Chapter 28: Diuretic Drugs
Lilley: Pharmacology and the Nursing Process, 9th Edition
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MULTIPLE CHOICE
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1. When monitoring a patient who has diabetes and is receiving a carbonic anhydrase inhibitor
for edema, the nurse will monitor for which possible adverse effect?
a. Metabolic alkalosis
b. Elevated blood glucose
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c. Hyperkalemia
d. Mental alertness
ANS: B
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An undesirable effect of carbonic anhydrase inhibitors is that they elevate the blood glucose
level and cause glycosuria in diabetic patients. They induce metabolic acidosis, making their
effectiveness diminishes in 2 to 4 days. In addition, hypokalemia and drowsiness may occur.
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DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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2. The nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient is
taking which of these diuretics?
a. Hydrochlorothiazide (HydroDIURIL)
b. Furosemide (Lasix)
c. Acetazolamide (Diamox)
d. Spironolactone (Aldactone)
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ANS: D
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Spironolactone (Aldactone) is a potassium-sparing diuretic, and patients taking this drug must
be monitored for signs of hyperkalemia. The other drugs do not cause hyperkalemia but
instead cause hypokalemia.
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DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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3. Mannitol (Osmitrol) has been ordered for a patient with acute renal failure. The nurse will
administer this drug using which procedure?
a. Intravenously, through a filter
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b. By rapid intravenous bolus
c. By mouth in a single morning dose
d. Through a gravity intravenous drip with standard tubing
ANS: A
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Mannitol is administered via intravenous infusion through a filter because of possible
crystallization. It is not available in oral form. The other options are incorrect.
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DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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4. Furosemide (Lasix) is prescribed for a patient who is about to be discharged, and the nurse
provides instructions to the patient about the medication. Which statement by the nurse is
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correct?
a. “Take this medication in the evening.”
b. “Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and
dates.”
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c. “If you experience weight gain, such as 5 pounds or more per week, be sure to tell
your physician during your next routine visit.”
d. “Be sure to change positions slowly and rise slowly after sitting or lying so as to
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prevent dizziness and possible fainting because of blood
pressure changes.”
ANS: D
Orthostatic hypotension is a possible problem with diuretic therapy. Foods high in potassium
should be eaten more often, and the drug needs to be takenabirb.com/test
in the morning so that the diuretic
effects do not interfere with sleep. A weight gain of 5 pounds or more per week must be
reported immediately.
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DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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5. When reviewing the mechanisms of action of diuretics, the nurse knows that which statement
is true about loop diuretics?
a. They work by inhibiting aldosterone.
b. They are very potent, having a diuretic effect that lastsabirb.com/test
at least 6 hours.
c. They have a rapid onset of action and cause rapid diuresis.
d. They are not effective when the creatinine clearance decreases below 25 mL/min.
ANS: C
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The loop diuretics have a rapid onset of action; therefore, they are useful when rapid onset is
desired. Their effect lasts for about 2 hours, and a distinct advantage they have over thiazide
diuretics is that their diuretic action continues even when creatinine
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25 mL/min.
DIF: Cognitive Level: Understanding (Comprehension)
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TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. When monitoring a patient who is taking hydrochlorothiazide (HydroDIURIL), the nurse
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notes that which drug is most likely to cause a severe interaction
with the diuretic?
a. Digitalis
b. Penicillin
c. Potassium supplements
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d. Aspirin
ANS: A
There is an increased risk for digitalis toxicity in the presence
of hypokalemia, which may
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develop with hydrochlorothiazide therapy. Potassium supplements are often prescribed with
hydrochlorothiazide therapy to prevent hypokalemia. The other options do not have
interactions with hydrochlorothiazide.
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DIF: Cognitive Level: Applying (Application)
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TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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7. When a patient is receiving diuretic therapy, which of these assessment measures would best
reflect the patient’s fluid volume status?
a. Blood pressure and pulse
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b. Serum potassium and sodium levels
c. Intake, output, and daily weight
d. Measurements of abdominal girth and calf circumference
ANS: C
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Urinary intake and output and daily weights are the best reflections of a patient’s fluid volume
status.
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DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
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8. A patient is being discharged to home on a single daily dose of a diuretic. The nurse instructs
the patient to take the dose at which time so it will be least disruptive to the patient’s daily
routine?
