Diuretic Drugs Flashcards
(35 cards)
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. Hypoglycemia
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. Hypoglycemia is not an adverse effect.
The nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of these diuretics?
a. Hydrochlorothiazide
b. Furosemide
c. Acetazolamide
d. Spironolactone
ANS: DSpironolactone (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 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 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/min.
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, the nurse notes that which drug is most likely to cause a severe interaction with the diuretic?
a. Digoxinb. 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 diureticsb. 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 falls.
ANS: 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 prescriber.
The 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 inhibitors
ANS: 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. Lethargy
ANS: D, E, F
Symptoms of hypokalemia include anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension. The other symptoms are not associated with hypokalemia.
The nurse is administering insulin lispro and will keep in mind that this insulin will start to have an effect within which time frame?
a. 15 minutes
b. 1 to 2 hours
c. 80 minutes
d. 3 to 5 hours
ANS: A
The onset of action for insulin lispro is 15 minutes. The peak plasma concentration is 1 to 2 hours; the elimination half-life is 80 minutes; and the duration of action is 3 to 5 hours.
When teaching about hypoglycemia, the nurse will make sure that the patient is aware of the early signs of hypoglycemia, including which of these?
a. Hypothermia and seizures
b. Nausea and diarrhea
c. Confusion and sweating
d. Fruity, acetone odor to the breath
ANS: C
Early symptoms of hypoglycemia include the central nervous system manifestations of confusion, irritability, tremor, and sweating. Hypothermia and seizures are later symptoms of hypoglycemia. The other options are incorrect.
The nurse is teaching a group of patients about self-administration of insulin. What content is important to include?
a. Patients need to use the injection site that is the most accessible.
b. If two different insulins are ordered, they need to be given in separate injections.
c. When mixing insulins, the cloudy (such as NPH) insulin is drawn up into the syringe first.
d. When mixing insulins, the clear (such as regular) insulin is drawn up into the syringe first.
ANS: D
If mixing insulins in one syringe, the clear (regular) insulin is always drawn up into the syringe first. Patients always need to rotate injection sites. Mixing of insulins may be ordered.
When monitoring a patient‘s response to oral antidiabetic drugs, the nurse knows that which laboratory result would indicate a therapeutic response?
a. Random blood glucose level 180 mg/dL
b. Blood glucose level of 50 mg/dL after meals
c. Fasting blood glucose level of 92 mg/dL
d. Evening blood glucose level below 80 mg/dL
ANS: C
The American Diabetes Association recommends a fasting blood glucose level of between 80 and 130 mg/dL for diabetic patients. The other options are incorrect.
A 75-year-old woman with type 2 diabetes has recently been placed on glipizide. She asks the nurse when the best time would be to take this medication. What is the nurse‘s best response?
a. ―Take this medication in the morning, 30 minutes before breakfast.‖
b. ―Take this medication in the evening with a snack.‖
c. ―This medication needs to be taken after the midday meal.‖
d. ―It does not matter what time of day you take this medication.‖
ANS: A
Glipizide is taken in the morning, 30 minutes before breakfast. This allows the timing of the insulin secretion induced by the glipizide to correspond with the elevation in blood glucose level induced by the meal in much the same way as endogenous insulin levels are raised in a person without diabetes.
A patient who has type 2 diabetes is scheduled for an oral endoscopy and has been NPO (nothing by mouth) since midnight. What is the best action by the nurse regarding the administration of her oral antidiabetic drugs?
a. Administer half the original dose.
b. Withhold all medications as ordered.
c. Contact the prescriber for further orders.
d. Give the medication with a sip of water.
ANS: C
When the diabetic patient is NPO, the prescriber needs to be contacted for further orders regarding the administration of the oral antidiabetic drugs. The other options are incorrect.
The nurse is reviewing instructions for a patient with type 2 diabetes who also takes insulin injections as part of the therapy. The nurse asks the patient, ―What should you do if your fasting blood glucose is 44 mg/dL?‖ Which response by the patient reflects a correct understanding of insulin therapy?
a. ―I will call my doctor right away.‖
b. ―I will give myself the regular insulin.‖c. ―I will take an oral form of glucose.‖
d. ―I will rest until the symptoms pass.‖
ANS: C
Hypoglycemia can be reversed if the patient eats glucose tablets or gel, corn syrup, or honey, or drinks fruit juice or a nondiet soft drink or other quick sources of glucose, which must always be kept at hand. The patient should not wait for instructions from the physician, nor delay taking the glucose by resting. The regular insulin would only lower the blood glucose levels more.
The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites?
a. Avoid the abdomen because absorption there is irregular.
b. Choose a different site at random for each injection.
c. Give the injection in the same area each time.
d. Rotate sites within the same location for about 1 week before rotating to a new location.
ANS: D
Patients taking insulin injections need to be instructed to rotate sites, but to do so within the same location for about 1 week (so that all injections are rotated in one area—for example, the right arm—before rotating to a new location, such as the left arm). Also, each injection needs to be at least 1/2 to 1 inch away from the previous site.
Which action is most appropriate regarding the nurse‘s administration of a rapid-acting insulin to a hospitalized patient?
a. Give it within 15 minutes of mealtime.
b. Give it after the meal has been completed.
c. Administer it once daily at the time of the midday meal.
d. Administer it with a snack before bedtime.
ANS: A
Rapid-acting insulins are able to mimic closely the body‘s natural rapid insulin output after eating a meal; for this reason, these insulins are usually administered within 15 minutes of the patient‘s mealtime. The other options are incorrect.
After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. The nurse will monitor which laboratory test to evaluate the patient‘s adherence to the antidiabetic therapy over the past few months?
a. Hemoglobin levels
b. Hemoglobin A1C level
c. Fingerstick fasting blood glucose level
d. Serum insulin levels
ANS: B
The hemoglobin A1C level reflects the patient‘s adherence to the therapy regimen for several months previously, thus evaluating how well the patient has been doing with diet and drug therapy. The other options are incorrect.
A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 38 mg/dL. The patient has just become unconscious. The nurse will anticipate which action to be next?
a. Having the patient eat glucose tablets
b. Having the patient consume fruit juice, a nondiet soft drink, or crackers
c. Administering intravenous glucose (50% dextrose)
d. Calling the lab to order a fasting blood glucose level
ANS: C
Intravenous glucose raises blood glucose levels when the patient is unconscious and unable to take oral forms of glucose. Having the lab draw a fasting glucose level is not an appropriate action at this time.
