A patient has been placed on a loop diuretic to reduce the fluid that has been accumulating in the lungs.
Which statement made by the patient indicates a need for further teaching about the medication by the nurse?
“I weigh myself each day before breakfast.”.
“If my shortness of breath returns, I’ll contact my healthcare provider.”.
“I’ll have a banana with my breakfast every morning.”.
“I’ll be sure to take my medication with supper.”.
The Correct Answer is D
Taking a loop diuretic with supper is not advisable because it can cause nocturia, which is the need to urinate frequently at night. This can disrupt sleep and affect quality of life. Loop diuretics should be taken in the morning or early afternoon to avoid this problem.
Choice A is wrong because weighing oneself each day before breakfast is a good way to monitor fluid balance and detect any signs of fluid retention or dehydration. This can help adjust the dose of the loop diuretic as needed.
Choice B is wrong because contacting the healthcare provider if shortness of breath returns is a sensible precaution and indicates awareness of the symptoms of worsening heart failure. Shortness of breath is caused by fluid accumulation in the lungs, which loop diuretics help to prevent or reduce.
Choice C is wrong because having a banana with breakfast every morning is a good source of potassium, which can help prevent hypokalemia, a common side effect of loop diuretics. Loop diuretics increase the excretion of potassium in the urine, which can lead to low blood levels of potassium and cause muscle weakness, cramps, fatigue, arrhythmias, and increased sensitivity to digoxin.
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Correct Answer is C
Explanation
This is because potassium sparing diuretics do not lower potassium levels in the blood, unlike some other types of diuretics. Potassium is an important electrolyte that helps regulate nerve and muscle functions, especially the heart. Low potassium levels can cause irregular heartbeats and other problems.Therefore, people who take diuretics should avoid foods that are high in potassium, such as bananas, oranges, tomatoes, and potatoes, unless they are taking potassium sparing diuretics.
Choice A is wrong because thiazide diuretics, such as hydrochlorothiazide, can cause low potassium levels in the blood and increase the risk of arrhythmias.
People who take thiazide diuretics may need to take potassium supplements or eat more potassium-rich foods.
Choice B is wrong because osmotic diuretics, such as mannitol, do not affect potassium levels in the blood.
They work by increasing the amount of water in the urine, but do not alter the electrolyte balance.
Osmotic diuretics are mainly used to treat brain swelling or glaucoma.
Choice D is wrong because loop diuretics, such as lasix, can also cause low potassium levels in the blood and increase the risk of arrhythmias.
People who take loop diuretics may also need to take potassium supplements or eat more potassium-rich foods.
Normal ranges for potassium in the blood are 3.5 to 5.0 millimoles per liter (mmol/L).
Correct Answer is A
Explanation
Hypokalemia is a condition of low potassium levels in the blood, which can be caused by diuretics such as furosemide (Lasix) that increase the excretion of potassium in the urine. Potassium is an important electrolyte that helps regulate the function of nerves and muscles, including the heart.Low potassium levels can cause symptoms such as confusion, tremors, muscle cramps, and nausea, which are consistent with the patient’s presentation.
Choice B, renal failure, is wrong because furosemide is used to treat fluid retention and edema caused by kidney disease, not to cause it.Renal failure would also cause symptoms such as decreased urine output, swelling, fatigue, and shortness of breath, which are not mentioned in the question.
Choice C, hyperkalemia, is wrong because hyperkalemia is a condition of high potassium levels in the blood, which can be caused by kidney disease or certain medications that decrease the excretion of potassium in the urine.Hyperkalemia can cause symptoms such as weakness, irregular heartbeat, paralysis, and chest pain, which are different from the patient’s symptoms.
Choice D, heart failure, is wrong because furosemide is also used to treat fluid retention and edema caused by heart failure, not to cause it.Heart failure would also cause symptoms such as shortness of breath, coughing, fatigue, and rapid weight gain, which are not mentioned in the question.
Normal ranges for potassium levels in the blood are 3.5 to 5.0 milliequivalents per liter (mEq/L) for adults and 3.4 to 4.7 mEq/L for children.
A level below 3.5 mEq/L is considered hypokalemic and a level above 5.0 mEq/L is considered hyperkalemic.
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