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Chapter 12: Drugs That Affect Urine Output


1. For which complication does the nurse remain alert when a patient is taking any type of diuretic?
a. Loss of appetite
b. Bladder spasms
c. Hypertension
d. Dehydration

Any type of diuretic increases water loss through urination. This water loss can cause dehydration if a patient’s fluid intake does not keep pace with his or her urine output.

2. A patient who has been taking a diuretic for the past 2 weeks now experiences all of the following changes. Which change indicates to the nurse that the diuretic is effective?
a. Weight loss of 7 lb
b. Heart rate increased from 72 to 80 beats per minute
c. Respiratory rate decreased from 20 to 16 breaths per minute
d. Morning blood glucose decreased from 142 mg/dL to 110 mg/dL

Diuretic drugs cause water loss and are often prescribed for edema. One liter of water weighs 2.2 lb. In helping the patient rid the body of excess water, the patient is expected to lose weight.

3. A patient prescribed a once-daily diuretic calls the office to report that yesterday’s drug dose was missed. What is the nurse’s best advice?
a. “Take today’s dose now and restrict today’s fluid intake to 1 L.”
b. “Take yesterday’s dose now and take today’s dose after another 6 hours.”
c. “Take today’s dose now and maintain your normal intake of food and fluids.”
d. “Skip today’s doses of all your medications and then begin everything fresh tomorrow.”

Too much time has passed to take both yesterday’s dose and today’s dose. Additional dosing would amount to doubling the dose, which could lead to more side effects and possible complications.

4. The nurse is teaching a patient about diuretic therapy. Which statement made by the patient indicates that more teaching is needed?
a. “I am so thankful that my high blood pressure has been cured by this drug.”
b. “I always try to drink just about the same amount of fluid that I urinate each day.”
c. “I will call my health care provider if my heart rate is less than 60 beats per minute.”
d. “I have been taking this drug early in the day so that I don’t have to get up during the night.”

Diuretics do not cure high blood pressure (hypertension), they only control the problem. If the patient stops taking the diuretic, blood pressure will increase.

5. A patient taking a thiazide diuretic has the following blood laboratory values for kidney function. Which value does the nurse report to the prescriber immediately?
a. Sodium 136 mEq/L
b. Potassium 2.6 mEq/L
c. Creatinine 0.9 mg/dL
d. Blood urea nitrogen 6 mg/dL

Normal blood levels of potassium range between 3.5 and 5.0 mEq/L. The value listed here, 2.6 mEq/L, is low (hypokalemia) and can weaken the skeletal muscles of respiration. Most likely, the diuretic therapy caused the kidneys to excrete too much potassium. Although the blood urea nitrogen level also is lower than normal, it does not pose an immediate health threat.

6. Why does the nurse teach a patient who is prescribed a thiazide diuretic to change positions slowly?
a. Moving rapidly from a standing position to a sitting position can raise blood pressure and increase the patient’s risk for a stroke.
b. Moving rapidly from a standing position to a sitting position can cause excess body fluids to collect in the feet and ankles increasing the patient’s risk for edema.
c. Moving rapidly from a sitting position to a standing position can put pressure on the bladder and increase the patient’s risk for incontinence.
d. Moving rapidly from a sitting position to a standing position can cause blood pressure to drop and increase the patient’s risk for falling.

Diuretics reduce the amount of blood in the circulatory system at any one time, lowering blood pressure. When the patient moves from a sitting position to a standing position too rapidly, blood pressure falls very quickly (orthostatic hypotension), causing too little blood to reach the brain and making the patient dizzy. This can cause the patient to faint or fall.

7. The nurse administers 20 mg of furosemide (Lasix) to a patient by the intravenous (IV) route. Which action is most important for the nurse to take?
a. Give the drug slowly over at least 2 minutes.
b. Check the patient carefully for symptoms of low blood glucose levels.
c. Mix the drug with potassium chloride to prevent a rapid drop in serum potassium levels.
d. Monitor the IV site after giving the drug because furosemide causes severe tissue damage if infiltration occurs.

Furosemide is ototoxic (can reduce hearing). This effect is more likely to occur when the drug is administered intravenously at a rapid rate (faster than 10 mg/min).

8. Which side effect is associated only with loop diuretics?
a. Dizziness
b. Hearing loss
c. Urinary frequency
d. Increased sun sensitivity

All loop diuretics are ototoxic (can cause hearing loss). No other class of diuretics is ototoxic.

