Diuretic Agents

1.

The class of diuretics that act to block the chloride pump in the distal convoluted tubules and leads to a loss of sodium and potassium and a minor loss of water is what?
A)
Carbonic anhydrase inhibitors
B)
Osmotic diuretics
C)
Potassium-sparing diuretics
D)
Thiazide diuretics
Ans:
D

Feedback:

Thiazide diuretics work to block the chloride pump, which leads to a loss of sodium, potassium, and some water. They are considered mild diuretics. Carbonic anhydrase inhibitors work to block the formation of carbonic acid and bicarbonate in the renal tubules. Osmotic diuretics use hypertonic pull to remove fluid from the intravascular spaces and to deliver large amounts of water into the renal tubules. Potassium-sparing diuretics are mild and act to spare potassium in exchange for the loss of sodium and water.

2.

The nurse is providing discharge instructions to a 72-year-old patient who has been discharged home on a diuretic. What would the patient’s instructions regarding the use of a diuretic at home include?
A)
Measuring intake and output of urine
B)
To weigh themselves on the same scale, at the same time of day, in the same clothing
C)
Restrict fluids to 500 mL/d to limit the need to urinate
D)
Decrease exercise to conserve energy
Ans:
B

Feedback:

Patients taking a diuretic at home need to learn to weigh themselves every day, at the same time, and in the same clothes to monitor for loss or retention of fluid. They should not be asked to measure urine output or to decrease activity. Restricting fluids can lead to a rebound fluid retention when compensatory mechanisms are activated.

3.

The emergency department (ED) nurse is caring for a patient who is experiencing pulmonary edema. The patient is treated with furosemide (Lasix). What will the nurse monitor?
A)
Sodium levels
B)
Bone narrow function
C)
Calcium levels
D)
Potassium levels
Ans:
D

Feedback:

Furosemide is associated with loss of potassium, so that the patient will need to be monitored carefully for low potassium levels, which could cause cardiac arrhythmias and further aggravate pulmonary edema. The nurse would not monitor sodium or calcium levels or bone marrow function because of the effects of the drug during the acute treatment of pulmonary edema.

4.

The nurse on the coronary unit is caring for a patient with known coronary artery disease who is being treated with cholestyramine (Questran) and hydrochlorothiazide (HydroDIURIL). What action will the nurse take?
A)
Call the physician and refuse to give the drugs without further orders.
B)
Make sure that the drugs are given at least 2 hours apart.
C)
Give the patient an antacid with the drugs.
D)
Check the patient’s blood glucose level before giving the drugs.
Ans:
B

Feedback:

Because of its effects in the GI tract, cholestyramine should be taken at least 2 hours earlier or later than hydrochlorothiazide to ensure the absorption of hydrochlorothiazide. This combination of drugs can be used effectively. An antacid would further aggravate drug absorption and would not be recommended. Blood glucose levels would not be affected by either of these drugs.

5.

The pharmacology instructor is discussing diuretic drugs with the nursing class. What would the instructor cite as an adverse effect of loop diuretics?
A)
Hyperkalemia
B)
Alkalosis
C)
Hypertension
D)
Hypercalcemia
Ans:
B

Feedback:

Alkalosis is a drop in serum pH to an alkaline state due to bicarbonate loss in urine. Hypokalemia, hypocalcemia, and hypotension are also adverse effect of these drugs. Therefore, the other options are not correct.

6.

A patient with glaucoma has been prescribed a diuretic as treatment of his or her disease process. What drug does the nurse suspect that the patient will be prescribed?
A)
Acetazolamide (Diamox)
B)
Spironolactone (Aldactone)
C)
Chlorthalidone (Hygroton)
D)
Bendroflumethiazide (Naturetin)
Ans:
A

Feedback:

Acetazolamide is used to treat glaucoma. The inhibition of carbonic anhydrase results in decreased secretion of aqueous humor of the eye. Spironolactone is a potassium-sparing diuretic used to treat edema caused by congestive heart failure, liver disease, hypertension, hyperkalemia, and hyperaldosterone. Chlorthalidone is a thiazide-like diuretic and bendroflumethiazide, a thiazide diuretic, are used to treat edema caused by congestive heart failure, liver disease, kidney disease, and as adjunct treatment of hypertension.

7.

