The physician prescribes the patient a loop diuretic. As the nurse you know that this type of diuretic causes diuresis by MAINLY affecting what structure in the nephron?
A. Distal convoluted tubule
B. Descending limb of the loop of Henle
C. Proximal convoluted tubule
D. Ascending limb of the lo...
Nursing pharmacology - Cardiac
The physician prescribes the patient a loop diuretic. As the nurse you know that this
type of diuretic causes diuresis by MAINLY affecting what structure in the nephron?
A. Distal convoluted tubule
B. Descending limb of the loop of Henle
C. Proximal convoluted tubule
D. Ascending limb of the loop of Henle - ANSWER==D Loop diuretics affect the loop of
Henle, specifically the ASCENDING limb (the thick part of this limb).
Loop diuretics are effective with inhibiting sodium reabsorption within the nephron
because it inhibits?
A. the sodium-chloride transporter
B. the effects of aldosterone on the distal convoluted tubule
C. the sodium-potassium-chloride cotransporter
D. the transport of bicarbonate by the proximal convoluted tubule - ANSWER==The
answer is C. Loop diuretics INHIBIT the sodium-potassium-chloride (NKCC2)
cotransporter in the thick ascending limb of the loop of Henle. This inhibits the amount
of sodium that is reabsorbed by the kidneys, which will cause the nephron to decrease
the amount of water it reabsorbs...hence leading to more water leaving the kidneys via
the urine (leading to its diuretics affects). Option A is how thiazide diuretics work, option
B is how potassium-sparing diuretics work, and option D is how carbonic anhydrase
inhibitors work.
Select all the medications below that are considered loop diuretics:
A. Chlorothiazide
B. Bumetanide
C. Triamterene
D. Spironolactone
E. Furosemide
,F. Torsemide
G. Hydrochlorothiazide - ANSWER==The answers are B, E, and F.
Your patient is ordered a loop diuretic at 1000. Which finding below would require you to
hold the dose and notify the physician for further orders?
A. Calcium level 9 mg/L
B. Potassium level 1.5 mEq/L
C. Blood pressure 102/78
D. Sodium level 144 - ANSWER==The answer is B. Loop diuretics are known to
decrease potassium levels due to the way they affect how the nephron wastes
potassium (this happens in the distal convoluted tubule due to the high concentrated
amount of sodium in the filtrate...this tubule will exchange potassium and hydrogen ions
for sodium ions under the influence of aldosterone, which will lead potassium to enter
the filtrate and exit the body as urine.)
You're developing a plan of care for a patient with fluid volume overload related to heart
failure exacerbation. The physician has prescribed an IV loop diuretic. What nursing
interventions will you include in the patient's plan of care? Select all that apply:
A. Perform and assess daily weights.
B. Educate the patient about consuming a low potassium diet.
C. Strict measuring of the patient's daily intake and output.
D. Encourage the patient to drink 2 L of fluids per day.
E. Assess lung sounds every shift. - ANSWER==The answers are A, C, and E. The
patient with heart failure exacerbation can experience fluid volume overload because
the heart is failing to pump blood forward. This causes blood to backflow into the lungs
causing pulmonary edema and respiratory distress. In addition, it can cause edema in
the extremities. A loop diuretic will help remove this extra fluid by altering the way the
kidneys reabsorb sodium and water. Due to the way loop diuretic works by removing
extra fluid, the nurse should monitor the patient for dehydration, effectiveness of the
medication (decrease in edema, clear lung fields), electrolyte imbalances, and
measuring intake and output. Therefore daily weights, measuring I and O's, and
assessing lungs sounds are the answers. Option B is not the answer because the
patient should be consuming a diet with potassium (loop diuretics can decrease the
potassium level). Option D is wrong because this is too much fluid for a patient to
, consume with heart failure. This medication would be unable to do its job if the patient
consumed 2L of fluid per day...it would not be effective.
Which patients below may be prescribed a loop diuretic based on their diagnosis?
Select all that apply:
A. A 58-year-old male with congestive heart failure.
B. A 69-year-old female with pulmonary edema.
C. A 45-year-old male with hypercalcemia.
D. A 50-year-old male experiencing a gout attack. - ANSWER==The answers are A, B,
and C. Option D is not a candidate for loop diuretics because these medications can
increase uric acid levels, which is already an issue for this patient with a gout attack
(remember gout occurs due to increase uric acids levels). Loop diuretics help remove
extra fluid from the blood. This is helpful for patients with heart failure and pulmonary
edema. Loop diuretics also decrease calcium reabsorption (hence causing the calcium
to be excreted rather than staying in the blood), and this would help treat a high calcium
level (hypercalcemia).
A patient with heart failure is prescribed Digoxin and a loop diuretic. The nurse knows
that what finding below would increase a patient's risk of developing Digoxin toxicity?
A. Magnesium level 1.8 mg/dL
B. Potassium 2 mEq/L
C. BUN 15
D. Albumin 5 g/dL - ANSWER==The answer is B. Hypokalemia (low potassium level in
the blood) increases the risk of Digoxin toxicity (normal potassium 3.5-5 mEq/L).
Therefore, the nurse should always check a patient's potassium result before
administering Digoxin, especially if they are taking a loop diuretic (remember loop
diuretics waste potassium and can decrease the blood level).
You're educating a group of new nurse graduates about loop diuretics. One topic you
discuss is ototoxicity. You ask the new nurses to explain how to prevent this adverse
side effect in a patient prescribed a loop diuretic. Which response by one of the new
nurses is correct?
A. "Always administer intravenous loop diuretics slowly."
B. "Monitor for signs and symptoms of low potassium levels because this increases the
risk of inner ear damage while taking loop diuretics."
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