Nokea
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.
Correct Answer: D
Rationale: Caution must be exercised in the administration of diuretics to 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.
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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.
Correct Answer: C
Rationale: 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 assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency, which would include what symptoms?
- A. Dyspnea
- B. Constipation
- C. Tinnitus
- D. Muscle weakness
- E. Anorexia
- F. Lethargy
Correct Answer: D,E,F
Rationale: Symptoms of hypokalemia include anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension. The other symptoms are not associated with hypokalemia.
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
Correct Answer: B
Rationale: 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 diminish in 2 to 4 days. In addition, hypokalemia and drowsiness may occur. Hypoglycemia is not an adverse effect.
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
Correct Answer: B
Rationale: Mannitol, an osmotic diuretic, is commonly used to reduce intracranial pressure and cerebral edema resulting from head trauma.
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
Correct Answer: A
Rationale: 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.