Week Four Flashcards
What are the three important processes of kidney function?
A) Filtration, diffusion, osmosis
B) Filtration, reabsorption, active tubular secretion
C) Filtration, absorption, active secretion
D) Secretion, absorption, excretion
Correct Answer:
B) Filtration, reabsorption, active tubular secretion
Rationale:
Kidney function relies on three main processes: filtration (where substances are filtered out of the blood), reabsorption (where important molecules like water and electrolytes are reabsorbed), and active tubular secretion (where waste products are secreted into the nephron for excretion).
Where does reabsorption occur in the nephron?
(Select all that apply)
A) Proximal convoluted tubule (PCT)
B) Loop of Henle
C) Early distal convoluted tubule (DCT)
D) Late distal convoluted tubule (DCT)
Correct Answer:
A) Proximal convoluted tubule (PCT)
B) Loop of Henle
C) Early distal convoluted tubule (DCT)
D) Late distal convoluted tubule (DCT)
Rationale:
Reabsorption occurs in multiple parts of the nephron, including the PCT, Loop of Henle, and both the early and late DCT, which are key areas where substances such as water, electrolytes, and nutrients are reabsorbed back into the bloodstream.
How do most diuretics work in the nephron?
A) They increase water absorption
B) They block sodium and chloride reabsorption
C) They enhance glucose excretion
D) They stimulate the release of antidiuretic hormone (ADH)
Correct Answer:
B) They block sodium and chloride reabsorption
Rationale:
Most diuretics work by blocking the reabsorption of sodium (Na) and chloride (Cl) in the nephron, preventing water from being reabsorbed into the bloodstream, which increases urine output.
What is the relationship between sodium reabsorption and urine volume?
A) The more sodium reabsorption is blocked, the less water is in the urine
B) The amount of water in the urine is proportional to the amount of sodium reabsorption that is blocked
C) Blocking sodium reabsorption decreases urine volume
D) There is no connection between sodium reabsorption and urine volume
Correct Answer:
B) The amount of water in the urine is proportional to the amount of sodium reabsorption that is blocked
Rationale:
The volume of water in the urine is directly proportional to how much sodium reabsorption is blocked. The more sodium reabsorption is blocked, the more water remains in the urine, leading to increased urine output.
Which part of the nephron would impact urine volume the most when blocked by a diuretic?
A) Proximal convoluted tubule (PCT)
B) Loop of Henle
C) Early distal convoluted tubule (DCT)
D) Collecting duct
Correct Answer:
B) Loop of Henle
Rationale:
Blocking sodium and chloride reabsorption in the Loop of Henle will have the greatest impact on urine volume, as a significant amount of sodium and water is reabsorbed here. A medication acting on this part of the nephron would cause the most diuretic effect, leading to a larger volume of urine.
How much filtrate do the kidneys create per day, and how is it managed by the body?
A) 125mL/day, most of it is excreted
B) 180L/day, most of it is reabsorbed
C) 50L/day, none of it is reabsorbed
D) 200L/day, some of it is reabsorbed
Correct Answer:
B) 180L/day, most of it is reabsorbed
Rationale:
The kidneys produce 125mL of filtrate per hour, which equals 180 liters per day. Most of this filtrate is reabsorbed back into the body, leaving only a small portion to be excreted as urine.
What could be the potential negative effects of diuretics that block sodium reabsorption?
A) Increased blood volume
B) Electrolyte imbalances and dehydration
C) Hypertension and water retention
D) Reduced urine output
Correct Answer:
B) Electrolyte imbalances and dehydration
Rationale:
Blocking sodium reabsorption causes more water to be excreted, which can lead to electrolyte imbalances (like low sodium or potassium) and dehydration due to increased urine output.
What strategies can be used to minimize the negative effects of diuretics?
A) Give long-acting diuretics
B) Time administration to allow drug-free periods
C) Increase the dose of diuretics
D) Avoid using diuretics altogether
Correct Answer:
B) Time administration to allow drug-free periods
Rationale:
To reduce the risk of dehydration and electrolyte imbalances, diuretics can be given as short-acting medications or administered in a way that allows the kidneys to have drug-free periods, helping the body maintain better balance between fluid and electrolyte levels.
What is the primary mechanism of action of loop diuretics such as Lasix and Furosemide?
A) They act on the proximal convoluted tubule
B) They act in the descending limb of the loop of Henle
C) They prevent the reabsorption of Na in the ascending limb of the loop of Henle
D) They increase the reabsorption of water in the distal convoluted tubule
Correct Answer:
C) They prevent the reabsorption of Na in the ascending limb of the loop of Henle
Rationale:
Loop diuretics like Lasix and Furosemide act specifically in the ascending limb of the loop of Henle, where they inhibit sodium reabsorption, leading to increased urine output.
