NU 578 Unit 3 Exam (
Update) University Of South Alabama,
Questions & Answers (Verified Answers) |
Complete A+ Guide
Section 1: Diuretics (Questions 1-20)
Q1. A client taking hydrochlorothiazide (HCTZ) is started on triamterene (Dyrenium). The client asks why
both medications are required. What is the best response?
A) Both are weak potassium-losing diuretics.
B) The combination produces a synergistic diuretic effect.
C) Triamterene prevents the potassium loss caused by HCTZ.
D) HCTZ prevents the hyperkalemia caused by triamterene.
Answer: C) Triamterene prevents the potassium loss caused by HCTZ.
Rationale: HCTZ is a thiazide diuretic that causes potassium wasting. Triamterene is a potassium-sparing
diuretic that blocks sodium-potassium exchange in the distal nephron. The combination (e.g., Dyazide,
Maxzide) maintains normal potassium levels while achieving diuresis .
Q2. A patient on furosemide (Lasix) reports muscle weakness and cramping. Which electrolyte
imbalance is the most likely cause?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypocalcemia
Answer: B) Hypokalemia
Rationale: Loop diuretics increase potassium excretion in the distal nephron. Hypokalemia (K+ <3.5
mEq/L) causes muscle weakness, cramping, fatigue, and can lead to fatal dysrhythmias if severe .
Q3. A patient on furosemide and digoxin presents with nausea, vomiting, and yellow vision. ECG shows
PVCs. What is the priority action?
A) Administer potassium chloride immediately
B) Check the digoxin level
C) Hold the furosemide
D) Administer lidocaine
,Answer: B) Check the digoxin level
Rationale: Hypokalemia from furosemide increases the risk of digoxin toxicity. The symptoms described
(nausea, visual changes, PVCs) are classic for digoxin toxicity. The priority is to assess the digoxin level
before intervening .
Q4. A nurse is preparing to administer eardrops to an infant. Which technique is correct?
A) Pull up and back on the ear; direct solution onto the eardrum.
B) Pull down and back on the ear; direct solution onto the eardrum.
C) Pull down and back on the ear; direct solution toward the wall of the canal.
D) Pull up and back on the ear; direct solution toward the wall of the canal.
Answer: C) Pull down and back on the ear; direct solution toward the wall of the canal.
Rationale: In infants and children under 3 years, the ear canal is straightened by pulling the pinna down
and back. The solution should be directed toward the wall of the ear canal to prevent air bubbles and
discomfort .
Q5. Furosemide (Lasix) acts on which segment of the nephron?
A) Proximal convoluted tubule
B) Ascending limb of the loop of Henle
C) Early distal convoluted tubule
D) Collecting duct
Answer: B) Ascending limb of the loop of Henle
Rationale: Loop diuretics block sodium and chloride reabsorption in the thick ascending limb of the loop
of Henle, producing profound diuresis. This site blocks approximately 20-25% of filtered sodium .
Q6. Which medication is most effective for a patient with severe renal impairment (GFR <15 mL/min)?
A) Hydrochlorothiazide (HCTZ)
B) Furosemide (Lasix)
C) Spironolactone (Aldactone)
D) Triamterene (Dyrenium)
Answer: B) Furosemide (Lasix)
Rationale: Loop diuretics remain effective even when renal blood flow and GFR is low. Thiazide diuretics
are ineffective when GFR falls below 15-20 mL/min .
Q7. Which INR value indicates that warfarin (Coumadin) therapy is at a therapeutic range for most
indications?
A) 1.0 to 2.0
B) 2.0 to 3.0
C) 3.0 to 4.0
D) 4.0 to 5.0
Answer: B) 2.0 to 3.0
Rationale: For most indications (atrial fibrillation, DVT, PE), the therapeutic INR range is 2.0-3.0. Higher
targets (2.5-3.5) are used for mechanical heart valves .
, Q8. Which statement about spironolactone (Aldactone) is correct?
A) It causes significant potassium wasting.
B) It acts as an aldosterone antagonist in the distal nephron.
C) It has rapid onset of action within 2 hours.
D) It is first-line for acute pulmonary edema.
Answer: B) It acts as an aldosterone antagonist in the distal nephron.
Rationale: Spironolactone blocks aldosterone receptors in the distal nephron, leading to potassium
retention and sodium excretion. Onset is delayed (up to 48 hours) because it requires blocking new
protein synthesis .
Q9. A patient on spironolactone reports breast tenderness and gynecomastia. What is the mechanism?
A) Increased estrogen production
B) Androgen receptor blockade
C) Prolactin elevation
D) Testosterone suppression
Answer: B) Androgen receptor blockade
Rationale: Spironolactone is a steroid derivative that blocks androgen receptors, causing endocrine
effects including gynecomastia, menstrual irregularities, impotence, and hirsutism .
Q10. A patient on furosemide and gentamicin is at increased risk for which adverse effect?
A) Nephrotoxicity
B) Ototoxicity
C) Hepatotoxicity
D) Cardiotoxicity
Answer: B) Ototoxicity
Rationale: Both furosemide and aminoglycosides (gentamicin) are ototoxic drugs. Concurrent use
significantly increases the risk of hearing impairment, which may be irreversible .
Q11. Which diuretic is first-line for essential hypertension?
A) Furosemide (Lasix)
B) Hydrochlorothiazide (HCTZ)
C) Spironolactone (Aldactone)
D) Mannitol (Osmitrol)
Answer: B) Hydrochlorothiazide (HCTZ)
Rationale: Thiazide diuretics, including hydrochlorothiazide, are first-line agents for essential
hypertension due to their efficacy, tolerability, and low cost .
