Diuretic Drugs

Question 1

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

Answer 1

ANS: B
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 diminishes in 2 to 4 days. In addition, hypokalemia and drowsiness may occur. Hypoglycemia is not an adverse effect.

Question 2

The nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of these diuretics?
a. Hydrochlorothiazide
b. Furosemide
c. Acetazolamide
d. Spironolactone

Answer 2

ANS: DSpironolactone (Aldactone) is a potassium-sparing diuretic, and patients taking this drug must be monitored for signs of hyperkalemia. The other drugs do not cause hyperkalemia but instead cause hypokalemia.

Question 3

Mannitol has been ordered for a patient with acute renal failure. The nurse will administer this drug using which procedure?
a. Intravenously, through a filter
b. By rapid intravenous bolus
c. By mouth in a single morning dose
d. Through a gravity intravenous drip with standard tubing

Answer 3

ANS: A
Mannitol is administered via intravenous infusion through a filter because of possible crystallization. It is not available in oral form. The other options are incorrect.

Question 4

Furosemide is prescribed for a patient who is about to be discharged, and the nurse provides instructions to the patient about the medication. Which statement by the nurse is correct?
a. ―Take this medication in the evening.‖
b. ―Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and dates.‖
c. ―If you experience weight gain, such as 5 pounds or more per week, be sure to tell your physician during your next routine visit.‖
d. ―Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes.‖

Answer 4

ANS: D
Orthostatic hypotension is a possible problem with diuretic therapy. Foods high in potassium should be eaten more often, and the drug needs to be taken in the morning so that the diuretic effects do not interfere with sleep. A weight gain of 5 pounds or more per week must be reported immediately.

Question 5

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.

Answer 5

ANS: C
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.

Question 6

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. Digoxinb. Penicillin
c. Potassium supplements
d. Aspirin

Answer 6

ANS: A
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.

Question 7

When a patient is receiving diuretic therapy, which of these assessment measures would best reflect the patient‘s fluid volume status?
a. Blood pressure and pulse
b. Serum potassium and sodium levels
c. Intake, output, and daily weight
d. Measurements of abdominal girth and calf circumference

Answer 7

ANS: C
Urinary intake and output and daily weights are the best reflections of a patient‘s fluid volume status.

Question 8

A patient is being discharged to home on a single daily dose of a diuretic. The nurse instructs the patient to take the dose at which time so it will be least disruptive to the patient‘s daily routine?
a. In the morning
b. At noon
c. With supper
d. At bedtime

Answer 8

ANS: A
It is better to take the diuretic medication early in the morning to prevent urination during the night. Taking the diuretic at the other times may cause nighttime urination and disrupt sleep.

Question 9

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 diureticsb. Osmotic diuretics
c. Thiazide diuretics
d. Potassium-sparing diuretics

Answer 9

ANS: C
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 hypertension. The other drug classes are not considered first-line treatments.

Question 10

A patient in the neurologic intensive care unit is being treated for cerebral edema. Which class of diuretic is used to reduce intracranial pressure?
a. Loop diuretics
b. Osmotic diuretics
c. Thiazide diuretics
d. Vasodilators

Answer 10

ANS: B
Mannitol, an osmotic diuretic, is commonly used to reduce intracranial pressure and cerebral edema resulting from head trauma.

Question 11

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.

Answer 11

ANS: D
Caution must be exercised in the administration of diuretics to the 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.

Question 12

The nurse is monitoring a patient who is taking a potassium-sparing diuretic. Which of the drugs or drug classes may have an interaction with this type of diuretic? (Select all that apply.)
a. Lithium
b. Vancomycin
c. Potassium supplements
d. NSAIDs
e. Antidiabetic drugs
f. ACE inhibitors

Answer 12

ANS: A, C, D, F
Taking lithium with potassium-sparing diuretics may cause lithium toxicity; taking ACE inhibitors or potassium supplements may lead to hyperkalemia. Taking NSAIDs with potassium-sparing diuretics may cause a decreased diuretic response. There are no interactions with vancomycin or antidiabetic drugs and potassium-sparing diuretics.

