis by inhibiting the reabsorption of sodium and chloride ions from the ascending limb of the loop of Henle. Potassium-sparing diuretics act on the distal renal tubule to retain potassium and excrete sodium. Ethacrynic acid (Edecrin) acts on the ascending loop of Henle and the proximal and distal tubules to prevent sodium and chloride reabsorption. Thiazide diuretics act primarily on the distal tubules to block the reabsorption ofsodium and chloride ions.
Which drug administered concurrently with chlorothiazide (Diuril) might cause a patient to experience weakness, lethargy, nausea, persistent vomiting, diarrhea, and fine tremors? Digoxin (Lanoxin) Lithium (Lithobid) Insulin (Humulin Naproxen (Naprelan)
Lithium (Lithobid) Rationale Thiazide diuretics such as chlorothiazide (Diuril may induce lithium toxicity when lithium (Lithobid) is taker concurrently with chlorothiazide (Diuril). Lithium toxicity is characterized by nausea, anorexia, fine tremors, persistent vomiting, profuse diarrhea, hyperreflexia, lethargy, and weakness. Digoxin (Lanoxin) may cause digitalis toxicity when taken with chlorothiazide (Diuril) that is characterized by anorexia, nausea, fatigue, blurred or colored vision, bradycardia, dysrhythmias. Chlorothiazide (Diuril) can cause hyperglycemia so the dosage of insulin (Humulin many needs to be adjusted. Naproxen (Naprelan) may inhibit the diuretic activity of chlorothiazide (Diuril)
Which adverse effects would a patient be taught to expect when taking spironolactone? Select all that apply. Pruritus Anorexia Flatulence Mental confusion Breast tenderness
Mental confusion Breast tenderness Rationale Spironolactone (Aldactone) is a potassium-sparing diuretic used to treat ascites. Mental confusion and breast tenderness are expected adverse effects Pruritusis an adverse effect of triamterene. Anorexia: and flatulence are adverse effects of amiloride (Midamor).
A patient arrives at the clinic with edema of the face, anorexia, nocturia, and general malaise. The nurse notes crackle on auscultation of the lungs, jugular vein distention, and cola-colored urine. The nurse learns that the patient had a beta-hemolytic streptococcal infection 2 weeks ago. The nurse anticipates which diagnosis? O Impetigo O Rheumatic fever O Infective endocarditis O Acute glomerulonephritis
O Acute glomerulonephritis Rationale Acute glomerulonephritis is characterized by general malaise, fluid overload, and decreased urine output. It is caused by inflammation of the glomeruli as a result of infection by the beta hemolytic streptococci. Impetigo, rheumatic fever, and infective endocarditis do not explain the patient's symptoms.
A patient with diabetes reports drowsiness and seizures. The hematology and urinalysis reports show urinary output as low as 400 mL/24 hr and elevated blood urea nitrogen (BUN) and creatinine. Which measures must be taken to prevent any complications? Select all that apply. O Increase sodium and potassium contents in the patient's diet O Administer fluids and osmotic solutions to the patient. O Administer sodium polystyrenesulfonate (Kayexalate). O Administer antibiotics regardless of renal excretion O Perform frequent skin care of the patient with hot water
O Administer fluids and osmotic solutions to the patient.O Administer sodium polystyrenesulfonate (Kayexalate).O Administer antibiotics regardless of renal excretionRationalePatients with acute renal failure show signs of drowsiness, seizures, urinary output as low as 400 mL/24 hr and elevated BUN and creatinine. Fluids and osmotic preparations should be administered to prevent decreased renal perfusion and restore the normal fluid and electrolyte balance. Sodium polystyrene sulfonate (Kayexalate) should be administered to remove potassium through the gastrointestinal tract. Antibiotics that are not dependent on renal excretion must be administered to prevent drug accumulation and toxicity. The patient has renal failure, which may cause retention of sodium and potassium. Therefore, the patient should limit the intake of sodium and potassium in the diet Frequent skin care of the patient should be performed with tepid water, not hot water, to remove the urea crystals.
Side effects for thiazides -____ -GI irritation, N/V, _________________ (admin with food & milk) -Electrolyte low K+ (give K+ supplements) -_____________________ -______________________ -Hives, pruritus, rash
OHTN constipation hyperuricemia hyperglycemia
Loop diuretic (not sulfonamide type) ethacrynic acid Edecrin Side effect to expect: _____ Side effects to report: -lyte imbalance, _____________ -dizziness, deafness & _________________ (occurs in pts with impaired renal fx) -GI bleeding (esp if given IV), diarrhea -__________________ careful with diabetics
OHTN dehydration tinnitus hyperglycemia
Which gastrointestinal adverse effect of furosemide (Lasix) is most common? Anorexia Flatulence Constipation Oral irritation
Oral irritation Rationale Oral irritation is the most common gastrointestinal adverse effect of furosemide (Lasix) Anorexia and flatulence are common gastrointestinal adverse effects of amiloride (Midamor). Constipation n is a common gastrointestinal adverse effect of benzothiadiazides.
