Chapter 51: Diuretic Agents

True or False: The risk for ototoxicity increases if loop diuretics are combined with aminoglycosides.

True (Rationale: Ototoxicity can result if loop diuretics are combined with aminoglycosides. The risk of ototoxicity increases if loop diuretics are combined with aminoglycosides or cisplatin. An example of an aminoglycoside would be gentamicin sulfate.)

A patient is receiving acetazolamide in a sustained-release form. The nurse would anticipate the onset of drug action in approximately which time frame? a. 2 hours b. 3 hours c. 4 hours d. 1 hour

a. 2 hours (Rationale: Acetazolamide in sustained release form has an onset of action of 2 hours.)

A patient is prescribed a thiazide diuretic that is to be administered intravenously. Which agent would this most likely be? a. Chlorothiazide b. Methylchlorothiazide c. Bendroflumethiazide d. Hydrochlorothiazide

a. Chlorothiazide (Rationale: Chlorothiazide is administered orally or intravenously. The other agents are only administered orally.)

A patient is receiving bumetanide. The nurse would instruct the patient to be alert for what adverse effects? (Select all that apply.) a. Dizziness b. Muscle cramps c. Hypotension d. Weakness e. Irreversible hearing loss

a. Dizziness b. Muscle cramps c. Hypotension d. Weakness (Rationale: Bumetanide may cause hypotension and dizziness due to the rapid fluid loss, reversible hearing loss, and signs and symptoms of hypokalemia, such as weakness and muscle cramps.)

Before ordering a loop diuretic, the nurse practitioner would check the patient's history for the current use of which drug? (Select all that apply.) a. Ibuprofen b. Indomethacin c. Doxycycline d. Omeprazole e. Coumadin

a. Ibuprofen b. Indomethacin e. Coumadin (Rationale: Loop diuretics if given with an anticoagulant may increase the effects of the anticoagulant. There is a decreased loss of sodium and decreased antihypertensive effects if loop diuretics are given with indomethacin, ibuprofen, salicylates, and NSAIDs. There is no drug-drug interaction with omeprazole or doxycycline.)

The nurse understands that the action of most diuretics typically results in what effect? (Select all that apply.) a. Loss of water b. Loss of calcium c. Loss of chloride d. Retention of sodium e. Retention of potassium

a. Loss of water c. Loss of chloride (Rationale: Most diuretics result in the loss of water, sodium, and chloride along with the sodium. Potassium may or may not be lost depending on the type of diuretic used. Calcium typically is not affected by diuretics.)

A patient has just received a dose of mannitol for treatment of increased intracranial pressure. The nurse would be alert for which adverse effects? (Select all that apply.) a. Nausea b. Tinnitus c. Confusion d. Dizziness e. Hypertension

a. Nausea c. Confusion d. Dizziness (Rationale: Adverse effects related to the use of an osmotic diuretic include nausea, vomiting, hypotension, lightheadedness, confusion, and headache, which can be accompanied by cardiac decompensation and even shock. Tinnitus [ringing in the ears] is not associated with osmotic diuretics.)

Which medications are considered potassium-sparing diuretics? (Select all that apply.) a. Spironolactone b. Methazolamide c. Metolazone d. Triamterene e. Amiloride

a. Spironolactone d. Triamterene e. Amiloride (Rationale: Amiloride, spironolactone, and triamterene are all examples of potassium-sparing diuretics. Methazolamide is a carbonic anhydrase inhibitor and metolazone is a thiazide-like diuretic.)

A nurse understands that loop diuretics are considered "high-ceiling" diuretics because of what effect? a. They cause a greater diuresis. b. They require large doses to achieve effect. c. They cause a greater loss of potassium. d. They are associated with more adverse effects.

a. They cause a greater diuresis. (Rationale: High-ceiling diuretics are those that cause a greater degree of diuresis than other diuretics. The term high ceiling only refers to the amount of diuresis produced. Loop diuretics may have more adverse effects in comparison to potassium-sparing diuretics but this has no connection to the term high ceiling. Loop diuretics achieve their effect with a relatively small dose. Loop diuretics do cause a loss of potassium but so do thiazide and thiazide-like diuretics.)

