Exam 2: Loop Diuretics

Question 1

Loop Diuretics influence the “blank” of “blank”

Answer 1

Loop of Henli

Question 2

Loop Diuretics increase urine output by affecting “blank” reabsorption in the “blank.”

Answer 2

affecting Na+ reabsorption in the nephron

Question 3

Which of these is a loop diuretic, and which is a Thiazide diuretic?

-Metolazone
-Bumetanide
-Furosemide
-Torsemide

Answer 3

Metolazone is the only Thiazide, the rest are Loop.

Loop D’s typically end with “Nide” or “Mide”

Question 4

Loop diuretics inhibit the NKCC cotransporters. Since Diuretics influence electrolyte transportation throughout the nephrons of the kidney, and prevent the reuptake for them from filtrate, what does the name NKCC tell you about what a loop diuretic inhibits?

Answer 4

1 Na+
1 K+
and 2 Cl- molecules

Question 5

Which part of the loop of Henli does the loop diuretic specifically target?

Answer 5

The ascending loop.

That is where all of the electrolytes are filtered out of filtrate and into the bloodstream

Question 6

What diseases of affectations would lopp diuretics be used for treating?

Answer 6

-Heart Failure (Fluid Volume Overload)
-PE’s from backed up lung fluid
-Ascites (Liver impairment) which is abdominal swelling
-HTN (Not as helpful as a Thiazide diuretic)
-Hypercalcemia-Unlike Thiazide D’s, Calcium stays in the filtrate with loop diuretics

Question 7

Since loop diuretics are still diuretics, what should a nurse look for in a patient using them?

Answer 7

Dehydration

Question 8

If a patients SBP is <90, and their pulse is >100, what does this signify in a patient taking a loop diuretic?

Answer 8

Dehydration.

Question 9

With loop diuretics inhibiting certain cotransporters, what electrolyte imbalance diseases would you expect to see in a loop diuretic patient?

Answer 9

Hyponatremia
Hypokalemia
Hypocalcemia

Basically all electrolytes

Question 10

Would a loop diuretic lead to hypouricemia or hyperuricemia?

Answer 10

Hyperuricemia (>7), like all diuretics. This increases risk for gout attacks.

Question 11

Loop diuretics can also lead to ototoxicity. What is ototoxicity?

Answer 11

Inner ear damage

Question 12

How do you prevent ototoxicity from the use of a loop diuretic?

Answer 12

Administering an IV slowly

Question 13

A patient with swelling, an edema, and lung crackles in the base is at risk for what?

Answer 13

Heart failure

Question 14

What diet change would you incorporate to counter act loop diuretic electrolyte side effects?

Answer 14

Eat foods rich in potassium

Question 15

A patient taking loop diuretics is experiencing polydipsia, lethargy, and the inability to urinate. What is the patient most likely experiencing?

Answer 15

Dehydration

Question 16

The physician prescribes the patient a loop diuretic. As the nurse you know that this type of diuretic causes diuresis by MAINLY affecting what structure in the nephron?

A. Distal convoluted tubule
B. Descending limb of the loop of Henle
C. Proximal convoluted tubule
D. Ascending limb of the loop of Henle

Answer 16

The answer is D. Loop diuretics affect the loop of Henle, specifically the ASCENDING limb (the thick part of this limb).

Question 17

Loop diuretics are effective with inhibiting sodium reabsorption within the nephron because it inhibits?

A. the sodium-chloride transporter
B. the effects of aldosterone on the distal convoluted tubule
C. the sodium-potassium-chloride cotransporter
D. the transport of bicarbonate by the proximal convoluted tubule

Answer 17

The answer is C. Loop diuretics INHIBIT the sodium-potassium-chloride (NKCC2) cotransporter in the thick ascending limb of the loop of Henle. This inhibits the amount of sodium that is reabsorbed by the kidneys, which will cause the nephron to decrease the amount of water it reabsorbs…hence leading to more water leaving the kidneys via the urine (leading to its diuretics affects). Option A is how thiazide diuretics work, option B is how potassium-sparing diuretics work, and option D is how carbonic anhydrase inhibitors work.

Question 18

Select all the medications below that are considered loop diuretics:

A. Chlorothiazide
B. Bumetanide
C. Triamterene
D. Spironolactone
E. Furosemide
F. Torsemide
G. Hydrochlorothiazide

Answer 18

The answers are B, E, and F. Options A and G are thiazide diuretics, and Options C and D are potassium-sparing diuretics.

Question 19

Your patient is ordered a loop diuretic at 1000. Which finding below would require you to hold the dose and notify the physician for further orders?

