[10] FINALS | RENAL DRUGS

Question 1

acts to increase flow of urine

Answer 1

DIURETICS

Question 2

DIURETICS

Purpose:
* Decrease h____
* Decrease e____

Answer 2

Purpose:
* Decrease hypertension
* Decrease edema

Question 3

DIURETICS

Drug Categories:
A. T____

B. L____

C. K____

D. C____

E. O____

Answer 3

Drug Categories:
A. Thiazides & Thiazide-like

B. Loop diuretics

C. K+ sparing diuretics

D. Carbonic Anhydrase inhibitor

E. Osmotic Diuretics

Question 4

THIAZIDES & THIAZIDE-LIKE

EXAMPLES (2)

Answer 4

Chlorothiazide (Diuril), Hydrochlorothiazide (Hydrodiuril - most common)

Question 5

THIAZIDES & THIAZIDE-LIKE

I: hypertension and p____

MOA: Acts on the ____ renal tubules to promote Na, Cl, and water excretion

S/E: h____ , hypomagnesemia, h____ , dizziness, headache, N&V, constipation, o____ , hyperglycemia, h____

Answer 5

I: hypertension and peripheral edema

MOA: Acts on the distal convoluted renal tubules to promote Na, Cl, and water excretion

S/E: Hypokalemia, hypomagnesemia, hypercalcemia, dizziness, headache, N&V, constipation, orthostatic hypotension, hyperglycemia, hyperuricemia

Question 6

THIAZIDES

Nursing Considerations:
Assessment:

• VS, Weight, u____, e____

Check:

• Peripheral extremities – e____
• History of drugs and herbal supplements taken daily
• Review drug to drug interactions (d____, corticosteroids, antidiabetics, g____, l____)

Answer 6

Nursing Considerations:
Assessment:

• VS, Weight, Urine Output, Electrolyte values

Check:

• Peripheral extremities – Edema
• History of drugs and herbal supplements taken daily
• Review drug to drug interactions (digoxin, corticosteroids, antidiabetics, gingko, licorice)

Question 7

THIAZIDES

Nursing Considerations:

✓Monitor VS (BP & Pulse) and s____ levels- report changes

✓Watch out for d____ and h____
❑ (muscle weakness, leg cramps, and cardiac
dysrhythmias)

✓Monitor daily weight- weight gain of ____ lbs. is equivalent to 1 L of body fluids

✓Note urine output (fluid loss or retention)

Answer 7

Nursing Considerations:

✓Monitor VS and serum electrolyte levels- report changes

✓Watch out for digitalis toxicity and hypokalemia
❑ (muscle weakness, leg cramps, and cardiac
dysrhythmias)

✓Monitor daily weight- weight gain of 2.2 lbs. is equivalent to 1 L of body fluids

✓Note urine output (fluid loss or retention)

Question 8

THIAZIDES

Patient teaching:

• Emphasize adherence to the therapy plan
• Take drug e____
• Keep drugs out of reach of small children
• Inform – certain h____ may interact with
  thiazide diuretics
• Teach on how to take and record b____ (daily)

Answer 8

Patient teaching:

• Emphasize adherence to the therapy plan
• Take drug early in the morning
• Keep drugs out of reach of small children
• Inform – certain herbal products may interact with
  thiazide diuretics
• Teach on how to take and record BP (daily)

Question 9

THIAZIDES

Patient teaching:

• Prevent o____ - by slowly changing position from lying to standing
• Use sunblock – to prevent p____
• Eat foods rich in p____ (e.g. avocado, banana) - supplements may be prescribed
• Taken with f____ - to avoid GI upset (diarrhea, N/V, anorexia)

Answer 9

Patient teaching:

• Prevent orthostatic hypotension - by slowly changing position from lying to standing
• Use sunblock – to prevent photosensitivity
• Eat foods rich in Potassium (e.g. avocado, banana) - supplements may be prescribed
• Taken with FOOD- to avoid GI upset (diarrhea, N/V, anorexia)

Question 10

LOOP DIURETICS/ HIGH CEILING

EXAMPLES (2)

Answer 10

Furosemide (Lasix - most common), Bumetanide (Bumex)

Question 11

LOOP DIURETICS/ HIGH CEILING

I: E____ and hypertension

MOA: Acts on the a____ by inhibiting Na reabsorption

S/E: H____, Na, Ca, Mg, Cl, dizziness, headache, N&V, o____

Answer 11

I: Edema and hypertension

MOA: Acts on the ascending loop of Henle by inhibiting Na reabsorption

S/E: Hypokalemia, Na, Ca, Mg, Cl, dizziness, headache, N&V, orthostatic hypotension

