NR 293 Final Exam Study Guide
1. Sildenafil
Nitrates contraindicated with sildenafil (Viagra). Use of the erectile dysfunction drugs Sildenafil
(Viagra).
Sildenafil (Viagra)***
o First oral drug for treatment of ED
o Causes relaxation of the smooth muscle in the corpora cavernosa (erectile tubes) of the penis
and permits the inflow of blood.
o Sildenafil contraindicated in men with major cardiovascular disorders, especially if they use
nitrate medications such as nitroglycerin*** - it can cause severe hypotension.
2. EC aspirin education
*** Ask students: What is Enteric-coated aspirin mean?
When a medication is EC or Enteric-coated is to prevent the breakdown in the stomach.
*** Patient education: avoid giving children under the age of 18 Aspirin. Reye’s Syndrome
(Acute and potentially life-threatening condition involving progressive neurologic deficits that
can lead to coma and may also involve liver damage).
Crushing the pill destroys that protection and can cause stomachache or indigestion.
Enteric coated aspirin is best taken with 6 to 8 ounces of water and with food to help decrease
GI upset - to avoid irritation to the esophagus instruct the patient to remain upright and not lie
down for up to 30 mins after taking the aspirin ** if it has a strong vinegar like odor then discard
(page 422) - enteric coated is not to be crushed or broken - instruct patient to report any ringing
in the ears, persistent GI or abdominal pain, or easy bruising and/or bleeding (page 691)
3. Bumetanide
***Bumetanide report hearing loss; ototoxicity
***Bumetanide: is a high-ceiling loop diuretic.
***High-ceiling diuretics can cause ototoxicity. Patient education about the possible hearing
loss and to notify their medical provider with a tinnitus or hearing loss
NOTE: Bumetanide is a strong diuretic ('water pill') and may cause dehydration and electrolyte
imbalance. (LOOP DIURETIC)
4. Furosemide X 10 (questions)
,***Hypokalemia is an adverse effect of Furosemide
***Best source of Potassium is Bananas; 1 cup contains ~ 806 mg of Potassium (K+)
***Patient education. If a patient is prescribed K+ 20 mEq extended-release medication. The
patient needs to take the pill whole as it is an extended release. Patient needs to avoid crushing,
breaking, or chewing the medication.
*** Loop Diuretics; Dietary teaching- provider will include K on their diet; Instruct patient to
consult health care professional regarding a diet high in potassium
*** know Lasix- dietary - While you don't have to avoid any specific food when you are taking
furosemide, your doctor may prescribe a low-sodium or low-salt diet. He also may recommend
that you add plenty of potassium-rich foods and beverages to your diet, such as bananas,
raisins and orange juice; he also may prescribe a potassium supplement.
***Compute Lasix IV’s
Additional NOTES:
Pt is taking furosemide, what dietary thing do they need to increase while taking this drug and
what should we tell them to eat
o Increase potassium and eat bananas
Pt has heart failure and they have been given furosemide. What lab levels would you monitor
o Potassium bc it is a loop diuretic that depletes potassium
o Watch for hypokalemia
Nursing/Patient Teaching
Food high in potassium include bananas, oranges, dates, apricots, raisins, broccoli, green beans,
potatoes, meats, fish, and legumes.
Patients taking diuretics along with a digitalis preparation should be taught to monitor for
digitalis toxicity (Bradycardia, HA, dizziness, confusion, nausea, and visual disturbances -
Gastrointestinal: anorexia, nausea, vomiting, diarrhea).
Patients with diabetes mellitus who are taking thiazide or loop diuretics should be told to
monitor blood glucose and watch for elevated levels.
Teach patients to change positions slowly and to rise slowly after sitting or lying to prevent
dizziness and fainting related to orthostatic hypotension.
Encourage patients to keep a log of their daily weight.
Patients who have been ill with nausea, vomiting, or diarrhea should notify their primary care
providers because fluid and electrolyte imbalances can result.
