Chapter 28: Drugs Used for Diuresis

The nurse has provided patient teaching about potassium sparing diuretic therapy. Which statement by the patient indicates a need for further teaching? a. "I will take my medication in the morning." b. "I will report a weight gain of 2 lb in 2 days." c. "I will rise slowly when I get up from a sitting position." d. "I will use a salt substitute because I limit my salt intake."

d. "I will use a salt substitute because I limit my salt intake." Salt substitutes are potentially dangerous because they are high in potassium.

Which nursing intervention(s) would be performed for a patient who is on diuretic therapy? (Select all that apply.) a. Auscultation of lung sounds b. Assessment of skin turgor c. Initiation of electrolyte supplements d. Positioning techniques e. Monitoring of intake and output

a. Auscultation of lung sounds b. Assessment of skin turgor d. Positioning techniques e. Monitoring of intake and output Lungs should be auscultated to detect the presence of fluid as a result of heart failure. Skin turgor is directly related to the degree of hydration. Skin that is well hydrated is elastic and rapidly returns to a flat position after being pinched. In dehydrated patients, the skin remains in a peaked or pinched position and returns very slowly to the flat, normal position. Positioning techniques are essential to avoid skin breakdown resulting from edema or dehydration. Assessment of intake and output will assist in determining the effectiveness of diuretic therapy. The healthcare provider, not the nurse, will determine the need for electrolyte supplementation. When ordered, the nurse will administer the appropriate replacements. Maintaining the ordered diet therapy is within the role of the nurse.

The nurse transcribes a new order for ethacrynic acid (Edecrin) on a patient with edema resulting from cirrhosis of the liver. Which currently prescribed medication(s) should the nurse report to the ordering healthcare provider? (Select all that apply.) a. Digoxin b. Prednisone c. Tobramycin d. Lipitor e. Zofran

a. Digoxin b. Prednisone c. Tobramycin Drug interactions with ethacrynic acid (Edecrin) include digoxin, corticosteroids (such as prednisone), and aminoglycosides (such as tobramycin). Lipitor (a statin drug) and Zofran (an antiemetic) are not of concern when administered with ethacrynic acid.

Which are common signs and symptoms of dehydration? (Select all that apply.) a. Furrowed tongue b. Decreased intake and output levels c. Bounding pulse rate d. Mental confusion e. Elastic skin turgor

a. Furrowed tongue b. Decreased intake and output levels d. Mental confusion Furrowed tongue is a sign of dehydration. Signs of dehydration and hyponatremia include decreased intake and output or output greater than intake. Signs of dehydration may also include possible mental confusion, weak pulse/weak pedal pulses, inelastic skin turgor, and delayed capillary refill.

Individuals with which disorder(s) are particularly susceptible to the development of electrolyte disturbances during diuretic therapy? (Select all that apply.) a. History of cardiac disease b. History of renal disease c. History of hormonal disorders d. History of psychiatric illness e. Massive trauma f. Serious burns g. Overhydration

a. History of cardiac disease b. History of renal disease c. History of hormonal disorders e. Massive trauma f. Serious burns Patients with cardiac disease, renal disease, hormonal disorders, massive trauma, and serious burns are at risk for developing electrolyte imbalance during diuresis therapy. Psychiatric disorders do not have an effect on diuretic treatment. Although overhydration may cause an electrolyte disturbance, it is not related to diuretic treatment.

Which medical condition(s) may contribute to fluid volume excess? (Select all that apply.) a. Hypertension b. Liver disease c. Pregnancy d. Use of corticosteroids e. Skin disorders

a. Hypertension b. Liver disease c. Pregnancy d. Use of corticosteroids Hypertension, underlying medical diseases of the liver, pregnancy, and use of corticosteroids may contribute to fluid volume excess. Skin disorders do not contribute to fluid volume excess.

The nurse would expect to assess which serum potassium level in a patient who has severe vomiting and diarrhea? a. Less than 3.5 mEq/L b. Between 3.5 and 4.5 mEq/L c. Between 4.6 and 5 mEq/L d. Higher than 5.5 mEq/L

a. Less than 3.5 mEq/L Serum potassium (K+) levels would be less than 3.5 mEq/L. Hypokalemia is especially likely to occur when a patient exhibits vomiting, diarrhea, or heavy diuresis. Between 3.5 and 4.5 mEq/L is the low end of normal range for serum potassium. Between 4.6 and 5 mEq/L is the high end of normal range for serum potassium. Serum K+ levels higher than 5.5 mEq/L indicate hyperkalemia, which occurs most commonly when a patient is given excessive amounts of potassium supplementation.

