Diuretics Quiz

Which of the following actions by the nurse is the most important when caring for a client with renal disease who has an order for furosemide (Lasix)? 1. Assess urine output and renal laboratory values for signs of nephrotoxicity. 2. Check the specific gravity of the urine daily. 3. Eliminate potassium- rich foods from the diet. 4. Encourage the client to void every 4 hours.

Answer: 1 Rationale: Because the kidneys excrete most drugs, clients with renal failure may need a lower dosage of furosemide (Lasix) to prevent further damage to the kidneys. Options 2,3 and 4 are incorrect. Urine specific gravity will not adequately assess renal status and may be altered by the diuresis secondary to the furosemide. Potassium should be increased when furosemide, a potent loop diuretic, is ordered and not eliminated. If diuresis is occurring, the patient may need to void more often then every 4 hours.

The nurse is providing teaching to a client who has been prescribed furosemide (Lasix). Which of the following should the nurse teach the client? 1. Avoid consuming large amounts of kale, cauliflower, or cabbage. 2. Rise slowly from a lying or sitting position. 3. Count the pulse for one full minute before taking this medication. 4. Restrict fluid intake to no more than 1L per 24 hour period.

Answer: 2 Rationale: Loop diuretics such as furosemide (Lasix) may dramatically reduce a client's circulating blood volume from diuresis and may cause orthostatic hypotension. To minimize the chance for syncope and falls, the client should be taught to rise slowly from a lying or sitting position to standing. Options 1,3, and 4 are incorrect. Kale, cauliflower and cabbage contain vitamin K, which does not need to be restricted during diuretic therapy. Monitoring the pulse along with blood pressure to assess for tachycardia is advised, but the pulse does not need to be taken for 1 full minute before taking the drug. Fluids should not be restricted during diuretic therapy unless ordered by the provider.

Which of the following manifestations may indicate the the client taking metolazone (Zaroxolyn) is experiencing hypokalemia? 1. Hypertension 2. Polydipsia 3. Cardiac dysrhythmias 4. Skin rash

Answer: 3 Rationale: Metolazone (Zaroxolyn) is a thiazide diuretic and causes potassium loss. Signs of hypokalemia include cardiac dysrhythmias, hypotension, dizziness and fainting. Options 1,2 and 4 are incorrect. Polydipsia is not associated with hypokalemia. Hypertension is a clinical indication for the use for diuretics. Skin rashes are an adverse effect of metolazone but are not a symptom of hypokalemia.

While planning for a client's discharge from the hospital, which of the following teaching points would be included for a client going home with a prescription for chlorothiazide (Diuril)? 1. Increase fluid and salt intake to make up for the losses caused by the drug. 2. Increase intake of vitamin C- rich foods such as grapefruit and oranges. 3. Report muscle cramping or weakness to the health care provider. 4. Take the drug at night because it may cause drowsiness.

Answer: 3 Rationale: Muscle cramping or weakness may indicate hypokalemia and should be reported to the health care provider. Options 1,2, and 4 are incorrect. Clients on diuretic therapy are taught to monitor sodium (salt) and water intake to maintain adequate, but not excessive, amounts. Vitamin C -rich foods do not need to be increased while a client is taking chlorothiazide (Diuril). The drug should be taken early in the day to avoid nocturia. It does not cause drowsiness.

The client admitted for heart failure (HF) has been receiving hydrochlorothiazide (Microzide). Which of the following laboratory levels should the nurse carefully monitor? (Select all that apply) 1. Platelet count 2. WBC count 3. Potassium 4. Sodium 5. Uric acid

Answer: 3,4,5 Rationale: Thiazide diuretics such as hydrochlorothiazide (Microzide) cause loss of sodium and potassium but may cause hyperuricemia. Options 1 and 2 are incorrect. Hydrochlorothiazide does not have a direct effect on blood cells.

Which of the following medications acts by blocking the reabsorption of sodium and chloride in Henle's loop? a. Furosemide (Lasix) b. Chlorothiazide (Diuril) c. Spironolactone (Aldactone) d. Metolazone (Zaroxolyn)

Answer: a. Furosemide (Lasix) Rationale: Furosemide (Lasix) is a loop diuretic that blocks the reabsorption of sodium and chloride in Henle's loop.

Which of the following actions by the nurse is most important when caring for a client with renal disease? a. Identify medications that have the potential for nephrotoxicity. b. Check the specific gravity of the urine daily. c. Eliminate potassium-rich foods from the diet. d. Encourage the client to void every four hours.

