02 ATI Pharmacology Made Easy 4.0 diuretics & pharm ch 19

When providing medication teaching to a client who has been prescribed spironolactone, what foods should the nurse instruct the client to minimize consumption of? a. fish b. apples c. bananas d. crackers

ANS: C - Bananas RATIONALE: Bananas are high in potassium and should be avoided with potassium-sparing diuretics. It is acceptable for the client to eat fish, apples, and crackers because of their low sodium content.

A nurse is administering hydrochlorothiazide to a client who has gouty arthritis. The nurse should monitor the client for which of the following findings that indicates an adverse effects of the drug?

Hyperuremia

A nurse is monitoring a client who is taking a loop diuretic and is experiencing a thready, irregular pulse, orthostatic hypotension, and confusion. The nurse should identify that these manifestations indicate which of the following adverse effects?

Hypokalemia

A nurse is caring for a client who is taking spironolactone to treat hypertension. The nurse should recognize that which of the following of the clients laboratory values require immediate intervention?

Potassium 5.2 mEq/L

A nurse is caring for a client who is taking a diuretic. The nurse should instruct the client to include which of the following foods in their diet to increase potassium intake?

Raisins

A nurse is caring for a client with a glomerular filtration rate of 10 mL/min and a reduced urine output. The nurse should clarify a prescription for hydrochlorothiazide for this client because of which of the following characteristics of the drug?

The drug does not promote diuresis for clients who have renal insufficiency.

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? a. Weigh the client daily. b. Auscultate the client's chest each morning. c. Assess the client's skin turgor on a daily basis. d. Test the osmolarity of the client's urine regularly.

ANS : A Weigh the client daily. RATIONALE: The nurse should measure and record weights to assist in determining the amount of mobilization of excess fluid. This is a more accurate gauge of changes in fluid status than skin turgor, urine osmolarity, or chest auscultation.

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? a. The client will identify strategies for limiting sodium intake. b. The client will describe the rationale for increasing fluid intake. c. The client will accurately describe the basic structure and functions of the kidneys. d. The client will be able to demonstrate correct technique for blood glucose monitoring.

ANS : A the client will identify strategies for limiting sodium intake RATIONALE: 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.

6. 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? a. Osmotic diuretics b. Thiazide diuretics c. Potassium-sparing diuretics d. Carbonic anhydrase inhibitors

ANS : B. thiazide diuretics RATIONALE: A cross-sensitivity reaction may occur with the thiazide diuretics and sulfonamides. 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. Potassium-sparing diuretics can lead to hyperkalemia and is most likely to occur in clients with inadequate fluid intake and urine output, those with diabetes or renal failure, older adults, and those who are severely ill. Teach the client to avoid the use of salt substitutes containing potassium. 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.

4. 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? a. Mannitol b. Bumetanide c. Spironolactone d. Ethacrynic acid

ANS : a. Mannitol RATIONALE: 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 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? a. Thiazide b. Loop diuretic c. Osmotic diuretic d. Potassium-sparing diuretic

ANS : b. Loop diuretic RATIONALE: 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.

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? a. ibuprofen b. prednisone c. vitamin D d. calcium carbonate

ANS : b. prednisone RATIONALE: Corticosteroids increase the risk of hypokalemia in clients who are taking furosemide. Vitamin D, calcium supplements, and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen do not have this effect.

A male client has been ordered spironolactone (Aldactone) for hypertension. Which statement by the client indicates a need for further education? a. "I will weigh myself daily." b. "I may experience breast enlargement." c. "I will take the medication when my blood pressure is elevated." d. "I do not need to increase my potassium intake with this medication."

ANS : c. "I will take the medication when my blood pressure is elevated." RATIONALE: Spironolactone (Aldactone) should be taken daily to decrease blood pressure, not only when blood pressure is elevated. Spironolactone (Aldactone) is a potassium-sparing diuretic; therefore, no additional potassium is needed. Adverse reactions include gynecomastia, headache, diarrhea, and cramping. It is important that the client weigh himself daily.

What type of diet should a patient taking diuretics have? a. No effect on diet b. Eat low-sodium, low-potassium diet c. Eat sodium-rich or low-sodium diet as appropriate d. Eat potassium-rich or low-potassium diet as appropriate

ANS : d. Eat potassium-rich or low-potassium diet as appropriate RATIONALE: Provide potassium-rich or low-potassium diet as appropriate to maintain electrolyte balance and replace lost potassium or prevent hyperkalemia, depending on the diuretic used.

