NURS 317 Unit 1 Chapter 51 Pharm Point Questions

Question 1

The diuretic nesiritide is given to individuals who have what issue related to heart failure?

A) Jugular distention

B) Dyspnea at rest

C) Edema of the feet and hands

D) Nausea

Answer 1

B) Dyspnea at rest

Rationale:Nesiritide is intended for the treatment of client with acutely decompensated heart failure who experiences dyspnea at rest, not edema, jugular distention, or nausea

Question 2

The risk for ototoxicity increases if loop diuretics are combined with aminoglycosides.

A) TRUE

B) FALSE

Answer 2

A) TRUE

Rationale:Ototoxicity can result if loop diuretics are combined with aminoglycosides. The risk of ototoxicity increases if loop diuretics are combined with aminoglycosides or cisplatin. An example of an aminoglycoside would be gentamicin sulfate.

Question 3

A client with glaucoma has been prescribed acetazolamide. The nurse should monitor the client for signs and symptoms of:

A) increased intracranial pressure.

B) metabolic acidosis.

C) hepatotoxicity.

D) bone marrow suppression.

Answer 3

B) metabolic acidosis.

Rationale:Metabolic acidosis is a relatively common and potentially dangerous effect of acetazolamide that occurs when bicarbonate is lost.

Question 4

A client is receiving acetazolamide in a sustained-release form. The nurse would anticipate the onset of diuresis in approximately which time frame?

A) 1 hour

B) 4 hours

C) 3 hours

D) 2 hours

Answer 4

D) 2 hours

Rationale:Acetazolamide in sustained-release form has an onset of action of 2 hours.

Question 5

A client in intensive care is beginning to show signs and symptoms of increased intracranial pressure. What action should the nurse perform in order to prepare for the administration of mannitol?

A) Inspect the client’s ventogluteal injection site.

B) Assist the client up to the bathroom to void.

C) Ensure the client has reliable intravenous access.

D) Administer a potassium supplement as prescribed.

Answer 5

C) Ensure the client has reliable intravenous access.

Rationale:Mannitol is only available for intravenous administration; intramuscular injection is not possible. Assisting a client to the bathroom who has increased intracranial pressure would be unsafe for the client and likely to exacerbate the condition. There is no need to administer a potassium supplement.

Question 6

An adult client with a recent onset of oliguria has been prescribed mannitol 1.75 mg/kg IV. What is the nurse’s best action?

A) Assess the client’s allergy status.

B) Administer the medication and monitor the client throughout the infusion.

C) Obtain the client’s baseline weight.

D) Contact the provider to question the dose

Answer 6

D) Contact the provider to question the dose

Rationale:Doses of mannitol are much smaller when used to treat oliguria rather than increased intracranial pressure. The nurse should contact the provider because this dose is excessive. This would be the priority over the other subsequent actions.

Question 7

What would the nurse expect to be ordered for a client experiencing an acute increase in intraocular pressure?

A) Amiloride

B) Mannitol

C) Furosemide

D) Metolazone

Answer 7

B) Mannitol

Rationale:An acute increase in intraocular pressure is an emergency situation requiring the use of a potent osmotic diuretic. Currently, only one osmotic diuretic is available, mannitol. Furosemide is a loop diuretic; metolazone is a thiazide-like diuretic; amiloride is a potassium-sparing diuretic; none are used for emergency increased intraocular pressure problems

Question 8

A client asks the nurse why a diuretic has been prescribed for the treatment of his high blood pressure. What is the nurse’s best response?

A) “Diuretics relax the blood vessel wall, which then moves fluid and reduces blood pressure.”

B) “Diuretics remove urine from the circulatory system, cause a drop in blood pressure.”

C) “Diuretics indirectly slow the heart, which then decreases blood pressure by increasing urination.”

D) “Diuretics decrease water and sodium in the blood vessels, reducing blood pressure.”

Answer 8

D) “Diuretics decrease water and sodium in the blood vessels, reducing blood pressure.”

Rationale:Diuretics are used to decrease volume and sodium, which then decreases pressure in the system. Diuretics do not have an effect on the blood vessel wall; they decrease water and sodium in the blood vessel, which decreases pressure. Cardiotonics strengthen the heart muscle, which slows the rate, not diuretics. Diuretics cause the removal of fluid from circulation; however, urine is never in circulation because it is created by the kidneys.

Question 9

A client is prescribed a thiazide diuretic that is to be administered intravenously. Which agent would this most likely be?

A) Hydroflumethiazide

B) Methylchlorothiazide

C) Hydrochlorothiazide

D) Chlorothiazide

Answer 9

D) Chlorothiazide

Rationale:Chlorothiazide is administered orally or intravenously. The other agents are only administered orally.

Question 10

The nurse understands that the action of most diuretics typically results in what effect? Select all that apply.

