EXAM 4 Cumulative Study Set: Cardiovascular

What are the three types of Diuretics

Thiazide

Loop

Potassium Sparing

Diuretics are used to

to get rid of excess fluids

Diuretics promote

Water excretion for fluid overload by increasing urine production

Diuretics are used in combination with

Other blood pressure medications to control high blood pressure

What route are diuretics given

PO or IV

Thiazide diuretics like

Hydrochlorothiazide (HCTZ) are the drug of choice for hypertension

Hydrochlorothiazide (HCTZ) Is given

PO or IV

Thiazide Diuretics inhibits

The reabsorption of sodium and chloride

Thiazide Diuretics increase the secretion of

Sodium and water

Thiazide Diuretics decrease

Plasma volume

Preload and workload of the heart

Blood pressure

Thiazide Diuretics are used to

Manage blood pressure

Treat fluid retention (edema)

Prevent Heart failure

Adverse effects of Thiazide Diuretics

Hypotension

Potassium and sodium electrolyte imbalance

Ototoxicity

Drugs that decrease the effects of Thiazide Diuretics

NSAIDS

ototoxicity is more likely in someone who already has existing

Kidney issues and when taken with other Ototoxicity drugs at the same time

Drugs that increase the effects of Thiazide Diuretics

ETOH

Barbiturates

MAOIs

Beta blockers

Corticosteroids

With Thiazide Diuretics use caution with

Pregnancy

Those allergic to sulfa meds

With Thiazide Diuretics, watch for signs of

Hypotension and dehydration

After administration

Reassess BP

Thiazide Diuretics Nursing implications

Check blood pressure

Check electrolytes (especially potassium and sodium)

Organic nitrates implications

Prior to administration check

Think like a nurse

Assessment, values

A client is prescribed hydrochlorothiazide. Which electrolyte imbalance is the nurse most concerned about?

Hypokalemia, Thiazide diuretics increase potassium excretion, placing patients at risk for hypokalemia. Monitoring potassium levels is essential.

Which adverse effect is associated with loop diuretics like furosemide?

Ototoxicity, High doses or rapid IV administration of loop diuretics can cause ototoxicity (hearing loss or tinnitus).

Spironolactone should be avoided in patients with:

Renal insufficiency with high potassium,

Because Spironolactone is potassium-sparing and can cause life-threatening hyperkalemia, especially in renal impairment.

the nurse is preparing to administer sublingual nitroglycerin. Which is a priority assessment?

Blood pressure

Rationale: Nitroglycerin causes vasodilation, which can significantly lower BP. Hold if systolic <90 mmHg.

A client is taking isosorbide mononitrate. What is an expected side effect?

Headache

Rationale: Vasodilation increases blood flow to the head, commonly causing headaches.

Which is an indication for loop diuretics?

Pulmonary edema from heart failure

Rationale: Loop diuretics like furosemide rapidly remove fluid in acute HF with pulmonary congestion.

What dietary instruction should be given to a client taking thiazide diuretics?

Increase potassium-rich foods

Rationale: Thiazides cause potassium loss, so intake of potassium (e.g., bananas, oranges) should be encouraged.

Which of the following is a contraindication to nitroglycerin use?

Use of erectile dysfunction medications

Hypotension

Rationale: Nitroglycerin with ED drugs (e.g., sildenafil) can cause fatal hypotension; it’s also contraindicated in low BP.

A client receiving spironolactone develops muscle weakness and irregular heart rate. What should the nurse suspect?

Hyperkalemia

Rationale: Spironolactone retains potassium;(potassium sparing) symptoms indicate potential toxic levels.

How do nitrates relieve chest pain?

Reduce myocardial oxygen demand

Rationale: Nitrates reduce preload and afterload, decreasing the heart’s workload.

Which client is most at risk for adverse effects from loop diuretics?

Elderly client with CHF

Rationale: Elderly clients are more sensitive to fluid/electrolyte imbalances and hypotension.

The nurse teaches the client to take hydrochlorothiazide:

With breakfast

Rationale: To avoid nocturia, take diuretics in the morning

What assessment finding is a red flag when giving nitrates?

BP 84/56

Rationale: BP <90 systolic is too low for nitrates, which could cause further hypotension.

A nurse holds spironolactone for which potassium level?

5.2 mEq/L

Rationale: Hyperkalemia (>5.0) increases risk of cardiac arrhythmias when taking potassium-sparing diuretics.

What’s a key teaching point for clients using long-acting nitrates?

Tolerance may develop; schedule a nitrate-free interval

Rationale: Nitrate tolerance is reduced by having a nitrate-free period (usually at night).

Which medication would you question with a high potassium level?

Spironolactone

Rationale: Spironolactone retains potassium and is contraindicated in hyperkalemia

Which lab is most important before administering furosemide?

Potassium

Rationale: Furosemide can cause significant potassium loss leading to arrhythmias.

A client asks why they take isosorbide daily. What’s the best response?

It prevents chest pain.”

Rationale: Long-acting nitrates like isosorbide prevent angina episodes.

A nurse giving IV furosemide should monitor for:

Ototoxicity

Rationale: High IV doses or rapid administration of furosemide can damage the auditory nerve.

What is the main therapeutic goal of diuretics in heart failure?

Reduce fluid overload

Rationale: Diuretics relieve symptoms by decreasing preload through fluid reduction.

What are loop diuretics

a type of medication, often referred to as water pills, that work by reducing fluid buildup in the body.

What is a nephron

A nephron is the functional unit of the kidney, responsible for filtering blood and producing urine.

