NU141- Chapter 51 Diuretic Agents

Osmotic pull

drawing force of large molecules on water, pulling it into a tubule or capillary essential for maintaining normal fluid balance within the body; used to draw out excess fluid into the vascular system or the renal tubule

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."

A male client has been ordered spironolactone (Aldactone) for hypertension. Which statement by the client indicates a need for further education?

"I will take the medication when my blood pressure is elevated."

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 is being switched from furosemide to spironolactone?" What is the nurse's best response?

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

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."

A client is receiving hydrochlorothiazide. The nurse would expect this drug to begin acting within which time frame?

2 hours

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

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

30 minutes

The health care provider orders furosemide for a pediatric client. The nurse knows that the established dose of the drug should not exceed how many milligrams per kilogram of body weight per day?

6

A patient has been prescribed a daily dosage of 20 mg of torsemide for the treatment of acute pulmonary edema. The drug is available in the form of 10 mg tablets. How many tablets should the nurse get for the course of 4 days?

8

A patient receives furosemide intravenously at 9 AM. The nurse would expect to assess peak effects of the drug at which time?

9:30 AM

A client with a long-standing diagnosis of heart failure has been taking hydrochlorothiazide (HCTZ) for several weeks. The client reports experiencing moderate diuresis, but the care provider and the client agree that increased diuresis would be of benefit. However, the care provider has explained that the client is likely near the ceiling threshold of this drug. What is the main implication when a client prescribed hydrochlorothiazide (HCTZ) is told they are, "nearing the drug's ceiling threshold"?

A higher dose of HCTZ will not result in increased diuresis.

A client has edema of the lower extremities and abdomen. What is the reason to administer a stronger diuretic than a thiazide diuretic to this client?

A thiazide diuretic will be ineffective when immediate diuresis is needed.

A nurse demonstrates understanding of diuretics when identifying which medication as exerting its effect by inhibiting the enzyme carbonic anhydrase?

Acetazolamide

A nurse is reviewing the medical record of a client with seizures and notes that the client is taking a drug classified as a diuretic. Which medication would the nurse identify?

Acetazolamide

Which drugs are sulfonamides, with nonbacteriostatic action, that inhibit the enzyme carbonic anhydrase? (Select all that apply.)

Acetazolamide (Diamox) Methazolamide (Naptazane)

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.

What would be a contraindication to the use of carbonic anhydrase inhibitors?

Allergy to sulfonamides

When describing the action of spironolactone, the nurse would explain that this drug acts by:

Blocking aldosterone in the distal tubule

What sign is most indicative of dehydration in a patient taking diuretics?

Body weight

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 upon which site in the nephron?

Descending limb of loop of Henle

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

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

What type of diet should a patient taking diuretics have?

Eat potassium-rich or low-potassium diet as appropriate

The nurse is evaluating an 82-year-old client's medical record. The client is receiving hydrochlorothiazide. What abnormal laboratory result is related to the medication?

Elevated uric acid levels

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.

After teaching a group of students about loop diuretics, the instructor determines that the teaching has been successful when the students identify which agent as the safest for use in the home?

Furosemide

An elderly patient with a history of congestive heart failure has been admitted to hospital with failure to thrive and admission blood work reveals a hemoglobin level of 6.9 g/dL. The care team has consequently administered two units of packed red blood cells, but auscultation of the client's lungs now reveals diffuse crackles. Administration of what drug is likely to resolve the patient's pulmonary edema?

Furosemide

Which is an example of a loop diuretic?

Furosemide (Lasix)

When preparing the teaching plan for a male client who is prescribed spironolactone, the nurse would alert the client to the possibility of which of the following?

Gynecomastia

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 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

What would contraindicate the use of indapamide?

Hypokalemia

The nurse assesses a client receiving furosemide for:

Hypotension

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

A female client is diagnosed with hyponatremia. What type of diuretic would most likely cause this symptom?

Loop

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 diuresing. Which diuretic will most likely be the initial drug of choice?

Loop diuretic

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

Mannitol

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

Because of the action of methazolamide, the nurse would assess a patient closely for signs and symptoms of which acid-base imbalance?

Metabolic acidosis

Which would the nurse expect to find in a client receiving acetazolamide?

Metabolic acidosis

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

Oral

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

An ED nurse is caring for a patient who is receiving furosemide for treatment of pulmonary edema. What will the nurse monitor to observe for adverse effects of the drug?

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.

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 intracranial pressure Reduction of intraocular pressure Urinary excretion of toxic substances

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 nurse is preparing to administer a diuretic that antagonizes the action of aldosterone. Which drug would the nurse be most likely to administer?

Spironolactone

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

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.

A 64-year-old patient is admitted to the emergency department with pulmonary edema. The physician orders furosemide 40 mg IV. If the drug is available in a 100 mg/10 mL preparation, how will the nurse administer it?

The nurse will administer 4 mL over 1 to 2 minutes.

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

They may cause hyperkalemia.

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 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.

Routine nursing care of a client receiving a diuretic would include which interventions? a. Daily weighing b. Tight fluid restrictions c. Periodic electrolyte evaluations d. Monitoring of urinary output e. Regular IOP testing f. Teaching the patient to report muscle cramping

a. Daily weighing c. Periodic electrolyte evaluations d. Monitoring of urinary output f. Teaching the patient to report muscle cramping

Diuretics are currently recommended for the treatment of which conditions? a. Hypertension b. Renal disease c. Obesity d. Severe liver disease e. Fluid retention of pregnancy f. Heart failure

a. Hypertension b. Renal disease d. Severe liver disease f. Heart failure

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.

