Nur 2474 / Nur2474 Pharmacology Exam 2
Questions And Answers With Rationales.
A patient is brought to the emergency department with shortness of breath, a respiratory
rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse
caring for this patient will expect to administer which drug?
a.Furosemide (Lasix)
b.Hydrochlorothiazide (HydroDIURIL)
c.Mannitol (Osmitrol)
d.Spironolactone (Aldactone) (Correct Answer) - ✅✅ a.Furosemide (Lasix)
Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is
needed. This patient shows severe signs of congestive heart failure with respiratory
distress and pulmonary edema and needs immediate mobilization of fluid.
Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema, because
their diuretic effects are less rapid. Mannitol is indicated for patients with increased
intracranial pressure and must be discontinued immediately if signs of pulmonary
congestion or heart failure occur.
A patient who is taking digoxin is admitted to the hospital for treatment of congestive
heart failure. The prescriber has ordered furosemide (Lasix). The nurse notes an irregular
heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood
pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which
laboratory value causes the nurse the most concern?
a.Blood glucose level of 120 mg/dL
,b.Oxygen saturation of 90%
c.Potassium level of 3.5 mEq/L
d.Sodium level of 140 mEq/L (Correct Answer) - ✅✅ c.Potassium level of 3.5 mEq/L
This patient has an irregular, rapid heartbeat that might be caused by a dysrhythmia. This
patient's serum potassium level is low, which can trigger fatal dysrhythmias, especially in
patients taking digoxin. Furosemide contributes to loss of potassium through its effects
on the distal nephron. Potassium-sparing diuretics often are used in conjunction with
furosemide to prevent this complication. This patient's serum glucose and sodium levels
are normal and of no concern at this point, although they can be affected by furosemide.
The oxygen saturation is somewhat low and needs to be monitored, although it may
improve with diuresis.
A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the
lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which
diuretic agent ordered by the prescriber should the nurse question?
a.Bumetanide (Bumex)
b.Furosemide (Lasix)
c.Spironolactone (Aldactone)
d.Hydrochlorothiazide (HydroDIURIL) (Correct Answer) - ✅✅ c.Spironolactone
(Aldactone)
Spironolactone is a non-potassium-wasting diuretic; therefore, if the patient has a serum
potassium level of 6 mEq/L, indicating hyperkalemia, an order for this drug should be
questioned. Bumetanide, furosemide, and hydrochlorothiazide are potassium-wasting
diuretics and would be appropriate to administer in a patient with hyperkalemia.
,A nurse preparing to administer morning medications notes that a patient with a history
of hypertension has been prescribed the angiotensin-converting enzyme (ACE) inhibitor
captopril (Capoten) concurrently with spironolactone (Aldactone). Morning laboratory
results reveal a serum sodium level of 144 mg/dL, a serum potassium level of 5.1 mEq/L,
and a blood glucose level of 128 mg/dL. Which intervention is appropriate?
a.Administer the medications as ordered.
b.Ask the patient about the use of salt substitutes.
c.Contact the provider to report the laboratory values.
d.Request an order for furosemide (Lasix). (Correct Answer) - ✅✅ c.Contact the
provider to report the laboratory values.
Spironolactone should not be administered with ACE inhibitors, which can also elevate
potassium levels. Because the potassium level is elevated, the nurse should not administer
the medication and should obtain clarification of the order. There is no need to repeat the
potassium level test that was just done this morning. Requesting an order for furosemide
is appropriate only after the provider has been notified of the laboratory values.
A patient with hypertension is taking furosemide (Lasix) for congestive heart failure. The
prescriber orders digoxin to help increase cardiac output. What other medication will the
nurse expect to be ordered for this patient?
a.Bumetanide (Bumex)
b.Chlorothiazide (Diuril)
c.Hydrochlorothiazide (HydroDIURIL)
d.Spironolactone (Aldactone) (Correct Answer) - ✅✅ d.Spironolactone (Aldactone)
, Spironolactone is used in conjunction with furosemide because of its potassium-sparing
effects. Furosemide can contribute to hypokalemia, which can increase the risk of fatal
dysrhythmias, especially with digoxin administration. The other diuretics listed are all
potassium-wasting diuretics.
A patient is taking gentamicin (Garamycin) and furosemide (Lasix). The nurse should
counsel this patient to report which symptom?
a.Frequent nocturia
b.Headaches
c.Ringing in the ears
d.Urinary retention (Correct Answer) - ✅✅ c.Ringing in the ears
Patients taking furosemide should be advised that the risk of furosemide-induced hearing
loss can be increased when other ototoxic drugs, such as gentamicin, are also taken.
Patients should be told to report tinnitus or dizziness or hearing loss. Nocturia may be an
expected effect of furosemide. Headaches are not likely to occur with concomitant use of
gentamicin and furosemide. Urinary retention is not an expected side effect.
An older adult patient with congestive heart failure develops crackles in both lungs and
pitting edema of all extremities. The physician orders hydrochlorothiazide
(HydroDIURIL). Before administering this medication, the nurse reviews the patient's
chart. Which laboratory value causes the nurse the most concern?
a.Elevated creatinine clearance
b.Elevated serum potassium level
c.Normal blood glucose level
Questions And Answers With Rationales.
