Diuretics

You're providing discharge teaching to a patient who will be taking a thiazide diuretic for the treatment of hypertension. You note that the patient has type I diabetes. What statement by the patient represents they misunderstood your teaching points about this medication and requires you reinforce some of the education pieces?

" This medication can cause sudden and severe drops in my blood glucose." Thiazide diuretics can INCREASE the blood glucose (lead to hyperglycemia)... not hypoglycemia. Therefore, the nurse should educate the patient to monitor the blood glucose level closely.

You're educating a group of new nurse graduates about loop diuretics. One topic you discuss is ototoxicity. You ask the new nurses to explain how to prevent this adverse side effect in a patient prescribed a loop diuretic. Which response by one of the new nurses is correct?

"Always administer intravenous loop diuretics slowly." Rapid IV administration of a loop diuretic can increase the risk of ototoxicity in a patient taking loop diuretics. Always give these medications slowly when ordered the IV route.

You're providing discharge instructions to a patient who will be taking a loop diuretic at home. Which statement by the patient demonstrates they did NOT understand the teaching material and requires that you reinforce some of the teaching points?

"This medication can cause dehydration, so I will stay hydrated by consuming at least 2 L or more of fluid per day." The patient should be educated on the signs and symptoms of dehydration (excessive thirst, fatigue, hypotension etc.). However, they should not be taught to consume 2L or more of fluid per day. Many patients are prescribed loop diuretics to treat issues with fluid volume overload (example heart failure). These patients must monitor how much fluid they are drinking. If too much fluid is consumed this will cancel out the effectiveness of the medication.

Your patient is prescribed to take Lisinopril and Triamterene. As the nurse you know that these medications increase a patient's risk for developing?

. Hyperkalemia Lisinopril is an ACE inhibitor (ACEI) and this medication can increase potassium levels due to how it affects the RAAS. Triamterene is a potassium-sparing diuretic, which can increase potassium levels. Therefore, the nurse should monitor for HYPERkalemia

. Which patients below may be prescribed a loop diuretic based on their diagnosis? Select all that apply: A. A 58-year-old male with congestive heart failure. B. A 69-year-old female with pulmonary edema. C. A 45-year-old male with hypercalcemia. D. A 50-year-old male experiencing a gout attack.

A. A 58-year-old male with congestive heart failure. B. A 69-year-old female with pulmonary edema. C. A 45-year-old male with hypercalcemia. The answers are A, B, and C. Loop diuretics help remove extra fluid from the blood. This is helpful for patients with heart failure and pulmonary edema. Loop diuretics also decrease calcium reabsorption (hence causing the calcium to be excreted rather than staying in the blood), and this would help treat a high calcium level (hypercalcemia).

You're developing a plan of care for a patient with fluid volume overload related to heart failure exacerbation. The physician has prescribed an IV loop diuretic. What nursing interventions will you include in the patient's plan of care? Select all that apply: A. Perform and assess daily weights. B. Educate the patient about consuming a low potassium diet. C. Strict measuring of the patient's daily intake and output. D. Encourage the patient to drink 2 L of fluids per day. E. Assess lung sounds every shift.

A. Perform and assess daily weights. C. Strict measuring of the patient's daily intake and output. . E. Assess lung sounds every shift. The answers are A, C, and E. The patient with heart failure exacerbation can experience fluid volume overload because the heart is failing to pump blood forward. This causes blood to backflow into the lungs causing pulmonary edema and respiratory distress. In addition, it can cause edema in the extremities. A loop diuretic will help remove this extra fluid by altering the way the kidneys reabsorb sodium and water. Due to the way loop diuretic works by removing extra fluid, the nurse should monitor the patient for dehydration, effectiveness of the medication (decrease in edema, clear lung fields), electrolyte imbalances, and measuring intake and output. Therefore daily weights, measuring I and O's, and assessing lungs sounds are the answers.

You're providing discharge teaching to a patient who will be taking Amiloride. Which items below should the patient limit in their diet? Select all that apply: A. Salt-substitutes B. Spinach C. Bananas D. Rice E. Cheese

A. Salt-substitutes B. Spinach C. Bananas The answers are A, B, and C. All of these items are high in potassium. Amiloride is a potassium-sparing diuretic that can increase the blood levels of potassium. Therefore, the patient should limit these items.

