Diuretics EAQ

What is the best information for the nurse to provide to a patient who is receiving spironolactone (Aldactone) and furosemide (Lasix) therapy?

"This combination promotes diuresis but decreases the risk of hypokalemia." Spironolactone is a potassium-sparing diuretic; furosemide causes potassium loss. Giving these together minimizes electrolyte imbalance. It is not accurate to state that the drug combination prevents dehydration and hypovolemia or that it increases the osmolality of plasma and the glomerular filtration rate. Stating that giving two different diuretics is more effective is not specific enough information for the patient.

How long after intravenous administration of furosemide (Lasix) does the nurse anticipate the beginning of diuresis?

5 minutes The effects of IV furosemide (Lasix) begin within 5 minutes of administration and last for 2 hours. IV therapy is used in critical situations (e.g., pulmonary edema) that demand immediate mobilization and elimination of fluid. If furosemide (Lasix) is applied by the oral route, the onset of action starts in 30 to 60 minutes. One minute is too little time to have any action of any drug.

Which drug is used cautiously in patients with a sulfa drug allergy?

Furosemide (Lasix) Furosemide (Lasix) is a structurally similar drug to sulfonamide antibiotics; hence it is contraindicated in patients with a sulfa drug allergy. Acetazolamide (Diamox) is not a chemical derivative of the sulfonamide antibiotic; therefore there are no significant contraindications in patients with a sulfa drug allergy. Mannitol (Osmitrol) is not contraindicated in patients with a sulfa drug allergy, because it is not related structurally or chemically to sulfonamide antibiotics. Amiloride (Midamor) can be given to patients with a sulfa drug allergy, because it is not chemically related to the sulfa drugs.

Which side effect is associated with furosemide (Lasix)?

Hypokalemia Furosemide (Lasix) is a structurally similar drug to sulfonamide antibiotics; hence it is contraindicated in patients with a sulfa drug allergy. Acetazolamide (Diamox) is not a chemical derivative of the sulfonamide antibiotic; therefore there are no significant contraindications in patients with a sulfa drug allergy. Mannitol (Osmitrol) is not contraindicated in patients with a sulfa drug allergy, because it is not related structurally or chemically to sulfonamide antibiotics. Amiloride (Midamor) can be given to patients with a sulfa drug allergy, because it is not chemically related to the sulfa drugs.

A patient with acute pulmonary edema is receiving furosemide (Lasix). What assessment finding indicates to the nurse that the intervention is working?

Lungs clear Furosemide (Lasix) is a potent, rapid-acting diuretic that would be the drug of choice to treat acute pulmonary edema. Furosemide should not cause a drastic change in output or decrease in potassium level, and there is no evidence that it will create any change in mental status.

The nurse is caring for a patient who has severe hepatic failure. The patient's blood pressure is 160/100 mmHg. What does the nurse anticipate the primary health care provider will prescribe for this patient?

Spironolactone (Aldactone) When the patient's blood pressure is 160/100 mmHg, it indicates that the patient has hypertension. Diuretics are frequently used to control hypertension. Spironolactone (Aldactone) is not contraindicated in patients with hepatic failure, so it would be safe to administer to the patient. Furosemide (Lasix), triamterene (Dyrenium), and hydrochlorothiazide (HydroDIURIL) are contraindicated in patients with hepatic failure, because they are metabolized in the liver. Administration of these drugs in patients with hepatic failure results in drug accumulation and increased adverse effects in the patients.

A nurse is caring for a patient receiving acetazolamide (Diamox). Which assessment finding will require immediate nursing intervention?

A decrease in arterial pH Acetazolamide (Diamox) causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat metabolic alkalosis, edema, seizures, and acute glaucoma. A decrease in blood pH would indicate that the patient was becoming more acidotic.

A 10-year-old child who has congestive heart failure has been prescribed furosemide (Lasix). Which instruction does the nurse give to the child's parents to prevent adverse effects of the medication?

"Protect your child from excessive sunlight exposure." The parents should be instructed to prevent the child from being exposed to sunlight. Exposure to excessive sunlight may cause loss of fluids and electrolytes in the child and result in dehydration. The diuretic medication needs to be taken early in the morning with food or milk at the same time every day. Medication at night causes nocturia in the child. Oral rehydration supplements may be given in case of excessive loss of fluids. Furosemide (Lasix) should be given with meals or with milk to prevent gastrointestinal irritation. Therefore, the nurse should not instruct the parents to give the medication on an empty stomach.

The nurse is assessing a patient who has been prescribed hydrochlorothiazide (HydroDIURIL). What does the nurse inform the patient about the medication regimen?

