Pharm - Chapter 28 - Diuretic Drugs
Which diuretic is the drug of choice for the prevention of tissue damage after a closed head injury? 1 Mannitol 2 Metolazone 3 Spironolactone 4 Hydrochlorothiazide
1 Mannitol 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 as an osmotic diuretic. Metolazone is a thiazide-like diuretic, spironolactone is an aldosterone-inhibiting diuretic, and hydrochlorothiazide is a thiazide diuretic; they are of little benefit in reducing cerebral edema.
How long after intravenous (IV) administration of furosemide does the nurse anticipate the beginning of diuresis? 1 1 minute 2 5 minutes 3 30 minutes 4 60 minutes
2 5 minutes The effects of IV furosemide 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 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.
In the given figure of a nephron, identify the site of action of diuretics used to treat hyperaldosteronism and hypertension. 1 1 2 2 3 3 4 4
1 1 Potassium-sparing diuretics are used to treat hyperaldosteronism and hypertension. They act at the distal convoluted tubule (1) and the collecting duct and inhibit the resorption of sodium and water. Potassium-sparing diuretics do not act on the ascending loop of Henle (2). Osmotic diuretics act on the descending loop of Henle (3). Osmotic diuretics and carbonic anhydrase inhibitors act on the proximal convoluted tubule (4).
A patient with acute pulmonary edema is receiving furosemide. Which assessment finding indicates to the nurse that the intervention is working? 1 Lungs clear 2 Output 30 mL/hr 3 Improvement in mental status 4 Potassium level decreased from 4.5 to 3.5 mEq/L
1 Lungs clear Furosemide 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 congestive heart failure that resulted from diastolic dysfunction. The patient's medical history indicates that the patient has a history of chronic kidney disease. Which drug does the nurse anticipate will be prescribed for the patient? 1 Furosemide 2 Metolazone 3 Spironolactone 4 Hydrochlorothiazide
1 Furosemide All of the above drugs are recommended to treat diastolic dysfunction. However, because the patient has chronic kidney disease, the nurse anticipates that the primary health care provider will prescribe furosemide, which is safe in patients with chronic kidney disease. The use of metolazone, spironolactone, or hydrochlorothiazide is contraindicated in patients with chronic kidney disease.
The nurse observes that a patient's vision is not improving after acetazolamide treatment. Which drug does the nurse anticipate will be prescribed for the patient for reducing intraocular pressure? 1 Mannitol 2 Amiloride 3 Furosemide 4 Spironolactone
1 Mannitol Acetazolamide is a carbonic anhydrase inhibitor (CAI) that is used in the treatment of open-angle glaucoma to reduce intraocular pressure. Mannitol can be used to reduce intraocular pressure in patients who are unresponsive to other drug therapies. Amiloride, furosemide, and spironolactone are not used for reducing intraocular pressure. Amiloride is a potassium-sparing diuretic that is used in the treatment of metabolic alkalosis and heart failure. Furosemide is a loop diuretic that is used in the treatment of pulmonary edema and the edema associated with heart failure, liver disease, nephrotic syndrome, and ascites. Spironolactone is a potassium-sparing diuretic that is used in the treatment of ascites related to liver cirrhosis.
Which information will the nurse obtain prior to administering furosemide to a patient? Select all that apply. 1 The patient's allergies 2 The patient's serum potassium level 3 The patient's level of consciousness 4 The patient's baseline renal function 5 The patient's fluid intake and urine output
1 The patient's allergies 2 The patient's serum potassium level 4 The patient's baseline renal function 5 The patient's fluid intake and urine output The nurse would verify whether the patient is allergic to sulfonamides because there is a cross-allergy to loop diuretics. Before administering a loop diuretic such as furosemide to a patient, the nurse would assess the patient's serum potassium level. A major side effect of loop diuretics is hypokalemia. If the patient's potassium level is not within normal limits, the dose should not be given, and the primary health care provider should be notified. The nurse would also assess the patient's baseline renal function because loop diuretics should not be administered to patients with end-stage renal disease, in which the nephrons are not functioning. The nurse would also assess the patient's fluid intake and urine output. A loop diuretic pulls off excess fluid, so if the output is greater than the intake, the medication is effective. The patient's level of consciousness would be assessed if an osmotic diuretic was administered for cerebral edema.
A patient with hypertension has been prescribed furosemide. On reviewing the patient's medical history, the nurse learns that the patient is also taking ibuprofen for rheumatoid arthritis. Which action does the nurse anticipate the primary health care provider will prescribe? 1 Decreased dose of ibuprofen 2 Increased dose of furosemide 3 Alternating doses of both medications 4 STAT venipuncture for serum calcium
2 Increased dose of furosemide When furosemide is used with nonsteroidal antiinflammatory drugs (NSAIDs), the diuretic activity of the drug is decreased due to the inhibition of the renal prostaglandins. The nurse can expect the primary health care provider to increase the dose of furosemide to have effective diuresis. Decreasing the dose of ibuprofen may not be effective in relieving the patient's pain. The primary health care provider does not alternate the doses of the two medications because the patient will neither achieve effective pain relief nor receive the full effect of the diuretic. When furosemide is given with an NSAID, there is no impact on the serum calcium level.
