41.3.33: Chapter 34
Unfolding Case Study
1.
c.
The client is presenting with signs and symptoms of edema—weight gain and peripheral edema.
2.
d.
A chemistry panel measures key electrolytes and renal function tests.
3.
b.
Anuria is a contraindication to diuretic administration. Accordingly, decreasing urine output should be reported to the health care provider because it could indicate that the client’s renal function is deteriorating.
4.
b.
Nonpharmacologic treatment for edema includes a low-sodium diet, walking, and elevating extremities to reduce swelling.
5.
a.
Green, leafy vegetables are an important part of a low-sodium diet with potassium-rich foods. This statement indicates a need for further teaching.
6.
c.
Thiazide diuretics can cause hypokalemia, which can cause changes in heart rate and rhythm.
Review Questions
1.
c.
The diuretic effect of furosemide can cause electrolyte abnormalities such as hyponatremia and hypokalemia, which cause weakness.
2.
d.
Amiloride is a potassium-sparing diuretic, so salt substitutes containing potassium should be avoided.
3.
c.
An eGFR value less than 60 mL/minute/1.73 m
2
for 3 months indicates chronic renal disease.
4.
b.
Mannitol is an osmotic diuretic that creates an osmotic gradient that pulls water from cells into the intravascular space.
5.
b.
Thiazide diuretics such as hydrochlorothiazide maintain serum calcium levels.
6.
a.
Mannitol is contraindicated for clients with heart failure. Lung congestion and peripheral edema are signs of this condition for which the nurse needs to monitor.
7.
d.
Clients taking spironolactone are at risk for developing bradycardia.
8.
a.
The nurse should instruct the client to take diuretics in the morning to help prevent nocturia.
9.
d.
Loop diuretics cause potassium to be excreted and can be used for clients with hyperkalemia.
10.
b.
Diuretics such as furosemide have a threshold dose that is required for response, as well as a ceiling dose beyond which the diuretic effect will not increase.