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 patient with heart failure is
prescribed digoxin. The nurse reviews the medication
administration record (MAR) and notes that the patient is also
taking furosemide.
Question Stem: Based on the patient's medication profile, for
which adverse effect should the nurse be most vigilant?
Answer Options:
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypomagnesemia
Correct Answer: B. Hypokalemia
Comprehensive Rationale:
The correct answer is B. Furosemide is a loop diuretic that
inhibits sodium and chloride reabsorption in the ascending loop
of Henle, leading to increased excretion of potassium in the
distal tubule. This can result in hypokalemia. Digoxin, a cardiac
glycoside, binds to and inhibits the Na+/K+-ATPase pump. In a
hypokalemic state, the Na+/K+-ATPase pump is more easily
inhibited, increasing the risk of digoxin toxicity (e.g.,
dysrhythmias). The combined effect of these two medications
,creates a significant risk for this adverse outcome. Monitoring
serum potassium levels and taking action to correct
hypokalemia is a critical nursing responsibility.
Distractor Analysis:
• A. Hyperkalemia: Incorrect. Furosemide promotes
potassium loss, not retention. Hyperkalemia is more likely
with potassium-sparing diuretics (e.g., spironolactone).
o Clinical Misconception: Confusing the effects of
different classes of diuretics.
o Safety Risk: Administering potassium supplements or
using potassium-sparing diuretics without monitoring
could lead to hyperkalemia.
o Nursing Action: Differentiate between diuretic classes
and their effects on electrolytes.
• C. Hypercalcemia: Incorrect. Furosemide increases calcium
excretion, so it is more likely to cause hypocalcemia, not
hypercalcemia. It is often used to manage hypercalcemia.
o Clinical Misconception: Assuming all electrolyte
imbalances are similar.
o Safety Risk: Failing to monitor for and manage
hypercalcemia in a patient with a condition like
malignancy.
, o Nursing Action: Understand the specific electrolyte
effects of medications.
• D. Hypomagnesemia: Incorrect. While furosemide can
cause hypomagnesemia, it is not the most significant risk
in the context of digoxin therapy. Hypokalemia is the
primary electrolyte imbalance of concern due to its
profound effect on cardiac contractility and the risk of
digoxin toxicity.
o Clinical Misconception: Not prioritizing the most
critical drug-drug and drug-electrolyte interaction.
o Safety Risk: Overlooking the primary risk
(hypokalemia) while focusing on a less critical one
(hypomagnesemia).
o Nursing Action: Prioritize potential risks based on
medication profile and patient condition.
Nursing Process Integration:
• Assessment: The nurse must assess serum electrolyte
levels (especially potassium), renal function, and cardiac
rhythm before and during therapy.
• Diagnosis: Risk for Decreased Cardiac Output related to
digoxin toxicity secondary to hypokalemia.
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 patient with heart failure is
prescribed digoxin. The nurse reviews the medication
administration record (MAR) and notes that the patient is also
taking furosemide.
Question Stem: Based on the patient's medication profile, for
which adverse effect should the nurse be most vigilant?
Answer Options:
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypomagnesemia
Correct Answer: B. Hypokalemia
Comprehensive Rationale:
The correct answer is B. Furosemide is a loop diuretic that
inhibits sodium and chloride reabsorption in the ascending loop
of Henle, leading to increased excretion of potassium in the
distal tubule. This can result in hypokalemia. Digoxin, a cardiac
glycoside, binds to and inhibits the Na+/K+-ATPase pump. In a
hypokalemic state, the Na+/K+-ATPase pump is more easily
inhibited, increasing the risk of digoxin toxicity (e.g.,
dysrhythmias). The combined effect of these two medications
,creates a significant risk for this adverse outcome. Monitoring
serum potassium levels and taking action to correct
hypokalemia is a critical nursing responsibility.
Distractor Analysis:
• A. Hyperkalemia: Incorrect. Furosemide promotes
potassium loss, not retention. Hyperkalemia is more likely
with potassium-sparing diuretics (e.g., spironolactone).
o Clinical Misconception: Confusing the effects of
different classes of diuretics.
o Safety Risk: Administering potassium supplements or
using potassium-sparing diuretics without monitoring
could lead to hyperkalemia.
o Nursing Action: Differentiate between diuretic classes
and their effects on electrolytes.
• C. Hypercalcemia: Incorrect. Furosemide increases calcium
excretion, so it is more likely to cause hypocalcemia, not
hypercalcemia. It is often used to manage hypercalcemia.
o Clinical Misconception: Assuming all electrolyte
imbalances are similar.
o Safety Risk: Failing to monitor for and manage
hypercalcemia in a patient with a condition like
malignancy.
, o Nursing Action: Understand the specific electrolyte
effects of medications.
• D. Hypomagnesemia: Incorrect. While furosemide can
cause hypomagnesemia, it is not the most significant risk
in the context of digoxin therapy. Hypokalemia is the
primary electrolyte imbalance of concern due to its
profound effect on cardiac contractility and the risk of
digoxin toxicity.
o Clinical Misconception: Not prioritizing the most
critical drug-drug and drug-electrolyte interaction.
o Safety Risk: Overlooking the primary risk
(hypokalemia) while focusing on a less critical one
(hypomagnesemia).
o Nursing Action: Prioritize potential risks based on
medication profile and patient condition.
Nursing Process Integration:
• Assessment: The nurse must assess serum electrolyte
levels (especially potassium), renal function, and cardiac
rhythm before and during therapy.
• Diagnosis: Risk for Decreased Cardiac Output related to
digoxin toxicity secondary to hypokalemia.
