NUR 521 – Exam 2 | University of Alabama – 2026 Exam | High-
Yield Questions, Answers & Detailed Rationales
Question 1. A patient with hypertension is prescribed furosemide. Which
mechanism best describes the action of this medication?
A. Inhibition of sodium reabsorption in the proximal tubule
B. Inhibition of the Na⁺-K⁺-2Cl⁻ cotransporter in the thick ascending loop of
Henle
C. Blockade of aldosterone receptors in the collecting duct
D. Inhibition of sodium-chloride transport in the distal convoluted tubule
Correct Answer: B
Rationale: Furosemide is a loop diuretic that inhibits the Na⁺-K⁺-2Cl⁻
cotransporter in the thick ascending limb of the loop of Henle. This produces
potent natriuresis and diuresis. Because this segment normally reabsorbs a
substantial amount of filtered sodium, blocking it produces a much greater
diuretic effect than most other diuretic classes.
Question 2. A patient receiving high-dose furosemide reports new-onset
ringing in the ears. Which adverse effect should the nurse suspect?
A. Hepatotoxicity
B. Ototoxicity
C. Pulmonary fibrosis
D. Agranulocytosis
Correct Answer: B
Rationale: Loop diuretics, particularly high-dose or rapidly administered
intravenous furosemide, can cause ototoxicity. The patient may report
tinnitus, hearing changes, or hearing loss. The risk increases with high doses,
rapid IV administration, renal impairment, and concurrent use of other
ototoxic medications.
1
,Question 3. Which electrolyte abnormality is most likely to occur with
prolonged furosemide therapy?
A. Hyperkalemia
B. Hypercalcemia
C. Hypokalemia
D. Hypermagnesemia
Correct Answer: C
Rationale: Furosemide increases urinary sodium and water excretion and
also increases potassium loss. Significant hypokalemia can produce weakness,
muscle cramps, and cardiac dysrhythmias. Potassium levels should therefore
be monitored during therapy.
Question 4. A patient is prescribed hydrochlorothiazide. At which nephron
site does this medication primarily act?
A. Proximal convoluted tubule
B. Thick ascending limb
C. Distal convoluted tubule
D. Collecting duct
Correct Answer: C
Rationale: Hydrochlorothiazide is a thiazide diuretic that inhibits the sodium-
chloride cotransporter in the early distal convoluted tubule. It produces
moderate diuresis and is commonly used for hypertension and mild fluid
retention.
Question 5. Which electrolyte change is associated with thiazide diuretic
therapy?
A. Hypokalemia
B. Hyperkalemia
C. Severe hypermagnesemia
D. Hypocalcemia
2
,Correct Answer: A
Rationale: Thiazides can increase potassium excretion and cause
hypokalemia. Unlike loop diuretics, however, thiazides tend to decrease
urinary calcium excretion and may increase serum calcium levels.
Question 6. A patient taking hydrochlorothiazide has a history of recurrent
gout. Why should the nurse notify the prescriber?
A. Thiazides increase uric acid levels.
B. Thiazides cause severe hypoglycemia.
C. Thiazides directly destroy urate crystals.
D. Thiazides cause excessive calcium loss.
Correct Answer: A
Rationale: Thiazides can decrease renal uric acid excretion, resulting in
hyperuricemia. Increased uric acid may precipitate or worsen gout. A history
of gout therefore requires consideration when selecting or monitoring
thiazide therapy.
Question 7. Which medication is classified as a potassium-sparing diuretic?
A. Furosemide
B. Hydrochlorothiazide
C. Spironolactone
D. Mannitol
Correct Answer: C
Rationale: Spironolactone is a potassium-sparing diuretic and aldosterone
antagonist. It promotes sodium and water excretion while reducing potassium
excretion. Because it can cause hyperkalemia, serum potassium and renal
function must be monitored.
3
, Question 8. A patient taking spironolactone should be taught to avoid
excessive intake of which substance?
A. Calcium
B. Potassium
C. Iron
D. Vitamin C
Correct Answer: B
Rationale: Spironolactone decreases potassium excretion. Excessive
potassium intake, potassium-containing salt substitutes, or concurrent
medications that increase potassium can increase the risk of clinically
significant hyperkalemia.
Question 9. Which adverse effect is particularly associated with
spironolactone?
A. Ototoxicity
B. Gynecomastia
C. Pulmonary fibrosis
D. Severe constipation
Correct Answer: B
Rationale: Spironolactone has antiandrogenic effects and can cause
gynecomastia, decreased libido, and menstrual irregularities. Eplerenone is a
more selective mineralocorticoid receptor antagonist and is less likely to
produce these endocrine adverse effects.
Question 10. A patient with heart failure is prescribed spironolactone. What
is the primary therapeutic rationale?
