NUR 2474 PHARM EXAM 2 NCLEX QUESTIONS AND
ANSWERS | 2025/2026 UPDATE | WITH COMPLETE
SOLUTION
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) 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 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) 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). 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) 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 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?
ANSWERS | 2025/2026 UPDATE | WITH COMPLETE
SOLUTION
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) 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 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) 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). 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) 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 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?
