NUR 2474 Pharmacology Exam 2 Test
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Section 1: Diuretics (Questions 1-20)
Question 1
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
Rationale: Furosemide, a potent loop diuretic, is used when rapid or massive mobilization of fluid 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 increased intracranial pressure and must be discontinued immediately if signs of
pulmonary congestion or heart failure occur .
Question 2
A patient who is taking digoxin is admitted for treatment of congestive heart failure. The prescriber
orders furosemide (Lasix). The nurse notes an irregular heart rate of 86 beats per minute, crackles in
both lungs, and a blood pressure of 130/82 mm Hg. 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
,Rationale: This patient has an irregular heartbeat that might be caused by a dysrhythmia. The serum
potassium level is low (3.5 mEq/L), 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 are often used with furosemide to prevent this complication. The glucose
and sodium levels are normal; oxygen saturation may improve with diuresis .
Question 3
A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation 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
Rationale: Spironolactone is a potassium-sparing diuretic; therefore, if the patient has a serum
potassium level of 6 mEq/L (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 .
Question 4
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
Rationale: Spironolactone is used in conjunction with furosemide because of its potassium-sparing
effects. Furosemide can contribute to hypokalemia, which increases the risk of fatal dysrhythmias,
especially with digoxin administration. The other diuretics listed are all potassium-wasting diuretics .
Question 5
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
Rationale: Patients taking furosemide should be advised that the risk of furosemide-induced hearing
loss increases when other ototoxic drugs, such as gentamicin, are also taken. Patients should be told to
report tinnitus (ringing in the ears), dizziness, or hearing loss .
Question 6
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
Rationale: Hydrochlorothiazide should not be given to patients with severe renal impairment; therefore,
an elevated creatinine clearance (indicating poor kidney function) would cause the most concern.
Thiazide diuretics are potassium-wasting drugs and may actually improve the patient's potassium level if
elevated. Thiazides may elevate serum glucose and increase LDL cholesterol .
Question 7
A patient with chronic congestive heart failure has repeated hospitalizations despite treatment with
hydrochlorothiazide (HydroDIURIL) and digoxin. The prescriber orders spironolactone (Aldactone).
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."
D. "I should watch closely for dehydration."
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic used to counter the potassium-wasting effects
of hydrochlorothiazide. Patients taking potassium supplements are at risk for hyperkalemia, 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 dehydration risk is not increased .
, Question 8
A nurse preparing to administer morning medications notes that a patient has been prescribed captopril
(Capoten) with spironolactone (Aldactone). Morning labs show serum potassium of 5.1 mEq/L. 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
Rationale: Spironolactone should not be administered with ACE inhibitors, which can also elevate
potassium levels. Because the potassium level is elevated (5.1 mEq/L), the nurse should not administer
the medication and should obtain clarification of the order .
Question 9
A patient with heart failure is prescribed furosemide (Lasix). The nurse should monitor for which adverse
effect?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypoglycemia
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting, leading to hypokalemia (low
potassium). This can precipitate fatal dysrhythmias, especially in patients taking digoxin. Monitor
potassium levels regularly .
Question 10
A patient taking spironolactone (Aldactone) should be cautioned to avoid which of the following?
A. Foods high in sodium
B. Salt substitutes containing potassium
C. Foods high in calcium
D. Grapefruit juice
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic. Salt substitutes contain high levels of
potassium and can lead to life-threatening hyperkalemia when combined with this medication .
Bank| NCLEX-Style Questions &
Verified Answers | Exam Prep
Section 1: Diuretics (Questions 1-20)
Question 1
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
Rationale: Furosemide, a potent loop diuretic, is used when rapid or massive mobilization of fluid 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 increased intracranial pressure and must be discontinued immediately if signs of
pulmonary congestion or heart failure occur .
Question 2
A patient who is taking digoxin is admitted for treatment of congestive heart failure. The prescriber
orders furosemide (Lasix). The nurse notes an irregular heart rate of 86 beats per minute, crackles in
both lungs, and a blood pressure of 130/82 mm Hg. 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
,Rationale: This patient has an irregular heartbeat that might be caused by a dysrhythmia. The serum
potassium level is low (3.5 mEq/L), 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 are often used with furosemide to prevent this complication. The glucose
and sodium levels are normal; oxygen saturation may improve with diuresis .
Question 3
A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation 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
Rationale: Spironolactone is a potassium-sparing diuretic; therefore, if the patient has a serum
potassium level of 6 mEq/L (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 .
Question 4
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
Rationale: Spironolactone is used in conjunction with furosemide because of its potassium-sparing
effects. Furosemide can contribute to hypokalemia, which increases the risk of fatal dysrhythmias,
especially with digoxin administration. The other diuretics listed are all potassium-wasting diuretics .
Question 5
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
Rationale: Patients taking furosemide should be advised that the risk of furosemide-induced hearing
loss increases when other ototoxic drugs, such as gentamicin, are also taken. Patients should be told to
report tinnitus (ringing in the ears), dizziness, or hearing loss .
Question 6
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
Rationale: Hydrochlorothiazide should not be given to patients with severe renal impairment; therefore,
an elevated creatinine clearance (indicating poor kidney function) would cause the most concern.
Thiazide diuretics are potassium-wasting drugs and may actually improve the patient's potassium level if
elevated. Thiazides may elevate serum glucose and increase LDL cholesterol .
Question 7
A patient with chronic congestive heart failure has repeated hospitalizations despite treatment with
hydrochlorothiazide (HydroDIURIL) and digoxin. The prescriber orders spironolactone (Aldactone).
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."
D. "I should watch closely for dehydration."
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic used to counter the potassium-wasting effects
of hydrochlorothiazide. Patients taking potassium supplements are at risk for hyperkalemia, 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 dehydration risk is not increased .
, Question 8
A nurse preparing to administer morning medications notes that a patient has been prescribed captopril
(Capoten) with spironolactone (Aldactone). Morning labs show serum potassium of 5.1 mEq/L. 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
Rationale: Spironolactone should not be administered with ACE inhibitors, which can also elevate
potassium levels. Because the potassium level is elevated (5.1 mEq/L), the nurse should not administer
the medication and should obtain clarification of the order .
Question 9
A patient with heart failure is prescribed furosemide (Lasix). The nurse should monitor for which adverse
effect?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypoglycemia
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting, leading to hypokalemia (low
potassium). This can precipitate fatal dysrhythmias, especially in patients taking digoxin. Monitor
potassium levels regularly .
Question 10
A patient taking spironolactone (Aldactone) should be cautioned to avoid which of the following?
A. Foods high in sodium
B. Salt substitutes containing potassium
C. Foods high in calcium
D. Grapefruit juice
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic. Salt substitutes contain high levels of
potassium and can lead to life-threatening hyperkalemia when combined with this medication .
