51: Diuretic Agents
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."
Which instruction would be most appropriate for a client who is taking a diuretic?
"It's okay to take it with food."
A client is receiving hydrochlorothiazide. The nurse would expect this drug to begin acting within which time frame?
2 hours
The physician 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
Which diuretic exerts its effect by inhibiting the enzyme carbonic anhydrase?
Acetazolamide (Diamox)
Which diuretic has been administered to patients with epileptic seizures?
Acetazolamide (Diamox)
1. A nurse is preparing a teaching plan for a client with edema who is prescribed a diuretic. Which teaching should the nurse prioritize?
Administer early in the day.
10. A nursing instructor is teaching a class on the actions of the different classes of diuretics. Which drugs will the instructor point out as exerting action on the loop of Henle and distal and proximal tubules? Select all that apply.
Furosemide Bumetanide
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? *Sudden pain in the joints *Increased blood glucose levels *Occurrence of gout attacks *Sudden increase in weight
Increased blood glucose levels The nurse should monitor for increased blood glucose levels in the diabetic client receiving a loop diuretic. The blood glucometer test results for these clients may be elevated, or urine may test positive for glucose. Thiazide diuretic agents may cause gout attacks and sudden joint pain. The nurse need not monitor for a sudden increase in weight as the administration of loop diuretics to a diabetic client will not cause this effect. Reference:
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
14. A client has been receiving acetazolamide as prescribed. Which substance will the nurse prioritize for monitoring on routine laboratory work? Select all that apply.
Potassium Sodium Bicarbonate
23. A nurse is reviewing the laboratory test results of a client who is receiving diuretic therapy. The nurse determines that the client is at risk for electrolyte imbalance based on which results? Select all that apply.
Potassium 2.9 mEq/L Sodium 124 mEq/L
27. A client with cerebral edema is prescribed mannitol. Which assessment should the nurse prioritize during the ongoing assessment?
Response of pupils to light.
The nurse understands that the action of most diuretics typically results in what effect? (Select all that apply.) a. Loss of water b. Loss of calcium c. Loss of chloride d. Retention of sodium e. Retention of potassium
a. Loss of water c. Loss of chloride (Rationale: Most diuretics result in the loss of water, sodium, and chloride along with the sodium. Potassium may or may not be lost depending on the type of diuretic used. Calcium typically is not affected by diuretics.)
When describing the action of chlorothiazide, what would a nurse include? a. Blocking the action of carbonic anhydrase b. Blocking of the chloride pump c. Acting as an aldosterone antagonist d. Blocking of potassium secretion through the tubule
b. Blocking of the chloride pump (Rationale: Chlorothiazide, a thiazide diuretic, blocks the chloride pump. Carbonic anhydrase inhibitors such as acetazolamide block the action of carbonic anhydrase. Spironolactone, a potassium-sparing diuretic, acts as an aldosterone antagonist. Amiloride and triamterene, potassium-sparing diuretics, block potassium secretion through the tubule.)
A nurse understands that loop diuretics are considered high ceiling diuretics because they:
cause a greater diuresis.
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
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
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." "I should take the medicine around dinnertime for the best effect." "I need to take the drug on an empty stomach." "I can still use my salt substitute if I want to."
"I need to make sure I don't eat too many high potassium foods." The drug is a potassium sparing diuretic placing the patient at risk for hyperkalemia, especially if the patient consumes foods high in potassium. The patient should take the medication in the morning to prevent interfering with sleep by having to get up at night to void. The patient can take the drug with meals if GI upset occurs. Many salt substitutes contain potassium, which could increase the patient's risk for hyperkalemia.
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
A patient is admitted the hospital with congestive heart failure. The patient is ordered to receive furosemide (Lasix) 40 mg IV. How soon will diuretic effects occur after administration?
5 minutes
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 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? 8:15 AM 8:30 AM 8:45 AM 9:00 AM
8:30 Furosemide, when given intravenously, begins to act in 5 minutes, reaching peak effects in 30 minutes. In this case, this would be 8:30 AM.
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.
When describing the action of spironolactone, the nurse would explain that this drug acts by:
Blocking aldosterone in the distal tubule
The nurse is caring for a 53-year-old man with a 30-year history of alcohol dependency. He presents with ascites, secondary to cirrhosis. Which mechanism is involved in his fluid shift?
