33 Diuretics

A nurse is caring for a client with edema due to congestive heart failure (CHF). The primary health care provider has prescribed indapamide. The client is also receiving digoxin. Which intervention would be most appropriate for the nurse to implement? A) Encourage oral fluids at frequent intervals during waking hours. B) Encourage the client to eat or drink between meals and in the evening. C) Frequently monitor the client's pulse rate and rhythm. D) Closely monitor the client for signs of hyperkalemia.

Ans: C Feedback: Clients receiving a diuretic, particularly a loop or thiazide diuretic such as indapamide, and a digitalis glycoside concurrently require frequent monitoring of the pulse rate and rhythm because of the possibility of cardiac arrhythmias. Any significant changes in the pulse rate and rhythm are immediately reported to the primary health care provider. The nurse should encourage oral fluids at frequent intervals during waking hours when caring for older clients to prevent a fluid volume deficit. In such cases the nurse should also encourage elderly clients to eat or drink between meals and in the evening. The nurse must closely observe clients receiving a potassium-sparing diuretic for signs of hyperkalemia, a serious and potentially fatal electrolyte imbalance.

A client is receiving mannitol as treatment to promote diuresis in acute renal failure. The nurse would expect to administer the drug by which route? A) Intramuscularly B) Subcutaneously C) Intravenously D) Orally

Ans: C Feedback: Mannitol is administered intravenously. It is not given intramuscularly, subcutaneously, or orally.

A nurse is caring for a client with edema. The physician has prescribed diuretic therapy for the client. Which of the following would be most appropriate for the nurse to do? A) Ask the client to decrease fluid intake. B) Gradually increase the drug dosage. C) Administer the drug early in the day. D) Encourage the client to exercise.

Ans: C Feedback: 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 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.

A client is prescribed a diuretic that is to be taken twice a day. When instructing the client about the schedule for administration, the nurse would suggest that the client take the drug at which times? A) In the early morning and at bedtime B) After lunch and dinner C) At breakfast and midafternoon D) Midmorning and before dinner

Ans: C Feedback: Twice-a-day dosing should be administered early in the morning (e.g., 7 a.m.) and early afternoon (e.g., 2 p.m.) to prevent the drug from interfering with the client's sleep.

A nurse suspects that a client who is receiving acetazolamide is developing hyponatremia based on assessment of which of the following? Select all that apply. A) Bradycardia B) Anorexia C) Hypotension D) Hypoglycemia E) Decreased skin turgor

Ans: C, E Feedback: The following are signs of hyponatremia: cold, clammy skin; decreased skin turgor; confusion; hypotension; irritability; and tachycardia.

A physician prescribes diuretic therapy to a client with nephrotic syndrome. The nurse suspects that the client is hyponatremic based on assessment of which of the following? A) Paresthesias B) Tremors C) Visual hallucination D) Tachycardia

Ans: D Feedback: The nurse should monitor for tachycardia, cold and clammy skin, confusion, and hypotension in the client experiencing hyponatremia. Hyponatremia is excessive loss of sodium and is a common fluid and electrolyte imbalance associated with diuretic therapy. Tremors, visual hallucinations, and paresthesias are the symptoms of hypomagnesemia and not hyponatremia.

After teaching a group of nursing students about diuretics, the instructor determines that the teaching was successful when the students identify which of the following as causing diuresis by increasing the density of filtrate in the glomerulus? Select all that apply. A) Amiloride B) Torsemide C) Ethacrynic acid D) Mannitol E) Urea

Ans: D, E Feedback: Osmotic diuretics, like mannitol and urea, cause diuresis by increasing the density of the filtrate in the glomerulus. Amiloride is a potassium-sparing diuretic that acts to block the reabsorption of sodium in the kidney tubules, thereby increasing sodium and water in the urine. Torsemide and ethacrynic acid are loop diuretics that inhibit reabsorption of sodium and chloride in the distal and proximal tubules of the kidney and in the loop of Henle.

A nurse is reviewing the laboratory test results of a client who is receiving diuretic therapy. The nurse determines that the client is at risk for electrolyte imbalance based on which results? Select all that apply. A) Potassium 4.5 mEq/L B) Sodium 139 mEq/L C) Magnesium 2.0 mEq/L D) Sodium 124 mEq/L E) Potassium 2.9 mEq/L

Ans: D, E Feedback: Sodium levels below 132 mEq/L, such as 124 mEq/L, or above 145 mEq/L would indicate an imbalance. Potassium imbalances would occur with levels below 3.0 mEq/L, such as 2.9 mEq/L, or above 5 mEq/L. A magnesium level of 2.0 mEq/L is within the normal range of 1.5 to 2.5 mEq/L.