The nurse is assessing a patient who has been prescribed hydrochlorothiazide. Which information does the nurse give the patient about the medication regimen? 1 "Take iron supplements every day." 2 "Take the dose only in the morning." 3 "You should limit your intake of oats." 4 "You should not eat melons or grapes."
2 "Take the dose only in the morning." Hydrochlorothiazide 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 would instruct the patient to take the medication only in the morning to avoid the side effects of the drug. This medication does not cause anemia; therefore the patient need not take iron supplements. The nurse can suggest that the patient eat fiber-rich food such as oats to help prevent constipation, but not because a diuretic is prescribed. 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.
A patient reveals that he or she is taking daily ibuprofen for chronic back pain. On reviewing the patient's medical history, the nurse learns that the patient is also taking furosemide for high blood pressure. What does the nurse anticipate that the primary health care provider will prescribe? 1 Decreased dose of ibuprofen 2 Increased dose of furosemide 3 Alternating doses of both medications 4 STAT venipuncture for serum calcium
2 Increased dose of furosemide When furosemide is used with nonsteroidal antiinflammatory drugs (NSAIDs), the diuretic activity of the drug is decreased due to the inhibition of the renal prostaglandins. The nurse can expect the primary health care provider to increase the dose of furosemide to have effective diuresis. Decreasing the dose of ibuprofen may not be effective in relieving the patient's pain. The primary health care provider does not alternate the doses of the two medications because the patient will neither achieve effective pain relief nor receive the full effect of the diuretic. When furosemide is given with an NSAID, there is no impact on the serum calcium level.
It is ordered that a patient be given furosemide via intravenous push. Which interventions will the nurse perform? Select all that apply. 1 Monitor ECG continuously. 2 Maintain accurate intake and output record. 3 Assess lung sounds before and after administration. 4 Assess blood pressure before and after administration. 5 Insert an arterial line for continuous blood pressure monitoring.
2 Maintain accurate intake and output record. 3 Assess lung sounds before and after administration. 4 Assess blood pressure before and after administration. Furosemide can be infused via intravenous push at the rate of 20 mg/min. It is appropriate to monitor intake and output for a patient receiving a diuretic. Furosemide will decrease fluid in alveoli, and assessing lung sounds can help to determine therapeutic effect. Blood pressure should decrease with the administration of a diuretic, so it is appropriate to monitor it before and after administration. There is no need to continuously monitor an electrocardiogram (ECG) because the medication is not cardiotoxic. Also, there is no need to insert an arterial line to continuously monitor the blood pressure because it should not fluctuate that dramatically.
A patient with congestive heart failure is prescribed furosemide and amiloride. However, while assessing the patient's medical record, the nurse observes that the patient is on therapy with lithium carbonate to treat bipolar disorder. How would the nurse respond in this situation? 1 Instruct the patient to stop taking lithium carbonate during diuretic therapy. 2 Report to the health care provider about the patient's lithium carbonate therapy. 3 Report to the health care provider about the patient's bipolar disorder. 4 Instruct the patient to take lithium carbonate 1 hour before administering the diuretics.
2 Report to the health care provider about the patient's lithium carbonate therapy. Amiloride is a potassium-sparing diuretic. Concurrent use of a potassium-sparing diuretic with lithium will cause lithium toxicity. Therefore the nurse would report to the health care provider about the patient's lithium therapy. The nurse would not tell the patient to stop taking lithium carbonate because this is out of the scope of nursing practice. Reporting to the provider about the patient's bipolar disorder will not help change the medications used in diuretic therapy. The nurse would not instruct the patient to take lithium carbonate 1 hour before administering the diuretics because concurrent use of these two medications leads to lithium toxicity and because this is out of the scope of nursing practice.
A patient has abnormal levels of antidiuretic hormone. The nurse knows that this hormone is primarily active in which part of the nephron? 1 Distal tubule 2 Loop of Henle 3 Collecting duct 4 Proximal tubule
3 Collecting duct The collecting duct is the final portion of the nephron, where the filtrate is acted on by antidiuretic hormone to increase water absorption into the bloodstream and prevent excess water from being lost in the urine. The distal tubule is where approximately 5-10% of sodium resorption takes place. Sodium, potassium, and chloride are transported into the bloodstream in the loop of Henle. The proximal tubule, right after the glomerulus, is responsible for the majority of water and sodium resorption back into the bloodstream.