A patient is brought to the emergency department with shortness of breath, a respiratory
rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse
caring for this patient will expect to administer which drug?
a.Furosemide (Lasix)
b.Hydrochlorothiazide (HydroDIURIL)
c.Mannitol (Osmitrol)
d.Spironolactone (Aldactone) (Correct Answer) - ✅✅ a.Furosemide (Lasix)
Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is
needed. This patient shows severe signs of congestive heart failure with respiratory
distress and pulmonary edema and needs immediate mobilization of fluid.
Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema, because
their diuretic effects are less rapid. Mannitol is indicated for patients with increased
intracranial pressure and must be discontinued immediately if signs of pulmonary
congestion or heart failure occur.
A patient who is taking digoxin is admitted to the hospital for treatment of congestive
heart failure. The prescriber has ordered furosemide (Lasix). The nurse notes an irregular
heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood
pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which
laboratory value causes the nurse the most concern?
a.Blood glucose level of 120 mg/dL
,b.Oxygen saturation of 90%
c.Potassium level of 3.5 mEq/L
d.Sodium level of 140 mEq/L (Correct Answer) - ✅✅ c.Potassium level of 3.5 mEq/L
This patient has an irregular, rapid heartbeat that might be caused by a dysrhythmia. This
patient's serum potassium level is low, which can trigger fatal dysrhythmias, especially in
patients taking digoxin. Furosemide contributes to loss of potassium through its effects
on the distal nephron. Potassium-sparing diuretics often are used in conjunction with
furosemide to prevent this complication. This patient's serum glucose and sodium levels
are normal and of no concern at this point, although they can be affected by furosemide.
The oxygen saturation is somewhat low and needs to be monitored, although it may
improve with diuresis.
A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the
lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which
diuretic agent ordered by the prescriber should the nurse question?
a.Bumetanide (Bumex)
b.Furosemide (Lasix)
c.Spironolactone (Aldactone)
d.Hydrochlorothiazide (HydroDIURIL) (Correct Answer) - ✅✅ c.Spironolactone
(Aldactone)
Spironolactone is a non-potassium-wasting diuretic; therefore, if the patient has a serum
potassium level of 6 mEq/L, indicating hyperkalemia, an order for this drug should be
questioned. Bumetanide, furosemide, and hydrochlorothiazide are potassium-wasting
diuretics and would be appropriate to administer in a patient with hyperkalemia.
,A nurse preparing to administer morning medications notes that a patient with a history
of hypertension has been prescribed the angiotensin-converting enzyme (ACE) inhibitor
captopril (Capoten) concurrently with spironolactone (Aldactone). Morning laboratory
results reveal a serum sodium level of 144 mg/dL, a serum potassium level of 5.1 mEq/L,
and a blood glucose level of 128 mg/dL. Which intervention is appropriate?
a.Administer the medications as ordered.
b.Ask the patient about the use of salt substitutes.
c.Contact the provider to report the laboratory values.
d.Request an order for furosemide (Lasix). (Correct Answer) - ✅✅ c.Contact the
provider to report the laboratory values.
Spironolactone should not be administered with ACE inhibitors, which can also elevate
potassium levels. Because the potassium level is elevated, the nurse should not administer
the medication and should obtain clarification of the order. There is no need to repeat the
potassium level test that was just done this morning. Requesting an order for furosemide
is appropriate only after the provider has been notified of the laboratory values.
A patient with hypertension is taking furosemide (Lasix) for congestive heart failure. The
prescriber orders digoxin to help increase cardiac output. What other medication will the
nurse expect to be ordered for this patient?
a.Bumetanide (Bumex)
b.Chlorothiazide (Diuril)
c.Hydrochlorothiazide (HydroDIURIL)
d.Spironolactone (Aldactone) (Correct Answer) - ✅✅ d.Spironolactone (Aldactone)
, Spironolactone is used in conjunction with furosemide because of its potassium-sparing
effects. Furosemide can contribute to hypokalemia, which can increase the risk of fatal
dysrhythmias, especially with digoxin administration. The other diuretics listed are all
potassium-wasting diuretics.
A patient is taking gentamicin (Garamycin) and furosemide (Lasix). The nurse should
counsel this patient to report which symptom?
a.Frequent nocturia
b.Headaches
c.Ringing in the ears
d.Urinary retention (Correct Answer) - ✅✅ c.Ringing in the ears
Patients taking furosemide should be advised that the risk of furosemide-induced hearing
loss can be increased when other ototoxic drugs, such as gentamicin, are also taken.
Patients should be told to report tinnitus or dizziness or hearing loss. Nocturia may be an
expected effect of furosemide. Headaches are not likely to occur with concomitant use of
gentamicin and furosemide. Urinary retention is not an expected side effect.
An older adult patient with congestive heart failure develops crackles in both lungs and
pitting edema of all extremities. The physician orders hydrochlorothiazide
(HydroDIURIL). Before administering this medication, the nurse reviews the patient's
chart. Which laboratory value causes the nurse the most concern?
a.Elevated creatinine clearance
b.Elevated serum potassium level
c.Normal blood glucose level