Q12. Hydrochlorothiazide is ineffective when:
A) The patient is elderly
B) The patient has diabetes
Update) University Of South Alabama,
Questions & Answers (Verified Answers) |
Complete A+ Guide
Section 1: Diuretics (Questions 1-20)
Q1. A client taking hydrochlorothiazide (HCTZ) is started on triamterene (Dyrenium). The client asks why
both medications are required. What is the best response?
A) Both are weak potassium-losing diuretics.
B) The combination produces a synergistic diuretic effect.
C) Triamterene prevents the potassium loss caused by HCTZ.
D) HCTZ prevents the hyperkalemia caused by triamterene.
Answer: C) Triamterene prevents the potassium loss caused by HCTZ.
Rationale: HCTZ is a thiazide diuretic that causes potassium wasting. Triamterene is a potassium-sparing
diuretic that blocks sodium-potassium exchange in the distal nephron. The combination (e.g., Dyazide,
Maxzide) maintains normal potassium levels while achieving diuresis .
Q2. A patient on furosemide (Lasix) reports muscle weakness and cramping. Which electrolyte
imbalance is the most likely cause?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypocalcemia
Answer: B) Hypokalemia
Rationale: Loop diuretics increase potassium excretion in the distal nephron. Hypokalemia (K+ <3.5
mEq/L) causes muscle weakness, cramping, fatigue, and can lead to fatal dysrhythmias if severe .
Q3. A patient on furosemide and digoxin presents with nausea, vomiting, and yellow vision. ECG shows
PVCs. What is the priority action?
A) Administer potassium chloride immediately
B) Check the digoxin level
C) Hold the furosemide
D) Administer lidocaine
,Answer: B) Check the digoxin level
Rationale: Hypokalemia from furosemide increases the risk of digoxin toxicity. The symptoms described
(nausea, visual changes, PVCs) are classic for digoxin toxicity. The priority is to assess the digoxin level
before intervening .
Q4. A nurse is preparing to administer eardrops to an infant. Which technique is correct?
A) Pull up and back on the ear; direct solution onto the eardrum.
B) Pull down and back on the ear; direct solution onto the eardrum.
C) Pull down and back on the ear; direct solution toward the wall of the canal.
D) Pull up and back on the ear; direct solution toward the wall of the canal.
Answer: C) Pull down and back on the ear; direct solution toward the wall of the canal.
Rationale: In infants and children under 3 years, the ear canal is straightened by pulling the pinna down
and back. The solution should be directed toward the wall of the ear canal to prevent air bubbles and
discomfort .
Q5. Furosemide (Lasix) acts on which segment of the nephron?
A) Proximal convoluted tubule
B) Ascending limb of the loop of Henle
C) Early distal convoluted tubule
D) Collecting duct
Answer: B) Ascending limb of the loop of Henle
Rationale: Loop diuretics block sodium and chloride reabsorption in the thick ascending limb of the loop
of Henle, producing profound diuresis. This site blocks approximately 20-25% of filtered sodium .
Q6. Which medication is most effective for a patient with severe renal impairment (GFR <15 mL/min)?
A) Hydrochlorothiazide (HCTZ)
B) Furosemide (Lasix)
C) Spironolactone (Aldactone)
D) Triamterene (Dyrenium)
Answer: B) Furosemide (Lasix)
Rationale: Loop diuretics remain effective even when renal blood flow and GFR is low. Thiazide diuretics
are ineffective when GFR falls below 15-20 mL/min .
Q7. Which INR value indicates that warfarin (Coumadin) therapy is at a therapeutic range for most
indications?
A) 1.0 to 2.0
B) 2.0 to 3.0
C) 3.0 to 4.0
D) 4.0 to 5.0
Answer: B) 2.0 to 3.0
Rationale: For most indications (atrial fibrillation, DVT, PE), the therapeutic INR range is 2.0-3.0. Higher
targets (2.5-3.5) are used for mechanical heart valves .
, Q8. Which statement about spironolactone (Aldactone) is correct?
A) It causes significant potassium wasting.
B) It acts as an aldosterone antagonist in the distal nephron.
C) It has rapid onset of action within 2 hours.
D) It is first-line for acute pulmonary edema.
Answer: B) It acts as an aldosterone antagonist in the distal nephron.
Rationale: Spironolactone blocks aldosterone receptors in the distal nephron, leading to potassium
retention and sodium excretion. Onset is delayed (up to 48 hours) because it requires blocking new
protein synthesis .
Q9. A patient on spironolactone reports breast tenderness and gynecomastia. What is the mechanism?
A) Increased estrogen production
B) Androgen receptor blockade
C) Prolactin elevation
D) Testosterone suppression
Answer: B) Androgen receptor blockade
Rationale: Spironolactone is a steroid derivative that blocks androgen receptors, causing endocrine
effects including gynecomastia, menstrual irregularities, impotence, and hirsutism .
Q10. A patient on furosemide and gentamicin is at increased risk for which adverse effect?
A) Nephrotoxicity
B) Ototoxicity
C) Hepatotoxicity
D) Cardiotoxicity
Answer: B) Ototoxicity
Rationale: Both furosemide and aminoglycosides (gentamicin) are ototoxic drugs. Concurrent use
significantly increases the risk of hearing impairment, which may be irreversible .
Q11. Which diuretic is first-line for essential hypertension?
A) Furosemide (Lasix)
B) Hydrochlorothiazide (HCTZ)
C) Spironolactone (Aldactone)
D) Mannitol (Osmitrol)
Answer: B) Hydrochlorothiazide (HCTZ)
Rationale: Thiazide diuretics, including hydrochlorothiazide, are first-line agents for essential
hypertension due to their efficacy, tolerability, and low cost .
Q12. Hydrochlorothiazide is ineffective when:
A) The patient is elderly
B) The patient has diabetes