A) Retention of potassium

B) Loss of chloride

C) Loss of water

D) Loss of calcium

E) Retention of sodium

Answer 10

B) Loss of chloride
C) Loss of water

Rationale:Most diuretics result in the loss of water, sodium, and chloride along with the sodium. Potassium may or may not be lost depending on the type of diuretic used. Calcium typically is not affected by diuretics.

Question 11

What would be a contraindication to the use of carbonic anhydrase inhibitors?

A) Cataracts

B) Active infection

C) Fluid volume excess

D) Allergy to sulfonamides

Answer 11

D) Allergy to sulfonamides

Rationale:Carbonic anhydrase inhibitors are sulfonamides, and as such are contraindicated in clients with an allergy to sulfonamides. Cataracts and infections do not prevent their use. Fluid volume excess would be an indication, not a contraindication.

Question 12

Before ordering a loop diuretic, the nurse practitioner should check the client’s history for the current use of which drugs? Select all that apply.

A) Coumadin

B) Doxycycline

C) Omeprazole

D) Indomethacin

E) Ibuprofen

Answer 12

A) Coumadin
D) Indomethacin
E) Ibuprofen

Rationale:Loop diuretics if given with an anticoagulant may increase the effects of the anticoagulant. There is a decreased loss of sodium and decreased antihypertensive effects if loop diuretics are given with indomethacin, ibuprofen, salicylates, and NSAIDs. There is no drug–drug interaction with omeprazole or doxycycline.

Question 13

A nurse encourages a client who is receiving a diuretic to maintain adequate fluid intake to prevent the risk for developing what problem?

A) Dehydration

B) Hyperkalemia

C) Fluid rebound

D) Weight loss

Answer 13

C) Fluid rebound

Rationale:When a client who is taking a diuretic decreases fluid intake, fluid rebound occurs, which leads to water retention and subsequent edema and weight gain, not dehydration or weight loss. Electrolyte imbalances may or may not occur depending on the type of diuretic being used.

Question 14

A nurse knows that thiazide diuretics can have various adverse effects. Which conditions are possible adverse effects of these drugs? Select all that apply.

A) Hyperuricemia

B) Hypotension

C) Hyperglycemia

D) Hypokalemia

E) Hypocalcemia

Answer 14

A) Hyperuricemia
B) Hypotension
C) Hyperglycemia
D) Hypokalemia

Rationale:Thiazide diuretics can cause hypokalemia, hyperuricemia (increased uric acid levels), hypercalcemia, hypotension, and hyperglycemia (with long-term use).

Question 15

A client is receiving bumetanide. The nurse would instruct the client to be alert for what adverse effects? Select all that apply.

A) Irreversible hearing loss

B) Muscle cramps

C) Weakness

D) Hypotension

E) Dizziness

Answer 15

B) Muscle cramps
C) Weakness
D) Hypotension
E) Dizziness

Rationale:Bumetanide may cause hypotension and dizziness due to the rapid fluid loss, reversible hearing loss, and signs and symptoms of hypokalemia, such as weakness and muscle cramps.

Question 16

Spironolactone is the drug of choice for treating which condition?

A) Hyperaldosteronism

B) Hypertension

C) Acute kidney injury

D) Hyperkalemia

Answer 16

A) Hyperaldosteronism

Rationale:Spironolactone is a potassium-sparing diuretic and is the drug of choice for treating hyperaldosteronism, which is seen in cirrhosis of the liver and nephrotic syndrome. It can cause hyperkalemia so it is not used in the presence of hyperkalemia and is not recommended for renal failure. Spironolactone is used to treat hypertension in many clients, but it is not the drug of choice or the first-line treatment for hypertension.

Question 17

The nurse is caring for a client with acute pulmonary edema. What diuretic will the nurse most likely administer?

A) Indapamide

B) Mannitol

C) Furosemide

D) Triamterene

Answer 17

C) Furosemide

Rationale:Furosemide is often the diuretic of choice when rapid diuresis is needed. Because of its high ceiling, it would normally be first-line treatment for pulmonary edema and would be preferred over the other listed options.

Question 18

Which medications are considered potassium-sparing diuretics? Select all that apply.

A) Triamterene

B) Metolazone

C) Amiloride

D) Methazolamide

E) Spironolactone

Answer 18

A) Triamterene
C) Amiloride
E) Spironolactone

Rationale:Amiloride, spironolactone, and triamterene are all examples of potassium-sparing diuretics. Methazolamide is a carbonic anhydrase inhibitor, and metolazone is a thiazide-like diuretic.

Question 19

Which diuretics are most often used in the treatment of glaucoma and increased intraocular pressure? Select all that apply.

