Diuretics

Question 1

functions of the kidney

Answer 1

filtration = 125 mL/min
reabsorption = 99% of water/electrolytes/nutrients filtered are reabsorbed
active tubular secretion = acid/base balance & urine concentration

Question 2

functional sites of nephron

Answer 2

glomerulus
proximal convoluted tubule
loop of henle
distal convoluted tubule
collecting duct

Question 3

indications for diuretic therapy

Answer 3

-hypertension
-decrease total body fluid volume
-electrolyte management
-decrease ICP

Question 4

furosemide type

Answer 4

loop diuretic -> works in loop of henle

Question 5

furosemide use

Answer 5

fluid overload
HTN

Question 6

furosemide action

Answer 6

-blocks reabsorption of sodium and chloride and prevents reabsorption of water
-extensive diuresis

Question 7

furosemide admin

Answer 7

IV
PO
IM

Question 8

furosemide SE

Answer 8

electrolyte disturbances
renal failure
dehydration
ototoxicity
hypotension

Question 9

furosemide prec/contra

Answer 9

prec:
-pregnancy
-CV disease
-digoxin
-antihypertensive agents
contra:
-anuria

Question 10

furosemide interactions

Answer 10

digoxin
antihypertensives
other diuretics
NSAIDs

Question 11

furosemide client education

Answer 11

VS
daily weights
slow to stand
report:
-CP/palpitations
-cramping
-tinnitus

Question 12

furosemide nursing interventions

Answer 12

VS
daily weights
monitor I&O
timing considerations (not at night)
consider ECG monitoring

Question 13

hydrochlorothiazide (HCTZ) type

Answer 13

thiazide diuretics

Question 14

HCTZ use

Answer 14

HTN
peripheral edema secondary to HTN management
not diuresis

Question 15

HCTZ action

Answer 15

act on distal convoluted tubule
promote sodium, chloride, water excretion

Question 16

HCTZ admin

Answer 16

PO

Question 17

HCTZ SE

Answer 17

dehydration
electrolyte disturbances
decreased urinary output
hyperglycemia

Question 18

HCTZ prec/contra

Answer 18

prec:
-pregnancy/lactating
-CV disease
-DM
contra:
-renal impairment/failure

Question 19

HCTZ interactions

Answer 19

digoxin
other potassium wasting drugs

Question 20

HCTZ nursing interventions

Answer 20

BP (postural hypotension)
determine fluid volume status (vital sign trends, daily weights)
electrolytes

Question 21

HCTZ client education

Answer 21

early day dosing (after 1 month becoming effective)
fluid intake
BP (slow to rise)

Question 22

spironolactone type

Answer 22

potassium-sparing diuretics

Question 23

spironolactone use

Answer 23

diuresis
HTN
minimization of potassium loss
aldosterone inhibitor:
-hyperaldosteronism
-PCOS
-acne
-hirsutism

Question 24

spironolactone action

Answer 24

weakest diuretic
inhibits aldosterone in DCT and collecting ducts

Question 25

spironolactone admin

Answer 25

PO

Question 26

spironolactone SE

Answer 26

hyperkalemia gynecomastia menstrual irregularities

Question 27

spironolactone prec/contra

Answer 27

prec: -pregnancy/lactation -metabolic acidosis contra: -hyperkalemia -renal failure

Question 28

spironolactone interactions

Answer 28

ACE inhibitors/ARB K increasing medications high potassium food

Question 29

spironolactone interventions

Answer 29

monitor: -I&O -daily weights -electrolytes VS

Question 30

spironolactone education

Answer 30

avoid salt substitutions BP report: cramps, cp/palpitations (s/s of hyperkalemia) slow to stand

Question 31

mannitol type

Answer 31

osmotic diuretic

Question 32

mannitol use

Answer 32

indications for increased ICP

Question 33

mannitol action

Answer 33

increase osmolality of blood increases kidney perfusion minimally reabsorbed in kidney

Question 34

mannitol admin

Answer 34

IV -tubing filter (can crystallize) **-ICU setting**

Question 35

mannitol SE

Answer 35

edema relative hypervolemia electrolyte imbalances

Question 36

mannitol prec/contra

Answer 36

prec: -electrolyte imbalances contra: -active ICH -HF -renal failure

Question 37

mannitol interactions

Answer 37

lithium (increased lithium excretion) cardiac glycosides (low potassium)

Question 38

mannitol interventions

Answer 38

ICU - neuro status VS total body fluid volume status I&O (urinary output, hypervolemia) may crystallize in bottle - must dissolve before admin

Question 39

mannitol education

Answer 39

slow to rise general weakness