Study Questions Choose the one best answer

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252 
18. Diuretics
Study Questions
Choose the ONE best answer.
18.1 An elderly patient with a history of heart disease is 
brought to the emergency room with difficulty breathing. 
Examination reveals that she has pulmonary edema. 
Which treatment is indicated?
A. Acetazolamide.
B. Chlorthalidone.
C. Furosemide.
D. Hydrochlorothiazide.
E. Spironolactone.
18.2 A group of college students is planning a mountain 
climbing trip to the Andes. Which would be appropriate 
for them to take to prevent mountain sickness?
A. A thiazide diuretic such as hydrochlorothiazide.
B. An anticholinergic such as atropine.
C. A carbonic anhydrase inhibitor such as 
acetazolamide.
D. A loop diuretic such as furosemide.
E. A 
β
-blocker such as metoprolol.
18.3 An alcoholic male has developed hepatic cirrhosis. 
To control the ascites and edema, which should be 
prescribed?
A. Acetazolamide.
B. Chlorthalidone.
C. Furosemide.
D. Hydrochlorothiazide.
E. Spironolactone.
18.4 A 55-year-old male with kidney stones has been placed 
on a diuretic to decrease calcium excretion. However, 
after a few weeks, he develops an attack of gout. Which 
diuretic was he taking?
A. Furosemide.
B. Hydrochlorothiazide.
C. Spironolactone.
D. Triamterene.
E. Urea.
18.5 A 75-year-old woman with hypertension is being treated 
with a thiazide. Her blood pressure responds well and 
reads at 120/76 mm Hg. After several months on the 
medication, she complains of being tired and weak. An 
analysis of the blood indicates low values for which of 
the following?
A. Calcium.
B. Glucose.
C. Potassium.
D. Sodium.
E. Uric acid.
Correct answer = C. This is a potentially fatal situation. It 
is important to administer a diuretic that will reduce fluid 
accumulation in the lungs and, thus, improve oxygenation 
and heart function. The loop diuretics are most effective in 
removing large fluid volumes from the body and are the 
treatment of choice in this situation. In this situation, furo-
semide should be administered intravenously. The other 
choices are inappropriate.
Correct answer = C. Acetazolamide is used prophylactically 
for several days before an ascent above 10,000 feet. This 
treatment prevents the cerebral and pulmonary problems 
associated with the syndrome as well as other difficulties, 
such as nausea.
Correct answer = E. Spironolactone is very effective in the 
treatment of hepatic edema. These patients are frequently 
resistant to the diuretic action of loop diuretics, although 
a combination with spironolactone may be beneficial. The 
other agents are not indicated.
Correct answer = B. Hydrochlorothiazide is effective in 
increasing calcium reabsorption, thus decreasing the amount 
of calcium excreted, and decreasing the formation of kidney 
stones that contain calcium phosphate or calcium oxalate. 
However, hydrochlorothiazide can also inhibit the excretion of 
uric acid and cause its accumulation, leading to an attack of 
gout in some individuals. Furosemide increases the excretion 
of calcium, whereas the K
+
-sparing osmotic diuretics, spi-
ronolactone and triamterene, and urea do not have an effect.
Correct answer = C. Hypokalemia is a common adverse 
effect of the thiazides and causes fatigue and lethargy in the 
patient. Supplementation with potassium chloride or foods 
high in K
+
corrects the problem. Alternatively, a potassium-
sparing diuretic, such as spironolactone, may be added. 
Calcium, uric acid, and glucose are usually elevated by thi-
azide diuretics. Sodium loss would not weaken the patient.
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Study Questions 
253
18.6 Which is contraindicated in a patient with hyperkalemia?
A. Acetazolamide.
B. Chlorthalidone.
C. Chlorothiazide.
D. Ethacrynic acid.
E. Spironolactone.
18.7 Which of the following should be avoided in a patient 
with a history of severe anaphylactic reaction to sulfa 
medications?
A. Amiloride.
B. Hydrochlorothiazide.
C. Mannitol.
D. Spironolactone.
E. Triamterene.
18.8 A male patient is placed on a new medication and 
notes that his breasts have become enlarged and 
tender to the touch. Which medication is he most likely 
taking?
A. Chlorthalidone.
B. Furosemide.
C. Hydrochlorothiazide.
D. Spironolactone.
E. Triamterene.
18.9 A patient presents to the emergency department with 
an extreme headache. After a thorough workup, the 
attending physician concludes that the pain is due to 
increased intracranial pressure. Which diuretic would 
work best to reduce this pressure?
A. Acetazolamide.
B. Indapamide.
C. Furosemide.
D. Hydrochlorothiazide.
E. Mannitol.
18.10 Which diuretic has been shown to improve blood 
pressure in resistant hypertension or those already 
treated with three blood pressure medications 
including a thiazide or thiazide-like diuretic?
A. Chlorthalidone.
B. Indapamide.
C. Furosemide.
D. Mannitol.
E. Spironolactone.
Correct answer = B. Hydrochlorothiazide, like many thiazide 
and thiazide-like diuretics, contains a sulfa moiety within its 
chemical structure. It is important to avoid use in those indi-
viduals with severe hypersensitivity to sulfa medications. It 
may be used with caution, however, in those with only minor 
reaction to sulfa medications.
Correct answer = D. An adverse drug reaction to spirono-
lactone is gynecomastia due to its effects on androgens 
and progesterone in the body. Eplerenone may be a suit-
able alternative if the patient is in need of an aldosterone 
antagonist but has a history of gynecomastia.
Correct answer = E. Osmotic diuretics, such as mannitol, 
are a mainstay of treatment for patients with increased 
intracranial pressure or acute renal failure due to shock, 
drug toxicities, and trauma.
Correct answer = E. Resistant hypertension, defined by 
the use of three or more medications without reaching the 
blood pressure goal, often responds well to aldosterone 
antagonists. This effect can be seen in those with or without 
elevated aldosterone levels.
Correct answer = E. Spironolactone acts in the collect-
ing tubule to inhibit Na
+
reabsorption and K
+
excretion. It 
is extremely important that patients who are treated with 
any potassium-sparing diuretic be closely monitored for 
potassium levels. Exogenous potassium supplementation 
is usually discontinued when potassium-sparing diuretic 
therapy is instituted and spironolactone is contraindicated 
in patients with hyperkalemia. The other drugs promote the 
excretion of potassium.
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