(P) Diuretics

Which action should the nurse take when caring for a patient receiving triamterene? 1 Assess potassium levels 2 Monitor for hypernatremia 3 Monitor for effects of hypoglycemia 4 Assess urinary output every other day

1 Rationale: Triamterene is a potassium-sparing diuretic. The nurse should monitor potassium for potential hyperkalemia. Urine output should be assessed more frequently than every other day. Hypoglycemia and hypernatremia are not common adverse effects of this drug.

The nurse is caring for a patient with heart failure who needs a diuretic. Which agent is likely to be chosen because it has been shown to reduce mortality greatly in patients with heart failure? 1 Mannitol 2 Furosemide 3 Spironolactone 4 Hydrochlorothiazide

3 Rationale: Spironolactone is a potassium-sparing diuretic used to treat both hypertension and edema. It is a preferred drug in mild heart failure because it has been shown to have a cardioprotective effect, reducing mortality in patients with heart failure.

The nurse knows that diuretics mostly affect which function of the kidneys? 1 Excretion of metabolic waste 2 Elimination of foreign substances 3 Maintenance of acid-base balance 4 Maintenance of extracellular fluid volume

4 Rationale: Most diuretics block sodium and chloride reabsorption, thus affecting maintenance of extracellular fluid volume. Acid-base balance, elimination of foreign substances, and excretion of metabolic waste are less affected by diuretics.

The nurse is administering several different diuretics. Which drug will produce the most diuresis in a patient? 1 Furosemide 2 Triamterene 3 Spironolactone 4 Hydrochlorothiazide

1 Rationale: Furosemide is the most potent diuretic. Drugs that act early in the nephron have the opportunity to block the greatest amount of solute reabsorption. Furosemide works at the loop of Henle; as a result, furosemide produces the greatest diuresis. Hydrochlorothiazide works on the early distal convoluted tubule so does not have the capacity to excrete as much sodium and water as a loop diuretic and is less effective. Triamterene and spironolactone work at the distal nephron so do not have the ability to excrete as much sodium and water as loop diuretics

The nurse should monitor for which adverse effect after administering hydrochlorothiazide and digoxin to a patient? 1. Dehydration 2. Heart failure 3. Digoxin toxicity 4. Decreased diuretic effect

3 Rationale: Digoxin levels have an inverse relationship with potassium levels. Because hydrochlorothiazide can lower potassium levels, combined use of hydrochlorothiazide and digoxin poses a risk for elevated digoxin levels and ensuing digoxin toxicity.

The nurse is teaching a patient who has a new prescription for spironolactone. Which statement by the patient indicates that the teaching was effective? 1 "I will take this medication at bedtime each evening." 2 "I will use salt substitutes to lower my sodium intake." 3 "I will call my doctor if I my periods become irregular." 4 "I will increase my intake of foods that are high in potassium."

3 Rationale: Spironolactone is a potassium-sparing, aldosterone-blocking diuretic. As such, it can cause endocrine effects, such as gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of the voice. Patients taking spironolactone should avoid salt substitutes because they contain potassium, and high-potassium foods should be avoided with this drug. Ideally, all diuretics should be taken in the morning to prevent nocturia.

The nurse reviews the laboratory values of a patient receiving furosemide. Which lab result indicates to the nurse that an adverse effect is occurring? 1 Decreased glucose 2 Decreased uric acid 3 Decreased phosphate 4 Decreased magnesium

4 Rationale: Furosemide increases urinary excretion of magnesium, posing a risk of magnesium deficiency. Hyperglycemia (increased glucose) and hyperuricemia (increased uric acid) are adverse effects. Furosemide does not affect phosphate.

A postmenopausal woman is receiving a diuretic. Which diuretic will the nurse most likely be administering? 1 Furosemide 2 Bumetanide 3 Ethacrynic acid 4 Hydrochlorothiazide

4 Rationale: Thiazides promote reabsorption of calcium in renal tubules. Therefore, they may lower osteoporosis risk for postmenopausal women. Because thiazides promote renal calcium retention, they may counteract the calcium loss associated with menopause and may thereby help preserve bone integrity. Loop diuretics (furosemide, bumetanide, and ethacrynic acid) are not as effective at preserving bone integrity.

Which assessment findings indicate the patient is experiencing adverse effects from furosemide? Select all that apply. 1 Oliguria 2 Dry mouth 3 Clear lungs 4 Unusual thirst 5 Clear yellow urine

1, 2, 4 Rationale: Furosemide can produce dehydration. Signs of evolving dehydration include dry mouth, unusual thirst, and oliguria (urine output less than 25 mL/hr). Therapeutic effects of furosemide include clear lungs and an increased amount of clear yellow urine.

