PrepU Chapter 51

Which instruction would be most appropriate for a client who is taking a diuretic?

"It's okay to take it with food." Instructions for a client taking a diuretic include taking the drug with food or meals if gastrointestinal upset occurs, taking the dose early in the morning to prevent interfering with sleep, implementing safety precautions if dizziness or weakness is a problem, and ensuring adequate fluid intake to prevent fluid rebound. It is not necessary to lie down after taking the drug.

A male client has cirrhosis and is receiving diuretic therapy. The nurse knows that what drug will help prevent metabolic alkalosis or hypokalemia in this client? Bumetanide Hydrochlorothiazide Spironolactone Dyazide

Spironolactone For clients with cirrhosis, diuretic therapy should be initiated in a hospital setting, with small doses and careful monitoring. To prevent hypokalemia and metabolic alkalosis, supplemental potassium or spironolactone may be needed.

Why would potassium-sparing diuretics be contraindicated for clients experiencing renal failure?

They may cause hyperkalemia. Potassium-sparing diuretics are contraindicated in the presence of renal insufficiency because their use may cause hyperkalemia because of the kidneys' ineffective filtration abilities. The remaining options would not result from impaired renal failure.

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. The client is most likely experiencing muscle cramps due to potassium loss. Therefore, the nurse should advise the client to include potassium supplements in the diet. Drinking plenty of fluids or using calcium supplements will not reduce the occurrence of cramps. It is important to caution the client to avoid foods high in sodium because they could counteract the effects of drug therapy.

A patient receives furosemide intravenously at 9 AM. The nurse would expect to assess peak effects of the drug at which time? 9:15 AM 10:00 AM 9:30 AM 10:30 AM

9:30 AM Furosemide, when given IV, peaks in 30 minutes; the nurse would see peak drug action at approximately 9:30 AM.

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.) Bumetanide (Bumex) Furosemide (Lasix) Chlorothiazide (Diuril) Spironolactone (Aldactone) Mannitol (Osmitrol)

Furosemide (Lasix) Bumetanide (Bumex) Loop diuretics, like furosemide (Lasix) and bumetanide (Bumex), cause diuresis by inhibiting re-absorption of sodium and chloride ions in the distal and proximal tubules and in the loop of Henle.

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?

Hyperkalemia The major adverse effect of potassium-sparing diuretics such as spironolactone is hyperkalemia. Clients receiving these drugs should not be given potassium supplements and should not be encouraged to eat foods high in potassium.

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 Potassium-sparing diuretics are contraindicated in clients with renal impairment because of the high risk of hyperkalemia. If they are used at all, frequent monitoring of serum electrolytes, creatinine, and BUN is needed.

A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route?

Oral Hydrochlorothiazide is only available as an oral preparation. Only chlorothiazide can be given by intravenous infusion.

A male client has cirrhosis and is receiving diuretic therapy. The nurse knows that what drug will help prevent metabolic alkalosis or hypokalemia in this client? Bumetanide Spironolactone Hydrochlorothiazide Dyazide

Spironolactone For clients with cirrhosis, diuretic therapy should be initiated in a hospital setting, with small doses and careful monitoring. To prevent hypokalemia and metabolic alkalosis, supplemental potassium or spironolactone may be needed.

A client, prescribed digoxin and furosemide, is at risk for developing which adverse effect? hyperglycemia digoxin toxicity hyperkalemia tachycardia

digoxin toxicity When digoxin and diuretics are used concomitantly, the risk of digoxin toxicity is increased. The client is at risk for hypokalemia, not hyperkalemia. The client is not at risk for hyperglycemia or tachycardia.

The nurse is teaching a 62-year-old client about hydrochlorothiazide, which the health care provider has prescribed for treatment of hypertension. What statement, made by the client, suggests that the client understands the teaching? "I will need to stand slowly." "I must take my medication on an empty stomach." "I will need to make sure that I am consuming enough sodium." "I can jump right into action!"

"I will need to stand slowly." Diuretics, including hydrochlorothiazide, can cause orthostatic hypotension. Rising slowly to a standing position can reduce the risk of falls. Patients taking diuretics should restrict sodium intake to avoid the need for higher doses, which increase the likelihood of adverse effects. Taking diuretics with food can help avoid the GI irritation frequently associated with these drugs.

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? Hypocalcemia Hyperkalemia Hypercalcemia Hypokalemia

Hypokalemia Thiazides, such as hydrochlorothiazide, are potassium-losing diuretics, and their use can lead to hypokalemia. Symptoms of hypokalemia include muscle weakness, dysrhythmia, hypotension, anorexia, and and shallow respirations.

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?

Increased blood glucose levels The nurse should monitor for increased blood glucose levels in the diabetic client receiving a loop diuretic. The blood glucometer test results for these clients may be elevated, or urine may test positive for glucose. Thiazide diuretic agents may cause gout attacks and sudden joint pain. The nurse need not monitor for a sudden increase in weight as the administration of loop diuretics to a diabetic client will not cause this effect.