A nurse is preparing to administer spironolactone to a client. When reviewing the client's medical record, the nurse would be alert for the development of hyperkalemia if the client was also receiving which of the following? A) Lisinopril (Prinivil) B) Metoprolol (Lopressor) C) Terazosin (Hytrin) D) Diltiazem (Cardizem)

Ans: A Feedback: Spironolactone when given with ACE inhibitors (lisinopril) can lead to hyperkalemia. Hyperkalemia is not associated with the combination of spironolactone and metoprolol, terazosin, or diltiazem.

A nurse is preparing to administer spironolactone to a client. The nurse would contact the primary health care provider about the need to change the order if the client has a history of which of the following? A) Hyperkalemia B) Liver disease C) Gout D) Diabetes

Ans: A Feedback: 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 these conditions do not contraindicate the use of potassium diuretics.

A nurse is caring for a client with increased intraocular pressure who is receiving urea. After administering the drug, the nurse would assess the client for which of the following? A) Syncope B) Cramping C) Photosensitivity D) Blurred vision

Ans: A Feedback: The nurse should observe the client for syncope after administering urea. Other adverse reactions associated with the administration of urea include headache, nausea, vomiting, and fluid and electrolyte imbalance. Cramping is an adverse reaction of the drug spironolactone. The nurse should observe the client for photosensitivity after administering triamterene. Blurred vision is an adverse reaction of mannitol.

The nurse understands that the use of diuretics is contraindicated in clients with which of the following? Select all that apply. A) Hyponatremia B) Hypokalemia C) Hypertension D) Anuria E) Asthma

Ans: A, B, D Feedback: Diuretics are contraindicated in clients with known hypersensitivity to the drugs, electrolyte imbalance (hyponatremia and hypokalemia), severe kidney or liver dysfunction, and anuria.

A nurse may notice a decrease in diuretic effect when furosemide (Lasix) is given with which of the following drugs? Select all that apply. A) Phenytoin B) Naproxen C) Digoxin D) Lithium E) Ibuprofen

Ans: A, B, E Feedback: A nurse may notice a decrease in diuretic effect when furosemide (Lasix) is given with the following drugs: hydantoins (phenytoin) and NSAIDs (naproxen and ibuprofen). There is an increased risk of lithium toxicity if furosemide is given with lithium. An increased risk of cardiac arrhythmias occurs when digoxin is given with furosemide.

A nurse is reviewing the medical record of several clients who are prescribed amiloride. The nurse would identify a client with which condition as being at highest risk for developing hyperkalemia? Select all that apply. A) Diabetes B) Hypertension C) Renal disease D) Epilepsy E) Asthma

Ans: A, C Feedback: Hyperkalemia is most likely to occur in clients with an inadequate fluid intake and urine output, those with diabetes or renal disease, the elderly, and those who are severely ill.

A nurse is providing care to a client who has an allergy to sulfamethoxazole/trimethoprim. The nurse understands that the client may have cross-sensitivity reactions with which of the following diuretics? Select all that apply. A) Chlorothiazide B) Furosemide C) Chlorthalidone D) Metolazone E) Spironolactone

Ans: A, C, D Feedback: A cross-sensitivity reaction may occur with the thiazides (chlorothiazide, chlorthalidone, and metolazone) and sulfonamides (sulfamethoxazole).

A nurse is administering acetazolamide to a client. The nurse understands that this drug leads to excretion of which of the following? Select all that apply. A) Sodium B) Magnesium C) Potassium D) Bicarbonate E) Chloride

Ans: A, C, D Feedback: Carbonic anhydrase inhibitors, like acetazolamide, result in the excretion of sodium, potassium, bicarbonate, and water.

Prior to the administration of furosemide (Lasix), a nurse would assess which of the following? Select all that apply. A) Weight B) Blood glucose C) Pulse D) Temperature E) Respiratory rate

Ans: A, C, D, E Feedback: Before administering furosemide (Lasix), the nurse takes the vital signs (blood pressure, pulse, temperature, respiratory rate, and weight) There is no need to assess the client's blood glucose.

The nurse is to administer bumetanide. The nurse reviews the client's medication history for possible interacting drugs. Which of the following, if found, would the nurse identify as having an increased risk for toxicity? Select all that apply. A) Lithium B) Phenytoin C) Gentamicin D) Warfarin E) Digoxin

Ans: A, C, D, E Feedback: Loop diuretics, like bumetanide, can increase toxicity of the following medications: lithium (Eskalith), gentamicin, warfarin (Coumadin), and digoxin (Lanoxin). A decrease in diuretic effect occurs when bumetanide is given with phenytoin.

