NUR 2092 Pharmacology Ch 51 Drugs acting on the Renal system - diuretic agents
A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route?
Oral
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
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
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 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."
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
What sign is most indicative of dehydration in a patient taking diuretics?
Body weight
A client has been prescribed both digoxin and furosemide. The nurse should monitor the client for development of what adverse effect?
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
What type of diet should a patient taking diuretics have?
Eat potassium-rich or low-potassium diet as appropriate
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
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
Which diuretic will most likely be the initial drug of choice when a client demonstrates dyspnea related to pulmonary edema?
Furosemide
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 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
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?
Increased blood glucose levels
A female client is diagnosed with hyponatremia. What type of diuretic would most likely cause this symptom?
Loop
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
When describing where bumetanide acts, what would the nurse include?
Loop of Henle
A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered?
Mannitol
Because of the action of methazolamide, the nurse would assess a patient closely for signs and symptoms of which acid-base imbalance?
Metabolic acidosis
Which would the nurse expect to find in a client receiving acetazolamide?
Metabolic acidosis
What is the term for the action of a diuretic in a patient with glaucoma?
Osmotic pull
What would contraindicate the use of indapamide?
Renal disease
What substance is reabsorbed in the ascending limb of the loop of Henle?
Sodium
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
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 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.
A nurse understands that loop diuretics are considered high ceiling diuretics because they:
cause a greater diuresis.
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
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.
A client with a history of allergy to sulfonamides is identified as a candidate for diuretic therapy. What diuretics would be contraindicated by the allergy? Select all that apply.
hydrochlorothiazide furosemide chlorothiazide
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."
A client is receiving triamterene. The nurse instructs the client to avoid what foods? (Select all that apply.)
Bananas Prunes Broccoli
The nurse is providing education to a client prescribed furosemide 20 mg PO. The nurse should teach the client that a diet high in sodium will cause what effect?
Decreased diuresis
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 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
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
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
The nurse is administering furosemide IV to a client. How soon after administration does the nurse expect diuretic effects to peak?
30 minutes
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 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 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
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
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
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
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
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
A client has been prescribed furosemide. What medication education should the nurse provide this client? (Select all that apply.) The medication will cause you to urinate larger amounts of urine than you are accustom to. You should try to avoid excessive intake of salt. Be aware that standing up quickly can cause you to be dizzy.
Notify your health care provider if you have more than a 3-pound weight change in one day.
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.
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 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
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.
The nurse is providing education to a client who has been prescribed long-term diuretic therapy. Which client statement demonstrates an understanding of self-monitoring to identify fluid-related issues? Select all that apply.
"I take my scale with me when I stay overnight with friends." "I weigh myself in the same clothes every day." "I weigh myself immediately before breakfast every day."
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."
When describing the action of spironolactone, the nurse would explain that this drug acts by:
Blocking aldosterone in the distal tubule
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
An older adult 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 Renal function Hepatic function
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.
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 is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed?
Osmotic diuretic
