Diuretics Prep U 125-pharm csn

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.

The nurse is providing education to a client who has been prescribed long-term diuretic therapy. Which client statement demonstrates an understanding of self-monitoring to identify fluid-related issues? Select all that apply.

"I take my scale with me when I stay overnight with friends." "I weigh myself in the same clothes every day." "I weigh myself immediately before breakfast every day."

A client with heart failure is prescribed a loop diuretic. Which client statement indicates that teaching provided by the nurse about this medication was effective?

"I will change positions slowly if I feel dizzy." Loop diuretics can cause a sudden and dramatic increase in urine output and a drop in total body fluid. Because of the loss of fluid, blood pressure may drop causing feelings of dizziness. Because of this, the client should change positions slowly if dizziness occurs. The client should measure weight every day. Fluid intake should not be reduced because this could cause fluid rebound. The medication can be taken with food, which will eliminate any stomach upset.

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." Explanation: Diuretics, including hydrochlorothiazide, can cause orthostatic hypotension. Rising slowly to a standing position can reduce the risk of falls. Patients taking diuretics should restrict sodium intake to avoid the need for higher doses, which increase the likelihood of adverse effects. Taking diuretics with food can help avoid the GI irritation frequently associated with these drugs.

An adult client with heart failure is prescribed a thiazide diuretic. Which client statement(s) indicates to the nurse that teaching about the medication was effective? Select all that apply.

"I will weigh myself every day." "I will wear the same clothes to weigh myself." "I will weigh myself at the same time every day." "I will use the same scale to weigh myself each time."

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

"It's okay to take it with food." Instructions for a client taking a diuretic include taking the drug with food or meals if gastrointestinal upset occurs, taking the dose early in the morning to prevent interfering with sleep, implementing safety precautions if dizziness or weakness is a problem, and ensuring adequate fluid intake to prevent fluid rebound. It is not necessary to lie down after taking the drug.

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." By inhibiting the effects of aldosterone in the distal tubules, spironolactone promotes potassium retention. The client will not have greater potassium losses, water losses, or sodium losses with spironolactone rather than furosemide.

A patient is receiving acetazolamide in a sustained release form. The nurse would anticipate the onset of drug action in approximately which time frame?

2 hours Explanation: Acetazolamide in sustained release form has an onset of action of 2 hours.

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 Explanation: Furosemide, when given intravenously, begins to act in 5 minutes, reaching peak effects in 30 minutes. In this case, this would be 8:30 AM.

A patient is prescribed a thiazide diuretic that is to be administered intravenously. Which agent would this most likely be?

Chlorothiazide Chlorothiazide is administered orally or intravenously. Hydrochlorothiazide, Bendroflumethiazide, and methyclothiazide are administered orally only.

A 75-year-old client is diagnosed with atrial fibrillation and chronic congestive heart failure. The health care provider orders a combination of digoxin and diuretics to treat the client's diseases. Recent laboratory results indicate that the client's potassium level is 2 mEq/L. This client is at risk for which problem?

Digoxin toxicity Explanation: When digoxin and diuretics are given concomitantly, the risk of digoxin toxicity is increased due to diuretic-induced hypokalemia.

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

Digoxin toxicity Explanation: When digoxin and diuretics are used concomitantly, the risk of digoxin toxicity is increased. The client is at risk for hypokalemia, not hyperkalemia. The client is not at risk for hyperglycemia or tachycardia.

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 Explanation: Thiazide diuretics act in the nephron's distal tubule.

Diuretics increase the production and output of urine. Which statement helps explain how diuretics achieve these effects?

Diuretics reduce the reabsorption of water in the kidneys. Explanation: Diuretics increase urine production and output by reducing the reabsorption of water and electrolytes in the kidneys.

What type of diet should a patient taking diuretics have?

Eat potassium-rich or low-potassium diet as appropriate Explanation: Provide potassium-rich or low-potassium diet as appropriate to maintain electrolyte balance and replace lost potassium or prevent hyperkalemia.

A nurse is caring for a patient with edema due to congestive heart failure (CHF). The physician has prescribed indapamide to the patient. The patient is also undergoing treatment with digitalis glycoside. Which intervention should the nurse perform when caring for this patient?

