Pharmacology Chapter 51 Diuretic Agents

A patient with a longstanding diagnosis of chronic renal failure has experienced a significant decline in urine output in recent days, prompting him to seek care at a local clinic. A nurse at the clinic has suggested to a colleague that the administration of a diuretic such as hydrochlorothiazide may improve the patient's urine output. How should the colleague best respond to this suggestion?

"Actually, patients with renal failure usually can't take hydrochlorothiazide."

A client asks, "Why is my prescription is being switched from furosemide to spironolactone?" What is the nurse's best response?

"You will lose less potassium with spironolactone than with furosemide."

The nurse is caring for a client who is receiving mannitol. The nurse knows that it is used to manage oliguria or anuria. The nurse knows that it is also used for what other conditions? (Select all that apply.)

-Reduction of intraocular pressure -Urinary excretion of toxic substances -Reduction of intracranial pressure

The nurse is caring for a patient with edema who has just begun taking a diuretic. What will the nurse use to evaluate the effectiveness of this medication? (Select all that apply.)

A) Daily weight B) Decrease in edema D) Increase in urinary output

A patient with glaucoma has been prescribed acetazolamide (Diamox). What adverse effects would the nurse caution the patient about? (Select all that apply.)

A) Paresthesia B) Confusion C) Drowsiness

A patient with glaucoma has been prescribed a diuretic as treatment of his or her disease process. What drug does the nurse suspect that the patient will be prescribed?

Acetazolamide (Diamox)

The pharmacology instructor is discussing diuretic drugs with the nursing class. What would the instructor cite as an adverse effect of loop diuretics?

Alkalosis

The nurse is conducting an admission assessment of a patient who has been prescribed hydrochlorothiazide (HydroDIURIL). Which situation would contraindicate the administration of hydrochlorothiazide (HydroDIURIL)?

Allergy to sulfa drugs

A patient who was recently prescribed spironolactone calls the clinic and complains that he is not urinating as much as he did when he first started taking this medication. What would be an appropriate question for the nurse to ask this patient?

Are you taking a salicylate?

The nurse has just administered 150 g of mannitol IV to a patient with increased intracranial pressure. What is most important for the nurse to monitor in the hour after administration?

Blood pressure of patient

A patient has been prescribed hydrochlorothiazide (HydroDIURIL) and the nurse is preparing to give the patient discharge instructions. Which adverse effects may this patient experience while taking this medication? (Select all that apply.)

D) Nocturia E) Muscle cramps B) Dizziness

A client has been prescribed both digoxin and furosemide. The nurse should monitor the client for development of what adverse effect?

Digoxin toxicity

What type of diet should a patient taking diuretics have?

Eat potassium-rich or low-potassium diet as appropriate

When evaluating an 82-year-old patient receiving hydrochlorothiazide (HydroDIURIL), what laboratory value deviations may be related to the medication?

Elevated uric acid levels

After teaching a group of nursing students about diuretics, the instructor determines that the teaching was successful when the group identifies which as a loop diuretic?

Furosemide

A 68-year-old patient, who has type 1 diabetes, is to receive hydrochlorothiazide (HydroDIURIL). Before administration of this medication, what information is most important for the nurse to communicate to the patient?

His or her insulin dose may need to be increased.

A 91-year-old client, who is being prepared for discharge, has been prescribed the diuretic spironolactone. While teaching the client about the drug, what major adverse effect should the nurse be sure to mention?

Hyperkalemia

A client who has been taking hydrochlorothiazide arrives at the clinic for his 1-month follow-up appointment. The client tells the nurse that he feels weaker since he began taking the drug. What should the nurse consider as a possible cause of these symptoms?

Hypokalemia

A patient comes to the clinic for a 1-month follow-up appointment. The patient tells the nurse he or she has been taking chlorothiazide (Diruil) for a month and now has leg cramps and feels tired all the time. What will the nurse consider as the cause of the patient's symptoms?

Hypokalemia

The nurse is writing a plan of care for a patient who is taking a diuretic. What would be an appropriate nursing diagnosis for this patient?

Impaired urinary elimination

A health care provider has prescribed a loop diuretic for a client with hypertension. The client also has diabetes mellitus. What condition should the nurse monitor for in this client after administering the prescribed drug?

