Loop Diuretics

Loop diuretics usually end in ________?

"-ide"

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? A. "I will eat a diet rich in potatoes, bananas, avocados, strawberries, and spinach." B. "I will weight myself daily and report to my physician if I gain more than 3 lbs in 1 day." C. "I will change position slowly because I can become dizzy easily while taking this medication." D. "This medication can cause dehydration, so I will stay hydrated by consuming at least 2 L or more of fluid per day."

D. "This medication can cause dehydration, so I will stay hydrated by consuming at least 2 L or more of fluid per day." The answer is D. 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.

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? A. Distal convoluted tubule B. Descending limb of the loop of Henle C. Proximal convoluted tubule D. Ascending limb of the loop of Henle

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

Where do loop diuretics work?

Loop of Henle in renal tubule

K+ wasting or sparing?

wasting; check serum K+ before administration

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? A. "Always administer intravenous loop diuretics slowly." B. "Monitor for signs and symptoms of low potassium levels because this increases the risk of inner ear damage while taking loop diuretics." C. "Administer the medication with meals." D. "Avoid administering loop diuretics with a tetracycline."

A. "Always administer intravenous loop diuretics slowly." The answer is A. 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.

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. Option D is not a candidate for loop diuretics because these medications can increase uric acid levels, which is already an issue for this patient with a gout attack (remember gout occurs due to increase uric acids levels). 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. Option B is not the answer because the patient should be consuming a diet with potassium (loop diuretics can decrease the potassium level). Option D is wrong because this is too much fluid for a patient to consume with heart failure. This medication would be unable to do its job if the patient consumed 2L of fluid per day...it would not be effective.

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 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.

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? A. Magnesium level 1.8 mg/dL B. Potassium 2 mEq/L C. BUN 15 D. Albumin 5 g/dL

B. Potassium 2 mEq/L The answer is B. 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).

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? A. Calcium level 9 mg/L B. Potassium level 1.5 mEq/L C. Blood pressure 102/78 D. Sodium level 144

B. Potassium level 1.5 mEq/L The answer is B. 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.)

Loop diuretics are effective with inhibiting sodium reabsorption within the nephron because it inhibits? A. the sodium-chloride transporter B. the effects of aldosterone on the distal convoluted tubule C. the sodium-potassium-chloride co-transporter D. the transport of bicarbonate by the proximal convoluted tubule

C. the sodium-potassium-chloride cotransporter The answer is C. 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). Option A is how thiazide diuretics work, option B is how potassium-sparing diuretics work, and option D is how carbonic anhydrase inhibitors work.