Ch 51:
A client asks, "Why is my prescription being switched from furosemide to spironolactone?" What is the nurse's best response?
"You will lose less potassium with spironolactone than with furosemide." Explanation:By inhibiting the effects of aldosterone in the distal tubules, spironolactone promotes potassium retention. The client will not have greater potassium losses, water losses, or sodium losses with spironolactone rather than furosemide.
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. Explanation: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 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. Explanation:The nurse should administer the drug early in the day to prevent any nighttime sleep disturbance caused by increased urination when caring for a client receiving a diuretic therapy for acute renal failure. 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.
A client is receiving triamterene. The nurse instructs the client to avoid what foods? (Select all that apply.)
Bananas Prunes Broccoli Explanation:Foods high in potassium should be avoided. These would include bananas, prunes, and broccoli.
When describing the action of chlorothiazide, what would a nurse include?
Blocking of the chloride pump Explanation: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.
What sign is most indicative of dehydration in a patient taking diuretics?
Body weight Explanation:Obtain an accurate body weight, to provide a baseline to monitor fluid balance. The other options would not indicate dehydration.
The staff educator in the ICU is talking with a group of new nurses about osmotic diuretics. The educator would tell the new nurses that osmotic diuretics act upon which site in the nephron?
Descending limb of loop of Henle Explanation:These drugs are freely filtered at the renal glomerulus, poorly reabsorbed by the renal tubule, not secreted by the tubule, and resistant to metabolism. Therefore Options A, C, and D are incorrect.
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 Explanation:When digoxin and diuretics are given concomitantly, the risk of digoxin toxicity is increased due to diuretic-induced hypokalemia.
Which instruction would be most appropriate for a client who is taking a diuretic?
"It's okay to take it with food." Explanation: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.
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." Explanation:The use of diuretics to change the fluid shifts associated with pregnancy is not appropriate. Women maintained on these drugs for underlying medical reasons should not stop taking them, but they need to be aware of the potential for adverse effects on the fetus. Women who are nursing and need a diuretic should find another method of feeding the baby because of the potential for adverse effects on the baby as well as the lactating mother.
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 Explanation: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?
Chlorothiazide Explanation:Chlorothiazide is administered orally or intravenously. Hydrochlorothiazide, Bendroflumethiazide, and methyclothiazide are administered orally only.
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." Explanation:Renal disease and severe renal impairment contraindicate the use of hydrochlorothiazide. HCTZ affects the kidneys, not the bladder, and is not administered intravenously.
A client has been prescribed both digoxin and furosemide. The nurse should monitor the client for development of what adverse effect?
Digoxin toxicity Explanation: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
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. Explanation:Diuretics increase urine production and output by reducing the reabsorption of water and electrolytes in the kidneys.
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 Explanation:Furosemide is an example of a loop diuretic. Hydrochlorothiazide is a thiazide diuretic. Acetazolamide is a carbonic anhydrase inhibitor. Spironolactone is a potassium-sparing diuretic.
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 Explanation:Furosemide is less powerful than bumetanide and torsemide and therefore has a larger margin of safety for home use (see the Critical Thinking Scenario in this chapter for additional information about using furosemide in heart failure). Ethacrynic acid is used less frequently in the clinical setting because of the improved potency and reliability of the newer drugs.
Which drugs cause diuresis by inhibiting re-absorption of sodium and chloride ions in the distal and proximal tubules and in the loop of Henle? (Select all that apply.)
Furosemide (Lasix) Bumetanide (Bumex) Explanation:Loop diuretics, like furosemide (Lasix) and bumetanide (Bumex), cause diuresis by inhibiting re-absorption of sodium and chloride ions in the distal and proximal tubules and in the loop of Henle.
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 health care provider has prescribed furosemide. What order would be most consistent with this client's health needs?
Furosemide 40 mg PO BID Explanation:For hypertension, furosemide is commonly given as 40 mg PO twice daily and gradually increased if necessary. The other prescriptions include incorrect routes, frequencies, or doses.
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 Explanation: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.
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 Explanation:The major adverse effect of potassium-sparing diuretics such as spironolactone is hyperkalemia. Clients receiving these drugs should not be given potassium supplements and should not be encouraged to eat foods high in potassium.
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 Explanation: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.
A female client is diagnosed with hyponatremia. What type of diuretic would most likely cause this symptom?
Loop Explanation:Loop diuretics have a sodium-losing effect up to 10 times greater than that of thiazide diuretics.