What are the different parts of a nephron

Bowman’s capsule

Glomerulus

Collecting duct

Henles loop

Efferent arteriole

Afferent arteriole

What is Na and Cl

Na is sodium

Cl is chloride

Loop diuretics inhibit

The reabsorption of Na and Cl into the loop of Henle

Loop diuretics produce significant

Diuresis

What is diuresis

the increased production and excretion of urine by the kidney

How many nephrons do we have in our body

Each of your kidneys is made up of about a million filtering units called nephrons.

Each nephron includes a

a filter, called the glomerulus, and a tubule.

How do the nephrons work

through a two-step process: the glomerulus filters your blood, and the tubule returns needed substances to your blood and removes waste

What is the loop of henle responsible for

ITS ,a part of the kidney responsible for reabsorbing sodium and water.

loop diuretics lead to

increased urination and excretion of sodium and water, helping to reduce swelling and lower blood pressure levels

What is a loop diuretic

Furosemide ( Lasix)

Furosemide has a rapid effect and is the diuretic of choice when

Rapid diuresis is needed

Furosemide is the recommended diuretic when a patient has an

Impaired kidney function but they must be able to make urine or it won’t work

Furosemide can be titrated for

Maximum effect

Loop diuretics like furosemide are the most

Effective and versatile

What route are Loop diuretics like furosemide given

PO or IV

Loop diuretics like furosemide are used to

Treat heart failure

Reduce pulmonary edema

Treat hepatic and renal disease

HTN

Adverse effects of Loop diuretics like furosemide

Electrolyte Imbalances : especially Na and K

Dehydration

Ototoxicity

Hypotension

Loop diuretics like furosemide are contraindicated in those who cannot

Create or output urine

What is Ototoxicity

inner ear damage that can affect hearing and balance.

can be a side effect of certain medications or exposure to chemicals

. Symptoms can be temporary or permanent, and range from mild to profound hearing loss. 

Prior to administering furosemide check

Blood pressure

Na

K

BUN and creatine

Glucose levels if the pt is diabetic

After administering furosemide monitor the

Blood pressure

Input and output

Signs of fluid reduction

Side effects

What are side effects of furosemide ( loop diuretics )

Dehydration

Tachycardia

Electrolytes disturbance

What drugs increase the effect of furosemide

Ibuprofen

Phenytoin

What drugs decrease effects of furosemide

Corticosteroids

Digoxin

Loop diuretics work by affectingv

Henles loop

Potassium sparing diuretics work by affecting

The collecting duct

What is a potassium sparing diuretic

Spironolactone (Aldactone)

potassium sparing diuretics like Spironolactone can be

Combined with loop diuretics like furosemide

potassium sparing diuretics like Spironolactone are administered

PO

It takes up to 6 weeks for

potassium sparing diuretics like Spironolactone to reach the maximum effect

potassium sparing diuretics like Spironolactone reduce

Potassium loss and lower the dosage of loop diuretic needed if taken in combination

potassium sparing diuretics like Spironolactone block

Aldosterone

potassium sparing diuretics like Spironolactone promote

Water and sodium excretion

Potassium retention

What is potassium sparing diuretics like Spironolactone used for

Heart failure

Ascites

Hypokalemia

HTN

Hyperaldosteronism

Adverse effects of potassium sparing diuretics like Spironolactone

Dizziness

Headache

Abdominal cramps

Diarrhea

Increased serum K levels

What is the black box warning for potassium sparing diuretics like Spironolactone

May cause tumor growth so do not use unnecessarily

Who are potassium sparing diuretics like Spironolactone contraindicated in

Women in the 1st trimester of pregnancy

Those with abnormal kidney function

potassium sparing diuretics like Spironolactone must be taken at the

Same time each day and preferably in the morning

You can take potassium sparing diuretics like Spironolactone with

Food to help with GI issues

Keep taking spironolactone even if

You feel good

potassium sparing diuretics like Spironolactone are similar to

Loop diuretics

Before administering potassium sparing diuretics like Spironolactone check the patient’s

Blood pressure

Electrolytes

BUN and creatinine

After administering potassium sparing diuretics like Spironolactone monitor

For signs of dehydration or electrolytes imbalance

Drug interactions between potassium sparing diuretics like Spironolactone

Lithium and digoxin can reach toxic levels

Drug interactions between potassium sparing diuretics like Spironolactone

Ginger and licorice can increase the effects of spironolactone

Drugs that increase the effects of potassium sparing diuretics like Spironolactone

ACE inhibitors

ARBs

K containing drugs

Beta blockers

Drugs that decrease the effects of potassium sparing diuretics like Spironolactone

ETOH (ethyl alcohol )

Vasodilators

Salicylates

Organic nitrates are used to treat

Angina

What is angina

Pain in the heart / chest caused by the lack of perfusion and oxygenation to the heart

What causes narrowed arteries

Plaque

Atherosclerosis

What is Atherosclerosis

a condition where fat, cholesterol, and other substances build up in the artery walls, forming plaque.

This buildup narrows the arteries, reducing blood flow and potentially leading to serious complications like heart attack, stroke, and peripheral artery disease

Coronary artery disease (CAD )

Damage or disease in the heart's major blood vessels.

usually caused by buildup of plaque which causes coronary arteries to narrow, limiting blood flow to the heart.

Coronary artery disease can range from no symptoms, to chest pain, to a heart attack.

Treatments include lifestyle changes, medications, angioplasty, and surgery.

What drugs treat angina

Organic nitrates

Beta blockers

Calcium channels blockers

Organic nitrates cause

Vasodilation which opens up the coronary arteries and improves perfusion to the heart.

Organic nitrates decrease the

Workload of the heart via preload and after load