Which condition may cause symptoms of increased abdominal girth and neck vein distention? Dehydration Hyperkalemia Overhydration Hypernatremia
Overhydration Rationale Signs of overhydration include an increase in abdominal girth, weight gain, neck vein distention and an increased circumference of the medial malleolus. In this condition, crackles develop during lung auscultation. Signs of dehydration are mental confusion and a weak pedal pulse. When a patient is given excessive amounts of potassium supplements, either intravenously or orally, he or she may develop hyperkalemia. Hypernatremia occurs most frequently when a patient is given IVfuids in excess of the fluid excreted from the body.
Which patient would most likely be prescribed a benzothiadiazide? Patient A Edema associated with heart failure Patient B Edema associated with obesity Patient C Edema associated with cirrhosis of the liver Patient D Edema associated with malignancy
Patient B Edema associated with obesity Rationale Benzothiadiazides are used to treat edema associated with obesity. Therefore patient B should I be treated with this medication. Patient A should be treated with furosemide (Lasix) and ethacrynic acid (Edecrin). Patient C should be treated with ethacrynic acid (Edecrin) or bumetanide (Bumex). Patient D should be treated with ethacrynic acid ( Edecrin).
Which patient is showing adverse effects related to furosemide (Lasix)? Patient A Mental confusion Patient B Anorexia Patient C Oral irritation Patient D Constipation
Patient C Oral irritation Rationale Patient C has oral irritation, which is an adverse effect of furosemide (Lasix) Patient A has mental confusion, which is an adverse effect of spironolactone (Aldactone) Patient B has anorexia, which is an adverse effect of amiloride (Midamor). Patient C has constipatior n, which is an adverse effect ofhydrochlorothiazide
What are the advantages of combination products used for diuresis? Select all that apply. Prevention of hyperkalemia and hyponatremia Promotion of diuresis and antihypertensive effects Initial therapy for edema or hypertension Maintenance of normal serum potassium levels in the body Elimination of the risk of adverse effects of the component drugs
Promotion of diuresis and antihypertensive effects Maintenance of normal serum potassium levels in the body Rationale The goal of combination products is to promote diuresis and antihypertensive effects through different mechanisms of action. They also maintain normal serum potassium levels in the body. hyperkalemia and hyponatremia are risks related to the combination products. Combination products should not be used as initial therapy for edema or hypertension. Patients who have received combination products are at risk for adverse effects resulting from any of the component drugs.
Retention or excretion of which electrolyte is an advantage of using ethacrynic acid (Edecrin) over furosemide (Lasix) in patients with significant renal failure? Calcium Potassium Magnesium Sodium
Sodium Rationale Inhibiting the reabsorption of sodium will help decrease fluid overload in a patient with renal failure. Ethacrynic acid (Edecrin will not reabsorb more calcium or magnesium than furosemide (Lasix). Furosemide (Lasix causes a greater loss of potassium than does ethacrynic acid (Edecrin),
Which additional treatment would be most appropriate for a patient with heart failure who has treated with an angiotensin-converting enzyme (ACE) inhibitor and a loop diuretic who is not responding to the treatment? Amiloride (Moduretic;) Triamterene (Maxzide) Metolazone (Zaroxolyn) Spironolactone (Aldactazide)
Spironolactone (Aldactazide Rationale Spironolactone (Aldactazide) is a diuretic that is used to relieve edema and ascites in patients who do not respond to the usual diuretics. This drug has also been shown to reduce morbidity and mortality in patients with heart failure who are also being g treated with an ACE inhibitor and a loop diuretic. Amiloride (Moduretic is a potassium-sparing diuretic that has weak antihypertensive activity. Triamterene (Maxzide) is a very mild diuretic and should not be used within an ACE inhibitor, as, this combination can significantly increase potassium levels. Metolazone (Zaroxolyn) is a thiazide diuretic that may cause hypokalemia, which further increases the risk of heart failure
Which drug might have led to a male patient developing gynecomastia? Chlorothiazide (Diuril) Triamterene (Dyazide) Ethacrynic acid (Edecrin) Spironolactone (Aldactazide)
Spironolactone (Aldactazide)