A client is admitted to the emergency department with pulmonary edema. What diuretic
Loop diuretic Explanation: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.
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?
Loop diuretic Explanation: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.
When describing where bumetanide acts, what would the nurse include?
Loop of Henle Explanation: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.
A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered?
Mannitol Explanation:Mannitol is a powerful osmotic diuretic that is used to treat increased intracranial pressure. It is given intravenously and begins to work in 30 to 60 minutes. Furosemide, amiloride, and bumetanide are not indicated for the treatment of increased intracranial pressure.
Because of the action of methazolamide, the nurse would assess a patient closely for signs and symptoms of which acid-base imbalance?
Metabolic acidosis Explanation:Methazolamide is a carbonic anhydrase inhibitor that can cause metabolic acidosis due to the loss of bicarbonate.
A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed?
Osmotic diuretic Explanation:An osmotic diuretic is used to reduce intracranial pressure related to a head injury. Loop diuretics, potassium-sparing diuretics, and thiazide diuretics do not reduce intracranial pressure.
An ED nurse is caring for a patient who is receiving furosemide for treatment of pulmonary edema. What will the nurse monitor to observe for adverse effects of the drug?
Potassium levels Explanation:Furosemide, a loop diuretic, causes potassium loss, which can lead to hypokalemia. Serum potassium levels should be monitored in patients taking the drug to help avoid the condition and its effects.
The nurse is caring for a client who is receiving mannitol. The nurse knows that it is used to manage oliguria or anuria. The nurse knows that it is also used for what other conditions? (Select all that apply.)
Reduction of intracranial pressure Reduction of intraocular pressure Urinary excretion of toxic substances Explanation:Mannitol is an osmotic diuretic that is used to treat oliguria and anuria in an effort to prevent renal failure. It is also used to reduce intracranial pressure, reduce intraocular pressure, and assist in the urinary excretion of toxic substances. It is not used to reduce mild to moderate swelling or to reduce venous jugular pressure.
What would contraindicate the use of indapamide?
Renal disease Explanation:Indapamide would be contraindicated in a client with severe renal disease, which may prevent the diuretic from working or precipitate a crisis stage due to blood flow changes brought about by the diuretic. Indapamide would be used cautiously in clients with diabetes, systemic lupus erythematosus, or gout.
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 Explanation:For clients with cirrhosis, diuretic therapy should be initiated in a hospital setting, with small doses and careful monitoring. To prevent hypokalemia and metabolic alkalosis, supplemental potassium or spironolactone may be needed.
The health care provider indicates that a client experiencing renal failure is not a candidate for therapy with potassium-sparing diuretics. How will the nurse respond when the client's family member asks why this is the case?
They may cause hyperkalemia. Explanation:Potassium-sparing diuretics accumulate in renal insufficiency and present the risk for hyperkalemia. For this reason, health care practitioners typically avoid the drug in this population. Potassium-sparing diuretics decrease potassium excretion, and, by themselves, they are weak diuretics. Rebound edema may be a concern when a diuretic is discontinued, but it is not the reason this client is a poor candidate for a potassium-sparing diuretic.
A nurse is providing care to a client who is to receive acetazolamide for epilepsy. Before administering this drug, the nurse would assess which of the following?
Vital signs and weight Explanation:Before administering a diuretic, the nurse should take the vital signs and weigh the client. The preadministration physical assessment of the client receiving a diuretic for epilepsy includes vital signs and weight. Response of pupils to light needs to be assessed as part of the ongoing assessment when the client is receiving the osmotic diuretics mannitol or urea for the treatment of increased intracranial pressure caused by cerebral edema. The nurse need not monitor for intraocular pressure or intracranial bleeding in the client as part of the preadministration assessment for a client receiving a diuretic.
The nurse is caring for an older adult client who receives furosemide on a regular basis. The nurse should prioritize assessments related to what health problem?
dehydration Explanation:Excessive diuresis, particularly in older adults, may cause dehydration, blood volume reduction with circulatory collapse, and the risk of vascular thrombosis and embolism. Hypernatremia, urinary retention, and dysrhythmias are unlikely to result from the use of furosemide.
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. Explanation:One adverse effect of potassium-losing diuretics, such as the thiazides, is hyperglycemia. Clients with diabetes mellitus may require larger doses of hypoglycemic agents (e.g., insulin) while taking these diuretics to control blood sugar levels. Decreasing potassium intake is inappropriate for clients taking thiazides because it increases the risk of hypokalemia. Increasing sodium intake would lessen the effectiveness of the diuretic.
