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45 Cards in this Set

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Diuretics are drugs that increase renal excretion of water, sodium, and other electrolytes, thereby increasing urine formation and ___________
output
The primary function of the kidneys is to regulate the volume, _____________, and pH of body fluids.
Composition
Each nephron is composed of a _____________ and a tubule.
Glomerus
The glomerulus is a network of __________ that receives blood from the renal artery.
Capillaries
__________ __________ is a thin walled structure that surrounds the glomerulus then narrows and continues as the tubule.
Bowman's capsule
act at the distal tubule to decrease sodium re-absorption and potassium excretion.
Potassium sparing diuretics
Produce rapid diuresis by increasing the solute load (osmotic pressure) of the glomerular filtrate
Osmotic agents
Synthetic drugs that are chemically related to the sulfonamides.
Thiazide Diuretics
Used to prevent potassium imbalances.
Diuretic combinations
Diuretics that inhibit sodium and chloride re-absorption in the ascending limb of the loop of Henle
Loop diuretics
Explain how convoluted tubules enhance renal function.
The tubules are often called convoluted tubules because of their many twists and turns. The convolutions provide a large surface area that brings the blood flowing through the peritubular capillaries and the glomerular filtrate flowing through the tubular lumen into close proximity.
Describe the process of glomerular filtration.
The nephron functions by three processes: glomerular filtration, tubular re absorption, and tubular secretion. These processes normally maintain the fluid volume, electrolyte concentration, and pH of body fluids with in a relatively narrow range. They also remove waste products of cellular metabolism. A minimum daily urine output of aproximately 400mL is required to remove normal amounts of metabolic end products.
What happens to the fluid processed during glomerular filtration?
The glomerular filtration rate (GFR) is about 180L per day or 125mL per minute. Most of this fluid is reabsorbed as the glomerular filtrate travels through the tubules. The end product is about 2L of urine daily. Because filtration is a non-selective process the re absorption and secretion processes determine the composition of the urine. After it is formed urine flows into collecting tubules which carry it to the renal pelvis, then through the ureters bladder and urethra for elimination from the body.
What happens to blood that does not become part of the glomerular filtrate?
Blood that does not become part of the glomerular filtrate leaves the glomerulus through the efferent arteriole. The efferent arteriole branches into the peritubular capillaries that eventually empty into veins, which return the blood to systemic circulation.
Mrs. Watson, age 75, is diagnosed with atrial fibrillation and chronic congestive heart failure. The physician orders a combination of digoxin and diuretics to treat her diseases. recent laboratory results indicate that the clients potassium level is 2mEq/L. The patient is at risk for which of the following?

a. Exacerbation of the atrial fibrillation

b. Subtherapeutic levels of serum digoxin.

c. Digoxin toxicity

d. Congestive heart failure.
c

Rationale: When digoxin and diuretics are given concomitantly, the risk of digoxin toxicity is increased due to diuretic induced hypokalemia.
Mr. Bingham presents to the emergency room with shortness of breath, dizziness, and confusion. He is diagnosed with severe congestive heart failure. The physician orders high dose furosemide continuous IV infusions. You would expect that the rate of dosage would be which of the following to decrease adverse effect?

a. 4mg/min or less

b. 5mg/min or less

c. 6mg/min or less

d. 8mg/min or less
a

Rationale: High dose furosemide continuous IV infusions should be given at a rate of 4mg/min or less to decrease or avoid risks of adverse effects including ototoxicity.
Mrs. Carter is diagnosed with chronic congestive heart failure and hypertension. You would expect the physician to order which of the following types of diuretics?

a. Hydrochlorothiazide

b. Furosemide

c. Bumetanide

d. Torsemide
a

Rationale: Thiazides and related diuretics are the drugs of choice for most patients who require diuretic therapy, especially for long term management of the heart failure and hypertension.
There is a known cross sensitivity of some sulfonamide allergic patients to which of the following sulfonamide non antibiotics?

a. Hydrochlorothiazide

b. Furosemide

c. Bumetanide

d. Torsemide
a

Rationale: There is a known cross sensitivity of some sulfonamide allergic patients to sulfonamide non antibiotics such as thiazides.
Mr. Hackmore is prescribed potassium sparing diuretics to treat his disease process. During his annual visit to the physician he complains that he is experiencing muscle weakness and tingling in his fingers. Which of the following conditions do you suspect?

a. Hypokalemia

b. Hyperkalemia

c. Hypocalcemia

d. Hypercalcemia
b

Rationale: Potassium sparing diuretics are contraindicated in patients with renal impairment because of the high risk of hypekalemia.
Mrs. Kingman is diagnosed with hyponatremia. Which of the following diuretics would most likely promote this symptom?

