Question

a nurse is caring for a client who has a glomerular filtration rate of 10 ml/min and a reduced urine output. the nurse should clarify a prescription for hydrochlorothiazide for this client because of which of the following characteristics of the medication? the medication can cause hypoglycemia in clients who have a low urine output. the medication does not reduce blood pressure for clients who have a low urine output. the medication can increase the risk of pulmonary edema for clients who have renal insufficiency. the medication does not promote diuresis for clients who have renal insufficiency.

Explanation:

Hydrochlorothiazide is a thiazide diuretic. Its mechanism of action involves acting on the distal convoluted tubule, and it requires a certain level of renal function (usually a GFR above 30 mL/min, though some sources consider lower thresholds) to promote diuresis. In clients with renal insufficiency (GFR 10 mL/min here, indicating significant renal impairment) and reduced urine output, thiazide diuretics like hydrochlorothiazide are ineffective at promoting diuresis because their site of action is not adequately perfused or the renal physiology is altered such that the drug can't work as intended.

• Option 1: Hydrochlorothiazide is more associated with hyperglycemia (not hypoglycemia) in some cases, so this is incorrect.
• Option 2: The drug's blood pressure - lowering effect isn't the main concern here; the issue is diuresis in renal insufficiency, so this is incorrect.
• Option 3: Hydrochlorothiazide doesn't typically increase the risk of pulmonary edema in renal insufficiency; in fact, if it were effective, it might help reduce fluid overload (though it's not effective here), so this is incorrect.
• Option 4: This correctly states that hydrochlorothiazide does not promote diuresis in clients with renal insufficiency (as seen in this client with GFR 10 mL/min and reduced urine output).

Answer:

D. The medication does not promote diuresis for clients who have renal insufficiency.