Pharm Chapter 38: Diuretics

The patient has been receiving spironolactone 50 mg/day for heart failure. The nurse should closely monitor the patient for which condition? a. Hypokalemia b. Hyperkalemia c. Hypoglycemia d. Hypermagnesemia

b. Hyperkalemia

Key Term: Osmolality

Concentration

Key Term: Hypertension

Blood pressure greater than 140/90 mmHg

Key Term: Hypercalcemia

Calcium excess.

Key Term: Antihypertensive

Diuretics have antihypertensive effect because they promote sodium and water loss by blocking sodium and chloride reabsorption. This causes a decrease in fluid volume, which lowers BP.

Key Term: Potassium-wasting diuretics

Diuretics that promote potassium excretion

Key Term: Postassium-sparing diuretics

Diuretics that promote potassium retention

Key Term: Hyperglycemia

Elevated blood glucose

Key Term: Hyperuricemia

Elevated serum uric acid level

Key Term: Diuresis

Increased urine flow

Key Term: Hypokalemia

Low potassium level

Key Term: Oliguria

Marked decrease in urine output

Key Term: Hyperkalemia

Serum potassium excess

Key Term: Saluretic

Sodium chloride-losing

Key Term: Natriuresis

Sodium loss in the urine

Key Term: Natriuretic

Sodium-losing

Key Term: Diuretics

Used for two main purposes: to decrease hypertension (lower BP) and to decrease edema, typically peripheral and pulmonary, in heart failure and renal/liver disorders. Produce increased urine flow by inhibiting sodium and water reabsorption from the kidney tubules.

A patient is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. The nurse plans to monitor the patient for which potential electrolyte imbalance? a. Hypocalcemia b. Hypokalemia c. Hyperkalemia d. Hypermagnesemia

b. Hypokalemia

A patient is ordered furosemide to be given via intravenous push. Which interventions will the nurse perform? (Select all) a. Administer at a rate no faster than 20 mg/min. b. Assess lung sounds before and after administration. c. Assess blood pressure before and after administration. d. Maintain accurate intake and output record. e. Monitor the electrocardiogram continuously. f. Insert an arterial line for continuous blood pressure monitoring.

a, b, c, d *Furosemide can be infused via intravenous push at the rate of 20 mg/min. Furosemide is a diuretic and will decrease fluid in alveoli, and assessing lung sounds can help to determine therapeutic effect. Blood pressure should decrease with the administration of a diuretic. It is appropriate to monitor before and after administration. It is appropriate to monitor intake and output for a patient receiving a diuretic. There is no need to insert an arterial line to continuously monitor the blood pressure since it should not fluctuate that dramatically. Also, there is no need to continuously monitor the electrocardiogram because the medication is not cardiotoxic.

Which assessment indicates to the nurse a therapeutic effect of mannitol has been achieved? a. Decreased intracranial pressure b. Decreased potassium c. Increased urine osmolality d. Decreased serum osmolality

a. Decreased intracranial pressure *Mannitol is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This will decrease intracranial pressure, increase excretion of medications, decrease urine osmolality, and increase serum osmolality.

What does the nurse know to be correct concerning the use of mannitol in patients? a. It decreases intracranial pressure b. It increases intraocular pressure c. It causes sodium and potassium retention d. It causes diuresis in several days

a. It decreases intracranial pressure

The nurse knows that which statement is correct regarding nursing care of a patient receiving hydrochlorothiazide? (Select all) a. Monitor patients for signs of hypoglycemia b. Administer ordered potassium supplements c. Monitor serum potassium and uric acid levels d. Assess blood pressure before administration e. Notify the provider if a patient has had oliguria for 24 hours f. Assess for decreased cholesterol and triglyceride levels

b. Administer ordered potassium supplements c. Monitor serum potassium and uric acid levels d. Assess blood pressure before administration e. Notify the provider if a patient has had oliguria for 24 hours

Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide? a. Sodium level of 140 mEq/L b. Fasting blood glucose level of 140 mg/dL c. Calcium level of 9 mg/dL d. Chloride level of 100 mEq/L

b. Fasting blood glucose level of 140 mg/dL *Hydrochlorothiazide can cause hyperglycemia. Normal calcium level is approximately 8.8-10.3 mg/dL; normal sodium level is 135-147 mEq/L; normal chloride level is 95-107 mEq/L, and normal fasting blood glucose should be 60-110 mg/dL.

What should the nurse do when a patient is taking furosemide? a. Instruct the patient to change positions quickly when getting out of bed b. Assess blood pressure before administration c. Administer the drug at bedtime for maximum effectiveness d. Teach the patient to avoid fruits to prevent hyperkalemia

b. Assess blood pressure before administration

The nurse notes that the patient is receiving hydrochlorothiazide for hypertension. Which additional medication in the patient's drug regimen would cause concern on the part of the nurse? a. Maalox b. Digoxin c. Nitroglycerine d. Albuterol

b. Digoxin *Of the numerous thiazide drug interactions with hydrochlorothiazide, the most serious occurs with digoxin. Thiazides can cause hypokalemia, which enhances the action of digoxin, and digitalis toxicity can occur.