The physician prescribes the patient a loop diuretic. As the nurse you know that this type of diuretic causes diuresis by MAINLY affecting what structure in the nephron?

Ascending limb of the loop of Henle Loop diuretics affect the loop of Henle, specifically the ASCENDING limb (the thick part of this limb).

Based on your nursing knowledge of how thiazide diuretics work, which patients below would benefit from these types of medications? Select all that apply: A. A patient with a glomerular filtration rate (GFR) of less than 30 cc/hr. B. A patient with a recurrent history of renal calcium calculi. C. A patient with primary hypertension. D. A patient with heart failure and frequent gout attacks. E. A patient with diabetes that has uncontrolled hyperglycemia.

B. A patient with a recurrent history of renal calcium calculi. C. A patient with primary hypertension. The answers are B and C. Why? Option B: thiazide diuretics help INCREASE reabsorption of calcium into the blood (hence causes hypercalcemia)...therefore it removes it from the urine and can help prevent renal calculi that are composed of calcium. Option C: thiazide diuretics help remove extra fluid volume in the blood and this can decrease blood pressure. Thiazides are not for patients who have a decrease in renal function (example GFR of less than 30 cc/hr), gout attacks (they can cause an increase in uric acid levels), and uncontrolled hyperglycemia (they increase blood glucose levels).

Select all the medications below that are considered loop diuretics: A. Chlorothiazide B. Bumetanide C. Triamterene D. Spironolactone E. Furosemide F. Torsemide G. Hydrochlorothiazide

B. Bumetanide E. Furosemide F. Torsemide The answers are B, E, and F. Options A and G are thiazide diuretics, and Options C and D are potassium-sparing diuretics

What conditions below are potassium-sparing diuretics ordered to treat? Select all that apply: A. Edema due to renal failure B. Hyperaldosteronism C. Hypertension D. Hypokalemia secondary to loop or thiazide diuretic usage

B. Hyperaldosteronism C. Hypertension D. Hypokalemia secondary to loop or thiazide diuretic usage The answers are B, C, and D. Potassium-sparing diuretics are NOT for patients who have renal failure (therefore, option A is wrong). Yes, they treat edema/swelling due to heart failure, liver impairment, or nephrotic syndrome, but are contraindicated in patients with renal failure. However, potassium-sparing diuretics help treat hyperaldosteronism (specifically Spironolactone). Hyperaldosteronism is where the body produces too much aldosterone, which leads to low potassium levels, high sodium levels, and hypertension. Spironolactone will antagonize the aldosterone and decrease it. Many times potassium-sparing diuretics are ordered with loop or thiazide diuretics to treat hypertension. In addition, since potassium-sparing diuretics increase the blood level of potassium, they may be ordered for patients who are experiencing hypokalemia while taking diuretics that waste potassium (loop or thiazide diuretics).

What electrolyte imbalances would the nurse monitor for in the patient who is taking a loop diuretic? Select all that apply: A. Hyperkalemia B. Hypocalcemia C. Hypernatremia D. Hypokalemia E. Hypomagnesemia

B. Hypocalcemia D. Hypokalemia E. Hypomagnesemia The answers are B, D, and E. Loop diuretics can cause hypokalemia, hyponatremia, and hypomagnesemia.

Your patient will be started on a thiazide diuretic to help manage blood pressure. Select all the medications below that are considered a type of thiazide diuretic: A. Furosemide B. Indapamine C. Hydrochlorothiazide D. Spironolactone E. Metolazone F. Chlorothiazide

B. Indapamine C. Hydrochlorothiazide E. Metolazone F. Chlorothiazide

You're developing a plan of care for a patient with heart failure that will be prescribed a thiazide diuretic. What nursing interventions will you include in this patient's plan of care? Select all that apply: A. Encourage the patient to limit the consumption of bananas, avocadoes, spinach, strawberries, and potatoes. B. Measure the patient's intake and output daily. C. Weigh the patient daily using a bedside scale. D. Assess lab results for electrolyte imbalances like hypercalcemia and hyperkalemia.

B. Measure the patient's intake and output daily. C. Weigh the patient daily using a bedside scale. Remember thiazide diuretics waste potassium. . Options B and C are correct because these medication increase urination (hence they cause fluid depletion)...therefore, the nurse must monitor the patient's fluid status.

A patient is scheduled to take a dose of Lithium at 1000. The patient is also prescribed a thiazide diuretic. What lab result below requires the nurse to hold the dose of Lithium and notify the physician for further orders?

B. Sodium 115 mEq/L The nurse must monitor for Lithium toxicity in patients who are taking Lithium and a thiazide diuretic. These types of diuretics lower the amount of sodium in the blood because it prevents the reabsorption of it within the nephron...so more is excreted into the urine. Therefore, low sodium levels in the blood INCREASE the risk of Lithium toxicity. A normal blood sodium level is 135-145 mEq/L.

Which potassium-sparing diuretics are known to antagonize aldosterone in order to cause diuresis? Select all that apply: A. Triamterene B. Spironolactone C. Amiloride D. Eplerenone

B. Spironolactone D. Eplerenone Spironolactone and Eplerenone are types of potassium-sparing diuretics that are known as the aldosterone antagnoists or aldosterone receptor blockers. These medications work against aldosterone (hence the name aldosterone "antagnoists"). Aldosterone normally works to influence epithelial sodium channels and the sodium-potassium pumps in the distal tubule and collecting duct by increasing this number. This leads to the reabsorption of sodium into the bloodstream from the filtrate and secretion of potassium into the filtrate from the blood. However, when this is inhibited (due to these medications) sodium is NOT reabsorbed back into the blood and potassium is NOT secreted into the filtrate but stays in the blood (hence this can lead to HYPERkalemia). Triamterene and Amiloride are potassium-sparing diuretics, BUT they work to inhibit the epithelial sodium channels, which causes the same affects as the aldosterone antagonists but in a different way.

A 55-year-old-male with hypertension is prescribed a thiazide diuretic. The patient has a health history of diabetes type I and gout. What lab results below represent some known side effects of this medication and requires the nurse to report the lab results to the physician? Select all that apply: A. Potassium 5.2 mEq/L B. Calcium 9 mg/L C. Blood glucose 300 mg/dL D. Ammonia 20 mcg/dL E. Uric acid level 15 mg/dL F. Blood glucose 45 mg/dL

C. Blood glucose 300 mg/dL E. Uric acid level 15 mg/dL Thiazide diuretics can cause an increase in blood glucose (hyperglycemia), hyperuricemia (high uric acid levels...this increases a gout attack), hypokalemia (low potassium levels), and hypercalcemia (high calcium levels). Due to the patient's health history of diabetes and gout, the nurse should monitor the patient's glucose and uric acid levels. A normal blood glucose level is about 70-100 mg/dL, and a normal uric acid level varies for female and males...with anything greater than 7 for males or 6 for female being considered high. Therefore, the patient's uric acid level of 15 mg/dL and glucose of 300 mg/dL is abnormal and should be reported.

Potassium-sparing diuretics alter how sodium is reabsorbed in what part of the nephron? Select all that apply: A. Loop of Henle B. Proximal Convoluted Tubule C. Distal Convoluted Tubule D. Collecting Duct E. Thick ascending limb of the loop of Henle

C. Distal Convoluted Tubule D. Collecting Duct Potassium-sparing diuretics work in the distal parts of the nephron (the late part of the distal tubule and collecting duct) to alter the sodium and potassium exchange within the nephron.

Your patient is prescribed hydrochlorothiazide. The patient's potassium level is 2 mEq/L. What medication below should the nurse hold and notify the physician for further orders?

Digoxin Hypokalemia (low potassium level in the blood) can increase Digoxin toxicity. Hydrochlorothiazide causes the body to lose potassium. A normal blood potassium level is 3.5-5 mEq/L. Therefore, the nurse should hold the Digoxin and notify the physician for further orders.

True or False: Thiazide diuretics are more potent than loop diuretics and provide immediate diuresis affects. True False

FALSE. Thiazide diuretics are NOT more potent than loop diuretics and do not provide immediate diuresis affects like loop diuretics. Loop diuretics inhibit sodium reabsorption in the loop of Henle, which is responsible for about 25% of sodium reabsorption....whereas, thiazide diuretics inhibit sodium reabsorption in the early part of the distal convoluted tubule, which is responsible for about 5-7% of sodium reabsorption. Therefore, the higher percentage of sodium reabsorption inhibited the stronger the effects, which makes loop diuretics more potent.