A patient who has heart failure and difficulty breathing is being admitted. Which physical assessment(s) indicate(s) fluid volume excess? (Select all that apply.) a. Rapid, bounding, irregular pulse rate b. Clear lung sounds c. 3+ pitting ankle edema d. Neck vein engorgement e. Shortness of breath

a. Rapid, bounding, irregular pulse rate c. 3+ pitting ankle edema d. Neck vein engorgement e. Shortness of breath The patient with overhydration caused by heart failure often presents with a rapid and irregular pulse rate, peripheral and abdominal edema, distended neck veins, dyspnea and adventitious breath sounds of crackles and/or rhonchi in lung fields.

Which premedication assessment(s) would the nurse obtain prior to the initiation of bumetanide (Bumex)? (Select all that apply.) a. Serum potassium b. Bowel sounds c. Lung sounds d. Orientation level e. Blood pressure

a. Serum potassium c. Lung sounds d. Orientation level e. Blood pressure Serum potassium levels may be altered because of bumetanide therapy and therefore need to be assessed. Lung sounds, orientation level, and vital signs need to be assessed prior to initiation of therapy. Bowel sounds are not generally assessed prior to bumetanide therapy.

The nurse is reviewing lab work received on a patient admitted with the diagnosis of dehydration. The nurse will notify the physician of which lab value? a. Serum sodium level: 115 mEq/L b. Serum potassium level: 5.0 mEq/L c. Serum sodium level: 140 mEq/L d. Serum potassium level: 3.5 mEq/L

a. Serum sodium level: 115 mEq/L A serum sodium level lower than 135 mEq/L is considered hyponatremia. A serum potassium level of 3.5 or 5.0 mEq/L and a serum sodium level of 140 mEq/L are considered within normal limits.

Which medication, if administered with spironolactone (Aldactone), will alert the nurse to assess the patient for signs and symptoms of hyperkalemia? a. Propranolol (Inderal) b. Captopril (Capoten) c. Furosemide (Lasix) d. Ibuprofen (Motrin)

b. Captopril (Capoten) ACE inhibitors, such as captopril, inhibit aldosterone and thus may contribute to the development of hyperkalemia. Beta blockers, such as propranolol, do not affect potassium levels. Loop diuretics, such as furosemide, cause hypokalemia. NSAIDs, such as ibuprofen, do not affect potassium levels.

Which sign(s) and/or symptom(s) of dehydration may occur as a result of a diuretic? (Select all that apply.) a. Decreased urine specific gravity b. Skin remains peaked on turgor assessment c. Bounding peripheral pulses d. Neck vein engorgement e. Soft, sunken eyeballs

b. Skin remains peaked on turgor assessment e. Soft, sunken eyeballs A sign of dehydration is skin that is nonelastic or does not return to normal position when pulled taut on assessment. A sign of dehydration is eyeballs that appear soft or sunken. Dehydrated patients have a urine specific gravity and weak pulses. Overhydrated patients have engorged neck veins.

Which medication is a potassium sparing diuretic? a. Acetazolamide (Diamox) b. Spironolactone (Aldactone) c. Furosemide (Lasix) d. Bumetanide (Bumex)

b. Spironolactone (Aldactone) Spironolactone is a potassium sparing diuretic that blocks the sodium retaining and potassium and magnesium excreting properties of aldosterone. This results in loss of water, with increased sodium excretion and retention of potassium. Acetazolamide is a carbonic anhydrase inhibitor and does not spare potassium. Furosemide is a loop diuretic. Bumetanide is a loop diuretic and does not spare potassium.

5. How soon will diuresis be expected to occur after the nurse has administered 20 mg of furosemide (Lasix) intravenously (IV) to a patient with heart failure? a. As soon as injected b. Within 10 minutes c. After 2 hours d. After 4 hours

b. Within 10 minutes The onset of diuresis following IV furosemide administration is 5 to 10 minutes after administration. The diuretic effect peaks within 30 minutes and lasts approximately 2 hours.

