Chapter 34: Fluid Volume Excess

Question 1

Hydrochlorothiazide (what)

Answer 1

prototype diuretic, only works efficiently when urine flow is adequate

Question 2

Hydrochlorothiazide (why)

Answer 2

decrease the reabsorption of sodium, water, chloride, and bicarbonate in the distal convoluted tubule

treats mild to moderate hypertension and the edema associated with heart failure and nephrotic syndrome

Question 3

Hydrochlorothiazide (contraindications)

Answer 3

sensitivity to thiazides of sulfonamide-derived agents or renal decompensation or anuria

Question 4

Hydrochlorothiazide (side effects)

Answer 4

hypersensitivity reactions, hypotension, weakness,
dizziness, diarrhea, constipation, electrolyte imbalances

Question 5

Hydrochlorothiazide (assessment)

Answer 5

assess for the return of blood pressure to acceptable levels and
improvement in the edema associated with heart failure and nephrotic syndrome

Look out for negative effects as hearing impairment, tinnitus, or dizziness

Question 6

Hydrochlorothiazide (pt teaching)

Answer 6

instruct the patient regarding the importance of taking the medication as prescribed, keeping follow-up appointments, and watching for signs and
symptoms of adverse effect

Question 7

Furosemide (what)

Answer 7

most used loop diuretic and serves as the prototype for the group

Question 8

Furosemide (why)

Answer 8

inhibits sodium and chloride reabsorption in the
ascending limb of the loop of Henle, where reabsorption of most filtered sodium occurs

treat hypertension alone or combined with other drugs

Question 9

Furosemide (side effects)

Answer 9

Fluid / electrolyte imbalance, ototoxicity (avoid with slow admission of does)

Question 10

Furosemide (contraindications)

Answer 10

known sensitivity to the drug or anuria, pt allergic to sulfa drugs can be allergic to furosemide

Question 11

Furosemide (assessments)

Answer 11

assess for decreased or absent edema, increased urine output,
and decreased BP

observe decreased dyspnea, crackles, cyanosis, and cough

Assess side effects as causes of volume depletion and electrolyte imbalance

Assess for signs of ototoxicity (diminished hearing)

Question 12

Furosemide (pt teaching)

Answer 12

Reduce sodium intake and increase potassium intake, record weight daily wearing the same clothes to evaluate fluid loss

Question 13

Spironolactone (what)

Answer 13

aldosterone antagonist that blocks the effects of aldosterone

to diminish aldosterone-induced salt and
water retention and impair vascular function

Question 14

Spironolactone (why)

Answer 14

improves cardiac function and reduces symptoms, hospitalizations, and mortality in patients with heart failure. Improves BP

Question 15

Spironolactone (side effects)

Answer 15

dizziness, headache, abdominal cramping, and diarrhea

increased risk of gastric bleeding

Question 16

Spironolactone (contraindications)

Answer 16

Presence of renal insufficiency

Question 17

Spironolactone (assessments)

Answer 17

assess for decrease or absence of edema, increased urine output, decreased blood pressure

Measure weight and assess abdominal girth

Assess for adverse effects such as fluid and electrolyte imbalance

Question 18

Spironolactone (pt teaching)

Answer 18

Measure BP routinely, drug may cause drowsiness or dizziness