Ms. Crampton is prescribed furosemide for chronic heart failure. The nurse knows that furosemide can cause electrolyte imbalances and what other serious side effect? Compensated respiratory alkalosis Metabolic acidosis Metabolic alkalosis Compensated respiratory acidosis

Metabolic alkalosis 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.

An adult client with a diagnosis of hypertension has been prescribed oral furosemide. What goal should the nurse identify when planning this client's medication teaching session? The client will identify strategies for limiting sodium intake. The client will be able to demonstrate correct technique for blood glucose monitoring. The client will accurately describe the basic structure and functions of the kidneys. The client will describe the rationale for increasing fluid intake.

The client will identify strategies for limiting sodium intake. The reason for furosemide use should guide client teaching. In most instances, it is necessary to initiate measures to limit sodium intake. Key considerations should include not adding salt to food during preparation or at the dinner table, reading food labels carefully to be aware of hidden sources of sodium, and avoiding processed or high-sodium foods. Blood glucose monitoring is not indicated, and there is no need for increased fluid intake. Renal anatomy and physiology are not priority teaching points.

A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed? thiazide diuretic loop diuretic potassium-sparing diuretic osmotic diuretic

osmotic diuretic An osmotic diuretic is used to reduce intracranial pressure related to a head injury. Loop diuretics, potassium-sparing diuretics, and thiazide diuretics do not reduce intracranial pressure.

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." The drug is a potassium sparing diuretic placing the patient at risk for hyperkalemia, especially if the patient consumes foods high in potassium. The patient should take the medication in the morning to prevent interfering with sleep by having to get up at night to void. The patient can take the drug with meals if GI upset occurs. Many salt substitutes contain potassium, which could increase the patient's risk for hyperkalemia.

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 water losses with spironolactone than with furosemide." "You will have greater sodium losses with spironolactone than with furosemide." "You will have greater potassium losses with spironolactone than with furosemide."

"You will lose less potassium with spironolactone than with furosemide." Spironolactone promotes retention of sodium and water and excretion of potassium by stimulating the sodium-potassium exchange mechanism in the distal tubule. The client will not have greater potassium losses, water losses, or sodium losses with spironolactone rather than furosemide.

The nurse is monitoring the results of laboratory testing for a client receiving chlorthalidone. What finding would be a cause for concern?

Hypercalcemia Chlorthalidone is a thiazide-like diuretic that may lead to hypercalcemia (due to decreased calcium excretion), hyperuricemia (increased levels of uric acid due to decreased uric acid secretion), and hypokalemia. Anemia is not associated with this drug.

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 Hypertension Angina

Hyperkalemia The major adverse effect of potassium-sparing diuretics such as spironolactone is hyperkalemia. Clients receiving these drugs should not be given potassium supplements and should not be encouraged to eat foods high in potassium.

When describing where bumetanide acts, what would the nurse include? Loop of Henle Proximal convoluted tubule Glomerulus Collecting tubule

Loop of Henle 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.

Why would potassium-sparing diuretics be contraindicated for clients experiencing renal failure? They may cause hyperkalemia. They promote excretion of potassium. They are the strongest form of diuretics. They may cause rebound edema.

They may cause hyperkalemia. Potassium-sparing diuretics are contraindicated in the presence of renal insufficiency because their use may cause hyperkalemia because of the kidneys' ineffective filtration abilities. The remaining options would not result from impaired renal failure.

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 The nurse should know that potassium-sparing diuretics are contraindicated in clients with hyperkalemia and are not recommended for children. Potassium-sparing diuretics should be used cautiously in clients with liver disease, diabetes, or gout, but presence of these conditions does not contraindicate the use of potassium diuretics.

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?

hyperkalemia The presence of renal insufficiency is also a contraindication to the use of spironolactone because use of spironolactone may cause hyperkalemia through the inhibition of aldosterone and the subsequent retention of potassium. A prescription for spironolactone does not put this client at a greatly increased risk of anemia, hypocalcemia, or acidosis since none of these conditions are associated with potassium.

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

Mannitol Mannitol is a powerful osmotic diuretic that is used to treat increased intracranial pressure. It is given intravenously and begins to work in 30 to 60 minutes. Furosemide, amiloride, and bumetanide are not indicated for the treatment of increased intracranial pressure.

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 Furosemide, when given intravenously, begins to act in 5 minutes, reaching peak effects in 30 minutes. In this case, this would be 8:30 AM.

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. The nurse should inform the client about the increased risk of hyperkalemia as the effect of the interaction between triamterene, which is a potassium-sparing diuretic, and potassium supplements. When the client is administered loop diuretics with anticoagulants or thrombolytics, there will be increased risk of bleeding. When the client is administered digitalis with loop diuretics, there is an increased risk of arrhythmias. Decreased diuretic effect, in this case decreased effect of triamterene, will occur when a potassium-sparing diuretic such as triamterene is administered with NSAIDs, salicylates, and anticoagulants.

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?

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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. The nurse should administer the drug early in the day to prevent any nighttime sleep disturbance caused by increased urination when caring for a client receiving a diuretic therapy for acute renal failure. The nurse need not ask the client to decrease fluid intake, gradually increase the drug dosage, or encourage the client to exercise as these are not appropriate interventions and will not help in reducing the discomfort caused by increased urination.