Question 13

When assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency, which would include what symptoms? (Select all that apply.)
a. Dyspnea
b. Constipation
c. Tinnitus
d. Muscle weakness
e. Anorexia
f. Lethargy

Answer 13

ANS: D, E, F
Symptoms of hypokalemia include anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension. The other symptoms are not associated with hypokalemia.

Question 14

The nurse is administering insulin lispro and will keep in mind that this insulin will start to have an effect within which time frame?
a. 15 minutes
b. 1 to 2 hours
c. 80 minutes
d. 3 to 5 hours

Answer 14

ANS: A
The onset of action for insulin lispro is 15 minutes. The peak plasma concentration is 1 to 2 hours; the elimination half-life is 80 minutes; and the duration of action is 3 to 5 hours.

Question 15

When teaching about hypoglycemia, the nurse will make sure that the patient is aware of the early signs of hypoglycemia, including which of these?
a. Hypothermia and seizures
b. Nausea and diarrhea
c. Confusion and sweating
d. Fruity, acetone odor to the breath

Answer 15

ANS: C
Early symptoms of hypoglycemia include the central nervous system manifestations of confusion, irritability, tremor, and sweating. Hypothermia and seizures are later symptoms of hypoglycemia. The other options are incorrect.

Question 16

The nurse is teaching a group of patients about self-administration of insulin. What content is important to include?
a. Patients need to use the injection site that is the most accessible.
b. If two different insulins are ordered, they need to be given in separate injections.
c. When mixing insulins, the cloudy (such as NPH) insulin is drawn up into the syringe first.
d. When mixing insulins, the clear (such as regular) insulin is drawn up into the syringe first.

Answer 16

ANS: D
If mixing insulins in one syringe, the clear (regular) insulin is always drawn up into the syringe first. Patients always need to rotate injection sites. Mixing of insulins may be ordered.

Question 17

When monitoring a patient‘s response to oral antidiabetic drugs, the nurse knows that which laboratory result would indicate a therapeutic response?
a. Random blood glucose level 180 mg/dL
b. Blood glucose level of 50 mg/dL after meals
c. Fasting blood glucose level of 92 mg/dL
d. Evening blood glucose level below 80 mg/dL

Answer 17

ANS: C
The American Diabetes Association recommends a fasting blood glucose level of between 80 and 130 mg/dL for diabetic patients. The other options are incorrect.

Question 18

A 75-year-old woman with type 2 diabetes has recently been placed on glipizide. She asks the nurse when the best time would be to take this medication. What is the nurse‘s best response?
a. ―Take this medication in the morning, 30 minutes before breakfast.‖
b. ―Take this medication in the evening with a snack.‖
c. ―This medication needs to be taken after the midday meal.‖
d. ―It does not matter what time of day you take this medication.‖

Answer 18

ANS: A
Glipizide is taken in the morning, 30 minutes before breakfast. This allows the timing of the insulin secretion induced by the glipizide to correspond with the elevation in blood glucose level induced by the meal in much the same way as endogenous insulin levels are raised in a person without diabetes.

Question 19

A patient who has type 2 diabetes is scheduled for an oral endoscopy and has been NPO (nothing by mouth) since midnight. What is the best action by the nurse regarding the administration of her oral antidiabetic drugs?
a. Administer half the original dose.
b. Withhold all medications as ordered.
c. Contact the prescriber for further orders.
d. Give the medication with a sip of water.

Answer 19

ANS: C
When the diabetic patient is NPO, the prescriber needs to be contacted for further orders regarding the administration of the oral antidiabetic drugs. The other options are incorrect.

Question 20

The nurse is reviewing instructions for a patient with type 2 diabetes who also takes insulin injections as part of the therapy. The nurse asks the patient, ―What should you do if your fasting blood glucose is 44 mg/dL?‖ Which response by the patient reflects a correct understanding of insulin therapy?
a. ―I will call my doctor right away.‖
b. ―I will give myself the regular insulin.‖c. ―I will take an oral form of glucose.‖
d. ―I will rest until the symptoms pass.‖

Answer 20

ANS: C
Hypoglycemia can be reversed if the patient eats glucose tablets or gel, corn syrup, or honey, or drinks fruit juice or a nondiet soft drink or other quick sources of glucose, which must always be kept at hand. The patient should not wait for instructions from the physician, nor delay taking the glucose by resting. The regular insulin would only lower the blood glucose levels more.