Frequently monitor the patient's pulse rate and rhythm. Explanation: Patients receiving a diuretic, particularly a loop or thiazide diuretic such as indapamide, and a digitalis glycoside concurrently require frequent monitoring of the pulse rate and rhythm because of the possibility of cardiac arrhythmias. Any significant changes in the pulse rate and rhythm are immediately reported to the primary health care provider. The nurse should encourage oral fluids at frequent intervals at waking hours when caring for older patients to prevent a fluid volume deficit. In such cases the nurse should also encourage elderly patients to eat or drink between meals and in the evening. The nurse must closely observe patients receiving a potassium-sparing diuretic for signs of hyperkalemia, a serious and potentially fatal electrolyte imbalance.

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 For hypertension, furosemide is commonly given as 40 mg PO twice daily and gradually increased if necessary. The other prescriptions include incorrect routes, frequencies, or doses.

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 Explanation: Diuretics are often used to manage edema and ascites in clients with hepatic impairment. These drugs must be used with caution, because diuretic-induced fluid and electrolyte imbalances may precipitate or worsen hepatic encephalopathy and coma.

A client who is allergic to sulfonamide would use what diuretic cautiously?

Hydrochlorothiazide Explanation: There is a known cross-sensitivity of some sulfonamide-allergic clients to sulfonamide nonantibiotics, such as thiazides.

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 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 Explanation: Potassium-sparing diuretics are contraindicated in clients with renal impairment because of the high risk of 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 Thiazides, such as hydrochlorothiazide, are potassium-losing diuretics, and their use can lead to hypokalemia. Symptoms of hypokalemia include muscle weakness, arrhythmia, hypotension, anorexia, and shallow respirations.

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 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 nurse notes that a newly admitted client is currently prescribed both a loop diuretic as well as a thiazide diuretic. The nurse understands what primary rationale for the concurrent use of these two drugs?

Increased diuretic effect Explanation: When an inadequate diuretic response occurs with one drug, people sometimes take two potassium-losing diuretics concurrently. The combination of a loop and a thiazide diuretic has synergistic effects because the drugs act in different segments of the renal tubule. Thus, the rationale for this particular combination is not rooted in prevention of potassium imbalances, increased adherence, or maintenance of a normal heart rate.

A client is admitted to the emergency department with pulmonary edema. What diuretic does the nurse expect the health care provider to prescribe to achieve rapid therapeutic effect?

Loop diuretic Explanation: Loop diuretics are the diuretics of choice when rapid effects are required, such as in the treatment of pulmonary edema. The health care provider is, therefore, less likely to prescribe one of the other medications at this time.

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

Loop of Henle Explanation: Bumetanide is a loop diuretic that blocks the chloride pump in the ascending loop of Henle. It also has a similar effect in the descending loop and in the distal convoluted tubule.

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 Explanation: Mannitol is an osmotic diuretic used frequently in cases of increased ICP. Bumetanide and ethacrynic acid are loop diuretics, and spironolactone is a potassium-sparing 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 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 unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed?

Osmotic diuretic 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 child experiencing edema as a result of a congenital heart defect is prescribed a thiazide diuretic. The nurse should closely monitor which of the client's clinical characteristics? (Select all that apply.)

Potassium level Daily weight Blood pressure Appetite

What would contraindicate the use of indapamide?

Renal disease Explanation: Indapamide would be contraindicated in a client with severe renal disease, which may prevent the diuretic from working or precipitate a crisis stage due to blood flow changes brought about by the diuretic. Indapamide would be used cautiously in clients with diabetes, systemic lupus erythematosus, or gout.

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.

An adult client with a diagnosis of hypertension has been prescribed oral furosemide. What goal should the nurse identify when planning this client's medication teaching session?

The client will identify strategies for limiting sodium intake. Explanation: The reason for furosemide use should guide client teaching. In most instances, it is necessary to initiate measures to limit sodium intake. Key considerations should include not adding salt to food during preparation or at the dinner table, reading food labels carefully to be aware of hidden sources of sodium, and avoiding processed or high-sodium foods. Blood glucose monitoring is not indicated, and there is no need for increased fluid intake. Renal anatomy and physiology are not priority teaching points.

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.

