Osmotic Diuretics

Every question here, with the answer

1. Before hanging a mannitol infusion, the nurse sees crystals in the vial. What should the nurse do?

   1. Give it as is; the crystals dissolve in the blood.
   2. Mix it with a unit of blood to dissolve the crystals.
   3. Shake it and give it through a peripheral line without a filter.
   4. Warm the solution, agitate it vigorously, and cool it to body temperature before giving.

   Answer: Warm the solution, agitate it vigorously, and cool it to body temperature before giving.

   If crystals are present, the vial is warmed, agitated vigorously, and cooled to body temperature before administration, through filtered tubing. Crystals can cause vascular and end-organ damage, and mannitol must not be given with blood products.

2. A client receiving mannitol for increased intracranial pressure develops new crackles in the lungs and shortness of breath. What does the nurse suspect?

   1. Heart failure from the rapid fluid shift into the vessels
   2. Hypertonic saline reaction
   3. Dehydration
   4. Expected response to the drug

   Answer: Heart failure from the rapid fluid shift into the vessels

   Mannitol can cause heart failure because water shifts rapidly into the intravascular space, so the nurse monitors lung sounds for congestion. Crackles are not an expected effect and do not indicate dehydration.

3. Which nursing actions are correct when administering mannitol? Select all that apply.

   1. Monitor the site for extravasation.
   2. Stop checking electrolytes once urine output increases.
   3. Use a dedicated IV line in a large central vein.
   4. Use filtered tubing.
   5. Give it at the same time as a blood transfusion through the same line.

   Answer: Monitor the site for extravasation., Use a dedicated IV line in a large central vein., Use filtered tubing.

   Mannitol is given through a dedicated central line with filtered tubing, and the site is monitored for extravasation. It should not be given simultaneously with blood products, and electrolytes are monitored throughout.

4. In which clients would mannitol be contraindicated or used with caution? Select all that apply.

   1. A client with congestive heart failure
   2. A client with increased intraocular pressure
   3. A client with pulmonary edema
   4. A client who is severely dehydrated
   5. A client with anuria

   Answer: A client with congestive heart failure, A client with pulmonary edema, A client who is severely dehydrated, A client with anuria

   Mannitol should be avoided with anuria, congestive heart failure, pulmonary edema and severe dehydration. Increased intraocular pressure is one of its main indications.

5. A client has a mannitol infusion running in the arm. The nurse notices swelling and pain at the site. The nurse recognises the risk of which complication?

   1. Ototoxicity
   2. Hyperkalemia
   3. Compartment syndrome
   4. Rebound hypertension

   Answer: Compartment syndrome

   Extravasation of mannitol can lead to compartment syndrome in the arm where it is infusing, so the site is monitored during the infusion. The other complications are not linked to extravasation in the section.

6. A client with normal kidney function is receiving mannitol. A student nurse says renal labs are not needed because the kidneys are healthy. What is the best response?

   1. Renal labs are needed only after the infusion ends.
   2. Renal function is monitored in all clients because acute renal failure can occur even with normal kidneys.
   3. Only urine color needs to be checked.
   4. That is correct; only clients with kidney disease need monitoring.

   Answer: Renal function is monitored in all clients because acute renal failure can occur even with normal kidneys.

   Renal function is monitored in all clients receiving mannitol, because acute renal failure can occur even in clients with normal renal function. The other statements limit monitoring in ways the section does not support.