Decreased plasma oncotic pressure
A patient has been prescribed digoxin (Lanoxin) and furosemide (Lasix) for treatment of congestive heart failure. What is the patient at risk for developing with this combination of medications?
Digoxin toxicity
Which is an example of a loop diuretic?
Furosemide (Lasix)
26. A client who is receiving diuretic therapy comes to the clinic for a follow-up visit. The client states that their mouth is often dry and that they are "urinating like there is no tomorrow." Assessment reveals dry mucous membranes and decreased skin turgor. Which nursing diagnosis would the nurse most likely prioritize?
Risk for Deficient Fluid Volume
Adminsitering urea to a client with intraicular pressure
Syncope
A group of students are reviewing the various classes of diuretics. The students demonstrate understanding of the information when they identify what as a loop diuretic? a. Triamterene b. Furosemide c. Mannitol d. Indapamide
b. Furosemide (Rationale: Furosemide is a loop diuretic. Triamterene is a potassium-sparing diuretic. Mannitol is an osmotic diuretic. Indapamide is a thiazide-like diuretic.)
When providing medication teaching about to a client prescribed spironolactone, what foods should the client be instructed to avoid?
bananas
The nurse encourages a patient who is receiving a diuretic to maintain his fluid intake to prevent the risk of developing what problem? a. Weight loss b. Dehydration c. Fluid rebound d. Hyperkalemia
c. Fluid rebound (Rationale: When a patient who is taking a diuretic decreases fluid intake, fluid rebound occurs, which leads to water retention and subsequent edema and weight gain, not dehydration or weight loss. Electrolyte imbalances may or may not occur depending on the type of diuretic being used.)
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.
2. A client is admitted in acute renal failure and prescribed mannitol. The nurse prepares to administer this drug via which route?
intravenously
3. The health care provider has prescribed spironolactone for a client. The nurse is prepared to carefully monitor the client's potassium level if the client is also administered which drug?
lisinopril
9. The nurse is preparing to administer bumetanide to the client, The nurse should question this order after noting which drugs are currently being administered? Select all that apply.
lithium gentamicin digoxin warfarin
15. A group of nursing students are comparing the actions of the various diuretic classes. Which drugs should the students choose when examining the ones that work on the glomerulus? Select all that apply.
mannitol urea
12. The nursing instructor is teaching a group of nursing students comparing the different classes of diuretics. The instructor determines the session is successful when the students select?
methazolamide acetazolamide
What substance is reabsorbed in the ascending limb of the loop of Henle?
sodium
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 is receiving a diuretic and tells the nurse that he has decreased his fluid intake so that he does not have to make so many trips to the bathroom. The nurse realizes the client is at risk for:
Fluid rebound
17. A client with congestive heart failure and currently administered digoxin is now prescribed indapamide for edema. Which intervention should the nurse prioritize?
Frequently monitor the client'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
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
Why would potassium-sparing diuretics be contraindicated for clients experiencing renal failure?
They may cause hyperkalemia.
The nurse would contact the physician if a patient who has been prescribed hydrochlorothiazide (HydroDIURIL) has which condition? (Select all that apply.) a. Otitis media b. Systemic lupus erythematosus c. Gout d. Osteoarthritis e. Diabetes mellitus
b. Systemic lupus erythematosus c. Gout e. Diabetes mellitus (Rationale: Caution should be used with thiazide and thiazide-like diuretics if the patient has the following conditions: systemic lupus erythematosus, diabetes mellitus, gout, liver disease, hyperparathyroidism, or bipolar disorder. Otitis media and osteoarthritis do not have any contraindications for use with this drug.)
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 cognitive function respiratory function renal function hepatic functio
cardiac function renal function hepatic function In general, dose selection for the older adults requires caution reflecting the increased likelihood that older adults have decreased cardiac, renal, or hepatic function. This medication therapy has a lower risk for effecting respirations or cognition.
