Chapter 51: Diuretic Agents
The nurse is teaching a 62-year-old client about hydrochlorothiazide, which the health care provider has prescribed for treatment of hypertension. What statement, made by the client, suggests that the client understands the teaching?
"I will need to stand slowly."
Which instruction would be most appropriate for a client who is taking a diuretic?
"It's okay to take it with food."
A client asks, "Why is my prescription being switched from furosemide to spironolactone?" What is the nurse's best response?
"You will lose less potassium with spironolactone than with furosemide."
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 should be aware that diuresis will peak how long after furosemide is administered?
30 minutes
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
Why would potassium-sparing diuretics be contraindicated for clients experiencing renal failure?
They may cause hyperkalemia. Rationale: Potassium-sparing diuretics are contraindicated in the presence of renal insufficiency because their use may cause hyperkalemia because of the kidneys' ineffective filtration abilities. The remaining options would not result from impaired renal failure.
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 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 Rationale: The nurse should inform the client about the increased risk of hyperkalemia as the effect of the interaction between triamterene, which is a potassium-sparing diuretic, and potassium supplements. When the client is administered loop diuretics with anticoagulants or thrombolytics, there will be increased risk of bleeding. When the client is administered digitalis with loop diuretics, there is an increased risk of arrhythmias. Decreased diuretic effect, in this case decreased effect of triamterene, will occur when a potassium-sparing diuretic such as triamterene is administered with NSAIDs, salicylates, and anticoagulants.
A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed?
osmotic diuretic Rationale: An osmotic diuretic is used to reduce intracranial pressure related to a head injury. Loop diuretics, potassium-sparing diuretics, and thiazide diuretics do not reduce intracranial pressure.
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." Rationale: Spironolactone promotes retention of sodium and water and excretion of potassium by stimulating the sodium-potassium exchange mechanism in the distal tubule. The client will not have greater potassium losses, water losses, or sodium losses with spironolactone rather than furosemide.
After reviewing information about thiazide diuretics, a group of students demonstrate the need for additional teaching when they identify what as a possible adverse effect?
Hypocalcemia Rationale: Thiazide diuretics can cause hypokalemia, hyperuricemia (increased uric acid levels), hypercalcemia, and hyperglycemia (with long-term use).
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 bestrespond to this suggestion?
"Actually, patients with renal failure usually can't take hydrochlorothiazide." Rationale: Renal disease and severe renal impairment contraindicate the use of hydrochlorothiazide. Hydrochlorothiazide 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 patient is switched from furosemide (Lasix) to spironolactone (Aldactone). The patient asks the nurse why she has been switched to a new medicine. What is the best answer that will provide patient education regarding the change?
"You will lose less potassium with spironolactone than with furosemide." Rationale: Spironolactone promotes retention of sodium and water and excretion of potassium by stimulating the sodium-potassium exchange mechanism in the distal tubule. The patient will not have greater potassium losses, water losses, or sodium losses with spironolactone rather than furosemide.
A client receives a dose of furosemide intravenously at 8:00 AM. The nurse would expect this drug to exert is peak effects at which time?
8:30 AM
A nurse is caring for a client with acute renal failure. The health care provider has prescribed a diuretic therapy for the client to promote dieresis. What intervention should the nurse perform to prevent the inconvenience caused by increased urination?
Administer the drug early in the day. Rationale: The nurse should administer the drug early in the day to prevent any nighttime sleep disturbance caused by increased urination when caring for a client receiving a diuretic therapy for acute renal failure. The nurse need not ask the client to decrease fluid intake, gradually increase the drug dosage, or encourage the client to exercise as these are not appropriate interventions and will not help in reducing the discomfort caused by increased urination.
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 Rationale: Furosemide (Lasix) is an example of a loop diuretic. Hydrochlorothiazide is a thiazide diuretic. Acetazolamide is a carbonic anhydrase inhibitor. Spironolactone is a potassium-sparing diuretic.
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 Rationale: 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 Rationale: The nurse should monitor for increased blood glucose levels in the diabetic client receiving a loop diuretic. The blood glucometer test results for these clients may be elevated, or urine may test positive for glucose. Thiazide diuretic agents may cause gout attacks and sudden joint pain. The nurse need not monitor for a sudden increase in weight as the administration of loop diuretics to a diabetic client will not cause this effect.
A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered?
Mannitol Rationale: 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 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 Rationale: Potassium-sparing diuretics are contraindicated in clients with renal impairment because of the high risk of hyperkalemia. If they are used at all, frequent monitoring of serum electrolytes, creatinine, and BUN is needed.
A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route?
Oral Rationale: Hydrochlorothiazide is only available as an oral preparation. Only chlorothiazide can be given by intravenous infusion.
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.
When describing the action of spironolactone, the nurse would explain that this drug acts by:
blocking aldosterone in the distal tubulele
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 Rationale: The client is most likely experiencing muscle cramps due to potassium loss. Therefore, the nurse should advise the client to include potassium supplements in the diet. Drinking plenty of fluids or using calcium supplements will not reduce the occurrence of cramps. It is important to caution the client to avoid foods high in sodium because they could counteract the effects of drug therapy.
A male client has cirrhosis of the liver that has caused ascites. The nurse knows that what condition may occur if diuretics are used to reduce the ascites?
hepatic encephalopathy
A male client is prescribed potassium-sparing diuretics to treat his disease process. During his annual visit to the health care provider, he reports experiencing muscle weakness and tingling in his fingers. What does the nurse suspect is wrong with this client?
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 care provider's prescription for oral spironolactone because the client's health problems would contribute to a high risk of which adverse reaction?
hyperkalemia Rationale: The presence of renal insufficiency is also a contraindication to the use of spironolactone because use of spironolactone may cause hyperkalemia through the inhibition of aldosterone and the subsequent retention of potassium. A prescription for spironolactone does not put this client at a greatly increased risk of anemia, hypocalcemia, or acidosis since none of these conditions are associated with potassium.
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 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
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."
What would contraindicate the use of indapamide?
Hypokalemia Rationale: Indapamide would be contraindicated in a client with hypokalemia because any fluid and electrolyte imbalance could be potentiated by the changes caused by the diuretic. Indapamide would be used cautiously in clients with diabetes, systemic lupus erythematosus, or gout.
The nurse assesses a client receiving furosemide for:
Hypotension Rationale: Use of furosemide can lead to hypotension due to fluid loss, alkalosis due to loss of bicarbonate, hypocalcemia due to loss of calcium, and hyperglycemia (with long-term use) due to diuretic effect on glucose levels.
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.
Which diuretic will most likely be the initial drug of choice when a client demonstrates dyspnea related to pulmonary edema?
furosemide
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
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 Rationale: 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, but presence of these conditions does not contraindicate the use of potassium diuretics.
