Pharmacology Chapter 34: Drug Therapy for Fluid Volume Excess

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?

"Actually, patients with renal failure usually can't take hydrochlorothiazide."

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."

A clinic nurse has been assigned to follow up with a group of patients on hydrochlorothiazide therapy. Which patient will the nurse most closely monitor for hyponatremia?

A 71-year-old female who has advanced arteriosclerosis

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?

Administer the drug early in the day.

A nurse is caring for a client with increased intracranial pressure caused by cerebral edema. The health care provider has prescribed mannitol. What assessment should the nurse perform after administering the drug to the client?

Check response of pupils to light.

A nurse is preparing to administer a diuretic to a client. The nurse should question administering which drug after noting an allergy to sulfamethoxazole/trimethoprim? Select all that apply.

Chlorothiazide Furosemide Chlorthalidone Metolazone

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?

Hypokalemia

A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered?

Mannitol

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?

Monitoring of serum electrolytes, creatinine, and BUN

The emergency department (ED) nurse is caring for a client who is experiencing pulmonary edema. The client is treated with furosemide. What will the nurse monitor most closely?

Potassium levels

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 hydrochlorothiazide than with spironolactone.

A client with hypertension has been prescribed spironolactone. The client's previous diuretic, furosemide, has been discontinued. The nurse should explain what benefit of this change?

Potassium losses are lower with spironolactone than with furosemide.

A client asks the nurse what regulates the flow of fluid into the glomerulus by increasing or decreasing pressure on either side of the glomerulus. What is the nurse's best response?

The arterioles

What is the expected outcome when the glomerular membrane is damaged?

The filtration of fluid from the blood into the kidney's nephron tubule is impaired

What best describes the structure of the kidneys?

The renal pelvises drain urine into the ureters.

A 49-year-old client reports frequent muscle cramps while on hydrochlorothiazide therapy. The nurse would advise the client to do which?

eat potassium-rich foods.

A health care provider is considering ordering hydrochlorothiazide for a client. This drug must be used cautiously, if at all, if the client has a history of:

hypersensitivity to sulfonamides.

The nurse is caring for a client whose potassium level is 5.9 mmol/L (5.9 mg/dL). The client's kidneys will respond to this potassium level by:

removing more potassium in the distal convoluted tubule.

A group of students are reviewing the function of the kidneys and demonstrate understanding when they identify that the kidneys receive what portion of the cardiac output?

¼

A 10-year-old child has edema caused by a heart defect. The client is taking furosemide. The dosage is 3 mg/kg/d. The child weighs 76 lbs. How many milligrams does the child receive each day?

105 mg

provider order: heparin 25,000 units in 250 mL of 5% dextrose and water infuse at 600 units/hour how many mL/hour should the IV pump set at

6

A patient has been prescribed a daily dosage of 20 mg of torsemide for the treatment of acute pulmonary edema. The drug is available in the form of 10 mg tablets. How many tablets should the nurse get for the course of 4 days?

8

A client has been diagnosed with renal failure and is surprised to learn of the large volume of blood that is filtered by the kidneys. The client asks, "If that much blood gets filtered, why don't people produce more urine than they do?" In response, the nurse should describe what phenomenon?

A very large majority of filtrate is returned to circulation.

When explaining the underlying mechanisms associated with renal failure, which would be most important for the nurse to keep in mind?

Extensive kidney damage has usually occurred by the time the patient is symptomatic.

What term is used to describe the process that moves fluid and small particles out of the blood through the glomerulus and into the nephron tubule

Filtration

A client with congestive heart failure and currently administered digoxin is now prescribed indapamide for edema. Which intervention should the nurse prioritize?

Frequently monitor the client's pulse rate and rhythm.

The nurse is caring for a client suspected of having renal dysfunction. The presence of what substances in the client's urine would be considered pathological?

Glucose and protein

A nurse caring for a client with diabetes controlled on metformin (Glucophage) has recently begun taking a drug for edema. The nurse notices that the client's blood glucoses are increasing. Which of the following diuretics are likely to cause hyperglycemia? Select all that apply:

Hydrochlorothiazide (Microzide) Chlorthalidone (Thalitone) Metolazone (Zaroxolyn)

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