Pharm Ch. 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."

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 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 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 male client is critically ill with a diagnosis of congestive heart failure exacerbated by a myocardial infarction. The nurse understands that what fast-acting diuretics would be appropriate for the physician to order? (Select all that apply.)

-Furosemide -Bumetanide *Fast-acting, potent diuretics such as furosemide and bumetanide are the most likely diuretics to be used in critically ill clients (e.g., those with pulmonary edema).

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

2 hours

Which diuretic has been administered to patients with epileptic seizures?

Acetazolamide (Diamox)

A patient is taking spironolactone (Aldactone). When providing patient teaching about this medication, what foods should the patient be instructed to avoid?

Bananas

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

Blocking aldosterone in the distal tubule *Spironolactone acts as an aldosterone antagonist blocking the actions of aldosterone in the distal tubule. Amiloride and triamterene block potassium secretion through the tubule. Carbonic anhydrase inhibitors slow the movement of hydrogen ions. Loop diuretics block the chloride pump.

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 evaluating an 82-year-old client who is receiving hydrochlorothiazide. What abnormal laboratory result might the nurse see related to the medication?

Elevated uric acid levels

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 *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 91-year-old patient, who is being prepared for discharge, has been prescribed the diuretic spironolactone. While teaching the patient 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

The nurse assesses a client receiving furosemide for:

Hypotension

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

Increased blood glucose levels

A physician has prescribed triamterene to a male patient with renal disease. The patient informs the nurse that he is taking potassium supplements to overcome cardiovascular problems. What effect of the interaction between these two drugs should the nurse look for in the patient?

Increased risk of hyperkalemia

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

Loop of Henle

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

Mannitol

The nurse is caring for a patient who is experiencing elevated intracranial pressure following neurosurgery. The physician orders an osmotic diuretic to reduce pressure. Which agent would the physician select?

Mannitol

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 patient is admitted to emergency and is unconscious as a result of a head injury. The patient's intracranial pressure is increased. What diuretic will be administered to the patient?

Osmotic diuretic

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

A 36-year-old male client undergoes dialysis three times weekly while waiting for renal transplant. A diuretic has been added to his current medications to combat developing edema. Why would potassium-sparing diuretics be contraindicated?

They may cause hyperkalemia.

A female patient reports that she has frequent muscle cramps while on hydrochlorothiazide therapy. The nurse will advise her to

eat potassium-rich foods.

A group of students are reviewing the various classes of diuretics. The students demonstrated understanding of the information when they identify what as a loop diuretic?

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

A physician prescribes spironolactone, a potassium-sparing diuretic, for a patient with cirrhosis. For which category of patients is the use of potassium-sparing diuretics contraindicated?

Patients with hyperkalemia