The nurse is administering loop diuretics to a group of patients. The nurse should be familiar with the mechanism of action and adverse effects of which medications to be administered to these patients? Select all that apply. 1 Torsemide 2 Bumetanide 3 Chlorothiazide 4 Ethacrynic acid 5 Spironolactone

1, 2, 4 Rationale: Torsemide, bumetanide, and ethacrynic acid are all loop diuretics. Chlorothiazide is a thiazide diuretic, while spironolactone is a potassium-sparing diuretic.

After the nurse reviews the chart, which findings would cause the nurse to notify the provider? 1 Hypouricemia and edema 2 Digoxin and hypokalemia 3 Hypocalcemia and the patient lives alone 4 Furosemide and spironolactone

2 Ratioanle: The nurse should notify the provider when hypokalemia and a prescription for digoxin occur together. Loss of potassium is of special concern for patients taking digoxin, a drug for heart failure. By lowering potassium levels, loop diuretics increase the risk of fatal dysrhythmias from digoxin. Hypouricemia and edema are not a concern; hyperuricemia is. There is no adverse interaction between hypocalcemia and living alone. Furosemide and spironolactone can be given together, so this is not a concern.

A patient taking spironolactone has been taught about the medication. Which menu selection indicates the patient understands teaching related to this medication? 1. Nuts 2. Spinach 3. Chicken 4. Potatoes

3 Rationale: Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Of the foods listed, chicken is lowest in potassium. Nuts, potatoes, dried fruits, spinach, citrus fruits, and bananas all are known to contain high levels of potassium.

Which assessment indicates to the nurse that a therapeutic effect of mannitol has been achieved? 1 Increased calcium 2 Decreased potassium 3 Increased intraocular pressure (IOP) 4 Decreased intracranial pressure (ICP)

4 Rationale: ICP that has been elevated by cerebral edema can be reduced with mannitol. The drug lowers ICP because its presence in the blood vessels of the brain creates an osmotic force that draws edematous fluid from the brain into the blood. Mannitol has no significant effect on the excretion of potassium and other electrolytes. Mannitol will decrease IOP.

A patient with hypertension has been prescribed furosemide. On reviewing the patient's medical history, the nurse learns that the patient is also taking a nonsteroidal anti-inflammatory drug (NSAID) for rheumatoid arthritis. What would the nurse anticipate the healthcare provider would prescribe? 1 Serum blood level for pH 2 Serum blood level of calcium 3 Decreased dose of the NSAID 4 Increased dose of furosemide

4 Rationale: When furosemide is used with NSAIDs, the diuretic activity of the drug is decreased due to the inhibition of prostaglandin synthesis. The nurse should expect the provider to increase the dose of furosemide to produce effective diuresis. When furosemide is given with an NSAID, there is no impact on the serum calcium level or pH. Decreasing the dose of the NSAID may not be effective in relieving the patient's pain.

The nurse is caring for a patient who has congestive heart failure. The patient's medical history indicates that the patient has a history of chronic kidney disease with a low glomerular filtration rate (GFR). Which drug would the nurse anticipate being prescribed for the patient? 1 Furosemide 2 Metolazone 3 Methyclothiazide 4 Hydrochlorothiazide

1 Rationale: Furosemide is especially useful in patients with severe renal impairment, because, unlike the thiazides, the drug can promote diuresis even when renal blood flow and GFR are low. The use of thiazides (metolazone, hydrochlorothiazide, or methyclothiazide) is not effective with a low GFR.

A patient with hypertension is receiving spironolactone therapy. The nurse notes that the patient's serum potassium level is 6.2 mEq/L. What would the nurse anticipate to be prescribed for the patient? 1 Insulin 2 Mannitol 3 Amiloride 4 Triamterene

1 Rationale: If serum potassium rises above 5 mEq/L, or if signs of hyperkalemia develop (eg, abnormal heart rhythm), spironolactone should be discontinued and potassium intake restricted. Injection of insulin can help lower potassium levels by promoting potassium uptake into cells. Amiloride and triamterene are potassium-sparing diuretics, which, on administration, may cause further increase in the serum potassium levels. Mannitol is an osmotic diuretic that does not show any significant effect on potassium levels.