a. Osmotic

b. Thiazide

c. Potassium sparing

d. Loop
d

Rationale: Loop diuretics have a sodium losing effect up to 10times greater than that of thiazide diuretics.
Mr. Tabor is excited because it is football season. he has season tickets and attends most games with his friends. At his latest appointment, Mr. Tabors blood pressure is elevated. Which of the following do you suspect is the cause?

a. He is anxious about his team.

b. He is consuming excessive salty foods at the games.

c. He is developing comorbidities.

d. He has become a vegetarian until his team wins the championship.
b

Rationale: Excessive table salt and salty foods may aggravate edema or hypertension.
A body weight change of _________ lbs or _________ kg may indicate a gain or loss of 1000mL of fluid.
2.2lbs or 1kg
Diuretic drugs act on the kidneys to decrease ___________ of sodium, chloride, water, and other substances.
Re-absorption
Diuretics are often taken in the home setting. The home care nurse may need to assist patients and caregivers by doing which of the following tasks? (select all that apply)

a. Monitoring patient responses

b. Assessing use of over the counter medications that may aggravate the patients condition.

c. Weighing the patient daily

d. Appropriation all sodium rich foods in the home.
a,b

Rationale: Diuretics are often taken in the home setting. The home care nurse may need to assist patients and caregivers in using the drugs safely and effectively; monitor patients responses (ex. with each home visit, assess nutritional status, blood pressure, weight, use of over the counter medications that may aggravate edema or hypertension); and provide information as indicated.
Mr. Gardner is critically ill with a diagnosis of congestive heart failure exacerbated by a myocardial infraction. Which of the following fast acting diuretics would be appropriate for the physician to order? (select all that apply)

a. Furosemide

b. Diazide

c. Hydrochlorothiazide

d. Bumetanide
a,d


Rationale: Fast acting potent diuretics such as furosemide and bumetanide ae the most likely diuretics to be used in critically ill patients (ex. those with pulmonary edema)
Which of the following methods of administration of fast acting diuretics would be most effective and least likely to produce adverse effects in a critically ill client with pulmonary edema?

a. IV bolus doses

b. Continuous intravenous infusion

c. Subcutaneous doses

d. Intramuscular doses
b

Rationale: Although IV bolus doses of drugs are often given to critically ill clients continuous IV infusions may be more effective and less likely to produce adverse effects in critically ill patients.
Although they are needed to reduce ascites in clients with hepatic impairment, diuretics may precipitate which of the following conditions?

a. Ammonia absorption

b. Sub-therapeutic drug levels

c. Hepatic encephalopathy

d. Hepatomegaly
c

Rationale: Diuretics are often used to manage edema and ascites in patients with hepatic impairment. These drugs must be used with caution, because diuretic induced fluid and electrolyte imbalances may precipitate or worsen hepatic encephalopathy and coma.
To prevent metabolic alkalosis or hypokalemia, which of the following drugs may be administered to patients with cirrhosis in addition to diuretic therapy?

a. Spironolactone

b. Diazide

c. Hydrochlorothiazide

d. Bumetanide
a

Rationale: Patients with cirrhosis, diuretic therapy should be initiated in a hospital setting, with small doses an careful monitoring. To prevent hypokalemia and metabolic alkalosis supplemental potassium or spironolactone may be needed.
Potassium sparing diuretics are contraindicated in patients with renal impairment because of he high risk of hyperkalemia. If they are used at all which of the following would be a priority?

a. Administration of concurrent potassium.

b. Monitoring of serum electrolytes, creatinine, and BUN

c. Administration of a thiazide diuretic

d. Monitoring of CBC and serum albumin
b

Rationale: Potassium sparing diuretics are contraindicated in patients with a renal impairment because of the high risk of hyperkalemia. If they are used at all frequent monitoring of serum electrolytes, creatinine, and BUN is needed.
To prevent accelerated degradation of furosemide which of the following IV solutions should be used to mix the drug?

a. D5W

b. D 51/2 NS

c. Lactated ringers solution

d. D 51/4 NS
c

Rationale: For continuous infusion furosemide should be mixed with NS or lactated ringers solution
Mr. Andrews age 71 is hospitalized with pulmonary edema; he is discharged with a prescription for a loop diuretic. He presents to the physicians office 1 wk later with symptoms indicating excessive diuresis. This patient is also at risk for which of the following?