Which additional treatment would be most appropriate for a patient with heart failure who has treated with an angiotensin-converting enzyme (ACE) inhibitor and a loop diuretic who is not responding to the treatment? Amiloride (Moduretic; Triamterene (Maxzide) Metolazone (Zaroxolyn') Spironolactone (Aldactazide)
Spironolactone (Aldactazide) Rationale Spironolactone (Aldactazide) is a diuretic that is used to relieve edema and ascites in patients who do not respond to the usual diuretics. This drug has also been shown to reduce morbidity and mortality in patients with heart failure who are also being treated with an ACE inhibitor and a loop diuretic. Amiloride (Moduretic' is a potassium-sparing diuretic that has weak antihypertensive activity. Triamterene (Maxzide) is a very mild diuretic and should not be used with an ACE inhibitor, as, this combination can significantly increase potassium levels. Metolazone (Zaroxolyn)is a thiazide diuretic that may cause hypokalemia, which further increases the risk of heart failure
Which drug is particularly useful for relieving edema and ascites in patients who do not respond to the usual diuretics? Amiloride (Midamor) Torsemide Triamterene (Dyrenium) Spironolactone (Aldactone)
Spironolactone (Aldactone) Rationale Spironolactone (Aldactone) is particularly useful in relieving edema and ascites in patients who do not respond to the usual diuretics. Amiloride (Midamor) is used in combination with other diuretics in patients with hypertension. Torsemide is used to treat edema resulting from heart failure cirrhosis of the liver, and renal disease, including the nephrotic syndrome. Triamterene Dyrenium) is best used in conjunction with potassium-sparing diuretics.
Which actions are related to ethacrynic acid? Select all that apply. The diuretic activity lasts for 6 to 8 hours. Diuresis begins after 30 minutes. The drug action is on the proximal and distal tubules. Renal blood flow and the glomerular filtration rate are increased. The drug action is primarily on the descending limb of the loop of Henle.
The diuretic activity lasts for 6 to 8 hours. The drug action is on the proximal and distal tubules. Rationale Ethacrynic acid is a loop diuretic. The diuretic activity of ethacrynic acid lasts for about 6 to 8 hours. It acts on the proximal and distal tubules to prevent sodium and chloride reabsorption. Its diuretic activity begins within 30 minutes and peaks in approximately 2 hour. Ethacrynic acid does not appear to affect renal blood flow or the glomerular filtration rate. It acts primarily on the ascending limb of the loop of Henle.
Which medication when given concurrently with ethacrynic acid (Edecrin) may cause ototoxicity? Digoxin (Lanoxin' Tobramycin (Tobrex Indomethacin (Indocin' Prednisone (Deltasone
Tobramycin (Tobrex Rationale Tobramycin (Tobrex) is an aminoglycoside that increases the potential for ototoxicity in patients taking ethacrynic acid (Edecrin). Digoxin (Lanoxin) may lead to digitalis toxicity when used concurrently with ethacrynic acid (Edecrin) because of excess potassium loss. Nonsteroidal antiinflammatory drugs such as indomethacin (Indocin) inhibit the diuretic activity of ethacrynic acid (Edecrin) Corticosteroids such as prednisone (Deltasone) may enhance the loss of potassium, which leads to hypokalemia.
Which drug is an effective agent to use in conjunction with potassium-sparing diuretics? Amiloride (Midamor) Triamterene (Dyrenium) Spironolactone (Aldactone) Benzothiadiazide
Triamterene (Dyrenium)
Which diuretic blocks the exchange of potassium for sodium in the distal tubule of the kidney? Amiloride (Midamor) Triamterene (Dyrenium) Acetazolamide (Diamox) Spironolactone (Aldactone)
Triamterene (Dyrenium) Rationale Triamterene (Dyrenium) is a very mild diuretic that acts by blocking the exchange of potassium for sodium in the distal tubule of the kidney. Amiloride (Midamor) acts by causing the distal renal tubule to retain potassium and excrete sodium, resulting in a mild diuresis. Acetazolamide (Diamox) promotes the excretion of sodium, potassium, water, and bicarbonate. Spironolactone (Aldactone) blocks aldosterone, resulting in a loss of water with increased sodium excretion.
Which statements regarding triamterene (Dyrenium) are true? Select all that apply. Triamterene (Dyrenium) is a very mild diuretic that acts by blocking the exchange of potassium for sodium. Triamterene (Dyrenium) is ineffective if it is used in conjunction with potassium-excreting diuretics. Triamterene (Dyrenium) may lead to hyperkalemia, which may be resolved only by discontinuing the therapy. Common side effects of triamterene (Dyrenium) include electrolyte imbalance, dehydration, leg cramps, and weakness. Triamterene (Dyrenium) helps reduce edema and improves symptoms related to excessive fluid accumulation.
