Nursing Pharm Ch 35 Diuretic Therapy – Flashcards
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A client has severe protein malnutrition and is taking a drug that is 99% bound to albumin. What alteration in the concentration of this drug in the urinary filtrate will occur? 1. An increase in the amount of drug actively secreted across the walls of the renal tubule 2. A decrease in the amount of drug reabsorbed across the walls of the renal tubule 3. An increase in the amount of drug filtered into Bowman's capsule 4. An increase in the amount of drug passively secreted across the walls of the renal tubule
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3. A decrease in albumin concentration increases the proportion of free drug in the plasma available to be filtered into Bowman's capsule.
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A client with cancer is secreting excessive amounts of antidiuretic hormone. The nurse will monitor the client for which consequence of excess antidiuretic hormone secretion? 1. Fluid volume excess 2. Hyperkalemia 3. Hypernatremia 4. Dehydration
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1. Antidiuretic hormone increases renal tubular permeability and water retention.
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A client has been diagnosed with chronic renal failure and is receiving hydrochlorothiazide (HCTZ). The nurse has taught the client about the importance of kidney function and evaluates that learning has occurred when the client makes which statements? Select all that apply. 1. "The kidneys help my heart by balancing potassium." 2. "The kidneys help decrease infections by excreting bacteria." 3. "The kidneys keep blood pressure from getting too low." 4. "The kidneys balance the fluid and electrolytes in my body." 5. "The kidneys help regulate the oxygen levels in my blood."
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1,3,4. The kidneys are the primary organs for regulating potassium balance. The kidneys secrete renin, which helps to maintain blood pressure. The kidneys are the primary organs for regulating fluid and electrolyte balance.
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The nurse is caring for a client who is experiencing acute renal failure. The nurse knows that this client may experience problems regulating: Select all that apply. 1. Fluid balance. 2. Electrolyte composition. 3. The pH of body fluids. 4. Heart rate. 5. Blood pressure.
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1,2,3,5. The kidneys are the primary organs for regulating fluid balance through filtration and urine output.. The kidneys are the primary organs for regulating electrolyte composition through filtration and urine output. The kidneys are the primary organ for regulating the pH of body fluids through filtration and urine output. The kidneys play a role in regulating blood pressure through the secretion of renin.
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The formation of urine begins at which structure? 1. Glomerulus 2. Ureter 3. Collecting duct 4. Henle's loop
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1. The glomerulus is the site where filtration and production of urine begin.
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Which substances enter the filtrate by active secretion? Select all that apply. 1. Hydrogen 2. Potassium 3. Phosphate 4. Chloride 5. Sodium
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1,2,3. Hydrogen is pumped into filtrate by molecular pumps. Potassium is pumped into filtrate by molecular pumps. Phosphate is pumped into filtrate by molecular pumps.
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The nurse is reviewing results of a routine urinalysis that indicate the presence of protein in the urine. The nurse interprets this finding to mean that 1. The client probably has kidney damage. 2. The results are probably insignificant if the amount of protein is very small. 3. There is likely a mistake with the results, and the client should have another test done. 4. The client is in acute renal failure, and should be hospitalized.
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1. Protein is always an abnormal finding on urinalysis; it indicates damage to the glomerular membrane.
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The nurse is caring for a client with chronic renal failure and is assessing the client's urine output for the shift. In calculating the expected urine output, the nurse knows that the body produces _______ mL of urine per minute.
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1. The kidneys produce approximately 1 mL of urine each minute.
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The nurse caring for a client with renal failure will question the use of a usual dose of: 1. Digoxin (Lanoxin). 2. Cholestyramine (Questran). 3. Fluvastatin (Lescol). 4. Benzylpenicillin (penicillin G)
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1. Digoxin has a narrow therapeutic index and is renally excreted. The dose should be reduced.
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The nurse is managing care for a client with acute renal failure. What does the nurse recognize as the most important safety precaution with regard to medication administration? 1. Review the client's medication regimen to identify any nephrotoxic drugs. 2. Ensure that the client's fluid intake and output are measured precisely. 3. Review the client's medication regimen to identify any drugs that increase fluid retention. 4. Plan to administer less-than-average doses of all medications prescribed for the client.
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1. Persons in acute renal failure are at significantly increased risk of injury from nephrotoxic drugs.
