Chapter 34: Drug Therapy for Fluid Volume Excess

Which enzyme would a nurse identify as being responsible for the reabsorption of sodium ions?

Carbonic anhydrase

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

Oral-Hydrochlorothiazide is only available as an oral preparation. Only chlorothiazide can be given by intravenous infusion.

When describing the process of tubular reabsorption, which substances would the instructor include as being reabsorbed regularly?

With tubular reabsorption, about 99% of the water is reabsorbed along with vitamins, glucose, electrolytes, sodium bicarbonate, and sodium chloride.

The students are studying the male reproductive system. The instructor tells the students that in the male, the urethra leaves the urinary bladder and passes through the:

prostate gland.

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."- Renal disease and severe renal impairment contraindicate the use of hydrochlorothiazide. HCTZ affects the kidneys, not the bladder, and is not administered intravenously.

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 10-year-old child has edema caused by a heart defect. The client is taking furosemide. The dosage is 3 mg/kg/d. The child weighs 76 lbs. How many milligrams does the child receive each day?

105 mg- The nurse will administer 105 mg/dose of the drug (76 lbs divided by 2.2 = 34.5 kg, 35 kg times 3 mg = 105 mg).

The amount of fluid excreted as urine each day averages approximately less than how many liters?

2 L

The nurse is administering furosemide IV to a client. How soon after administration does the nurse expect diuretic effects to peak?

30 minutes

A clinic nurse has been assigned to follow up with a group of patients on hydrochlorothiazide therapy. Which patient will the nurse most closely monitor for hyponatremia?

A 71-year-old female who has advanced arteriosclerosis-While patients with diabetes or advanced arteriosclerosis should be monitored closely during hydrochlorothiazide therapy, older patients (over 65 years), especially women, are more at risk for hyponatremia. Older adults and their family members must be advised to report symptoms of hyponatremia such as weakness, nerve disorders, weight loss, salt hunger, cramps, and digestive problems.

A client has been diagnosed with renal failure and is surprised to learn of the large volume of blood that is filtered by the kidneys. The client asks, "If that much blood gets filtered, why don't people produce more urine than they do?" In response, the nurse should describe what phenomenon?

A very large majority of filtrate is returned to circulation.

Aldosterone levels would be affected if which gland was dysfunctional?

Adrenal

The nurse has finished a teaching session with a client who is prescribed a diuretic to be taken twice a day. The nurse determines the session is successful when the client correctly chooses which times to take the drug?

At breakfast and midafternoon-Twice-a-day dosing should be administered early in the morning (e.g., 0700) and early afternoon (e.g., 1400) to prevent the drug from interfering with the client's sleep.

The pharmacology instructor is discussing the various diuretic agents and their sites of action in the nephron. In what part of the nephron do thiazide diuretics act?

Distal tubule-

The nurse is caring for a client suspected of having renal dysfunction. The presence of what substances in the client's urine would be considered pathological?

Glucose and protein

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-The major adverse effect of potassium-sparing diuretics such as spironolactone is hyperkalemia. Clients receiving these drugs should not be given potassium supplements and should not be encouraged to eat foods high in potassium.

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

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

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

Potassium levels

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-For clients with cirrhosis, diuretic therapy should be initiated in a hospital setting, with small doses and careful monitoring. To prevent hypokalemia and metabolic alkalosis, supplemental potassium or spironolactone may be needed.

A client began taking hydrochlorothiazide 1 week ago and is reporting occasional dizziness when she stands up quickly from sitting or lying. What is the nurse's best action?

Teach the client about the blood pressure effects of the medication and relevant safety measures.- Mild dizziness upon rapid position changes is expected as a result of lowered blood pressure. The nurse should teach the client about this phenomenon and associated falls prevention. This is more likely a result of hypotension than changes in potassium levels. Bed rest would not be necessary and causes many other potential health problems. The nurse should not tell the client to withhold the medication since there is no evidence of severe adverse effects or an emergency.

A client has been prescribed hydrochlorothiazide, and the nurse is preparing to give the client discharge instructions. Which adverse effects should the nurse caution the client about?

The adverse effects associated with hydrochlorothiazide are dizziness, vertigo, orthostatic hypotension, nausea, anorexia, vomiting, dry mouth, diarrhea, constipation, polyuria, nocturia, muscle cramps, and spasms

The health care provider indicates that a client experiencing renal failure is not a candidate for therapy with potassium-sparing diuretics. How will the nurse respond when the client's family member asks why this is the case?

They may cause hyperkalemia- Potassium-sparing diuretics accumulate in renal insufficiency and present the risk for hyperkalemia. For this reason, health care practitioners typically avoid the drug in this population. Potassium-sparing diuretics decrease potassium excretion, and, by themselves, they are weak diuretics. Rebound edema may be a concern when a diuretic is discontinued, but it is not the reason this client is a poor candidate for a potassium-sparing diuretic.

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

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

A physician has prescribed triamterene to a client with renal disease. The client informs the nurse that they are taking potassium supplements to address some heart problems. The nurse would be alert for which of the following?

increased risk of hyperkalemia.-

A client is admitted in acute renal failure and prescribed mannitol. The nurse prepares to administer this drug via which route?

Intravenously-Mannitol is administered intravenously. It is not given intramuscularly, subcutaneously, or orally.

What term is used to describe the process that moves fluid and small particles out of the blood through the glomerulus and into the nephron tubule

Filtration

A deficiency in antidiuretic hormone (ADH) would be primarily associated with which condition?

Fluid imbalance-Antidiuretic hormone (ADH)is important in maintaining fluid balance.

A male client is excited because it is football season. He has season tickets and attends most games with his friends. At his latest appointment, the client's blood pressure is elevated. What does the nurse suspect is the cause?

He is consuming excessive salty foods at the games.-Excessive table salt and salty foods (e.g., ham, packaged sandwich meats, potato chips, dill pickles, most canned soups) may aggravate edema or hypertension.

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 nurse is preparing to administer spironolactone to a client. The nurse would question this order if which disorder is noted in the client's history?

Hyperkalemia-The nurse should know that potassium-sparing diuretics are contraindicated in clients with hyperkalemia and are not recommended for children. Potassium-sparing diuretics should be used cautiously in clients with liver disease, diabetes, or gout.

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

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

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

Mannitol-Mannitol is a powerful osmotic diuretic that is used to treat increased intracranial pressure. It is given intravenously and begins to work in 30 to 60 minutes. Furosemide, amiloride, and bumetanide are not indicated for the treatment of increased intracranial pressure.

A group of students are reviewing the structure and function of the renal system. The students demonstrate understanding when they identify what as the functional unit?

Nephron

The client has just been diagnosed with acute renal failure. The client asks the nurse what functional units of the kidneys are involved. What would the nurse reply?

Nephrons

A health care provider is considering ordering hydrochlorothiazide for a client. This drug must be used cautiously, if at all, if the client has a history of:

hypersensitivity to sulfonamides.

A group of students are reviewing the function of the kidneys and demonstrate understanding when they identify that the kidneys receive what portion of the cardiac output?

¼-The kidneys receive approximately 25% or ¼ of the cardiac output.