Thiazide diuretics pharmacology NCLEX questions for nursing students!
Thiazide diuretics are medications used to help remove extra fluid volume from the body. The nurse should be aware of how the drug works, why it is ordered, nursing implications, adverse reactions, and how to teach the patient how to take the medication.
This quiz is part of a pharmacology NCLEX question review series and will include various medications. This series will test your knowledge on nursing implications, side effects, patient teaching, therapeutic effects, and more.
Don’t forget to watch the lecture on thiazide diuretics before taking the quiz.
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Thiazide Diuretics Pharmacology NCLEX Questions
1. The physician prescribes the patient a thiazide diuretic. The patient is experiencing increased urination. As the nurse you know that this medication causes this type of affect by how it affects the nephron. It does this by?
A. inhibiting the sodium-potassium-chloride cotransporter in the distal convoluted tubule
B. inhibiting the sodium-chloride cotransporter in the distal convoluted tubule
C. inhibiting the water reabsorption in the distal convoluted tubule
D. inhibiting the sodium-potassium transporter in the distal convoluted tubule
The answer is B. Thiazide diuretics inhibit the sodium-chloride cotransporter in the early part of the distal convoluted tubule. When this occurs it prevents sodium from being reabsorbed back into the blood. Since the sodium stays in the tubule, it will keep water with it. This will decrease the amount of water reabsorbed into the blood/body…thus increasing urination and extra fluid removal from the blood (causing a diuretic effect).
2. Your patient will be started on a thiazide diuretic to help manage blood pressure. Select all the medications below that are considered a type of thiazide diuretic:
The answers are B, C, E, and F. Option A is a loop diuretic, and option D is a potassium-sparing diuretic.
3. True or False: Thiazide diuretics are more potent than loop diuretics and provide immediate diuresis affects.
The answer is FALSE. Thiazide diuretics are NOT more potent than loop diuretics and do not provide immediate diuresis affects like loop diuretics. Loop diuretics inhibit sodium reabsorption in the loop of Henle, which is responsible for about 25% of sodium reabsorption….whereas, thiazide diuretics inhibit sodium reabsorption in the early part of the distal convoluted tubule, which is responsible for about 5-7% of sodium reabsorption. Therefore, the higher percentage of sodium reabsorption inhibited the stronger the effects, which makes loop diuretics more potent.
4. A 55-year-old-male with hypertension is prescribed a thiazide diuretic. The patient has a health history of diabetes type I and gout. What lab results below represent some known side effects of this medication and requires the nurse to report the lab results to the physician? Select all that apply:
A. Potassium 5.2 mEq/L
B. Calcium 9 mg/L
C. Blood glucose 300 mg/dL
D. Ammonia 20 mcg/dL
E. Uric acid level 15 mg/dL
F. Blood glucose 45 mg/dL
The answers are C and E. Thiazide diuretics can cause an increase in blood glucose (hyperglycemia), hyperuricemia (high uric acid levels…this increases a gout attack), hypokalemia (low potassium levels), and hypercalcemia (high calcium levels). Due to the patient’s health history of diabetes and gout, the nurse should monitor the patient’s glucose and uric acid levels. A normal blood glucose level is about 70-100 mg/dL, and a normal uric acid level varies for female and males…with anything greater than 7 for males or 6 for female being considered high. Therefore, the patient’s uric acid level of 15 mg/dL and glucose of 300 mg/dL is abnormal and should be reported.
5. A patient is scheduled to take a dose of Lithium at 1000. The patient is also prescribed a thiazide diuretic. What lab result below requires the nurse to hold the dose of Lithium and notify the physician for further orders?
A. Potassium 3.2 mEq/L
B. Sodium 115 mEq/L
C. Calcium 10.5 mg/L
D. Magnesium 2 mg/dL
The answer is B. The nurse must monitor for Lithium toxicity in patients who are taking Lithium and a thiazide diuretic. These types of diuretics lower the amount of sodium in the blood because it prevents the reabsorption of it within the nephron…so more is excreted into the urine. Therefore, low sodium levels in the blood INCREASE the risk of Lithium toxicity. A normal blood sodium level is 135-145 mEq/L.
6. Your patient is prescribed hydrochlorothiazide. The patient’s potassium level is 2 mEq/L. What medication below should the nurse hold and notify the physician for further orders?
The answer is B. Hypokalemia (low potassium level in the blood) can increase Digoxin toxicity. Hydrochlorothiazide causes the body to lose potassium. A normal blood potassium level is 3.5-5 mEq/L. Therefore, the nurse should hold the Digoxin and notify the physician for further orders.
7. Based on your nursing knowledge of how thiazide diuretics work, which patients below would benefit from these types of medications? Select all that apply:
A. A patient with a glomerular filtration rate (GFR) of less than 30 cc/hr.
B. A patient with a recurrent history of renal calcium calculi.
C. A patient with primary hypertension.
D. A patient with heart failure and frequent gout attacks.
E. A patient with diabetes that has uncontrolled hyperglycemia.
The answers are B and C. Why? Option B: thiazide diuretics help INCREASE reabsorption of calcium into the blood (hence causes hypercalcemia)…therefore it removes it from the urine and can help prevent renal calculi that are composed of calcium. Option C: thiazide diuretics help remove extra fluid volume in the blood and this can decrease blood pressure. Thiazides are not for patients who have a decrease in renal function (example GFR of less than 30 cc/hr), gout attacks (they can cause an increase in uric acid levels), and uncontrolled hyperglycemia (they increase blood glucose levels).
8. You’re developing a plan of care for a patient with heart failure that will be prescribed a thiazide diuretic. What nursing interventions will you include in this patient’s plan of care? Select all that apply:
A. Encourage the patient to limit the consumption of bananas, avocadoes, spinach, strawberries, and potatoes.
B. Measure the patient’s intake and output daily.
C. Weigh the patient daily using a bedside scale.
D. Assess lab results for electrolyte imbalances like hypercalcemia and hyperkalemia.
The answers are B and C. Option A is wrong because the nurse should encourage the patient to consume (NOT limit) these foods because they are high in potassium. Remember thiazide diuretics waste potassium. Option D is wrong because these medications can cause electrolyte imbalances like hypercalcemia and HYPOkalemia (NOT hyperkalemia). Options B and C are correct because these medication increase urination (hence they cause fluid depletion)…therefore, the nurse must monitor the patient’s fluid status.
9. You’re providing discharge teaching to a patient who will be taking a thiazide diuretic for the treatment of hypertension. You note that the patient has type I diabetes. What statement by the patient represents they misunderstood your teaching points about this medication and requires you reinforce some of the education pieces?
A. “I must monitor my blood glucose closely while taking this medication.”
B.” This medication can cause sudden and severe drops in my blood glucose.”
C. “I will try my best to eat a diet that includes foods rich in potassium.”
D. “I will report to my physician if I experience excessive thirst, little or no urination, and extreme fatigue.”
The answer is B. Thiazide diuretics can INCREASE the blood glucose (lead to hyperglycemia)… not hypoglycemia. Therefore, the nurse should educate the patient to monitor the blood glucose level closely.
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