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The nurse caring for a client in renal failure should question an order for which drug? 1. Ibuprofen (Advil) 800 mg three times daily 2. Erythromycin (E-Mycin) 500 mg four times daily 3. Aluminum hydroxide gel 30 ml every 4 hours as needed 4. Acetylsalicylic acid (aspirin) 162 mg daily
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1. Ibuprofen (NSAID) is a nephrotoxic drug. Clients in renal failure have increased vulnerability to injury from nephrotoxic drugs.
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The nurse is caring for a client admitted to the med-surg unit with hypervolemia that has resulted from renal failure. The nurse anticipates that medications that may be ordered to treat this condition would include: Select all that apply. 1. Furosemide (Lasix). 2. Hydrochlorothiazide (Microzide). 3. Epoetin alfa (Procrit). 4. Polystyrene sulfate (Kayexalate). 5. Sodium bicarbonate.
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1,2. Loop diuretics are often given to treat the hypervolemia that accompanies renal failure. Thiazide diuretics are often given to treat the hypervolemia that accompanies renal failure.
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The nurse is caring for clients on a renal failure unit and recognizes which of the following as indications for diuretic therapy? Select all that apply. 1. Confusion and ataxia 2. Visual and auditory hallucinations 3. Blood pressure of 200/98 mm/Hg 4. Generalized edema and decreased urine output 5. Pinpoint pupils and extreme paranoia
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3,4. Hypertension is an indication for diuretic therapy. These are signs of renal failure and edema, which are indications for diuretic therapy.
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Spironolactone (Aldactone) is prescribed for a client with hypertension. The nurse recognizes which information as providing the most support for the use of this drug? 1. Diagnosis of hepatic failure 2. Insufficient therapeutic response to hydrochlorothiazide 3. Insufficient therapeutic response to furosemide (Lasix) 4. Diagnosis of renal failure
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1. Hepatic failure is accompanied by increased production of aldosterone, which increases reabsorption of sodium and water in the distal tubule and collecting ducts. Spironolactone (Aldactone) achieves a diuretic effect by blocking the effects of aldosterone.
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The nurse is caring for four pts on a renal failure unit and recognizes which drug as safe to administer to a client with hypokalemia? 1. Amiloride (Midamor) 2. Chlorothiazide (Diuril) 3. Bumetanide (Bumex) 4. Ethacrynic acid (Edecrin)
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1. Amiloride is a potassium-sparing diuretic.
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The nurse is caring for a client with sodium retention that has resulted in hypervolemia. The nurse knows that even a 1% increase in sodium is equivalent to _____ lb of fluid weight gain.
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4. A 1% increase in sodium reabsorption (retention) could potentially cause a 1.8-L net gain of water each day, which is equivalent to 4 lb of body weight.
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A client receiving bumetanide (Bumex) asks the nurse, "What is all this about 'loops' in my medicine?" The nurse's best response is: 1. "This medication reabsorbs potassium in Henle's loop in your kidney." 2. "This medication blocks sodium reabsorption in what is known as Bowman's capsule." 3. "This is a loop diuretic, which refers to the location where it acts in your kidneys." 4. "This is a loop diuretic, which means it works in the proximal tubule of your kidney."
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3. Bumetanide (Bumex) promotes sodium loss at Henle's loop, which leads to diuresis.
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The nurse has been teaching a client about spironolactone (Aldactone), and recognizes which statement as an indication that the client needs further teaching about this drug? 1. "I am really happy that I can have my cranberry juice." 2. "I am relieved that I do not have to give up my cabbage and mushrooms." 3. "Thank goodness I can still have my orange juice and bananas for breakfast." 4. "I need an apple a day to stay regular. I am glad I can still have this."
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3. Orange juice and bananas are rich in potassium and should be avoided by persons taking spironolactone (Aldactone), which is a potassium-sparing diuretic.
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The nurse is caring for a client with a brain tumor who has received mannitol (Osmitrol) IV. Which laboratory finding represents a potential adverse effect of this drug? 1. Serum cholesterol 300 mg/dL 2. Serum albumin 29 mg/dL 3. Serum sodium 104 mEq/L 4. Serum amylase 820 mg/dL
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3. Hyponatremia is a common adverse effect of mannitol (Osmitrol).
