Chapter 51: Diuretic Agents
A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered? a)Mannitol b)Amiloride c)Bumetanide d)Furosemide
a)Mannitol
A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route? a)Intravenous b)Oral c)Intramuscular d)Subcutaneous
b)Oral
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? a)metabolic acidosis b)hyperkalemia c)hypocalcemia d)hemolytic anemia
b)hyperkalemia
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: a)decreased diuretic effectiveness. b)increased risk of arrhythmias. c)increased risk of bleeding. d)increased risk of hyperkalemia.
d)increased risk of hyperkalemia.
A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed? a)potassium-sparing diuretic b)thiazide diuretic c)loop diuretic d)osmotic diuretic
d)osmotic diuretic
A client who been prescribed long-term diuretic therapy. Which statement demonstrates an understanding of the importance of self-monitoring to identify fluid-related issues? Select all that apply. a)"I take my scale with me when I stay overnight with friends." b)"I know it's important to weigh myself daily." c)"I weigh myself in the same clothes every day." d)"I'm weighing myself because my health provider said that I should." e)"I weigh myself before breakfast every day."
a)"I take my scale with me when I stay overnight with friends." b)"I know it's important to weigh myself daily." c)"I weigh myself in the same clothes every day." e)"I weigh myself before breakfast every day."
What information should the nurse discuss with the client considering pregnancy regarding the use of a diuretic during pregnancy? a)"Typically, women on diuretics prior to becoming pregnant can remain on the medication during their pregnancy." b)"No obstetrician will allow you to take a diuretic during a pregnancy." c)"You can take a diuretic while breastfeeding but not while you're pregnant." d)"There are serious potential adverse effects on a fetus when exposed to a diuretic in utero."
a)"Typically, women on diuretics prior to becoming pregnant can remain on the medication during their pregnancy."
Diuretics increase the production and output of urine. Which statement helps explain how diuretics achieve these effects? a)Diuretics reduce the reabsorption of water in the kidneys. b)Diuretics have no effect on reabsorption. c)Diuretics increase production of nephrons. d)Diuretics increase the reabsorption of electrolytes in the kidneys.
a)Diuretics reduce the reabsorption of water in the kidneys.
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.) a)Furosemide (Lasix) b)Bumetanide (Bumex) c)Mannitol (Osmitrol) d)Spironolactone (Aldactone) e)Chlorothiazide (Diuril)
a)Furosemide (Lasix) b)Bumetanide (Bumex)
A client who is allergic to sulfonamide would use what diuretic cautiously? a)Hydrochlorothiazide b)Bumetanide c)Furosemide d)Torsemide
a)Hydrochlorothiazide
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? a)Hypokalemia b)Hypercalcemia c)Hypocalcemia d)Hyperkalemia
a)Hypokalemia
When describing where bumetanide acts, what would the nurse include? a)Loop of Henle b)Proximal convoluted tubule c)Glomerulus d)Collecting tubule
a)Loop of Henle
Why would potassium-sparing diuretics be contraindicated for clients experiencing renal failure? a)They may cause hyperkalemia. b)They promote excretion of potassium. c)They may cause rebound edema. d)They are the strongest form of diuretics.
a)They may cause hyperkalemia.
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? a)Thiazide diuretics b)Osmotic diuretics c)Potassium-sparing diuretics d)Carbonic anhydrase inhibitors
a)Thiazide diuretics
Which instruction would be most appropriate for a client who is taking a diuretic? a)"Take the daily dose around dinnertime." b)"It's okay to take it with food." c)"Lie down after taking the drug." d)"Limit the amount of fluids you drink."
b)"It's okay to take it with food."
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? a)8:15 AM b)8:30 AM c)8:45 AM d)9:00 AM
b)8:30 AM
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? a)Gradually increase the drug dosage. b)Administer the drug early in the day. c)Ask the client to decrease fluid intake. d)Encourage the client to exercise.
b)Administer the drug early in the day.
An elderly patient with a history of congestive heart failure has been admitted to hospital with failure to thrive and admission blood work reveals a hemoglobin level of 6.9 g/dL. The care team has consequently administered two units of packed red blood cells, but auscultation of the client's lungs now reveals diffuse crackles. Administration of what drug is likely to resolve the patient's pulmonary edema? a)Hydrochlorothiazide b)Furosemide c)Triamterene Mannitol
b)Furosemide
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? a)Subtherapeutic drug levels b)Hepatic encephalopathy c)Hepatomegaly d)Ammonia absorption
b)Hepatic encephalopathy
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? a)Angina b)Hyperkalemia c)Hypokalemia d)Hypertension
b)Hyperkalemia
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? a)Sudden increase in weight b)Increased blood glucose levels c)Sudden pain in the joints d)Occurrence of gout attacks
b)Increased blood glucose levels
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? a)Bumetanide b)Spironolactone c)Hydrochlorothiazide d)Dyazide
b)Spironolactone
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? a)The client will describe the rationale for increasing fluid intake. b)The client will identify strategies for limiting sodium intake. c)The client will be able to demonstrate correct technique for blood glucose monitoring. d)The client will accurately describe the basic structure and functions of the kidneys.
b)The client will identify strategies for limiting sodium intake.