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 Explanation: A cross-sensitivity reaction may occur with the thiazide diuretics and sulfonamides. For clients who take carbonic anhydrase inhibitors during treatment for glaucoma, contact the primary health care provider immediately if eye pain is not relieved or if it increases. When a client with epilepsy is being treated for seizures, a family member of the client should keep a record of all seizures witnessed and bring this to the primary health care provider at the time of the next visit. Contact the primary health care provider immediately if the number of seizures increases. Potassium-sparing diuretics can lead to hyperkalemia and is most likely to occur in clients with an inadequate fluid intake and urine output, those with diabetes or renal failure, older adults, and those who are severely ill, and teach the client to avoid the use of salt substitutes containing potassium. Osmotic diuretics such as mannitol or urea for treatment of increased intracranial pressure caused by cerebral edema, perform neurologic assessments (response of the pupils to light, level of consciousness, or response to a painful stimulus) in addition to vital signs at the time intervals ordered by the primary health care provider.

Which medication exerts its effects by depressing the reabsorption of sodium in the kidney tubules, thereby increasing sodium and water excretion?

Triamterene Triamterene is a potassium-sparing diuretic that exerts its effect by depressing the reabsorption of sodium in the kidney tubules, thereby increasing sodium and water excretion. Furosemide is a loop diuretic which inhibits reabsorption of sodium and chloride in the distal and proximal tubules of the kidney and in the loop of Henle. Hydrochlorothiazide inhibits the reabsorption of sodium and chloride ions in the ascending portion of the loop of Henle and the early distal tubule of the nephron. This action results in the excretion of sodium, chloride, and water. Acetazolamide is a carbonic anhydrase inhibitor and is a sulfonamide, without bacteriostatic action, that inhibits the enzyme carbonic anhydrase. Carbonic anhydrase inhibition results in the excretion of sodium, potassium, bicarbonate, and water.

A client with glaucoma is prescribed a carbonic anhydrase inhibitor medication. For which reason would the nurse question giving the client this medication?

allergic to sulfonamides Explanation: Carbonic anhydrase inhibitors are contraindicated in clients with an allergy to sulfonamides. Because of this, the medication should be questioned for the client. Carbonic anhydrase inhibitors are not contraindicated for a hearing loss, use of NSAIDs, or in type 2 diabetes.

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. 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.

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

furosemide Explanation: Loop diuretics, like furosemide, are the diuretics of choice when rapid effects are required since they produce extensive diuresis for short periods, after which the kidney tubules regain their ability to reabsorb sodium. Thiazide diuretics, like hydrochlorothiazide, are the drugs of choice for most clients who require diuretic therapy, especially for long-term management of heart failure and hypertension. In clients with heart failure and inadequate renal function, the addition of spironolactone, a potassium-sparing diuretic, allows smaller doses of loop diuretics and potassium supplements to be administered as spironolactone reduces urinary potassium loss. Mannitol, an osmotic diuretic, is useful in managing oliguria or anuria, and it may prevent acute renal failure (ARF) during prolonged surgery, trauma, or infusion of cisplatin, an antineoplastic agent.

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 Explanation: 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.

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. 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.

The nurse is caring for a client with increased intracranial pressure. Which diuretic would the nurse anticipate being prescribed for this client?

mannitol Osmotic diuretics pull water into the renal tubule without sodium loss. Mannitol is a sugar that is not well reabsorbed by the tubules; it acts to pull large amounts of fluid into the urine due to the osmotic pull exerted by the large sugar molecule. Because the tubule is not able to reabsorb all of the sugar pulled into it, large amounts of fluid are lost in the urine. Because of this, it is the diuretic of choice in increased intracranial pressure. Neither furosemide, spironolactone, nor hydrochlorothiazide are identified as being the diuretic of choice for increased intracranial pressure.

A female client is prescribed a carbonic anhydrase inhibitor to manage glaucoma. The nurse stresses the importance of reporting which change in health status to the primary health care provider immediately?

pregnancy Some carbonic anhydrase inhibitors have been associated with fetal abnormalities in animals and should not be used during pregnancy in most circumstances. Routine use of a carbonic anhydrase inhibitor during pregnancy is not appropriate; these drugs should be reserved for situations in which the pregnant client has pathological reasons for use, not pregnancy manifestations or complications, and only if the benefit to the client clearly outweighs the risk to the fetus. None of the other options present as contraindications for use of this drug classification.

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

sodium Explanation: In the ascending limb of the loop of Henle, sodium is reabsorbed. Glucose and amino acids are reabsorbed by the proximal tubule, while water is reabsorbed by the descending limb of the loop of Henle.