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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.
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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.
The nurse is monitoring a patient who is taking a potassium-sparing diuretic. Which of the drugs or drug classes may have an interaction with this type of diuretic?
- A. Lithium
- B. Vancomycin
- C. Potassium supplements
- D. NSAIDs
- E. Antidiabetic drugs
- F. ACE Inhibitors
Correct Answer: A,C,D,F
Rationale: Taking lithium with potassium-sparing diuretics may cause lithium toxicity; taking ACE inhibitors or potassium supplements may lead to hyperkalemia. Taking NSAIDs with potassium-sparing diuretics may cause a decreased diuretic response. There are no interactions with vancomycin or antidiabetic drugs and potassium-sparing diuretics.
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.
When a patient is receiving diuretic therapy, which of these assessment measures would best reflect the patient's fluid volume status?
- A. Blood pressure and pulse
- B. Serum potassium and sodium levels
- C. Intake, output, and daily weight
- D. Measurements of abdominal girth and calf circumference
Correct Answer: C
Rationale: Urinary intake and output and daily weights are the best reflections of a patient's fluid volume status.
The order for a child reads, "Give furosemide (Lasix) 2 mg/kg IV STAT. The child weighs 44 pounds. Identify how many milligrams the child will receive for this dose.
Correct Answer: 40 mg
Rationale: First, convert 44 pounds to kilograms: 44 pounds ?· 2.2 = 20 kg. Next, calculate mg/kg: 2 mg/kg ?? 20 kg = 40 mg.