Chapter 32: Diuretics Introductory Clinical Pharmacology 12th Edition by Susan M Ford

Introductory Clinical Pharmacology 12th Edition by Susan M Ford 1. The health care provider has prescribed spironolactone for a client. The nurse is prepared to carefully monitor the client's potassium level if the client is also administered which drug? a. Lisinopril b. Metoprolol c. Terazosin d. Diltiazem Answer: A Rationale: Spironolactone when given with ACE inhibitors (lisinopril) can lead to hyperkalemia. Hyperkalemia is not associated with the combination of spironolactone and metoprolol, terazosin, or diltiazem. The three drugs are all used to treat hypertension, which may include the use of a diuretic as well. Question format: Multiple Choice Chapter: 32 Learning Objective: 2 Cognitive Level: Understand Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 406, Interactions 2. A client with cerebral edema is prescribed mannitol. Which assessment should the nurse prioritize during the ongoing assessment? a. Blood pressure every 4 hours b. Response of pupils to light c. Joint pain d. Serum uric acid concentrations Answer: B Rationale: When caring for a client who has been given mannitol for intracranial pressure, the nurse should perform neurologic assessments such as response of the pupils to light, level of consciousness, or response to a painful stimulus at the time intervals ordered by the primary health care provider. The nurse monitors the client for joint pain and other discomforts when the client is administered thiazide diuretics for renal impairment. When caring for clients taking thiazide diuretics, the nurse also monitors the serum uric acid concentrations because these drugs may precipitate an acute attack of gout. The nurse needs to monitor the client's blood pressure every 30–60 minutes when caring for a client receiving the osmotic diuretic mannitol or urea for the treatment of increased intracranial pressure caused by cerebral edema. Question format: Multiple Choice Chapter: 32 Learning Objective: 3 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 408, Client with Increased Intracranial Pressure 3. A nurse is preparing a teaching plan for a client with edema who is prescribed a diuretic. Which teaching should the nurse prioritize? a. Decrease fluid intake. b. Gradually increase the dosage. c. Administer early in the day. d. Encourage exercise. Answer: C Rationale: The drug should be administered early in the day to prevent any nighttime sleep disturbance caused by increased urination. Asking the client to decrease fluid intake may contribute to fluid and electrolyte imbalance. The drug should be used as directed without the client making any adjustments to the dosage. The client should remain as active as possible, depending on their overall condition; however, exercise is not a priority in this situation. Question format: Multiple Choice Chapter: 32 Learning Objective: 5 Cognitive Level: Apply Client Needs: Physiological Integrity: Basic Care and Comfort Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 408, Increased Urinary Frequency 4. A client with a history of seizures is admitted to the unit with pulmonary edema. After administering furosemide, which assessment should the nurse prioritize after discovering the client is also prescribed phenytoin? a. Increased risk of bleeding b. Decreased diuretic effectiveness c. Increased blood glucose levels d. Increased seizure episodes Answer: B Rationale: The nurse should monitor for decreased diuretic effectiveness in the client as the effect of the interaction between furosemide and hydantoins. When the client is administered loop diuretics with anticoagulants or thrombolytics, there is an increased risk of bleeding. Increased blood glucose may occur when thiazide diuretics are given with antidiabetic drugs. Decreased effectiveness of hydantoins, such as manifested by increased seizure activity, is not known to occur as a result of the effect of the interaction between furosemide and hydantoins, and so the nurse need not monitor for the same in the client. Question format: Multiple Choice Chapter: 32 Learning Objective: 3 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 406, Interactions 5. A health care provider prescribes diuretic therapy to a client with nephrotic syndrome. The nurse suspects that the client is hyponatremic based on which assessment finding? a. Paresthesias b. Tremors c. Visual hallucination d. Tachycardia Answer: D Rationale: The nurse should monitor for tachycardia, cold and clammy skin, confusion, and hypotension in the client experiencing hyponatremia. Hyponatremia is excessive loss of sodium and is a common fluid and electrolyte imbalance associated with diuretic therapy. Tremors, visual hallucinations, and paresthesias are the symptoms of hypomagnesemia and not hyponatremia. Question format: Multiple Choice Chapter: 32 Learning Objective: 3 Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 409, Box 32.1 Signs and Symptoms of Common Fluid and Electrolyte Imbalance Associated with Diuretic Therapy 6. The nurse is preparing to teach a client with renal insufficiency about the recently prescribed bumetanide for hypertension. Which instruction should the nurse prioritize for this client?