A patient with hypertension is receiving spironolactone therapy. The nurse notices that the patient's serum potassium level is 6.2 mEq/L. What does the nurse anticipate will be prescribed for the patient? 1 Mannitol 2 Amiloride 3 Furosemide 4 Acetazolamide
3 Furosemide The patient has been diagnosed with hyperkalemia, or elevated serum potassium. This contraindicates spironolactone because it is a potassium-sparing diuretic and will worsen the hyperkalemia. The primary health care provider would prescribe a loop diuretic such as furosemide, which eliminates potassium. Mannitol is an osmotic diuretic, which does not show any significant effect on the patient's potassium levels. Amiloride is a potassium-sparing diuretic that, when administered, may cause a further increase in the serum potassium levels. Acetazolamide is a carbonic anhydrase inhibitor, which does not help eliminate potassium.
The nurse notices that a patient who is receiving lithium has moderate bilateral pitting edema. The primary health care provider has prescribed a loop diuretic for the patient. For which side effect does the nurse monitor? 1 Amenorrhea 2 Bloody stools 3 Lithium levels 4 Itching and rashes
3 Lithium levels Lithium is a medication used to treat bipolar disorder. When a loop diuretic is given to a patient in conjunction with lithium, it can cause lithium toxicity. Therefore the nurse would monitor the patient's lithium levels. Amenorrhea (lack of menstrual cycles), bloody stools (melena), and itching and rashes (urticaria) are not associated with loop diuretics. Amenorrhea is an adverse effect of spironolactone, which is a potassium-sparing diuretic. Melena and urticaria are adverse effects of carbonic anhydrase inhibitors (CAI).
Which drug can be prescribed for the treatment of idiopathic hypercalciuria? 1 Mannitol 2 Amiloride 3 Metolazone 4 Furosemide
3 Metolazone Thiazide diuretics are used to treat idiopathic hypercalciuria. Metolazone is a thiazide diuretic drug that is useful in the treatment of idiopathic hypercalciuria. Mannitol, amiloride, and furosemide are not used to treat idiopathic hypercalciuria. Mannitol is an osmotic diuretic that is used for the treatment of cerebral edema and acute renal failure. Amiloride is a potassium-sparing diuretic that is used in the management of heart failure and metabolic alkalosis. Furosemide is a loop diuretic that is used in the treatment of pulmonary edema and the edema associated with heart failure, liver disease, nephrotic syndrome, and ascites.
Which intervention does the nurse incorporate while caring for a patient who experiences furosemide toxicity? 1 Administer deferoxamine. 2 Administer activated charcoal. 3 Replace the fluids and the electrolytes. 4 Replace the indwelling urinary catheter.
3 Replace the fluids and the electrolytes. Furosemide is a loop diuretic, which causes fluid and electrolyte imbalances from toxicity. Therefore the nurse would administer intravenous fluid and electrolytes to replace the fluids and to maintain the electrolyte balance in the patient. Deferoxamine mesylate is used for preventing iron toxicity, but not furosemide toxicity. Activated charcoal is an antidote used for treating many chemical poisonings, but it is not effective in reducing the effects of furosemide toxicity. Replacing the indwelling urinary catheter regularly may increase the risk of infections but does not reduce the effects of furosemide toxicity.
A 10-year-old child who has congestive heart failure has been prescribed furosemide. Which instruction does the nurse give to the child's parents to prevent adverse effects of the medication? 1 "Administer the medication on an empty stomach." 2 "Do not give oral rehydration drinks to your child." 3 "Give the medication to your child before bedtime." 4 "Protect your child from excessive sunlight exposure."
4 "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. Furosemide should be given with meals or with milk to prevent gastrointestinal irritation. Therefore the nurse would not instruct the parents to give the medication on an empty stomach. Oral rehydration supplements may be given in case of excessive loss of fluids. 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.
Which class of diuretics is indicated for the treatment of glaucoma? 1 Loop diuretics 2 Thiazide diuretics 3 Potassium-sparing diuretics 4 Carbonic anhydrase inhibitors
4 Carbonic anhydrase inhibitors Carbonic anhydrase inhibitors increase the outflow of aqueous humor. Therefore they are used in the long-term management of open-angle glaucoma. Loop diuretics are used to manage edema associated with heart failure and/or renal diseases. Thiazide diuretics are used to manage edema associated with various origins. Potassium-sparing diuretics are used in the management of hyperaldosteronism and hypertension.
The nurse is caring for a patient who has severe hepatic failure. The patient's blood pressure is 160/100 mm Hg. Which medication does the nurse anticipate that the primary health care provider will prescribe for this patient? 1 Furosemide 2 Triamterene 3 Azathioprine 4 Spironolactone
4 Spironolactone Blood pressure of 160/100 mm Hg indicates that the patient has hypertension. Diuretics are frequently used to control hypertension. Spironolactone is not contraindicated in patients with hepatic failure, so it would be safe to administer to the patient. Furosemide and triamterene 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. Azathioprine is an immunosuppressant used to prevent organ rejection in kidney transplantation. Because it is an immunosuppressant, hepatic failure would be a relative contraindication.