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) Bow-Tie Item
• Item Type: Bow-Tie
• Clinical Scenario: A 67-year-old male with a history of
chronic heart failure (HFrEF) and chronic kidney disease
(CKD Stage 3, Baseline Cr 1.6 mg/dL) is admitted with an
acute exacerbation of heart failure. The patient's vital signs
are: BP 142/88 mmHg, HR 92 bpm, RR 24 rpm, SpO2 91%
on room air. Physical exam reveals 3+ pitting bilateral lower
extremity edema and bibasilar crackles. The provider
prescribes intravenous furosemide 80 mg IV push x 1 dose.
• Question Stem: Complete the bow-tie diagram by
selecting the one central clinical complication the patient
is at highest risk for developing due to rapid loop diuretic
administration, two immediate nursing assessments to
perform, and two critical nursing interventions to
implement.
[ Nursing Assessment 1 ] [ Nursing Intervention 1 ]
\ /
\ /
[ Nursing Assessment 2 ] ---> [ CENTER COMPLICATION ] <---
[ Nursing Intervention 2 ]
Options Box:
, • Assessments:
o A1: Assess patellar deep tendon reflexes.
o A2: Continuous telemetry monitoring for cardiac
dysrhythmias.
o A3: Assess hourly urine output via urometer.
o A4: Monitor serum calcium levels for hypercalcemia.
• Center Complications:
o CC1: Acute Ototoxicity and Hypokalemia-induced
Torsades de Pointes.
o CC2: Hypervolemic Hyponatremia.
o CC3: Metabolic Acidosis.
• Interventions:
o I1: Administer furosemide IV push over at least 4 to 8
minutes.
o I2: Place the patient in a flat, supine position.
o I3: Prepare an immediate infusion of 3% hypertonic
saline.
o I4: Maintain strict intake and output (I&O) recording
and daily weight logs.
Correct Configuration:
, • Assessments: A2 (Continuous telemetry) and A3 (Hourly
urine output)
• Center Complication: CC1 (Acute Ototoxicity and
Hypokalemia-induced Torsades de Pointes)
• Interventions: I1 (Administer over 4 to 8 minutes) and I4
(Maintain strict I&O and daily weight logs)
Comprehensive Rationale:
Furosemide is a potent loop diuretic acting on the thick
ascending limb of the loop of Henle, blocking the Na+/K+/2Cl−
cotransporter. Rapid intravenous administration can lead to
transient or permanent ototoxicity due to electrolyte shifts in
the endolymph of the inner ear. The rate of administration must
not exceed 4 mg/min (meaning an 80 mg dose requires at least
20 minutes if adhering strictly to high-risk limits, or 4–8 minutes
at minimum standard safe push speeds for moderate doses,
avoiding swift boluses). Loop diuretics cause profound excretion
of potassium, sodium, chloride, and magnesium. Hypokalemia
increases the risk of dangerous cardiac dysrhythmias, notably
prolonging the QT interval and precipitating Torsades de
Pointes, especially in patients with preexisting myocardial
remodeling or CKD.
Distractor Analysis:
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1: Next-Generation NCLEX (NGN) Bow-Tie Item
• Item Type: Bow-Tie
• Clinical Scenario: A 67-year-old male with a history of
chronic heart failure (HFrEF) and chronic kidney disease
(CKD Stage 3, Baseline Cr 1.6 mg/dL) is admitted with an
acute exacerbation of heart failure. The patient's vital signs
are: BP 142/88 mmHg, HR 92 bpm, RR 24 rpm, SpO2 91%
on room air. Physical exam reveals 3+ pitting bilateral lower
extremity edema and bibasilar crackles. The provider
prescribes intravenous furosemide 80 mg IV push x 1 dose.
• Question Stem: Complete the bow-tie diagram by
selecting the one central clinical complication the patient
is at highest risk for developing due to rapid loop diuretic
administration, two immediate nursing assessments to
perform, and two critical nursing interventions to
implement.
[ Nursing Assessment 1 ] [ Nursing Intervention 1 ]
\ /
\ /
[ Nursing Assessment 2 ] ---> [ CENTER COMPLICATION ] <---
[ Nursing Intervention 2 ]
Options Box:
, • Assessments:
o A1: Assess patellar deep tendon reflexes.
o A2: Continuous telemetry monitoring for cardiac
dysrhythmias.
o A3: Assess hourly urine output via urometer.
o A4: Monitor serum calcium levels for hypercalcemia.
• Center Complications:
o CC1: Acute Ototoxicity and Hypokalemia-induced
Torsades de Pointes.
o CC2: Hypervolemic Hyponatremia.
o CC3: Metabolic Acidosis.
• Interventions:
o I1: Administer furosemide IV push over at least 4 to 8
minutes.
o I2: Place the patient in a flat, supine position.
o I3: Prepare an immediate infusion of 3% hypertonic
saline.
o I4: Maintain strict intake and output (I&O) recording
and daily weight logs.
Correct Configuration:
, • Assessments: A2 (Continuous telemetry) and A3 (Hourly
urine output)
• Center Complication: CC1 (Acute Ototoxicity and
Hypokalemia-induced Torsades de Pointes)
• Interventions: I1 (Administer over 4 to 8 minutes) and I4
(Maintain strict I&O and daily weight logs)
Comprehensive Rationale:
Furosemide is a potent loop diuretic acting on the thick
ascending limb of the loop of Henle, blocking the Na+/K+/2Cl−
cotransporter. Rapid intravenous administration can lead to
transient or permanent ototoxicity due to electrolyte shifts in
the endolymph of the inner ear. The rate of administration must
not exceed 4 mg/min (meaning an 80 mg dose requires at least
20 minutes if adhering strictly to high-risk limits, or 4–8 minutes
at minimum standard safe push speeds for moderate doses,
avoiding swift boluses). Loop diuretics cause profound excretion
of potassium, sodium, chloride, and magnesium. Hypokalemia
increases the risk of dangerous cardiac dysrhythmias, notably
prolonging the QT interval and precipitating Torsades de
Pointes, especially in patients with preexisting myocardial
remodeling or CKD.
Distractor Analysis:
