Chapter 40: Diuretics

Chapter 40: Diuretics

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

1. A nurse is caring for an obese patient who is 3 days postoperative. Upon assessment, the nurse discovers that the patient is short of breath, has respirations of 32/minute, and is coughing up pink, frothy sputum. The nurse should anticipate the administration of which medication?

ANS:   B

Furosemide should be administered to this patient, because it is a rapid and highly effective diuretic, which is indicated for a patient in pulmonary edema, as described. It also can be given intravenously to increase the rapidity of its effectiveness.

Mannitol typically is indicated for patients with increased intracranial pressure caused by increases in cerebrospinal fluid. Mannitol must be stopped immediately if signs of pulmonary congestion or heart failure occur.

Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema, because their diuretic effects are less rapid and effective than are needed to manage a patient with pulmonary edema.

DIF:    Cognitive Level: Application             REF:    p. 446

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

2. A nurse is caring for a patient with meningitis who is receiving spironolactone (Aldactone). A prescriber writes an order for potassium penicillin. What considerations should the nurse focus on prior to administration?

ANS:   B

Obtaining potassium levels is essential with a potassium-sparing diuretic, such as spironolactone. If the patient has evidence of hyperkalemia, the medication should be held and the prescriber notified.

Obtaining the patient’s blood pressure is more important when one of the more rapidly working diuretics (e.g., furosemide) is used to treat edema secondary to pulmonary edema or heart failure.

Level of consciousness would not be a consideration prior to administration of spironolactone.

Serum sodium levels are not important as they relate to the administration of spironolactone.

DIF:    Cognitive Level: Application             REF:    pp. 449-450

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Health Promotion and Maintenance

3. A patient has 2+ pitting edema of the lower extremities bilaterally; auscultation of the lungs reveals crackles bilaterally; and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question?

ANS:   C

Spironolactone is a non-potassium-wasting diuretic; therefore, if the patient has a serum potassium level of 6 mEq/L, indicating hyperkalemia, an order for this drug should be questioned.

Bumetanide and furosemide are potassium-wasting diuretics and would be appropriate to administer in a patient with hyperkalemia.

Hydrochlorothiazide is a partially potassium-sparing diuretic and would not be contraindicated in this patient.

DIF:    Cognitive Level: Application             REF:    p. 449-450

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential