Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
,TEST BANK
Question 1: Next-Generation NCLEX (NGN) Case Study (6-Item
Cluster)
Clinical Scenario
A 67-year-old male with a history of chronic heart failure (HFrEF,
ejection fraction 32%) and stage 3 chronic kidney disease (CKD,
baseline eGFR $42\text{ mL/min/1.73m}^2$) is admitted to the
progressive care unit with a 4-day history of worsening
shortness of breath, orthopnea, a 4.5-kg (10-lb) weight gain,
and $3+$ pitting bilateral lower extremity edema.
Initial Vital Signs:
• BP: 158/92 mmHg
• HR: 94 bpm (sinus rhythm)
• RR: 26 breaths/min
• SpO2: 89% on room air
• Temp: 36.8°C (98.2°F)
Admission Provider Orders:
, 1. Continuous pulse oximetry; titrate supplemental $O_2$ via
nasal cannula to maintain $\text{SpO2} \ge 92\%$.
2. Furosemide 80 mg intravenous (IV) push injection x 1 dose
now over 4 minutes.
3. Initiate strict Intake & Output (I&O) monitoring and daily
morning weights.
4. Draw Basic Metabolic Panel (BMP) and Serum Digoxin level
STAT.
Item 1.1: MCQ (Recognize Cues)
Question Stem:
The nurse prepares to administer the ordered IV push
furosemide. Which assessment finding is the absolute highest
priority for the nurse to evaluate before pushing the
medication?
• A. Serum potassium level of 3.4 mEq/L
• B. Current urine output of 25 mL over the past hour
• C. Presence of coarse crackles in the bilateral lung bases
• D. Patient report of mild tinnitus in the right ear
Correct Answer: A
Comprehensive Rationale
, Furosemide is a potent loop diuretic that acts primarily by
inhibiting the $\text{Na}^+/\text{K}^+/2\text{Cl}^-$ symporter
in the thick ascending limb of the loop of Henle. This
mechanism causes a profound excretion of sodium, chloride,
water, and potassium. Administering a high dose of an IV loop
diuretic to a patient who is already hypokalemic (potassium less
than 3.5 mEq/L) can precipitate life-threatening cardiac
dysrhythmias, especially in a patient with an underlying history
of heart failure who may also be taking digoxin. Hypokalemia
significantly potentiates digoxin toxicity.
Distractor Analysis
• B is incorrect: While low urine output can reflect poor
renal perfusion or acute kidney injury, loop diuretics are
actively used to promote diuresis in fluid-overloaded
states. It is expected that urine output is low before
administration, but hypokalemia poses an immediate
lethal cardiac risk.
• C is incorrect: The presence of crackles confirms fluid
overload and pulmonary congestion, which is the
therapeutic indication for giving furosemide, not a
contraindication.
• D is incorrect: Ototoxicity (transient or permanent hearing
loss/tinnitus) is a known adverse effect of loop diuretics,
particularly when pushed too rapidly. While important, a
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
,TEST BANK
Question 1: Next-Generation NCLEX (NGN) Case Study (6-Item
Cluster)
Clinical Scenario
A 67-year-old male with a history of chronic heart failure (HFrEF,
ejection fraction 32%) and stage 3 chronic kidney disease (CKD,
baseline eGFR $42\text{ mL/min/1.73m}^2$) is admitted to the
progressive care unit with a 4-day history of worsening
shortness of breath, orthopnea, a 4.5-kg (10-lb) weight gain,
and $3+$ pitting bilateral lower extremity edema.
Initial Vital Signs:
• BP: 158/92 mmHg
• HR: 94 bpm (sinus rhythm)
• RR: 26 breaths/min
• SpO2: 89% on room air
• Temp: 36.8°C (98.2°F)
Admission Provider Orders:
, 1. Continuous pulse oximetry; titrate supplemental $O_2$ via
nasal cannula to maintain $\text{SpO2} \ge 92\%$.
2. Furosemide 80 mg intravenous (IV) push injection x 1 dose
now over 4 minutes.
3. Initiate strict Intake & Output (I&O) monitoring and daily
morning weights.
4. Draw Basic Metabolic Panel (BMP) and Serum Digoxin level
STAT.
Item 1.1: MCQ (Recognize Cues)
Question Stem:
The nurse prepares to administer the ordered IV push
furosemide. Which assessment finding is the absolute highest
priority for the nurse to evaluate before pushing the
medication?
• A. Serum potassium level of 3.4 mEq/L
• B. Current urine output of 25 mL over the past hour
• C. Presence of coarse crackles in the bilateral lung bases
• D. Patient report of mild tinnitus in the right ear
Correct Answer: A
Comprehensive Rationale
, Furosemide is a potent loop diuretic that acts primarily by
inhibiting the $\text{Na}^+/\text{K}^+/2\text{Cl}^-$ symporter
in the thick ascending limb of the loop of Henle. This
mechanism causes a profound excretion of sodium, chloride,
water, and potassium. Administering a high dose of an IV loop
diuretic to a patient who is already hypokalemic (potassium less
than 3.5 mEq/L) can precipitate life-threatening cardiac
dysrhythmias, especially in a patient with an underlying history
of heart failure who may also be taking digoxin. Hypokalemia
significantly potentiates digoxin toxicity.
Distractor Analysis
• B is incorrect: While low urine output can reflect poor
renal perfusion or acute kidney injury, loop diuretics are
actively used to promote diuresis in fluid-overloaded
states. It is expected that urine output is low before
administration, but hypokalemia poses an immediate
lethal cardiac risk.
• C is incorrect: The presence of crackles confirms fluid
overload and pulmonary congestion, which is the
therapeutic indication for giving furosemide, not a
contraindication.
• D is incorrect: Ototoxicity (transient or permanent hearing
loss/tinnitus) is a known adverse effect of loop diuretics,
particularly when pushed too rapidly. While important, a