20. A nurse is preparing to administer a diuretic to a client. The nurse should question administering which drug after noting an allergy to sulfamethoxazole/trimethoprim? Select all that apply.
chlorothiazide furosemide metolazone chlorthalidone
The nurse is aware that diuretics are used to relieve what symptom associated with many disorders? a. Pain b. Fatigue c. Dizziness d. Edema
d. Edema (Rationale: Diuretics are indicated for the treatment of edema associated with heart failure, liver disease, and renal disease. Diuretics do not relieve pain. Diuretics may cause dizziness when administered; it is not a treatment of dizziness that may accompany other disorders. Diuretics may increase fatigue because of the need to void more often, disrupting sleep.)
Spironolactone is the drug of choice for treating which condition? a. Renal failure b. Heart failure c. Hyperkalemia d. Hyperaldosteronism
d. Hyperaldosteronism (Rationale: Spironolactone is a potassium-sparing diuretic and is the drug of choice for treating hyperaldosteronism, which is seen in cirrhosis of the liver and nephrotic syndrome. It can cause hyperkalemia so it is not used in the presence of hyperkalemia, and it is not recommended for either renal failure or heart failure.)
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 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? *"That would probably help, but we'd have to do blood work first." *"Actually, patients with renal failure usually can't take hydrochlorothiazide." *"That would only work if he could come in twice a day to get it intravenously." *"Maybe, but hydrochlorothiazide affects the bladder more than the kidneys."
"Actually, patients with renal failure usually can't take hydrochlorothiazide." Renal disease and severe renal impairment contraindicate the use of hydrochlorothiazide. HCTZ affects the kidneys, not the bladder, and is not administered intravenously.
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."
Which instruction would be most appropriate for a client who is taking a diuretic? "Take the daily dose around dinnertime." "It's okay to take it with food." "Lie down after taking the drug." "Limit the amount of fluids you drink."
"It's okay to take it with food." Instructions for a client taking a diuretic include taking the drug with food or meals if gastrointestinal upset occurs, taking the dose early in the morning to prevent interfering with sleep, implementing safety precautions if dizziness or weakness is a problem, and ensuring adequate fluid intake to prevent fluid rebound. It is not necessary to lie down after taking the drug.
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 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 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 patient has edema of the lower extremities and abdomen. What is the reason to administer a stronger diuretic than a thiazide diuretic to this patient?
A thiazide diuretic will be ineffective for immediate 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 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 reabsorb potassium in the distal tubule. *A thiazide diuretic will be ineffective when immediate diuresis is needed. *A thiazide diuretic will provide peak effects in 2 hours. *A thiazide diuretic will be excreted in more than 72 hours.
A thiazide diuretic will be ineffective when immediate diuresis is needed. Thiazide diuretics are ineffective when immediate diuresis is required. A thiazide diuretic acts to reabsorb sodium, not potassium, in the distal convoluted tubule. A thiazide diuretic reaches its peak in 4 to 6 hours. A thiazide diuretic is excreted in 72 hours maximum.
A nurse is caring for a patient with acute renal failure. The physician has prescribed a diuretic therapy for the patient to promote dieresis. What intervention should the nurse perform to prevent the inconvenience caused by increased urination?
Administer the drug early in the day.
16. The nurse has finished a teaching session with a client who is prescribed a diuretic to be taken twice a day. The nurse determines the session is successful when the client correctly chooses which times to take the drug?
At breakfast and midafternoon
4. The nurse is preparing to teach a client with renal insufficiency about the recently prescribed bumetanide for hypertension. Which instruction should the nurse prioritize for this client?
Avoid over-the-counter drugs for cold symptoms.
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 chlorothiazide, what would a nurse include?
Blocking of the chloride pump
A patient is prescribed a thiazide diuretic that is to be administered intravenously. Which agent would this most likely be?
Chlorothiazide
21. A client with a history of seizures is admitted to the unit with pulmonary edema. After administering furosemide, which assessment should the nurse prioritize after discovering the client is also prescribed phenytoin?
Decreased diuretic effectiveness
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 75-year-old client is diagnosed with atrial fibrillation and chronic congestive heart failure. The physician 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
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.
6. A client has been receiving a diuretic as prescribed. Which findings on the ongoing assessment should the nurse priotize?
Dry mouth muscle cramps tachycardia
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.
