Chapter 32: Diuretics

Chapter 32: Diuretics

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A patient develops hypertension. The primary care nurse practitioner (NP) plans to begin diuretic therapy for this patient. The NP notes clear breath sounds, no organomegaly, and no peripheral edema. The patient’s serum electrolytes are normal. The NP should prescribe:

ANS:  D

Thiazide diuretics are first-line drugs for treating hypertension. The other three drugs are not thiazide diuretics.

DIF:    Cognitive Level: Applying (Application)                           REF:   376

2. A patient takes hydrochlorothiazide to treat hypertension and asks the primary care NP why it is necessary to reduce sodium intake while taking this medication. The NP should explain that decreasing sodium is necessary to:

ANS:  C

If dietary salt intake is high, the amount of sodium lost in response to the diuretic may be partially or completely offset by postdiuretic sodium retention. Sodium restriction does not prevent renal insufficiency or minimize the incidence of hypokalemia. Sodium restriction is necessary to maintain the drug’s effectiveness but does not increase the chance of discontinuing the medication.

DIF:    Cognitive Level: Applying (Application)                           REF:   372

3. A patient with congestive heart failure will begin therapy with a diuretic medication. The primary care NP orders laboratory tests, which reveal a glomerular filtration rate (GFR) of 25 mL/minute. The initial drug the NP should prescribe is:

ANS:  A

Thiazides are the most frequently used and the least expensive drugs administered to treat hypertension and are considered first-line treatments. In patients with a GFR less than 30 mL/minute, thiazides are relatively ineffective, with the exception of metolazone. Furosemide may be added as a second-line drug. Potassium-sparing diuretics, such as spironolactone, should be used with great caution or avoided altogether in patients with renal insufficiency.

DIF:    Cognitive Level: Applying (Application)                           REF:   372

4. A patient who has congestive heart failure and arthritis has been taking chlorthalidone (Zaroxolyn) 25 mg daily for 6 months. The primary care NP notes a persistent blood pressure of 145/90 mm Hg. The NP should:

ANS:  A

For diuretic resistance, the NP should evaluate factors such as patient nonadherence, physiologic causes, and drugs that may increase resistance, including nonsteroidal antiinflammatory drugs (NSAIDs). This patient has arthritis, and it is likely that NSAID use may be causing diuretic resistance. A second drug, such as furosemide, should be added after the cause of diuretic resistance is determined. The maximum daily dose of chlorthalidone is 100 mg per day, but increasing the dose is not recommended to treat diuretic resistance. Recommending salt substitutes is not indicated.

DIF:    Cognitive Level: Applying (Application)                           REF:   373