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Chapter 34: Diuretic Drugs

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Chapter 34: Diuretic Drugs

16 problems · 0 figures

Case Study 34.1.1 §34.1 source ↗

Read the following clinical scenario to answer the questions that follow. This case study will evolve throughout the chapter.

Gordon Jefferson is a 74-year-old client who presents to his health care provider’s office reporting a recent weight gain and lower leg swelling for approximately 1 week.

History
Chronic renal disease
Hypertension

Current Medications
Losartan 50 mg orally daily
Dapagliflozin 10 mg orally daily

Based on the information above, what diagnosis should the nurse anticipate from the health care provider?
  1. a.
    Kidney failure
  2. b.
    Arthritis
  3. c.
    Edema
  4. d.
    Obesity
Table 34.1 in the book ↗
Vital Signs Physical Examination
Temperature: 97.8°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Cardiovascular: No jugular vein distention; 2+ peripheral edema noted bilaterally; S1, S2 noted, regular rhythm

• Respiratory: Respirations unlabored; no adventitious lung sounds

• GI: Abdomen soft, nontender, nondistended

• GU: Reports normal urine output

• Neurologic: Within normal limits

• Integumentary: No abnormal findings
Blood pressure: 178/92 mm Hg
Heart rate: 76 beats/min
Respiratory rate: 20 breaths/min
Oxygen saturation: 98% on room air
Height: 5'9"
Weight: 201 lb

Answer

C. Edema
The client is presenting with signs and symptoms of edema—weight gain and peripheral edema.

Case Study 34.1.2 §34.1 source ↗

Read the following clinical scenario to answer the questions that follow. This case study will evolve throughout the chapter.

Gordon Jefferson is a 74-year-old client who presents to his health care provider’s office reporting a recent weight gain and lower leg swelling for approximately 1 week.

History
Chronic renal disease
Hypertension

Current Medications
Losartan 50 mg orally daily
Dapagliflozin 10 mg orally daily

Which diagnostic test would the nurse expect the health care provider to order for Gordon?
  1. a.
    Electrocardiogram
  2. b.
    Urinalysis
  3. c.
    Lipid profile
  4. d.
    Chemistry panel
Table 34.1 in the book ↗
Vital Signs Physical Examination
Temperature: 97.8°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Cardiovascular: No jugular vein distention; 2+ peripheral edema noted bilaterally; S1, S2 noted, regular rhythm

• Respiratory: Respirations unlabored; no adventitious lung sounds

• GI: Abdomen soft, nontender, nondistended

• GU: Reports normal urine output

• Neurologic: Within normal limits

• Integumentary: No abnormal findings
Blood pressure: 178/92 mm Hg
Heart rate: 76 beats/min
Respiratory rate: 20 breaths/min
Oxygen saturation: 98% on room air
Height: 5'9"
Weight: 201 lb

Answer

D. Chemistry panel
A chemistry panel measures key electrolytes and renal function tests.

Case Study 34.5.3 §34.5 source ↗

Read the following clinical scenario to answer the questions that follow. This case study is a follow-up to Case Study Part A.

Gordon Jefferson completes his diagnostic evaluation, and the health care provider diagnoses him with edema. He follows up with his health care provider 1 week later to get the results of his diagnostic studies and review his treatment plan. He is prescribed metolazone 10 mg once daily by mouth for his edema.

Because of Gordon’s history of chronic renal disease, which symptom should the nurse tell him to report immediately if it occurs?
  1. a.
    Increased urine output
  2. b.
    Decreased urine output
  3. c.
    Weight loss of 3 pounds in a week
  4. d.
    Weight gain of 3 pounds in a week

Answer

B. Decreased urine output
Anuria is a contraindication to diuretic administration. Accordingly, decreasing urine output should be reported to the health care provider because it could indicate that the client’s renal function is deteriorating.

Case Study 34.5.4 §34.5 source ↗

Read the following clinical scenario to answer the questions that follow. This case study is a follow-up to Case Study Part A.

Gordon Jefferson completes his diagnostic evaluation, and the health care provider diagnoses him with edema. He follows up with his health care provider 1 week later to get the results of his diagnostic studies and review his treatment plan. He is prescribed metolazone 10 mg once daily by mouth for his edema.

Which nonpharmacologic treatment should the nurse question if the health care provider prescribes it for the client?
  1. a.
    Eat a low-sodium diet.
  2. b.
    Eat a low-potassium diet.
  3. c.
    Walk 10 minutes three times a week.
  4. d.
    Elevate legs when sitting.

Answer

B. Eat a low-potassium diet.
Nonpharmacologic treatment for edema includes a low-sodium diet, walking, and elevating extremities to reduce swelling.

Case Study 34.5.5 §34.5 source ↗

Table 34.9 in the book ↗
Vital Signs Physical Examination Chemistry Panel
Temperature: 98.0°F

• HEENT: Within normal limits

• Cardiovascular: No jugular vein distention; S1, S2 noted; trace peripheral edema noted

• Respiratory: Within normal limits

• GI: Within normal limits

• GU: Within normal limits

• Neurologic: Within normal limits

• Integumentary: No abnormal findings

 Sodium: 140 mEq/L
Potassium: 2.9 mEq/L
BUN: 24 mg/dL
Creatinine: 1.4 mg/dL
eGFR: 40 mL/minute/1.73 m2
Blood pressure: 138/88 mm Hg
Heart rate: 76 beats/min
Respiratory rate: 16 breaths/min
Oxygen saturation: 98% on room air
Height: 5'9"
Weight: 191 lb

Read the following clinical scenario to answer the questions that follow. This case study is a follow-up from Case Study Parts A and B.

Gordon Jefferson is following up with the health care provider 3 months after his initial diagnosis of edema. He reports that the swelling in his legs has improved; however, he is now reporting generalized weakness. The health care provider examines the client and reviews the chemistry panel results from laboratory work drawn earlier in the morning. Gordon says he has been taking his prescribed medications:

Current Medications
Losartan 50 mg orally daily
Dapagliflozin 10 mg orally daily
Metolazone 10 mg orally daily

The health care provider diagnoses the client with hypokalemia, prescribes a potassium supplement, and recommends a low-sodium diet with potassium-rich foods.

The nurse provides teaching about the new diet to Gordon. Which of the following statements by Gordon indicates a need for further teaching?
  1. a.
    “I will limit my intake of green vegetables.”
  2. b.
    “I am going to start eating a banana a day to keep the doctor away.”
  3. c.
    “I have a salt substitute I can use on my food to add flavor.”
  4. d.
    “I am going to cut back on the number of sandwiches I get from the deli.”

Answer

A. “I will limit my intake of green vegetables.”
Green, leafy vegetables are an important part of a low-sodium diet with potassium-rich foods. This statement indicates a need for further teaching.

Case Study 34.5.6 §34.5 source ↗

Table 34.9 in the book ↗
Vital Signs Physical Examination Chemistry Panel
Temperature: 98.0°F

• HEENT: Within normal limits

• Cardiovascular: No jugular vein distention; S1, S2 noted; trace peripheral edema noted

• Respiratory: Within normal limits

• GI: Within normal limits

• GU: Within normal limits

• Neurologic: Within normal limits

• Integumentary: No abnormal findings

 Sodium: 140 mEq/L
Potassium: 2.9 mEq/L
BUN: 24 mg/dL
Creatinine: 1.4 mg/dL
eGFR: 40 mL/minute/1.73 m2
Blood pressure: 138/88 mm Hg
Heart rate: 76 beats/min
Respiratory rate: 16 breaths/min
Oxygen saturation: 98% on room air
Height: 5'9"
Weight: 191 lb

Read the following clinical scenario to answer the questions that follow. This case study is a follow-up from Case Study Parts A and B.

Gordon Jefferson is following up with the health care provider 3 months after his initial diagnosis of edema. He reports that the swelling in his legs has improved; however, he is now reporting generalized weakness. The health care provider examines the client and reviews the chemistry panel results from laboratory work drawn earlier in the morning. Gordon says he has been taking his prescribed medications:

Current Medications
Losartan 50 mg orally daily
Dapagliflozin 10 mg orally daily
Metolazone 10 mg orally daily

The health care provider diagnoses the client with hypokalemia, prescribes a potassium supplement, and recommends a low-sodium diet with potassium-rich foods.

When reviewing Gordon’s medications, the nurse should remind him to immediately report which of the following symptoms?
  1. a.
    Weight gain of 2 pounds in 1 week
  2. b.
    Increased urine output
  3. c.
    A slower than normal heart rate
  4. d.
    Dry mouth

Answer

C. A slower than normal heart rate
Thiazide diuretics can cause hypokalemia, which can cause changes in heart rate and rhythm.

34-1 §34.RQ source ↗

Which symptom is most likely to occur in a client who is taking furosemide?
  1. a.
    Bradycardia
  2. b.
    Chest pain
  3. c.
    Muscle weakness
  4. d.
    More concentrated urine

Answer

C. Muscle weakness
The diuretic effect of furosemide can cause electrolyte abnormalities such as hyponatremia and hypokalemia, which cause weakness.