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 Bell peppers Mushrooms Fresh pineapple
Fresh pineapple The nurse will advise the patient to avoid foods high in potassium, which include apricots, avocados, bananas, cantaloupe, fish, honeydew, kiwi, meat, milk, oranges, potatoes, poultry, prunes, spinach, sweet potatoes, tomatoes, winter squash, and yams. Triamterene achieves its diuretic effect by inhibiting transport of sodium in the distal tubules independent of aldosterone. This mechanism causes increased loss of sodium, water, bicarbonate, and calcium and promotes retention of potassium and magnesium. Hyperkalemia can be a serious adverse effect of the drug. Reference:
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
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 Hydrochlorothiazide Mannitol Triamterene
Furosemide Furosemide can be given intravenously to provide rapid relief from pulmonary edema. Mannitol is not normally used to treat pulmonary edema and neither HCTZ nor triamterene is used in the acute treatment of pulmonary edema.
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 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? Ammonia absorption Subtherapeutic drug levels Hepatic encephalopathy Hepatomegaly
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 nurse understands that loop diuretics are considered high ceiling diuretics because they: cause a greater diuresis. are associated with more adverse effects. cause a greater loss of potassium. require large doses to achieve effect.
High ceiling diuretics are those that cause a greater degree of diuresis than other diuretics.
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 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
After reviewing information about thiazide diuretics, a group of students demonstrate the need for additional teaching when they identify what as a possible adverse effect?
Hypocalcemia
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
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? Hypercalcemia Hypocalcemia Hyperkalemia Hypokalemia
Hypokalemia Thiazides, such as hydrochlorothiazide, are potassium-losing diuretics, and their use can lead to hypokalemia. Symptoms of hypokalemia include muscle weakness, dysrhythmia, hypotension, anorexia, and and shallow respirations.
A patient is receiving bumetanide. The nurse would instruct the patient to be alert for what issues? (Select all that apply.)
Hypotension Dizziness Weakness Muscle cramps
patient is receiving bumetanide. The nurse would instruct the patient to be alert for what issues? (Select all that apply.) Hypotension Dizziness Weakness Muscle cramps Irreversible hearing loss
Hypotension Dizziness Weakness Muscle cramps Bumetanide may cause hypotension and dizziness due to the rapid fluid loss, reversible hearing loss, and signs and symptoms of hypokalemia, such as weakness and muscle cramps.
22. A primary health care provider has prescribed a loop diuretic for hypertension in a client with diabetes mellitus, Which assessment should the nurse prioritize?
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
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
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 Thiazide Potassium-sparing diuretic Osmotic diuretic
Loop diuretics Loop diuretics are the diuretics of choice when rapid effects are required.
When describing where bumetanide acts, what would the nurse include?
Loop of Henle
When describing where bumetanide acts, what would the nurse include? *Proximal convoluted tubule *Loop of Henle *Collecting tubule *Glomerulus
Loop of Henle Bumetanide is a loop diuretic that blocks the chloride pump in the ascending loop of Henle. It also has a similar effect in the descending loop and in the distal convoluted tubule.
The nurse understands that the action of most diuretics typically results in which effects? (Select all that apply.)
Loss of water Loss of chloride
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
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
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? Spironolactone Bumetanide Mannitol Ethacrynic acid
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.
Because of the action of methazolamide, the nurse would assess a patient closely for signs and symptoms of which acid-base imbalance?
Metabolic acidosis
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
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 Metabolic acidosis Compensated respiratory alkalosis Compensated respiratory acidosis
Metabolic alkalosis Most of furosemide's adverse effects relate to fluid or electrolyte imbalance. Electrolyte imbalances, which are most likely to occur within the first 2 weeks of therapy, include hyponatremia, hypokalemia, hypochloridemia, and hypocalcemia. Loss of hydrogen ions can also lead to metabolic alkalosis.
After reviewing the different classes of diuretics available, a student demonstrates understanding when the student identifies what as an example of a thiazide-like diuretic?
Metolazone
Diuretics are often taken in the home setting. The home care nurse may need to assist clients and caregivers by doing what tasks? (Select all that apply.)
