Unit1: Chapter 51- Diuretic Agents (Kach 7th Ed) Flashcards
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.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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 A1C levels are normal and not affected by the medication.
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.
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.
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.
