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NCLEX Practice Pharm 41: Diuretics

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The nurse prepares to administer which medication to reduce intracranial pressure by creating an osmotic gradient and decreasing cerebral edema?

Hydrochlorothiazide (HydroDIURIL) Spironolactone (Aldactone) Furosemide (Lasix) Mannitol (Osmitrol) ✔✔Mannitol (Osmitrol)

Mannitol is a potent osmotic diuretic that leads to water being pulled out of the brain. This drug is indicated in the treatment of increased intracranial pressure because it facilitates the movement of edema (water) out of brain tissue.

In administering diuretics, the nurse understands that most of these drugs work by disrupting which stage of the renal process?

Water filtration Solute filtration

Water reabsorption Solute reabsorption ✔✔Solute reabsorption

Most diuretics act by disrupting solute reabsorption. It is important to understand the major processes by which nephrons reabsorb filtered solutes. Because sodium and chloride ions are the predominant solutes in the filtrate, reabsorption of these ions is of greatest interest.

The nurse is comparing the actions of several diuretics. The nurse reads that greater diuresis occurs when the diuretic works on which part of the nephron?

Proximal convoluted tubule Descending loop of Henle Ascending loop of Henle Distal convoluted tubule ✔✔Proximal convoluted tubule

Drugs that block solute reabsorption to the greatest degree produce the most profound diuresis.Because the amount of solute in the nephron becomes progressively smaller as filtrate flows from the proximal tubule to the collecting duct, drugs whose site of action is early in the nephron have the opportunity to block the greatest amount of solute reabsorption and produce the greatest diuresis. Because most of the filtered solute has already been reabsorbed by the time the filtrate

reaches the distal parts of the nephron, diuretics that act at distal sites have little reabsorption available to block, and these distally acting agents produce relatively scant diuresis.

In administering intravenous furosemide (Lasix) to a patient, the nurse anticipates diuresis to begin within what time frame?

• minute
• minutes

30 minutes 60 minutes ✔✔5 minutes

Furosemide can be administered orally, IV, and IM. With oral administration, diuresis begins in 60 minutes and persists for 8 hours. Oral therapy is used when rapid onset is not required. The effects of intravenous furosemide begin within 5 minutes and last for 2 hours. Intravenous therapy is used in critical situations (e.g., pulmonary edema) that demand immediate mobilization of fluid

The nurse correlates the action of aldosterone with the reabsorption of ________ from the distal nephron.

sodium calcium potassium magnesium ✔✔sodium

Aldosterone, the principal mineralocorticoid of the adrenal cortex, stimulates the reabsorption of sodium from the distal nephron. At the same time, aldosterone causes potassium to be secreted. It has no direct action on calcium or magnesium regulation.

The nurse recognizes that antidiuretic hormone (ADH) causes what?

Excretion of sodium Conservation of water Reabsorption of potassium Excretion of waste products ✔✔Conservation of water

ADH acts on the collecting duct to regulate conservation of water. In the absence of ADH, the collecting duct is impermeable by water. Tubular urine entering the collecting duct is isotonic (300 mOsm/L). ADH acts on the collecting duct to increase its permeability by water. By