Nokea
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
Correct Answer: C
Rationale: The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8) guidelines reaffirmed the role of thiazide diuretics as among the first-line drugs in the treatment of hypertension. The other drug classes are not considered first-line treatments.
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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
- C. Hyperkalemia
- D. Hypoglycemia
Correct Answer: B
Rationale: 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 diminish in 2 to 4 days. In addition, hypokalemia and drowsiness may occur. Hypoglycemia is not an adverse effect.
A patient is to receive furosemide (Lasix) via a percutaneous endoscopic gastrostomy (PEG) tube. The order reads, "Give furosemide, 60 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 administer for each dose.
Correct Answer: 7.5 mL
Rationale: 40 mg : 5 mL :: 60 mg : x mL; (40 * x) = (5 * 60); 40x = 300; x = 300/40 = 7.5 mL.
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 lasts 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.
Correct Answer: C
Rationale: 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 clearance decreases below 25 mL/min.
When monitoring a patient who is taking hydrochlorothiazide, the nurse notes that which drug is most likely to cause a severe interaction with the diuretic?
- A. Digoxin
- B. Penicillin
- C. Potassium supplements
- D. Aspirin
Correct Answer: A
Rationale: There is an increased risk for digitalis toxicity in the presence of hypokalemia, which may develop with hydrochlorothiazide therapy. Potassium supplements are often prescribed with hydrochlorothiazide therapy to prevent hypokalemia. The other options do not have interactions with hydrochlorothiazide.
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?
- 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.
- D. He needs to take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls.
Correct Answer: D
Rationale: Caution must be exercised in the administration of diuretics to 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. 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.