Diuretics can either block the reabsorption of components of the urine or block the reabsorption of water back into the body. What does the increase in urine flow from the body depend on with a patient on loop diuretics?
The amount of sodium and chloride reabsorption that it blocks Explanation:The increase in urine flow that a diuretic produces is related to the amount of sodium and chloride reabsorption that it blocks. The other answers are not correct.
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." Explanation: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.
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." Explanation:Diuretics, including hydrochlorothiazide, can cause orthostatic hypotension. Rising slowly to a standing position can reduce the risk of falls. Patients taking diuretics should restrict sodium intake to avoid the need for higher doses, which increase the likelihood of adverse effects. Taking diuretics with food can help avoid the GI irritation frequently associated with these drugs.
The health care provider 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 Explanation:Furosemide is the loop diuretic used most often in children. Oral therapy is preferred when feasible, and doses greater than 6 mg/kg of body weight per day are not recommended.
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 Explanation: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 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 Explanation: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.
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. Explanation:Patients receiving a diuretic, particularly a loop or thiazide diuretic such as indapamide, and a digitalis glycoside concurrently require frequent monitoring of the pulse rate and rhythm because of the possibility of cardiac arrhythmias. Any significant changes in the pulse rate and rhythm are immediately reported to the primary health care provider. The nurse should encourage oral fluids at frequent intervals at waking hours when caring for older patients to prevent a fluid volume deficit. In such cases the nurse should also encourage elderly patients to eat or drink between meals and in the evening. The nurse must closely observe patients receiving a potassium-sparing diuretic for signs of hyperkalemia, a serious and potentially fatal electrolyte imbalance.
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 Explanation: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 is preparing to administer a diuretic that antagonizes the action of aldosterone. Which drug would the nurse likely administer?
Spironolactone Explanation:Spironolactone is a potassium-sparing diuretic that exerts its diuretic effect by antagonizing the action of aldosterone. Furosemide is a loop diuretic when given with lithium increases the risk for lithium toxicity. Hydrochlorothiazide given with anesthetics increases the anesthetic effectiveness. Acetazolamide when given with primidone for seizures, decreases the primidone effectiveness.
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 Explanation:Furosemide, when given IV, peaks in 30 minutes; the nurse would see peak drug action at approximately 9:30 AM.
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 Explanation:Thiazides, such as hydrochlorothiazide, are potassium-losing diuretics, and their use can lead to hypokalemia. Symptoms of hypokalemia include muscle weakness, arrhythmia, hypotension, anorexia, and shallow respirations.
Hydrochlorothiazide works by what mechanism of action?
Increasing the excretion of sodium and chloride in the distal tubule Explanation:Hydrochlorothiazide acts in the distal tubule and possibly in the diluting segment of the ascending loop of Henle. It increases the excretion of sodium and chloride in the distal convoluted tubule by slightly inhibiting the ion pumps that work in sodium and chloride reabsorption. This action also inhibits water reabsorption.
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 Explanation: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 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 Explanation:A cross-sensitivity reaction may occur with the thiazide diuretics and sulfonamides. 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. When a client with epilepsy is being treated for seizures, a family member of the client should keep a record of all seizures witnessed and bring this to the primary health care provider at the time of the next visit. Contact the primary health care provider immediately if the number of seizures increases. Potassium-sparing diuretics can lead to hyperkalemia and is most likely to occur in clients with an inadequate fluid intake and urine output, those with diabetes or renal failure, older adults, and those who are severely ill, and teach the client to avoid the use of salt substitutes containing potassium. 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.
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 Explanation:The nurse should know that potassium-sparing diuretics are contraindicated in clients with hyperkalemia and are not recommended for children. Potassium-sparing diuretics should be used cautiously in clients with liver disease, diabetes, or gout, but presence of these conditions does not contraindicate the use of potassium diuretics.
A physician has prescribed triamterene to a client with renal disease. The client informs the nurse that they are taking potassium supplements to address some heart problems. The nurse would be alert for which of the following?
increased risk of hyperkalemia. Explanation: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.
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 Explanation: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 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 Explanation:Potassium-sparing diuretics are contraindicated in clients with renal impairment because of the high risk of 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 health care provider's prescription for oral spironolactone because the client's health problems would contribute to a high risk of which adverse reaction?
