TEST BANK LEHNE’S PHARMACOLOGY
CHAPTERS 41-45
Chapter 41: Diuretics
MULTIPLE CHOICE
1. A patient is brought to the emergency department with shortness of breath, a respiratory
rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse
caring for this patient will expect to administer which drug?
a. Furosemide (Lasix)
b. Hydrochlorothiazide (HydroDIURIL)
c. Mannitol (Osmitrol)
d. Spironolactone (Aldactone)
ANS: A
Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is
needed. This patient shows severe signs of congestive heart failure with respiratory
distress and pulmonary edema and needs immediate mobilization of fluid.
Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema,
because their diuretic effects are less rapid. Mannitol is indicated for patients with
increased intracranial pressure and must be discontinued immediately if signs of
pulmonary congestion or heart failure occur.
DIF: Cognitive Level: Application REF: High-Ceiling (Loop) Diuretics |
Furosemide | Therapeutic Uses | Thiazides and Related Diuretics |
Hydrochlorothiazides | Therapeutic Uses | Potassium-Sparing Diuretics |
Spironolactone | Therapeutic Uses | Mannitol, an Osmotic Diuretic
TOP: Nursing Process: Planning MSC: NCLEX Client Needs
Category: Physiologic Integrity: Reduction of Risk Potential
2. A patient who is taking digoxin is admitted to the hospital for treatment of congestive
heart failure. The prescriber has ordered furosemide (Lasix). The nurse notes an irregular
heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood
pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which
laboratory value causes the nurse the most concern?
a. Blood glucose level of 120 mg/dL
b. Oxygen saturation of 90%
c. Potassium level of 3.5 mEq/L
d. Sodium level of 140 mEq/L
, ANS: C
This patient has an irregular, rapid heartbeat that might be caused by a dysrhythmia.
This patient’s serum potassium level is low, which can trigger fatal dysrhythmias,
especially in patients taking digoxin. Furosemide contributes to loss of potassium
through its effects on the distal nephron. Potassium-sparing diuretics often are used in
conjunction with furosemide to prevent this complication. This patient’s serum
glucose and sodium levels are normal and of no concern at this point, although they
can be affected by furosemide. The oxygen saturation is somewhat low and needs to
be monitored, although it may improve with diuresis.
DIF: Cognitive Level: Application REF: High-Ceiling (Loop) Diuretics |
Furosemide | Adverse Effects TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity:
Reduction of Risk Potential
3. A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the
lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which
diuretic agent ordered by the prescriber should the nurse question?
a. Bumetanide (Bumex)
b. Furosemide (Lasix)
c. Spironolactone (Aldactone)
d. Hydrochlorothiazide (HydroDIURIL)
ANS: C
Spironolactone is a non–potassium-wasting diuretic; therefore, if the patient has a
serum potassium level of 6 mEq/L, indicating hyperkalemia, an order for this drug
should be questioned. Bumetanide, furosemide, and hydrochlorothiazide are
potassium-wasting diuretics and would be appropriate to administer in a patient with
hyperkalemia.
DIF: Cognitive Level: Application REF: Potassium-Sparing Diuretics |
Spironolactone | Therapeutic Uses | Adverse Effects TOP: Nursing
Process: Implementation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Reduction of Risk Potential
4. A nurse preparing to administer morning medications notes that a patient with a history of
hypertension has been prescribed the angiotensin-converting enzyme (ACE) inhibitor
captopril (Capoten) concurrently with spironolactone (Aldactone). Morning laboratory
results reveal a serum sodium level of 144 mg/dL, a serum potassium level of 5.1 mEq/L,
and a blood glucose level of 128 mg/dL. Which intervention is appropriate?
a. Administer the medications as ordered.
b. Ask the patient about the use of salt substitutes.
c. Contact the provider to report the laboratory values.
d. Request an order for furosemide (Lasix).
ANS: C
, Spironolactone should not be administered with ACE inhibitors, which can also
elevate potassium levels. Because the potassium level is elevated, the nurse should not
administer the medication and should obtain clarification of the order. There is no
need to repeat the potassium level test that was just done this morning. Requesting an
order for furosemide is appropriate only after the provider has been notified of the
laboratory values.
