Chapter 9 Diuretics
MULTIPLE CHOICE
1. The nurse is preparing to administer the first dose of hydrochlorothiazide (HydroDIURIL) 50
mg to a patient who has a blood pressure of 160/95 mm Hg. The nurse notes that the patient
had a urine output of 200 mL in the past 12 hours. The nurse will perform which action? a.
Administer the medication as ordered.
b. Encourage the patient to drink more fluids.
c. Hold the medication and request an order for serum BUN and creatinine.
d. Request an order for serum electrolytes and administer the medication.
ANS C
Thiazide diuretics are contraindicated in renal failure. This patient has oliguria and should
be evaluated for renal failure prior to administration of the diureticespecially in the absence
of known renal failure for this patient. Drinking more fluids will not increase urine output
in patients with renal failure.
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NURSING PROCESS Assessment/Nursing Intervention
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
2. The nurse is preparing to administer doses of hydrochlorothiazide (HydroDIURIL) and
digoxin (Lanoxin) to a patient who has heart failure. The patient reports having blurred vision.
The nurse notes a heart rate of 60 beats per minute and a blood pressure of 140/78 mm Hg.
Which action will the nurse take?
a. Administer the medications and request an order for serum electrolytes.
b. Give both medications and evaluate serum blood glucose frequently.
c. Hold the digoxin and notify the provider.
d. Hold the hydrochlorothiazide and notify the provider.
ANS C
When thiazide diuretics are taken with digoxin, patients are at risk of digoxin toxicity because
thiazides can cause hypokalemia. The patient has bradycardia and blurred vision, which are
both signs of digoxin toxicity. The nurse should hold the digoxin and notify the provider.
Serum electrolytes may be ordered, but the digoxin should not be given.
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MSC NCLEX Physiological Integrity Pathophysiology
3. The nurse is teaching a patient about taking hydrochlorothiazide. Which statement by the
patient indicates a need for further teaching?
a. I may need extra sodium and calcium while taking this drug.
b. I should eat plenty of fruits and vegetables while taking this medication.
c. I should take care when rising from a bed or chair when Im on this medication.
, d. I will take the medication in the morning to minimize certain side effects. ANS A
Patients do not need extra sodium or calcium while taking thiazide diuretics.
Thiazide diuretics can lead to hypokalemia, so patients should be counseled to eat fruits and
vegetables that are high in potassium. Patients can develop orthostatic hypotension and should
be counseled to rise from sitting or lying down slowly. Taking the medication in the morning
helps to prevent nocturia-induced insomnia.
DIF COGNITIVE LEVEL Applying (Application) REF dm 624
TOP NURSING PROCESS Nursing Intervention Patient Teaching
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
4. The nurse is caring for a patient who is to begin receiving a thiazide diuretic to treat heart
failure. When performing a health history on this patient, the nurse will be concerned about
a history of which condition? a. Asthma
b. Glaucoma
c. Gout
d. Hypertension
ANS C
Thiazides block uric acid secretion and elevated levels can contribute to gout. Patients with
a history of gout should take thiazide diuretics with caution; they may need behavioral
and/or pharmacologic changes to their gout treatment.
DIF COGNITIVE LEVEL Applying (Application) REF dm 626
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MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
5. The nurse is caring for a patient who develops marked edema and a low urine output as a
result of heart failure. Which medication will the nurse expect the provider to order for this
patient?
a. Digoxin (Lanoxin)
b. Furosemide (Lasix)
c. Hydrochlorothiazide (HydroDIURIL)
d. Spironolactone (Aldactone)
ANS B
Furosemide is a loop diuretic and is given when the patients condition warrants immediate
removal of body fluid, as in heart failure. Digoxin improves cardiac function but does not
remove fluid quickly. The other diuretics may be used when immediate fluid removal is
not necessary.
DIF COGNITIVE LEVEL Applying (Application) REF dm 627 TOP
NURSING PROCESS Nursing Intervention
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
MULTIPLE CHOICE
1. The nurse is preparing to administer the first dose of hydrochlorothiazide (HydroDIURIL) 50
mg to a patient who has a blood pressure of 160/95 mm Hg. The nurse notes that the patient
had a urine output of 200 mL in the past 12 hours. The nurse will perform which action? a.