A client is prescribed metolazone. As part of the client's teaching plan, the nurse instructs the client to increase his consumption of potassium-rich foods. The nurse determines that the teaching was successful when the client identifies which of the following as a good choice? Select all that apply. A) Bananas B) Shrimp C) Asparagus D) Salmon E) Peanuts

Ans: A, C, D, E Feedback: The top 10 foods with the highest amount of potassium per serving include white beans, dark leafy greens, baked potatoes with skin on, dried apricots, acorn squash, plain low-fat yogurt, salmon, avocado, mushrooms, and bananas. Fruits high in potassium include apricots, prunes, dried currants/raisins, dates, figs, dried coconut, avocado, bananas, oranges, nectarines, and peaches. Vegetables high in potassium include sun-dried tomatoes, spinach, Swiss chard, mushrooms, sweet potato, kale, brussels sprouts, zucchini, green beans, and asparagus. Other sources include chocolate, molasses, nuts, and nut butters.

A client is prescribed amiloride. The nurse would administer this drug cautiously if the client had a history of which of the following? Select all that apply. A) Gout B) Asthma C) Diabetes D) HIV E) Hepatic disease

Ans: A, C, E Feedback: Potassium-sparing diuretics, like amiloride, should be used cautiously in clients with gout, diabetes, and hepatic disease.

A nurse caring for a client with diabetes controlled with metformin recently began taking a drug for edema. The nurse notices that the client's blood glucose levels are increasing. Which of the following diuretics are likely to cause hyperglycemia? Select all that apply. A) Hydrochlorothiazide B) Furosemide C) Chlorthalidone D) Acetazolamide E) Metolazone

Ans: A, C, E Feedback: Thiazide diuretics, like hydrochlorothiazide, chlorthalidone, and metolazone, can result in hyperglycemia in clients receiving antidiabetic drugs, like metformin.

A nurse is assessing a client after administering a diuretic. Which of the following would lead the nurse to suspect that the client is experiencing a fluid and electrolyte imbalance? Select all that apply. A) Dry mouth B) Diaphoresis C) Muscle cramps D) Hypertension E) Tachycardia

Ans: A, C, E Feedback: Warning signs of a fluid and electrolyte imbalance include dry mouth, thirst, lethargy, weakness, drowsiness, restlessness, muscle pain or cramps, confusion, GI disturbances, hypotension, oliguria, tachycardia, and seizures.

A client who is receiving diuretic therapy comes to the clinic for a follow-up visit. The client states that his mouth is often dry and that he is urinating like there is no tomorrow. Assessment reveals dry mucous membranes and decreased skin turgor. Which nursing diagnosis would the nurse most likely identify? A) Risk for Injury B) Risk for Deficient Fluid Volume C) Impaired Urinary Elimination D) Deficient Knowledge

Ans: B Feedback: Based on the client's report and assessment findings, a nursing diagnosis of Risk for Deficient Fluid Volume would be most appropriate. Risk for Injury would be appropriate if the client was complaining of dizziness on changing positions or changes in heart rate and rhythm. Although the client is experiencing frequency, that is the intended effect of the drug. Although possible, there is no evidence provided to support a nursing diagnosis of Deficient Knowledge.

A physician has prescribed bumetanide for a client with high blood pressure who also has renal insufficiency. Which of the following instructions should the nurse include in the teaching plan for this client? A) Avoid salt substitutes containing potassium. B) Avoid over-the-counter drugs for cold symptoms. C) Always take the drug before meals. D) Omit the drug dose when feeling dizzy.

Ans: B Feedback: The nurse should instruct the hypertensive client to avoid medications that increase blood pressure, such as OTC drugs for appetite suppression and cold symptoms. The nurse should instruct clients taking potassium-sparing diuretics, not loop diuretics such as bumetanide, to refrain from using salt substitutes containing potassium. The nurse need not instruct the client to take the drug before meals since doing so will not decrease the client's blood pressure. The nurse should instruct the client to observe caution while driving or performing hazardous tasks when dizziness or weakness occurs. In such cases, the nurse instructs the client to rise slowly from a sitting or lying position and avoid standing in one place for an extended time.