A. Calcium level 9 mg/L
B. Potassium level 1.5 mEq/L
C. Blood pressure 102/78
D. Sodium level 144

Answer 19

The answer is B. Loop diuretics are known to decrease potassium levels due to the way they affect how the nephron wastes potassium (this happens in the distal convoluted tubule due to the high concentrated amount of sodium in the filtrate…this tubule will exchange potassium and hydrogen ions for sodium ions under the influence of aldosterone, which will lead potassium to enter the filtrate and exit the body as urine.)

Question 20

You’re developing a plan of care for a patient with fluid volume overload related to heart failure exacerbation. The physician has prescribed an IV loop diuretic. What nursing interventions will you include in the patient’s plan of care? Select all that apply:

A. Perform and assess daily weights.
B. Educate the patient about consuming a low potassium diet.
C. Strict measuring of the patient’s daily intake and output.
D. Encourage the patient to drink 2 L of fluids per day.
E. Assess lung sounds every shift.

Answer 20

The answers are A, C, and E.

Question 21

Which patients below may be prescribed a loop diuretic based on their diagnosis? Select all that apply:
A. A 58-year-old male with congestive heart failure.

B. A 69-year-old female with pulmonary edema.
C. A 45-year-old male with hypercalcemia.
D. A 50-year-old male experiencing a gout attack.

Answer 21

The answers are A, B, and C. Option D is not a candidate for loop diuretics because these medications can increase uric acid levels, which is already an issue for this patient with a gout attack (remember gout occurs due to increase uric acids levels). Loop diuretics help remove extra fluid from the blood. This is helpful for patients with heart failure and pulmonary edema. Loop diuretics also decrease calcium reabsorption (hence causing the calcium to be excreted rather than staying in the blood), and this would help treat a high calcium level (hypercalcemia).

Question 22

A patient with heart failure is prescribed Digoxin and a loop diuretic. The nurse knows that what finding below would increase a patient’s risk of developing Digoxin toxicity?

A. Magnesium level 1.8 mg/dL
B. Potassium 2 mEq/L
C. BUN 15
D. Albumin 5 g/dL
The answer is B. Hypokalemia (low

Answer 22

potassium level in the blood) increases the risk of Digoxin toxicity (normal potassium 3.5-5 mEq/L). Therefore, the nurse should always check a patient’s potassium result before administering Digoxin, especially if they are taking a loop diuretic (remember loop diuretics waste potassium and can decrease the blood level).

Question 23

You’re educating a group of new nurse graduates about loop diuretics. One topic you discuss is ototoxicity. You ask the new nurses to explain how to prevent this adverse side effect in a patient prescribed a loop diuretic. Which response by one of the new nurses is correct?

A. “Always administer intravenous loop diuretics slowly.”
B. “Monitor for signs and symptoms of low potassium levels because this increases the risk of inner ear damage while taking loop diuretics.”
C. “Administer the medication with meals.”
D. “Avoid administering loop diuretics with a tetracycline.”

Answer 23

The answer is A. Rapid IV administration of a loop diuretic can increase the risk of ototoxicity in a patient taking loop diuretics. Always give these medications slowly when ordered the IV route.

Question 24

You’re providing discharge instructions to a patient who will be taking a loop diuretic at home. Which statement by the patient demonstrates they did NOT understand the teaching material and requires that you reinforce some of the teaching points?

A. “I will eat a diet rich in potatoes, bananas, avocadoes, strawberries, and spinach.”
B. “I will weight myself daily and report to my physician if I gain more than 3 lbs in 1 day.”
C. “I will change position slowly because I can become dizzy easily while taking this medication.”
D. “This medication can cause dehydration, so I will stay hydrated by consuming at least 2 L or more of fluid per day.”

Answer 24

The answer is D. The patient should be educated on the signs and symptoms of dehydration (excessive thirst, fatigue, hypotension etc.). However, they should not be taught to consume 2L or more of fluid per day. Many patients are prescribed loop diuretics to treat issues with fluid volume overload (example heart failure). These patients must monitor how much fluid they are drinking. If too much fluid is consumed this will cancel out the effectiveness of the medication.

Question 25

What electrolyte imbalances would the nurse monitor for in the patient who is taking a loop diuretic? Select all that apply:

A. Hyperkalemia
B. Hypocalcemia
C. Hypernatremia
D. Hypokalemia
E. Hypomagnesemia

Answer 25

The answers are B, D, and E. Loop diuretics can cause hypokalemia, hyponatremia, and hypomagnesemia.