DIF: Cognitive Level: Application REF: Potassium-Sparing Diuretics |
Spironolactone | Therapeutic Uses | Adverse Effects | Drug Interactions
TOP: Nursing Process: Implementation MSC: NCLEX Client
Needs Category: Physiologic Integrity: Reduction of Risk Potential
5. A patient with hypertension is taking furosemide (Lasix) for congestive heart failure. The
prescriber orders digoxin to help increase cardiac output. What other medication will the
nurse expect to be ordered for this patient?
a. Bumetanide (Bumex)
b. Chlorothiazide (Diuril)
c. Hydrochlorothiazide (HydroDIURIL)
d. Spironolactone (Aldactone)
ANS: D
Spironolactone is used in conjunction with furosemide because of its potassium-
sparing effects. Furosemide can contribute to hypokalemia, which can increase the
risk of fatal dysrhythmias, especially with digoxin administration. The other diuretics
listed are all potassium-wasting diuretics.
DIF: Cognitive Level: Application REF: High-Ceiling (Loop) Diuretics |
Furosemide | Therapeutic Uses | Thiazides and Related Diuretics |
Hydrochlorothiazides | Therapeutic Uses | Potassium-Sparing Diuretics |
Spironolactone | Therapeutic Uses TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity:
Reduction of Risk Potential
6. A patient who was in a motor vehicle accident sustained a severe head injury and is
brought into the emergency department. The provider orders intravenous mannitol
(Osmitrol). The nurse knows that this is given to:
a. reduce intracranial pressure.
b. reduce renal perfusion.
c. reduce peripheral edema.
d. restore extracellular fluid.
ANS: A
Mannitol is an osmotic diuretic that is used to reduce intracranial pressure by
relieving cerebral edema. The presence of mannitol in blood vessels in the brain
creates an osmotic force that draws edematous fluid from the brain into the blood. It
can also be used to increase renal perfusion. It can cause peripheral edema and is not
CHAPTERS 41-45
Chapter 41: Diuretics
MULTIPLE CHOICE
1. A patient is brought to the emergency department with shortness of breath, a respiratory
rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse
caring for this patient will expect to administer which drug?
a. Furosemide (Lasix)
b. Hydrochlorothiazide (HydroDIURIL)
c. Mannitol (Osmitrol)
d. Spironolactone (Aldactone)
ANS: A
Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is
needed. This patient shows severe signs of congestive heart failure with respiratory
distress and pulmonary edema and needs immediate mobilization of fluid.
Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema,
because their diuretic effects are less rapid. Mannitol is indicated for patients with
increased intracranial pressure and must be discontinued immediately if signs of
pulmonary congestion or heart failure occur.
DIF: Cognitive Level: Application REF: High-Ceiling (Loop) Diuretics |
Furosemide | Therapeutic Uses | Thiazides and Related Diuretics |
Hydrochlorothiazides | Therapeutic Uses | Potassium-Sparing Diuretics |
Spironolactone | Therapeutic Uses | Mannitol, an Osmotic Diuretic
TOP: Nursing Process: Planning MSC: NCLEX Client Needs
Category: Physiologic Integrity: Reduction of Risk Potential
2. A patient who is taking digoxin is admitted to the hospital for treatment of congestive
heart failure. The prescriber has ordered furosemide (Lasix). The nurse notes an irregular
heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood
pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which
laboratory value causes the nurse the most concern?
a. Blood glucose level of 120 mg/dL
b. Oxygen saturation of 90%
c. Potassium level of 3.5 mEq/L
d. Sodium level of 140 mEq/L
, ANS: C
This patient has an irregular, rapid heartbeat that might be caused by a dysrhythmia.
This patient’s serum potassium level is low, which can trigger fatal dysrhythmias,
especially in patients taking digoxin. Furosemide contributes to loss of potassium
through its effects on the distal nephron. Potassium-sparing diuretics often are used in
conjunction with furosemide to prevent this complication. This patient’s serum
glucose and sodium levels are normal and of no concern at this point, although they
can be affected by furosemide. The oxygen saturation is somewhat low and needs to
be monitored, although it may improve with diuresis.
