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Questions and Answers
Which of the following best describes the primary mechanism of action (MOA) of furosemide?
Which of the following best describes the primary mechanism of action (MOA) of furosemide?
A patient is prescribed furosemide. Which of the following electrolyte imbalances is a common adverse effect associated with this medication?
A patient is prescribed furosemide. Which of the following electrolyte imbalances is a common adverse effect associated with this medication?
A patient taking furosemide will need to be monitored for which of the following potential adverse effects?
A patient taking furosemide will need to be monitored for which of the following potential adverse effects?
Why is it important to check a patient's potassium level before administering Lasix?
Why is it important to check a patient's potassium level before administering Lasix?
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A patient is started on furosemide. The nurse should plan to monitor which of the following to evaluate the therapy effectively?
A patient is started on furosemide. The nurse should plan to monitor which of the following to evaluate the therapy effectively?
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What is considered the normal Glomerular Filtration Rate (GFR)?
What is considered the normal Glomerular Filtration Rate (GFR)?
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If a patient gains 3 or more pounds in a few days of diuretic therapy, what should the patient do?
If a patient gains 3 or more pounds in a few days of diuretic therapy, what should the patient do?
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What is the best way to administer furosemide IV?
What is the best way to administer furosemide IV?
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Which diuretic is classified as a potassium-wasting diuretic?
Which diuretic is classified as a potassium-wasting diuretic?
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A patient is prescribed hydrochlorothiazide. What electrolyte imbalance should the nurse monitor for?
A patient is prescribed hydrochlorothiazide. What electrolyte imbalance should the nurse monitor for?
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Which diuretic works by creating an osmotic action that inhibits passive reabsorption of water in the proximal convoluted tubule?
Which diuretic works by creating an osmotic action that inhibits passive reabsorption of water in the proximal convoluted tubule?
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A patient has a low glomerular filtration rate (GFR) of 10 mL/min. Which diuretic would be least effective for this patient?
A patient has a low glomerular filtration rate (GFR) of 10 mL/min. Which diuretic would be least effective for this patient?
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What is the primary mechanism of action for spironolactone?
What is the primary mechanism of action for spironolactone?
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A patient taking hydrochlorothiazide is at risk of digoxin toxicity. Why is this?
A patient taking hydrochlorothiazide is at risk of digoxin toxicity. Why is this?
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Which condition is a contraindication for the use of hydrochlorothiazide?
Which condition is a contraindication for the use of hydrochlorothiazide?
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A patient is prescribed mannitol. What route of administration is appropriate for this drug?
A patient is prescribed mannitol. What route of administration is appropriate for this drug?
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Which of the following adverse effects is most associated with the use of spironolactone (Aldactone)?
Which of the following adverse effects is most associated with the use of spironolactone (Aldactone)?
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What is the primary mechanism of action of triamterene?
What is the primary mechanism of action of triamterene?
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A patient is prescribed spironolactone and an ACE inhibitor. Why should caution be exercised in this combination?
A patient is prescribed spironolactone and an ACE inhibitor. Why should caution be exercised in this combination?
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Which of the following is a contraindication while taking triamterene?
Which of the following is a contraindication while taking triamterene?
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What is the primary indication for potassium chloride (KCl) supplementation?
What is the primary indication for potassium chloride (KCl) supplementation?
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Which of the following is NOT an adverse effect of oral potassium chloride?
Which of the following is NOT an adverse effect of oral potassium chloride?
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A patient is prescribed a medication to counteract the potassium-wasting effects of another diuretic. Which medication is MOST likely being used for this purpose?
A patient is prescribed a medication to counteract the potassium-wasting effects of another diuretic. Which medication is MOST likely being used for this purpose?
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Which of the following best describes the use of potassium chloride (KCl) as an intravenous (IV) infusion?
Which of the following best describes the use of potassium chloride (KCl) as an intravenous (IV) infusion?