Question 12

LOOP DIURETICS/ HIGH CEILING

Assessment:

• Check for drugs that may cause drug interaction (e.g. alcohol, a____, anticoagulants, corticosteroids, l____, a____, digitalis)
• VS, serum electrolytes, weight, and UO
• Note hypersensitivity to s____

Answer 12

Assessment:

• Check for drugs that may cause drug interaction (e.g. alcohol, aminoglycosides, anticoagulants, corticosteroids, lithium, amphotericin B, digitalis)
• VS, serum electrolytes, weight, and UO
• Note hypersensitivity to sulfonamides

Question 13

LOOP DIURETICS/ HIGH CEILING

Nursing Considerations:

• Monitor VS (decrease B____) and UO (should be at least ____ mL/h or ____ mL/24 hr)
• Notify doctor – if UO does not increase (s____ may be present)
• Weigh the patient - A loss of ____ lbs is equivalent to a fluid loss of 1 L

Answer 13

Nursing Considerations:

• Monitor VS (decrease BP) and UO (should be at least 30 mL/h or 600 mL/24 hr)
• Notify doctor – if UO does not increase (severe renal disorder may be present)
• Weigh the patient - A loss of 2.2 lbs is equivalent to a fluid loss of 1 L

Question 14

LOOP DIURETICS/ HIGH CEILING

Nursing Considerations:

• Administer IV f____ SLOWLY
• h____ may occur if it is rapidly injected
• Check for signs of h____ (< 3.5 mEq/L) - Muscles weakness, abdominal distention, leg cramps, or cardiac dysrhythmias
• Taken in the m____
• Rise slowly from lying to standing (dizziness resulting from fluid loss)

Answer 14

Nursing Considerations:

• Administer IV furosemide SLOWLY
• Hearing loss may occur if it is rapidly injected
• Check for signs of hypokalemia (< 3.5 mEq/L) - Muscles weakness, abdominal distention, leg cramps, or cardiac dysrhythmias
• Taken in the morning
• Rise slowly from lying to standing (dizziness resulting from fluid loss)

Question 15

OSMOTIC DIURETIC

EXAMPLES (2)

Answer 15

Mannitol (Osmitrol - most common), Urea (Ureaphil)

Question 16

OSMOTIC DIURETIC

I: Increased i____, i____ and prevent k____

MOA: Increases p____ and b____ concentration in renal tubules

S/E:
✓ F____ imbalance
✓ Pulmonary Edema
✓ N&V
✓ T____
✓ A____

Answer 16

I: Increased IOP, ICP and prevent kidney failure

MOA: Increases plasma and blood concentration in renal tubules

S/E:
✓ F&E imbalance
✓ Pulmonary Edema
✓ N&V
✓ Tachycardia
✓ Acidosis

Question 17

OSMOTIC DIURETIC

Nursing Consideration for Mannitol

• Mannitol c____ at low temperature
  -use i____
  -may be warmed
  -f____ drip
  -give with extreme caution if with h____

Answer 17

Nursing Consideration for Mannitol

• Mannitol CRYSTALLIZES at low temperature
  -use in-line filter
  -may be warmed
  -fast drip
  -give with extreme caution if with heart condition/ heart failure

Question 18

CARBONIC ANHYDRASE INHIBITORS

EXAMPLE (1)

Answer 18

Acetazolamide (Diamox)

Question 19

CARBONIC ANHYDRASE INHIBITORS

I: increased IOP in o____ only, epilepsy, high altitude or a____; r____

MOA: Blocks the action of the enzyme c____ = increased NA, K, HCO3 excretion

S/E: f____ imbalance, Metabolic acidosis, c____, Orthostatic Hypotension, N/V, a____, confusion

Answer 19

I: increased IOP in open angle glaucoma only, epilepsy, high altitude or acute mountain sickness; respiratory acidosis

MOA: Blocks the action of the enzyme Carbonic Anhydrase = increased NA, K, HCO3 excretion

S/E: F&E imbalance, Metabolic acidosis, Crystalluria, Orthostatic Hypotension, N/V, anorexia, confusion

Question 20

POTASSIUM- SPARING DIURETICS

EXAMPLES (2)

Answer 20

Spinorolactone (Aldactone)
Amiloride (Midamor)