Question 21

The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites?
a. Avoid the abdomen because absorption there is irregular.
b. Choose a different site at random for each injection.
c. Give the injection in the same area each time.
d. Rotate sites within the same location for about 1 week before rotating to a new location.

Answer 21

ANS: D
Patients taking insulin injections need to be instructed to rotate sites, but to do so within the same location for about 1 week (so that all injections are rotated in one area—for example, the right arm—before rotating to a new location, such as the left arm). Also, each injection needs to be at least 1/2 to 1 inch away from the previous site.

Question 22

Which action is most appropriate regarding the nurse‘s administration of a rapid-acting insulin to a hospitalized patient?
a. Give it within 15 minutes of mealtime.
b. Give it after the meal has been completed.
c. Administer it once daily at the time of the midday meal.
d. Administer it with a snack before bedtime.

Answer 22

ANS: A
Rapid-acting insulins are able to mimic closely the body‘s natural rapid insulin output after eating a meal; for this reason, these insulins are usually administered within 15 minutes of the patient‘s mealtime. The other options are incorrect.

Question 23

After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. The nurse will monitor which laboratory test to evaluate the patient‘s adherence to the antidiabetic therapy over the past few months?
a. Hemoglobin levels
b. Hemoglobin A1C level
c. Fingerstick fasting blood glucose level
d. Serum insulin levels

Answer 23

ANS: B
The hemoglobin A1C level reflects the patient‘s adherence to the therapy regimen for several months previously, thus evaluating how well the patient has been doing with diet and drug therapy. The other options are incorrect.

Question 24

A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 38 mg/dL. The patient has just become unconscious. The nurse will anticipate which action to be next?
a. Having the patient eat glucose tablets
b. Having the patient consume fruit juice, a nondiet soft drink, or crackers
c. Administering intravenous glucose (50% dextrose)
d. Calling the lab to order a fasting blood glucose level

Answer 24

ANS: C
Intravenous glucose raises blood glucose levels when the patient is unconscious and unable to take oral forms of glucose. Having the lab draw a fasting glucose level is not an appropriate action at this time.

Question 25

The nurse is preparing to administer insulin intravenously. Which statement about the administration of intravenous insulin is true?
a. Insulin is never given intravenously.
b. Only regular insulin can be administered intravenously.
c. Insulin aspart or insulin lispro can be administered intravenously, but there must be a 50% dose reduction.
d. Any form of insulin can be administered intravenously at the same dose as that is ordered for subcutaneous administration.

Answer 25

ANS: B
Regular insulin is the usual insulin product to be dosed via intravenous bolus, intravenous infusion, or even intramuscularly. These routes, especially the intravenous infusion route, are often used in cases of diabetic ketoacidosis, or coma associated with uncontrolled type 1
diabetes.

Question 26

A patient with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes has been treated for pneumonia for the past week. The patient has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, the pneumonia has resolved, but when monitoring the blood glucose levels, the nurse notices that the level is still
elevated. What is the best explanation for this elevation?
a. The antibiotics may cause an increase in glucose levels.
b. The corticosteroids may cause an increase in glucose levels.c. The patient‘s type 2 diabetes has converted to type 1.
d. The hypoxia caused by the COPD causes an increased need for insulin

Answer 26

ANS: B
Corticosteroids can antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose levels. The other options are incorrect.

Question 27

The nurse knows to administer acarbose, an alpha-glucosidase inhibitor, at which time?
a. 30 minutes before breakfast
b. With the first bite of each main meal
c. 30 minutes after breakfast
d. Once daily at bedtime

Answer 27

ANS: B
When an alpha-glucosidase inhibitor is taken with the first bite of a meal, excessive postprandial blood glucose elevation (a glucose spike) can be reduced or prevented.

Question 28

A patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin. The nurse knows that the purpose of the metformin, in this situation, is which of these?
a. To increase the pancreatic secretion of insulin
b. To decrease insulin resistance
c. To increase blood glucose levels
d. To decrease the pancreatic secretion of insulin

Answer 28

ANS: B
Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; and improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance. The other options are incorrect.