, Signs and symptoms of hypokalemia include muscle weakness, constipation, irregular pulse
rate, and overall feeling of lethargy.
Remind patients to return for follow-up visits and lab work.
Instruct patients to notify their primary care providers immediately if they experience rapid
heart rates or syncope (reflects hypotension or fluid loss).
Excessive consumption of licorice can lead to additive hypokalemia in patients taking thiazides.
Monitor for adverse effects:
● Metabolic alkalosis, drowsiness, lethargy, hypokalemia, tachycardia, hypotension, leg
cramps, restlessness, decreased mental alertness
Monitor for hyperkalemia with potassium-sparing diuretics.
Monitor for therapeutic effects:
● Reduction of edema
● Reduction of fluid volume overload
● Improvement in manifestations of HF
● Reduction of hypertension
● Return to normal intraocular pressures
5. Medication Calculations: 3 Questions
6. Potassium Chloride
Just Got this in the book.
A patient has been given a new order for spironolactone (Aldactone), 50 mg daily. While
reviewing the patient’s orders, the nurse notes that the patient has an existing order for
potassium chloride (K-Dur), 20 mEq daily. The patient’s potassium level is 4.0 mEq/L. What is
the nurse’s priority action at this time?
Answer: Normal 3.5-5.5 mEq/L
Spironolactone (Aldactone) is a potassium-sparing diuretic, meaning that the patient’s
potassium levels may increase. At this time, the patient’s potassium level is within normal limits,
but taking the potassium supplement with the spironolactone may cause a dangerous rise in
potassium levels. The priority action will be for the nurse to contact the prescriber to clarify the
orders and to hold the potassium dose until the orders have been clarified. In addition, the
patient’s potassium level will need to be monitored regularly.
A Potassium supplement. For treatment and prevention of potassium depletion commonly
found in diuretic therapy. Also used for arrhythmias occurring with digoxin toxicity.
Adverse reactions/side effects: Confusion, weakness, arrhythmias, ECG changes, GI
disturbances. Important to infuse SLOWLY through IV infusion pump.
1. Sildenafil
Nitrates contraindicated with sildenafil (Viagra). Use of the erectile dysfunction drugs Sildenafil
(Viagra).
Sildenafil (Viagra)***
o First oral drug for treatment of ED
o Causes relaxation of the smooth muscle in the corpora cavernosa (erectile tubes) of the penis
and permits the inflow of blood.
o Sildenafil contraindicated in men with major cardiovascular disorders, especially if they use
nitrate medications such as nitroglycerin*** - it can cause severe hypotension.
2. EC aspirin education
*** Ask students: What is Enteric-coated aspirin mean?
When a medication is EC or Enteric-coated is to prevent the breakdown in the stomach.
*** Patient education: avoid giving children under the age of 18 Aspirin. Reye’s Syndrome
(Acute and potentially life-threatening condition involving progressive neurologic deficits that
can lead to coma and may also involve liver damage).
Crushing the pill destroys that protection and can cause stomachache or indigestion.
Enteric coated aspirin is best taken with 6 to 8 ounces of water and with food to help decrease
GI upset - to avoid irritation to the esophagus instruct the patient to remain upright and not lie
down for up to 30 mins after taking the aspirin ** if it has a strong vinegar like odor then discard
(page 422) - enteric coated is not to be crushed or broken - instruct patient to report any ringing
in the ears, persistent GI or abdominal pain, or easy bruising and/or bleeding (page 691)
3. Bumetanide
***Bumetanide report hearing loss; ototoxicity
***Bumetanide: is a high-ceiling loop diuretic.
***High-ceiling diuretics can cause ototoxicity. Patient education about the possible hearing
loss and to notify their medical provider with a tinnitus or hearing loss
NOTE: Bumetanide is a strong diuretic ('water pill') and may cause dehydration and electrolyte
imbalance. (LOOP DIURETIC)
4. Furosemide X 10 (questions)
,***Hypokalemia is an adverse effect of Furosemide
***Best source of Potassium is Bananas; 1 cup contains ~ 806 mg of Potassium (K+)
***Patient education. If a patient is prescribed K+ 20 mEq extended-release medication. The
patient needs to take the pill whole as it is an extended release. Patient needs to avoid crushing,
breaking, or chewing the medication.