Question 21

POTASSIUM- SPARING DIURETICS

I: Edema and h____

MOA: Acts primarily in the c____ renal
tubules to promote Na, H2O excretion & K
retention

S/E:
* H____
* Caution with poor renal functioning
* A____, N/V, diarrhea

Answer 21

I: Edema and HF

MOA: Acts primarily in the collecting duct renal
tubules to promote Na,H20 excretion & K
retention

S/E:
* Hyperkalemia
* Caution with poor renal functioning
* Anorexia, N/V, diarrhea

Question 22

POTASSIUM- SPARING DIURETICS

Assessment:

• Check history of drugs taken daily
• VS, s____, weight, and UO
• UO should increase - report if UO is less than ____ mL/hr or less than ____ mL/day
• Check for ____ (>5.0 mEq/L; give potassium chloride) - Nausea, diarrhea, abdominal cramps, numbness and tingling of the hands and feet, leg cramps, tachycardia and later bradycardia, peaked narrow T wave on ECG, oliguria

Answer 22

Assessment:

• Check history of drugs taken daily
• VS, serum electrolytes, weight, and UO
• UO should increase - report if UO is less than 30 mL/hr or less than 600 mL/day
• Check for hyperkalemia (>5.0 mEq/L; give potassium chloride) - Nausea, diarrhea, abdominal cramps, numbness and tingling of the hands and feet, leg cramps, tachycardia and later bradycardia, peaked narrow T wave on ECG, oliguria

Question 23

POTASSIUM- SPARING DIURETICS

Patient Teaching:

• Take s____ with or after meals
• Do not discontinue without consulting the Doctor
• Spironolactone- can cause p____ - Use sunblock
• Report r____, dizziness, w____ and GI upset
• Advise patients with hyperkalemia to avoid foods rich in p____ - when taking potassium-sparing diuretics

Answer 23

Patient Teaching:

• Take spironolactone with or after meals
• Do not discontinue without consulting the Doctor
• Spironolactone- can cause photosensitivity - Use sunblock
• Report rash, dizziness, weakness and GI upset
• Advise patients with hyperkalemia to avoid foods rich in potassium - when taking potassium-sparing diuretics

Question 24

BODY FLUIDS

Osmolality of body fluids - concentration of body fluids

• Normal serum osmolality: ____ mOsm/kg

Answer 24

Osmolality of body fluids - concentration of body fluids

• Normal serum osmolality: 275 to 295 mOsm/kg

Question 25

# **BODY FLUIDS** * Three (3) Types of fluid concentration (based on the osmolality of body fluids): 1. I____ 2. H____ 3. H____

Answer 25

* Three (3) Types of fluid concentration (based on the osmolality of body fluids): 1. **Isoosmolar** 2. **Hypoosmolar** 3. **Hyperosmolar**

Question 26

# TYPES OF INTRAVENOUS SOLUTIONS A. C____ 1. Isotonic 2. Hypotonic 3. Hypertonic B. C____ C. B____

Answer 26

A. **Crystalloids** 1. Isotonic 2. Hypotonic 3. Hypertonic B. **Colloids** C. **Blood and blood products**

Question 27

# **CRYSTALLOIDS - ISOTONIC SOLUTION** **Example**: * LR, R____, 0____, 5____ in water **Uses**: * Corrects D____ and Na depletion * Replace GI losses * D____ provide some calories

Answer 27

**Example**: * **LR, Ringer’s solution, 0.9% NaCl, 5% Dextrose** in water **Uses**: * Corrects **DHN** and Na depletion * Replace GI losses * **Dextrose** provide some calories

Question 28

# **CRYSTALLOIDS - ISOTONIC SOLUTION** **Cautions for use**: * LR should be used cautiously to patients with: r____ (contains K+), a____, l____ * Isotonic solutions should be used cautiously in patients with: c____ or r____ disease (risk of FVE) Note: DO NOT administer Isotonic solutions to patients with known or suspected I____

Answer 28

**Cautions for use**: * LR should be used cautiously to patients with: **renal failure (contains K+), alkalosis, liver disease** * Isotonic solutions should be used cautiously in patients with: **Cardiac or renal disease (risk of FVE)** Note: DO NOT administer Isotonic solutions to patients with known or suspected **ICP**

Question 29

# **CRYSTALLOIDS - HYPOTONIC SOLUTION** **Examples**: * ____% NaCl, ____% NaCl, ____% NaCl **Uses**: * Treats intracellular d____ (DKA - Diabetes TYPE 1, Hyperosmolar hyperglycemic State - Diabetes TYPE 2) * Provides f____ to allow excretion of body wastes * D____ provides some calories

