Giving an IV loop diuretic too rapidly raises the risk of ototoxicity, damage to the inner ear that can cause tinnitus and hearing loss.
Missing Word
ototoxicity
Ototoxicity from loop diuretics is linked to rapid injection, high doses, severe kidney impairment and combination with other ear-damaging drugs, so IV doses are pushed slowly and hearing changes are reported.
Category: Loop Diuretics
Question 2
By increasing urinary loss of chloride and hydrogen ions, loop diuretics can cause metabolic alkalosis.
Missing Word
alkalosis
Losing chloride and hydrogen ions and shrinking the extracellular volume raises serum bicarbonate, producing metabolic alkalosis, which thiazides can also cause.
Category: Loop Diuretics
Question 3
Along with calcium, loop diuretics increase urinary loss of magnesium, the other divalent cation normally reabsorbed in the thick ascending limb.
Missing Word
magnesium
Blocking the loop's sodium-potassium-chloride carrier removes the electrical gradient that drives calcium and magnesium reabsorption, so long-term therapy can lower serum magnesium.
Category: Loop Diuretics
Question 4
Hydrochlorothiazide can trigger acute angle-closure glaucoma, so sudden eye pain or blurred vision after starting the drug is reported to the provider at once.
Missing Word
glaucoma
Hydrochlorothiazide, a sulfonamide, can cause an idiosyncratic reaction with acute myopia and angle-closure glaucoma, typically soon after the drug is started; the drug is stopped as quickly as possible because untreated glaucoma can cause permanent vision loss.
Category: Thiazide Diuretics
Question 5
Urine output that drops well below normal but has not stopped completely is called oliguria, a finding the nurse reports in a patient receiving diuretic therapy.
Missing Word
oliguria
Oliguria is scant urine output, as opposed to anuria, which is no output; during diuretic therapy it can signal volume depletion or kidney injury, so intake, output and kidney function are tracked closely.
Category: Diuretic Nursing Care
Question 6
The thiazide diuretic that can be given intravenously, for patients who cannot take oral therapy, is chlorothiazide.
Missing Word
chlorothiazide
Chlorothiazide is available as an injection as well as orally, while most other thiazide and thiazide-like diuretics are oral only.
Category: Thiazide Diuretics
Question 7
Loop and thiazide diuretics can rarely cause pancreatitis, an inflammation that presents with severe upper abdominal pain.
Missing Word
pancreatitis
Drug-induced pancreatitis is uncommon with diuretics but most likely in patients with a history of it, so new severe abdominal pain is reported.
Category: Diuretic Nursing Care
Question 8
The mineralocorticoid receptor antagonist approved to treat primary hyperaldosteronism is spironolactone.
Missing Word
spironolactone
Spironolactone blocks aldosterone at its receptor and is used for primary hyperaldosteronism, heart failure, resistant hypertension and edema; eplerenone is not approved for this adrenal disorder.
Category: Potassium-Sparing Diuretics
Question 9
Because of its antiandrogen action, one aldosterone blocker is prescribed off-label for hirsutism, excess male-pattern hair growth in women.
Missing Word
hirsutism
Spironolactone blocks androgen receptors as well as aldosterone receptors, which explains both this off-label use for hirsutism and acne and its endocrine adverse effects.
Category: Potassium-Sparing Diuretics
Question 10
Mannitol is infused through an administration set with a filter so that crystals cannot enter the bloodstream.
Missing Word
filter
Mannitol solutions can form crystals, and the filter traps any that remain; the solution is also inspected before use and is not given with blood through the same set.
Category: Osmotic Diuretics
Question 11
Hypertonic mannitol that leaks out of the vein can raise pressure inside a closed muscle space and cause compartment syndrome.
Missing Word
compartment
Compartment syndrome is rising pressure within a muscle compartment that cuts off blood flow and injures nerves and muscle; mannitol labeling warns of it with extravasation, so the nurse checks the IV site throughout the infusion.
Category: Osmotic Diuretics
Question 12
Combining mannitol with other nephrotoxic drugs, such as aminoglycosides, raises the risk of acute kidney injury.
Missing Word
nephrotoxic
Nephrotoxic drugs damage kidney tissue, and their effect adds to the renal risk of mannitol, which can cause acute kidney injury even in patients whose kidney function was normal.
Category: Osmotic Diuretics
Question 13
Thiazide and loop diuretics can raise blood glucose, so a client with diabetes who starts one is monitored for hyperglycemia.
Missing Word
hyperglycemia
Thiazide and loop diuretics can impair glucose tolerance, partly through potassium loss that reduces insulin release. A client with diabetes may need closer glucose monitoring and an adjustment of diabetes therapy after a diuretic is started.
Category: Loop Diuretics
Question 14
Tingling of the fingers, toes and face, called paresthesias, is a common adverse effect of carbonic anhydrase inhibitors.
Missing Word
paresthesias
Paresthesias are among the most frequent complaints with these drugs, along with taste changes, fatigue and increased urination, and patients are told what to expect.
Category: Carbonic Anhydrase Inhibitors
Question 15
Systemic carbonic anhydrase inhibitors are contraindicated in cirrhosis because they can trigger hepatic encephalopathy.
Missing Word
cirrhosis
Alkaline urine from these drugs reduces ammonia excretion, and in a patient with a scarred, poorly functioning liver the extra ammonia can cause confusion and encephalopathy.
Category: Carbonic Anhydrase Inhibitors