PN119 PrepU Chapter 33

The nurse should advise male patients taking spironolactone (Aldactone) that what may occur?

Gynecomastia

What exerts its diuretic effect by inhibiting the reabsorption of sodium and chloride ions in the ascending portion of the loop of Henle and the early distal tubule of the nephron?

Hydrochlorothiazide (Microzide)

A 91-year-old patient, who is being prepared for discharge, has been prescribed the diuretic spironolactone. While teaching the patient about the drug, what major adverse effect should the nurse be sure to mention?

Hyperkalemia

After reviewing information about thiazide diuretics, a group of students demonstrate the need for additional teaching when they identify what as a possible adverse effect?

Hypocalcemia

The nurse assesses the client for which of the following symptoms that may indicate that the client has excessive potassium loss?

Hypotension

A patient has been prescribed furosemide (Lasix). Because this drug causes potassium loss, what will the nurse instruct the patient to eat?

Peaches

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 is explaining about the diuretic the patient has just been ordered. Why would the nurse tell the patient to drink 8 to 10 glasses of water daily (unless it is counterindicated)?

To avoid rebound edema

Which drug exerts its diuretic effects by increasing the density of the filtrate in the glomerulus?

Which drug exerts its diuretic effects by increasing the density of the filtrate in the glomerulus?

A female patient reports that she has frequent muscle cramps while on hydrochlorothiazide therapy. The nurse will advise her to

eat potassium-rich foods.

A 68-year-old patient, an insulin-dependent diabetic, is to receive hydrochlorothiazide (HydroDIURIL). Prior to administering the dose, the nurse should inform the patient that:

her insulin dose may need to be increased.

A nurse is caring for a patient who is receiving mannitol. The nurse should be aware that the ongoing mannitol administration should be withheld if

the urine output is less than 30 mL/hour after the test dose.

A client is taking spironolactone (Aldactone) for edema. The nurse identifies that the client's potassium level is 5.4 mEq/L. Which of the following questions would be appropriate for the nurse to ask the client?

"Do you use a salt substitute?"

Which statement by a 62-year-old patient indicates that the patient understands the nurse's teaching about diuretics?

"I will weigh myself daily and report significant changes."

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

A patient is receiving digoxin (Lanoxin) and a potassium supplement. When monitoring daily laboratory values, what should the potassium level be for this patient?

3.5-5.0 mEq/L

A patient has been prescribed a daily dosage of 20 mg of torsemide for the treatment of acute pulmonary edema. The drug is available in the form of 10 mg tablets. How many tablets should the nurse get for the course of 4 days?

8

A patient has edema of the lower extremities and abdomen. What is the reason to administer a stronger diuretic than a thiazide diuretic to this patient?

A thiazide diuretic will be ineffective for immediate diuresis.

A patient with glaucoma has been prescribed a diuretic as treatment of her disease process. What drug does the nurse suspect that the patient will be prescribed?

Acetazolamide (Diamox)

What would be a contraindication to the use of carbonic anhydrase inhibitors?

Allergy to sulfonamides

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

What sign is most indicative of dehydration in a patient taking diuretics?

Body weight

Which of the following herbal products does not produce diuresis? (Choose one)

Chamomile

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.

What type of diet should a patient taking diuretics have?

Eat potassium-rich or low-potassium diet as appropriate

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 patient about hydrochlorothiazide, which the physician has prescribed for treatment of hypertension. What statement, made by the patient, suggests that the patient understands the teaching?

"I will need to stand slowly."

A male client has been ordered spironolactone (Aldactone) for hypertension. Which statement by the client indicates a need for further education?

"I will take the medication when my blood pressure is elevated."

A patient is switched from furosemide (Lasix) to spironolactone (Aldactone). The patient asks the nurse why she has been switched to a new medicine. What is the best answer that will provide patient education regarding the change?

"You will lose less potassium with spironolactone than with furosemide."

A patient has edema of the lower extremities with crackles in the lung bases. The patient is prescribed furosemide 40 mg two times per day orally. What is the recommended weight loss per day?

2 pounds per day

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

A patient is admitted the hospital with congestive heart failure. The patient is ordered to receive furosemide (Lasix) 40 mg IV. How soon will diuretic effects occur after administration?

5 minutes

Which diuretic exerts its effect by inhibiting the enzyme carbonic anhydrase?

Acetazolamide (Diamox)

Which diuretic has been administered to patients with epileptic seizures?

Acetazolamide (Diamox)

You have been prescribed HydroDIURIL. What will the nurse tell you is considered a contraindication to the administration of hydrochlorothiazide (HydroDIURIL)?

Allergy to sulfa drugs

A patient who was recently prescribed spironolactone calls the clinic. The patient states that they aren't going to the bathroom any more than before they started talking the spironolactone. What would be an appropriate question to ask this patient?

Are you taking a salicylate?

A patient is taking spironolactone (Aldactone). When providing patient teaching about this medication, what foods should the patient be instructed to avoid?

Bananas

The nurse is caring for a patient who has been prescribed hydrochlorothiazide for the management of hypertension. The medical history of the patient states that the patient is sensitive to tartrazine. What adverse reaction to the drug due to the presence of tartrazine should the nurse monitor for in this patient?