Answer 29

**Examples**: * **0.45% NaCl, 0.33% NaCl, 0.225% NaCl** **Uses**: * Treats intracellular **dehydration** (DKA - Diabetes TYPE 1, Hyperosmolar hyperglycemic State - Diabetes TYPE 2) * Provides **free water** to allow excretion of body wastes * **Dextrose** provides some calories

Question 30

# **CRYSTALLOIDS - HYPOTONIC SOLUTION** **Contraindications**: * Do not use in patients with: known or suspected i____, l____, shock, trauma, b____ **Considerations**: * Monitor for signs of F____ and worsening of h____ (due to decrease in vascular volume)

Answer 30

**Contraindications**: * Do not use in patients with: known or suspected **ICP**, **liver disease**, shock, trauma, **burns** **Considerations**: * Monitor for signs of **FVD** and worsening of **hypovolemia** (due to decrease in vascular volume)

Question 31

# **CRYSTALLOIDS - HYPERTONIC SOLUTION** **Example**: * ____% NaCl; 5% Dextrose and ____% NaCl; 5% Dextrose and ____% NaCl; % Dextrose in LR; ____% Dextrose and water; ____% Dextrose and water **Uses**: * Corrects severe h____ * Decreases i____ (cerebral edema) * Dextrose provides some calories

Answer 31

**Example**: * **3% NaCl, 5% Dextrose and 0.45% NaCl, 5% Dextrose and 0.9% NaCl, % Dextrose in LR, 10% Dextrose and water, 50% Dextrose and water** **Uses**: * Corrects severe **hyponatremia** * Decreases **ICP** (cerebral edema) * Dextrose provides some calories

Question 32

# **CRYSTALLOIDS - HYPERTONIC SOLUTION** **Considerations**: * May cause i____ and pulmonary edema - Administer slowly and carefully with infusion control pump and constant monitoring * Avoid p____ use * Higher concentrations of dextrose (>____%) must be given through - Central venous access device * May be added to amino acid solutions as T____ **Contraindications**: * C____ or r____ disease * D____ or D____

Answer 32

**Considerations**: * May cause **intravascular volume overload** and pulmonary edema - Administer slowly and carefully with infusion control pump and constant monitoring * Avoid **prolonged** use * Higher concentrations of dextrose (>**10**%) must be given through - Central venous access device * May be added to amino acid solutions as **TPN (total parenteral nutrition)** **Contraindications**: * **Cardiac or renal disease** * **DHN or DKA**

Question 33

used primarily as a measurement of the concentration of IV solutions compared with the osmolality of body fluids

Answer 33

**TONICITY**

Question 34

# TONICITY OF INTRAVENOUS SOLUTIONS 1. **Hypotonic**: <____ mOsm/kg 2. **Isotonic**: ____ mOsm/kg 3. **Hypertonic**: >____ mOsm/kg * IV solutions are used to replace body fluid loss

Answer 34

1. **Hypotonic**: <280 mOsm/kg 2. **Isotonic**: 280–300 mOsm/kg 3. **Hypertonic**: >300 mOsm/kg * IV solutions are used to replace body fluid loss

Question 35

# **COLLOIDS** Volume expanders * D____ * A____ * H____ * P____ * C____

Answer 35

Volume expanders * **Dextran solutions** * **Amino acids** * **Hetastarch** * **Plasmanate** * **Colloidal gelatin**

Question 36

# **BLOOD AND BLOOD PRODUCTS** EXAMPLES (4)

Answer 36

**Packed RBCs (PRBC), plasma, platelets, cryoprecipitate**

Question 37

# **BLOOD AND BLOOD PRODUCTS** **Considerations**: * Proper products-to- patient identification * Maximum rate of infusion – ____ hours per unit * Pre-medications (e.g. d____) * Multiple Blood transfusions – check for serum ionized c____ levels * Never add medications to the unit of blood

Answer 37

**Considerations**: * Proper products-to- patient identification * Maximum rate of infusion – **4 hours** per unit * Pre-medications (e.g. **diphenhydramine**) * Multiple Blood transfusions – check for serum ionized **calcium** levels * Never add medications to the unit of blood

Question 38

# **BLOOD AND BLOOD PRODUCTS** * I____ - known as lipid emulsion * Patient must have c____ or p____ inserted vascular access device * N & V, elevated t____ - if given rapidly