A patient has heart failure, and a high dose of furosemide is ordered. What suggests a favorable response to furosemide? a. A decrease in level of consciousness occurs, and the patient sleeps more b. Respiratory rate decreases from 28/min to 20/min, and the depth increases c. Increased congestion is heard in breath sounds, and the patient complains of shortness of breath d. Urine output is 50 mL/4 h and intake is 200 mL

b. Respiratory rate decreases from 28/min to 20/min, and the depth increases

What is the best information for the nurse to provide to the patient who is receiving spironolactone and furosemide (Lasix) therapy? a. Moderate doses of two different diuretics are more effective than a large dose of one. b. This combination promotes diuresis but decreases the risk of hypokalemia. c. This combination prevents dehydration and hypovolemia. d. Using two drugs increases the osmolality of plasma and the glomerular filtration rate.

b. This combination promotes diuresis but decreases the risk of hypokalemia. *Spironolactone is a potassium-sparing diuretic; furosemide causes potassium loss. Giving these together minimizes electrolyte imbalance. It is not accurate to state that the drug combination prevents dehydration and hypovolemia or that it increases the osmolality of plasma and the glomerular filtration rate. Stating that giving two different diuretics is more effective is not specific enough information for the patient.

For the patient taking a diuretic, a combination such as triamterene and hydrochlorothiazide may be prescribed. The nurse realizes that this combo is ordered for which purpose? a. To decrease serum potassium level b. To increase serum potassium level c. To decrease glucose level d. To increase glucose level

b. To increase serum potassium level

Which patient would the nurse need to assess first if the patient is receiving mannitol? a. A 67-year-old patient with type 1 diabetes mellitus b. A 21-year-old patient with a head injury c. A 47-year-old patient with anuria d. A 55-year-old patient receiving cisplatin to treat ovarian cancer

c. A 47-year-old patient with anuria *Mannitol is not metabolized but excreted unchanged by the kidneys. Potential water intoxication could occur if mannitol is given to a patient with anuria. Mannitol is safe to use with diabetic patients and those with head injuries, and it may function as a nephroprotectant when cisplatin is being used.

A nurse is caring for a patient receiving acetazolamide. Which assessment finding will require immediate nursing intervention? a. A decrease in bicarbonate level b. An increase in urinary output c. A decrease in arterial pH d. An increase in PaO2

c. A decrease in arterial pH *Acetazolamide causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat metabolic alkalosis, edema, seizures, and acute glaucoma. A decrease in blood pH would indicate that the patient was becoming more acidotic.

The nurse is assessing a patient who is taking furosemide. The patient's potassium level is 3.4 mEq/L; chloride is 90 mmol/L, and sodium is 140 mEq/L. Based on the nurse's understanding of the laboratory results, what prescribed therapy can the nurse anticipate administering? a. Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly. b. Administer sodium polystyrene sulfonate. c. Administer 2 mEq potassium chloride per kilogram per day IV. d. Administer calcium acetate, two tablets three times per day.

c. Administer 2 mEq potassium chloride per kilogram per day IV. *Furosemide is a potent loop diuretic, resulting in the loss of potassium as well as water, sodium, and chloride. The patient needs chloride replacement. Normal potassium level is 3.5-5.2 mEq/L; normal sodium level is 135-147 mEq/L, and normal chloride level is 95-107 mEq/L. Potassium is never given by rapid infusion.

What intervention will the nurse perform when monitoring a patient receiving triamterene? a. Assess urinary output every other day. b. Monitor for side effect of hypoglycemia. c. Assess potassium levels. d. Monitor for hypernatremia.

c. Assess potassium levels. *Triamterene is a potassium-sparing diuretic. The nurse should monitor potassium for potential hyperkalemia.

A patient taking spironolactone has been taught about the medication. Which menu selection indicates that the patient understands teaching related to this medication? a. Potatoes b. Lima beans c. Chicken d. Strawberries

c. Chicken *Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Chicken is the only appropriate choice of the foods listed because it is lower in potassium. Potatoes, lima beans, and strawberries are all known to contain high levels of potassium.

A patient with acute pulmonary edema is receiving furosemide. What assessment finding indicates to the nurse that the intervention is working? a. Potassium level decreased from 4.5-3.5 mEq/L b. Improvement in mental status c. Lungs clear to auscultation d. Output 30 mL/h

c. Lungs clear to auscultation *Furosemide is a potent, rapid-acting diuretic that would be the drug of choice to treat acute pulmonary edema. Furosemide should not cause a drastic change in output or decrease in potassium level, and there is no evidence that it will create any change in mental status.

A patient is prescribed chlorthalidone. What is the most important information the nurse will teach the patient? a. "Do not drink more than 10 ounces of fluid a day while on this medication." b. "Take this medication on an empty stomach." c. "Take this medication before bed each night." d. "Wear protective clothing and sunscreen while taking this medication."

d. "Wear protective clothing and sunscreen while taking this medication." *Adverse effects associated with chlorthalidone include photosensitivity. The nurse should teach the patient to protect himself when out in the sun. There is no evidence that fluid should be restricted while taking the medication, that it should be taken on an empty stomach, or that it should only be taken at bedtime.