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Raus Respiratory Care Pharmacology 8th Edition Gardenhire Test Bank

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Raus Respiratory Care Pharmacology 8th Edition Gardenhire Test Bank

ISBN-13: 978-0323075282

ISBN-10: 0323075282

 

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Raus Respiratory Care Pharmacology 8th Edition Gardenhire Test Bank

ISBN-13: 978-0323075282

ISBN-10: 0323075282

 

 

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Chapter 19: Diuretic Agents

Test Bank

 

MULTIPLE CHOICE

 

  1. This group of diuretic agents is the most potent.
a. Potassium-sparing
b. Osmotic
c. Loop
d. Thiazide

 

 

ANS:  C

Loop diuretics are often called “high-ceiling” diuretics because they can cause 20% of the filtered load of sodium chloride and water to be excreted in the urine.

 

REF:   pg. 318           OBJ:   3 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. ________ is not a complication in the use of diuretics.
a. Hypokalemia
b. Volume depletion
c. Hyperkalemia
d. Hyperglycemia

 

 

ANS:  C

Because diuretics promote sodium and fluid excretion, elimination may exceed intake, resulting in hypovolemia. Preserving potassium balance has emerged as one of the most important factors in the management of hypertension. Potassium is exchanged for sodium in the distal convoluted tubule and collecting duct. Any diuretic that increases sodium delivery to those regions may potentially induce hypokalemia. In addition to a direct potassium loss, diuretic-induced volume depletion produces reabsorption of sodium via release of aldosterone in the distal tubule in an effort to bolster intravascular volume. Loop and thiazide diuretics have been associated with hyperglycemia.

 

REF:   pg. 320           OBJ:   5 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. Any substance that increases urine flow is termed:
a. A corticosteroid
b. A diuretic
c. A vasopressor
d. An antihypertensive

 

 

ANS:  B

The main purpose of diuretics, or agents that increase urine output, is to eliminate excess fluid from the body. Introduced into medicine in 1958, diuretics are drugs that increase the excretion of solutes and water by directly increasing urine output. The preceding definition excludes agents, such as digitalis, that promote urine output without a direct action on the kidney. Generally, the primary goal of diuretic therapy is to reduce extracellular fluid volume to lower blood pressure or rid the body of excess interstitial fluid.

 

REF:   pg. 314           OBJ:   1 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. The functional unit of the kidney is the:
a. Loop of Henle
b. Proximal tubule
c. Glomerulus
d. Nephron

 

 

ANS:  D

The nephron is the functional unit of the kidney, similar to the alveolus in the lung. The nephron is composed of the glomerulus, proximal tubule, loop of Henle, distal tubule, and collecting duct. Although each kidney contains as many as 1 million nephrons, 75% of them may be compromised before renal disease is apparent.

 

REF:   pg. 314           OBJ:   2 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. Approximately what percentage of cardiac output flows through the renal system per minute?
a. 10
b. 20
c. 30
d. 40

 

 

ANS:  B

Kidneys receive the highest blood flow per gram of organ weight in the body. Approximately 22% of the cardiac output, or about 1.1 L/min in a normal 70-kg adult, flows through the kidneys.

 

REF:   pg. 314           OBJ:   2 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. Which ions are filtered and exchanged in the kidney tubules?
  2. Na+
  3. H2O
  4. K+
  5. Cl
  6. HCO3
a. 1 and 4 only
b. 2, 3, and 5 only
c. 1, 3, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

ANS:  C

The following ions are filtered and exchanged in the tubules.

  • Sodium: About 70% of Na+ in the filtrate is reabsorbed in the proximal tubules, 20% is reabsorbed in the loops of Henle, and about 10% is reabsorbed in the distal tubules. There is an exchange of Na+ for H+ or K+ in the distal tubules.
  • Potassium: Most filtered K+ is reabsorbed in the proximal tubules. K+ found in the urine is that secreted by the distal tubule.
  • Chloride and bicarbonate: Cl and HCO3 are passively reabsorbed in the proximal and distal tubules.

 

REF:   pg. 315           OBJ:   2 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. Aldosterone:
a. Increases sodium and water reabsorption
b. Decreases sodium and water reabsorption
c. Increases glomerular blood flow
d. Increases urine output

 

 

ANS:  A

Aldosterone, a mineralocorticoid secreted by the adrenal cortex, increases sodium and water reabsorption in the distal tubule. A diuretic such as spironolactone can increase sodium and water loss by inhibiting aldosterone.

 

REF:   pg. 313           OBJ:   2 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. Osmotic diuretics function by:
a. Blocking reabsorption of sodium and chloride in the distal tubule
b. Blocking reabsorption in the ascending limb of the loop of Henle
c. Blocking reabsorption of NaCl in the proximal tubule and descending limb of the loop of Henle
d. Blocking reabsorption of sodium and bicarbonate from the proximal tubule

 

 

ANS:  C

Osmotic diuretics are freely filtered at the glomerulus but are not reabsorbed. These agents remain in the tubule lumen and impair the ability of the proximal tubule and thick ascending limb of the loop of Henle to reabsorb NaCl. The net result is that osmotic substances are potent diuretics that lead to increased excretion of water and NaCl. However, the resultant increased delivery of sodium and chloride to the distal tubule results in increased exchange of Na+ for K+, producing a net K+ loss in urine.

