Mod 7: 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."
A client is prescribed ethacrynic acid to treat edema secondary to heart failure. After teaching the client about this drug, the nurse determines that additional teaching is needed when the client states which of the following? "I need to avoid eating foods that contain potassium." "I should take the dose early in the day." "I should weigh myself about once a week." "I need to change my position slowly if I feel dizzy."
"I need to avoid eating foods that contain potassium."
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."
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."
A client asks, "Why is my prescription is being switched from furosemide to spironolactone?" What is the nurse's best response? "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."
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."
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 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 9:15 AM 10:00 AM 10:30 AM
9:30 AM
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? Ask the client to decrease fluid intake. Gradually increase the drug dosage. Administer the drug early in the day. Encourage the client to exercise.
Administer the drug early in the day.
When describing the action of spironolactone, the nurse would explain that this drug acts by: Blocking potassium secretion through the tubule Slowing the movement of hydrogen ions Blocking the chloride pump Blocking aldosterone in the distal tubule
Blocking aldosterone in the distal tubule
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? Exacerbation of the atrial fibrillation Subtherapeutic levels of serum digoxin Digoxin toxicity Congestive heart failure
Digoxin toxicity
The pharmacology instructor is discussing the various diuretic agents and their sites of action in the nephron. In what part of the nephron do thiazide diuretics act? Proximal tubule Descending limb of the loop of Henle Ascending limb of the loop of Henle Distal tubule
Distal tubule
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. Diuretics increase production of nephrons. Diuretics increase the reabsorption of electrolytes in the kidneys. Diuretics have no effect on reabsorption.
Diuretics reduce the reabsorption of water in the kidneys.
After teaching a group of nursing students about diuretics, the instructor determines that the teaching was successful when the group identifies which as a loop diuretic? Furosemide Hydrochlorothiazide Acetazolamide Spironolactone
Furosemide
After teaching a group of students about loop diuretics, the instructor determines that the teaching has been successful when the students identify which agent as the safest for use in the home? Furosemide Ethacrynic acid Bumetanide Torsemide
Furosemide
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
Which drugs cause diuresis by inhibiting re-absorption of sodium and chloride ions in the distal and proximal tubules and in the loop of Henle? (Select all that apply.) Chlorothiazide (Diuril) Furosemide (Lasix) Bumetanide (Bumex) Mannitol (Osmitrol) Spironolactone (Aldactone)
Furosemide (Lasix) Bumetanide (Bumex)
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? Hypokalemia Hyperkalemia Angina Hypertension
Hyperkalemia
The nurse assesses a client receiving furosemide for: Acidosis Hypercalcemia Hypotension Hypoglycemia
Hypotension
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
Hydrochlorothiazide works by what mechanism of action? Decreasing sodium absorption in the loop of Henle Promoting increased chloride concentrations in the urine Increasing the excretion of sodium and chloride in the distal tubule Increasing water reabsorption in the ascending loop of Henle
Increasing the excretion of sodium and chloride in the distal tubule
When describing where bumetanide acts, what would the nurse include? Proximal convoluted tubule Loop of Henle Collecting tubule Glomerulus
Loop of Henle
A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered? Mannitol Furosemide Amiloride Bumetanide
Mannitol
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
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
After reviewing the different classes of diuretics available, a student demonstrates understanding when the student identifies what as an example of a thiazide-like diuretic? Metolazone Chlorothiazide Furosemide Triamterene
Metolazone
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? Administration of concurrent potassium Monitoring of serum electrolytes, creatinine, and BUN Administration of a thiazide diuretic Monitoring of CBC and serum albumin
Monitoring of serum electrolytes, creatinine, and BUN
A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route? Oral Subcutaneous Intramuscular Intravenous
Oral
Why would potassium-sparing diuretics be contraindicated for clients experiencing renal failure? They may cause hyperkalemia. They are the strongest form of diuretics. They promote excretion of potassium. They may cause rebound edema.
They may cause hyperkalemia.
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 Carbonic anhydrase inhibitors Potassium-sparing diuretics Osmotic diuretics
Thiazide diuretics
A nurse is providing care to a client who is to receive acetazolamide for epilepsy. Before administering this drug, the nurse would assess which of the following? Intraocular pressure and eye pain Response of pupils to light and blink reflex Vital signs and weight Intracranial bleeding and level of consciousness
Vital signs and weight
A client, prescribed digoxin and furosemide, is at risk for developing which adverse effect? hyperkalemia hyperglycemia tachycardia digoxin toxicity
digoxin toxicity
A 49-year-old client reports frequent muscle cramps while on hydrochlorothiazide therapy. The nurse would advise the client to do which? drink plenty of fluids. eat potassium-rich foods. take calcium supplements. include high-sodium foods in her diet.
eat potassium-rich foods.
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
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
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
An older adult client has a complex medical history that includes heart failure, type 1 diabetes, and diabetic nephropathy. The nurse has questioned a care provider's prescription for oral spironolactone because the client's health problems would contribute to a high risk of which adverse reaction? metabolic acidosis hypocalcemia hemolytic anemia hyperkalemia
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.
A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed? loop diuretic potassium-sparing diuretic thiazide diuretic osmotic diuretic
osmotic diuretic
What substance is reabsorbed in the ascending limb of the loop of Henle? sodium water glucose amino acids
sodium