Monitoring client responses Assessing use of over-the-counter medications that may aggravate the client's condition
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
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
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 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 spironolactone than with hydrochlorothiazide. *Potassium losses are greater with hydrochlorothiazide than with spironolactone. *Spironolactone is more likely to be taken with a potassium supplement. *The two diuretics act in different parts of the nephron
Potassium losses are greater with hydrochlorothiazide than with spironolactone. Unlike hydrochlorothiazide, sprionolactone is a potassium-sparing diuretic. To avoid the risk of hyperkalemia, patients receiving potassium-sparing diuretics should not be given supplemental potassium. Both diuretics act in the distal tubule of the nephron.
The client is receiving triamterene. The nurse instructs the client to avoid what foods? (Select all that apply.) Bananas Prunes Lettuce Broccoli Apples
Prunes Broccoli Bananas Foods high in potassium should be avoided. These would include bananas, prunes, and broccoli.
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
The physician has ordered the patient hydrochlorothiazide. What assessment should the nurse make before administering the first dose of hydrochlorothiazide?
Sulfonamide allergy
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 client will describe the rationale for increasing fluid intake. * The client will be able to demonstrate correct technique for blood glucose monitoring. *The client will accurately describe the basic structure and functions of the kidneys.
The client will identify strategies for limiting sodium intake. 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.
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.
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 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 should obtain an allergy history from patients as which class of diuretics may result in a cross-sensitivity reaction with sulfonamides?
Thiazide diuretics
Which exerts its effects by depressing the reabsorption of sodium in the kidney tubules, thereby increasing sodium and water excretion?
Triamterene (Dyrenium)
True or False: The risk for ototoxicity increases if loop diuretics are combined with aminoglycosides.
True (Rationale: Ototoxicity can result if loop diuretics are combined with aminoglycosides. The risk of ototoxicity increases if loop diuretics are combined with aminoglycosides or cisplatin. An example of an aminoglycoside would be gentamicin sulfate.)
A nurse is caring for a patient with epilepsy. The physician has prescribed acetazolamide to the patient. What should the nurse assess in the patient before administering the drug?
Vital signs and weight
8. A nurse administers chlorothiazide to a client with renal compromise. Which action should the nurse prioritize after noting the BUN level is rising?
Withhold the next dose of the drug.
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." "You will have greater potassium losses with spironolactone than with furosemide." "You will have greater water losses with spironolactone than with furosemide." "You will have greater sodium losses with spironolactone than with furosemide."
You will lose less potassium with spironolactone than with furosemide Spironolactone promotes retention of sodium and water and excretion of potassium by stimulating the sodium-potassium exchange mechanism in the distal tubule. The patient will not have greater potassium losses, water losses, or sodium losses with spironolactone rather than furosemide.
A patient is receiving acetazolamide in a sustained-release form. The nurse would anticipate the onset of drug action in approximately which time frame? a. 2 hours b. 3 hours c. 4 hours d. 1 hour
a. 2 hours (Rationale: Acetazolamide in sustained release form has an onset of action of 2 hours.)
A patient is prescribed a thiazide diuretic that is to be administered intravenously. Which agent would this most likely be? a. Chlorothiazide b. Methylchlorothiazide c. Bendroflumethiazide d. Hydrochlorothiazide
a. Chlorothiazide (Rationale: Chlorothiazide is administered orally or intravenously. The other agents are only administered orally.)
A patient is receiving bumetanide. The nurse would instruct the patient to be alert for what adverse effects? (Select all that apply.) a. Dizziness b. Muscle cramps c. Hypotension d. Weakness e. Irreversible hearing loss
a. Dizziness b. Muscle cramps c. Hypotension d. Weakness (Rationale: Bumetanide may cause hypotension and dizziness due to the rapid fluid loss, reversible hearing loss, and signs and symptoms of hypokalemia, such as weakness and muscle cramps.)
Before ordering a loop diuretic, the nurse practitioner would check the patient's history for the current use of which drug? (Select all that apply.) a. Ibuprofen b. Indomethacin c. Doxycycline d. Omeprazole e. Coumadin
a. Ibuprofen b. Indomethacin e. Coumadin (Rationale: Loop diuretics if given with an anticoagulant may increase the effects of the anticoagulant. There is a decreased loss of sodium and decreased antihypertensive effects if loop diuretics are given with indomethacin, ibuprofen, salicylates, and NSAIDs. There is no drug-drug interaction with omeprazole or doxycycline.)