What is the expected onset of diuresis when loop diuretics are administered orally versus intravenously?
A) Oral: diuresis in 5 minutes; IV: diuresis in 60 minutes
B) Oral: diuresis in 60 minutes; IV: diuresis in 5 minutes
C) Both routes cause diuresis in 30 minutes
D) Oral: diuresis in 2 hours; IV: diuresis in 1 hour
Correct Answer:
B) Oral: diuresis in 60 minutes; IV: diuresis in 5 minutes
Rationale:
Loop diuretics taken orally typically lead to diuresis within 60 minutes, while IV administration results in diuresis within 5 minutes, making IV use suitable for critical needs.
What is the duration of action for loop diuretics when given orally and intravenously?
A) Oral: 5 hours; IV: 60 minutes
B) Oral: 8 hours; IV: 2 hours
C) Both routes last for 8 hours
D) Oral: 2 hours; IV: 4 hours
Correct Answer:
B) Oral: 8 hours; IV: 2 hours
Rationale:
The effects of loop diuretics last approximately 8 hours when taken orally and 2 hours when given IV, reflecting their pharmacokinetic profiles.
What are the routes of administration for loop diuretics like Lasix and Furosemide?
A) Oral and topical
B) Oral, IV, and IM
C) Only oral
D) IV and subcutaneous
Correct Answer:
B) Oral, IV, and IM
Rationale:
Loop diuretics can be administered through various routes, including oral, intravenous (IV), and intramuscular (IM), providing flexibility in treatment based on the clinical scenario.
What are the primary uses of loop diuretics like Lasix and Furosemide?
A) To promote weight gain
B) For rapid/large fluid excretion when needed
C) To increase sodium reabsorption
D) For treating infections
Correct Answer:
B) For rapid/large fluid excretion when needed
Rationale:
Loop diuretics, such as Lasix and Furosemide, are primarily used when rapid or large fluid excretion is required, making them effective in various clinical situations.
In which situation can loop diuretics be beneficial even when kidney function is compromised?
A) Only when GFR is normal
B) When the glomerular filtration rate (GFR) is low
C) They should not be used with low GFR
D) Only in cases of chronic kidney disease
Correct Answer:
B) When the glomerular filtration rate (GFR) is low
Rationale:
Loop diuretics can be effective even when the GFR is low, which allows for diuresis and management of fluid overload in patients with kidney injuries.
What are some common adverse effects associated with the use of Lasix and Furosemide?
A) Hypernatremia and hyperchloremia
B) Hyponatremia, hypochloremia, and dehydration
C) Weight gain and hypertension
D) Increased appetite and insomnia
Correct Answer:
B) Hyponatremia, hypochloremia, and dehydration
Rationale:
The use of loop diuretics can lead to hyponatremia, hypochloremia, and dehydration, which are important adverse effects to monitor during treatment.
How can the use of loop diuretics like Lasix and Furosemide impact blood pressure?
A) They can cause hypertension
B) They can lead to hypotension
C) They have no effect on blood pressure
D) They increase heart rate but do not affect blood pressure
Correct Answer:
B) They can lead to hypotension
Rationale:
Loop diuretics can cause hypotension due to significant fluid loss, which is a critical adverse effect to consider when managing patients on these medications.
What is a common electrolyte imbalance that may occur with the use of Lasix and Furosemide?
A) Hyperkalemia
B) Hyponatremia
C) Hypercalcemia
D) Hypophosphatemia
Correct Answer:
B) Hyponatremia
Rationale:
The use of Lasix and Furosemide can lead to hyponatremia due to a lack of sodium reabsorption in the kidneys, which necessitates monitoring for signs and symptoms of dehydration.
What symptoms should be monitored to assess for dehydration in patients taking Lasix or Furosemide?
A) Weight gain and swelling
B) Dizziness, lightheadedness, and syncope
C) Increased thirst and dry skin
D) Hyperactivity and insomnia
Correct Answer:
B) Dizziness, lightheadedness, and syncope
Rationale:
Patients on Lasix and Furosemide should be monitored for dizziness, lightheadedness, and syncope, which are signs of hypotension and potential dehydration due to volume loss.
What dietary recommendations should be made to a patient taking Lasix to manage potassium levels?