Increased blood glucose levels

Hydrochlorothiazide works by what mechanism of action?

Increasing the excretion of sodium and chloride in the distal tubule

When describing where bumetanide acts, what would the nurse include?

Loop of Henle

The nurse is caring for a client who is experiencing elevated intracranial pressure following neurosurgery. The health care provider orders an osmotic diuretic to reduce pressure. Which medication would the nurse expect to be ordered?

Mannitol

7. The nurse is caring for a patient with a severe head injury. An osmotic diuretic is ordered. The nurse understands which drug is an osmotic diuretic?

Mannitol (Osmitrol)

A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route?

Oral

A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed?

Osmotic diuretic

What is the term for the action of a diuretic in a patient with glaucoma?

Osmotic pull

The emergency department (ED) nurse is caring for a patient who is experiencing pulmonary edema. The patient is treated with furosemide (Lasix). What will the nurse monitor?

Potassium levels

The pharmacology instructor is discussing the differences among the various diuretic agents. Which would the instructor cite as a difference between spironolactone and hydrochlorothiazide?

Potassium losses are greater with hydrochlorothiazide than with spironolactone.

Why would potassium-sparing diuretics be contraindicated for clients experiencing renal failure?

They may cause hyperkalemia.

A female patient has a history of frequent bladder infections. Which classification of diuretic would not be recommended for this patient?

Thiazide and thiazide-like diuretics

A patient has just begun to take a prescribed diuretic. Why would the nurse tell the patient to drink 8 to 10 glasses of water daily (unless it is counterindicated)?

To avoid rebound edema

The nurse is providing discharge instructions to a 72-year-old patient who has been discharged home on a diuretic. What would the patient's instructions regarding the use of a diuretic at home include?

To weigh themselves on the same scale, at the same time of day, in the same clothing

Which diuretic will most likely be the initial drug of choice when a client demonstrates dyspnea related to pulmonary edema?

furosemide

A health care provider prescribes spironolactone, a potassium-sparing diuretic, for a client with cirrhosis. For which category of clients is the use of potassium-sparing diuretics contraindicated?

hyperkalemia

What substance is reabsorbed in the ascending limb of the loop of Henle?

sodium

Which instruction would be most appropriate for a client who is taking a diuretic?

"It's okay to take it with food."

An older adult client with a history of heart failure has presented to the emergency department in respiratory distress. Assessment reveals the presence of pulmonary edema, and an infusion of IV furosemide has been prescribed. For the duration of treatment, the nurse should prioritize assessments related to which expected age-related dysfunctions? Select all that apply.

-Cardiac Function -Renal Function -Hepatic Function

A 10-year-old child has edema caused by a heart defect. The patient is taking furosemide (Lasix). The dosage is 6 mg/kg/d. The child weighs 76 pounds. How many mg does the child receive in each dose?

210 mg

The nurse should be aware that diuresis will peak how long after furosemide is administered?

30 minutes

A nursing instructor is teaching a group of students about loop diuretics. Which would be included in this classification? (Select all that apply.)

B) Torsemide C) Ethacrynic acid E) Bumetanide

A nurse encourages a patient who is receiving a diuretic to maintain his fluid intake to prevent the risk for developing:

Fluid rebound

The nurse is talking with a group of nursing students. What drug would the nurse tell them, when combined with furosemide (Lasix), is likely to cause hearing loss?

Gentamicin (Garamycin)

A 64-year-old patient in hypertensive crisis is to receive furosemide (Lasix) 40 mg IV. Lasix comes in 100 mg/10 mL containers. How will the nurse administer the medication?

Give 4 mL over 1 to 2 minutes IV.

The staff educator in the ICU is talking with a group of new nurses about osmotic diuretics. The educator would tell the new nurses that osmotic diuretics act on which site in the nephron?

Glomerulus

The nurse is caring for a patient who is taking acetazolamide (Diamox) for treatment of glaucoma. What drug, if taken with acetazolamide (Diamox), would cause the nurse to contact the physician?

Lithium (Eskalith)

A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered?

