Chapter 43: Diuretics

Chapter 43: Diuretics

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

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 diuretic—especially 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 I’m 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