A) Increase sodium intake
B) Eat potassium-rich foods or consider taking a potassium supplement
C) Limit fluid intake
D) Decrease protein consumption
Correct Answer:
B) Eat potassium-rich foods or consider taking a potassium supplement
Rationale:
Since Lasix and Furosemide can cause hypokalemia, it’s important to promote the consumption of potassium-rich foods or consider a potassium supplement to maintain levels within the normal range (3.5-5 mmol/L).
What is a potential auditory side effect of Lasix and Furosemide?
A) Hearing loss that is always permanent
B) Ototoxicity that may be transient with Lasix
C) Enhanced hearing
D) Ringing in the ears that is always reversible
Correct Answer:
B) Ototoxicity that may be transient with Lasix
Rationale:
Ototoxicity is a potential adverse effect of Lasix, which may be transient; however, it can be permanent with other loop diuretics, necessitating monitoring of auditory function in patients receiving these medications.
What are the signs and symptoms of hypotension that a patient taking Lasix should be educated to monitor for?
A) Increased appetite and weight gain
B) Dizziness, lightheadedness, and syncope
C) Elevated heart rate and sweating
D) Nausea and vomiting
Correct Answer:
B) Dizziness, lightheadedness, and syncope
Rationale:
Patients on Lasix should be educated to monitor for signs of hypotension, such as dizziness, lightheadedness, and syncope, due to volume loss from diuresis, which can lead to decreased blood pressure.
How should a nurse manage a patient experiencing dehydration due to the use of Lasix?
A) Increase the patient’s sodium intake immediately
B) Administer IV fluids as needed and monitor electrolyte levels
C) Encourage the patient to take more diuretics
D) Advise the patient to drink caffeinated beverages
Correct Answer:
B) Administer IV fluids as needed and monitor electrolyte levels
Rationale:
In cases of dehydration caused by Lasix, the nurse should administer IV fluids as needed and continuously monitor electrolyte levels to prevent complications such as hyponatremia and hypokalemia.
What is the primary concern when a patient on Lasix is also taking Digoxin?
A) Risk of hyperkalemia
B) Increased risk of toxicity when the patient is hypokalemic
C) Decreased effectiveness of Lasix
D) Increased diuretic effect
Correct Answer:
B) Increased risk of toxicity when the patient is hypokalemic
Rationale:
When a patient is on Lasix, there is a high risk of Digoxin toxicity if the patient becomes hypokalemic, as low potassium levels can increase the risk of adverse effects from Digoxin.
What should a nurse be cautious about when a patient on Lasix is prescribed another ototoxic drug?
A) The risk of electrolyte imbalance
B) Increased risk of hearing loss
C) Enhanced diuretic effect
D) Reduced effectiveness of both drugs
Correct Answer:
B) Increased risk of hearing loss
Rationale:
Administering Lasix with other ototoxic drugs can lead to an increased risk of hearing loss, so careful monitoring of hearing function is essential.
How might the administration of potassium-sparing diuretics affect a patient taking Lasix?
A) They can increase the potassium-wasting effect of Lasix.
B) They can enhance the diuretic effect of Lasix.
C) They can counteract the potassium-wasting effect of Lasix.
D) They have no effect on the action of Lasix.
Correct Answer:
C) They can counteract the potassium-wasting effect of Lasix.
Rationale:
Potassium-sparing diuretics can help counteract the potassium-wasting effect of Lasix, making it safer for patients who are at risk of hypokalemia.
Which patient statement indicates a need for further education about drug interactions with Lasix?
A) “I need to be careful if I’m taking Digoxin.”
B) “I can take any pain reliever without any concern.”
C) “I should let my doctor know if I start taking other diuretics.”
D) “I understand I might need to monitor my potassium levels.”
Correct Answer:
B) “I can take any pain reliever without any concern.”
Rationale:
This statement shows a lack of understanding about potential drug interactions with Lasix; some pain relievers may interact with diuretics or affect kidney function, so patients need to consult with their healthcare provider before taking them.
How does the diuretic effect of thiazide diuretics compare to loop diuretics?
A) Thiazide diuretics have a stronger effect than loop diuretics.
B) Thiazide diuretics have a similar effect to loop diuretics.
C) Thiazide diuretics have a less potent effect than loop diuretics.
D) Thiazide diuretics do not have a diuretic effect.
Correct Answer: C) Thiazide diuretics have a less potent effect than loop diuretics.
Rationale: The effect of thiazide diuretics is less than that of loop diuretics.
Why are thiazide diuretics not used in patients with kidney disease?
A) They can cause hyperkalemia.
B) They have no effect on urine flow.
C) They are ineffective if kidney function is impaired.
D) They cause excessive sodium retention.
Correct Answer: C) They are ineffective if kidney function is impaired.