A patient comes to the clinic for a 1-month follow-up appointment. The patient tells the nurse he or she has been taking chlorothiazide (Diruil) for a month and now has leg cramps and “feels tired all the time.” What will the nurse consider as the cause of the patient’s symptoms?
A)
Hypercalcemia
B)
Hypocalcemia
C)
Hyperkalemia
D)
Hypokalemia
Ans:
D

Feedback:

Hypokalemia results from the loss of potassium in the distal tubule and causes muscle weakness, fatigue, and arrhythmias. Hyperkalemia presents with cardiac arrhythmias and occasionally muscle weakness. Hypercalcemia is characterized by fatigue, depression, mental confusion, nausea, vomiting, and constipation. Hypocalcemia presents with muscle spasms, facial grimacing, possible convulsions, irritability, and depression.

8.

A patient has been prescribed furosemide (Lasix). Because this drug causes potassium loss, what will the nurse instruct the patient to eat?
A)
Peaches
B)
Apples
C)
Pears
D)
Pineapple
Ans:
A

Feedback:

Peaches, as well as bananas, oranges, raisins, and other fruits, spices, and vegetables are high in potassium and consuming them should be encouraged when taking furosemide. Apples, pears, and pineapple, however, do not replace potassium in the body.

9.

A 10-year-old child has edema caused by a heart defect. The patient is taking furosemide (Lasix). The dosage is 6 mg/kg/d. The child weighs 76 pounds. How many mg does the child receive in each dose?
A)
20 mg
B)
50 mg
C)
105 mg
D)
210 mg
Ans:
D

Feedback:

The nurse will administer 210 mg/dose of the drug (2.2 pounds: 1 kg = 76 pounds: × kg, 76 divided by 2.2 = 34.5, 35 times 6 = 210 mg).

10.

The nurse is caring for a patient who is taking acetazolamide (Diamox) for treatment of glaucoma. What drug, if taken with acetazolamide (Diamox), would cause the nurse to contact the physician?
A)
Indomethacin (Indocin)
B)
Colestipol (Colestid)
C)
Lithium (Eskalith)
D)
Ibuprofen (Motrin)
Ans:
C

Feedback:

An increase in the excretion of lithium can occur when taken with acetazolamide, so that special monitoring or a dosage adjustment may be necessary. Indomethacin, colestipol, and ibuprofen do not produce drug-to-drug interactions when given with acetazolamide.

11.

A 68-year-old patient, who has type 1 diabetes, is to receive hydrochlorothiazide (HydroDIURIL). Before administration of this medication, what information is most important for the nurse to communicate to the patient?
A)
His or her insulin dose may need to be increased.
B)
His or he insulin dose may need to be decreased.
C)
He or she will need to have him or her urine checked for ketones four times a day.
D)
He or she will need to have a creatinine clearance done once a month.
Ans:
A

Feedback:

Caution should be used with the following conditions, which include systemic lupus erythematosus (SLE), which frequently causes glomerular changes and renal dysfunction that could precipitate renal failure in some cases; glucose tolerance abnormalities or diabetes mellitus, which is worsened by the glucose-elevating effects of many diuretics; and gout, which reflects an abnormality in normal tubule reabsorption and secretion. There would be no reason to check ketones four times daily or to have a creatinine clearance once a month.

12.

When evaluating an 82-year-old patient receiving hydrochlorothiazide (HydroDIURIL), what laboratory value deviations may be related to the medication?
A)
Elevated uric acid levels
B)
Reduced blood urea nitrogen (BUN) levels
C)
A serum potassium level of 4.7 mEq/L
D)
A hemoglobin A1C of 4.8
Ans:
A

Feedback:

Uric acid excretion is decreased because thiazides interfere with its secretory mechanism. High levels of uric acid can result in a condition called gout.Hydrochlorothiazide does not reduce BUN levels. Thiazide diuretics may lead to hypokalemia and increase blood glucose levels. The potassium and hemoglobin A1Clevels are normal and not affected by the medication.

13.

What statement by the 62-year-old patient indicates that the patient understand the nurse’s teaching about diuretics?
A)
“I will weigh myself daily and report significant changes.”
B)
“I will have to limit my high sugar foods.”
C)
“If my leg gets swollen again, I’ll take an additional pill.”
D)
“I will take my medication before bedtime on an empty stomach.”
Ans:
A

Feedback:

Daily weights and blood pressures should be monitored at home in a patient taking diuretics. Options B, C, and D would indicate that further teaching is needed.