A patient has just received a dose of mannitol for treatment of increased intracranial pressure. The nurse would be alert for which adverse effects? (Select all that apply.) a. Nausea b. Tinnitus c. Confusion d. Dizziness e. Hypertension
a. Nausea c. Confusion d. Dizziness (Rationale: Adverse effects related to the use of an osmotic diuretic include nausea, vomiting, hypotension, lightheadedness, confusion, and headache, which can be accompanied by cardiac decompensation and even shock. Tinnitus [ringing in the ears] is not associated with osmotic diuretics.)
Which medications are considered potassium-sparing diuretics? (Select all that apply.) a. Spironolactone b. Methazolamide c. Metolazone d. Triamterene e. Amiloride
a. Spironolactone d. Triamterene e. Amiloride (Rationale: Amiloride, spironolactone, and triamterene are all examples of potassium-sparing diuretics. Methazolamide is a carbonic anhydrase inhibitor and metolazone is a thiazide-like diuretic.)
A nurse understands that loop diuretics are considered "high-ceiling" diuretics because of what effect? a. They cause a greater diuresis. b. They require large doses to achieve effect. c. They cause a greater loss of potassium. d. They are associated with more adverse effects.
a. They cause a greater diuresis. (Rationale: High-ceiling diuretics are those that cause a greater degree of diuresis than other diuretics. The term high ceiling only refers to the amount of diuresis produced. Loop diuretics may have more adverse effects in comparison to potassium-sparing diuretics but this has no connection to the term high ceiling. Loop diuretics achieve their effect with a relatively small dose. Loop diuretics do cause a loss of potassium but so do thiazide and thiazide-like diuretics.)
30. The nurse has administered torsemide to a client. Which findings on the ongoing assessment should the nurse prioritize? Select all that apply.
anorexia drowsiness depression
31. The nurse is preparing to administer a diuretic to a client. The nurse should question this order if which disorder is noted in the client's history? Select all that apply.
anuria hyponatremia hypokalemia
28. The nurse is teaching a client about the prescribed metolazone and providing suggestions for foods to eat which will help increase potassium consumption, The nurse determines the teaching is successful after the client correctly chooses which foods? Select all that apply.
asparagus bananas salmon peanuts
A patient asks the nurse why a diuretic has been prescribed for the treatment of his high blood pressure. What is the nurse's best response? a. "Diuretics slow the heart, which then decreases blood pressure." b. "Diuretics block the angiotensin-converting enzyme, which results in lowered blood pressure." c. "Diuretics decrease water and sodium in the blood vessels, which decreases blood pressure." d. "Diuretics relax the blood vessel wall, which reduces blood pressure."
c. "Diuretics decrease water and sodium in the blood vessels, which decreases blood pressure." (Rationale: Diuretics are used to decrease volume and sodium, which then decreases pressure in the system. Diuretics do not have an effect on the blood vessel wall; they decrease water and sodium in the blood vessel, which decreases pressure. Cardiotonics strengthen the heart muscle which slows the rate, not diuretics. ACE inhibitors block the angiotensin-converting enzyme.)
After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states what? a. "I need to take the drug on an empty stomach." b. "I can still use my salt substitute if I want to." c. "I need to make sure I don't eat too many high-potassium foods." d. "I should take the medicine around dinnertime for the best effect."
c. "I need to make sure I don't eat too many high-potassium foods." (Rationale: The drug is a potassium-sparing diuretic placing the patient at risk for hyperkalemia, especially if the patient consumes foods high in potassium. The patient should take the medication in the morning to prevent interfering with sleep due to getting up at night to void. The patient can take the drug with meals if GI upset occurs. Many salt substitutes contain potassium, which could increase the patient's risk for hyperkalemia.)
A patient receives furosemide intravenously at 9 a.m. The nurse would expect to assess peak effects of the drug at which time? a. 9:15 a.m. b. 10:00 a.m. c. 9:30 a.m. d. 10:30 a.m.
c. 9:30 a.m. (Rationale: Furosemide, when given IV, peaks in 30 minutes; the nurse would see peak drug action at approximately 9:30 a.m.)
