Pharmacology Ch 51 (3)

A male client has been ordered spironolactone (Aldactone) for hypertension. Which statement by the client indicates a need for further education?

"I will take the medication when my blood pressure is elevated."

A child experiencing edema as a result of a congenital heart defect is prescribed a thiazide diuretic. The nurse should closely monitor which of the client's clinical characteristics? (Select all that apply.)

- Potassium level - Daily weight - Blood pressure - Appetite Rationale: Hypokalemia is a serious side effect of thiazide diuretics that can cause dysrhythmias. Weight and appetite should be monitored because anorexia is an adverse effect associated with thiazide diuretics. Thiazide diuretics inhibit the reabsorption of sodium, which lowers blood pressure. Patients should be assessed for hypotension.

A patient is receiving acetazolamide in a sustained release form. The nurse would anticipate the onset of drug action in approximately which time frame?

2 hours Rationale: Acetazolamide in sustained release form has an onset of action of 2 hours.

The nurse should be aware that diuresis will peak how long after furosemide is administered?

30 minutes

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 be ineffective when immediate diuresis is needed. Rationale: 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.

A nurse demonstrates understanding of diuretics when identifying which medication as exerting its effect by inhibiting the enzyme carbonic anhydrase?

Acetazolamide

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?

Distal tubule

What type of diet should a patient taking diuretics have?

Eat potassium-rich or low-potassium diet as appropriate

A client who is allergic to sulfonamide would use what diuretic cautiously?

Hydrochlorothiazide Rationale: There is a known cross-sensitivity of some sulfonamide-allergic clients to sulfonamide nonantibiotics, such as thiazides.

A male client is prescribed potassium-sparing diuretics to treat his disease process. During his annual visit to the health care provider, he reports experiencing muscle weakness and tingling in his fingers. What does the nurse suspect is wrong with this client?

Hyperkalemia Rationale: Potassium-sparing diuretics are contraindicated in clients with renal impairment because of the high risk of hyperkalemia.

When describing where bumetanide acts, what would the nurse include?

Loop of Henle Rationale: 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.

The nurse is caring for a client who is experiencing elevated intracranial pressure following neurosurgery. The health care provider orders an osmotic diuretic to reduce pressure. Which medication would the nurse expect to be ordered?

Mannitol Rationale: 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.

Which would the nurse expect to find in a client receiving acetazolamide?

Metabolic acidosis Rationale: Metabolic acidosis is a relatively common and potentially dangerous effect that occurs when bicarbonate is lost due to the action of carbonic anhydrase inhibitors. Metabolic alkalosis would occur if bicarbonate were retained. No respiratory acid-base imbalances are associated with this drug.

Because of the action of methazolamide, the nurse would assess a patient closely for signs and symptoms of which acid-base imbalance?

Metabolic acidosis Rationale: Methazolamide is a carbonic anhydrase inhibitor that can cause metabolic acidosis, not alkalosis, due to the loss of bicarbonate. It is not associated with either respiratory acidosis or alkalosis.

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 Rationale: 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.

When providing care for older adults who are taking furosemide on a regular basis, the nurse should prioritize assessments that are relevant to what health problem?

dehydration Rationale: Excessive diuresis, particularly in older adults, may cause dehydration, blood volume reduction with circulatory collapse, and the risk of vascular thrombosis and embolism. Hypernatremia, urinary retention, and dysrhythmias are unlikely to result from the use of furosemide.

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

furosemide Rationale: 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 antineoplastic agent.

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 mostconsistent with this client's health needs?

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

The nurse is caring for a 68-year-old female client with type 1 diabetes mellitus whose health care provider has ordered hydrochlorothiazide. As a consequence of taking the diuretic, the client may need to:

increase her insulin dose

An adult client with multiple chronic health problems has been prescribed furosemide in the management of hypertension. When reviewing this client's current medication administration record, what drug should signal the nurse to a potentially increased risk of hypokalemia?

prednisone