TRUE or FALSE: Potassium-sparing diuretics are the most effective type of diuretic and are often combined with loop or thiazide diuretics.

FALSE. Potassium-sparing diuretics are the WEAKEST (not most effective) type of diuretic. However, yes, they are often combined with loop or thiazide diuretics to help prevent HYPOkalemia, which is a common side effect of loop and thiazide diuretics.

A patient is currently taking a potassium-sparing diuretic. The patient is experiencing EKG changes with tall-peaked T-waves, nausea, diarrhea, and paresthesia. The patient's morning lab results are back and the nurse makes it priority to check what lab result?

Potassium Potassium-sparing diuretics can increase a patient's potassium level and based on the patient's signs and symptoms in the scenario above this correlates with hyperkalemia. The nurse should check the morning lab result for potassium.

A patient with heart failure is prescribed Digoxin and a loop diuretic. The nurse knows that what finding below would increase a patient's risk of developing Digoxin toxicity?

Potassium 2 mEq/L Hypokalemia (low potassium level in the blood) increases the risk of Digoxin toxicity (normal potassium 3.5-5 mEq/L). Therefore, the nurse should always check a patient's potassium result before administering Digoxin, especially if they are taking a loop diuretic (remember loop diuretics waste potassium and can decrease the blood level).

A patient has a dose of Spironolactone due at 1000. Which finding below would require the nurse to hold the dose and notify the physician for further orders?

Potassium 7 mEq/L A normal potassium level is 3.5-5 mEq/L. Spironolactone can increase potassium levels because it's a potassium-sparing diuretic. Therefore, the nurse should hold the scheduled dose and notify the MD for further orders.

Your patient is ordered a loop diuretic at 1000. Which finding below would require you to hold the dose and notify the physician for further orders?

Potassium level 1.5 mEq/L Loop diuretics are known to decrease potassium levels due to the way they affect how the nephron wastes potassium (this happens in the distal convoluted tubule due to the high concentrated amount of sodium in the filtrate...this tubule will exchange potassium and hydrogen ions for sodium ions under the influence of aldosterone, which will lead potassium to enter the filtrate and exit the body as urine.)

Which potassium-sparing diuretic can cause antiandrogenic effects in a patient, such as menstrual irregularities, gynecomastia, and decreased sex drive?

Spironolactone Spironolactone can have antiandrogen effects on some patients (gynecomastia, increase hair growth in women, menstrual irregulars, sexual dysfunction). This is because Spironolactone affects the androgen and progesterone receptors.

The physician prescribes the patient a potassium-sparing diuretic. Which statement below best describes how this medication works to cause diuresis?

These medications work to inhibit the sodium and potassium exchange within the sodium channels in the distal tubule and collecting duct. . Potassium-sparing diuretics work to inhibit the sodium and potassium exchange within the sodium channels in the distal tubule and collecting duct.

Loop diuretics are effective with inhibiting sodium reabsorption within the nephron because it inhibits?

the sodium-potassium-chloride cotransporter Loop diuretics INHIBIT the sodium-potassium-chloride (NKCC2) cotransporter in the thick ascending limb of the loop of Henle. This inhibits the amount of sodium that is reabsorbed by the kidneys, which will cause the nephron to decrease the amount of water it reabsorbs...hence leading to more water leaving the kidneys via the urine (leading to its diuretics affects).

The physician prescribes the patient a thiazide diuretic. The patient is experiencing increased urination. As the nurse you know that this medication causes this type of affect by how it affects the nephron. It does this by?

inhibiting the sodium-chloride cotransporter in the distal convoluted tubule Thiazide diuretics inhibit the sodium-chloride cotransporter in the early part of the distal convoluted tubule. When this occurs it prevents sodium from being reabsorbed back into the blood. Since the sodium stays in the tubule, it will keep water with it. This will decrease the amount of water reabsorbed into the blood/body...thus increasing urination and extra fluid removal from the blood (causing a diuretic effect).