A. It blocks beta-1 receptors.
B. It antagonizes aldosterone and limits sodium and water retention.
C. It directly increases calcium absorption.
D. It stimulates renin release.
4
Yield Questions, Answers & Detailed Rationales
Question 1. A patient with hypertension is prescribed furosemide. Which
mechanism best describes the action of this medication?
A. Inhibition of sodium reabsorption in the proximal tubule
B. Inhibition of the Na⁺-K⁺-2Cl⁻ cotransporter in the thick ascending loop of
Henle
C. Blockade of aldosterone receptors in the collecting duct
D. Inhibition of sodium-chloride transport in the distal convoluted tubule
Correct Answer: B
Rationale: Furosemide is a loop diuretic that inhibits the Na⁺-K⁺-2Cl⁻
cotransporter in the thick ascending limb of the loop of Henle. This produces
potent natriuresis and diuresis. Because this segment normally reabsorbs a
substantial amount of filtered sodium, blocking it produces a much greater
diuretic effect than most other diuretic classes.
Question 2. A patient receiving high-dose furosemide reports new-onset
ringing in the ears. Which adverse effect should the nurse suspect?
A. Hepatotoxicity
B. Ototoxicity
C. Pulmonary fibrosis
D. Agranulocytosis
Correct Answer: B
Rationale: Loop diuretics, particularly high-dose or rapidly administered
intravenous furosemide, can cause ototoxicity. The patient may report
tinnitus, hearing changes, or hearing loss. The risk increases with high doses,
rapid IV administration, renal impairment, and concurrent use of other
ototoxic medications.
1
,Question 3. Which electrolyte abnormality is most likely to occur with
prolonged furosemide therapy?
A. Hyperkalemia
B. Hypercalcemia
C. Hypokalemia
D. Hypermagnesemia
Correct Answer: C
Rationale: Furosemide increases urinary sodium and water excretion and
also increases potassium loss. Significant hypokalemia can produce weakness,
muscle cramps, and cardiac dysrhythmias. Potassium levels should therefore
be monitored during therapy.
Question 4. A patient is prescribed hydrochlorothiazide. At which nephron
site does this medication primarily act?
A. Proximal convoluted tubule
B. Thick ascending limb
C. Distal convoluted tubule
D. Collecting duct
Correct Answer: C
Rationale: Hydrochlorothiazide is a thiazide diuretic that inhibits the sodium-
chloride cotransporter in the early distal convoluted tubule. It produces
moderate diuresis and is commonly used for hypertension and mild fluid
retention.
Question 5. Which electrolyte change is associated with thiazide diuretic
therapy?
A. Hypokalemia
B. Hyperkalemia
C. Severe hypermagnesemia
D. Hypocalcemia
2
,Correct Answer: A
Rationale: Thiazides can increase potassium excretion and cause
hypokalemia. Unlike loop diuretics, however, thiazides tend to decrease
urinary calcium excretion and may increase serum calcium levels.
Question 6. A patient taking hydrochlorothiazide has a history of recurrent
gout. Why should the nurse notify the prescriber?
A. Thiazides increase uric acid levels.
B. Thiazides cause severe hypoglycemia.
C. Thiazides directly destroy urate crystals.
D. Thiazides cause excessive calcium loss.
Correct Answer: A
Rationale: Thiazides can decrease renal uric acid excretion, resulting in
hyperuricemia. Increased uric acid may precipitate or worsen gout. A history
of gout therefore requires consideration when selecting or monitoring
thiazide therapy.
Question 7. Which medication is classified as a potassium-sparing diuretic?
A. Furosemide
B. Hydrochlorothiazide
C. Spironolactone
D. Mannitol
Correct Answer: C
Rationale: Spironolactone is a potassium-sparing diuretic and aldosterone
antagonist. It promotes sodium and water excretion while reducing potassium
excretion. Because it can cause hyperkalemia, serum potassium and renal
function must be monitored.
3
, Question 8. A patient taking spironolactone should be taught to avoid
excessive intake of which substance?
A. Calcium
B. Potassium
C. Iron
D. Vitamin C
Correct Answer: B
Rationale: Spironolactone decreases potassium excretion. Excessive
potassium intake, potassium-containing salt substitutes, or concurrent
medications that increase potassium can increase the risk of clinically
significant hyperkalemia.
Question 9. Which adverse effect is particularly associated with
spironolactone?
A. Ototoxicity
B. Gynecomastia
C. Pulmonary fibrosis
D. Severe constipation
Correct Answer: B
Rationale: Spironolactone has antiandrogenic effects and can cause
gynecomastia, decreased libido, and menstrual irregularities. Eplerenone is a
more selective mineralocorticoid receptor antagonist and is less likely to
produce these endocrine adverse effects.
Question 10. A patient with heart failure is prescribed spironolactone. What
is the primary therapeutic rationale?
A. It blocks beta-1 receptors.
B. It antagonizes aldosterone and limits sodium and water retention.
C. It directly increases calcium absorption.
D. It stimulates renin release.
4