 

REF:   pg. 317           OBJ:   3 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. Which of the following is the most selected osmotic diuretic agent?
a. Urea
b. Furosemide
c. Chlorothiazide
d. Mannitol

 

 

ANS:  D

Of the four currently available osmotic diuretics (glycerin, isosorbide, mannitol, and urea), mannitol is the typically selected agent because of its lower toxicity. Mannitol has a relatively short half-life and a rapid onset and quick offset of action. To maintain a continued diuretic action, the drug is frequently administered via continuous infusion. Osmotic diuretics are often used in the management of cerebral edema.

 

REF:   pg. 317           OBJ:   3 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. The use of carbonic anhydrase inhibitors (CAIs) results in:
a. Metabolic alkalosis
b. Metabolic acidosis
c. Respiratory alkalosis
d. Respiratory acidosis

 

 

ANS:  B

CAIs prevent the normal breakdown of carbonic acid and decrease bicarbonate reabsorption. CAIs also inhibit NaCl reabsorption at the proximal tubule. The net result is a moderate increase in sodium and bicarbonate in the urine along with increased water excretion. The potential for metabolic acidosis coupled with their weak diuretic properties limit the use of CAIs as first-line treatment for patients who require more aggressive management of their hypervolemic status.

 

REF:   pg. 318           OBJ:   3 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. Diuretics that produce their effect by inhibiting the reabsorption of chloride and sodium in the ascending limb of the loop of Henle are known as:
a. Potassium-sparing
b. Osmotic
c. Loop
d. Thiazide

 

 

ANS:  C

Loop diuretics are often called “high-ceiling” diuretics because they can cause 20% of the filtered load of NaCl and water to be excreted in the urine. They inhibit the reabsorption of NaCl at the thick ascending limb of the loop of Henle, where about 20% of filtered NaCl is usually reabsorbed.

 

REF:   pg. 318           OBJ:   3 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. Thiazide diuretics work by:
a. Blocking reabsorption of sodium and bicarbonate from the proximal tubule
b. Blocking reabsorption of sodium and chloride in the ascending limb of the loop of Henle
c. Blocking reabsorption of NaCl in the proximal tubule and loop of Henle
d. Blocking sodium and chloride reabsorption in the distal tubule

 

 

ANS:  D

Thiazide diuretics block NaCl reabsorption at the distal tubule. Loop diuretics are often called “high-ceiling” diuretics because they can cause 20% of the filtered load of NaCl and water to be excreted in the urine. They inhibit the reabsorption of NaCl at the thick ascending limb of the loop of Henle, where about 20% of filtered NaCl is usually reabsorbed. Carbonic anhydrase inhibitors (CAIs) prevent the normal breakdown of carbonic acid and decrease bicarbonate reabsorption. CAIs also inhibit NaCl reabsorption at the proximal tubule. The decreased osmotic gradient for water reabsorption results in increased delivery of NaHCO3, NaCl, and water from the proximal tubule. Osmotic diuretics are freely filtered at the glomerulus but are not reabsorbed. These agents remain in the tubule lumen and impair the ability of the proximal tubule and thick ascending limb of the loop of Henle to reabsorb NaCl. The net result is that osmotic substances are potent diuretics that lead to increased excretion of water and NaCl.

 

REF:   pg. 319           OBJ:   3 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. Agents that block reabsorption of sodium in the distal tubule are:
a. Osmotic diuretics
b. Thiazide diuretics
c. Potassium-sparing diuretics
d. Loop diuretics

 

 

ANS:  C

In the distal tubule, sodium is typically exchanged for potassium and hydrogen. Blocking this exchange is what makes these agents potassium-sparing diuretics. Thiazide diuretics block NaCl reabsorption at the distal tubule. Loop diuretics are often called “high-ceiling” diuretics because they can cause 20% of the filtered load of NaCl and water to be excreted in the urine. They inhibit the reabsorption of NaCl at the thick ascending limb of the loop of Henle, where about 20% of filtered NaCl is usually reabsorbed. Carbonic anhydrase inhibitors (CAIs) prevent the normal breakdown of carbonic acid and decrease bicarbonate reabsorption. CAIs also inhibit NaCl reabsorption at the proximal tubule. The decreased osmotic gradient for water reabsorption results in increased delivery of NaHCO3, NaCl, and water from the proximal tubule. Osmotic diuretics are freely filtered at the glomerulus but are not reabsorbed. These agents remain in the tubule lumen and impair the ability of the proximal tubule and thick ascending limb of the loop of Henle to reabsorb NaCl. The net result is that osmotic substances are potent diuretics that lead to increased excretion of water and NaCl.

 

REF:   pg. 319           OBJ:   3 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. The most common adverse reactions associated with diuretics include:
  2. Ototoxicity
  3. Volume depletion
  4. Diarrhea
  5. Allergic reactions
  6. Electrolyte abnormalities
a. 1 only
b. 2 and 5 only
c. 2, 3, and 4 only
d. 2, 3, 4, and 5 only

 

 

ANS:  B

Most complications associated with diuretic use can be anticipated as an extension of their pharmacologic activity, with hypovolemia and electrolyte and acid-base abnormalities being the most common.

 

REF:   pg. 320           OBJ:   5 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. Your patient has cerebral edema. Which group of diuretic agents would you expect to be administered?
a. Loop
b. Osmotic
c. Carbonic anhydrase inhibitors
d. Thiazide

 

 

ANS:  B

Osmotic diuretics are often used in the management of cerebral edema. Of the four currently available osmotic diuretics (glycerin, isosorbide, mannitol, and urea), mannitol is the typically selected agent because of its lower toxicity. Mannitol has a relatively short half-life and manifests with a rapid onset and quick offset of action. To maintain a continued diuretic action, the drug is frequently administered via continuous infusion.

 

REF:   pg. 317           OBJ:   4 LEVEL: Application                     MSC:  Chapter 19 Diuretic Agents

 

  1. Your patient is receiving intravenous furosemide (Lasix) and complains of a ringing in her ears. What steps could you take to help alleviate this side effect without changing the medication itself?
a. Speed up the rate of infusion
b. Slow the rate of infusion
c. Deliver the medication as an intravenous bolus
d. Both A and C

 

 

ANS:  B

Loop diuretics may cause a dose-related ototoxicity consisting of tinnitus and clinical or subclinical hearing loss. Ototoxicity results from anatomic and chemical abnormalities produced within the inner ear. Ototoxicity is related to the blood level of these agents. Rapid infusion and drug accumulation with large parenteral doses in renal failure predispose patients to ototoxicity. Reducing the infusion rate or administering the drug orally may alleviate the hearing loss.

 

REF:   pg. 321           OBJ:   5 LEVEL: Application                     MSC:  Chapter 19 Diuretic Agents

 

  1. Which of the following electrolyte imbalances would force Na+ to exchange for H+ producing metabolic alkalosis?
  2. Hypochloremia
  3. Hyperchloremia
  4. Hypokalemia
  5. Hyperkalemia
  6. HCO3
a. 1 and 3 only
b. 2, 4, and 5 only
c. 1, 3, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

ANS:  A

Either low chloride (hypochloremia) or low potassium (hypokalemia) would force Na+ to exchange for H+, producing a loss of H+ and metabolic alkalosis.

 

REF:   pg. 315           OBJ:   2 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. Loop diuretics can cause which of the following?
a. Increased pulmonary capillary wedge pressure and increased blood pressure
b. Decreased pulmonary capillary wedge pressure and increased blood pressure
c. Increased pulmonary capillary wedge pressure and decreased blood pressure
d. Decreased pulmonary capillary wedge pressure and decreased blood pressure

 

 

ANS:  D

Loop diuretics produce a hemodynamic effect characterized by acute vasodilation and manifested by a decrease in pulmonary capillary wedge pressure, blood pressure, and systemic vascular resistance.

 

REF:   pg. 318           OBJ:   5 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. Your patient has mild hypertension. Which group of diuretic agents would you expect the physician to prescribe?
a. Loop
b. Osmotic
c. Carbonic anhydrase inhibitors
d. Thiazide

 

 

ANS:  D

Thiazide diuretics are considered first-line therapy for mild hypertension.

 

REF:   pg. 319           OBJ:   4 LEVEL: Application                     MSC:  Chapter 19 Diuretic Agents

 

  1. Which diuretics have been associated with hyperglycemia?
a. Loop and osmotic
b. Osmotic and thiazide
c. Thiazide and loop
d. Carbonic anhydrase inhibitors and loop

 

 

ANS:  C

Loop and thiazide diuretics have been associated with hyperglycemia. The average increase in serum glucose is 6.5 to 9.6 mg/dl, although cases of diabetic ketoacidosis have also been reported. The severity of glucose elevation in these reports was related to the dose of diuretic used and to the decrease in potassium levels. Although the cause of hyperglycemia is not completely understood, several possible etiologies have been postulated, including decreased pancreatic insulin release and insulin resistance with impaired uptake of glucose in response to insulin.

 

REF:   pg. 321           OBJ:   4 LEVEL: Recall                             MSC:  Chapter 19 Diuretic Agents

 

  1. Your pregnant patient has mild hypertension and has been taking diuretics. Which group of diuretic agents would you expect the physician to prescribe while she is pregnant?
a. Loop
b. Thiazide
c. Carbonic anhydrase inhibitors
d. None are recommended for pregnant women

 

 

ANS:  D

Diuretics are not recommended for pregnant women because the effects of the drug on the fetus are unknown. Because many diuretics pass into breast milk, diuretics are not recommended to breastfeeding women owing to the risk of dehydration in the infant.

 

REF:   pg. 321           OBJ:   6 LEVEL: Application                     MSC:  Chapter 19 Diuretic Agents