Which diuretics are most often used in the treatment of glaucoma and increased intraocular pressure? (Select all that apply.) a. Hydrochlorothiazide b. Spironolactone c. Acetazolamide d. Ethacrynic acid e. Mannitol
c. Acetazolamide e. Mannitol (Rationale: Acetazolamide is a carbonic anhydrase inhibitor and mannitol is an osmotic diuretic. These two classifications of diuretics are the ones most frequently used in the treatment of glaucoma and increased intraocular pressure. Thiazide and thiazide-like [hydrochlorothiazide], loop [ethacrynic acid], and potassium-sparing [spironolactone] diuretics are not indicated for the treatment of glaucoma or increased intraocular pressure.)
What would be a contraindication to the use of carbonic anhydrase inhibitors? a. Respiratory acidosis b. Chronic obstructive pulmonary disease c. Allergy to sulfonamides d. Adrenocortical insufficiency
c. Allergy to sulfonamides (Rationale: Carbonic anhydrase inhibitors are sulfonamides, and as such are contraindicated in patients with an allergy to sulfonamides. Carbonic anhydrase inhibitors are used cautiously in patients with adrenocortical insufficiency, respiratory acidosis, and COPD because these conditions could be exacerbated by the use of the drug.)
The diuretic nesiritide (Natrecor) is given to individuals who have what issue related to heart failure? a. Edema of the feet and hands b. Jugular distention c. Dyspnea at rest d. Nausea
c. Dyspnea at rest (Rationale: Nesiritide is intended for the treatment of patients with acutely decompensated heart failure who experiences dyspnea at rest, not edema, jugular distention, or nausea.)
Diuretics are frequently prescribed for patients with what conditions? (Select all that apply.) a. Sprained ankle b. Hypokalemia c. Hypertension d. Liver failure e. Heart failure
c. Hypertension d. Liver failure e. Heart failure (Rationale: Diuretics are indicated for the treatment of edema associated with heart failure, acute pulmonary edema, liver disease, renal disease, and the treatment of hypertension. They are also used to decrease potassium levels in the treatment of conditions that cause hyperkalemia; therefore, they are not indicated for hypokalemia. They are also not indicated for the treatment of edema related to a sprain or fracture.)
After reviewing information about thiazide diuretics, a group of students demonstrate the need for additional teaching when they identify what as a possible adverse effect? a. Hyperuricemia b. Hypokalemia c. Hypocalcemia d. Hyperglycemia
c. Hypocalcemia (Rationale: Thiazide diuretics can cause hypokalemia, hyperuricemia [increased uric acid levels], hypercalcemia, and hyperglycemia [with long-term use].)
What would the nurse expect to be ordered for a patient experiencing an acute increase in intraocular pressure? a. Amiloride b. Furosemide c. Mannitol d. Metolazone
c. Mannitol (Rationale: An acute increase in intraocular pressure is an emergency situation requiring the use of a potent osmotic diuretic. Currently, only one osmotic diuretic is available, mannitol. Furosemide is a loop diuretic; metolazone is a thiazide-like diuretic; amiloride is a potassium-sparing diuretic; none are used for emergency increased intraocular pressure problems.)
Due to the action of methazolamide, the nurse would assess a patient closely for signs and symptoms of which acid-base imbalance? a. Metabolic alkalosis b. Respiratory acidosis c. Respiratory alkalosis d. Metabolic acidosis
d. Metabolic acidosis (Rationale: Methazolamide is a carbonic anhydrase inhibitor that can cause metabolic acidosis, not alkalosis, due to the loss of bicarbonate. It is not associated with either respiratory acidosis or alkalosis.)
25. The nurse has administered acetazolamide to a client. The nurse should question the client's serum sodium level after noting which findings on the ongoing assessment? Select all that apply.
decreased skin turgor hypotension
if the client is diagnosed with which disorder? Select all that apply. 5. The nurse is preparing to administer amiloride to a client. The nurse will exercise caution
diabetes gout hepatic disease
29. A nurse is administering amiloride to several clients. The nurse should prioritize monitoring the serum potassium levels for clients with which noted disorder? Select all that apply.
diabetes renal disease
A client, prescribed digoxin and furosemide, is at risk for developing which adverse effect? * hyperkalemia *hyperglycemia *tachycardia *digoxin toxicity
digoxin toxicity When digoxin and diuretics are used concomitantly, the risk of digoxin toxicity is increased. The client is at risk for hypokalemia, not hyperkalemia. The client is not at risk for hyperglycemia or tachycardia
Which diuretic will most likely be the initial drug of choice when a client demonstrates dyspnea related to pulmonary edema?
