Chapter 51- Diuretic Agents

After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states: a. "I need to make sure I don't eat too many high potassium foods." b. "I should take the medicine around dinnertime for the best effect." c. "I need to take the drug on an empty stomach." d. "I can still use my salt substitute if I want to."

a. "I need to make sure I don't eat too many high potassium foods."

A client with a long-standing diagnosis of heart failure has been taking hydrochlorothiazide (HCTZ) for several weeks. The health care provider (HCP) indicates that the client would benefit from increased diuresis but is likely "near the ceiling threshold" of the drug. What is the HCP's concern? a. A higher dose of HCTZ will not result in increased diuresis. b. Increased use of HCTZ will have a paradoxical effect of reducing diuresis. c. Increased use of HCTZ will exacerbate, rather than alleviate, heart failure. d. A higher dose of HCTZ will reduce the client's ability to produce concentrated urine.

a. A higher dose of HCTZ will not result in increased diuresis.

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? a. Furosemide b. Hydrochlorothiazide c. Acetazolamide d. Spironolactone

a. Furosemide

A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered? a. Mannitol b. Furosemide c. Amiloride d. Bumetanide

a. Mannitol

A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route? a. Oral b. Subcutaneous c. Intramuscular d. Intravenous

a. Oral

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. Spironolactone b. Dyazide c. Hydrochlorothiazide d. Bumetanide

a. Spironolactone

The health care provider indicates that a client experiencing renal failure is not a candidate for therapy with potassium-sparing diuretics. How will the nurse respond when the client's family member asks why this is the case? a. They may cause hyperkalemia. b. They are the strongest form of diuretics. c. They promote excretion of potassium. d. They may cause rebound edema.

a. They may cause hyperkalemia.

Which diuretic will most likely be the initial drug of choice when a client demonstrates dyspnea related to pulmonary edema? a. furosemide b. hydrochlorothiazide c. spironolactone d. mannitol

a. furosemide

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. hyperkalemia b. liver disease c. gout d. diabetes

a. hyperkalemia

A physician has prescribed triamterene to a client with renal disease. The client informs the nurse that they are taking potassium supplements to address some heart problems. The nurse would be alert for which of the following? a. increased risk of hyperkalemia. b. increased risk of bleeding. c. decreased diuretic effectiveness. d. increased risk of arrhythmias.

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

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

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. Hypokalemia b. Hyperkalemia c. Angina 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 pain in the joints b. Increased blood glucose levels c. Occurrence of gout attacks d. Sudden increase in weight

b. Increased blood glucose levels

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

b. Loop of Henle

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 concurrent potassium b. Monitoring of serum electrolytes, creatinine, and BUN c. Administration of a thiazide diuretic d. Monitoring of CBC and serum albumin

b. Monitoring of serum electrolytes, creatinine, and BUN

The pharmacology instructor is discussing the differences among the various diuretic agents. Which would the instructor cite as a difference between spironolactone and hydrochlorothiazide? a. Potassium losses are greater with spironolactone than with hydrochlorothiazide. b. Potassium losses are greater with hydrochlorothiazide than with spironolactone. c. Spironolactone is more likely to be taken with a potassium supplement. d. The two diuretics act in different parts of the nephron.

b. Potassium losses are greater with hydrochlorothiazide than with spironolactone.

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. take calcium supplements. d. include high-sodium foods in her diet.

b. eat potassium-rich foods.

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? a. Spironolactone b. Bumetanide c. Mannitol d. Ethacrynic acid

c. Mannitol

What would contraindicate the use of indapamide? a. Diabetes b. Systemic lupus erythematosus c. Renal disease d. Gout

c. Renal disease

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. Test the osmolarity of the client's urine regularly. c. Weigh the client daily. d. Auscultate the client's chest each morning.

c. Weigh the client daily.

An older adult client has a complex medical history that includes heart failure, type 1 diabetes, and diabetic nephropathy. The nurse has questioned a health 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. Hypocalcemia c. Hemolytic anemia d. Hyperkalemia

d. Hyperkalemia

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. Hypercalcemia b. Hypocalcemia c. Hyperkalemia d. Hypokalemia

d. Hypokalemia

A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed? a. Loop diuretic b. Potassium-sparing diuretic c. Thiazide diuretic d. Osmotic diuretic

d. Osmotic diuretic

An ED nurse is caring for a patient who is receiving furosemide for treatment of pulmonary edema. What will the nurse monitor to observe for adverse effects of the drug? a. Temperature b. Bone marrow function c. Blood oxygen saturation d. Potassium levels

d. Potassium levels