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a. In the morning
b. At noon
c. With supper
d. At bedtime
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ANS: A
It is better to take the diuretic medication early in the morning to prevent urination during the
night. Taking the diuretic at the other times may cause nighttime
urination and disrupt sleep.
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DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Implementation
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MSC: NCLEX: Safe and Effective Care Environment: Management
of Care
9. A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in
which class is likely to be used initially?
a. Loop diuretics
b. Osmotic diuretics
c. Thiazide diuretics
d. Potassium-sparing diuretics
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ANS: C
The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and
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Treatment of High Blood Pressure (JNC-8) guidelines reaffirmed
the role of thiazide diuretics
as among the first-line drugs in the treatment hypertension. The other drug classes are not
considered first-line treatments.
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DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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10. A patient in the neurologic intensive care unit is being treated for cerebral edema. Which class
of diuretic is used to reduce intracranial pressure?
a. Loop diuretics
b. Osmotic diuretics
c. Thiazide diuretics
d. Vasodilators
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ANS: B
Mannitol, an osmotic diuretic, is commonly used to reduce intracranial pressure and cerebral
edema resulting from head trauma.
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DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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11. A 79-year-old patient is taking a diuretic for treatment of hypertension. This patient is very
independent and wants to continue to live at home. The nurse will know that which teaching
point is important for this patient?
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a. He should take the diuretic with his evening meal.
b. He should skip the diuretic dose if he plans to leave the house.
c. If he feels dizzy while on this medication, he needs to stop taking it and take
potassium supplements instead.
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d. He needs to take extra precautions when standing up because of possible
orthostatic hypotension and resulting injury from falls.
ANS: D
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Caution must be exercised in the administration of diuretics to the older adults because they
are more sensitive to the therapeutic effects of these drugs and are more sensitive to the
adverse effects of diuretics, such as dehydration, electrolyte loss, dizziness, and syncope.
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Taking the diuretic with the evening meal may disrupt sleep
because of nocturia. Doses
should never be skipped or stopped without checking with the prescriber.
DIF: Cognitive Level: Applying (Application)
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TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
MULTIPLE RESPONSE
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1. The nurse is monitoring a patient who is taking a potassium-sparing diuretic. Which of the
drugs or drug classes may have an interaction with this type
of diuretic? (Select all that
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apply.)
a. Lithium
b. Vancomycin
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c. Potassium supplements
d. NSAIDs
e. Antidiabetic drugs
f. ACE inhibitors
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ANS: A, C, D, F
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Taking lithium with potassium-sparing diuretics may cause lithium toxicity; taking ACE
inhibitors or potassium supplements may lead to hyperkalemia. Taking NSAIDs with
potassium-sparing diuretics may cause a decreased diureticabirb.com/test
response. There are no interactions
with vancomycin or antidiabetic drugs and potassium-sparing diuretics.
DIF: Cognitive Level: Applying (Application)
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TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
2. When assessing a patient who is receiving a loop diuretic,abirb.com/test
the nurse looks for the
manifestations of potassium deficiency, which would include what symptoms? (Select all that
apply.)
a. Dyspnea
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b. Constipation
c. Tinnitus
d. Muscle weakness
e. Anorexia
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f. Lethargy
ANS: D, E, F
Symptoms of hypokalemia include anorexia, nausea, lethargy,
muscle weakness, mental
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confusion, and hypotension. The other symptoms are not associated with hypokalemia.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
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COMPLETION
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1. A patient is to receive furosemide (Lasix) via a percutaneous endoscopic gastrostomy (PEG)
tube. The order reads, “Give furosemide, 80 mg, per PEG tube once daily.” The medication is
available in a liquid form, 40 mg/5 mL. Identify how many milliliters the nurse will
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administer for each dose. _______
ANS:
10 mL
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40 mg:5 mL :: 80 mg:x mg
(40 × x) = (5 × 80); 40x = 400; x = 10 mL
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DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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2. The order for a child reads, “Give furosemide (Lasix) 2 mg/kg IV STAT.” The child weighs
33 pounds. Identify how many milligrams the child will receive for this dose. _______
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ANS:
30 mg
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First, convert 33 pounds to kilograms: 33 pounds ÷ 2.2 = 15
kg.
Next, calculate mg/kg: 2 mg/kg × 15 kg = 30 mg.
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DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Implementation
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MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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