9. Which diuretic may cause an adverse effect of a higher than normal serum potassium level?
a. spironolactone (Aldactone)
b. bumetanide (Bumex)
c. chlorothiazide (Diuril)
d. furosemide (Lasix)

Spironolactone (Aldactone) is a potassium-sparing diuretic which reduces the amount of potassium excreted by the kidneys. As a result, serum potassium levels can become higher than normal.

10. A patient is prescribed spironolactone (Aldactone). Why does the nurse advise the patient to avoid the use of salt substitutes?
a. They may cause the patient to be at risk for a high potassium level.
b. They can increase the patient’s risk for hypertension.
c. They may lead to hypokalemia.
d. They can cause water retention.

Most salt substitutes are made by replacing sodium with potassium. Use of salt substitutes at the same time as potassium-sparing diuretics such as spironolactone increases the patient’s risk of a high potassium level (hyperkalemia).

11. A patient who has been taking amiloride (Midamor) for the past 3 months reports that she must shave her legs more frequently. What is the nurse’s best action?
a. Hold the next dose and notify the prescriber immediately.
b. Instruct the patient to stop taking oral contraceptives while she is taking this drug.
c. Document the response and reassure the patient that this is an expected side effect.
d. Ask the patient whether she has noticed any changes in the thickness of her scalp hair.

A common and nonharmful side effect of amiloride and other potassium-sparing diuretics is an increase in body hair (hirsutism) in women. It is not necessary to stop taking this drug.

12. The nurse prepares to give a second dose of furosemide (Lasix) to a patient by intravenous (IV) push. Before the injection is started, the patient reports having chest pain ever since the last dose of the drug. What is the nurse’s best action?
a. Assist the patient to lay flat and encourage him or her to take slow, deep breaths.
b. Document the report as the only action for this expected side effect.
c. Slow the IV drip rate and examine the infusion site for infiltration.
d. Hold the dose and notify the prescriber immediately.

Chest pain is a serious side effect or adverse reaction to furosemide and can indicate that the patient is having a heart attack. Another dose could cause a more severe response. The prescriber should be notified about this response immediately for preventive action.

13. A patient with overactive bladder has been prescribed tolterodine (Detrol). While assessing the patient, the nurse discovers the presence of the following health problems. Which problem causes the nurse to contact the prescriber and question the drug order?
a. Asthma
b. Glaucoma
c. Hypotension
d. Diabetes mellitus

Tolterodine (Detrol) is an anticholinergic drug that can close the angle of the iris of the eye and decrease the outflow of aqueous fluid in the eye. For people who have closed angle glaucoma, the intraocular pressure can become even higher and the risk for blindness increases.

14. A patient is prescribed an extended-release drug for overactive bladder. Which precaution is most important for the nurse to teach the patient?
a. “Avoid taking this drug at bedtime.”
b. “Drink at least 3 L of fluid daily.”
c. “Swallow the tablet or capsule whole.”
d. “Perform a home pregnancy test monthly.”

Extended-release tablets or capsules are meant to release a drug at a relatively even dose throughout the day. Chewing or crushing the drug ruins the timed-release feature and allows most of the drug dose to be absorbed at once. This can cause more side effects and limits how long the drug will be effective.

15. A patient is prescribed a drug for overactive bladder. Which instruction does the nurse provide to prevent a serious complication?
a. “Be sure to let your prescriber know if your symptoms do not improve.”
b. “When using the patch, press it firmly to make sure it stays in place.”
c. “Use alcohol in moderation while taking this drug.”
d. “Avoid becoming overheated or dehydrated.”

Urinary antispasmodic drugs decrease the sweating response, increasing the risk for heat stroke. Patients can reduce this risk by ensuring that they keep themselves well hydrated during exercise or when in hot environments.

16. Which laboratory value is always checked before giving a dose of furosemide (Lasix)?
a. Calcium
b. Magnesium
c. Creatinine
d. Potassium

Blood levels of potassium often decrease when furosemide (a loop diuretic) is administered, causing dry mouth, increased thirst, irregular heartbeat, mental and mood changes, muscle cramps or muscle pain, nausea and vomiting, tiredness, weakness, and weak pulses.

17. What must the nurse teach a patient who is taking a diuretic drug?
a. Avoid foods that are rich in potassium such as bananas and broccoli.
b. Sit on the side of the bed for 1 to 2 minutes before getting out of bed.
c. Notify the prescriber if the heart rate is less than 70 beats per minute.
d. Keep a record of dietary intake for a few weeks.

A common side effect of diuretics is hypotension and patients should be advised to change positions slowly. Patients should also be taught the signs of hypotension such as dizziness and light-headedness.