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 Furosemide is less powerful than bumetanide and torsemide and therefore has a larger margin of safety for home use (see the Critical Thinking Scenario in this chapter for additional information about using furosemide in heart failure). Ethacrynic acid is used less frequently in the clinical setting because of the improved potency and reliability of the newer drugs.

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 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.

A nurse is preparing to administer a diuretic that antagonizes the action of aldosterone. Which drug would the nurse be most likely to administer? Furosemide Spironolactone Hydrochlorothiazide Acetazolamide

Spironolactone Spironolactone is a potassium-sparing diuretic that exerts its diuretic effect by antagonizing the action of aldosterone. Furosemide is a loop diuretic when given with lithium increases the risk for lithium toxicity. Hydrochlorothiazide given with anesthetics increases the anesthetic effectiveness. Acetazolamide when given with primidone for seizures, decreases the primidone effectiveness.

A nurse understands that loop diuretics are considered high ceiling diuretics because they: require large doses to achieve effect. cause a greater loss of potassium. cause a greater diuresis. are associated with more adverse effects.

cause a greater diuresis. High ceiling diuretics are those that cause a greater degree of diuresis than other diuretics.

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 bestrespond to this suggestion? "That would only work if he could come in twice a day to get it intravenously." "That would probably help, but we'd have to do blood work first." "Actually, patients with renal failure usually can't take hydrochlorothiazide." "Maybe, but hydrochlorothiazide affects the bladder more than the kidneys."

"Actually, patients with renal failure usually can't take hydrochlorothiazide." Renal disease and severe renal impairment contraindicate the use of hydrochlorothiazide. HCTZ affects the kidneys, not the bladder, and is not administered intravenously.

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." Spironolactone promotes retention of sodium and water and excretion of potassium by stimulating the sodium-potassium exchange mechanism in the distal tubule. The patient will not have greater potassium losses, water losses, or sodium losses with spironolactone rather than furosemide.

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 Furosemide (Lasix) is an example of a loop diuretic. Hydrochlorothiazide is a thiazide diuretic. Acetazolamide is a carbonic anhydrase inhibitor. Spironolactone is a potassium-sparing diuretic.

As part of a class presentation, a nursing student is describing the actions of the different diuretics. Which medication would the student include as exerting its diuretic effect by inhibiting the reabsorption of sodium and chloride ions in the ascending portion of the loop of Henle and the early distal tubule of the nephron? Spironolactone Hydrochlorothiazide Acetazolamide Furosemide

Hydrochlorothiazide Hydrochlorothiazide is a thiazide diuretic that exerts its diuretic effect by inhibiting the reabsorption of sodium and chloride ions in the ascending portion of the loop of Henle and the early distal tubule of the nephron. Acetazolamide is a carbonic anhydrase inhibitor and is a sulfonamide, without bacteriostatic action, that inhibits the enzyme carbonic anhydrase. Carbonic anhydrase inhibition results in the excretion of sodium, potassium, bicarbonate, and water. Furosemide is a loop diuretic which inhibits reabsorption of sodium and chloride in the distal and proximal tubules of the kidney and in the loop of Henle. Spironolactone is a potassium-sparing diuretic works to antagonize the action of aldosterone. Aldosterone, a hormone produced by the adrenal cortex, enhances the reabsorption of sodium in the distal convoluted tubules of the kidney. When this is blocked by the drug, sodium (but not potassium) and water are excreted.

Upon her visit to the primary care provider's office, a female client presents with 14 pounds of additional weight since her visit 3 weeks ago. Her lower extremities are quite swollen, and her facial features are puffy. The provider prescribes a diuretic and requests a follow-up visit in 3 days. Two days later, the client contacts the office and is so dyspneic that she is hard to understand over the phone. An ambulance is dispatched, and she is admitted to the hospital for rapid diuresing. Which diuretic will most likely be the initial drug of choice? Osmotic diuretic Loop diuretic Potassium-sparing diuretic Thiazide

Loop diuretic Loop diuretics are the diuretics of choice when rapid effects are required.

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 A cross-sensitivity reaction may occur with the thiazide diuretics and sulfonamides. For clients who take carbonic anhydrase inhibitors during treatment for glaucoma, contact the primary health care provider immediately if eye pain is not relieved or if it increases. When a client with epilepsy is being treated for seizures, a family member of the client should keep a record of all seizures witnessed and bring this to the primary health care provider at the time of the next visit. Contact the primary health care provider immediately if the number of seizures increases. Potassium-sparing diuretics can lead to hyperkalemia and is most likely to occur in clients with an inadequate fluid intake and urine output, those with diabetes or renal failure, older adults, and those who are severely ill, and teach the client to avoid the use of salt substitutes containing potassium. Osmotic diuretics such as mannitol or urea for treatment of increased intracranial pressure caused by cerebral edema, perform neurologic assessments (response of the pupils to light, level of consciousness, or response to a painful stimulus) in addition to vital signs at the time intervals ordered by the primary health care provider.