Diuretics Flashcards
A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to administer which drug?
a. Furosemide (Lasix)
b. Hydrochlorothiazide (HydroDIURIL)
c. Mannitol (Osmitrol)
d. Spironolactone (Aldactone)
A
Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is needed. This patient shows severe signs of congestive heart failure with respiratory distress and pulmonary edema and needs immediate mobilization of fluid. Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema, because their diuretic effects are less rapid. Mannitol is indicated for patients with increased intracranial pressure and must be discontinued immediately if signs of pulmonary congestion or heart failure occur.
A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide (Lasix). The nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern?
a. Blood glucose level of 120 mg/dL
b. Oxygen saturation of 90%
c. Potassium level of 3.5 mEq/L
d. Sodium level of 140 mEq/L
C
This patient has an irregular, rapid heartbeat that might be caused by a dysrhythmia. This patient’s serum potassium level is low, which can trigger fatal dysrhythmias, especially in patients taking digoxin. Furosemide contributes to loss of potassium through its effects on the distal nephron. Potassium-sparing diuretics often are used in conjunction with furosemide to prevent this complication. This patient’s serum glucose and sodium levels are normal and of no concern at this point, although they can be affected by furosemide. The oxygen saturation is somewhat low and needs to be monitored, although it may improve with diuresis.
A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question?
a. Bumetanide (Bumex)
b. Furosemide (Lasix)
c. Spironolactone (Aldactone)
d. Hydrochlorothiazide (HydroDIURIL)
C
Spironolactone is a non–potassium-wasting diuretic; therefore, if the patient has a serum potassium level of 6 mEq/L, indicating hyperkalemia, an order for this drug should be questioned. Bumetanide, furosemide, and hydrochlorothiazide are potassium-wasting diuretics and would be appropriate to administer in a patient with hyperkalemia.
A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten) concurrently with spironolactone (Aldactone). Morning laboratory results reveal a serum sodium level of 144 mg/dL, a serum potassium level of 5.1 mEq/L, and a blood glucose level of 128 mg/dL. Which intervention is appropriate?
a. Administer the medications as ordered.
b. Ask the patient about the use of salt substitutes.
c. Contact the provider to report the laboratory values.
d. Request an order for furosemide (Lasix).
C
Spironolactone should not be administered with ACE inhibitors, which can also elevate potassium levels. Because the potassium level is elevated, the nurse should not administer the medication and should obtain clarification of the order. There is no need to repeat the potassium level test that was just done this morning. Requesting an order for furosemide is appropriate only after the provider has been notified of the laboratory values.
A patient with hypertension is taking furosemide (Lasix) for congestive heart failure. The prescriber orders digoxin to help increase cardiac output. What other medication will the nurse expect to be ordered for this patient?
a. Bumetanide (Bumex)
b. Chlorothiazide (Diuril)
c. Hydrochlorothiazide (HydroDIURIL)
d. Spironolactone (Aldactone)
D
Spironolactone is used in conjunction with furosemide because of its potassium-sparing effects. Furosemide can contribute to hypokalemia, which can increase the risk of fatal dysrhythmias, especially with digoxin administration. The other diuretics listed are all potassium-wasting diuretics.
A patient who was in a motor vehicle accident sustained a severe head injury and is brought into the emergency department. The provider orders intravenous mannitol (Osmitrol). The nurse knows that this is given to:
a. reduce intracranial pressure.
b. reduce renal perfusion.
c. reduce peripheral edema.
d. restore extracellular fluid.
A
Mannitol is an osmotic diuretic that is used to reduce intracranial pressure by relieving cerebral edema. The presence of mannitol in blood vessels in the brain creates an osmotic force that draws edematous fluid from the brain into the blood. It can also be used to increase renal perfusion. It can cause peripheral edema and is not used to restore extracellular fluid.
A patient is taking gentamicin (Garamycin) and furosemide (Lasix). The nurse should counsel this patient to report which symptom?
a. Frequent nocturia
b. Headaches
c. Ringing in the ears
d. Urinary retention
C
Patients taking furosemide should be advised that the risk of furosemide-induced hearing loss can be increased when other ototoxic drugs, such as gentamicin, are also taken. Patients should be told to report tinnitus or dizziness or hearing loss. Nocturia may be an expected effect of furosemide. Headaches are not likely to occur with concomitant use of gentamicin and furosemide. Urinary retention is not an expected side effect.
An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide (HydroDIURIL). Before administering this medication, the nurse reviews the patient’s chart. Which laboratory value causes the nurse the most concern?
a. Elevated creatinine clearance
b. Elevated serum potassium level
c. Normal blood glucose level
d. Low levels of low-density lipoprotein (LDL) cholesterol
A
Hydrochlorothiazide should not be given to patients with severe renal impairment; therefore, an elevated creatinine clearance would cause the most concern. Thiazide diuretics are potassium-wasting drugs and thus may actually improve the patient’s potassium level. Thiazides may elevate the serum glucose level in diabetic patients. Thiazides increase LDL cholesterol; however, this patient’s levels are low, so this is not a risk.
A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide (HydroDIURIL) and digoxin. The prescriber has ordered spironolactone (Aldactone) to be added to this patient’s drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching?
a. “I can expect improvement within a few hours after taking this drug.”
b. “I need to stop taking potassium supplements.”
c. “I should use salt substitutes to prevent toxic side effects.”
d. “I should watch closely for dehydration.”
B
Spironolactone is a potassium-sparing diuretic used to counter the potassium-wasting effects of hydrochlorothiazides. Patients taking potassium supplements are at risk for hyperkalemia when taking this medication, so they should be advised to stop the supplements. Spironolactone takes up to 48 hours to have effects. Salt substitutes contain high levels of potassium and are contraindicated. Spironolactone is a weak diuretic, so the risk of dehydration is not increased.
Besides having diuretic effects for patients with congestive heart failure, thiazides are also used to treat what? (Select all that apply.)
a. Diabetes insipidus
b. Hepatic failure
c. Increased intracranial pressure
d. Intraocular pressure
e. Postmenopausal osteoporosis
A, B, E
Thiazide diuretics have the paradoxical effect of reducing urine output in patients with diabetes insipidus. They can also be used to mobilize edema associated with liver disease. They promote tubular reabsorption of calcium, which may reduce the risk of osteoporosis in postmenopausal women. Mannitol is used to treat edema that causes increased intracranial pressure and intraocular pressure.
