(NGN) NUR 2474 Pharm Exam 2 NCLEX
Questions\/ NUR 2474 Pharmacology
Completed 2023
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) ——– Correct 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 ——– Correct 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.<\/p>\n\n\n\n
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) ——– Correct 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). ——– Correct 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) ——– Correct 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<\/p>\n\n\n\n
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 ——– Correct 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?
a.Elevated creatinine clearance
b.Elevated serum potassium level
c.Normal blood glucose level
d.Low levels of low-density lipoprotein (LDL) cholesterol ——– Correct Answer ——–
a.Elevated creatinine clearance
Hydrochlorothiazide should not be given to patients with severe renal impairment;
therefore, an elevated creatinine clearance would cause the most concern. Thiazide
diuretics are potassium-wasting drugs and thus may actually improve the patient’s
potassium level. Thiazides may elevate the serum glucose level in diabetic patients.
Thiazides increase LDL cholesterol; however, this patient’s levels are low, so this is not
a risk.
A patient with chronic congestive heart failure has repeated hospitalizations in spite of
ongoing treatment with hydrochlorothiazide (HydroDIURIL) and digoxin. The prescriber
has ordered spironolactone (Aldactone) to be added to this patient’s drug regimen, and
the nurse provides education about this medication. Which statement by the patient
indicates understanding of the teaching?
a.”I can expect improvement within a few hours after taking this drug.”
b.”I need to stop taking potassium supplements.”
c.”I should use salt substitutes to prevent toxic side effects.”<\/p>\n\n\n\n
d.”I should watch closely for dehydration.” ——– Correct Answer ——– b.”I need to
stop taking potassium supplements.”
Spironolactone is a potassium-sparing diuretic used to counter the potassium-wasting
effects of hydrochlorothiazides. Patients taking potassium supplements are at risk for
hyperkalemia when taking this medication, so they should be advised to stop the
supplements. Spironolactone takes up to 48 hours to have effects. Salt substitutes
contain high levels of potassium and are contraindicated. Spironolactone is a weak
diuretic, so the risk of dehydration is not increased.
A patient with hypertension is prescribed an angiotensin-converting enzyme (ACE)
inhibitor. The nurse reviewing this patient’s chart before administering the medication
will be most concerned about which other disease process?
a.Bronchial asthma
b.Coronary artery disease
c.Diabetes mellitus
d.Renal artery stenosis ——– Correct Answer ——– d.Renal artery stenosis
ACE inhibitors can cause severe renal insufficiency in patients with bilateral renal artery
stenosis or stenosis in the artery to a single remaining kidney. Bronchial asthma,
coronary artery disease, and diabetes mellitus are not comorbidities that are
contraindications to treatment with an ACE inhibitor.
A nurse administers an ACE inhibitor to a patient who is taking the drug for the first
time. What will the nurse do?
a.Instruct the patient not to get up without assistance.
b.Make sure the patient takes a potassium supplement.
c.Report the presence of a dry cough to the prescriber.
d.Request an order for a diuretic to counter the side effects of the ACE inhibitor. ——–
Correct Answer ——– a.Instruct the patient not to get up without assistance.
Severe hypotension can result with the first dose of an ACE inhibitor. The patient should
be discouraged from getting up without assistance. Potassium supplements are
contraindicated. A dry cough is an expected side effect that eventually may cause a
patient to discontinue the drug; however, it is not a contraindication to treatment.
Diuretics can exacerbate hypotension and should be discontinued temporarily when a
patient starts an ACE inhibitor.
A patient who has been taking an antihypertensive medication for several years is
recovering from a myocardial infarction. The prescriber changes the patient’s
medication to an ACE inhibitor. The patient asks the nurse why a new drug is
necessary. What is the nurse’s response?
a.”ACE inhibitors can prevent or reverse pathologic changes in the heart’s structure.”<\/p>\n","protected":false},"excerpt":{"rendered":"
(NGN) NUR 2474 Pharm Exam 2 NCLEXQuestions\/ NUR 2474 PharmacologyCompleted 2023A patient is brought to the emergency department with shortness of breath, a respiratoryrate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nursecaring for this patient will expect to administer which drug?a.Furosemide (Lasix)b.Hydrochlorothiazide (HydroDIURIL)c.Mannitol (Osmitrol)d.Spironolactone (Aldactone) ——– Correct Answer ——– a.Furosemide […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-115438","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/115438","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=115438"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/115438\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=115438"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=115438"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=115438"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}