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NUR 2474 Pharm Exam 2 NCLEX - Questions With Complete Solutions
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NUR 2474 Pharm Exam 2 NCLEX - Questions WithComplete Solutions
A patient is brought to the emergency department with shortness of breath, a
respiratory rate of 30 breaths per minute, intercostal retractions, and frothy,
pink sputum. The nurse caring for this patient will expect to administer which
drug?
a.Furosemide (Lasix)
b.Hydrochlorothiazide (HydroDIURIL)
c.Mannitol (Osmitrol)
d.Spironolactone (Aldactone) ✔️Ans - a.Furosemide (Lasix)
Furosemide, a potent diuretic, is used when rapid or massive mobilization of
fluids is needed. This patient shows severe signs of congestive heart failure
with respiratory distress and pulmonary edema and needs immediate
mobilization of fluid. Hydrochlorothiazide and spironolactone are not
indicated for pulmonary edema, because their diuretic effects are less rapid.
Mannitol is indicated for patients with increased intracranial pressure and
must be discontinued immediately if signs of pulmonary congestion or heart
failure occur.
A patient who is taking digoxin is admitted to the hospital for treatment of
congestive heart failure. The prescriber has ordered furosemide (Lasix). The
nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate
of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse
auscultates crackles in both lungs. Which laboratory value causes the nurse
the most concern?
a.Blood glucose level of 120 mg/dL
b.Oxygen saturation of 90%
c.Potassium level of 3.5 mEq/L
d.Sodium level of 140 mEq/L ✔️Ans - c.Potassium level of 3.5 mEq/L
This patient has an irregular, rapid heartbeat that might be caused by a
dysrhythmia. This patient's serum potassium level is low, which can trigger
fatal dysrhythmias, especially in patients taking digoxin. Furosemide
contributes to loss of potassium through its effects on the distal nephron.
,Potassium-sparing diuretics often are used in conjunction with furosemide to
prevent this complication. This patient's serum glucose and sodium levels are
normal and of no concern at this point, although they can be affected by
furosemide. The oxygen saturation is somewhat low and needs to be
monitored, although it may improve with diuresis.
A patient has 2+ pitting edema of the lower extremities bilaterally.
Auscultation of the lungs reveals crackles bilaterally, and the serum potassium
level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the
nurse question?
a.Bumetanide (Bumex)
b.Furosemide (Lasix)
c.Spironolactone (Aldactone)
d.Hydrochlorothiazide (HydroDIURIL) ✔️Ans - c.Spironolactone
(Aldactone)
Spironolactone is a non-potassium-wasting diuretic; therefore, if the patient
has a serum potassium level of 6 mEq/L, indicating hyperkalemia, an order for
this drug should be questioned. Bumetanide, furosemide, and
hydrochlorothiazide are potassium-wasting diuretics and would be
appropriate to administer in a patient with hyperkalemia.
A nurse preparing to administer morning medications notes that a patient
with a history of hypertension has been prescribed the angiotensin-
converting enzyme (ACE) inhibitor captopril (Capoten) concurrently with
spironolactone (Aldactone). Morning laboratory results reveal a serum
sodium level of 144 mg/dL, a serum potassium level of 5.1 mEq/L, and a blood
glucose level of 128 mg/dL. Which intervention is appropriate?
a.Administer the medications as ordered.
b.Ask the patient about the use of salt substitutes.
c.Contact the provider to report the laboratory values.
d.Request an order for furosemide (Lasix). ✔️Ans - c.Contact the provider
to report the laboratory values.
Spironolactone should not be administered with ACE inhibitors, which can
also elevate potassium levels. Because the potassium level is elevated, the
nurse should not administer the medication and should obtain clarification of
,the order. There is no need to repeat the potassium level test that was just
done this morning. Requesting an order for furosemide is appropriate only
after the provider has been notified of the laboratory values.
A patient with hypertension is taking furosemide (Lasix) for congestive heart
failure. The prescriber orders digoxin to help increase cardiac output. What
other medication will the nurse expect to be ordered for this patient?
a.Bumetanide (Bumex)
b.Chlorothiazide (Diuril)
c.Hydrochlorothiazide (HydroDIURIL)
d.Spironolactone (Aldactone) ✔️Ans - d.Spironolactone (Aldactone)
Spironolactone is used in conjunction with furosemide because of its
potassium-sparing effects. Furosemide can contribute to hypokalemia, which
can increase the risk of fatal dysrhythmias, especially with digoxin
administration. The other diuretics listed are all potassium-wasting diuretics.
A patient is taking gentamicin (Garamycin) and furosemide (Lasix). The nurse
should counsel this patient to report which symptom?
a.Frequent nocturia
b.Headaches
c.Ringing in the ears
d.Urinary retention ✔️Ans - c.Ringing in the ears
Patients taking furosemide should be advised that the risk of furosemide-
induced hearing loss can be increased when other ototoxic drugs, such as
gentamicin, are also taken. Patients should be told to report tinnitus or
dizziness or hearing loss. Nocturia may be an expected effect of furosemide.
Headaches are not likely to occur with concomitant use of gentamicin and
furosemide. Urinary retention is not an expected side effect.
An older adult patient with congestive heart failure develops crackles in both
lungs and pitting edema of all extremities. The physician orders
hydrochlorothiazide (HydroDIURIL). Before administering this medication,
the nurse reviews the patient's chart. Which laboratory value causes the nurse
the most concern?
, a.Elevated creatinine clearance
b.Elevated serum potassium level
c.Normal blood glucose level
d.Low levels of low-density lipoprotein (LDL) cholesterol ✔️Ans -
a.Elevated creatinine clearance
Hydrochlorothiazide should not be given to patients with severe renal
impairment; therefore, an elevated creatinine clearance would cause the most
concern. Thiazide diuretics are potassium-wasting drugs and thus may
actually improve the patient's potassium level. Thiazides may elevate the
serum glucose level in diabetic patients. Thiazides increase LDL cholesterol;
however, this patient's levels are low, so this is not a risk.
A patient with chronic congestive heart failure has repeated hospitalizations
in spite of ongoing treatment with hydrochlorothiazide (HydroDIURIL) and
digoxin. The prescriber has ordered spironolactone (Aldactone) to be added
to this patient's drug regimen, and the nurse provides education about this
medication. Which statement by the patient indicates understanding of the
teaching?
a."I can expect improvement within a few hours after taking this drug."
b."I need to stop taking potassium supplements."
c."I should use salt substitutes to prevent toxic side effects."
d."I should watch closely for dehydration." ✔️Ans - b."I need to stop taking
potassium supplements."
Spironolactone is a potassium-sparing diuretic used to counter the potassium-
wasting effects of hydrochlorothiazides. Patients taking potassium
supplements are at risk for hyperkalemia when taking this medication, so they
should be advised to stop the supplements. Spironolactone takes up to 48
hours to have effects. Salt substitutes contain high levels of potassium and are
contraindicated. Spironolactone is a weak diuretic, so the risk of dehydration
is not increased.
A patient with hypertension is prescribed an angiotensin-converting enzyme
(ACE) inhibitor. The nurse reviewing this patient's chart before administering
the medication will be most concerned about which other disease process?
a.Bronchial asthma
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