Chapter 43: Diuretics Nursing School Test Banks

Chapter 43: Diuretics
Test Bank

MULTIPLE CHOICE

1. The nurse is preparing to administer the first dose of hydrochlorothiazide (HydroDIURIL) 50 mg to a patient who has a blood pressure of 160/95 mm Hg. The nurse notes that the patient had a urine output of 200 mL in the past 12 hours. The nurse will perform which action?
a. Administer the medication as ordered.
b. Encourage the patient to drink more fluids.
c. Hold the medication and request an order for serum BUN and creatinine.
d. Request an order for serum electrolytes and administer the medication.
ANS: C
Thiazide diuretics are contraindicated in renal failure. This patient has oliguria and should be evaluated for renal failure prior to administration of the diureticespecially in the absence of known renal failure for this patient. Drinking more fluids will not increase urine output in patients with renal failure.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 623
TOP: NURSING PROCESS: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. The nurse is preparing to administer doses of hydrochlorothiazide (HydroDIURIL) and digoxin (Lanoxin) to a patient who has heart failure. The patient reports having blurred vision. The nurse notes a heart rate of 60 beats per minute and a blood pressure of 140/78 mm Hg. Which action will the nurse take?
a. Administer the medications and request an order for serum electrolytes.
b. Give both medications and evaluate serum blood glucose frequently.
c. Hold the digoxin and notify the provider.
d. Hold the hydrochlorothiazide and notify the provider.
ANS: C
When thiazide diuretics are taken with digoxin, patients are at risk of digoxin toxicity because thiazides can cause hypokalemia. The patient has bradycardia and blurred vision, which are both signs of digoxin toxicity. The nurse should hold the digoxin and notify the provider. Serum electrolytes may be ordered, but the digoxin should not be given.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 623
TOP: NURSING PROCESS: Nursing Intervention/Evaluation
MSC: NCLEX: Physiological Integrity: Pathophysiology

3. The nurse is teaching a patient about taking hydrochlorothiazide. Which statement by the patient indicates a need for further teaching?
a. I may need extra sodium and calcium while taking this drug.
b. I should eat plenty of fruits and vegetables while taking this medication.
c. I should take care when rising from a bed or chair when Im on this medication.
d. I will take the medication in the morning to minimize certain side effects.
ANS: A
Patients do not need extra sodium or calcium while taking thiazide diuretics.
Thiazide diuretics can lead to hypokalemia, so patients should be counseled to eat fruits and vegetables that are high in potassium. Patients can develop orthostatic hypotension and should be counseled to rise from sitting or lying down slowly. Taking the medication in the morning helps to prevent nocturia-induced insomnia.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 624
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. The nurse is caring for a patient who is to begin receiving a thiazide diuretic to treat heart failure. When performing a health history on this patient, the nurse will be concerned about a history of which condition?
a. Asthma
b. Glaucoma
c. Gout
d. Hypertension
ANS: C
Thiazides block uric acid secretion and elevated levels can contribute to gout. Patients with a history of gout should take thiazide diuretics with caution; they may need behavioral and/or pharmacologic changes to their gout treatment.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 626
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse is caring for a patient who develops marked edema and a low urine output as a result of heart failure. Which medication will the nurse expect the provider to order for this patient?
a. Digoxin (Lanoxin)
b. Furosemide (Lasix)
c. Hydrochlorothiazide (HydroDIURIL)
d. Spironolactone (Aldactone)
ANS: B
Furosemide is a loop diuretic and is given when the patients condition warrants immediate removal of body fluid, as in heart failure. Digoxin improves cardiac function but does not remove fluid quickly. The other diuretics may be used when immediate fluid removal is not necessary.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 627
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse is caring for a patient who is receiving furosemide (Lasix) and an aminoglycoside antibiotic. The nurse will be most concerned if the patient reports which symptom?
a. Dizziness
b. Dysuria
c. Nausea
d. Tinnitus
ANS: D
The interaction of furosemide and an aminoglycoside can produce ototoxicity in the patient. Tinnitus is a sign of ototoxicity. Dizziness can occur as a result of diuretic therapy but not necessarily as a result of this combination. Dysuria and nausea are not common signs of these drugs interacting.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 627
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. The nurse is teaching a patient who will begin taking furosemide. The nurse learns that the patient has just begun a 2-week course of a steroid medication. What will the nurse recommend?
a. Consume licorice to prevent excess potassium loss.
b. Report a urine output greater than 600 mL/24 hours.
c. Obtain an order for a potassium supplement.
d. Take the furosemide at bedtime.
ANS: C
The interaction of furosemide and a steroid drug can result in an increased loss of potassium. Patients should take a potassium supplement. Patients should avoid licorice while taking furosemide, partially due to the hypokalemic effects of both substances. Urine output greater than 600 mL/24 hours is normal. Patients should take furosemide in the morning to avoid nocturia.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 623
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is caring for a patient who has metabolic alkalosis and is experiencing fluid overload. The provider orders acetazolamide (Diamox). The patient reports right-sided flank pain after taking this medication. The nurse suspects that this patient has developed which condition?
a. Gout
b. Hemolytic anemia
c. Metabolic acidosis
d. Renal calculi
ANS: D
Carbonic anhydrase inhibitors, such as acetazolamide, are used to treat patients who are in metabolic alkalosis and need a diuretic. They can cause electrolyte imbalance, metabolic acidosis, hemolytic anemia, and renal calculi. This patient has right-sided flank pain, which occurs with renal calculi.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 629
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A patient has begun taking spironolactone (Aldactone) in addition to a thiazide diuretic. With the addition of the spironolactone, the nurse will counsel this patient to
a. continue taking a potassium supplement daily.
b. recognize that abdominal cramping is a transient side effect.
c. report decreased urine output to the provider.
d. take these medications at bedtime.
ANS: C
Caution must be used when giving potassium-sparing diuretics to patients with poor renal function, so patients should be taught to report a decrease in urine output. Patients taking potassium-sparing diuretics are at risk for hyperkalemia, so they should not take potassium supplements. Abdominal cramping should be reported to the provider. The medications should be taken in the morning for patients who sleep during the night.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 629
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. The nurse notes a blood pressure of 160/90 mm Hg in a patient taking a thiazide diuretic. The patient reports taking an herbal medication that a friend recommended. Which herbal product is likely, given this patients blood pressure?
a. Ginkgo
b. Hawthorne
c. Licorice
d. St. Johns wort
ANS: A
Increased blood pressure can result when ginkgo is used in combination with a thiazide diuretic. Hawthorne can potentiate hypotension. Licorice can increase potassium loss, leading to hypokalemia. St. Johns wort is not listed as an herbal alert substance with thiazide diuretics.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 624
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. The nurse is caring for a patient who is taking hydrochlorothiazide (HydroDIURIL) and digoxin (Lanoxin). Which potential electrolyte imbalance will the nurse monitor for in this patient?
a. Hypermagnesemia
b. Hypernatremia
c. Hypocalcemia
d. Hypokalemia
ANS: D
Thiazide diuretics can cause hypokalemia, which enhances the effects of digoxin and can lead to digoxin toxicity. Thiazides can cause hypercalcemia.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 622
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A patient has been taking spironolactone (Aldactone) to treat heart failure. The nurse will monitor for
a. hyperkalemia.
b. hypermagnesemia.
c. hypocalcemia.
d. hypoglycemia.
ANS: A
Spironolactone is a potassium-sparing diuretic and can cause hyperkalemia.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 629
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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