Administer the medication as ordered.
b. Encourage the patient to drink more fluids.
c. Hold the medication and request an order for serum BUN and creatinine.
d. Request an order for serum electrolytes and administer the medication.
ANS C
Thiazide diuretics are contraindicated in renal failure. This patient has oliguria and should
be evaluated for renal failure prior to administration of the diureticespecially in the absence
of known renal failure for this patient. Drinking more fluids will not increase urine output
in patients with renal failure.
DIF COGNITIVE LEVEL Applying (Application) REF dm 623 TOP
NURSING PROCESS Assessment/Nursing Intervention
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
2. The nurse is preparing to administer doses of hydrochlorothiazide (HydroDIURIL) and
digoxin (Lanoxin) to a patient who has heart failure. The patient reports having blurred vision.
The nurse notes a heart rate of 60 beats per minute and a blood pressure of 140/78 mm Hg.
Which action will the nurse take?
a. Administer the medications and request an order for serum electrolytes.
b. Give both medications and evaluate serum blood glucose frequently.
c. Hold the digoxin and notify the provider.
d. Hold the hydrochlorothiazide and notify the provider.
ANS C
When thiazide diuretics are taken with digoxin, patients are at risk of digoxin toxicity because
thiazides can cause hypokalemia. The patient has bradycardia and blurred vision, which are
both signs of digoxin toxicity. The nurse should hold the digoxin and notify the provider.
Serum electrolytes may be ordered, but the digoxin should not be given.
DIF COGNITIVE LEVEL Applying (Application) REF dm 623
TOP NURSING PROCESS Nursing Intervention/Evaluation
MSC NCLEX Physiological Integrity Pathophysiology
3. The nurse is teaching a patient about taking hydrochlorothiazide. Which statement by the
patient indicates a need for further teaching?
a. I may need extra sodium and calcium while taking this drug.
b. I should eat plenty of fruits and vegetables while taking this medication.
c. I should take care when rising from a bed or chair when Im on this medication.
, d. I will take the medication in the morning to minimize certain side effects. ANS A
Patients do not need extra sodium or calcium while taking thiazide diuretics.
Thiazide diuretics can lead to hypokalemia, so patients should be counseled to eat fruits and
vegetables that are high in potassium. Patients can develop orthostatic hypotension and should
be counseled to rise from sitting or lying down slowly. Taking the medication in the morning
helps to prevent nocturia-induced insomnia.
DIF COGNITIVE LEVEL Applying (Application) REF dm 624
TOP NURSING PROCESS Nursing Intervention Patient Teaching
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
4. The nurse is caring for a patient who is to begin receiving a thiazide diuretic to treat heart
failure. When performing a health history on this patient, the nurse will be concerned about
a history of which condition? a. Asthma
b. Glaucoma
c. Gout
d. Hypertension
ANS C
Thiazides block uric acid secretion and elevated levels can contribute to gout. Patients with
a history of gout should take thiazide diuretics with caution; they may need behavioral
and/or pharmacologic changes to their gout treatment.
DIF COGNITIVE LEVEL Applying (Application) REF dm 626
TOP NURSING PROCESS Assessment
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
5. The nurse is caring for a patient who develops marked edema and a low urine output as a
result of heart failure. Which medication will the nurse expect the provider to order for this
patient?
a. Digoxin (Lanoxin)
b. Furosemide (Lasix)
c. Hydrochlorothiazide (HydroDIURIL)
d. Spironolactone (Aldactone)
ANS B
Furosemide is a loop diuretic and is given when the patients condition warrants immediate
removal of body fluid, as in heart failure. Digoxin improves cardiac function but does not
remove fluid quickly. The other diuretics may be used when immediate fluid removal is
not necessary.
DIF COGNITIVE LEVEL Applying (Application) REF dm 627 TOP
NURSING PROCESS Nursing Intervention
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
