Exam 2: Thiazide Diuretics

Question 1

Thiazide diuretics work in the early part of the DCT (distal Convoluted Tubule), which is found in the “blank”

Answer 1

“Nephron”

Question 2

Thiazide inhibits the cotransporters of what two electrolytes?

Answer 2

Na+ and Cl-

Question 3

Thiazide diuretics stop Na+ and Cl- from reentering the body, instead staying in “blank” to be urinated.

Answer 3

staying in “filtrate” to be urinated.

Question 4

Which is more powerful: Loop diuretics or Thiazide diuretics?

Answer 4

Loop diuretics are more powerful

Question 5

Different Diuretics work on different structures of the nephron. Thiazide diuretics work at the DCT and account for what percentage of Na+ and Cl- reabsorption?

How does this compare to Loop diuretics?

Answer 5

5-7% of Na+ and Cl- reabsorption

Compared to loop diuretics 25%

Question 6

In addition to blocking Na+ and Cl- reabsorption, Thiazide diuretics also increase the absorption of “blank”

Because of this, what is a risk for pt using Thiazide diuretics?

Answer 6

Ca+

Hypercalcemia

Question 7

Thiazide diuretics are less effective in patients with a GFR (glomerular filtration rate) of less than “blank”

Answer 7

<30 mL/hr

Question 8

If a patient has a compromised GFR, would a diuretic be given to them at all?

Answer 8

Yes, a loop diuretic would work

Question 9

The DCT plays a role in reabsorbing what 3 electrolytes? What electrolyte does the DCT excrete?

Answer 9

Reabsorb:
Na+
Cl-
Ca+

Excrete: K+

Question 10

Thiazides stop the Na+/Cl- cotransporters by stopping what from getting into the blood?

Answer 10

Na+ and Cl-

Question 11

By stopping Na+ and Cl- from being reabsorbed, while enhancing the absorption of Ca+, Thiazide diuretics can lead to electrolyte imbalances like what?

Answer 11

Hyponatremia

Hypercalcemia

Question 12

Since the DCT is responsible for excreting K+, and Thiazide diuretics are responsible for increasing excretions, what imbalance might this cause?

Answer 12

Hypokalemia

Question 13

When taking a Thiazide diuretic, what diet change would you implement in a patient?

Answer 13

Increased Potassium diet

Question 14

In DM patients, Thiazide D’s can alter their blood sugar levels, causing hyperglycemia and an increase in uric acid.

What does this uric acid increase lead to?

Answer 14

Gout attacks

Question 15

What is a dangerous Uric Acid level in a patient?

Answer 15

> 7

Question 16

What are the two primary uses for Thiazide Diuretics?

Answer 16

HTN and getting Na+ and H2O out of the blood through pissing to lower BP

Question 17

Are Thiazide diuretics good for heart failure patients?

Answer 17

Yes, by lowering fluid volume to prevent fluid volume overload.

Question 18

What 1st line HTN drug class can be mixed with Thiazide diuretics to increase heart function?

Answer 18

ACE inhibitors

Question 19

What is a renal issue associated with Ca+ levels that can be treated with Thiazide diuretics?

Answer 19

Renal Calculi

These are Ca+ deposits that can be reabsorbed thanks to Thiazide diuretics.

Question 20

Since Thiazide is a diuretic, what is a sign that the nurse should always look for in a patient?

Answer 20

Dehydration

Question 21

Should you give a patient Thiazide diuretics’ at nighttime?

Answer 21

NO

Question 22

What electrolytes would you expect to see elevated in a Thiazide diuretic patient?

What about low levels?

Answer 22

Elevated:
Hypercalcemia
Hyperuricemia
hyperglycemia

Low:
Hypokalemia
Hyponatremia

Question 23

What drug combination (“blank” + Thiazide D) would be avoided in a patient with Hyponatremia?

What about Hypokalemia?

Answer 23

Hyponatremia is Lithium + Thiazide D
-Can cause Lithium Toxicity

Hypokalemia is Digoxin + Thiazide D
-Can cause Digoxin toxicity

Question 24

The physician prescribes the patient a thiazide diuretic. The patient is experiencing increased urination. As the nurse you know that this medication causes this type of affect by how it affects the nephron. It does this by?

A. inhibiting the sodium-potassium-chloride cotransporter in the distal convoluted tubule
B. inhibiting the sodium-chloride cotransporter in the distal convoluted tubule
C. inhibiting the water reabsorption in the distal convoluted tubule
D. inhibiting the sodium-potassium transporter in the distal convoluted tubule

Answer 24

The answer is B. Thiazide diuretics inhibit the sodium-chloride cotransporter in the early part of the distal convoluted tubule. When this occurs it prevents sodium from being reabsorbed back into the blood. Since the sodium stays in the tubule, it will keep water with it. This will decrease the amount of water reabsorbed into the blood/body…thus increasing urination and extra fluid removal from the blood (causing a diuretic effect).

Question 25

Your patient will be started on a thiazide diuretic to help manage blood pressure. Select all the medications below that are considered a type of thiazide diuretic:

A. Furosemide
B. Indapamine
C. Hydrochlorothiazide
D. Spironolactone
E. Metolazone
F. Chlorothiazide

Answer 25

The answers are B, C, E, and F. Option A is a loop diuretic, and option D is a potassium-sparing diuretic.

Question 26

True or False:
Thiazide diuretics are more potent than loop diuretics and provide immediate diuresis affects.

