Chapter 51: Diuretic Agents

A nurse is caring for a patient with edema due to congestive heart failure (CHF). The physician has prescribed indapamide to the patient. The patient is also undergoing treatment with digitalis glycoside. Which intervention should the nurse perform when caring for this patient?

Frequently monitor the patient's pulse rate and rhythm.

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

The nurse assesses a client receiving furosemide for:

Hypotension

A patient is receiving bumetanide. The nurse would instruct the patient to be alert for what issues? (Select all that apply.)

Hypotension Dizziness Weakness Muscle cramps

The nurse understands that the action of most diuretics typically results in which effects? (Select all that apply.)

Loss of water Loss of chloride

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

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

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

Diuretics are often taken in the home setting. The home care nurse may need to assist clients and caregivers by doing what tasks? (Select all that apply.)

Monitoring client responses Assessing use of over-the-counter medications that may aggravate the client's condition

The physician has ordered the patient hydrochlorothiazide. What assessment should the nurse make before administering the first dose of hydrochlorothiazide?

Sulfonamide allergy

Which exerts its effects by depressing the reabsorption of sodium in the kidney tubules, thereby increasing sodium and water excretion?

Triamterene (Dyrenium)

About 80% of water, sodium, potassium, and other substances are reabsorbed during renal processing; the remaining 20% enters the loop of Henle. What substance is reabsorbed in the ascending limb of the loop of Henle?

sodium

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

The physician orders furosemide for a pediatric client. The nurse knows that the established dose of the drug should not exceed how many milligrams per kilogram of body weight per day?

6

A patient has edema of the lower extremities and abdomen. What is the reason to administer a stronger diuretic than a thiazide diuretic to this patient?

A thiazide diuretic will be ineffective for immediate diuresis.

A nurse is providing patient teaching for a 62-year-old woman who is taking triamterene. The nurse will teach the patient to avoid what in her diet?

Avocados

A patient is taking spironolactone (Aldactone). When providing patient teaching about this medication, what foods should the patient be instructed to avoid?

Bananas

A patient is prescribed a thiazide diuretic that is to be administered intravenously. Which agent would this most likely be?

Chlorothiazide

The nurse is caring for a 53-year-old man with a 30-year history of alcohol dependency. He presents with ascites, secondary to cirrhosis. Which mechanism is involved in his fluid shift?

Decreased plasma oncotic pressure

A patient has been prescribed digoxin (Lanoxin) and furosemide (Lasix) for treatment of congestive heart failure. What is the patient at risk for developing with this combination of medications?

Digoxin toxicity

Which is an example of a loop diuretic?

Furosemide (Lasix)

A male client has cirrhosis of the liver that has caused ascites. The nurse knows that what condition may occur if diuretics are used to reduce the ascites?

Hepatic encephalopathy

A 91-year-old patient, who is being prepared for discharge, has been prescribed the diuretic spironolactone. While teaching the patient about the drug, what major adverse effect should the nurse be sure to mention?

Hyperkalemia

After reviewing information about thiazide diuretics, a group of students demonstrate the need for additional teaching when they identify what as a possible adverse effect?

Hypocalcemia

A physician has prescribed triamterene to a male patient with renal disease. The patient informs the nurse that he is taking potassium supplements to overcome cardiovascular problems. What effect of the interaction between these two drugs should the nurse look for in the patient?

Increased risk of hyperkalemia

Hydrochlorothiazide works by what mechanism of action?

Increasing the excretion of sodium and chloride in the distal tubule

A female client is diagnosed with hyponatremia. What type of diuretic would most likely cause this symptom?

Loop

The nurse is caring for a patient who is experiencing elevated intracranial pressure following neurosurgery. The physician orders an osmotic diuretic to reduce pressure. Which agent would the physician select?

Mannitol

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

Metabolic acidosis

A patient is admitted to emergency and is unconscious as a result of a head injury. The patient's intracranial pressure is increased. What diuretic will be administered to the patient?

Osmotic diuretic

A physician prescribes spironolactone, a potassium-sparing diuretic, for a patient with cirrhosis. For which category of patients is the use of potassium-sparing diuretics contraindicated?

Patients with hyperkalemia

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 36-year-old male client undergoes dialysis three times weekly while waiting for renal transplant. A diuretic has been added to his current medications to combat developing edema. Why would potassium-sparing diuretics be contraindicated?

They may cause hyperkalemia.

A nurse should obtain an allergy history from patients as which class of diuretics may result in a cross-sensitivity reaction with sulfonamides?

Thiazide diuretics

A nurse is caring for a patient with epilepsy. The physician has prescribed acetazolamide to the patient. What should the nurse assess in the patient before administering the drug?

Vital signs and weight

A nurse understands that loop diuretics are considered high ceiling diuretics because they:

cause a greater diuresis.

A nurse is caring for a 78-year-old patient with renal insufficiency and chronic heart failure who is receiving rapid infusions of high-dose furosemide. It will be a priority for the nurse to monitor for:

ototoxicity.

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."

A patient is admitted the hospital with congestive heart failure. The patient is ordered to receive furosemide (Lasix) 40 mg IV. How soon will diuretic effects occur after administration?

5 minutes

Which diuretic exerts its effect by inhibiting the enzyme carbonic anhydrase?

Acetazolamide (Diamox)

Which diuretic has been administered to patients with epileptic seizures?

Acetazolamide (Diamox)

A nurse is caring for a patient with acute renal failure. The physician has prescribed a diuretic therapy for the patient to promote dieresis. What intervention should the nurse perform to prevent the inconvenience caused by increased urination?

Administer the drug early in the day.

When describing the action of spironolactone, the nurse would explain that this drug acts by:

Blocking aldosterone in the distal tubule

When describing the action of chlorothiazide, what would a nurse include?

Blocking of the chloride pump

A 75-year-old client is diagnosed with atrial fibrillation and chronic congestive heart failure. The physician 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?

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?

Distal tubule