Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1: Multiple-Choice Question (MCQ)
• Clinical Scenario: A 67-year-old male with a history of
chronic heart failure (HFrEF) and chronic kidney disease
(CKD, Stage 3, baseline eGFR 38 mL/min/1.73m²) is
admitted for worsening peripheral edema and dyspnea on
exertion. The provider prescribes oral spironolactone 25
mg daily. The patient’s morning laboratory values include:
Potassium $5.1\text{ mEq/L}$, Sodium $136\text{
mEq/L}$, Creatinine $1.9\text{ mg/dL}$, and Blood Urea
Nitrogen (BUN) $34\text{ mg/dL}$.
• Question Stem: Which action should the nurse take first
before administering this medication?
o A. Administer the spironolactone as prescribed and
recheck the potassium level in 24 hours.
o B. Hold the dose and notify the healthcare provider
regarding the patient's potassium and renal function
levels.
o C. Instruct the patient to strictly avoid high-potassium
foods like bananas and oranges, then administer the
dose.
o D. Request an order for an immediate intravenous
infusion of 10% calcium gluconate.
• Correct Answer: B
,• Comprehensive Rationale: Spironolactone is an
aldosterone antagonist and potassium-spparing diuretic. It
acts on the distal convoluted tubules and collecting ducts
to block aldosterone receptors, leading to the excretion of
sodium and water while retaining potassium. A major
contraindication or caution for its use is hyperkalemia
(potassium greater than $5.0\text{ mEq/L}$) and severe
renal impairment (due to the high risk of severe
hyperkalemia). The patient's baseline potassium is already
elevated ($5.1\text{ mEq/L}$) and renal function is
impaired (Creatinine $1.9\text{ mg/dL}$, BUN $34\text{
mg/dL}$). Administering spironolactone in this scenario
presents a critical patient safety risk for life-threatening
cardiac dysrhythmias secondary to profound hyperkalemia.
The nurse must hold the dose and notify the provider.
• Distractor Analysis:
o A is incorrect: Administering the drug with an already
elevated potassium level and impaired renal excretion
is unsafe and risks worsening hyperkalemia before the
next lab draw.
o C is incorrect: While dietary teaching is an appropriate
nursing action for patients on potassium-sparing
diuretics, it does not mitigate the immediate
physiological risk of giving the medication when
, laboratory parameters are already outside safe
thresholds.
o D is incorrect: Calcium gluconate is used to stabilize
the myocardium in severe, symptomatic hyperkalemia
(typically greater than $6.0-6.5\text{ mEq/L}$ with
ECG changes). The patient’s level ($5.1\text{ mEq/L}$)
does not warrant this emergency intervention yet, but
rather requires withholding the offending agent.
• Nursing Process Integration: Assessment is the primary
step. The nurse evaluates critical laboratory cues prior to
drug administration. Remaining steps: Nursing Diagnosis:
Risk for decreased cardiac output related to hyperkalemia-
induced dysrhythmia. Planning: Maintain serum potassium
between $3.5-5.0\text{ mEq/L}$. Implementation: Hold
the drug, notify the provider, monitor ECG. Evaluation:
Review follow-up potassium levels and cardiac rhythm.
• NCJMM Competency: Analyze Cues / Take Action
• Difficulty Level: Moderate
• Bloom’s Cognitive Level: Analyze
• NCLEX Client Needs Category: Pharmacological and
Parenteral Therapies
• Key Learning Objective: Recognize critical
contraindications and laboratory thresholds for potassium-
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1: Multiple-Choice Question (MCQ)
• Clinical Scenario: A 67-year-old male with a history of
chronic heart failure (HFrEF) and chronic kidney disease
(CKD, Stage 3, baseline eGFR 38 mL/min/1.73m²) is
admitted for worsening peripheral edema and dyspnea on
exertion. The provider prescribes oral spironolactone 25
mg daily. The patient’s morning laboratory values include:
Potassium $5.1\text{ mEq/L}$, Sodium $136\text{
mEq/L}$, Creatinine $1.9\text{ mg/dL}$, and Blood Urea
Nitrogen (BUN) $34\text{ mg/dL}$.
• Question Stem: Which action should the nurse take first
before administering this medication?
o A. Administer the spironolactone as prescribed and
recheck the potassium level in 24 hours.
o B. Hold the dose and notify the healthcare provider
regarding the patient's potassium and renal function
levels.
o C. Instruct the patient to strictly avoid high-potassium
foods like bananas and oranges, then administer the
dose.
o D. Request an order for an immediate intravenous
infusion of 10% calcium gluconate.
• Correct Answer: B
,• Comprehensive Rationale: Spironolactone is an
aldosterone antagonist and potassium-spparing diuretic. It
acts on the distal convoluted tubules and collecting ducts
to block aldosterone receptors, leading to the excretion of
sodium and water while retaining potassium. A major
contraindication or caution for its use is hyperkalemia
(potassium greater than $5.0\text{ mEq/L}$) and severe
renal impairment (due to the high risk of severe
hyperkalemia). The patient's baseline potassium is already
elevated ($5.1\text{ mEq/L}$) and renal function is
impaired (Creatinine $1.9\text{ mg/dL}$, BUN $34\text{
mg/dL}$). Administering spironolactone in this scenario
presents a critical patient safety risk for life-threatening
cardiac dysrhythmias secondary to profound hyperkalemia.
The nurse must hold the dose and notify the provider.
• Distractor Analysis:
o A is incorrect: Administering the drug with an already
elevated potassium level and impaired renal excretion
is unsafe and risks worsening hyperkalemia before the
next lab draw.
o C is incorrect: While dietary teaching is an appropriate
nursing action for patients on potassium-sparing
diuretics, it does not mitigate the immediate
physiological risk of giving the medication when
, laboratory parameters are already outside safe
thresholds.
o D is incorrect: Calcium gluconate is used to stabilize
the myocardium in severe, symptomatic hyperkalemia
(typically greater than $6.0-6.5\text{ mEq/L}$ with
ECG changes). The patient’s level ($5.1\text{ mEq/L}$)
does not warrant this emergency intervention yet, but
rather requires withholding the offending agent.
• Nursing Process Integration: Assessment is the primary
step. The nurse evaluates critical laboratory cues prior to
drug administration. Remaining steps: Nursing Diagnosis:
Risk for decreased cardiac output related to hyperkalemia-
induced dysrhythmia. Planning: Maintain serum potassium
between $3.5-5.0\text{ mEq/L}$. Implementation: Hold
the drug, notify the provider, monitor ECG. Evaluation:
Review follow-up potassium levels and cardiac rhythm.
• NCJMM Competency: Analyze Cues / Take Action
• Difficulty Level: Moderate
• Bloom’s Cognitive Level: Analyze
• NCLEX Client Needs Category: Pharmacological and
Parenteral Therapies
• Key Learning Objective: Recognize critical
contraindications and laboratory thresholds for potassium-
