NUR 2474 EXAM 2 – PHARMACOLOGY FOR
PROFESSIONAL NURSING: PRACTICE QUESTIONS
AND ANSWERS WITH RATIONALES
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 answers-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
1
,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 answers-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?
2
,a.Frequent nocturia
b.Headaches
c.Ringing in the ears
d.Urinary retention - correct answers-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
answers-a.Elevated creatinine clearance
3
, 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."
d. "I should watch closely for dehydration." - correct answers-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
4
PROFESSIONAL NURSING: PRACTICE QUESTIONS
AND ANSWERS WITH RATIONALES
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 answers-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
1
,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 answers-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?
2
,a.Frequent nocturia
b.Headaches
c.Ringing in the ears
d.Urinary retention - correct answers-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
answers-a.Elevated creatinine clearance
3
, 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."
d. "I should watch closely for dehydration." - correct answers-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
4