14.

The nurse is providing discharge instruction to a patient who has just begun using diuretics. The nurse counsels the patient that it is most important to monitor the intake of foods that contain which element?
A)
Calcium
B)
Potassium
C)
Glucose
D)
Magnesium
Ans:
B

Feedback:

Potassium is the most important element to monitor in the diet because diuretics are most likely to lead to hyper- or hypokalemia depending on the diuretic prescribed. Calcium, glucose, and magnesium may need to be monitored in the diet but potassium would be the most important.

15.

The nurse is talking with a group of nursing students. What drug would the nurse tell them, when combined with furosemide (Lasix), is likely to cause hearing loss?
A)
Codeine
B)
Ciprofloxacin (Cipro)
C)
Digoxin (Lanoxin)
D)
Gentamicin (Garamycin)
Ans:
D

Feedback:

The risk of ototoxicity increases if loop diuretics are combined with aminoglycoside antibiotics (gentamicin) or cisplatin. No known increased risk of ototoxicity exists when furosemide is taken with codeine, ciprofloxacin, or digoxin.

16.

A student asks the pharmacy instructor what the difference is between the diuretics spironolactone (Aldactone) and furosemide (Lasix). What would the instructor reply?
A)
Potassium losses are lower with spironolactone.
B)
Potassium losses are greater with spironolactone.
C)
Water losses are greater with spironolactone.
D)
Sodium losses are greater with spironolactone.
Ans:
A

Feedback:

Spironolactone is a potassium sparing diuretic; therefore, it promotes retention of potassium. Furosemide promotes greater water, sodium, and potassium losses than spironolactone.

17.

The nurse is caring for a patient with a severe head injury. An osmotic diuretic is ordered. The nurse understands which drug is an osmotic diuretic?
A)
Spironolactone (Aldactone)
B)
Bumetanide (Bumex)
C)
Mannitol (Osmitrol)
D)
Ethacrynic (Edecrin)
Ans:
C

Feedback:

Mannitol is an osmotic diuretic. Spironolactone is a potassium sparing diuretic. Bumetanide and ethacrynic are loop diuretics.

18.

The staff educator in the ICU is talking with a group of new nurses about osmotic diuretics. The educator would tell the new nurses that osmotic diuretics act on which site in the nephron?
A)
Proximal tubule
B)
Glomerulus
C)
Ascending limb of loop of Henle
D)
Collecting tubule
Ans:
B

Feedback:

These drugs are freely filtered at the renal glomerulus, poorly reabsorbed by the renal tubule, not secreted by the tubule, and resistant to metabolism. Therefore, options A, C, and D are not correct.

19.

A 64-year-old patient in hypertensive crisis is to receive furosemide (Lasix) 40 mg IV. Lasix comes in 100 mg/10 mL containers. How will the nurse administer the medication?
A)
Give 4 mL over 1 to 2 minutes IV.
B)
Give 4 mL over 10 minutes.
C)
Flush the line with normal saline, give 1 mL/min, flush again when finished.
D)
Fix 10 mL in an IV piggyback and deliver it over 30 minutes.
Ans:
A

Feedback:

Administer furosemide (Lasix) 40 mg over 1 to 2 minutes IV. The other options are not correct.

20.

A 91-year-old patient is being discharged on the diuretic spironolactone (Aldactone). What is the major adverse effect of this type of medication?
A)
Hypokalemia
B)
Hyperkalemia
C)
Gastric irritation
D)
Hypertension
Ans:
B

Feedback:

The most common adverse effect of potassium-sparing diuretics is hyperkalemia, which can cause lethargy, confusion, ataxia, muscle cramps, and cardiac arrhythmias. Hypokalemia, gastric irritation, and hypertension are not recognized as adverse effects of spironolactone.

21.

The nurse is conducting an admission assessment of a patient who has been prescribed hydrochlorothiazide (HydroDIURIL). Which situation would contraindicate the administration of hydrochlorothiazide (HydroDIURIL)?
A)
Allergy to sulfa drugs
B)
Allergy to codeine
C)
BP 160/96
D)
Blood glucose level of 140 mg/dL
Ans:
A

Feedback:

Thiazide and thiazide-like diuretics are contraindicated with allergy to thiazides or sulfonamides to prevent hypersensitivity reactions. The other options are not correct.