Triamterene (Dyrenium) is a very mild diuretic that acts by blocking the exchange of potassium for sodium. Common side effects of triamterene (Dyrenium) include electrolyte imbalance, dehydration, leg cramps, and weakness. Triamterene (Dyrenium) helps reduce edema and improves symptoms related to excessive fluid accumulation. Rationale Triamterene (Dyrenium) is a very mild diuretic that blocks the exchange of potassium with sodium in the distal tubule of the kidney. This results in potassium retention and sodium excretion. Common side effects include electrolyte imbalance, dehydration, leg cramps, and weakness. Triamterene (Dyrenium) also helps reduce edema and improves symptoms related to excessive fluid accumulation. This drug is effective when used in conjunction with potassium-excreting diuretics. This drug may lead to hyperkalemia, which will resolve without the need to discontinue therapy.
Carbonic anhydrase inhibitor ________________________ Diamox
acetazolamide
Sulfonamide LOOP Diuretics ________________ Bumex ________________ Lasix ________________ Demadex
bumetanide furosemide torsemide
Side effects of K+ sparing diuretics mental _________ _______________ diarrhea, dehydration electrolyte imbalance (Na+ decrease, K+ increased) _____________ breast ________________ decrease libido __________________ (abnormal breasts in men)
confusion headache hyperkalemia tenderness gynecomastia
Monitor patients on subsequent ___________ therapy! Excessive secretion of K+ __________________ may put them into dig ______________!
digoxin hypokalemia toxicity
Thiazide diuretic -act on _______ ________ & _____ reabsorption of Na+ and Cl ions from tubules
distal tubules block
Combo products thiazide + K+ sparing Goal -to promote __________ and antihypertensive effect while maintaining _________ serum K+ levels
diuresis normal
Carbonic anhydrase inhibitor acetazolamide Diamox Weak __________ -inhibits enzyme carbonic anhydrase within the kidney brain and eye promotes the excretion of sodium, potassium, water and bicarbonate -Uses *decrease intraocular pressure in glaucoma* & ________
diuretic seizures
Loop Diuretics SIDE EFFECTS _______ mouth _____ GI irritation take with _________ Dehydration/electrolyte imbalances (K+, Na+, Cl decreased) ______________ Hives, pruritus & rash
dry OHTN food hyperglycemia
Combo meds to know _______________ Maxide
dyazide
Loop diuretic (not sulfonamide type) ____________ __________ Edecrin
ethacrynic acid
Diuretic uses- Major form of treatment Heart ______________ ___
failure HTN
Sulfonamide LOOP Diuretics ___________ Lasix
furosemide
Thiazide diuretic ________________________________ (HCTZ) HydroDiuril
hydrochlorothiazide
Combo meds side effects ____________________ _____________________
hyponatremia hyperkalemia
Sulfonamide LOOP Diuretics bumetanide Bumex *POTENT DIURETIC* Action: ____________ Na+ & Cl reabsorption in the Loop of Henle Diuresis __ to __ min after admin po _ to __ IV
inhibits 30 to 60 5 to 10
Diuretics are also used for tx of: Cerebral edema- _____________ To decrease intraocular pressure- ______________ To decrease ascites associated with liver disease- _______________ Renal disease Hypercalcemia- _______________
mannitol acetazolamide spironolactone Lasix
Combo proucts K+ sparing ________ used alone -combine __________ with K+ sparing agents
rarely thiazide
K+ sparing diuretics sprionolactone Aldactone Act to *increase* Na+ loss but _____________ K+ Used for edema & ascites when other diuretics don't __________
retain work
K+ sparing diuretics __________________ Aldactone
sprionolactone
Sulfonamide LOOP Diuretics furosemide Lasix *POTENT*, effective & highly ________ Side effects ____________________ ____________________ (excessive uric acid, gout)
used hypokalemia hyperuricemia
Thiazide diuretic Increase net loss of _______________ Uses: tx of edema associated with CHF, renal disease, hepatic disease, PMS, pregnancy, obesity, & admin of corticosteriods (causes retention), HTN
water
Nursing interventions for Diuretic Therapy -I & O daily ___________ -Abdominal girths -AM dose to prevent _____________ -Monitor ____________ function -Monitor dehydration/electrolytes -K+ supplements or restrictions/foods -Monitor for dig toxicity- ________________!
weights nocturia renal hypokalemia