When describing the action of chlorothiazide, what would a nurse include? a. Blocking the action of carbonic anhydrase b. Blocking of the chloride pump c. Acting as an aldosterone antagonist d. Blocking of potassium secretion through the tubule

b. Blocking of the chloride pump (Rationale: Chlorothiazide, a thiazide diuretic, blocks the chloride pump. Carbonic anhydrase inhibitors such as acetazolamide block the action of carbonic anhydrase. Spironolactone, a potassium-sparing diuretic, acts as an aldosterone antagonist. Amiloride and triamterene, potassium-sparing diuretics, block potassium secretion through the tubule.)

A group of students are reviewing the various classes of diuretics. The students demonstrate understanding of the information when they identify what as a loop diuretic? a. Triamterene b. Furosemide c. Mannitol d. Indapamide

b. Furosemide (Rationale: Furosemide is a loop diuretic. Triamterene is a potassium-sparing diuretic. Mannitol is an osmotic diuretic. Indapamide is a thiazide-like diuretic.)

The nurse would contact the physician if a patient who has been prescribed hydrochlorothiazide (HydroDIURIL) has which condition? (Select all that apply.) a. Otitis media b. Systemic lupus erythematosus c. Gout d. Osteoarthritis e. Diabetes mellitus

b. Systemic lupus erythematosus c. Gout e. Diabetes mellitus (Rationale: Caution should be used with thiazide and thiazide-like diuretics if the patient has the following conditions: systemic lupus erythematosus, diabetes mellitus, gout, liver disease, hyperparathyroidism, or bipolar disorder. Otitis media and osteoarthritis do not have any contraindications for use with this drug.)

A patient asks the nurse why a diuretic has been prescribed for the treatment of his high blood pressure. What is the nurse's best response? a. "Diuretics slow the heart, which then decreases blood pressure." b. "Diuretics block the angiotensin-converting enzyme, which results in lowered blood pressure." c. "Diuretics decrease water and sodium in the blood vessels, which decreases blood pressure." d. "Diuretics relax the blood vessel wall, which reduces blood pressure."

c. "Diuretics decrease water and sodium in the blood vessels, which decreases blood pressure." (Rationale: Diuretics are used to decrease volume and sodium, which then decreases pressure in the system. Diuretics do not have an effect on the blood vessel wall; they decrease water and sodium in the blood vessel, which decreases pressure. Cardiotonics strengthen the heart muscle which slows the rate, not diuretics. ACE inhibitors block the angiotensin-converting enzyme.)

After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states what? a. "I need to take the drug on an empty stomach." b. "I can still use my salt substitute if I want to." c. "I need to make sure I don't eat too many high-potassium foods." d. "I should take the medicine around dinnertime for the best effect."

c. "I need to make sure I don't eat too many high-potassium foods." (Rationale: The drug is a potassium-sparing diuretic placing the patient at risk for hyperkalemia, especially if the patient consumes foods high in potassium. The patient should take the medication in the morning to prevent interfering with sleep due to getting up at night to void. The patient can take the drug with meals if GI upset occurs. Many salt substitutes contain potassium, which could increase the patient's risk for hyperkalemia.)

A patient receives furosemide intravenously at 9 a.m. The nurse would expect to assess peak effects of the drug at which time? a. 9:15 a.m. b. 10:00 a.m. c. 9:30 a.m. d. 10:30 a.m.

c. 9:30 a.m. (Rationale: Furosemide, when given IV, peaks in 30 minutes; the nurse would see peak drug action at approximately 9:30 a.m.)

Which diuretics are most often used in the treatment of glaucoma and increased intraocular pressure? (Select all that apply.) a. Hydrochlorothiazide b. Spironolactone c. Acetazolamide d. Ethacrynic acid e. Mannitol

c. Acetazolamide e. Mannitol (Rationale: Acetazolamide is a carbonic anhydrase inhibitor and mannitol is an osmotic diuretic. These two classifications of diuretics are the ones most frequently used in the treatment of glaucoma and increased intraocular pressure. Thiazide and thiazide-like [hydrochlorothiazide], loop [ethacrynic acid], and potassium-sparing [spironolactone] diuretics are not indicated for the treatment of glaucoma or increased intraocular pressure.)