A nurse is reviewing the medication record of a client who has heart failure and has potassium level of 2.4 mEq/L. The nurse should identify which of the following medications as a possible cause of the client's potassium level? A) Furosemide B) Nitroglycerin C) Metoprolo lD) Spironolactone

ANS: A) Furosemide RATIONALE: Furosemide is a high-ceiling loop diuretic that inhibits the reabsorption of sodium and chloride and results in diuresis. Potassium is lost through excretion in the distal nephrons when the client receives this medication. This laboratory result is interpreted as hypokalemia, which is an adverse effect associated with the administration of furosemide.

A nurse is caring for a client who is receiving furosemide to treat heart failure. Which of the following laboratory values should the nurse monitor for tis client? A) Serum potassium B) Serum amylase C) Serum triglyceride D) Serum cholesterol

ANS: A) Serum potassium RATIONALE: Furosemide is a loop diuretic that promotes the excretion of potassium. The nurse should be aware that a very low serum potassium level can cause cardiac dysrhythmias. The greatest risk to the client is injury from cardiac dysrhythmias; therefore, this is the priority laboratory value to monitor.

A nurse is reviewing the laboratory values for a client who has heart failure and is taking bumetanide. For which of the following results should the nurse notify the provider? A) Sodium 136 mEq/L B) Potassium 2.3 mEq/L C) Magnesium 1.4 mEq/L D) Calcium 10 mg/dL

ANS: B) Potassium 2.3 mEq/L RATIONALE: The nurse should recognize that bumetanide is a loop-diuretic and eliminates potassium in the urine. This client's potassium level is below the normal reference range of 3.5 to 5.0 mEq/L. The nurse should assess the client for manifestations of hypokalemia, such as abdominal pain, muscle weakness, urinary retention, lethargy, confusion, and heart dysrhythmias and contact the provider with the findings.

A nurse is reinforcing teaching with a client about nutrition. The client has hypertension and is taking potassium-wasting diuretic. Which of the following dietary instructions should the nurse include in the teaching? A) Increase consumption of canned tuna and salmon. B)Limit intake of dried fruits. C) Avoid cow's milk. D) Consume oranges and bananas

ANS: D) Consume oranges and bananas RATIONALE: Clients taking a potassium-wasting diuretic are at risk for hypokalemia. Therefore, the nurse should encourage the client to consume products high in potassium, such as oranges and bananas.

A nurse is caring for a client who has heart failure and is taking furosemide. For which of the following findings should the nurse withhold the medication? A) Crackles in bases of lungs B) Peripheral edema C) Ascites D) Potassium 2.8 mEq/L

ANS: D) Potassium 2.8 mEq/L RATIONALE: Furosemide promotes the excretion of potassium. A potassium level of 2.8 indicates hypokalemia, which places the client at risk for cardiac dysrhythmias and possibly death. The nurse should withhold the medication and contact the provider. Crackles in bases of lungs Left-sided heart failure can result in crackles in lung bases from the back up of blood in the pulmonary system. Clients can benefit from furosemide, a loop diuretic that promotes reabsorption of water and promotes excretion, thus ridding the body of excess fluid. Peripheral edema Right-sided heart failure can result in peripheral edema, jugular vein distention, anorexia, and nausea. Furosemide can promote fluid excretion and relieve these signs and symptoms of heart failure. Ascites Right-sided heart failure can result in ascites, abdominal distention, and liver and spleen enlargement and tenderness. Furosemide can promote fluid excretion and relieve these signs and symptoms of heart failure.

A nurse is planning care for a client who is receiving furosemide IV for peripheral edema. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Assess for tinnitus. B. Report urine output 50 mL/hr. C. Monitor blood potassium levels. D. Elevate the head of bed slowly before ambulation. E. Recommend eating a banana daily.

ANS: A, C, D, E RATIONALE: A. An adverse effect of furosemide is ototoxicity. Manifestations of tinnitus should be reported to the provider. C. A decrease in blood potassium levels is an adverse effect of furosemide, and the provider should be notified. D. Slowly elevating the head of the bed will prevent the client from developing orthostatic hypotension, which is a manifestation of hypovolemia. E. A banana is high in potassium. Encourage the client to eat foods high in potassium to prevent hypokalemia. NOT B. A urine output of 50 mL/hr is within the expected reference range. A urine output less than 30 mL/hr is a manifestation of dehydration, and the provider should be notified.