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The nurse is instructing a client on the importance of eating foods rich in potassium while taking a diuretic that causes hypokalemia. Which diuretics do not require potassium supplements? Select all that apply. 1. Furosemide (Lasix) 2. Chlorothiazide (Diuril) 3. Amiloride (Midamor) 4. Mannitol (Osmitrol) 5. Spironolactone (Aldactone)
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3,5. Amiloride (Midamor) is a potassium-sparing diuretic; therefore, clients do not need to eat foods high in potassium or take a potassium supplement while on this medication. Spironolactone (Aldactone) is a potassium-sparing diuretic. Clients on this medication are not required to eat foods high in potassium or take a potassium supplement.
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A client with chronic renal failure has been taking hydrochlorothiazide (HCTZ). He has gained 4 pounds in the past 24 hours. The nurse anticipates that he will receive which diuretic? 1. Triamterene (Dyrenium) 2. Ethacrynic acid (Edecrin) 3. Mannitol (Osmitrol) 4. Hydrochlorothiazide (HCTZ)
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2. As a loop diuretic, ethacrynic acid can produce significant diuresis in the presence of renal failure.
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The nurse is preparing to administer furosemide (Lasix) 40 mg IV to a client on complete bed rest who has renal failure and pulmonary edema. Which action is most appropriate prior to administering furosemide (Lasix) to this client? 1. Measure the client's urine output. 2. Monitor apical heart rate and rhythm. 3. Auscultate bowel sounds. 4. Lower the head of the bed.
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2. Furosemide (Lasix) can cause a decrease in serum potassium and precipitate cardiac dysrhythmias.
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An older adult reports ringing in the ears while the nurse is administering a dose of ethacrynic acid (Edecrin) intravenously. The priority intervention for this client is to: 1. Schedule a hearing test. 2. Stop infusion of the drug and notify the prescriber. 3. Question the client about recent history of hearing loss. 4. Review the client's fluid intake and assess fluid status.
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2. Tinnitus can be an early sign of hearing loss as an adverse effect of potassium-sparing drugs, which is more common with IV administration of ethacrynic acid (Edecrin).
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The nurse is preparing to discharge a client who has been placed on a loop diuretic for the treatment of congestive heart failure. Which foods should the nurse encourage the client to consume to prevent serious adverse effects associated with the medication? Select all that apply. 1. Bananas 2. Red meat 3. Oranges 4. Dried dates 5. Green leafy vegetables
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1,3,4. Bananas are a potassium-rich food. Clients on loop diuretics should eat foods rich in potassium. Citrus fruits are a good source of potassium. Clients on loop diuretics should eat foods rich in potassium. Dried dates are a good source of potassium. Clients on loop diuretics should eat foods rich in potassium.
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The health care provider has ordered hydrochlorothiazide (HCTZ) for a client in chronic renal failure. The nurse suspects the client is experiencing an ineffective response to the medication. Which adverse effect would be the most significant? 1. Hyponatremia 2. Excessive skin moisture 3. Rales 4. Hypertension
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3. Rales can represent pulmonary edema, which is a life-threatening complication of chronic renal failure and fluid retention.
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A client is taking acetazolamide (Diamox) to treat absence seizures. Which finding indicates that the next dose of this drug should be withheld? 1. Elevated serum pH 2. Decreased serum potassium 3. Increased seizure frequency 4. Nausea and dizziness
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2. Hypokalemia is a serious adverse effect of acetazolamide (Diamox).
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Mannitol (Osmitrol) is ordered to be administered IV to a client. The nurse will question the order for this drug if which manifestation is noted? 1. Mental confusion and elevated blood pressure 2. Fatigue and dizziness 3. Urinary output of 68 ml over 2 hours following administration of a test dose of mannitol (Osmitrol) 4. Urinary output of 45 ml over the previous 24 hours
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4. Mannitol (Osmitrol) is contraindicated in the presence of anuria.
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The nurse is administering furosemide (Lasix) IV to client with congestive heart failure. The nurse knows that the anticipated onset of action is within ____ minutes.
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5. Furosemide is frequently used in the treatment of acute edema associated with liver cirrhosis, renal impairment, or congestive heart failure because it has the ability to remove large amounts of edema fluid from the client in a short time. When given IV, diuresis begins within 5 minutes, providing clients quick relief from their symptoms.