Mannitol

A student asks the pharmacy instructor what the difference is between the diuretics spironolactone (Aldactone) and furosemide (Lasix). What would the instructor reply?

Potassium losses are lower with spironolactone.

The class of diuretics that act to block the chloride pump in the distal convoluted tubules and leads to a loss of sodium and potassium and a minor loss of water is what?

Thiazide diuretics

A 49-year-old client reports frequent muscle cramps while on hydrochlorothiazide therapy. The nurse would advise the client to do which?

eat potassium-rich foods.

A health care provider has prescribed triamterene to a male client with renal disease. The client informs the nurse that he is taking potassium supplements to address some heart problems. The nurse would be alert for:

increased risk of hyperkalemia.

After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states:

"I need to make sure I don't eat too many high potassium foods."

A 91-year-old patient is being discharged on the diuretic spironolactone (Aldactone). What is the major adverse effect of this type of medication?

Hyperkalemia

An older adult client has a complex medical history that includes heart failure, type 1 diabetes, and diabetic nephropathy. The nurse has questioned a health care provider's prescription for oral spironolactone because the client's health problems would contribute to a high risk of which adverse reaction?

Hyperkalemia

The nurse assesses a client receiving furosemide for:

Hypotension

Upon her visit to the primary care provider's office, a female client presents with 14 pounds of additional weight since her visit 3 weeks ago. Her lower extremities are quite swollen, and her facial features are puffy. The provider prescribes a diuretic and requests a follow-up visit in 3 days. Two days later, the client contacts the office and is so dyspneic that she is hard to understand over the phone. An ambulance is dispatched, and she is admitted to the hospital for rapid diuresis. Which diuretic will most likely be the initial drug of choice?

Loop diuretic

A client with renal impairment is in need of a diuretic. Because of the renal problem, potassium-sparing diuretics are contraindicated but may be used if there is no other option. If they are used at all, what nursing intervention would be most important for this client?

Monitoring of serum electrolytes, creatinine, and BUN

. A patient has just been prescribed furosemide (Lasix). After reviewing the patient's medication history, what drug would cause the nurse concern when taken with furosemide (Lasix)?

Naproxen sodium (Naprosyn)

A patient has been prescribed furosemide (Lasix). Because this drug causes potassium loss, what will the nurse instruct the patient to eat?

Peaches

The nurse is providing discharge instruction to a patient who has just begun using diuretics. The nurse counsels the patient that it is most important to monitor the intake of foods that contain which element

Potassium

A male client has cirrhosis and is receiving diuretic therapy. The nurse knows that what drug will help prevent metabolic alkalosis or hypokalemia in this client?

Spironolactone

The nurse is caring for a patient who has just been diagnosed with essential hypertension. The nurse is aware that the health care provider will begin therapy with which classification of diuretics?

Thiazide and thiazide-like diuretics

A nurse obtains an allergy history from a client based on the understanding that which class is associated with a cross-sensitivity reaction with sulfonamides?

Thiazide diuretics

A patient has just begun therapy with furosemide (Lasix), and the nurse is instructing the patient about the need to include foods high in potassium in the diet. Which foods would be appropriate for this patient to choose? (Select all that apply.)

A) Prunes C) Watermelon D) Lima beans

A client prescribed both an ACE inhibitor and a beta-blocker for the treatment of hypertension has been consistently obtaining blood pressure readings in the vicinity of 145/90 mm Hg. As a result, the client's primary health care provider has prescribed furosemide. What order would be most consistent with this client's health needs?

Furosemide 40 mg PO BID

What statement by the 62-year-old patient indicates that the patient understand the nurse's teaching about diuretics?

I will weigh myself daily and report significant changes.

Diuretics can either block the reabsorption of components of the urine or block the reabsorption of water back into the body. What does the increase in urine flow from the body depend on with a patient on loop diuretics?

The amount of sodium and chloride reabsorption that it blocks

A nurse is providing care to a client who is to receive acetazolamide for epilepsy. Before administering this drug, the nurse would assess which of the following?

Vital signs and weight

A hospital client demonstrating peripheral edema has been prescribed furosemide. How should the nurse best determine the extent of the client's desired fluid loss?

Weigh the client daily.