Answer 38

* **IV Fat Emulsion** - known as lipid emulsion * Patient must have **centrally or peripherally** inserted vascular access device * N & V, elevated **temperature**- if given rapidly

Question 39

# **BLOOD AND BLOOD PRODUCTS** **Cautions for use**: * At risk for fat e____ (fractured femur) * With allergy to e____ or soybeans * P____ * Bleeding disorders * L____ failure * R____ disease

Answer 39

**Cautions for use**: * At risk for fat **embolism** (fractured femur) * With allergy to **eggs or soybeans** * **Pancreatitis** * Bleeding disorders * **Liver failure** * **Respiratory disease**

Question 40

# **FLUID IMBALANCE** **Fluid Volume Deficit** * Strict I and O h____ * O____ Care * Encourage increase O____ * Monitor for s____ and pressure * Monitor for s/sx of F____ due to h____ - thirst, restlessness, HA, inability to concentrate, dry mucous membranes, poor skin turgor, tachycardia, changes in mental status, slightly decrease BP

Answer 40

**Fluid Volume Deficit** * Strict I and O **hourly** * **Oral Care** * Encourage increase **OFI** * Monitor for **skin breakdown** and pressure * Monitor for s/sx of **FVD** due to **hypovolemia** - thirst, restlessness, HA, inability to concentrate, dry mucous membranes, poor skin turgor, tachycardia, changes in mental status, slightly decrease BP

Question 41

# **FLUID IMBALANCE** **Fluid Volume Deficit** * Recognize late symptoms of hypovolemia: c____, cold clammy skins, w____, confusion and o____ * Assess for o____ - safety in transferring and changing of positions * Monitor lab results: H____ and H____, urine s____; increase NA, BUN, crea, electrolyte levels & serum osmolality

Answer 41

**Fluid Volume Deficit** * Recognize late symptoms of hypovolemia: **Cyanosis**, cold clammy skins, **weak thread pulse**, confusion and **oliguria** * Assess for **orthostatic hypotension**- safety in transferring and changing of positions * Monitor lab results: **Hgb and Hct**, urine **specific gravity (increased - concentrated urine)**; increase NA, BUN, crea, electrolyte levels & serum osmolality

Question 42

# **FLUID IMBALANCE** **Fluid Volume Excess** * Monitor for F____ * T____, bounding pulse, t____, increase BP and pulse pressure * Altered m____, generalized edema, a____, * Constant, irritated cough; dyspnea, o____, crackles, pulmonary congestion, muffled heart sounds * F____ * Increased ICP, j____ vein distention; increased UO * Monitor lab results - elevated BUN, Hgb and Hct, Na, Serum osmolality, urine specific gravity)

Answer 42

**Fluid Volume Excess** * Monitor for **FVE** * **Tachycardia**, bounding pulse, **tachypnea**, increase BP and pulse pressure * Altered **mental status**, generalized edema, **anasarca**, * Constant, irritated cough; dyspnea, **orthopnea**, crackles, pulmonary congestion, muffled heart sounds * Fatigue * Increased ICP, **jugular vein distention**; increased UO * Monitor lab results - elevated BUN, Hgb and Hct, Na, Serum osmolality, urine specific gravity)

Question 43

# FLUID IMBALANCE **Fluid Volume Excess** * Daily weight- sudden ____ * Administer d____ as ordered * Fluid and s____ restrictions * Head of the bed elevated ____ to ____ degrees - facilitate respiration

Answer 43

**Fluid Volume Excess** * Daily weight- sudden **increases** * Administer **diuretics** as ordered * Fluid and **sodium** restrictions * Head of the bed elevated **30 to 40 degrees** - facilitate respiration

Question 44

# FLUID IMBALANCE **Fluid Volume Excess** * Monitor e____ areas for signs of pressure and altered skin integrity * Meticulous s____ * R____

Answer 44

**Fluid Volume Excess** * Monitor **edematous** areas for signs of pressure and altered skin integrity * Meticulous **skin care** * **Repositioning**

Question 45

# **ELECTROLYTES** A. P____ B. S____ C. C____ D. M____ E. C____ F. P____

Answer 45

A. **Potassium** B. **Sodium** C. **Calcium** D. **Magnesium** E. **Chloride** F. **Phosphorus (phosphate**

Question 46

Transmission and conduction of nerve impulses and for the contraction of skeletal, cardiac and smooth muscles

Answer 46

**POTASSIUM (3.5-5.0 mEq/L)**

Question 47

# **POTASSIUM (3.5-5.0 mEq/L)**