Fluid Volume
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
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
When describing the mechanism for blood pressure control by the kidneys, which of the following occurs first when oxygenation to the nephron is decreased?
renin release
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 student asks the pathophysiology instructor what the function of renin is in the body. What is the instructor's best response to the student's question?
"Renin is directly involved in the control of arterial blood pressure and it is essential for proper functioning of the glomerulus."
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
The physician orders hydrochlorothiazide for a male client. The client has multiple comorbidities, and the physician chooses the smallest effective dose of the drug. The nurse expects the physician to order a daily dose in what range?
12.5 to 25mg
A 10-year-old child has edema caused by a heart defect. The patient is taking furosemide (Lasix). The dosage is 6 mg/kg per day. The child weighs 76 pounds. How many mg does the child receive in each dose?
210 mg
Your patient, a 37-year-old woman, was admitted due to elevated temperature, oliguria, and dehydration. With adequate hydration, the expected normal urine production would be approximately:
2L/day
A client with renal impairment has been receiving hydrochlorothiazide, and lately it has been less effective than usual. The nurse knows that thiazide drugs become ineffective when the GFR is less than what level?
30ml/min
A male client presents to the emergency department with shortness of breath, dizziness, and confusion. He is diagnosed with severe congestive heart failure. The physician orders high-dose furosemide continuous IV infusions. What does the nurse expect the rate of dosage to be?
4mg/min or less
An instructor is reviewing the process of tubular secretion. Which of the following would the nurse include?
Active movement of substances from the blood into the renal tubule
When describing the action of spironolactone, the nurse would explain that this drug acts by which of the following?
BLOCKING ALDOSTERONE IN THE DISTAL TUBULE
Hydrochlorothiazide works by what mechanism of action?
Increasing the excretion of sodium and chloride in the distal tubule
You are caring for a patient who is experiencing elevated intracranial pressure following neurosurgery. The physician orders an osmotic diuretic to reduce pressure. Which of the following agents would the physician select?
Mannitol
After reviewing the different classes of diuretics available, a student demonstrates understanding when he identifies which of the following as an example of a thiazide-like diuretic?
Metolazone
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
Which of the following best describes the structure of the kidneys?
The renal pelvises drain urine into the ureters.
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
The students are discussing the electrolytes in the body. What should the students know has the greatest influence on potassium loss from the body?
aldosterone
Much of the sodium in the filtrate is reabsorbed in the proximal convoluted tubule to the peritubular capillaries. As the sodium is moved out of the filtrate what does it take with it?
chloride ions
The anatomy class is learning about the countercurrent mechanism in the medullary nephrons. What would the students learn about this mechanism and what it acts to do?
concentrate or dilute the urine
You are caring for a patient who is in renal failure. When reviewing the patient's laboratory values what would the nurse expect to find?
decreased hgb
A female patient reports that she has frequent muscle cramps while on hydrochlorothiazide therapy. The nurse will advise her to
eat potassium rich foods
What effect on the diet of a patient will taking diuretics have?
eat potassium-rich or low potassium diet as appropriate
Which of the following would a nurse identify as responsible for causing the release of antidiuretic hormone?
falling blood volume
A group of students are reviewing the various classes of diuretics. The students demonstrated understanding of the information when they identify which of the following as a loop diuretic?
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
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
Your 68-year-old patient, an insulin-dependent diabetic, is to receive hydrochlorothiazide (HydroDIURIL). Prior to administering it, what should you inform her of?
her insulin dose may need to be increased
The nurse is monitoring the results of laboratory testing for a client receiving chlorthalidone. Which of the following would be a cause for concern?
hypercalcemia
Your 91-year-old patient is being discharged on the diuretic spironolactone (Aldactone). What is the major adverse effect of this type of medication?
hyperkalemia
A physician is considering ordering hydrochlorothiazide for a patient. This drug must be used cautiously, if at all, if the patient has a history of
hypersensitivity to sulfonamides
A client comes to the clinic for a 1 month follow-up appointment. They tell the nurse they have been taking chlorothiazide (Diruil) for the month it has been prescribed and now they have leg cramps and "feel tired all the time." What will the nurse consider as the cause of the patient's 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?
hypokalemia
Which of the following would contraindicate the use of indapamide?
hypokalemia
A physician has prescribed a loop diuretic for a patient with hypertension. The patient also has diabetes mellitus. What condition should the nurse monitor for in this patient after administering the prescribed drug?
increased blood glucose levels
A physician has prescribed triamterene to a 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
After teaching a group of students about the renal system, the instructor determines that the teaching was successful when the students state which of the following?
most fluid that is filtered through the kidney is returned to the body
Your patient has just been diagnosed with acute renal failure. The patient asks you what in his kidneys was the functional unit. What would you reply?
nephron
You are caring for a patient in the Emergency Department (ED) who is in pulmonary edema. The patient is treated with furosemide (Lasix). What will you monitor?
potassium levels
A student asks the pharmacy instructor what the difference is between the diuretics spironolactone (Aldactone) and furosemide (Lasix). What would the instructor reply?
potassium losses are less with spironolactone
About 80% of water, sodium, potassium, and other substances is 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
Your patient is a 36-year-old man who 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 should obtain an allergy history from patients as which of the following classes of diuretics may result in a cross-sensitivity reaction with sulfonamides? (Choose one)
thiazide diuretics
The countercurrent mechanism occurs in the loop of Henle.
true
The nursing instructor is talking with their students about the renal system. What would the instructor tell the students about the renal system and how it helps maintain calcium levels in the body by regulating the activation of what?
vitamin d
Which of the following substances are moved from the glomerulus into the tubule due to hydrostatic pressure?
water