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Which of the following is NOT a potential side effect of potassium chloride (KCl) administration?
Which of the following is NOT a potential side effect of potassium chloride (KCl) administration?
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A patient is prescribed oral potassium chloride (KCl) in large pill form. Which of the following instructions should the nurse provide?
A patient is prescribed oral potassium chloride (KCl) in large pill form. Which of the following instructions should the nurse provide?
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A patient is taking liquid potassium chloride (KCl). How should the nurse instruct the patient to take this medication?
A patient is taking liquid potassium chloride (KCl). How should the nurse instruct the patient to take this medication?
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Which of these is the most dangerous protocol related to intravenous (IV) potassium chloride (KCl) administration that the nurse must NEVER do?
Which of these is the most dangerous protocol related to intravenous (IV) potassium chloride (KCl) administration that the nurse must NEVER do?
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Which of the following lab values would indicate mild hyperkalemia?
Which of the following lab values would indicate mild hyperkalemia?
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A patient has severe hyperkalemia. Which of the following symptoms is most concerning for the nurse to assess?
A patient has severe hyperkalemia. Which of the following symptoms is most concerning for the nurse to assess?
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Which of the following medications does NOT directly contribute to the removal of potassium from the body?
Which of the following medications does NOT directly contribute to the removal of potassium from the body?
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A patient with hyperkalemia receives Kayexalate. What is the primary mechanism of action of this medication?
A patient with hyperkalemia receives Kayexalate. What is the primary mechanism of action of this medication?
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What is the primary mechanism of action for atropine in the cardiovascular system?
What is the primary mechanism of action for atropine in the cardiovascular system?
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Which of the following is a potential adverse effect associated with the use of atropine?
Which of the following is a potential adverse effect associated with the use of atropine?
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Prazosin is classified as which type of adrenergic antagonist?
Prazosin is classified as which type of adrenergic antagonist?
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A patient taking prazosin reports dizziness upon standing. What is the most likely cause?
A patient taking prazosin reports dizziness upon standing. What is the most likely cause?
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How do beta blockers generally affect the heart?
How do beta blockers generally affect the heart?
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What is a crucial consideration when discontinuing beta-blocker therapy, such as with propranolol?
What is a crucial consideration when discontinuing beta-blocker therapy, such as with propranolol?
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Which adrenergic receptor is primarily responsible for increasing heart rate and force of contraction?
Which adrenergic receptor is primarily responsible for increasing heart rate and force of contraction?
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Propranolol’s effect on the lungs is due to blockade of which type of receptor?
Propranolol’s effect on the lungs is due to blockade of which type of receptor?
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Which of the following drug combinations would you be most concerned about with regards to cardiac suppression?
Which of the following drug combinations would you be most concerned about with regards to cardiac suppression?
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A nurse is about to administer propranolol to a patient. Which assessment finding would require the nurse to hold the medication?
A nurse is about to administer propranolol to a patient. Which assessment finding would require the nurse to hold the medication?
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Study Notes
Diuretics & Cardiac Drugs
- Diuretics increase urine output (diuresis).
- Normal urine output is 30 mL/hour or greater.
- Normal GFR is 125 mL/hr.
- Normal output is about 60 mL/hr.
- Diuretics maintain extracellular fluid (ECF) by filtering, reabsorbing, and secreting in kidneys.
Furosemide (Lasix)
- Classification: Loop diuretic, potassium-wasting
- Mechanism of Action (MOA): Rapidly acting loop diuretic inhibiting Na/Cl reabsorption in the ascending loop of Henle, decreasing edema and blood pressure.
- Uses: Powerful diuretic for fluid movement in acute conditions or congestive heart failure (CHF). Thiazides are generally preferred when possible.
- Dosage/Route: PO, IV, or IM; 20-80 mg; IV begins in 5 minutes and lasts for 2 hours.