A client, prescribed digoxin and furosemide, is at risk for developing which adverse effect? a)tachycardia b)digoxin toxicity c)hyperglycemia d)hyperkalemia
b)digoxin toxicity
A 49-year-old client reports frequent muscle cramps while on hydrochlorothiazide therapy. The nurse would advise the client to do which? a)drink plenty of fluids. b)eat potassium-rich foods. c)include high-sodium foods in her diet. d)take calcium supplements.
b)eat potassium-rich foods.
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 most consistent with this client's health needs? a)furosemide 20 mg IV OD b)furosemide 40 mg PO BID c)furosemide 40 mg IV TID d)furosemide 125 mg PO OD
b)furosemide 40 mg PO BID
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? a)diabetes b)hyperkalemia c)gout d)liver disease
b)hyperkalemia
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? a)"Maybe, but hydrochlorothiazide affects the bladder more than the kidneys." b)"That would only work if he could come in twice a day to get it intravenously." c)"Actually, patients with renal failure usually can't take hydrochlorothiazide." d)"That would probably help, but we'd have to do blood work first."
c)"Actually, patients with renal failure usually can't take hydrochlorothiazide."
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? a)"I will need to make sure that I am consuming enough sodium." b)"I must take my medication on an empty stomach." c)"I will need to stand slowly." d)"I can jump right into action!"
c)"I will need to stand slowly."
A client asks, "Why is my prescription is being switched from furosemide to spironolactone?" What is the nurse's best response? a)"You will have greater water losses with spironolactone than with furosemide." b)"You will have greater potassium losses with spironolactone than with furosemide." c)"You will lose less potassium with spironolactone than with furosemide." "You will have greater sodium losses with spironolactone than with furosemide."
c)"You will lose less potassium with spironolactone than with furosemide."
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? a)"You will have greater sodium losses with spironolactone than with furosemide." b)"You will have greater potassium losses with spironolactone than with furosemide." c)"You will lose less potassium with spironolactone than with furosemide." d)"You will have greater water losses with spironolactone than with furosemide."
c)"You will lose less potassium with spironolactone than with furosemide."
A 75-year-old client is diagnosed with atrial fibrillation and chronic congestive heart failure. The health care provider 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? a)Subtherapeutic levels of serum digoxin b)Congestive heart failure c)Digoxin toxicity d)Exacerbation of the atrial fibrillation
c)Digoxin toxicity
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? a)Osmotic diuretic b)Thiazide c)Loop diuretic d)Potassium-sparing diuretic
c)Loop diuretic
A hospital client demonstrating peripheral edema has been prescribed furosemide. How should the nurse best determine the extent of the client's desired fluid loss? a)Assess the client's skin turgor on a daily basis. b)Auscultate the client's chest each morning. c)Weigh the client daily. d)Test the osmolarity of the client's urine regularly.
c)Weigh the client daily
A nurse notes that a newly admitted client is currently prescribed both a loop diuretic as well as a thiazide diuretic. The nurse understands what primary rationale for the concurrent use of these two drugs? a)increased adherence to treatment b)decreased blood pressure without a risk of bradycardia c)increased diuretic effect d)reduced risk of potassium imbalances
c)increased diuretic effect
What substance is reabsorbed in the ascending limb of the loop of Henle? a)glucose b)amino acids c)sodium d)water
c)sodium
After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states: a)"I can still use my salt substitute if I want to." b)"I need to take the drug on an empty stomach." c)"I should take the medicine around dinnertime for the best effect." d)"I need to make sure I don't eat too many high potassium foods."
d)"I need to make sure I don't eat too many high potassium foods."
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? a)Fresh pineapple b)Mushrooms c)Bell peppers d)Avocados
d)Avocados
The nurse is evaluating an 82-year-old client's medical record. The client is receiving hydrochlorothiazide. What abnormal laboratory result is related to the medication? a)Elevated serum magnesium levels b)Reduced blood glucose levels c)Elevated serum potassium levels d)Elevated uric acid levels
d)Elevated uric acid levels
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? a)Administration of a thiazide diuretic b)Administration of concurrent potassium c)Monitoring of CBC and serum albumin d)Monitoring of serum electrolytes, creatinine, and BUN
d)Monitoring of serum electrolytes, creatinine, and BUN