Hypokalemia

low potassium in the blood, which often occurs after diuretic use; characterized by weakness, muscle cramps, trembling, nausea, vomiting, diarrhea, and cardiac arrhythmias

Edema

movement of fluid into the interstitial spaces; occurs when the balance between osmotic pull (from plasma proteins) and hydrostatic push (from blood pressure) is imbalanced

A nurse is providing patient teaching for a 62-year-old woman who is taking triamterene. The nurse will teach the patient to avoid what in her diet?

Avocados

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

Hydrochlorothiazide

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

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

Loop of Henle

When providing medication teaching about to a client prescribed spironolactone, what foods should the client be instructed to avoid?

bananas

The nurse would anticipate an order for a loop diuretic as the drug of choice for a patient with a. hypertension. b. septic shock. c. pulmonary edema. d. fluid retention of pregnancy.

c. pulmonary edema.

An elderly 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 nurse understands that loop diuretics are considered high ceiling diuretics because they:

cause a greater diuresis.

A hospital client with a diagnosis of liver failure has been prescribed a low dose of spironolactone in order to treat ascites. The nurse who is providing this client's care should prioritize assessments for the signs and symptoms of what health problem?

hepatic encephalopathy

Alkalosis

state of not having enough acid to maintain normal homeostatic processes

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.

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

Ms. Crampton is prescribed furosemide for chronic heart failure. The nurse knows that furosemide can cause electrolyte imbalances and what other serious side effect?

Metabolic alkalosis

Most diuretics act in the body to cause a. loss of calcium. b. loss of sodium. c. retention of potassium. d. retention of chloride.

b. loss of sodium

Hyperaldosteronism

excessive output of aldosterone from the adrenal gland, leading to increased sodium and water retention and loss of potassium

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 care provider has prescribed furosemide. What order would be most consistent with this client's health needs?

furosemide 40 mg PO BID

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

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."

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."

The nurse is monitoring the results of laboratory testing for a client receiving chlorthalidone. What finding would be a cause for concern?

Hypercalcemia

Thiazide diuretics are considered mild diuretics because a. they block the sodium pump in the loop of Henle. b. they cause loss of sodium and chloride but little water. c. they do not cause fluid rebound when they work in the kidneys. d. they have little or no effect on electrolyte levels.

b. they cause loss of sodium and chloride but little water.

Diuretics cause a loss of fluid volume in the body. The drop in volume activates compensatory mechanisms to restore the volume, including a. suppression of ADH release and stimulation of the countercurrent mechanism. b. suppression of aldosterone release and increased ADH release. c. activation of the renin-angiotensin-aldosterone system with increased ADH and aldosterone. d. stimulation of the countercurrent mechanism with reflex drop in renin release.

c. activation of the renin-agiotensin-aldosterone system with increased ADH and aldosterone.

The nurse would instruct a patient receiving a loop diuretic to report a. yellow vision. b. weight loss of 1 lb/d. c. muscle cramping. d. increased urination.

c. muscle cramping.

When providing care to a patient who is receiving a loop diuretic, the nurse would determine the need to regularly monitor which? a. Sodium levels b. Bone marrow function c. Calcium levels d. Potassium levels

d. Potassium levels

The nurse is caring for a 68-year-old female client with type 1 diabetes mellitus whose health care provider has ordered hydrochlorothiazide. As a consequence of taking the diuretic, the client may need to:

increase her insulin dose.

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

A nurse is caring for a 78-year-old patient with renal insufficiency and chronic heart failure who is receiving rapid infusions of high-dose furosemide. It will be a priority for the nurse to monitor for:

ototoxicity.

What effect will a diet high in sodium have on a client prescribed furosemide 20 mg PO?

decreased diuresis

High-ceiling diuretics

powerful diuretics that work in the loop of Henle to inhibit the reabsorption of sodium and chloride, leading to a sodium-rich diuresis

A patient with severe glaucoma who is about to undergo eye surgery would benefit from a decrease in intraocular fluid. This is often best accomplished by giving the patient a. a loop diuretic. b. a thiazide diuretic. c. a carbonic anhydrase inhibitor. d. an osmotic diuretic.

d. an osmotic diuretic.

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

osmotic diuretic

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

Fluid rebound

reflex reaction of the body to the loss of fluid or sodium; the hypothalamus causes the release of antidiuretic hormone, which promotes water retention, and stress related to fluid loss combines with decreased blood flow to the kidneys to activate the renin-angiotensin-aldosterone system, leading to further water and sodium retention

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

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

Osmotic pull

When developing the plan of care for a patient with hyperaldosteronism, the nurse would expect the physician to prescribe which agent? a. Spironolactone b. Furosemide c. Hydrochlorothiazide d. Acetazolamide

a. Spironolactone

A client, prescribed digoxin and furosemide, is at risk for developing which adverse effect?

digoxin toxicity

When providing care for older adults who are taking furosemide on a regular basis, the nurse should prioritize assessments that are relevant to what health problem?

dehydration

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

An adult client with multiple chronic health problems has been prescribed furosemide in the management of hypertension. When reviewing this client's current medication administration record, what drug should signal the nurse to a potentially increased risk of hypokalemia?

prednisone

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

sodium