What would be a contraindication to the use of carbonic anhydrase inhibitors? a. Respiratory acidosis b. Chronic obstructive pulmonary disease c. Allergy to sulfonamides d. Adrenocortical insufficiency

c. Allergy to sulfonamides (Rationale: Carbonic anhydrase inhibitors are sulfonamides, and as such are contraindicated in patients with an allergy to sulfonamides. Carbonic anhydrase inhibitors are used cautiously in patients with adrenocortical insufficiency, respiratory acidosis, and COPD because these conditions could be exacerbated by the use of the drug.)

The diuretic nesiritide (Natrecor) is given to individuals who have what issue related to heart failure? a. Edema of the feet and hands b. Jugular distention c. Dyspnea at rest d. Nausea

c. Dyspnea at rest (Rationale: Nesiritide is intended for the treatment of patients with acutely decompensated heart failure who experiences dyspnea at rest, not edema, jugular distention, or nausea.)

The nurse encourages a patient who is receiving a diuretic to maintain his fluid intake to prevent the risk of developing what problem? a. Weight loss b. Dehydration c. Fluid rebound d. Hyperkalemia

c. Fluid rebound (Rationale: When a patient who is taking a diuretic decreases fluid intake, fluid rebound occurs, which leads to water retention and subsequent edema and weight gain, not dehydration or weight loss. Electrolyte imbalances may or may not occur depending on the type of diuretic being used.)

Diuretics are frequently prescribed for patients with what conditions? (Select all that apply.) a. Sprained ankle b. Hypokalemia c. Hypertension d. Liver failure e. Heart failure

c. Hypertension d. Liver failure e. Heart failure (Rationale: Diuretics are indicated for the treatment of edema associated with heart failure, acute pulmonary edema, liver disease, renal disease, and the treatment of hypertension. They are also used to decrease potassium levels in the treatment of conditions that cause hyperkalemia; therefore, they are not indicated for hypokalemia. They are also not indicated for the treatment of edema related to a sprain or fracture.)

After reviewing information about thiazide diuretics, a group of students demonstrate the need for additional teaching when they identify what as a possible adverse effect? a. Hyperuricemia b. Hypokalemia c. Hypocalcemia d. Hyperglycemia

c. Hypocalcemia (Rationale: Thiazide diuretics can cause hypokalemia, hyperuricemia [increased uric acid levels], hypercalcemia, and hyperglycemia [with long-term use].)

What would the nurse expect to be ordered for a patient experiencing an acute increase in intraocular pressure? a. Amiloride b. Furosemide c. Mannitol d. Metolazone

c. Mannitol (Rationale: An acute increase in intraocular pressure is an emergency situation requiring the use of a potent osmotic diuretic. Currently, only one osmotic diuretic is available, mannitol. Furosemide is a loop diuretic; metolazone is a thiazide-like diuretic; amiloride is a potassium-sparing diuretic; none are used for emergency increased intraocular pressure problems.)

The nurse is aware that diuretics are used to relieve what symptom associated with many disorders? a. Pain b. Fatigue c. Dizziness d. Edema

d. Edema (Rationale: Diuretics are indicated for the treatment of edema associated with heart failure, liver disease, and renal disease. Diuretics do not relieve pain. Diuretics may cause dizziness when administered; it is not a treatment of dizziness that may accompany other disorders. Diuretics may increase fatigue because of the need to void more often, disrupting sleep.)

Spironolactone is the drug of choice for treating which condition? a. Renal failure b. Heart failure c. Hyperkalemia d. Hyperaldosteronism

d. Hyperaldosteronism (Rationale: Spironolactone is a potassium-sparing diuretic and is the drug of choice for treating hyperaldosteronism, which is seen in cirrhosis of the liver and nephrotic syndrome. It can cause hyperkalemia so it is not used in the presence of hyperkalemia, and it is not recommended for either renal failure or heart failure.)

Due to the action of methazolamide, the nurse would assess a patient closely for signs and symptoms of which acid-base imbalance? a. Metabolic alkalosis b. Respiratory acidosis c. Respiratory alkalosis d. Metabolic acidosis

d. Metabolic acidosis (Rationale: Methazolamide is a carbonic anhydrase inhibitor that can cause metabolic acidosis, not alkalosis, due to the loss of bicarbonate. It is not associated with either respiratory acidosis or alkalosis.)