- Adverse effects: Postural hypotension, hypokalemia, hyponatremia, hypomagnesemia, hyperchloremia, nausea/vomiting, dehydration, tinnitus, aplastic anemia, and circulatory collapse.
- Drug Interactions: Increased risk of digoxin toxicity with low potassium; combined use with other ototoxic drugs (e.g., aminoglycosides) can cause hearing loss; combined with other antihypertensive drugs may cause hypotension, and combined with lithium may cause high sodium levels.
Hydrochlorothiazide (Hydrodiuril)
- Classification: Thiazide diuretic, potassium-wasting
- MOA: Blocks Na/Cl reabsorption in the early distal convoluted tubule. Less effective at lower GFR (15-20 mL/min).
- Uses: High blood pressure (HTN), mild to moderate heart failure (HF), mobilizes edema associated with liver or renal disease.
- Dose/Route: PO, varies by formulation.
- Adverse effects: Hyponatremia, hypochloremia, dehydration, hypokalemia, fetal harm (if taken during pregnancy), elevation of blood glucose (in diabetics), gout.
- Drug Interactions: Promotes digoxin toxicity, increase risk of hypotension with other antihypertensives.
- Patient Education: Not given to pregnant or breastfeeding patients, diabetics, or those with gouty arthritis. Monitor potassium, sodium, and chloride levels. Increase potassium intake.
Mannitol (Osmitrol)
- Classification: Osmotic diuretic
- MOA: Creates osmotic action in proximal convoluted tubules, preventing reabsorption of water, thus increasing urine output. Little effect on potassium excretion.
- Uses: Reduces intracranial pressure (ICP) in cases of cerebral edema, prevents/slows renal failure (RF) in severe high blood pressure (HTN) or hypovolemic shock. Reducing intraocular pressure.
- Dose/Route: IV infusion (hospital use only); 5-25% solution; warmed in water.
- Adverse Effects: Headache, nausea, vomiting, electrolyte imbalances, pulmonary edema, and congestive heart failure (CHF) edema.
Spironolactone (Aldactone)
- Classification: Potassium-sparing diuretic (aldosterone antagonist)
- MOA: Blocks aldosterone's action in the distal nephron. Aldosterone promotes sodium absorption and potassium loss; blockade leads to potassium retention and sodium loss.
- Uses: High blood pressure (HTN) and edema; usually combined with loop or thiazide diuretics.
- Adverse effects: Hyperkalemia (greater than 5.0 mEq/L). Endocrine side effects like gynecomastia and menstrual irregularities.
- Drug Interactions: Use caution when combined with ACE inhibitors, ARBs, or direct renin inhibitors.
- Patient Education: Monitor potassium levels. Do not use with other potassium-sparing drugs.
Triamterene (Dyrenium)
- Classification: Potassium-sparing diuretic (non-aldosterone sparing)
- MOA: Disrupts sodium-potassium exchange directly in the distal nephron.
- Uses: High blood pressure (HTN) and edema, counteracts potassium-wasting effects of other diuretics.
- Adverse effects: Nausea/Vomiting, leg cramps, dizziness, and hyperkalemia.
- Drug Interactions: Use caution when combined with ACE inhibitors, ARBs, and direct renin inhibitors.
- Patient Education: Monitor potassium levels. Do not use with other potassium-sparing drugs.
Potassium Supplements
- Classification: Potassium supplements
- MOA: Replaces potassium, essential for nerve impulse transmission and muscle function.
- Uses: Potassium deficiency.
Other Drugs
- Other diuretics and drug classes are discussed in the provided text including oral potassium chloride, and other treatments of high blood pressure.
- Different classes of heart medications are also mentioned along with indications and adverse effects.
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Description
This quiz covers essential concepts related to diuretics, particularly furosemide (Lasix) and hydrochlorothiazide. Questions focus on their mechanisms of action, common side effects, monitoring parameters, and administration techniques. It's designed for nursing students and professionals to enhance their understanding of diuretic therapy.