Answer 26

The answer is FALSE. Thiazide diuretics are NOT more potent than loop diuretics and do not provide immediate diuresis affects like loop diuretics. Loop diuretics inhibit sodium reabsorption in the loop of Henle, which is responsible for about 25% of sodium reabsorption….whereas, thiazide diuretics inhibit sodium reabsorption in the early part of the distal convoluted tubule, which is responsible for about 5-7% of sodium reabsorption. Therefore, the higher percentage of sodium reabsorption inhibited the stronger the effects, which makes loop diuretics more potent.

Question 27

A 55-year-old-male with hypertension is prescribed a thiazide diuretic. The patient has a health history of diabetes type I and gout. What lab results below represent some known side effects of this medication and requires the nurse to report the lab results to the physician? Select all that apply:

A. Potassium 5.2 mEq/L
B. Calcium 9 mg/L
C. Blood glucose 300 mg/dL
D. Ammonia 20 mcg/dL
E. Uric acid level 15 mg/dL
F. Blood glucose 45 mg/dL

Answer 27

The answers are C and E. Thiazide diuretics can cause an increase in blood glucose (hyperglycemia), hyperuricemia (high uric acid levels…this increases a gout attack), hypokalemia (low potassium levels), and hypercalcemia (high calcium levels). Due to the patient’s health history of diabetes and gout, the nurse should monitor the patient’s glucose and uric acid levels. A normal blood glucose level is about 70-100 mg/dL, and a normal uric acid level varies for female and males…with anything greater than 7 for males or 6 for female being considered high. Therefore, the patient’s uric acid level of 15 mg/dL and glucose of 300 mg/dL is abnormal and should be reported.

Question 28

A patient is scheduled to take a dose of Lithium at 1000. The patient is also prescribed a thiazide diuretic. What lab result below requires the nurse to hold the dose of Lithium and notify the physician for further orders?

A. Potassium 3.2 mEq/L
B. Sodium 115 mEq/L
C. Calcium 10.5 mg/L
D. Magnesium 2 mg/dL

Answer 28

The answer is B. The nurse must monitor for Lithium toxicity in patients who are taking Lithium and a thiazide diuretic. These types of diuretics lower the amount of sodium in the blood because it prevents the reabsorption of it within the nephron…so more is excreted into the urine. Therefore, low sodium levels in the blood INCREASE the risk of Lithium toxicity. A normal blood sodium level is 135-145 mEq/L.

Question 29

Your patient is prescribed hydrochlorothiazide. The patient’s potassium level is 2 mEq/L. What medication below should the nurse hold and notify the physician for further orders?

A. Dilantin
B. Digoxin
C. Warfarin
D. Lithium

Answer 29

The answer is B. Hypokalemia (low potassium level in the blood) can increase Digoxin toxicity. Hydrochlorothiazide causes the body to lose potassium. A normal blood potassium level is 3.5-5 mEq/L. Therefore, the nurse should hold the Digoxin and notify the physician for further orders.

Question 30

Based on your nursing knowledge of how thiazide diuretics work, which patients below would benefit from these types of medications? Select all that apply:

A. A patient with a glomerular filtration rate (GFR) of less than 30 cc/hr.
B. A patient with a recurrent history of renal calcium calculi.
C. A patient with primary hypertension.
D. A patient with heart failure and frequent gout attacks.
E. A patient with diabetes that has uncontrolled hyperglycemia.

Answer 30

The answers are B and C. Why? Option B: thiazide diuretics help INCREASE reabsorption of calcium into the blood (hence causes hypercalcemia)…therefore it removes it from the urine and can help prevent renal calculi that are composed of calcium. Option C: thiazide diuretics help remove extra fluid volume in the blood and this can decrease blood pressure. Thiazides are not for patients who have a decrease in renal function (example GFR of less than 30 cc/hr), gout attacks (they can cause an increase in uric acid levels), and uncontrolled hyperglycemia (they increase blood glucose levels).

Question 31

You’re developing a plan of care for a patient with heart failure that will be prescribed a thiazide diuretic. What nursing interventions will you include in this patient’s plan of care? Select all that apply:

A. Encourage the patient to limit the consumption of bananas, avocadoes, spinach, strawberries, and potatoes.
B. Measure the patient’s intake and output daily.
C. Weigh the patient daily using a bedside scale.
D. Assess lab results for electrolyte imbalances like hypercalcemia and hyperkalemia.

Answer 31

The answers are B and C. Option A is wrong because the nurse should encourage the patient to consume (NOT limit) these foods because they are high in potassium. Remember thiazide diuretics waste potassium. Option D is wrong because these medications can cause electrolyte imbalances like hypercalcemia and HYPOkalemia (NOT hyperkalemia). Options B and C are correct because these medication increase urination (hence they cause fluid depletion)…therefore, the nurse must monitor the patient’s fluid status.

Question 32

You’re providing discharge teaching to a patient who will be taking a thiazide diuretic for the treatment of hypertension. You note that the patient has type I diabetes. What statement by the patient represents they misunderstood your teaching points about this medication and requires you reinforce some of the education pieces?

A. “I must monitor my blood glucose closely while taking this medication.”
B.” This medication can cause sudden and severe drops in my blood glucose.”
C. “I will try my best to eat a diet that includes foods rich in potassium.”
D. “I will report to my physician if I experience excessive thirst, little or no urination, and extreme fatigue.”

Answer 32

The answer is B. Thiazide diuretics can INCREASE the blood glucose (lead to hyperglycemia)… not hypoglycemia. Therefore, the nurse should educate the patient to monitor the blood glucose level closely.