The healthcare provider orders furosemide 20 mg administered intravenously twice daily. The medication available is furosemide 10 mg/mL. How many milliliters should the nurse administer with each dose? 1. 1 mL 2. 2 mL 3. 4 mL 4. 0.5 mL

2 Rationale: The healthcare provider has ordered 20 mg of furosemide, which is available in 10 mg/mL. Multiply 10 mg/mL by 2 to equal 20 mg/2 mL. The nurse will administer 2 mL of furosemide to equal 20 mg with each dose.

Which statements about mannitol are correct? Select all that apply. 1 Mannitol is a loop diuretic. 2 Mannitol can cause edema. 3 Mannitol cannot be given orally. 4 Mannitol can cause renal failure. 5 Diuresis begins in 30 to 60 minutes after administration.

2, 3, 5 Rationale: Mannitol can cause edema because it exits the capillary beds in all areas except the brain. In doing so, it draws water with it. Mannitol is not absorbed through the gastrointestinal tract, so it must be given parenterally. Diuresis begins in 30 to 60 minutes and persists for 6 to 8 hours. Mannitol is used in prophylaxis of renal failure. Mannitol is an osmotic diuretic, not a loop diuretic.

The healthcare provider orders mannitol 72 g infusion over 24 hours. The nurse should plan to set the infusion pump for how many grams per hour? 1. 1 g 2. 2 g 3. 3 g 4. 4 g

3 Rationale: To infuse 72 g over 24 hours, divide 72 by 24 for the total per hour. 72 divided by 24 equals 3 g per hour.

The patient is undergoing treatment to reduce intraocular pressure. The nurse observes that a patient's vision is not improving after treatment. Which drug would the nurse anticipate will be prescribed for this patient? 1 Mannitol 2 Amiloride 3 Furosemide 4 Spironolactone

1 Rationale: Mannitol can be used to reduce intraocular pressure in patients who are unresponsive to other drug therapies. Furosemide (loop diuretic), amiloride (potassium-sparing diuretic), and spironolactone (potassium-sparing diuretic) are not used for reducing intraocular pressure.

Which patient receiving mannitol should the nurse assess first? 1. A patient with anuria 2. A patient with dehydration 3. A patient with a head injury 4. A patient with diabetes mellitus

1 Rationale: If urine flow declines to a very low rate (oliguria) or ceases entirely (anuria), the infusion should be stopped. Mannitol is safe to use with diabetic patients and those with head injuries, and it may function as a prophylaxis against renal failure in patients with dehydratio

A male patient is receiving spironolactone. For which endocrine effects should the nurse monitor in this patient? Select all that apply. 1 Impotence 2 Gynecomastia 3 Hyperglycemia 4 Diabetes development 5 Menstrual irregularities

1, 2 Rationale: Impotence and gynecomastia can develop in a male patient. Spironolactone, with a structure similar to that of steroid hormones, can cause a variety of endocrine effects, including gynecomastia, menstrual irregularities (females), impotence, hirsutism, and deepening of the voice. It does not cause hyperglycemia or diabetes.

A patient is ordered furosemide to be given via intravenous push. Which interventions should the nurse perform? Select all that apply. 1. Obtain weight 2. Assess lung sounds 3 Administer slowly over 1 to 2 minutes 4 Monitor electrocardiogram continuously 5 Maintain accurate intake and output record 6 Insert an arterial line for continuous blood pressure monitoring

1, 2, 3, 5 Rationale: Furosemide can be infused via intravenous push slowly over 1 to 2 minutes. For all patients, obtain baseline values for weight, blood pressure (sitting and supine), pulse, respirations, and electrolytes (sodium, potassium, chloride). It is appropriate to monitor intake and output for a patient receiving a diuretic. There is no need to insert an arterial line to continuously monitor the blood pressure. Also, there is no need to continuously monitor an electrocardiogram.

The healthcare provider instructs the nurse to administer mannitol to a patient who has cerebral edema. What should the nurse do before administering the drug to the patient? Select all that apply. 1 Mix mannitol in juice. 2 Keep mannitol warm. 3 Administer potassium supplements. 4 Use a filter needle and an in-line filter. 5 Give oral rehydration salts with the drug.

2, 4 Rationaele; When administering mannitol, keep it warm and use a filter needle and in-line filter. Note that mannitol may crystallize out of solution if exposed to a low temperature. Accordingly, preparations should be inspected for crystals before use. Preparations that contain crystals should be warmed (to redissolve the mannitol) and then cooled to body temperature for administration. A filter needle is employed to withdraw mannitol from the vial, and an in-line filter is used to prevent crystals from entering the circulation. Mannitol is administered by intravenous infusion only. Because mannitol is an osmotic, diuretic potassium and sodium are not lost, and supplements are not needed.