A nurse is caring for a client who has a heart failure notices that the client did not receive his scheduled dose of furosemide. When filling out an incident report about the occurrence, which of the following information should the nurse include? (Select all that apply.) A) Client's breath sounds clear bilaterally. B) The nurse documents the incident in the client's medical record. C) The nurse documents the client's status as a result of the occurrence .D) The client is informed of the incident report's contents. E) The client's statement about the occurrence.

ANS: A, C, E RATIONALE: Clients breath sounds clear bilaterally is correct. If a medication error occurs, the nurse should monitor the client for adverse effects. Furosemide is a loop diuretic and is used in clients who have heart failure to help eliminate excess fluid. The client missed a dose of furosemide, so the nurse should monitor for signs of fluid volume excess such as crackles and peripheral edema. It is appropriate for the nurse to document this finding in the incident report. The nurse documents the client's status as a result of the occurrence is correct. Factual information should be included in the incident report with details about the impact on the client. This is a factual statement, but the statement itself is not pertinent to the client response to the missed dose or medication. The client's statement about the occurrence is correct. The client's statement should be included in the incident report.

A nurse is providing information to a client who has a new prescription for hydrochlorothiazide. Which of the following information should the nurse include? A. Take the medication with food. B. Plan to take the medication at bedtime. C. Expect increased swelling of the ankles. D. Fluid intake should be limited in the morning.

ANS: A. Take the medication with food RATIONALE: the client should take hydrochlorothiazide with or after meals to prevent gastrointestinal upset. The client should take hydrochlorothiazide in the morning or no later than 1400, and not at bedtime, to prevent nocturia. The client should expect decreased swelling of the ankles. The client should maintain an adequate fluid intake (1,500 mL) throughout the day unless contraindicated.

A nurse is planning care for a client who is has a new prescription for torsemide. The nurse should plan to monitor for which of the following conditions as potential adverse reactions of this medication? (Select all that apply.) A. Respiratory acidosis B. Hypokalemia C. Hypotension D. Ototoxicity E. Ventricular dysrhythmias

ANS: B, C, D, E RATIONALE: Plan to monitor for hypokalemia, ototoxicity, hypotension, and ventricular dysrhythmias (a manifestation of hypokalemia) which are adverse effects of a loop diuretic such as torsemide.

A nurse is monitoring a client who is receiving spironolactone. Which of the following findings should the nurse report to the provider? A. Blood sodium 144 mEq/L B. Urine output 120 mL in 4 hr C. Blood potassium 5.2 mEq/L D. Blood pressure 140/90 mm Hg

ANS: C RATIONALE: Blood potassium of 5.2 mEq/L indicates hyperkalemia. Because spironolactone causes potassium retention, withhold the medication and notify the provider. Blood sodium of 144 mEq/L, Urine output of 30 mL/hr or 120 mL in 4 hr, and blood pressure of 140/90 mm Hg are within the expected reference range.

A nurse is caring for a client who has increased intracranial pressure and is receiving mannitol. Which of the following findings should the nurse report to the provider? A. Blood glucose 150 mg/dL B. Urine output 40 mL/hr C. Dyspnea D. Bilateral equal pupil size

ANS: C RATIONALE: Dyspnea is a manifestation of heart failure, an adverse effect of mannitol. Stop the medication and notify the provider. Blood glucose and Urine output of 40 mL/hr are within the expected reference range. Bilateral equal pupil size is an expected finding and can indicate reduction in intracranial pressure.

A nurse is reinforcing teaching with a middle-age client about hypertension. Which of the following information should the nurse include in the teaching? A) Set your goal body weight within 25% of ideal body weight B) Limit alcohol consumption to 3 drinks a day when hypertensive C) Plan to have potassium blood levels checked when taking a thiazide diuretics D) Plan to lower sodium intake to 3,000 mg each day.

ANS: C C) Plan to have potassium blood levels checked when taking a thiazide diuretics. RATIONALE: The nurse should include in the teaching to have the client plan to have potassium blood levels checked periodically when taking a thiazide diuretic. Thiazide diuretics can deplete the client of potassium through excretion by the kidney.

2. 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? a. Encourage the client to exercise. b. Gradually increase the drug dosage. c. Ask the client to decrease fluid intake. d. Administer the drug at the start of the client's day

ANS: d. Administer the drug at the start of the client's day RATIONALE: By administering the drug at the start of the day, it can help prevent any sleep disturbance caused by increased urination at night. The nurse need not ask the client to decrease fluid intake, gradually increase the drug dosage, or encourage the client to exercise as these are not appropriate interventions and will not help in reducing the discomfort caused by increased urination.