Lehnes 41-42.pdf

Lehnes Chapter 41: Diuretics MULTIPLE CHOICE 1. 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) ANS: 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. DIF: Cognitive Level: Application REF: High-Ceiling (Loop) Diuretics | Furosemide | Therapeutic Uses | Thiazides and Related Diuretics | Hydrochlorothiazides | Therapeutic Uses | Potassium-Sparing Diuretics | Spironolactone | Therapeutic Uses | Mannitol, an Osmotic Diuretic TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 2. 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 ANS: C This patient has an irregular, rapid heartbeat that might be caused by a dysrhythmia. This SaWienW¶V VeUXm SoWaVViXm leYel iV loZ, Zhich can WUiggeU faWal dVUhWhmiaV, eVSeciall 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 SUeYenW WhiV comSlicaWion. ThiV SaWienW¶V VeUXm glXcoVe and VodiXm leYelV aUe noUmal 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. DIF: Cognitive Level: Application REF: High-Ceiling (Loop) Diuretics | Furosemide | Adverse Effects TOP: Nursing Process: Evaluation Harryson 208 Test Bank - Lehne's Pharmacology for Nursing Care (10th Edition by Jacqueline Burchum) MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 3. 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) ANS: 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. DIF: Cognitive Level: Application REF: Potassium-Sparing Diuretics | Spironolactone | Therapeutic Uses | Adverse Effects TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 4. 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). ANS: 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. DIF: Cognitive Level: Application REF: Potassium-Sparing Diuretics | Spironolactone | Therapeutic Uses | Adverse Effects | Drug Interactions TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 5. 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)