Question 29

When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). Which action by the nurse is correct?
a. Give the drug as ordered 30 minutes before breakfast.
b. Hold the drug, and check the order with the prescriber.
c. Give a reduced dose of the drug with breakfast.
d. Give the drug, and monitor for adverse effects.

Answer 29

ANS: B
There is a potential for cross-allergy in patients who are allergic to sulfonamide antibiotics. Although such an allergy is listed as a contraindication by the manufacturer, most clinicians do prescribe sulfonylureas for such patients. The order needs to be clarified.

Question 30

The nurse is reviewing a patient‘s medication list and notes that sitagliptin (Januvia) is ordered. The nurse will question an additional order for which drug or drug class?
a. Glitazone
b. Insulin
c. Metformin
d. Sulfonylurea

Answer 30

ANS: B
Sitagliptin is indicated for management of type 2 diabetes either as monotherapy or in combination with metformin, a sulfonylurea, or a glitazone, but not with insulin.

Question 31

The nurse is teaching a review class to nurses about diabetes mellitus. Which statement by the nurse is correct?
a. ―Patients with type 2 diabetes will never need insulin.‖
b. ―Oral antidiabetic drugs are safe for use during pregnancy.‖
c. ―Pediatric patients cannot take insulin.‖
d. ―Insulin therapy is possible during pregnancy if managed carefully.‖

Answer 31

ANS: D
Oral medications are generally not recommended for pregnant patients because of a lack of firm safety data. For this reason, insulin therapy is the only currently recommended drug therapy for pregnant women with diabetes. Insulin is given to pediatric patients, with extreme care. Patients with type 2 diabetes may require insulin in certain situations or as their disease progresses.

Question 32

The nurse is teaching a group of patients about management of diabetes. Which statement about basal dosing is correct?
a. ―Basal dosing delivers a constant dose of insulin.‖
b. ―With basal dosing, you can eat what you want and then give yourself a dose of insulin.‖
c. ―Glargine insulin is given as a bolus with meals.‖
d. ―Basal-bolus dosing is the traditional method of managing blood glucose levels.‖

Answer 32

ANS: A
Basal-bolus therapy is the attempt to mimic a healthy pancreas by delivering basal insulin constantly as a basal, and then as needed as a bolus. Glargine insulin is used as a basal dose, not as a bolus with meals. Basal-bolus therapy is a newer therapy; historically, sliding-scale coverage was implemented.

Question 33

When teaching a patient who is starting metformin, which instruction by the nurse is correct?
a. ―Take metformin if your blood glucose level is above 180 mg/dL.‖
b. ―Take this 60 minutes after breakfast.‖
c. ―Take the medication on an empty stomach 1 hour before meals.‖
d. ―Take the medication with food to reduce gastrointestinal (GI) effects.‖

Answer 33

ANS: D
The GI adverse effects of metformin can be reduced by administering it with meals. The other options are incorrect.

Question 34

A patient is taking a sulfonylurea medication for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects during patient teaching, the nurse will include information about which of these effects? (Select all that apply.)
a. Hypoglycemia
b. Nausea
c. Diarrhea
d. Weight gain
e. Peripheral edema

Answer 34

ANS: A, B, D
The most common adverse effect of the sulfonylureas is hypoglycemia, the degree to which depends on the dose, eating habits, and presence of hepatic or renal disease. Another predictable adverse effect is weight gain because of the stimulation of insulin secretion. Other adverse effects include skin rash, nausea, epigastric fullness, and heartburn.

Question 35

A patient will be taking U-500 insulin. The nurse is reviewing the use of this drug. Which of these statements are true? (Select all that apply.)
a. U-500 insulin is 5 times stronger than U-100 insulin.
b. U-500 insulin syringes must be used when giving U-500 insulin.
c. U-500 syringes can deliver 500 units of insulin.
d. Each line on a U-500 syringe measures 5 units of U-500 insulin.
e. U-500 insulin delivers a smaller dose of insulin in a single injection.

Answer 35

ANS: A, B, D
U-500 insulin is 5 times stronger than U-100 insulin, and must be given with a U-500 syringe. Each line on a U-500 syringe measures 5 units of U-500 insulin. U-500 syringes can deliver 5 to 250 units of insulin; this insulin is more concentrated than regular strength insulin and can deliver a larger dose of insulin in a single injection.