furosemide
Which diuretic will most likely be the initial drug of choice when a client demonstrates dyspnea related to pulmonary edema? furosemide hydrochlorothiazide spironolactone mannitol
furosemide Loop diuretics, like furosemide, are the diuretics of choice when rapid effects are required since they produce extensive diuresis for short periods, after which the kidney tubules regain their ability to reabsorb sodium. Thiazide diuretics, like hydrochlorothiazide, are the drugs of choice for most clients who require diuretic therapy, especially for long-term management of heart failure and hypertension. In clients with heart failure and inadequate renal function, the addition of spironolactone, a potassium-sparing diuretic, allows smaller doses of loop diuretics and potassium supplements to be administered as spironolactone reduces urinary potassium loss. Osmotic diuretics, like mannitol, are useful in managing oliguria or anuria, and it may prevent acute renal failure (ARF) during prolonged surgery, trauma, or infusion of cisplatin, an an
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 125 mg PO OD furosemide 40 mg IV TID furosemide 20 mg IV OD furosemide 40 mg PO BID
furosemide 40 mg PO BID For hypertension, furosemide is commonly given as 40 mg PO twice daily and gradually increased if necessary.
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 Erectile dysfunction Priapism Alopecia
gynecomastia The nurse should advise male clients taking spironolactone that gynecomastia may occur. Erectile dysfunction, priapism, and alopecia are not associated with the drug.
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
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? peritonitis liver cancer cirrhosis hepatic encephalopathy
hepatic encephalopathy Spironolactone is used in the treatment of ascites. However, it should be used cautiously and carefully monitored in clients with significant hepatic impairment because a rapid change in fluid and electrolyte balance may lead to hepatic coma. It is important to monitor susceptible clients carefully for signs and symptoms of hepatic encephalopathy. There is no risk for liver cancer, cirrhosis, or peritonitis that results directly from the use of spironolactone.
18. A client with diabetes, controlled by metformin, was recently prescribed a diuretic. The nurse should question the administartion of which drug after noting the elevation of blood?
hydrochlorothiazide chlorthalidone metolazone
19. A nurse is preparing to administer spironolactone to a client. The nurse would question this order if which disorder is noted in the client's history?
hyperkalemia
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 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 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 liver disease gout diabetes
hyperkalemia The drug is a potassium sparing diuretic placing the patient at risk for hyperkalemia, especially if the patient consumes foods high in potassium. The patient should take the medication in the morning to prevent interfering with sleep by having to get up at night to void. The patient can take the drug with meals if GI upset occurs. Many salt substitutes contain potassium, which could increase the patient's risk for hyperkalemia.
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 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. *increased risk of bleeding. *decreased diuretic effectiveness. *increased risk of arrhythmias.
increased risk of hyperkalemia. The nurse should inform the client about the increased risk of hyperkalemia as the effect of the interaction between triamterene, which is a potassium-sparing diuretic, and potassium supplements. When the client is administered loop diuretics with anticoagulants or thrombolytics, there will be increased risk of bleeding. When the client is administered digitalis with loop diuretics, there is an increased risk of arrhythmias. Decreased diuretic effect, in this case decreased effect of triamterene, will occur when a potassium-sparing diuretic such as triamterene is administered with NSAIDs, salicylates, and anticoagulants.
A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed?
osmotic diuretic
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.
11. A nurse notes on assessment of a client receiving furosemide a decrease in urinary output. Which drugs should the nurse suspect is affecting the diuretic? Select all that apply.
phenytoin naproxen ibuprofen
About 80% of water, sodium, potassium, and other substances are reabsorbed during renal processing; the remaining 20% enters the loop of Henle. What substance is reabsorbed in the ascending limb of the loop of Henle?
sodium
13. A health care provider prescribes diuretic therapy to a client with nephrotic syndrome. The nurse suspects that the client is hyponatremic based on which assessment finding?
tachycardia
7. The nurse is preparing to administer furosemide to a client. Which factors should the nurse prioritize on the preadministration assessment? Select all that apply.
temperature weight respiratory rate pulse