Answer: a. Identify medications that have the potential for nephrotoxicity. Rationale: Since the kidneys excrete most drugs, clients with renal failure will need a significantly lower dosage in order to avoid fatal consequences.

The client admitted for congestive heart failure (CHF) is receiving digoxin (Lanoxin) and furosemide (Lasix). Which of the following laboratory findings should the nurse carefully monitor? a. Potassium b. Creatinine c. Calcium d. Sodium

Answer: a. Potassium Rationale: Potassium loss is a serious side effect of loop diuretics, and this is a serious concern to clients being treated with digoxin (Lanoxin).

Administration of potassium supplements is contraindicated in clients taking which of the following diuretics? a. Spironolactone (Aldactone) b. Furosemide (Lasix) c. Chlorothiazide (Diuril) d. Bumetanide (Bumex)

Answer: a. Spironolactone (Aldactone) Rationale: Unlike with loop and thiazide diuretics, clients taking potassium-sparing diuretics should not take potassium supplements, due to the increased risk of hyperkalemia.

Which of the following actions is dependent upon proper functioning of the kidneys or the administration of Epogen? a. Stimulates the production of RBCs. b. Inhibits the release of renin. c. Detoxifies drugs in the bloodstream. d. Secretes the hormone cortisol.

Answer: a. Stimulates the production of RBCs. Rationale: The kidney is responsible for the hormone erythropoietin, which stimulates the production of RBCs.

Client education as relates to loop diuretics should include goals of therapy and should include which of the following points? (Select all that apply.) a. Take in the morning to avoid nighttime urination that could result in increased risk of injury. b. Expect decreased urine output. c. Take potassium supplements, if ordered, and eat potassium-rich foods. d. Check weight daily, and report a weight gain of 2 pounds or greater in 24 hours. e. Report any change in hearing (deafness).

Answer: a. Take in the morning to avoid nighttime urination that could result in increased risk of injury.; c. Take potassium supplements, if ordered, and eat potassium-rich foods.; d. Check weight daily, and report a weight gain of 2 pounds or greater in 24 hours.; e. Report any change in hearing (deafness). Rationale: Client education should include reasons for obtaining baseline data such as vital signs and tests for renal disorders, and possible side effects.

Which of the following is an important point of emphasis the nurse should include when teaching a client with diabetes regarding thiazides? a. Hypocalcemia b. Hyperglycemia c. Urinary tract infections d. Anemia

Answer: b. Hyperglycemia Rationale: Some thiazide diuretics can cause hyperglycemia and glycosuria in diabetic patients. Thiazides do not affect calcium or red blood cell levels.

For which of the following disorders should the nurse assess before administering chlorothiazide (Diuril)? a. Chronic urinary tract infections b. Low blood pressure c. Congenital malformations d. Hyperkalemia

Answer: b. Low blood pressure Rationale: Thiazide diuretics reduce circulating blood volume, which can cause orthostatic hypotension.

Which of the following is the most important baseline value prior to initiation of diuretic therapy? a. Glucose level b. Amino acids c. Blood pressure d. Sodium bicarbonate

Answer: c. Blood pressure Rationale: Although many baseline values are important, blood pressure (sitting and supine) can indicate excessive diuresis, which can result in dehydration and hypovolemia.

Which of the following clinical manifestations might indicate that the client has excessive potassium loss? a. Hypertension; angina b. Excessive thirst; urination c. Low blood pressure; cardiac arrhythmias d. Pitting edema; weight gain

Answer: c. Low blood pressure; cardiac arrhythmias Rationale: Rapid excretion of large amounts of fluid predisposes the client to potassium deficits and is manifested by hypotension, dizziness, cardiac arrhythmias, and fainting.

A client with a history of HF will be started on spironolactone (Aldactone). Which of the following drug groups should not be used, or used with extreme caution in patients taking potassium-sparing diuretics? 1. NSAIDs 2. Corticosteroids 3. Loop diuretics 4. ACE inhibitors or ARBs

Answer:4 Rationale: ACE inhibitors and ARBs taken concurrently with potassium -sparing diuretics increase the risk of hyperkalemia. Options 1,2, and 3 are incorrect. NSAIDs are used cautiously with all diuretics because they are excreted through the kidney. Corticosteroids and loop diuretics may cause hypokalemia and may be paired with a potassium -sparing diuretic to reduce the risk of hypokalemia developing if a diuretic is needed.