McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach,
11th Edition
MULTIPLE CHOICE
1. The nurse is preparing to administer the first dose of hydrochlorothiazide 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 (blood urea nitrogen)
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 diuretic—especially
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) TOP: Nursing Process:
Assessment | Nursing Process: Nursing Intervention MSC: NCLEX:
Physiological Integrity: Pharmacological and Parenteral Therapies
2. The nurse is preparing to administer doses of hydrochlorothiazide and digoxin 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) TOP: Nursing Process:
Nursing Intervention | Nursing Process: 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 I’m starting 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) 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 help
manage 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) 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 due
to heart failure. Which medication will the nurse expect the provider to order for this
patient?
a. Digoxin
b. Furosemide
c. Hydrochlorothiazide
d. Spironolactone
ANS: B
, Furosemide is a loop diuretic and is given when the patient’s condition warrants
immediate removal of body fluid, as can occur 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) TOP: Nursing Process:
Nursing Intervention MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
6. The nurse is caring for a patient who is receiving furosemide and an aminoglycoside
antibiotic. the nurse will be most concerned if the patient reports which symptom?
a. Dizziness
b. Dysuria
c. Nausea
d. Tinnitus
ANS: D
The interaction of furosemide and an aminoglycoside can produce ototoxicity in the
patient. Tinnitus is a sign of ototoxicity. Dizziness can occur as a result of diuretic
therapy but not necessarily as a result of this combination. Dysuria and nausea are not
common signs of these drugs interacting.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Evaluation MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
7. The nurse is teaching a patient who will begin taking furosemide. the nurse learns that the
patient has just begun a 2-week course of a steroid medication. What will the nurse
recommend?
a. Consume licorice to prevent excess potassium loss.
b. Report a urine output greater than 600 mL/24 hours.
c. Obtain an order for a potassium supplement.
d. Take the furosemide at bedtime.
ANS: C
The interaction of furosemide and a steroid drug can result in an increased loss of
potassium. Patients should take a potassium supplement. Patients should avoid
licorice while taking furosemide, partially due to the hypokalemic effects of both
substances. Urine output greater than 600 mL/24 hours is normal. Patients should take
furosemide in the morning to avoid nocturia.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Nursing Intervention MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
8. The nurse is caring for a patient who has metabolic alkalosis and is experiencing fluid
overload. the provider orders acetazolamide. the patient reports right-sided flank pain
, after taking this medication. the nurse suspects that this patient has developed which
condition?
a. Gout
b. Hemolytic anemia
c. Metabolic acidosis
d. Renal calculi
ANS: D
Carbonic anhydrase inhibitors, such as acetazolamide, are used to treat patients who
are in metabolic alkalosis and need a diuretic. They can cause electrolyte imbalance,
metabolic acidosis, hemolytic anemia, and renal calculi. This patient has right-sided
flank pain, which occurs with renal calculi.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Evaluation MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
9. A patient has begun taking spironolactone in addition to a thiazide diuretic. With the
addition of the spironolactone, the nurse will counsel this patient to do which of the
following?
a. Continue taking a potassium supplement daily.
b. Recognize that abdominal cramping is a transient side effect.
c. Report decreased urine output to the provider.
d. Take these medications at bedtime.
ANS: C
Caution must be used when giving potassium-sparing diuretics to patients with poor
renal function, so patients should be taught to report a decrease in urine output.
Patients taking potassium-sparing diuretics are at risk for hyperkalemia, so they
should not take potassium supplements. Abdominal cramping should be reported to
the provider. the medications should be taken in the morning for patients who sleep
during the night.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Nursing Intervention: Patient Teaching MSC: NCLEX:
Physiological Integrity: Pharmacological and Parenteral Therapies
10. The nurse is caring for a patient who is taking hydrochlorothiazide and digoxin. Which
potential electrolyte imbalance will the nurse monitor for in this patient?