22.

The nurse is caring for a patient who has just been diagnosed with essential hypertension. The nurse is aware that the health care provider will begin therapy with which classification of diuretics?
A)
Loop diuretics
B)
Carbonic anhydrous inhibitors
C)
Thiazide and thiazide-like diuretics
D)
potassium-sparing diuretics
Ans:
C

Feedback:

Thiazides are considered to be mild diuretics compared with the more potent loop diuretics. These agents are the first-line drugs used to manage essential hypertension when drug therapy is needed. Loop and potassium-sparing diuretics and carbonic anhydrous inhibitors would be used in combination with or after the thiazide diuretics are no longer effective.

23.

A female patient has a history of frequent bladder infections. Which classification of diuretic would not be recommended for this patient?
A)
Thiazide and thiazide-like diuretics
B)
Loop diuretics
C)
potassium-sparing diuretics
D)
Osmotic diuretics
Ans:
A

Feedback:

Urine is slightly alkalinized when the thiazides or thiazide-like diuretics are used because they block reabsorption of bicarbonate. This effect can cause problems for patients who are susceptible to bladder infections. Loop, potassium sparing, and osmotic diuretics do not have this effect.

24.

What is the term for the action of a diuretic in a patient with glaucoma?
A)
Intraocular pressure (IOP)
B)
Osmotic pull
C)
Diuresis
D)
Potassium sparing
Ans:
B

Feedback:

Glaucoma is an eye disease characterized by increased pressure in the eye—known as intraocular pressure (IOP)—which can cause optic nerve atrophy and blindness. Diuretics are used to provide osmotic pull to remove some of the fluid from the eye, which decreases IOP, or as adjunctive therapy to reduce fluid volume and pressure in the cardiovascular system, which also decreases pressure in the eye somewhat. Potassium sparing refers to a class of diuretics that help to retainpotassium.

25.

A patient has just begun to take a prescribed diuretic. Why would the nurse tell the patient to drink 8 to 10 glasses of water daily (unless it is counterindicated)?
A)
To decrease the action of the renin–angiotensin cycle
B)
To make more concentrated plasma
C)
To dilute the urine
D)
To avoid rebound edema
Ans:
D

Feedback:

Care must be taken when using diuretics to avoid fluid rebound, which is associated with fluid loss. If a patient stops taking in water and takes the diuretic, the result will be a concentrated plasma of smaller volume. The decreased volume is sensed by the nephrons, which activate the renin-angiotensin cycle. When concentrated blood is sensed by the osmotic center in the brain, antidiuretic hormone (ADH) is released to retain water and dilute the blood. The result can be “rebound” edema as fluid is retained. Drinking 8 to 10 glasses of water will not decrease the action of the renin-angiotensin cycle, or make plasma more concentrated. It may produce urine that is dilute but that is not the reason it is recommended.

26.

A patient has just been prescribed furosemide (Lasix). After reviewing the patient’s medication history, what drug would cause the nurse concern when taken with furosemide (Lasix)?
A)
Acetaminophen
B)
Ferrous sulfate (Feosol)
C)
Naproxen sodium (Naprosyn)
D)
Ampicillin
Ans:
C

Feedback:

Naproxen sodium is a nonsteroidal antiinflammatory drug. There may also be a decreased loss of sodium and decreased antihypertensive effects if these drugs are combined with indomethacin, ibuprofen, salicylates, or other nonsteroidal antiinflammatory drugs. The patient receiving this combination should be monitored closely and appropriate dosage adjustments should be made. There is no contraindication to the intercurrent use of acetaminophen, ferrous sulfate, or ampicillin.

27.

A patient with glaucoma has been prescribed acetazolamide (Diamox). What adverse effects would the nurse caution the patient about? (Select all that apply.)
A)
Paresthesia
B)
Confusion
C)
Drowsiness
D)
Vomiting
E)
Hyperkalemia
Ans:
A, B, C

Feedback:

Metabolic acidosis is a relatively common and potentially dangerous adverse effect that occurs when bicarbonate is lost. Hypokalemia is also common. Patients also complain of paresthesias of the extremities, confusion, and drowsiness. Vomiting and hyperkalemia are not common adverse effects

28.

