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 pres-
sure 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
1
,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 pa-
tients 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 satura-
tion 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 po-
tassium level of 6 mEq/L, indicating hyperkalemia, an order for this drug should be ques-
tioned. 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 capto-
pril (Capoten) concurrently with spironolactone (Aldactone). Morning laboratory results re-
veal 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.
2
,Spironolactone should not be administered with ACE inhibitors, which can also elevate po-
tassium 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 potas-
sium level test that was just done this morning. Requesting an order for furosemide is appro-
priate only after the provider has been notified of the laboratory values.
A patient with hypertension is taking furosemide (Lasix) for congestive heart failure. The pre-
scriber 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 ef-
fects. Furosemide can contribute to hypokalemia, which can increase the risk of fatal
dysrhythmias, especially with digoxin administration. The other diuretics listed are all potas-
sium-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
3
, 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 pit-
ting edema of all extremities. The physician orders hydrochlorothiazide (HydroDIURIL). Be-
fore 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 - ANSWER a.Elevated creatinine
clearance
Hydrochlorothiazide should not be given to patients with severe renal impairment; there-
fore, 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. Thia-
zides may elevate the serum glucose level in diabetic patients. Thiazides increase LDL choles-
terol; 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 ongo-
ing treatment with hydrochlorothiazide (HydroDIURIL) and digoxin. The prescriber has or-
dered 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 under-
standing 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."
d."I should watch closely for dehydration." - ANSWER b."I need to stop taking potassium
supplements."
4
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 pres-
sure 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
1
,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 pa-
tients 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 satura-
tion 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 po-
tassium level of 6 mEq/L, indicating hyperkalemia, an order for this drug should be ques-
tioned. 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 capto-
pril (Capoten) concurrently with spironolactone (Aldactone). Morning laboratory results re-
veal 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.
2
,Spironolactone should not be administered with ACE inhibitors, which can also elevate po-
tassium 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 potas-
sium level test that was just done this morning. Requesting an order for furosemide is appro-
priate only after the provider has been notified of the laboratory values.
A patient with hypertension is taking furosemide (Lasix) for congestive heart failure. The pre-
scriber 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 ef-
fects. Furosemide can contribute to hypokalemia, which can increase the risk of fatal
dysrhythmias, especially with digoxin administration. The other diuretics listed are all potas-
sium-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
3
, 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 pit-
ting edema of all extremities. The physician orders hydrochlorothiazide (HydroDIURIL). Be-
fore 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 - ANSWER a.Elevated creatinine
clearance
Hydrochlorothiazide should not be given to patients with severe renal impairment; there-
fore, 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. Thia-
zides may elevate the serum glucose level in diabetic patients. Thiazides increase LDL choles-
terol; 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 ongo-
ing treatment with hydrochlorothiazide (HydroDIURIL) and digoxin. The prescriber has or-
dered 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 under-
standing 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."
d."I should watch closely for dehydration." - ANSWER b."I need to stop taking potassium
supplements."
4
