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 and chronic kidney
disease stage 3 is prescribed furosemide 40 mg IV push. The
patient's current vital signs are: BP 148/92 mmHg, HR 88 bpm,
RR 18/min, temperature 98.6°F. Laboratory results show: serum
potassium 3.8 mEq/L, BUN 32 mg/dL, creatinine 1.8 mg/dL.
Question Stem:
The nurse is preparing to administer IV furosemide to this
patient. Which assessment finding would be most concerning
and require the nurse to hold the medication and contact the
healthcare provider?
Answer Options:
A. Serum potassium level of 3.8 mEq/L
B. BUN level of 32 mg/dL
C. Blood pressure of 148/92 mmHg
D. Serum creatinine of 1.8 mg/dL
Correct Answer: D. Serum creatinine of 1.8 mg/dL
Comprehensive Rationale:
The correct answer is D. Furosemide, a loop diuretic, is primarily
excreted by the kidneys and requires adequate renal function
,for safe administration. A serum creatinine of 1.8 mg/dL
indicates impaired renal function (normal range: 0.6-1.2
mg/dL). In patients with renal impairment, the risk of
furosemide accumulation increases, potentially leading to
ototoxicity and nephrotoxicity. The drug's efficacy may also be
reduced in renal failure, requiring dose adjustments.
Pharmacologic Principles:
• Mechanism of Action: Furosemide blocks the Na⁺-K⁺-2Cl⁻
cotransporter in the ascending loop of Henle, inhibiting
sodium, chloride, and potassium reabsorption.
• Pharmacokinetics: Approximately 65% excreted
unchanged in urine; half-life prolonged in renal
impairment (from 1-2 hours to 4-6 hours).
• Pharmacodynamics: Produces potent diuresis with
significant fluid and electrolyte losses.
Nursing Process Integration:
• Primary Component: Assessment
• Supporting Steps: Evaluation and Planning (monitoring lab
values, anticipating dose adjustments)
Clinical Judgment Measurement Model (NCJMM):
• Recognize Cues: Identifying abnormal laboratory values
, • Analyze Cues: Understanding implications of renal
impairment on drug therapy
• Prioritize Hypotheses: Recognizing safety risks
• Generate Solutions: Determining need to hold medication
Distractor Analysis:
• A. Serum potassium 3.8 mEq/L (Incorrect): This falls
within normal range (3.5-5.0 mEq/L), though furosemide
can cause hypokalemia. This value is not an immediate
concern.
• B. BUN 32 mg/dL (Incorrect): While elevated (normal: 7-
20 mg/dL), it is less specific for renal function than
creatinine. Mild elevation may indicate prerenal azotemia.
• C. BP 148/92 mmHg (Incorrect): This indicates
hypertension, which is the reason for prescribing the
diuretic. This is a therapeutic target, not a contraindication.
Difficulty: Moderate
Bloom's Cognitive Level: Analyze
NCLEX Client Needs Category: Pharmacological and Parenteral
Therapies
Key Learning Objective: Identify assessment parameters
requiring medication modification or discontinuation in patients
receiving loop diuretics.
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 and chronic kidney
disease stage 3 is prescribed furosemide 40 mg IV push. The
patient's current vital signs are: BP 148/92 mmHg, HR 88 bpm,
RR 18/min, temperature 98.6°F. Laboratory results show: serum
potassium 3.8 mEq/L, BUN 32 mg/dL, creatinine 1.8 mg/dL.
Question Stem:
The nurse is preparing to administer IV furosemide to this
patient. Which assessment finding would be most concerning
and require the nurse to hold the medication and contact the
healthcare provider?
Answer Options:
A. Serum potassium level of 3.8 mEq/L
B. BUN level of 32 mg/dL
C. Blood pressure of 148/92 mmHg
D. Serum creatinine of 1.8 mg/dL
Correct Answer: D. Serum creatinine of 1.8 mg/dL
Comprehensive Rationale:
The correct answer is D. Furosemide, a loop diuretic, is primarily
excreted by the kidneys and requires adequate renal function
,for safe administration. A serum creatinine of 1.8 mg/dL
indicates impaired renal function (normal range: 0.6-1.2
mg/dL). In patients with renal impairment, the risk of
furosemide accumulation increases, potentially leading to
ototoxicity and nephrotoxicity. The drug's efficacy may also be
reduced in renal failure, requiring dose adjustments.
Pharmacologic Principles:
• Mechanism of Action: Furosemide blocks the Na⁺-K⁺-2Cl⁻
cotransporter in the ascending loop of Henle, inhibiting
sodium, chloride, and potassium reabsorption.
• Pharmacokinetics: Approximately 65% excreted
unchanged in urine; half-life prolonged in renal
impairment (from 1-2 hours to 4-6 hours).
• Pharmacodynamics: Produces potent diuresis with
significant fluid and electrolyte losses.
Nursing Process Integration:
• Primary Component: Assessment
• Supporting Steps: Evaluation and Planning (monitoring lab
values, anticipating dose adjustments)
Clinical Judgment Measurement Model (NCJMM):
• Recognize Cues: Identifying abnormal laboratory values
, • Analyze Cues: Understanding implications of renal
impairment on drug therapy
• Prioritize Hypotheses: Recognizing safety risks
• Generate Solutions: Determining need to hold medication
Distractor Analysis:
• A. Serum potassium 3.8 mEq/L (Incorrect): This falls
within normal range (3.5-5.0 mEq/L), though furosemide
can cause hypokalemia. This value is not an immediate
concern.
• B. BUN 32 mg/dL (Incorrect): While elevated (normal: 7-
20 mg/dL), it is less specific for renal function than
creatinine. Mild elevation may indicate prerenal azotemia.
• C. BP 148/92 mmHg (Incorrect): This indicates
hypertension, which is the reason for prescribing the
diuretic. This is a therapeutic target, not a contraindication.
Difficulty: Moderate
Bloom's Cognitive Level: Analyze
NCLEX Client Needs Category: Pharmacological and Parenteral
Therapies
Key Learning Objective: Identify assessment parameters
requiring medication modification or discontinuation in patients
receiving loop diuretics.