"Take the dose only in the morning." Hydrochlorothiazide (HydroDIURIL) is a thiazide diuretic that is used in the treatment of various types of edema. Diuretics are to be taken in the morning because they cause urination at night (nocturia) and subsequent loss of sleep when taken late in the afternoon or night. Therefore, the nurse should instruct the patient to take the medication only in the morning to avoid the side effects of the drug. The nurse can suggest that the patient eat fiber-rich food such as oats, because this helps prevent constipation, but not because of being a diuretic. Due to loss of fluids, the patient may have dehydration. Hence the nurse can suggest that the patient eat fruits high in fluid content such as melons and grapes. This medication does not cause anemia; therefore, patient need not take iron supplements.

The nurse is assessing a patient with lower extremity edema. The nurse learns that the patient is a mountain climber and has been suffering from headaches, nausea, and shortness of breath for the last few days. What drug does the nurse expect the primary health care provider to prescribe for the patient?

Acetazolamide (Diamox) Headaches, nausea, and shortness of breath are symptoms associated with high-altitude sickness. A carbonic anhydrase inhibitor such as acetazolamide (Diamox) is highly effective in relieving these symptoms. Spironolactone (Aldactone) is a potassium-sparing diuretic which can be used for congestive heart failure due to the hyperactivity of angiotensin. It can be used as a substitute drug for the treatment of heart failure. Mannitol (Osmitrol) is an osmotic diuretic that is used in the treatment of oliguria in renal failure. Hydrochlorothiazide (HydroDIURIL) can be used for the treatment of edema in heart failure, but it is effective as a first-line therapy. Therefore, these medications should not be prescribed to the patient.

A patient has been prescribed hydrochlorothiazide (HydroDIURIL). After reviewing the patient's laboratory report, the nurse informs the primary health care provider that the patient has hypokalemia. Which drug does the nurse expect to be included in the patient's prescription?

Amiloride (Midamor) Hydrochlorthazide (HydroDIURIL) is a thiazide diuretic, which causes hypokalemia (reduced potassium concentrations) as a side effect. Therefore, in order to prevent hypokalemia, potassium-sparing diuretics such as amiloride (Midamor) can be prescribed as an adjuvant to the patient. Furosemide (Lasix) a loop diuretic, Mannitol (Osmitrol) is an osmotic diuretic, and acetazolamide (Diamox) is carbon anhydrase inhibitor. These medications do not help prevent the loss of potassium. Therefore, these medications need not be included in the patient's prescription.

A patient is taking hydrochlorothiazide (HydroDIURIL). On assessment, the nurse notices the patient has muscle weakness and hypotension. What is the nurse's first intervention?

Assess the serum potassium level. Hydrochlorothiazide (HydroDIURIL) overdose leads to hypokalemic symptoms, which are characterized by muscle weakness and hypotension. The nurse should immediately assess the patient's serum potassium level to determine the course of action. Giving calcium supplements alone does not reduce the symptoms caused by potassium deficiency. Decreasing the salt intake would further reduce the patient's blood pressure and cause sodium deficiency. Reducing the dose of the medication will not help restore the electrolyte balance.

Which diuretic is the drug of choice for the prevention of tissue damage after a closed head injury?

Mannitol (Osmitrol) Mannitol is the drug of choice to prevent increased intracranial pressure after a closed head injury; although it works along the entire length of the nephron, it reduces intracranial pressure and cerebral edema by reducing cellular edema. Metolazone (Zaroxolyn) is a thiazide-like diuretic, furosemide is a loop diuretic, and hydrochlorothiazide is a thiazide diuretic; they are of little benefit in reducing cerebral edema.

Which intervention does the nurse incorporate while caring for a patient who experiences furosemide (Lasix) toxicity?

Replace the fluids and the electrolytes. Furosemide (Lasix) is a loop diuretic, which causes fluid and electrolyte imbalances from toxicity. Therefore, the nurse should administer intravenous fluid and electrolytes to replace the fluids and to maintain the electrolyte balance in the patient. Activated charcoal (Actidose) is an antidote used for treating many chemical poisonings, but it is not effective in reducing the effects of furosemide (Lasix) toxicity. Replacing the indwelling urinary catheter regularly may increase the risk of infections but does not reduce the effects of furosemide (Lasix) toxicity. Deferoxamine mesylate (Desferal) is used for preventing iron toxicity, but not furosemide (Lasix) toxicity.

An elderly patient who has hypertension has been prescribed furosemide (Lasix). The nurse advises the patient to take the medication in the morning. What rationale does the nurse give the patient?

To prevent the patient from urinating at night Furosemide (Lasix) causes nocturia (urinating during the night). This may cause sleep disturbances in the patient. Therefore, to prevent nocturia and promote sleep, the nurse instructs the patient to take the medication in the morning. Furosemide (Lasix) usually reduces the body weight, so taking the drug in the morning would not have any effect on body weight. Orthostatic hypotension and fluid electrolyte imbalances are the side effects of furosemide (Lasix). The nurse would instruct the patient to change positions slowly to prevent orthostatic hypotension. The nurse would administer intravenous fluids to prevent electrolyte imbalances.