a. Rebound hypertension

b. Hypervolemia

c. Embolism

d. Gastric ulcer disease
c

Rationale: With loop diuretics older adults are at greater risk of excessive diuresis, hypotension, fluid volume deficit, and possibly thrombosis or embolism.
The physician orders hydrochlorothiazide for Mr. Bunting. He has multiple comorbidities, and the physician chooses the smallest effective dose of the drug. You expect the physician to order a daily dose in which of the following ranges?

a. 0.25 to 0.50mg

b. 0.50 to 0.75mg

c. 8 to 12mg

d. 12.5 to 25mg
d

Rationale: The smallest effective dose to treat elder adults in need of diuresis is recommended usually a daily dose of 12.5 to 25 mg of hydrochlorothiazide or equivalent doses of other thiazides and related drugs.
Thiazide drugs become ineffective when the GFR is less than which of the following levels?

a. 30mL/min

b. 40mL/min

c. 50mL/min

d. 60mL/m
a

Rationale: Thiazides may be useful in managing edema caused by renal disorders such as nephrotic syndrome and acute glomerulonephritis. However, their effectiveness decreases as the GFR decreases, and the drugs become ineffective when the GFR is less than 30mL/min.
The physician orders furosemide for your pediatric client. The established dose of the drug should not exceed how many milligrams per kilogram of body weight per day?

a. 4

b. 6

c. 8

d. 10
b

Rationale: Furosemide is a loop diuretic used most often in children. Oral therapy is preferred when feasible, as doses greater than 6mg/kg of body weight per day are not recommended.
What is BUN and its normal range?
Blood Urea Nitrogen (BUN)
Normal range 8 - 20mg/DL
If the BUN is increased what does it mean?
increased in: Renal failure (acute or chronic), urinary tract obstruction, dehydration, shock, burns, CHF, gastrointestinal bleeding. Drugs with renal toxicity, eg, gentamicin.
If BUN is decreased what does this mean?
Decreased in: Hepatic failure, nephrotic syndrome, cachexia (low-protein and high-carbohydrate diets).
If you have an increase in Phosphorous what does it mean and what are the normal ranges?
Normal Range: 2.5-4.5 mg/dL

increased in can indicate renal failure, massive blood transfusion, sarcoidosis, neoplasms, adrenal insufficiency, acromegaly, hypoparathyroidism, hypervitaminosis D, phosphate infusions or enemas, osteolytic metastases to bone, leukemia, milk-alkali syndrome, healing bone fractures, pseudohypoparathyroidism, diabetes mellitus with ketosis, malignant hyperpyrexia, cirrhosis, lactic acidosis, respiratory acidosis. Drugs: eg, anabolic steroids, ergocalciferol, furosemide, hydrochlorothiazide and others.
If you have a decrease in phosphorous what does this mean?
Decreased in: Hyperparathyroidism, hypovitaminosis D (rickets, osteomalacia), malabsorption (steatorrhea); malnutrition, starvation or cachexia; GH deficiency, chronic alcoholism, severe diarrhea, vomiting, nasogastric suction, severe hypercalcemia (any cause), acute gout, osteoblastic metatases to bone, severe burns (diuretic phase), respiratory alkalosis, hyperalimentation with inadequate phosphate repletion, carbohydrate administration (intravenous), renal tubular acidosis and other renal tubular defects, diabetic ketoacidosis (during recovery), acid-base disturbances, hypokalemia, pregnancy, hypothyroidism; prolonged use of thiazides, glucose infusion, salicylates (toxicity). Drugs: eg, phosphate-binding antacids, anticonvulsants, estrogens, isoniazid, oral contraceptives.
___________ diuretic are synthetic drugs that are chemically related to sulfonamides and differ mainly in their duration of action. They are frequently prescribed in the long term management of heart failure and hypertension. They act to decrease re-absorption of sodium, water, chloride, and bicarbonate in the distal convoluted tubule. They work best only when urine flow is adequate.
Thiazides
____________ diuretics may be given orally or IV. They inhibit sodium and chloride re-absorption in the ascending limb of the loop of Henle and their effects are rapid occurring within 30 to 60mins. It is the diretics of choice for treatment of pulmonary edema. Contraindicated during pregnancy unless absolutely necessary.
Loop Diuretics
What are the thiazide diuretics?
1. Chlopothiazide
2. Chlorthalidone
3. Hydrochlorothiazide
4. Indapamide
5. Metolazone
What are the Loop diuretics?
1. Bumetanide
2. Ethacrynic acid
3. Furosemide
4. Torsemide
What are the potassium sparing diuretics?
1. Amiloride
2. Spironolactone
3. Triamterene
What are the Osmotic agents?
1. Glycerin
2. Mannitol