The nurse should plan to monitor closely for which clinical manifestation after administering furosemide? 1 Decreased pulse 2 Decreased temperature 3 Decreased blood pressure 4 Decreased respiratory rate

3 Rationale: High-ceiling loop diuretics, such as furosemide, are the most effective diuretic agents. They produce more loss of fluid and electrolytes than any others. A sudden loss of fluid can result in decreased blood pressure. When blood pressure drops, the pulse probably will increase rather than decrease. Furosemide should not affect temperature or respirations. The nurse also should closely monitor the patient's potassium level.

The nurse is assessing the hearing of a patient receiving furosemide. Which information in the chart would cause the nurse to perform this assessment? 1 Lithium ordered 2 Digoxin ordered 3 Gentamicin ordered 4 Spironolactone ordered

3 Rationale: The risk of hearing loss from loop diuretics is increased in the presence of other ototoxic drugs, especially aminoglycosides, such as gentamicin. Loop diuretics can suppress lithium excretion, thereby causing the drug to accumulate, possibly to toxic levels, but it does not lead to hearing loss. By lowering potassium levels, loop diuretics increase the risk of fatal dysrhythmias from digoxin, but not hearing loss. Diuretics (spironolactone) in other classes are not ototoxic.

A patient has been prescribed furosemide for pulmonary edema secondary to congestive heart failure. Which instructions will the nurse include in the patient teaching? Select all that apply. 1 Weigh yourself weekly. 2 Take the medication before bed. 3 Rise slowly from sitting or reclining positions. 4 Monitor your blood glucose diligently for hypoglycemia. 5 Report any irregular heartbeat, muscle weakness, or cramping. 6 Report any tenderness or swelling of the joints to your health care provider.

3, 5, 6 Rationale: Furosemide, a loop diuretic, can cause dehydration, so the nurse should teach the patient to monitor him or herself for any side effects. The nurse should tell the patient to rise slowly from sitting or reclining positions in order to minimize the risk of falls secondary to orthostatic hypotension that can occur as a side effect of the furosemide. The nurse should teach the patient to report any irregular heartbeat, muscle weakness, or cramping, since these can be signs of hypokalemia caused by the potassium-wasting properties of furosemide. The patient should also report any tenderness or swelling of the joints, because this can indicate gout caused by hyperuricemia that can occur as a side effect of furosemide. The nurse should teach the patient to weigh him or herself daily in order to monitor the therapeutic effects of the drug. The nurse should tell the patient to avoid taking furosemide later in the day, since it increases urine volume and may make the patient have to urinate frequently at night, disrupting sleep and therefore potentially compromising adherence. The patient should be taught to monitor his or her blood glucose regularly, but this is done for signs of hyperglycemia, not hypoglycemia.

What is the best information for the nurse to provide to a patient who is receiving spironolactone and furosemide therapy? 1 "Using two drugs increases the osmolality of plasma and the glomerular filtration rate." 2 "This combination prevents dehydration and loss of fluid volume." 3 "Moderate doses of two different diuretics are more effective than a large dose of one." 4 "This combination promotes urine output but decreases the risk of low potassium."

4 Rationale: Spironolactone is a potassium-sparing diuretic; furosemide causes potassium loss. Giving these together minimizes electrolyte imbalance. It is not accurate to state that the drug combination prevents dehydration and loss of fluid volume or that it increases the osmolality of plasma and the glomerular filtration rate. Stating that giving two different diuretics is more effective than a large dose of one is not accurate.

The nurse is reviewing the home medication list with the patient. The nurse should recognize that hydrochlorothiazide is used primarily for which condition? 1 Edema 2 Hypertension 3 Diabetes insipidus 4 Protection against postmenopausal osteoporosis

2 Rationale; The primary indication for hydrochlorothiazide is hypertension, a condition for which thiazides are often the drugs of first choice. Hydrochlorothiazides also are used for edema, diabetes insipidus, and protection against postmenopausal osteoporosis, but the primary indication is hypertension.