Rationale: The diuretic effect of thiazide diuretics is dependent on kidney function and urine flow, making them unsuitable for patients with kidney disease.
What is a common outcome when using thiazide diuretics?
A) Increased potassium retention
B) Decreased excretion of sodium
C) Increased renal excretion of water
D) Increased reabsorption of chloride
Correct Answer: C) Increased renal excretion of water
Rationale: Thiazide diuretics increase the excretion of sodium and chloride, which leads to increased renal excretion of water.
Which of the following is a reason to avoid thiazide diuretics in certain patients?
A) Their effect is enhanced by kidney disease.
B) They can cause significant diuresis in all patients.
C) Their effectiveness is dependent on adequate kidney function.
D) They promote the reabsorption of sodium and water.
Correct Answer: C) Their effectiveness is dependent on adequate kidney function.
Rationale: Thiazide diuretics are not effective if kidney function is compromised.
What is the primary mechanism of action of Hydrochlorothiazide?
A) Increases water reabsorption in the loop of Henle
B) Blocks sodium and chloride reabsorption in the early segment of the distal convoluted tubule (DCT)
C) Inhibits potassium reabsorption in the nephron
D) Increases potassium secretion in the collecting duct
Correct Answer: B) Blocks sodium and chloride reabsorption in the early segment of the distal convoluted tubule (DCT)
Rationale: Hydrochlorothiazide works by blocking sodium and chloride reabsorption in the early segment of the DCT.
What percentage of sodium and chloride reabsorption occurs in the early segment of the DCT where Hydrochlorothiazide acts?
A) 20%
B) 50%
C) 10%
D) 30%
Correct Answer: C) 10%
Rationale: Hydrochlorothiazide blocks the reabsorption of only 10% of sodium and chloride that occurs in the early segment of the DCT.
When does diuresis begin after oral administration of Hydrochlorothiazide?
A) 1 hour
B) 2 hours
C) 4 hours
D) 6 hours
Correct Answer: B) 2 hours
Rationale: Diuresis begins about 2 hours after oral administration of Hydrochlorothiazide.
What is the peak effect time for Hydrochlorothiazide after administration?
A) 1 hour
B) 2 hours
C) 4 hours
D) 12 hours
Correct Answer: C) 4 hours
Rationale: The peak effect of Hydrochlorothiazide occurs at approximately 4 hours after administration.
What is a significant characteristic of Hydrochlorothiazide’s pharmacokinetics?
A) It undergoes extensive hepatic metabolism.
B) It has a long duration of action.
C) It is excreted unchanged in urine.
D) It requires renal metabolism for efficacy.
Correct Answer: C) It is excreted unchanged in urine.
Rationale: Hydrochlorothiazide is excreted unchanged in the urine, and there is no metabolism involved.
Which of the following adverse effects is associated with Hydrochlorothiazide?
A) Ototoxicity
B) Hypokalemia
C) Hyponatremia
D) Both B and C
Correct Answer: D) Both B and C
Rationale: Adverse effects of Hydrochlorothiazide include hypokalemia and hyponatremia, similar to loop diuretics; however, Hydrochlorothiazide does not cause ototoxicity.
What is the primary benefit of potassium-sparing diuretics?
A) Increased sodium reabsorption
B) Moderate diuresis and potassium retention
C) Significant fluid retention
D) Inhibition of aldosterone production
Correct Answer: B) Moderate diuresis and potassium retention
Rationale: Potassium-sparing diuretics are useful for moderate diuresis while retaining potassium in the kidneys.
Why are potassium-sparing diuretics often used in conjunction with loop or thiazide diuretics?
A) To enhance potassium excretion
B) To prevent dehydration
C) To counteract potassium-wasting effects of other diuretics
D) To increase sodium reabsorption
Correct Answer: C) To counteract potassium-wasting effects of other diuretics
Rationale: Potassium-sparing diuretics are used with loop or thiazide diuretics to prevent the loss of potassium, which these other diuretics can cause.
Which of the following types of potassium-sparing diuretics acts as an aldosterone antagonist?
A) Spironolactone
B) Hydrochlorothiazide
C) Furosemide
D) Bumetanide
Correct Answer: A) Spironolactone
Rationale: Spironolactone is an example of a potassium-sparing diuretic that acts as an aldosterone antagonist.
What are the two types of potassium-sparing diuretics?
A) Thiazide and loop
B) Aldosterone antagonist and non-aldosterone antagonist
C) Osmotic and carbonic anhydrase inhibitors
D) Proximal and distal diuretics
Correct Answer: B) Aldosterone antagonist and non-aldosterone antagonist
Rationale: Potassium-sparing diuretics can be classified into two types: aldosterone antagonists and non-aldosterone antagonists.