34-2 §34.RQ source ↗

Which statement indicates that the client needs additional education on their newly prescribed medication, amiloride?
  1. a.
    “I will take this medication first thing in the morning.”
  2. b.
    “I will report any weight loss that occurs after I start taking it.”
  3. c.
    “I will avoid taking nonsteroidal anti-inflammatory medications.”
  4. d.
    “I will switch to a salt substitute containing potassium chloride.”

Answer

D. “I will switch to a salt substitute containing potassium chloride.”
Amiloride is a potassium-sparing diuretic, so salt substitutes containing potassium should be avoided.

34-3 §34.RQ source ↗

Which eGFR value is consistent with a client who has chronic renal disease?
  1. a.
    90 mL/minute/1.73 m2
  2. b.
    75 mL/minute/1.73 m2
  3. c.
    45 mL/minute/1.73 m2
  4. d.
    120 mL/minute/1.73 m2

Answer

C. 45 mL/minute/1.73 m2
An eGFR value less than 60 mL/minute/1.73 m2 for 3 months indicates chronic renal disease.

34-4 §34.RQ source ↗

Which medication increases solute concentration in the blood to drive fluid shifts for excretion?
  1. a.
    Bumetanide
  2. b.
    Mannitol
  3. c.
    Metolazone
  4. d.
    Triamterene

Answer

B. Mannitol
Mannitol is an osmotic diuretic that creates an osmotic gradient that pulls water from cells into the intravascular space.

34-5 §34.RQ source ↗

The nurse is caring for an older adult female client with a history of osteoporosis who was recently diagnosed with hypertension. Which diuretic would be most appropriate for this client?
  1. a.
    Triamterene
  2. b.
    Hydrochlorothiazide
  3. c.
    Spironolactone
  4. d.
    Furosemide

Answer

B. Hydrochlorothiazide
Thiazide diuretics such as hydrochlorothiazide maintain serum calcium levels.

34-6 §34.RQ source ↗

Which sign is most concerning for the client receiving mannitol?
  1. a.
    Lung congestion and peripheral edema
  2. b.
    Increased urine output
  3. c.
    Orthostatic hypotension
  4. d.
    Elevated blood glucose levels

Answer

A. Lung congestion and peripheral edema
Mannitol is contraindicated for clients with heart failure. Lung congestion and peripheral edema are signs of this condition for which the nurse needs to monitor.

34-7 §34.RQ source ↗

The nurse should monitor the client receiving spironolactone for which adverse effect?
  1. a.
    Nausea and vomiting
  2. b.
    Increased intracranial pressure
  3. c.
    Hearing loss
  4. d.
    Cardiac arrhythmias

Answer

D. Cardiac arrhythmias
Clients taking spironolactone are at risk for developing bradycardia.

34-8 §34.RQ source ↗

The nurse is providing discharge teaching for a client who was started on a thiazide diuretic during this hospitalization. Which statement indicates that additional instruction is required?
  1. a.
    “I’m concerned about getting up to go to the bathroom all night every night.”
  2. b.
    “I will let the doctor know if I develop leg cramps.”
  3. c.
    “I need to read food labels to check for salt.”
  4. d.
    “I need to eat some potassium every day for a month or so.”

Answer

A. “I’m concerned about getting up to go to the bathroom all night every night.”
The nurse should instruct the client to take diuretics in the morning to help prevent nocturia.

34-9 §34.RQ source ↗

Which medication could be prescribed to treat hyperkalemia?
  1. a.
    Mannitol
  2. b.
    Hydrochlorothiazide
  3. c.
    Spironolactone
  4. d.
    Furosemide

Answer

D. Furosemide
Loop diuretics cause potassium to be excreted and can be used for clients with hyperkalemia.

34-10 §34.RQ source ↗

Which of the following statements is correct?
  1. a.
    Furosemide is an effective treatment for nephrotic syndrome.
  2. b.
    To be effective, the dose of a diuretic must meet the threshold dose for the drug.
  3. c.
    Diuretic therapy improves clinical outcomes in clients with acute kidney injury.
  4. d.
    Oliguria is an absolute contraindication for diuretic therapy.

Answer

B. To be effective, the dose of a diuretic must meet the threshold dose for the drug.
Diuretics such as furosemide have a threshold dose that is required for response, as well as a ceiling dose beyond which the diuretic effect will not increase.

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Problems and answers are adapted from Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris and Dorie Weaver, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/pharmacology/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.