Hyperkalemia Explanation:The presence of renal insufficiency is also a contraindication to the use of spironolactone because use of spironolactone may cause hyperkalemia through the inhibition of aldosterone and the subsequent retention of potassium. A prescription for spironolactone does not put this client at a greatly increased risk of anemia, hypocalcemia, or acidosis since none of these conditions are associated with potassium.
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. Explanation:The client is most likely experiencing muscle cramps due to potassium loss. Therefore, the nurse should advise the client to include potassium supplements in the diet. Drinking plenty of fluids or using calcium supplements will not reduce the occurrence of cramps. It is important to caution the client to avoid foods high in sodium because they could counteract the effects of drug therapy.
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. Explanation: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.
Which diuretic will most likely be the initial drug of choice when a client demonstrates dyspnea related to pulmonary edema?
furosemide Explanation: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. Mannitol, an osmotic diuretic, is useful in managing oliguria or anuria, and it may prevent acute renal failure (ARF) during prolonged surgery, trauma, or infusion of cisplatin, an antineoplastic
Which medication exerts its effects by depressing the reabsorption of sodium in the kidney tubules, thereby increasing sodium and water excretion?
Triamterene Explanation:Triamterene is a potassium-sparing diuretic that exerts its effect by depressing the reabsorption of sodium in the kidney tubules, thereby increasing sodium and water excretion. Furosemide is a loop diuretic which inhibits reabsorption of sodium and chloride in the distal and proximal tubules of the kidney and in the loop of Henle. Hydrochlorothiazide inhibits the reabsorption of sodium and chloride ions in the ascending portion of the loop of Henle and the early distal tubule of the nephron. This action results in the excretion of sodium, chloride, and water. Acetazolamide is a carbonic anhydrase inhibitor and is a sulfonamide, without bacteriostatic action, that inhibits the enzyme carbonic anhydrase. Carbonic anhydrase inhibition results in the excretion of sodium, potassium, bicarbonate, and water.
A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route?
Oral Explanation:Hydrochlorothiazide is only available as an oral preparation. Only chlorothiazide can be given by intravenous infusion.
A nurse understands that loop diuretics are considered high ceiling diuretics because they:
cause a greater diuresis. Explanation:High ceiling diuretics are those that cause a greater degree of diuresis than other diuretics.
The nurse is administering furosemide IV to a client. How soon after administration does the nurse expect diuretic effects to peak?
30 minutes Explanation:After IV administration, diuretic effects of furosemide occur within 5 minutes, peak within 30 minutes, and last about 2 hours.
A nurse encourages a patient who is receiving a diuretic to maintain his fluid intake to prevent the risk for developing:
Fluid rebound Explanation: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. Electrolyte imbalances may or may not occur depending on the type of diuretic being used. Reference:
What type of diet should a patient taking diuretics have?
Eat potassium-rich or low-potassium diet as appropriate Explanation:Provide potassium-rich or low-potassium diet as appropriate to maintain electrolyte balance and replace lost potassium or prevent 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 Explanation:When an inadequate diuretic response occurs with one drug, people sometimes take two potassium-losing diuretics concurrently. The combination of a loop and a thiazide diuretic has synergistic effects because the drugs act in different segments of the renal tubule. Thus, the rationale for this particular combination is not rooted in prevention of potassium imbalances, increased adherence, or maintenance of a normal heart rate.
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 Explanation: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.
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 Explanation:Potassium-sparing diuretics are contraindicated in clients with renal impairment because of the high risk of hyperkalemia. If they are used at all, frequent monitoring of serum electrolytes, creatinine, and BUN is needed.
What is the term for the action of a diuretic in a patient with glaucoma?
Osmotic pull Explanation:Glaucoma is an eye disease characterized by increased pressure in the eye—known as intraocular pressure (IOP)—which can cause optic nerve atrophy and blindness. Diuretics are used to provide osmotic pull to remove some of the fluid from the eye, which decreases the IOP, or as adjunctive therapy to reduce fluid volume and pressure in the cardiovascular system, which also decreases pressure in the eye somewhat.
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. Explanation:Unlike hydrochlorothiazide, spironolactone 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.
What substance is reabsorbed in the ascending limb of the loop of Henle?
sodium Explanation:In the ascending limb of the loop of Henle, sodium is reabsorbed. Glucose and amino acids are reabsorbed by the proximal tubule, while water is reabsorbed by the descending limb of the loop of Henle.