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Pharmacology · chapter 18 · Antihypertensive and Antianginal Drugs

Diuretics

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. What diuretics do and treat

    Diuretics are a classification of drug that induces sodium loss and increases urine flow. They are typically used to treat hypertension, heart failure, and volume overload states.

  2. How thiazides work

    Thiazide and thiazide-like diuretics inhibit the reabsorption of sodium and chloride in the distal renal tubules. These diuretics increase the excretion of sodium and water by the kidneys, producing diuresis in the client, and also create a potassium loss within the body.

  3. Thiazides as first-line treatment

    Along with ACE inhibitors, thiazide and thiazide-like diuretics are often the first line of treatment for clients diagnosed with hypertension and may be used in conjunction with other antihypertensive drugs (Akbari Khorasani-Zadeh, 2022).

  4. How potassium-sparing diuretics work

    Potassium-sparing diuretics antagonize aldosterone. These drugs reduce aldosterone-induced sodium and water retention in the late distal tubules of the kidneys.

  5. Potassium kept; caution in renal impairment

    These types of diuretics retain potassium within the body; therefore, potassium does not need to be supplemented. Potassium-sparing diuretics are commonly used to treat hypertension and heart failure but should be used cautiously in clients with impaired renal function.

  6. Common adverse effects

    Common adverse effects include mineral loss, weakness, fatigue, muscle cramps, palpitations, dizziness, and electrolyte imbalances.

  7. Hypokalemia and hyperkalemia

    Adverse effects from hypokalemia (with thiazide and thiazide-like diuretics) and hyperkalemia (with potassium-sparing diuretics) are potentially severe and/or fatal.

  8. Clients needing caution

    Diuretics should be used cautiously in older clients and clients with hepatic or renal impairment, arrhythmias, or gout.

  9. Monitor blood pressure and pulse

    Assess the client’s blood pressure and pulse on an ongoing basis with initial dosing and intermittently during drug therapy.

  10. Electrolytes, glucose and urine output

    Assess the client for electrolyte imbalances and hyperglycemia as well as the client’s urine output. Urine output for an adult should be weight based at 0.5 mL/kg/hour.

  11. Take in the morning

    Take diuretics early in the morning to avoid increased urination during the night and sleep disturbance.

  12. Report weight changes

    Report a weight loss or weight gain greater than 2 pounds a day or 5 pounds a week to their health care provider.

  13. Thiazides: potassium foods and glucose

    Eat potassium-rich foods such as avocados, bananas, and spinach to replace potassium. If diabetic, monitor their blood glucose levels carefully due to these diuretics’ effects on carbohydrate metabolism.

  14. Potassium-sparing: sun and potassium foods

    Avoid exposure to direct sunlight because spironolactone can cause photosensitivity. Avoid potassium-rich foods such as avocados, bananas, beans, and spinach if their potassium levels are high.

Terms to know

Diuretics
Diuretics are a classification of drug that induces sodium loss and increases urine flow.
Potassium-sparing diuretics
Potassium-sparing diuretics are commonly used to treat hypertension and heart failure but should be used cautiously in clients with impaired renal function.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. A client starting hydrochlorothiazide asks when to take the daily dose. What should the nurse teach?

    1. Early in the morning.
    2. At bedtime, so it works overnight.
    3. On an empty stomach in the middle of the night.
    4. Only when the ankles look swollen.

    Answer: Early in the morning.

    Diuretics should be taken early in the morning to avoid increased urination during the night and sleep disturbance. Bedtime or night dosing causes nighttime urination, and taking it only when swollen is not the teaching.

  2. A client taking a thiazide diuretic reports leg cramps and weakness. Which laboratory finding should the nurse anticipate?

    1. Hypokalemia
    2. High sodium
    3. Low blood glucose
    4. Hyperkalemia

    Answer: Hypokalemia

    Thiazide and thiazide-like diuretics create a potassium loss, and adverse effects from hypokalemia are potentially severe. Hyperkalemia is linked to potassium-sparing diuretics, and thiazides are associated with hyperglycemia, not low glucose.

  3. A client taking spironolactone has a high serum potassium level. Which food should the nurse teach the client to avoid?

    1. White rice
    2. Plain pasta
    3. Apples
    4. Bananas

    Answer: Bananas

    Clients on a potassium-sparing diuretic should avoid potassium-rich foods such as avocados, bananas, beans, and spinach if their potassium levels are high. The other foods are not listed as potassium-rich in the section.

  4. A nurse is caring for a client who is taking a diuretic. Which assessments should the nurse include? Select all that apply.

    1. Blood pressure and pulse
    2. Visual acuity chart testing
    3. Urine output
    4. Blood glucose
    5. Electrolyte levels

    Answer: Blood pressure and pulse, Urine output, Blood glucose, Electrolyte levels

    The nurse assesses blood pressure and pulse, electrolyte imbalances, hyperglycemia, and urine output for clients on diuretics. Visual acuity charting is not among the listed nursing implications.

  5. A nurse is teaching a client who is going home on a thiazide diuretic. Which instructions should the nurse include? Select all that apply.

    1. Take the medication with food if it upsets your stomach.
    2. Monitor blood glucose carefully if you have diabetes.
    3. Avoid all potassium-rich foods.
    4. Report a weight gain greater than 2 pounds in a day.
    5. Eat potassium-rich foods such as bananas and spinach.

    Answer: Take the medication with food if it upsets your stomach., Monitor blood glucose carefully if you have diabetes., Report a weight gain greater than 2 pounds in a day., Eat potassium-rich foods such as bananas and spinach.

    Clients on thiazides report weight changes over 2 pounds a day, eat potassium-rich foods to replace potassium lost, monitor glucose if diabetic, and take diuretics with food to avoid GI upset. Avoiding potassium-rich foods applies to potassium-sparing diuretics when potassium is high.

  6. A client prescribed spironolactone works outdoors as a gardener. Which teaching point is specific to this drug?

    1. Drink grapefruit juice with each dose.
    2. Avoid exposure to direct sunlight.
    3. Take the dose at bedtime.
    4. Take a potassium supplement every day.

    Answer: Avoid exposure to direct sunlight.

    Spironolactone can cause photosensitivity, so the client should avoid direct sunlight. Potassium-sparing diuretics retain potassium, so supplements are not needed, and diuretics are taken in the morning.

Where every quote comes from

Section 18.6 Diuretics of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.