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 female patient with a history of hypertension,
heart failure with reduced ejection fraction, and chronic kidney
disease stage 3 (eGFR 45 mL/min/1.73m²) is admitted to the
medical-surgical unit with acute decompensated heart failure.
The healthcare provider orders furosemide 40 mg IV push. The
patient's current medications include lisinopril 20 mg daily,
carvedilol 12.5 mg twice daily, and potassium chloride 20 mEq
daily.
Question Stem:
Before administering the furosemide IV push, which nursing
action is the highest priority?
Answer Options:
A. Assess the patient's blood pressure and heart rate
B. Verify the patient's baseline serum potassium level
C. Review the patient's most recent serum creatinine and BUN
D. Assess the patient's daily weights and intake/output records
Correct Answer: B. Verify the patient's baseline serum
potassium level
,Comprehensive Rationale:
Furosemide is a loop diuretic that acts on the ascending loop of
Henle to inhibit the Na⁺-K⁺-2Cl⁻ cotransporter, resulting in
profound diuresis and electrolyte losses. Potassium depletion is
a significant adverse effect that can precipitate life-threatening
cardiac dysrhythmias, particularly in patients receiving digoxin
or those with underlying cardiac disease. This patient has
multiple risk factors for hypokalemia: advanced age, heart
failure, baseline renal impairment, and concurrent use of a loop
diuretic. The combination of furosemide with potassium-
wasting properties and the patient's preexisting cardiac disease
makes potassium monitoring essential before administration.
Normal serum potassium ranges from 3.5 to 5.0 mEq/L. If the
potassium level is below 3.5 mEq/L, administration of
furosemide may worsen hypokalemia and increase the risk of
ventricular dysrhythmias, particularly in a patient already
receiving medications affecting cardiac conduction. While
assessing blood pressure, renal function, and fluid balance are
important, electrolyte status directly impacts immediate patient
safety and medication effectiveness. The nurse should verify
potassium levels and implement appropriate interventions,
such as potassium supplementation or holding the medication
with provider notification, before administering the diuretic.
Distractor Analysis:
, • A. Assess the patient's blood pressure and heart rate -
While this is an important assessment before
administering furosemide, as the medication can cause
significant hypotension, it is not the highest priority. The
patient's potassium level presents a more immediate
safety concern related to cardiac dysrhythmias, especially
given the patient's heart failure diagnosis and age.
However, vital signs should be assessed concurrently as
part of the full pre-administration assessment.
• C. Review the patient's most recent serum creatinine and
BUN - Although renal function assessment is crucial for
determining appropriate furosemide dosing and
monitoring effectiveness, it is not the highest priority
before the initial dose. While renal impairment does affect
drug clearance and may require dosage adjustment, the
immediate safety concern is potassium depletion and its
cardiac effects. Renal function assessment is still important
for overall medication management but ranks lower in
priority than addressing potential electrolyte imbalances.
• D. Assess the patient's daily weights and intake/output
records - Weight changes and fluid balance are important
parameters for evaluating diuretic effectiveness but do not
represent an immediate safety concern before
administration. While these assessments contribute to
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 female patient with a history of hypertension,
heart failure with reduced ejection fraction, and chronic kidney
disease stage 3 (eGFR 45 mL/min/1.73m²) is admitted to the
medical-surgical unit with acute decompensated heart failure.
The healthcare provider orders furosemide 40 mg IV push. The
patient's current medications include lisinopril 20 mg daily,
carvedilol 12.5 mg twice daily, and potassium chloride 20 mEq
daily.
Question Stem:
Before administering the furosemide IV push, which nursing
action is the highest priority?
Answer Options:
A. Assess the patient's blood pressure and heart rate
B. Verify the patient's baseline serum potassium level
C. Review the patient's most recent serum creatinine and BUN
D. Assess the patient's daily weights and intake/output records
Correct Answer: B. Verify the patient's baseline serum
potassium level
,Comprehensive Rationale:
Furosemide is a loop diuretic that acts on the ascending loop of
Henle to inhibit the Na⁺-K⁺-2Cl⁻ cotransporter, resulting in
profound diuresis and electrolyte losses. Potassium depletion is
a significant adverse effect that can precipitate life-threatening
cardiac dysrhythmias, particularly in patients receiving digoxin
or those with underlying cardiac disease. This patient has
multiple risk factors for hypokalemia: advanced age, heart
failure, baseline renal impairment, and concurrent use of a loop
diuretic. The combination of furosemide with potassium-
wasting properties and the patient's preexisting cardiac disease
makes potassium monitoring essential before administration.
Normal serum potassium ranges from 3.5 to 5.0 mEq/L. If the
potassium level is below 3.5 mEq/L, administration of
furosemide may worsen hypokalemia and increase the risk of
ventricular dysrhythmias, particularly in a patient already
receiving medications affecting cardiac conduction. While
assessing blood pressure, renal function, and fluid balance are
important, electrolyte status directly impacts immediate patient
safety and medication effectiveness. The nurse should verify
potassium levels and implement appropriate interventions,
such as potassium supplementation or holding the medication
with provider notification, before administering the diuretic.
Distractor Analysis:
, • A. Assess the patient's blood pressure and heart rate -
While this is an important assessment before
administering furosemide, as the medication can cause
significant hypotension, it is not the highest priority. The
patient's potassium level presents a more immediate
safety concern related to cardiac dysrhythmias, especially
given the patient's heart failure diagnosis and age.
However, vital signs should be assessed concurrently as
part of the full pre-administration assessment.
• C. Review the patient's most recent serum creatinine and
BUN - Although renal function assessment is crucial for
determining appropriate furosemide dosing and
monitoring effectiveness, it is not the highest priority
before the initial dose. While renal impairment does affect
drug clearance and may require dosage adjustment, the
immediate safety concern is potassium depletion and its
cardiac effects. Renal function assessment is still important
for overall medication management but ranks lower in
priority than addressing potential electrolyte imbalances.
• D. Assess the patient's daily weights and intake/output
records - Weight changes and fluid balance are important
parameters for evaluating diuretic effectiveness but do not
represent an immediate safety concern before
administration. While these assessments contribute to