a. Hypermagnesemia
b. Hypernatremia
c. Hypocalcemia
d. Hypokalemia
ANS: D
Thiazide diuretics can cause hypokalemia, which enhances the effects of digoxin and
11th Edition
MULTIPLE CHOICE
1. The nurse is preparing to administer the first dose of hydrochlorothiazide 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 (blood urea nitrogen)
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 diuretic—especially
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) TOP: Nursing Process:
Assessment | Nursing Process: Nursing Intervention MSC: NCLEX:
Physiological Integrity: Pharmacological and Parenteral Therapies
2. The nurse is preparing to administer doses of hydrochlorothiazide and digoxin 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) TOP: Nursing Process:
Nursing Intervention | Nursing Process: 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 I’m starting 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) 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 help
manage 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) 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 due
to heart failure. Which medication will the nurse expect the provider to order for this
patient?
a. Digoxin
b. Furosemide
c. Hydrochlorothiazide
d. Spironolactone
ANS: B
, Furosemide is a loop diuretic and is given when the patient’s condition warrants
immediate removal of body fluid, as can occur 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) TOP: Nursing Process:
Nursing Intervention MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
6. The nurse is caring for a patient who is receiving furosemide and an aminoglycoside
antibiotic. the nurse will be most concerned if the patient reports which symptom?
a. Dizziness
b. Dysuria
c. Nausea
d. Tinnitus
ANS: D
The interaction of furosemide and an aminoglycoside can produce ototoxicity in the
patient. Tinnitus is a sign of ototoxicity. Dizziness can occur as a result of diuretic
therapy but not necessarily as a result of this combination. Dysuria and nausea are not
common signs of these drugs interacting.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Evaluation MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
7. The nurse is teaching a patient who will begin taking furosemide. the nurse learns that the
patient has just begun a 2-week course of a steroid medication. What will the nurse
recommend?
a. Consume licorice to prevent excess potassium loss.
b. Report a urine output greater than 600 mL/24 hours.
c. Obtain an order for a potassium supplement.
d. Take the furosemide at bedtime.
ANS: C
The interaction of furosemide and a steroid drug can result in an increased loss of
potassium. Patients should take a potassium supplement. Patients should avoid
licorice while taking furosemide, partially due to the hypokalemic effects of both
substances. Urine output greater than 600 mL/24 hours is normal. Patients should take
furosemide in the morning to avoid nocturia.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Nursing Intervention MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
8. The nurse is caring for a patient who has metabolic alkalosis and is experiencing fluid
overload. the provider orders acetazolamide. the patient reports right-sided flank pain
, after taking this medication. the nurse suspects that this patient has developed which
condition?
a. Gout
b. Hemolytic anemia
c. Metabolic acidosis
d. Renal calculi
ANS: D
Carbonic anhydrase inhibitors, such as acetazolamide, are used to treat patients who
are in metabolic alkalosis and need a diuretic. They can cause electrolyte imbalance,
metabolic acidosis, hemolytic anemia, and renal calculi. This patient has right-sided
flank pain, which occurs with renal calculi.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Evaluation MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
9. A patient has begun taking spironolactone in addition to a thiazide diuretic. With the
addition of the spironolactone, the nurse will counsel this patient to do which of the
following?
a. Continue taking a potassium supplement daily.
b. Recognize that abdominal cramping is a transient side effect.
c. Report decreased urine output to the provider.
d. Take these medications at bedtime.
ANS: C
Caution must be used when giving potassium-sparing diuretics to patients with poor
renal function, so patients should be taught to report a decrease in urine output.
Patients taking potassium-sparing diuretics are at risk for hyperkalemia, so they
should not take potassium supplements. Abdominal cramping should be reported to
the provider. the medications should be taken in the morning for patients who sleep
during the night.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Nursing Intervention: Patient Teaching MSC: NCLEX:
Physiological Integrity: Pharmacological and Parenteral Therapies
10. The nurse is caring for a patient who is taking hydrochlorothiazide and digoxin. Which
potential electrolyte imbalance will the nurse monitor for in this patient?
a. Hypermagnesemia
b. Hypernatremia
c. Hypocalcemia
d. Hypokalemia
ANS: D
Thiazide diuretics can cause hypokalemia, which enhances the effects of digoxin and