The nurse is working in the emergency department when a patient with a head injury develops increased intracranial pressure. Which drug would the nurse anticipate administering? 1 Mannitol 2 Metolazone 3 Spironolactone 4 Hydrochlorothiazide

1 Rationale: Intracranial pressure (ICP) that has been elevated by cerebral edema can be reduced with mannitol. The drug lowers ICP because its presence in the blood vessels of the brain creates an osmotic force that draws edematous fluid from the brain into the blood. Metolazone and hydrochlorothiazide are thiazide-like diuretics; spironolactone is a potassium-sparing diuretic; they are of little benefit in reducing cerebral edema.

The nurse is reviewing medication records of several different patients. Which patients should the nurse closely monitor for hyperkalemia? Select all that apply. 1 A patient taking amiloride and furosemide 2 A patient taking triamterene and a direct renin inhibitor 3 A patient taking spironolactone and hydrochlorothiazide 4 A patient taking spironolactone and angiotensin receptor blocker 5 A patient taking amiloride and an angiotensin-converting enzyme (ACE) inhibitor

2, 4, 5 Rationale; Three groups of drugs—ACE inhibitors, angiotensin receptor blockers, and direct renin inhibitors—can elevate potassium levels and thus should be combined with spironolactone, amiloride, and triamterene only when clearly necessary. Although they can be employed alone as diuretics, spironolactone and amiloride are used primarily to counteract potassium loss caused by more powerful diuretics (thiazides, loop diuretics) and do not have to be monitored as closely.

A patient is taking hydrochlorothiazide. On assessment, the nurse notes that the patient has muscle weakness, cramping, and leg discomfort. What should be the nurse's first intervention? 1. Reduce salt in the patient's diet 2 Administer calcium supplements 3 Assess the serum potassium level 4 Give a lower dose of the medication

3 Rationale: Hydrochlorothiazide can cause hypokalemia, characterized by muscle weakness, cramping, and leg discomfort. The nurse should immediately assess the patient's serum potassium level to determine the course of action. Giving calcium supplements does not reduce the symptoms caused by potassium deficiency. The patient is experiencing hypokalemia, not hypernatremia; reducing salt is for hypernatremia. Reducing the dose of the medication will not help restore the electrolyte balance.

The nurse caring for a patient taking furosemide is reviewing the patient's most recent laboratory results, which are sodium, 136 mEq/L; potassium, 3.2 mEq/L; chloride, 100 mEq/L; and blood urea nitrogen, 15 mg/dL. What would be the nurse's best action? 1 Begin a 24-hour urine collection. 2 Administer furosemide as ordered. 3 Place the patient on a cardiac monitor. 4 Hold the furosemide and notify the physician.

4 Rationale: The nurse's best action is to hold the furosemide and notify the physician. Loop diuretics, such as furosemide, can cause significant potassium loss. Normal potassium level is 3.5 to 5 mEq/L. The other listed electrolyte levels are normal. Administering the furosemide could result in a critically low potassium level. Effects of low potassium include cardiac dysrhythmias. Placing a patient on a cardiac monitor requires a physician's order and would warrant further assessment first, such as taking vital signs and asking the patient whether he or she is having any cardiac-related symptoms. Collecting a 24-hour urine specimen is not appropriate in this case.

The nurse is teaching a patient who has been prescribed hydrochlorothiazide. Which statement from the patient indicates a correct understanding of the teaching? 1 "I will limit my intake of oats." 2 "I will not eat melons or grapes." 3 "I will take iron supplements every day." 4 "I will take the dose only in the morning."

4 Rationale: To minimize nocturia, hydrochlorothiazide should not be taken late in the day. Taking the dose only in the morning indicates teaching was successful. Diuretics are to be taken in the morning because they cause urination at night (nocturia) and subsequent loss of sleep when taken late in the afternoon or at night. Limiting oats is not necessary for a diuretic. Instructing the patient to not eat melons or grapes is not appropriate for diuretic teaching. Hydrochlorothiazide does not cause anemia; therefore, an iron supplement is not needed.

A patient asks the nurse about taking potassium supplements while taking triamterene. What is the nurse's best response? 1 "You will need to discuss this important issue with your physician." 2 "You are correct about potassium. I will make sure that you get some right away." 3 "Your potassium level was normal in this morning's laboratory report, so no supplement is needed." 4 "You are on a diuretic that is potassium-sparing, so there is no need for extra potassium."

4 Rationale: Triamterene is a potassium-sparing diuretic. It causes sodium and water to be excreted while potassium is retained. Patients undergoing triamterene therapy do not need potassium supplements and thus do need to discuss potassium supplements with the physician. Potassium supplementation is not based on the patient's laboratory results when the patient is on a potassium-sparing diuretic.