A physician has prescribed furosemide to a client with pulmonary edema. The client informs the nurse that he is also taking phenytoin as treatment for seizures. The nurse would assess the client closely for which of the following? A) Increased risk of bleeding B) Decreased diuretic effectiveness C) Increased blood glucose levels D) Increased seizure episodes

Ans: B Feedback: The nurse should monitor for decreased diuretic effectiveness in the client as the effect of the interaction between furosemide and hydantoins. When the client is administered loop diuretics with anticoagulants or thrombolytics, there is an increased risk of bleeding. Increased blood glucose may occur when thiazide diuretics are given with antidiabetic drugs. Decreased effectiveness of hydantoins, such as manifested by increased seizure activity, is not known to occur as a result of the effect of the interaction between furosemide and hydantoins, and so the nurse need not monitor for the same in the client.

A primary health care provider has prescribed a loop diuretic for a client with hypertension. The client also has diabetes mellitus. The nurse would assess the client for which of the following after administering the drug? A) Sudden pain in the joints B) Increased blood glucose levels C) Occurrence of gout attacks D) Sudden increase in weight

Ans: B Feedback: The nurse should monitor for increased blood glucose levels in the diabetic client receiving a loop diuretic. The blood glucose levels 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.

A nurse administers a thiazide diuretic to a client with renal compromise as prescribed by the primary health care provider. Which action by the nurse would be most appropriate if the client's blood urea nitrogen level increases? A) Give prescribed magnesium supplements. B) Withhold the next dose of the drug. C) Administer the drug in a diluted form. D) Increase the fluid intake for the client.

Ans: B Feedback: The nurse should withhold the drug or discontinue its use if the blood urea nitrogen (BUN) rises in the client with renal compromise who is receiving a thiazide diuretic. Magnesium supplements or add-ons may be provided to clients taking loop diuretics as they are prone to magnesium deficiency. The nurse should encourage fluid intake to prevent a fluid volume deficit in elderly clients who are particularly prone to fluid volume deficit and electrolyte imbalances when taking a diuretic. The nurse need not administer the drug in a diluted form since doing so will not have an effect on the blood urea nitrogen level.

A nurse is caring for a client with increased intracranial pressure caused by cerebral edema. The physician has prescribed mannitol. After administering the drug, the nurse should do which of the following? A) Monitor blood pressure every 4 hours. B) Check response of pupils to light. C) Monitor client for joint pain. D) Monitor serum uric acid concentrations.

Ans: B Feedback: When caring for a client who has been given mannitol for intracranial pressure, the nurse should perform neurologic assessments such as response of the pupils to light, level of consciousness, or response to a painful stimulus at the time intervals ordered by the primary health care provider. The nurse monitors the client for joint pain and other discomforts when the client is administered thiazide diuretics for renal impairment. When caring for clients taking thiazide diuretics, the nurse also monitors the serum uric acid concentrations because these drugs may precipitate an acute attack of gout. The nurse needs to monitor the client's blood pressure every 30 to 60 minutes when caring for a client receiving the osmotic diuretic mannitol or urea for the treatment of increased intracranial pressure caused by cerebral edema.

A nurse is administering a diuretic that inhibits reabsorption of sodium and chloride ions in the distal and proximal tubules and in the loop of Henle. Which of the following might the nurse be administering? Select all that apply. A) Chlorothiazide B) Furosemide C) Bumetanide D) Mannitol E) Spironolactone

Ans: B, C Feedback: Loop diuretics, like furosemide (Lasix) and bumetanide (Bumex), cause dieresis by inhibiting reabsorption of sodium and chloride ions in the distal and proximal tubules and in the loop of Henle. Thiazide and related diuretics such as chlorothiazide inhibit the reabsorption of sodium and chloride ions in the ascending portion of the loop of Henle and the early distal tubule of the nephron. Osmotic diuretics such as mannitol increase the density of the filtrate in the glomerulus. Potassium-sparing diuretics such as spironolactone work by blocking the reabsorption of sodium in the kidney tubules, thereby increasing sodium and water in the urine.

After administering metolazone to a client, the nurse monitors for signs of hypokalemia, including which of the following? Select all that apply. A) Diarrhea B) Anorexia C) Depression D) Hypoglycemia E) Drowsiness

Ans: B, C, E Feedback: The following are signs of hypokalemia: anorexia, nausea, vomiting, depression, confusion, cardiac arrhythmias, impaired thought process, and drowsiness.

1. When describing the different classes of diuretics, the nursing instructor would include which of the following as sulfonamides, with nonbacteriostatic action, that inhibit the enzyme carbonic anhydrase? Select all that apply. A) Furosemide B) Acetazolamide C) Hydrochlorothiazide D) Methazolamide E) Torsemide

Ans: B, D Feedback: Acetazolamide and methazolamide are carbonic anhydrase inhibitors. Furosemide and torsemide are loop diuretics. Hydrochlorothiazide is a thiazide diuretic.