Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1
Item Type: MCQ
Clinical Scenario:
A 72-year-old male patient with a history of heart failure and
hypertension is admitted to the medical unit with worsening
dyspnea and peripheral edema. His current medications include
furosemide 40 mg PO daily, lisinopril 10 mg PO daily, and
potassium chloride 20 mEq PO daily. The healthcare provider
orders an increase in furosemide to 80 mg PO daily. The nurse
notes that the patient's serum potassium level from this
morning is 3.2 mEq/L (normal: 3.5-5.0 mEq/L).
Question Stem:
Which nursing action is the highest priority before
administering the increased furosemide dose?
Answer Options:
A. Administer the furosemide as ordered and monitor for
increased urine output
B. Hold the furosemide and notify the healthcare provider of
the potassium level
C. Administer the furosemide with a potassium-rich snack
D. Give the potassium chloride first, then administer the
furosemide 30 minutes later
,Correct Answer: B
Comprehensive Rationale:
Furosemide is a loop diuretic that acts on the ascending loop of
Henle to inhibit sodium-potassium-chloride cotransport,
resulting in increased excretion of sodium, chloride, and water.
However, furosemide also significantly increases potassium
excretion, placing patients at risk for hypokalemia. The patient's
serum potassium of 3.2 mEq/L indicates hypokalemia (normal
range: 3.5-5.0 mEq/L). Administering an increased dose of
furosemide when the patient is already hypokalemic would
further deplete potassium stores, potentially leading to cardiac
dysrhythmias, especially in a patient with underlying heart
failure who is also taking an ACE inhibitor (lisinopril). The
priority nursing action is to hold the medication and notify the
healthcare provider to address the electrolyte imbalance before
proceeding with the dose increase. The provider may order
potassium supplementation, adjust the diuretic dose, or
consider alternative therapy. The nurse should also assess for
clinical signs of hypokalemia including muscle weakness,
fatigue, leg cramps, and ECG changes (flattened T waves, U
waves).
Distractor Analysis:
• A. Administer the furosemide as ordered and monitor for
increased urine output: Incorrect. This action ignores the
, critical electrolyte imbalance. While monitoring urine
output is important, administering the medication without
addressing hypokalemia could precipitate life-threatening
cardiac dysrhythmias.
• C. Administer the furosemide with a potassium-rich
snack: Incorrect. While dietary potassium supplementation
may be beneficial, it is insufficient to rapidly correct
significant hypokalemia. The nurse must first notify the
provider for appropriate intervention, which may include
IV or oral potassium replacement.
• D. Give the potassium chloride first, then administer the
furosemide 30 minutes later: Incorrect. Although
administering potassium replacement is appropriate, the
nurse should not independently administer potassium
without a provider's order. Additionally, the furosemide
should be held until the potassium level is assessed and
addressed by the provider.
Nursing Process Integration:
• Primary Component: Assessment—The nurse must assess
laboratory values, recognize abnormal findings, and
identify potential risks before medication administration.
• Implementation: The nurse should hold the medication,
notify the provider, and prepare to implement ordered
interventions such as potassium supplementation.
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1
Item Type: MCQ
Clinical Scenario:
A 72-year-old male patient with a history of heart failure and
hypertension is admitted to the medical unit with worsening
dyspnea and peripheral edema. His current medications include
furosemide 40 mg PO daily, lisinopril 10 mg PO daily, and
potassium chloride 20 mEq PO daily. The healthcare provider
orders an increase in furosemide to 80 mg PO daily. The nurse
notes that the patient's serum potassium level from this
morning is 3.2 mEq/L (normal: 3.5-5.0 mEq/L).
Question Stem:
Which nursing action is the highest priority before
administering the increased furosemide dose?
Answer Options:
A. Administer the furosemide as ordered and monitor for
increased urine output
B. Hold the furosemide and notify the healthcare provider of
the potassium level
C. Administer the furosemide with a potassium-rich snack
D. Give the potassium chloride first, then administer the
furosemide 30 minutes later
,Correct Answer: B
Comprehensive Rationale:
Furosemide is a loop diuretic that acts on the ascending loop of
Henle to inhibit sodium-potassium-chloride cotransport,
resulting in increased excretion of sodium, chloride, and water.
However, furosemide also significantly increases potassium
excretion, placing patients at risk for hypokalemia. The patient's
serum potassium of 3.2 mEq/L indicates hypokalemia (normal
range: 3.5-5.0 mEq/L). Administering an increased dose of
furosemide when the patient is already hypokalemic would
further deplete potassium stores, potentially leading to cardiac
dysrhythmias, especially in a patient with underlying heart
failure who is also taking an ACE inhibitor (lisinopril). The
priority nursing action is to hold the medication and notify the
healthcare provider to address the electrolyte imbalance before
proceeding with the dose increase. The provider may order
potassium supplementation, adjust the diuretic dose, or
consider alternative therapy. The nurse should also assess for
clinical signs of hypokalemia including muscle weakness,
fatigue, leg cramps, and ECG changes (flattened T waves, U
waves).
Distractor Analysis:
• A. Administer the furosemide as ordered and monitor for
increased urine output: Incorrect. This action ignores the
, critical electrolyte imbalance. While monitoring urine
output is important, administering the medication without
addressing hypokalemia could precipitate life-threatening
cardiac dysrhythmias.
• C. Administer the furosemide with a potassium-rich
snack: Incorrect. While dietary potassium supplementation
may be beneficial, it is insufficient to rapidly correct
significant hypokalemia. The nurse must first notify the
provider for appropriate intervention, which may include
IV or oral potassium replacement.
• D. Give the potassium chloride first, then administer the
furosemide 30 minutes later: Incorrect. Although
administering potassium replacement is appropriate, the
nurse should not independently administer potassium
without a provider's order. Additionally, the furosemide
should be held until the potassium level is assessed and
addressed by the provider.
Nursing Process Integration:
• Primary Component: Assessment—The nurse must assess
laboratory values, recognize abnormal findings, and
identify potential risks before medication administration.
• Implementation: The nurse should hold the medication,
notify the provider, and prepare to implement ordered
interventions such as potassium supplementation.
