Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1: Multiple-Choice Question (MCQ)
• Clinical Scenario: A 67-year-old male with a history of
chronic heart failure and stage 3 chronic kidney disease
(CKD) is admitted with an acute exacerbation of fluid
overload. The healthcare provider prescribes an
intravenous bolus of furosemide. The patient's baseline
serum potassium is $3.6 \text{ mEq/L}$, and his serum
creatinine is $2.1 \text{ mg/dL}$.
• Question Stem: Which pharmacodynamic and
pharmacokinetic principle must the nurse prioritize when
planning the administration and monitoring of this
medication?
• Answer Options:
A. Furosemide has a low protein-binding capacity, meaning a
lower dose is required to avoid systemic toxicity in renal
impairment.
B. Furosemide acts on the proximal convoluted tubule;
therefore, its diuretic efficacy is independent of the patient’s
glomerular filtration rate (GFR).
C. Furosemide requires active tubular secretion to reach its site
of action in the thick ascending limb of the loop of Henle,
necessitating higher doses in patients with renal impairment.
,D. The drug increases calcium reabsorption in the distal tubule,
which puts this patient at an immediate risk for severe
hypercalcemia.
• Correct Answer: C
• Comprehensive Rationale: Furosemide is a loop diuretic
that exhibits high protein binding ($>95\%$). It must be
delivered to its site of action on the luminal side of the
thick ascending limb of the loop of Henle by binding to
organic anion transporters in the proximal tubule (active
tubular secretion). In stage 3 CKD, accumulated
endogenous organic acids competitively inhibit this
secretion, and fewer functioning nephrons are available.
Consequently, higher intravenous doses are typically
required to achieve the necessary luminal concentrations
to inhibit the $Na^+/K^+/2Cl^-$ cotransporter. Furosemide
causes profound natriuresis and kaliuresis, meaning a
baseline potassium of $3.6 \text{ mEq/L}$ places the
patient at immediate risk for severe hypokalemia, which
requires close monitoring.
• Distractor Analysis:
o Option A is incorrect because furosemide is highly
protein-bound, not lowly protein-bound. In uremic
states, altered protein binding can occur, but the
primary barrier to action is reduced tubular secretion,
, requiring larger doses, not smaller ones, to achieve
diuresis.
o Option B is incorrect because loop diuretics act on the
thick ascending limb of the loop of Henle, not the
proximal convoluted tubule, and their efficacy is
highly dependent on GFR and tubular secretory
capacity.
o Option D is incorrect because loop diuretics increase
the excretion of calcium ("loop lose calcium"), unlike
thiazide diuretics, which increase calcium
reabsorption.
• Nursing Process Integration:
o Primary Phase: Planning. The nurse must anticipate
the need for a higher effective dose due to renal
competition and plan for aggressive potassium
monitoring and replacement.
o Remaining Steps: Assessment involves checking
baseline electrolytes, fluid status, and renal labs.
Implementation requires administering the drug
slowly ($20 \text{ mg/min}$ maximum) to prevent
ototoxicity. Evaluation involves tracking urine output,
weight trends, and electrolyte shifts.
• NCJMM Competency: Analyze Cues / Generate Solutions
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1: Multiple-Choice Question (MCQ)
• Clinical Scenario: A 67-year-old male with a history of
chronic heart failure and stage 3 chronic kidney disease
(CKD) is admitted with an acute exacerbation of fluid
overload. The healthcare provider prescribes an
intravenous bolus of furosemide. The patient's baseline
serum potassium is $3.6 \text{ mEq/L}$, and his serum
creatinine is $2.1 \text{ mg/dL}$.
• Question Stem: Which pharmacodynamic and
pharmacokinetic principle must the nurse prioritize when
planning the administration and monitoring of this
medication?
• Answer Options:
A. Furosemide has a low protein-binding capacity, meaning a
lower dose is required to avoid systemic toxicity in renal
impairment.
B. Furosemide acts on the proximal convoluted tubule;
therefore, its diuretic efficacy is independent of the patient’s
glomerular filtration rate (GFR).
C. Furosemide requires active tubular secretion to reach its site
of action in the thick ascending limb of the loop of Henle,
necessitating higher doses in patients with renal impairment.
,D. The drug increases calcium reabsorption in the distal tubule,
which puts this patient at an immediate risk for severe
hypercalcemia.
• Correct Answer: C
• Comprehensive Rationale: Furosemide is a loop diuretic
that exhibits high protein binding ($>95\%$). It must be
delivered to its site of action on the luminal side of the
thick ascending limb of the loop of Henle by binding to
organic anion transporters in the proximal tubule (active
tubular secretion). In stage 3 CKD, accumulated
endogenous organic acids competitively inhibit this
secretion, and fewer functioning nephrons are available.
Consequently, higher intravenous doses are typically
required to achieve the necessary luminal concentrations
to inhibit the $Na^+/K^+/2Cl^-$ cotransporter. Furosemide
causes profound natriuresis and kaliuresis, meaning a
baseline potassium of $3.6 \text{ mEq/L}$ places the
patient at immediate risk for severe hypokalemia, which
requires close monitoring.
• Distractor Analysis:
o Option A is incorrect because furosemide is highly
protein-bound, not lowly protein-bound. In uremic
states, altered protein binding can occur, but the
primary barrier to action is reduced tubular secretion,
, requiring larger doses, not smaller ones, to achieve
diuresis.
o Option B is incorrect because loop diuretics act on the
thick ascending limb of the loop of Henle, not the
proximal convoluted tubule, and their efficacy is
highly dependent on GFR and tubular secretory
capacity.
o Option D is incorrect because loop diuretics increase
the excretion of calcium ("loop lose calcium"), unlike
thiazide diuretics, which increase calcium
reabsorption.
• Nursing Process Integration:
o Primary Phase: Planning. The nurse must anticipate
the need for a higher effective dose due to renal
competition and plan for aggressive potassium
monitoring and replacement.
o Remaining Steps: Assessment involves checking
baseline electrolytes, fluid status, and renal labs.
Implementation requires administering the drug
slowly ($20 \text{ mg/min}$ maximum) to prevent
ototoxicity. Evaluation involves tracking urine output,
weight trends, and electrolyte shifts.
• NCJMM Competency: Analyze Cues / Generate Solutions
