Chapter 34 - Drug Therapy for FVE

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."

A client with heart failure is prescribed a loop diuretic. Which client statement indicates that teaching provided by the nurse about this medication was effective?

"I will change positions slowly if I feel dizzy."

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."

A client with kidney disease asks why there is blood in the urine. Which process will the nurse explain to the client?

"The glomerulus in the kidney is scarred or damaged, permitting blood cells to escape in the urine."

An 8-year-old client weighing 57 lb. is prescribed furosemide 5 mg/kg/day. Calculate the amount of medication the nurse will provide to the client. Round your answer to the nearest whole number.

130

The amount of fluid excreted as urine each day averages approximately less than how many liters?

2 L

The nurse is providing health promotion education to a client regarding proper hydration. How much urine will the nurse indicate an adequately hydrated adult produces each day?

2 L/d

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 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?" In response, the nurse should describe what phenomenon?

A very large majority of filtrate is returned to circulation.

A nurse is preparing a teaching plan for a client with edema who is prescribed a diuretic. Which teaching should the nurse prioritize?

Administer early in day

The nurse has finished a teaching session with a client who is prescribed a diuretic to be taken twice a day. The nurse determines the session is successful when the client correctly chooses which times to take the drug?

At breakfast and midafternoon

A client presents with ascites, secondary to cirrhosis. What mechanism is involved in this fluid shift?

Decreased plasma oncotic pressure

The staff educator in the ICU is talking with a group of new nurses about osmotic diuretics. The educator would tell the new nurses that osmotic diuretics act upon which site in the nephron?

Descending limb of loop of Henle

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

A male client is excited because it is football season. He has season tickets and attends most games with his friends. At his latest appointment, the client's blood pressure is elevated. What does the nurse suspect is the cause?

He is consuming excessive salty foods at the games.

A client presents to the clinic for a 1-month follow-up appointment. The client tells the nurse, "I have been taking chlorothiazide for a month and now I have leg cramps and feel tired all the time." What will the nurse consider as the most likely cause of the client's symptoms?

Hypokalemia

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 glucose levels

A client is admitted in acute renal failure and prescribed mannitol. The nurse prepares to administer this drug via which route?

Intravenously

A client is receiving hydrochlorothiazide. The nurse would expect this drug to begin acting within which time frame?

Loop diuretic

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

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?

Mannitol

A group of students are reviewing the structure and function of the renal system. The students demonstrate understanding when they identify what as the functional unit?

Nephron

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 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?

Spironolactone

A client began taking hydrochlorothiazide 1 week ago and is reporting occasional dizziness when standing up quickly from sitting or lying. What is the nurse's best action?

Teach the client about the blood pressure effects of the medication and relevant safety measures.

What best describes the structure of the kidneys?

The renal pelvises drain urine into the ureters.

Which substances are moved from the glomerulus into the tubule due to hydrostatic pressure?

Water

A nurse administers chlorothiazide to a client with renal compromise. Which action should the nurse prioritize after noting the BUN level is rising?

Withhold the next dose of the drug.

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.

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

furosemide

A client with heart failure has developed acute shortness of breath and pulmonary edema. The nurse will prepare for administration of what medication and via what route?

furosemide IV

The nurse is providing education to a 72-year-old client who has been discharged home on a diuretic. What should the nurse include in the discharge instructions?

how to properly weigh themselves at home

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

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 with increased intracranial pressure. Which diuretic would the nurse anticipate being prescribed for this client?

mannitol

To which client should the nurse anticipate administering mannitol?

the client with increased intracranial pressure secondary to a subarachnoid hemorrhage

The nurse has administered a diuretic that acts to block the chloride pump in the distal convoluted tubules and leads to a loss of sodium and potassium and a minor loss of water. What type of diuretic did the nurse administer?

thiazide diuretic