A 37-year-old male presents at the emergency department reporting severe vomiting for the past 48 hours. When assessing skin turgor, the nurse will: a. exert pressure against the shin. b. gently pinch the skin together over the sternum. c. assess for vein distention. d. inspect oral mucous membranes.

b. gently pinch the skin together over the sternum. Skin turgor is assessed by gently pinching the skin together over the sternum, on the forehead, or on the forearm. Elasticity is present and skin rapidly returns to a flat position in the well-hydrated patient. Exerting pressure against the shin would assess for edema. Vein distention and oral mucous membranes are indicators of hydration status but are not considered when assessing skin turgor.

What would the nurse anticipate if a patient with a history of type 2 diabetes is prescribed a thiazide diuretic? a. No change in the antidiabetic regimen b. Decreased need for antidiabetic medication c. Increased blood sugar levels d. Less frequent monitoring of blood sugar level

c. Increased blood sugar levels The thiazides may induce hyperglycemia and aggravate cases of preexisting diabetes mellitus. Regular assessment for glycosuria is indicated. Dosages of oral hypoglycemics and insulin may need adjustment in patients with diabetes mellitus. Thiazides affect glucose metabolism, and the patient should change her regimen to accommodate this. Thiazides have the opposite effect on glucose metabolism. More frequent monitoring is warranted when the patient is being treated with thiazide diuretics.

Which condition warrants the use of acetazolamide (Diamox) as a diuretic? a. Increased intracranial pressure b. Increased extravascular fluid pressure c. Increased intraocular pressure d. Periorbital edema

c. Increased intraocular pressure Acetazolamide is used to reduce intraocular pressure associated with glaucoma. Mannitol is an osmotic diuretic used to decrease intracranial pressure. Diuretics such as furosemide or ethacrynic acid are used to reduce fluid volume in extravascular spaces. Diuretics are not used to treat periorbital edema.

When teaching a patient who is taking thiazide diuretics, the nurse will encourage the patient to increase the intake of which electrolyte? a. Calcium b. Sodium c. Potassium d. Magnesium

c. Potassium Thiazide diuretics cause a decrease in the level of potassium. The patient taking thiazide diuretics does not need to increase calcium or magnesium intake. Although sodium levels are altered in patients taking thiazide diuretics, patients do not need to increase sodium intake.

Which foods will the nurse recommend for a patient taking loop diuretics? a. Protein-rich foods such as poultry, whole grains, and fish b. Fiber-rich foods such as yellow vegetables, nuts, and lentils c. Potassium-rich foods such as raisins, figs, and bananas d. Sodium-rich foods such as canned vegetables and processed foods

c. Potassium-rich foods such as raisins, figs, and bananas Loop diuretics deplete potassium. Potassium-rich foods include raisins, figs, bananas, peaches, kiwis, dates, apricots, oranges, prunes, melons, broccoli, and potatoes. Protein- and fiber-rich foods are not needed in increased amounts by patients taking loop diuretics. Because of high sodium content, canned foods are restricted for patients on diuretic therapy.

Which patient assessment would alert the nurse to withhold a loop diuretic? a. Crackles in the lung bases b. +2 pitting peripheral edema c. Serum potassium of 2.6 mEq/L d. Weight gain of 2 lb in 2 days

c. Serum potassium of 2.6 mEq/L The level indicates hypokalemia and could worsen with the administration of a loop diuretic; therefore, the dose should be withheld. Crackles, peripheral edema, and weight gain do not warrant withholding the medication.

On admission, a patient with a history of cardiac insufficiency complains of shortness of breath. The nurse auscultates the lungs and notes bilateral crackles throughout both fields. In addition, there is bilateral +2 edema of the lower extremities. Which medication does the nurse anticipate that the healthcare provider will prescribe? a. Allopurinol (Zyloprim) b. Diphenhydramine (Benadryl) c. Mannitol d. Furosemide (Lasix)

d. Furosemide (Lasix) Diuretics, such as furosemide, are the mainstays of treatment in heart failure and hypertension. Allopurinol is used to treat gout. Diphenhydramine is an antihistamine and is not used for diuresis. Mannitol is used mainly to treat cerebral edema.