Pharm Ch 51 Prepu

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."

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

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.

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

Acetazolamide

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.

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.

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 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

When describing the action of chlorothiazide, what would a nurse include?

Blocking of the chloride pump

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.

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

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

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

Hydrochlorothiazide

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

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 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 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

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

Osmotic diuretic

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

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 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 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 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 is diagnosed with increased intracranial pressure. Which 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

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

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.

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."

What information should the nurse discuss with the client considering pregnancy regarding the use of a diuretic during pregnancy?

"Typically, women on diuretics prior to becoming pregnant can remain on the medication during their pregnancy."

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 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 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.

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

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

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

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

Loop of Henle

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

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

This may cause hyperkalemia

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

bananas

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

cause a greater diuresis

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

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

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

furosemide

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