What is a key characteristic of potassium-sparing diuretics compared to loop or thiazide diuretics?
A) They are less effective for fluid retention.
B) They cause significant potassium loss.
C) They are primarily used for severe diuresis.
D) They do not affect potassium levels
Correct Answer: A) They are less effective for fluid retention.
Rationale: Potassium-sparing diuretics are useful for moderate diuresis and primarily focus on retaining potassium, making them less effective for severe fluid retention compared to loop or thiazide diuretics.
What is the primary mechanism of action of Spironolactone?
A) Increases sodium reabsorption in the proximal tubule
B) Blocks aldosterone in the distal nephron (DCT and collecting duct)
C) Inhibits potassium secretion in the loop of Henle
D) Enhances reabsorption of water in the collecting duct
Correct Answer: B) Blocks aldosterone in the distal nephron (DCT and collecting duct)
Rationale: Spironolactone works by blocking aldosterone, which reduces sodium reabsorption and promotes potassium retention in the distal nephron.
Why is the amount of urine output small when using Spironolactone?
A) It is a strong diuretic.
B) It only works in the proximal convoluted tubule.
C) Its mechanism is primarily focused on potassium retention.
D) It has a rapid onset of action.
Correct Answer: C) Its mechanism is primarily focused on potassium retention.
Rationale: Spironolactone promotes mild diuresis by blocking aldosterone, but its primary role is to retain potassium, leading to a smaller volume of urine output compared to stronger diuretics.
What is the onset time for Spironolactone?
A) Immediate (within 1 hour)
B) Moderate (4-6 hours)
C) Slow (up to 48 hours)
D) Rapid (within 12 hours)
Correct Answer: C) Slow (up to 48 hours)
Rationale: The onset of action for Spironolactone is slow, taking up to 48 hours to achieve its full effect.
In which conditions is Spironolactone commonly used?
A) Severe dehydration and hypotension
B) Hypertension and heart failure
C) Acute renal failure
D) Urinary tract infections
Correct Answer: B) Hypertension and heart failure
Rationale: Spironolactone is primarily used to manage hypertension and heart failure, particularly to counteract the potassium-wasting effects of other diuretics.
What is a significant adverse effect of Spironolactone that needs monitoring?
A) Hyponatremia
B) Hyperkalemia
C) Hypocalcemia
D) Dehydration
Correct Answer: B) Hyperkalemia
Rationale: Hyperkalemia is a significant adverse effect of Spironolactone, necessitating monitoring of potassium levels, particularly if they exceed 5 mmol/L.
What endocrine effects may be associated with Spironolactone due to its steroid derivative nature?
A) Weight loss and increased energy
B) Gynecomastia, menstrual irregularities, impotence, hirsutism, deepening of voice
C) Increased libido and fertility
D) Decreased appetite and nausea
Correct Answer: B) Gynecomastia, menstrual irregularities, impotence, hirsutism, deepening of voice
Rationale: As a steroid derivative, Spironolactone can have various endocrine effects, including gynecomastia and other hormone-related changes.
What drug interactions should be considered with Spironolactone?
A) Drugs that decrease blood pressure
B) Other drugs (or foods) that increase potassium levels
C) Antibiotics
D) Anticoagulants
Correct Answer: B) Other drugs (or foods) that increase potassium levels
Rationale: Spironolactone can interact with other medications or foods that raise potassium levels, increasing the risk of hyperkalemia.
What is the primary mechanism of action of Triamterene?
A) Inhibits aldosterone in the distal nephron
B) Directly disrupts ion transport (Na/K) in the distal nephron
C) Blocks sodium reabsorption in the loop of Henle
D) Increases water reabsorption in the collecting duct
Correct Answer: B) Directly disrupts ion transport (Na/K) in the distal nephron
Rationale: Triamterene acts by directly disrupting the sodium-potassium ion transport in the distal nephron, leading to its diuretic effects.
What is a characteristic of the diuretic effect of Triamterene?
A) Strong and rapid diuresis
B) Minimal diuresis
C) Prolonged diuretic effect
D) Immediate urine output
Correct Answer: B) Minimal diuresis
Rationale: Triamterene is associated with minimal diuresis compared to other diuretics, as it primarily disrupts ion transport rather than significantly promoting urine output.
What is the pharmacokinetic feature of Triamterene?
A) Slow onset of action
B) Quick onset of action
C) Extended duration of effect
D) Metabolized by the liver
Correct Answer: B) Quick onset of action
Rationale: Triamterene has a quick onset of action due to its direct inhibition of the transport pump in the distal nephron.