18. What is the most common side effect of drugs used for benign prostate hypertrophy (BPH)?
a. Low blood pressure
b. Decreased libido
c. Light-headedness
d. Hair loss

Side effects of drugs used for BPH also include erectile dysfunction, decreased seminal fluid, and reduced fertility. The most common side effect of these drugs is a decreased interest in sexual activity.

19. An 82-year-old-man is prescribed a dihydrotestosterone (DHT) inhibitor to treat benign prostatic hypertrophy (BPH). Which health promotion activity is most important for the nurse to teach this patient?
a. Have vision and glaucoma checks yearly.
b. Participate in yearly prostate cancer screening.
c. Avoid both alcohol and caffeine while on the drug.
d. Avoid donating blood when taking the drug and for at least 6 months after drug therapy has stopped.

The symptoms of BPH and prostate cancer are the same. Prostate cancer is the most common cancer type in older men. DHT inhibitors improve the symptoms of obstruction, which can mask the presence of prostate cancer. Although younger men should be cautioned not to donate blood during therapy and for 6 months after therapy (because the drug in the blood could cause birth defects if a pregnant woman received the blood), most blood centers do not permit people older than 75 years to donate blood.

20. A patient has received furosemide (Lasix), 40 mg orally, 30 minutes ago. To prevent injury to the patient, what does the nurse do?
a. Assist the patient to the bathroom
b. Keep the patient on bed rest
c. Place all four side rails in the elevated position
d. Ask the patient to get out of bed rapidly

An expected action of diuretic drugs is loss of excess fluid. This can lead to hypovolemia with signs of decreased volume including dizziness and lightheadedness. To provide a safe environment for the patient, the nurse should ensure that the patient has assistance when getting out of bed.

21. A patient who is prescribed hydrochlorothiazide (HCTZ) informs the nurse that she plans to become pregnant. What does the nurse include in a care plan for the patient about this drug?
a. This drug is safe for use during pregnancy and breastfeeding.
b. The prescriber will most likely decrease your dose while you are pregnant.
c. You may take this drug during pregnancy, but should not use it if you plan to breastfeed.
d. This drug should be avoided during pregnancy and breastfeeding.

Thiazide diuretics should be avoided during pregnancy because they may cause side effects in the newborn, including jaundice and low potassium levels. Thiazide diuretics should also be avoided during breastfeeding because they pass into breast milk. The action of these drugs may decrease the flow of breast milk.

22. A patient taking tolterodine (Detrol) reports decreased urination, ankle swelling, and a weight gain of 5 pounds over the past 2 days. What does the nurse do next?
a. Holds the dose and notifies the prescriber
b. Checks the patient’s blood pressure and heart rate
c. Gives the dose as prescribed
d. Documents the finding as the only action

Adverse effects of drugs for overactive bladder include chest pain, fast or irregular heart rate, shortness of breath, swelling (edema) and rapid weight gain, confusion, and hallucinations. Additionally, these drugs may cause decreased urination or no urine output, and painful or difficult urination. The dose should be held and the prescriber notified.

23. A patient taking tamsulosin (Flomax) asks the nurse how the drug works. What is the nurse’s best response?
a. “This drug works on your prostate gland to decrease its size.”
b. “This drug signals the cells in your prostate gland not to grow.”
c. “This drug works by relaxing the detrusor muscle of your bladder.”
d. “This drug relaxes muscle around your urethra to improve urine flow.”

Tamsulosin is a selective alpha-1 blocker that acts to relax smooth muscle tissue in the prostate gland, the neck of the bladder, and in the urethra. When these receptors are bound with selective alpha-1 blockers, the smooth muscle relaxes, placing less pressure on the urethra and improving urine flow.

24. Which test or examination does a patient receive before taking any drug for benign prostate hypertrophy (BPH)?
a. Digital rectal examination
b. 24-hour urinalysis
c. Kidney function test
d. Urine culture

The signs and symptoms of BPH are the same as for prostate cancer. Before a drug for BPH is taken, the patient should have a digital rectal examination by his prescriber and have his blood tested for prostate specific antigen levels to rule out prostate cancer.

25. A patient taking finasteride (Proscar) informs the nurse that he is also taking the herbal supplement saw palmetto. What is the nurse’s best response?
a. “You should not take finasteride and saw palmetto at the same time.”
b. “Finasteride and saw palmetto taken together increase your risk of bleeding.”
c. “Be sure to notify your prescriber if you notice any unusual side effects.”
d. “Avoid people with viral infections while taking these two substances.”

Some common herbal preparations, including saw palmetto and soy isoflavones, have an action similar to DHT inhibitors. It is possible that a man taking a DHT inhibitor such as finasteride with one of these herbs could increase effects, including increased side effects.
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