Chapter 34 Drugs for Fluid Volume Excess Prep U
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 bestrespond to this suggestion?
"Actually, patients with renal failure usually can't take hydrochlorothiazide."
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."
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."
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 group of students are reviewing the function of the kidneys and demonstrate understanding when they identify that the kidneys receive what portion of the cardiac output?
1/4
A 10-year-old child has edema caused by a heart defect. The client is taking furosemide. The dosage is 3 mg/kg/d. The child weighs 76 lbs. How many milligrams does the child receive each day?
105 mg
The amount of fluid excreted as urine each day averages approximately less than how many liters?
2 L
You are monitoring serum electrolyte levels in a 55-year-old patient who has been prescribed digoxin and a potassium-sparing diuretic for treatment of heart failure. Which of the following potassium levels would you hope to see for this patient?
4.0 mEq/L
A 130-lb (59.1 kg) client with a traumatic head injury has developed increased intracranial pressure and prescribed an initial dose of mannitol 1.5 g/kg IV. The medication is available in premixed 500-mL bags of 20 g/100 mL. How many milliliters of solution should the nurse administer? Record the answer as a whole number.
443
A clinic nurse has been assigned to follow up with a group of patients on hydrochlorothiazide therapy. Which patient will the nurse most closely monitor for hyponatremia?
A 71-year-old female who has advanced arteriosclerosis
What is the expected result of a lack of aldosterone on the composition of urine?
A decrease in potassium levels
A client has been diagnosed with renal failure and is surprised to learn of the large volume of blood that is filtered by the kidneys. The client asks, "If that much blood gets filtered, why don't people produce more urine than they do?" In response, the nurse should describe what phenomenon?
A very large majority of filtrate is returned to circulation.
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.
Aldosterone levels would be affected if which gland was dysfunctional?
Adrenal
What acts as a catalyst to reabsorb sodium ions into the body?
Carbonic anhydrase
When explaining the underlying mechanisms associated with renal failure, which would be mostimportant for the nurse to keep in mind?
Extensive kidney damage has usually occurred by the time the patient is symptomatic. Explanation:
What term is used to describe the process that moves fluid and small particles out of the blood through the glomerulus and into the nephron tubule
Filtration
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
The nurse is caring for a client suspected of having renal dysfunction. The presence of what substances in the client's urine would be considered pathological?
Glucose and protein
Amiloride should be used cautiously in clients with the following medical conditions? Select all that apply:
Gout Diabetes Hepatic disease
A male client is excited because it is football season. He has season tickets and attends most games with his friends. At his latest appointment, the client's blood pressure is elevated. What does the nurse suspect is the cause?
He is consuming excessive salty foods at the games.
You are caring for a client who has been prescribed hydrochlorothiazide. When you interviewed the client earlier, you learned that he frequently eats items that are very high in sodium. What effect will his current diet have on his drug therapy?
He may require an increased dose.
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 client presents to the clinic for a 1-month follow-up appointment. The client tells the nurse he or she has been taking chlorothiazide for a month and now has leg cramps and "feels tired all the time." What will the nurse consider as the most likely cause of the client's symptoms?
Hypokalemia
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
A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered?
Mannitol
The nurse is caring for a client with a severe head injury. An osmotic diuretic is ordered. The nurse understands which drug is an osmotic diuretic?
Mannitol
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
The client has just been diagnosed with acute renal failure. The client asks the nurse what functional units of the kidneys are involved. What would the nurse reply?
Nephron
The emergency department (ED) nurse is caring for a client who is experiencing pulmonary edema. The client is treated with furosemide. What will the nurse monitor most closely?
Potassium levels
A client with hypertension has been prescribed spironolactone. The client's previous diuretic, furosemide, has been discontinued. The nurse should explain what benefit of this change?
Potassium losses are lower with spironolactone than with furosemide.
What function does the kidney perform to assist in maintaining acid-base balance within the necessary normal range?
Return bicarbonate to the body's circulation
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 client began taking hydrochlorothiazide 1 week ago and is reporting occasional dizziness when she stands up quickly from sitting or lying. What is the nurse's best action?
Teach the client about the blood pressure effects of the medication and relevant safety measures.
What is the expected outcome when the glomerular membrane is damaged?
The filtration of fluid from the blood into the kidney's nephron tubule is impaired
What best describes the structure of the kidneys?
The renal pelvises drain urine into the ureters.
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.
The nurse is conducting an admission assessment of a client who has been prescribed hydrochlorothiazide. The nurse should contact the provider because of the client's:
allergy to sulfa drugs.
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.
Which diuretic will most likely be the initial drug of choice when a client demonstrates dyspnea related to pulmonary edema?
furosemide
A health care provider is considering ordering hydrochlorothiazide for a client. This drug must be used cautiously, if at all, if the client has a history of:
hypersensitivity to sulfonamides.
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.
A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route?
oral
The students are studying the male reproductive system. The instructor tells the students that in the male, the urethra leaves the urinary bladder and passes through the:
prostate gland.
What substance is reabsorbed in the ascending limb of the loop of Henle?
sodium