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The nurse planning teaching for a client taking acetazolamide (Diamox) will include which instruction? 1. "Limit intake of foods high in potassium, such as peaches." 2. "Drink 1 to 2.5 quarts of fluids daily." 3. "Report signs of hypokalemia, such as vomiting and diarrhea." 4. "Weigh yourself daily, and report a weight gain of 1 pound or more in 24 hours."
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2. An adequate fluid intake is necessary to prevent formation of renal calculi, which are an adverse effect of acetazolamide (Diamox).
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A client with chronic renal failure receiving hydrochlorothiazide (HCTZ) asks the nurse what the best fluid to drink to avoid dehydration is. What is the best response by the nurse? 1. "Iced tea or coffee is good." 2. "You may drink alcohol in moderation." 3. "Plain water is best." 4. "Electrolyte-replacement fluids like Gatorade are excellent."
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3. Plain water is the preferred fluid for avoiding dehydration.
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The nurse administers a dose of hydrochlorothiazide (HCTZ) to a client who needs assistance walking and plans to assist the client to the bathroom in approximately: 1. 1 hour. 2. 2 hours. 3. 6 hours. 4. 30 minutes.
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2. Two hours is the time following administration of the drug when the onset of action occurs, and this client will likely need assistance to the bathroom.
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The nurse is assessing a client prior to the administration of a diuretic. The nurse knows it is essential to assess which vital signs at this time? Select all that apply. 1. Temperature 2. Pulse 3. Respirations 4. Blood pressure 5. Pain
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2,4. The nurse must assess the client's pulse prior to administering a diuretic. The nurse must assess the client's blood pressure prior to administering a diuretic.
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A client is taking a diuretic for the treatment of congestive heart failure. The nurse teaches the client the importance of daily weights and knows the client understands the instruction when he states, "I will report a weight gain or loss of _____ pounds in a 24-hour period."
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2.2. The client should report a weight gain or loss of over 1 kg (2.2 lb) in a 24-hour period.
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A home care nurse is instructing a client with congestive heart failure on daily self-monitoring between home care visits. The nurse should instruct the client to monitor and record: Select all that apply. 1. Weight. 2. Pulse. 3. Temperature. 4. Blood pressure. 5. Respiratory rate.
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1,2,4. It is essential that the client measure and record weight daily to monitor for fluid loss or retention. It is essential that the client measure and record the pulse daily to determine the effectiveness of the medication therapy. It is essential that the client measure and record daily BP to determine the effectiveness of the medication therapy.
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The nurse is instructing a client who is going home on diuretic therapy for the treatment of fluid retention caused by hypertension. The nurse instructs the client to stop the med and notify a HCP if the BP falls below 90/____ mmHg.
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60. The nurse instructs the client to stop taking the medication if BP is 90/60 mmHg or below, or is below the parameters set by the health care provider, and promptly notify the provider.
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The nurse caring for a client receiving chlorothiazide (Diuril) recognizes which assessment findings as indicating that the client is experiencing side effects of this medication? 1. Ataxia and diarrhea 2. Serum potassium 3.0 mEq/L and blood pressure 88/60 mmHg 3. Serum sodium 170 mEq/L and headaches 4. Mental confusion and dependent edema
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2. Chlorothiazide (Diuril) causes side effects of hypokalemia and hypotension.
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The nurse teaching an older adult taking chlorothiazide (Diuril) should include which instruction? 1. "It is all right to have a glass of wine with this medication." 2. "Avoid foods high in potassium while you are taking this medication." 3. "Be sure to include lots of salt in your diet." 4. "Take the medication early in the morning."
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4. Older adults are at risk for falls that might be associated with nocturia caused by taking diuretics in the evening.
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The nurse is assessing a client receiving chlorothiazide (Diuril), and recognizes which assessment findings as indications of hypokalemia? 1. Confusion and decreased urine output 2. General irritability and increased urine output 3. Muscle weakness or cramps 4. Diarrhea and projectile vomiting
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3. Confusion might accompany hypokalemia, but decreased urine output is not a sign of hypokalemia. Neither general irritability nor increased urine output is a sign of hypokalemia. Muscle weakness and cramps are indicators of hypokalemia.
