Nokea
A patient is being discharged to home on a single daily dose of a diuretic. The nurse instructs the patient to take the dose at which time so it will be least disruptive to the patient's daily routine?
- A. In the morning
- B. At noon
- C. With supper
- D. At bedtime
Correct Answer: A
Rationale: It is better to take the diuretic medication early in the morning to prevent urination during the night. Taking the diuretic at the other times may cause nighttime urination and disrupt sleep.
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When monitoring a patient who is taking hydrochlorothiazide, the nurse notes that which drug is most likely to cause a severe interaction with the diuretic?
- A. Digoxin
- B. Penicillin
- C. Potassium supplements
- D. Aspirin
Correct Answer: A
Rationale: There is an increased risk for digitalis toxicity in the presence of hypokalemia, which may develop with hydrochlorothiazide therapy. Potassium supplements are often prescribed with hydrochlorothiazide therapy to prevent hypokalemia. The other options do not have interactions with hydrochlorothiazide.
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.
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.
Furosemide is prescribed for a patient who is about to be discharged, and the nurse provides instructions to the patient about the medication. Which statement by the nurse is correct?
- A. Take this medication in the evening.
- B. Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and dates.
- C. If you experience weight gain, such as 5 pounds or more per week, be sure to tell your physician during your next routine visit.
- D. Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes.
Correct Answer: D
Rationale: Orthostatic hypotension is a possible problem with diuretic therapy. Foods high in potassium should be eaten more often, and the drug needs to be taken in the morning so that the diuretic effects do not interfere with sleep. A weight gain of 5 pounds or more per week must be reported immediately.
A patient is to receive furosemide (Lasix) via a percutaneous endoscopic gastrostomy (PEG) tube. The order reads, "Give furosemide, 60 mg, per PEG tube once daily. The medication is available in a liquid form, 40 mg/5 mL. Identify how many milliliters the nurse will administer for each dose.
Correct Answer: 7.5 mL
Rationale: 40 mg : 5 mL :: 60 mg : x mL; (40 * x) = (5 * 60); 40x = 300; x = 300/40 = 7.5 mL.