A) Acetazolamide

B) Hydrochlorothiazide

C) Mannitol

D) Spironolactone

E) Ethacrynic acid

Answer 19

A) Acetazolamide
C) Mannitol

Rationale:Acetazolamide is a carbonic anhydrase inhibitor and mannitol is an osmotic diuretic. These two classifications of diuretics are the ones most frequently used in the treatment of glaucoma and increased intraocular pressure. Thiazide and thiazide-like (hydrochlorothiazide), loop (ethacrynic acid), and potassium-sparing (spironolactone) diuretics are not indicated for the treatment of glaucoma or increased intraocular pressure.

Question 20

When describing the action of hydrochlorothiazide, what would a nurse include?

A) Blocking the action of carbonic anhydrase

B) Acting as an aldosterone antagonist

C) Blocking of the chloride pump

D) Blocking of potassium secretion through the tubule

Answer 20

C) Blocking of the chloride pump

Rationale:Chlorothiazide, a thiazide diuretic, blocks the chloride pump. Carbonic anhydrase inhibitors such as acetazolamide block the action of carbonic anhydrase. Spironolactone, a potassium-sparing diuretic, acts as an aldosterone antagonist. Amiloride and triamterene, potassium-sparing diuretics, block potassium secretion through the tubule.

Question 21

A client has just received a dose of mannitol for treatment of increased intracranial pressure. The nurse should assess for which adverse effects? Select all that apply.

A) Nausea

B) Hypertension

C) Tinnitus

D) Confusion

E) Dizziness

Answer 21

A) Nausea
D) Confusion
E) Dizziness

Rationale:Adverse effects related to the use of an osmotic diuretic include nausea, vomiting, hypotension, light-headedness, confusion, and headache, which can be accompanied by cardiac decompensation and even shock. Tinnitus is not associated with osmotic diuretics.

Question 22

A client who takes a diuretic on an ongoing basis has phoned the clinic to report a weight gain of 8 lbs over the past 3 days. What should the nurse encourage the client to do?

A) Go to the emergency department promptly.

B) Monitor his weight for the next 3 days and then report back.

C) Come into the clinic in order to be assessed.

D) Expect day-to-day weight fluctuations.

Answer 22

C) Come into the clinic in order to be assessed.

Rationale:A weight gain of 8 lbs over 3 days is significant and warrants follow-up. However, there is no indication of distress that would necessitate an emergency admission. This weight change is beyond the usual daily variations.

Question 23

After teaching a client about the action of spironolactone, the nurse determines that the teaching was successful when the client states what?

A) “I can still use my salt substitute if I want to.”

B) “I need to take the drug on an empty stomach.”

C) “I need to make sure I don’t eat too many high-potassium foods.”

D) “I should take the medicine around dinnertime for the best effect.”

Answer 23

C) “I need to make sure I don’t eat too many high-potassium foods.”

Rationale:The drug is a potassium-sparing diuretic placing the client at risk for hyperkalemia, especially if the client consumes foods high in potassium. The client should take the medication in the morning to prevent interfering with sleep due to getting up at night to void. The client can take the drug with meals if GI upset occurs. Many salt substitutes contain potassium, which could increase the client’s risk for hyperkalemia.

Question 24

The nurse would contact the physician if a client who has been prescribed hydrochlorothiazide has which condition? Select all that apply.

A) Otitis media

B) Diabetes mellitus

C) Osteoarthritis

D) Systemic lupus erythematosus

E) Gout

Answer 24

B) Diabetes mellitus
D) Systemic lupus erythematosus
E) Gout

Rationale:Caution should be used with thiazide and thiazide-like diuretics if the client has the following conditions: systemic lupus erythematosus, diabetes mellitus, gout, liver disease, hyperparathyroidism, or bipolar disorder. Otitis media and osteoarthritis do not have any contraindications for use with this drug.

Question 25

What client is most likely to benefit from the administration of a diuretic?

A) An older adult with a diagnosis of atrial fibrillation

B) A child who has endocarditis

C) An adult with chronic obstructive pulmonary disease

D) An older adult client who has heart failure

Answer 25

D) An older adult client who has heart failure

Rationale:Heart failure is a common indication for diuretics. Arrhythmias, endocarditis, and COPD do not commonly require diuresis.

Question 26

Diuretics are frequently prescribed for clients with what conditions? Select all that apply.

A) Heart failure

B) Myocarditis

C) Hypokalemia

D) Hypertension

E) Liver failure

Answer 26

A) Heart failure
D) Hypertension
E) Liver failure

Rationale:Diuretics are indicated for the treatment of edema associated with heart failure, acute pulmonary edema, liver disease, renal disease, and the treatment of hypertension. They are also used to decrease potassium levels in the treatment of conditions that cause hyperkalemia; therefore, they are not indicated for hypokalemia. They are also not indicated for the treatment of edema related to a sprain or fracture.