An adult is diagnosed with hypertension. He is prescribed chlorothiazide (Diuril) 500 mg PO. What nursing instruction is essential for him?

1. A

   Drink orange juice or eat a banana daily

2. B

   Drink at least two quarts of liquid daily

3. C

   Do not take aspirin

4. D

   Avoid hard cheeses

Appeared in: UPUMS Nsg.Officer-2024

Explanation

• Chlorothiazide is a thiazide diuretic, which is known to be 'potassium-wasting,' meaning it increases the excretion of potassium from the body.
• This potassium loss can lead to a dangerous condition called hypokalemia (serum potassium less than 3.5 mEq/L).
• Hypokalemia can cause muscle weakness, fatigue, and serious cardiac dysrhythmias.
• Instructing the patient to eat potassium-rich foods like bananas and orange juice is a crucial preventive measure to counteract this effect and maintain normal potassium levels.

Why Other Options Were Wrong

• Option B: The primary purpose of a diuretic in hypertension management is to reduce fluid volume. Instructing a patient to drink a large, fixed amount of fluid could counteract the therapeutic effect of the medication.
• Option C: This is not the most essential instruction. While high-dose NSAIDs can decrease diuretic efficacy, there is no strict contraindication against aspirin, especially low-dose aspirin often used for cardioprotection.
• Option D: This dietary restriction is for patients taking Monoamine Oxidase Inhibitors (MAOIs), not thiazide diuretics. Hard cheeses contain tyramine, which can cause a hypertensive crisis in patients on MAOIs.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Patient education and side effect management for thiazide diuretics helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Patient education is a cornerstone of managing chronic conditions like hypertension. As a nurse, you must empower patients to manage their medications safely at home.
• A key nursing responsibility is to monitor for electrolyte imbalances. For a patient on chlorothiazide, you would assess for signs of hypokalemia, such as muscle cramps, weakness, and palpitations, and monitor lab values.
• Normal serum potassium level is 3.5 to 5.0 mEq/L. A level below 3.5 mEq/L is hypokalemia and must be reported to the provider.

How to Approach the Question

• First, identify the drug mentioned in the question: Chlorothiazide (Diuril).
• Next, classify the drug. Chlorothiazide is a thiazide diuretic.
• Recall the primary mechanism and the most significant side effects of this drug class. Thiazide diuretics promote water and salt excretion but also cause potassium loss.
• Analyze the options in the context of managing the drug's side effects. The most 'essential' instruction will relate to the most common and potentially dangerous side effect.
• Option A directly addresses the risk of potassium loss (hypokalemia) by suggesting potassium-rich foods.
• Evaluate the other options: Option B could be counterproductive, Option C is not the primary concern, and Option D is for a different class of drugs (MAOIs). Therefore, Option A is the best answer.

Concept Tested & Keywords

• Concept Tested: Patient education and side effect management for thiazide diuretics.
• Stem keywords: hypertension, chlorothiazide, Diuril, nursing instruction
• Lead-in keywords: essential
• Negative lead-in flag: false

Question ID

Qt66vluIcrcNwmDZh6XPpQ

Copy ID

Reference Book

E6 Pharmacology Nursing Lilley 11e Part 2 p. 155-157

E6 Pharmacology Katzung 16e p. 409-411