Lilley pharm ch 28 diuretics

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When monitoring a patient who has diabetes and is receiving a carbonic anhydrase inhibitor for edema, the nurse will monitor for which possible adverse effect?
a. Metabolic alkalosis
b. Elevated blood glucose
c. Hyperkalemia
d. Mental alertness

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ANS: B
An undesirable effect of carbonic anhydrase inhibitors is that they elevate the blood glucose level and cause glycosuria in diabetic patients. They induce metabolic acidosis, making their effectiveness diminishes in 2 to 4 days. In addition, hypokalemia and drowsiness may occur

The nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of these diuretics?
a. Hydrochlorothiazide (HydroDIURIL)
b. Furosemide (Lasix)
c. Acetazolamide (Diamox)
d. Spironolactone (Aldactone)

ANS: D
Spironolactone (Aldactone) is a potassium-sparing diuretic, and patients taking this drug must be monitored for signs of hyperkalemia. The other drugs do not cause hyperkalemia but instead cause hypokalemia

Mannitol (Osmitrol) has been ordered for a patient with acute renal failure. The nurse will administer this drug using which procedure?
a. Intravenously, through a filter
b. By rapid intravenous bolus
c. By mouth in a single morning dose
d. Through a gravity intravenous drip with standard tubing

ANS: A
Mannitol is administered via intravenous infusion through a filter because of possible crystallization. It is not available in oral form. The other options are incorrect

Furosemide (Lasix) is prescribed for a patient who is about to be discharged, and the nurse provides instructions to the patient about the medication. Which statement by the nurse is correct?
a. "Take this medication in the evening."
b. "Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and
dates."
c. "If you experience weight gain, such as 5 pounds or more per week, be sure to tell
your physician during your next routine visit."
d. "Be sure to change positions slowly and rise slowly after sitting or lying so as to
prevent dizziness and possible fainting because of blood pressure changes."

ANS: D
Orthostatic hypotension is a possible problem with diuretic therapy. Foods high in potassium should be eaten more often, and the drug needs to be taken in the morning so that the diuretic effects do not interfere with sleep. A weight gain of 5 pounds or more per week must be reported immediately

When reviewing the mechanisms of action of diuretics, the nurse knows that which statement is true about loop diuretics?
a. They work by inhibiting aldosterone.
b. They are very potent, having a diuretic effect that lasts at least 6 hours.
c. They have a rapid onset of action and cause rapid diuresis.
d. They are not effective when the creatinine clearance decreases below 25 mL/m

ANS: C
The loop diuretics have a rapid onset of action; therefore, they are useful when rapid onset is desired. Their effect lasts for about 2 hours, and a distinct advantage they have over thiazide diuretics is that their diuretic action continues even when creatinine clearance decreases below 25 mL/min.

When monitoring a patient who is taking hydrochlorothiazide (HydroDIURIL), the nurse notes that which drug is most likely to cause a severe interaction with the diuretic?
a. Digitalis
b. Penicillin
c. Potassium supplements
d. Aspirin

ANS: A
There is an increased risk for digitalis toxicity in the presence of hypokalemia, which may develop with hydrochlorothiazide therapy. Potassium supplements are often prescribed with hydrochlorothiazide therapy to prevent hypokalemia. The other options do not have interactions with hydrochlorothiazide.

When a patient is receiving diuretic therapy, which of these assessment measures would best reflect the patient's fluid volume status?
a. Blood pressure and pulse
b. Serum potassium and sodium levels
c. Intake, output, and daily weight
d. Measurements of abdominal girth and calf circumference

ANS: C
Urinary intake and output and daily weights are the best reflections of a patient's fluid volume status.

A patient is being discharged to home on a single daily dose of a diuretic. The nurse instructs the patient to take the dose at which time so it will be least disruptive to the patient's daily routine?
a. In the morning
b. At noon
c. With supper
d. At bedtime

ANS: A
It is better to take the diuretic medication early in the morning to prevent urination during the night. Taking the diuretic at the other times may cause nighttime urination and disrupt sleep.

A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which class is likely to be used initially?
a. Loop diuretics
b. Osmotic diuretics
c. Thiazide diuretics
d. Potassium-sparing diuretics

ANS: C
The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8) guidelines reaffirmed the role of thiazide diuretics as among the first-line drugs in the treatment hypertension. The other drug classes are not considered first-line treatments.

A patient in the neurologic intensive care unit is being treated for cerebral edema. Which class of diuretic is used to reduce intracranial pressure?
a. Loop diuretics
b. Osmotic diuretics
c. Thiazide diuretics
d. Vasodilators

ANS: B
Mannitol, an osmotic diuretic, is commonly used to reduce intracranial pressure and cerebral edema resulting from head trauma.

A 79-year-old patient is taking a diuretic for treatment of hypertension. This patient is very independent and wants to continue to live at home. The nurse will know that which teaching point is important for this patient? a. He should take the diuretic with his evening meal. b. He should skip the diuretic dose if he plans to leave the house. c. If he feels dizzy while on this medication, he needs to stop taking it and take potassium supplements instead. d. He needs to take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from fallsANS: D Caution must be exercised in the administration of diuretics to the older adults because they are more sensitive to the therapeutic effects of these drugs and are more sensitive to the adverse effects of diuretics, such as dehydration, electrolyte loss, dizziness, and syncope. Taking the diuretic with the evening meal may disrupt sleep because of nocturia. Doses should never be skipped or stopped without checking with the prescriberThe nurse is monitoring a patient who is taking a potassium-sparing diuretic. Which of the drugs or drug classes may have an interaction with this type of diuretic? (Select all that apply.) a. Lithium b. Vancomycin c. Potassium supplements d. NSAIDs e. Antidiabetic drugs f. ACE inhibitorsANS: A, C, D, F Taking lithium with potassium-sparing diuretics may cause lithium toxicity; taking ACE inhibitors or potassium supplements may lead to hyperkalemia. Taking NSAIDs with potassium-sparing diuretics may cause a decreased diuretic response. There are no interactions with vancomycin or antidiabetic drugs and potassium-sparing diuretics.When assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency, which would include what symptoms? (Select all that apply.) a. Dyspnea b. Constipation c. Tinnitus d. Muscle weakness e. Anorexia f. LethargyANS: D, E, F Symptoms of hypokalemia include anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension. The other symptoms are not associated with hypokalemia.