Bronchial asthma

A patient is prescribed a thiazide diuretic that is to be administered intravenously. Which agent would this most likely be?

Chlorothiazide

The staff educator in the ICU is talking with a group of new nurses about osmotic diuretics. The educator would tell the new nurses that osmotic diuretics act upon which site in the nephron?

Descending limb of loop of Henle

The nurse is evaluating an 82-year-old client who is receiving hydrochlorothiazide. What abnormal laboratory result might the nurse see related to the medication?

Elevated uric acid levels

When evaluating an 82-year-old patient receiving hydrochlorothiazide (HydroDIURIL), which laboratory value deviations may be related to the medication?

Elevated uric acid levels

A nurse encourages a patient who is receiving a diuretic to maintain his fluid intake to prevent the risk for developing:

Fluid rebound

A group of students are reviewing the various classes of diuretics. The students demonstrated understanding of the information when they identify what 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

Which is an example of a loop diuretic?

Furosemide (Lasix)

A 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 client comes to the clinic for a 1-month follow-up appointment. The client states taking chlorothiazide (Diruil) for the month it has been prescribed and now has leg cramps and "feels tired all the time." What will the nurse consider as the cause of the patient's symptoms?

Hypokalemia

The client has been taking hydrochlorothiazide for hypertension. Which of the following manifestations would lead the nurse to believe the client is experiencing hyponatremia? Select all that apply.

Hypotension Confusion Tachycardia

A patient is receiving bumetanide. The nurse would instruct the patient to be alert for what issues? (Select all that apply.)

Hypotension Dizziness Weakness Muscle cramps

A nurse is writing a plan of care for a patient who is taking a diuretic. What would be an appropriate nursing diagnosis for this patient?

Impaired urinary elimination

A client takes digoxin and furosemide (Lasix), a potassium-wasting diuretic, for edema related to congestive heart failure. The nurse knows that hypokalemia has what effect on digoxin?

Increased risk of cardiac arrhythmias

A physician has prescribed triamterene to a male 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

Hydrochlorothiazide works by what mechanism of action?

Increasing the excretion of sodium and chloride in the distal tubule

A nurse has been assigned to patient who receives hydrochlorothiazide each morning for the treatment of primary hypertension. Which of the following components of the patient's morning blood work should prompt the nurse to temporarily hold the drug this morning and consult with the physician?

K+ 3.0 mEq/L

The nurse understands that the action of most diuretics typically results in which effects? (Select all that apply.)

Loss of water Loss of chloride

The nurse is caring for a patient who is experiencing elevated intracranial pressure following neurosurgery. The physician orders an osmotic diuretic to reduce pressure. Which agent would the physician select?

Mannitol

The nurse is caring for a patient with a severe head injury. An osmotic diuretic is ordered. Which drug is an osmotic diuretic?

Mannitol (Osmitrol)

A patient is admitted to emergency and is unconscious as a result of a head injury. The patient's intracranial pressure is increased. What diuretic will be administered to the patient?

Osmotic diuretic

A nurse is caring for a patient undergoing diuretic therapy for the treatment of ascites due to malignancy. The diuretic drugs are known to cause hypomagnesemia (low levels of magnesium). Which of the following symptoms of hypomagnesemia should the nurse monitor for in the patient? Select all that apply.

Paresthesias Tachycardia Tremors

A nurse administered a patient's scheduled oral dose of 20 mg furosemide (Lasix) at 8 AM this morning. This drug administration would have a bearing on which of the following assessments?

Pedal pulses and ankle circumference

The nurse is caring for a patient in the Emergency Department (ED) who is in pulmonary edema. The patient is treated with furosemide (Lasix). What should the nurse 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 are 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

What exerts its diuretic effect by antagonizing the action of aldosterone?

Spironolactone (Aldactone)

The physician has ordered the patient hydrochlorothiazide. What assessment should the nurse make before administering the first dose of hydrochlorothiazide?

Sulfonamide allergy

A 36-year-old male client 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.

Your 92-year-old patient is being seen for follow-up after her latest hospital discharge in her 15-year history of HF. To decrease her cardiac workload, what type of diuretic has she most likely been using in the management of her long-term HF?

Thiazide

A nurse should obtain an allergy history from patients as which class of diuretics may result in a cross-sensitivity reaction with sulfonamides?

Thiazide diuretics

The nurse is providing discharge instructions to a 72-year-old patient who has been discharged home on a diuretic. What would the patient's instructions regarding the use of a diuretic at home include?

To weigh themselves on the same scale, at the same time of day, in the same clothing

A nurse is caring for a patient with epilepsy. The physician has prescribed acetazolamide to the patient. What should the nurse assess in the patient before administering the drug?

Vital signs and weight

A patient with glaucoma has been prescribed acetazolamide (Diamox). What adverse effects would the nurse caution the patient about? (Mark all that apply.)

Weakness Rash Anorexia

The nurse is caring for a 68-year-old female client with type 1 diabetes mellitus whose physician has ordered hydrochlorothiazide. As a consequence of taking the diuretic, the client may need to:

increase her insulin dose.

The class of diuretics that act to block the chloride pump in the distal convoluted tubules and lead to a loss of sodium and potassium and a minor loss of water are the:

thiazide diuretics.