DIF: Cognitive Level: Application REF: High-Ceiling (Loop) Diuretics |
Furosemide | Adverse Effects TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity:
Reduction of Risk Potential
3. A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the
lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which
diuretic agent ordered by the prescriber should the nurse question?
a. Bumetanide (Bumex)
b. Furosemide (Lasix)
c. Spironolactone (Aldactone)
d. Hydrochlorothiazide (HydroDIURIL)
ANS: C
Spironolactone is a non–potassium-wasting diuretic; therefore, if the patient has a
serum potassium level of 6 mEq/L, indicating hyperkalemia, an order for this drug
should be questioned. Bumetanide, furosemide, and hydrochlorothiazide are
potassium-wasting diuretics and would be appropriate to administer in a patient with
hyperkalemia.
DIF: Cognitive Level: Application REF: Potassium-Sparing Diuretics |
Spironolactone | Therapeutic Uses | Adverse Effects TOP: Nursing
Process: Implementation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Reduction of Risk Potential
4. A nurse preparing to administer morning medications notes that a patient with a history of
hypertension has been prescribed the angiotensin-converting enzyme (ACE) inhibitor
captopril (Capoten) concurrently with spironolactone (Aldactone). Morning laboratory
results reveal a serum sodium level of 144 mg/dL, a serum potassium level of 5.1 mEq/L,
and a blood glucose level of 128 mg/dL. Which intervention is appropriate?
a. Administer the medications as ordered.
b. Ask the patient about the use of salt substitutes.
c. Contact the provider to report the laboratory values.
d. Request an order for furosemide (Lasix).
ANS: C
, Spironolactone should not be administered with ACE inhibitors, which can also
elevate potassium levels. Because the potassium level is elevated, the nurse should not
administer the medication and should obtain clarification of the order. There is no
need to repeat the potassium level test that was just done this morning. Requesting an
order for furosemide is appropriate only after the provider has been notified of the
laboratory values.
DIF: Cognitive Level: Application REF: Potassium-Sparing Diuretics |
Spironolactone | Therapeutic Uses | Adverse Effects | Drug Interactions
TOP: Nursing Process: Implementation MSC: NCLEX Client
Needs Category: Physiologic Integrity: Reduction of Risk Potential
5. A patient with hypertension is taking furosemide (Lasix) for congestive heart failure. The
prescriber orders digoxin to help increase cardiac output. What other medication will the
nurse expect to be ordered for this patient?
a. Bumetanide (Bumex)
b. Chlorothiazide (Diuril)
c. Hydrochlorothiazide (HydroDIURIL)
d. Spironolactone (Aldactone)
ANS: D
Spironolactone is used in conjunction with furosemide because of its potassium-
sparing effects. Furosemide can contribute to hypokalemia, which can increase the
risk of fatal dysrhythmias, especially with digoxin administration. The other diuretics
listed are all potassium-wasting diuretics.
DIF: Cognitive Level: Application REF: High-Ceiling (Loop) Diuretics |
Furosemide | Therapeutic Uses | Thiazides and Related Diuretics |
Hydrochlorothiazides | Therapeutic Uses | Potassium-Sparing Diuretics |
Spironolactone | Therapeutic Uses TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity:
Reduction of Risk Potential
6. A patient who was in a motor vehicle accident sustained a severe head injury and is
brought into the emergency department. The provider orders intravenous mannitol
(Osmitrol). The nurse knows that this is given to:
a. reduce intracranial pressure.
b. reduce renal perfusion.
c. reduce peripheral edema.
d. restore extracellular fluid.
ANS: A
Mannitol is an osmotic diuretic that is used to reduce intracranial pressure by
relieving cerebral edema. The presence of mannitol in blood vessels in the brain
creates an osmotic force that draws edematous fluid from the brain into the blood. It
can also be used to increase renal perfusion. It can cause peripheral edema and is not