A patient who was recently prescribed spironolactone calls the clinic and complains that he is not urinating as much as he did when he first started taking this medication. What would be an appropriate question for the nurse to ask this patient?
A)
“Are you taking a salicylate?”
B)
“Are you taking acetaminophen?”
C)
“Are you taking ibuprofen?”
D)
“Are you using a lot of salt?”
Ans:
A

Feedback:

The diuretic effect decreases if potassium-sparing diuretics are combined with salicylates. Dosage adjustment may be necessary to achieve therapeutic effects. There is no decrease in effect when spironolactone is combined with acetaminophen, ibuprofen, and increased sodium intake.

29.

The nurse is writing a plan of care for a patient who is taking a diuretic. What would be an appropriate nursing diagnosis for this patient?
A)
Impaired urinary elimination
B)
Monitor the patient response to the drug
C)
Imbalanced nutrition: More than body requirements
D)
Risk for fluid volume overload
Ans:
A

Feedback:

Nursing diagnoses related to drug therapy may include impaired urinary elimination related to drug effect. Options B, C, and D would not be appropriate nursing diagnoses.

30.

A patient has been prescribed hydrochlorothiazide (HydroDIURIL) and the nurse is preparing to give the patient discharge instructions. Which adverse effects may this patient experience while taking this medication? (Select all that apply.)
A)
Constipation
B)
Dizziness
C)
Polyphagia
D)
Nocturia
E)
Muscle cramps
Ans:
B, D, E

Feedback:

The adverse effects associated with hydrochlorothiazide are dizziness, vertigo, orthostatic hypotension, nausea, anorexia, vomiting, dry mouth, diarrhea, polyuria, nocturia, muscle cramps, and spasms. The patient would not experience polyphagia (great hunger) and constipation.

31.

A patient has just begun therapy with furosemide (Lasix), and the nurse is instructing the patient about the need to include foods high in potassium in the diet. Which foods would be appropriate for this patient to choose? (Select all that apply.)
A)
Prunes
B)
Apples
C)
Watermelon
D)
Lima beans
E)
Rice
Ans:
A, C, D

Feedback:

Foods high in potassium include avocados, bananas, broccoli, cantaloupe, dried fruits, grapefruit, lima beans, nuts, navy beans, oranges, peaches, potatoes, prunes, rhubarb, Sanka coffee, sunflower seeds, spinach, tomatoes, and watermelon. Apples and rice are not potassium-rich foods.

32.

A nursing instructor is teaching a group of students about loop diuretics. Which would be included in this classification? (Select all that apply.)
A)
Acetazolamide
B)
Torsemide
C)
Ethacrynic acid
D)
Mannitol
E)
Bumetanide
Ans:
B, C, E

Feedback:

Torsemide, ethacrynic acid, and bumetanide are examples of loop diuretics. Acetazolamide is a carbonic anhydrous inhibitor and mannitol is an osmotic diuretic.

33.

The nurse is caring for a patient with edema who has just begun taking a diuretic. What will the nurse use to evaluate the effectiveness of this medication? (Select all that apply.)
A)
Daily weight
B)
Decrease in edema
C)
Increase in blood pressure
D)
Increase in urinary output
E)
Increase in pulse
Ans:
A, B, D

Feedback:

Responsiveness to the use of a diuretic can be measured by daily weights, increased urinary output, decrease in edema, decrease in blood pressure and pulse rate. Options C and E are not correct.

34.

The nurse has just administered 150 g of mannitol IV to a patient with increased intracranial pressure. What is most important for the nurse to monitor in the hour after administration?
A)
Weight of patient
B)
Blood pressure of patient
C)
Pulse of patient
D)
Respiratory rate of patient
Ans:
B

Feedback:

The most common and potentially dangerous adverse effect related to an osmotic diuretic is the sudden drop in fluid levels. Mannitol peaks 1 hour after administration, therefore, it would be most important to monitor blood pressure. Weight is the best indicator over time but would not be as effective in indicating a dangerous fluid drop as the blood pressure. Respiratory and pulse rates would also not be as effective as blood pressure in evaluating dangerous fluid drops.