*** Loop Diuretics; Dietary teaching- provider will include K on their diet; Instruct patient to
consult health care professional regarding a diet high in potassium
*** know Lasix- dietary - While you don't have to avoid any specific food when you are taking
furosemide, your doctor may prescribe a low-sodium or low-salt diet. He also may recommend
that you add plenty of potassium-rich foods and beverages to your diet, such as bananas,
raisins and orange juice; he also may prescribe a potassium supplement.
***Compute Lasix IV’s
Additional NOTES:
Pt is taking furosemide, what dietary thing do they need to increase while taking this drug and
what should we tell them to eat
o Increase potassium and eat bananas
Pt has heart failure and they have been given furosemide. What lab levels would you monitor
o Potassium bc it is a loop diuretic that depletes potassium
o Watch for hypokalemia
Nursing/Patient Teaching
Food high in potassium include bananas, oranges, dates, apricots, raisins, broccoli, green beans,
potatoes, meats, fish, and legumes.
Patients taking diuretics along with a digitalis preparation should be taught to monitor for
digitalis toxicity (Bradycardia, HA, dizziness, confusion, nausea, and visual disturbances -
Gastrointestinal: anorexia, nausea, vomiting, diarrhea).
Patients with diabetes mellitus who are taking thiazide or loop diuretics should be told to
monitor blood glucose and watch for elevated levels.
Teach patients to change positions slowly and to rise slowly after sitting or lying to prevent
dizziness and fainting related to orthostatic hypotension.
Encourage patients to keep a log of their daily weight.
Patients who have been ill with nausea, vomiting, or diarrhea should notify their primary care
providers because fluid and electrolyte imbalances can result.
, Signs and symptoms of hypokalemia include muscle weakness, constipation, irregular pulse
rate, and overall feeling of lethargy.
Remind patients to return for follow-up visits and lab work.
Instruct patients to notify their primary care providers immediately if they experience rapid
heart rates or syncope (reflects hypotension or fluid loss).
Excessive consumption of licorice can lead to additive hypokalemia in patients taking thiazides.
Monitor for adverse effects:
● Metabolic alkalosis, drowsiness, lethargy, hypokalemia, tachycardia, hypotension, leg
cramps, restlessness, decreased mental alertness
Monitor for hyperkalemia with potassium-sparing diuretics.
Monitor for therapeutic effects:
● Reduction of edema
● Reduction of fluid volume overload
● Improvement in manifestations of HF
● Reduction of hypertension
● Return to normal intraocular pressures
5. Medication Calculations: 3 Questions
6. Potassium Chloride
Just Got this in the book.
A patient has been given a new order for spironolactone (Aldactone), 50 mg daily. While
reviewing the patient’s orders, the nurse notes that the patient has an existing order for
potassium chloride (K-Dur), 20 mEq daily. The patient’s potassium level is 4.0 mEq/L. What is
the nurse’s priority action at this time?
Answer: Normal 3.5-5.5 mEq/L
Spironolactone (Aldactone) is a potassium-sparing diuretic, meaning that the patient’s
potassium levels may increase. At this time, the patient’s potassium level is within normal limits,
but taking the potassium supplement with the spironolactone may cause a dangerous rise in
potassium levels. The priority action will be for the nurse to contact the prescriber to clarify the
orders and to hold the potassium dose until the orders have been clarified. In addition, the
patient’s potassium level will need to be monitored regularly.
A Potassium supplement. For treatment and prevention of potassium depletion commonly
found in diuretic therapy. Also used for arrhythmias occurring with digoxin toxicity.
Adverse reactions/side effects: Confusion, weakness, arrhythmias, ECG changes, GI
disturbances. Important to infuse SLOWLY through IV infusion pump.
