NUR 108 Pharm Part 3

NUR 108 Pharm Part 3

• 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?

• Furosemide [Lasix]
• Hydrochlorothiazide [HydroDIURIL]
• Mannitol [Osmitrol]
• Spironolactone [Aldactone]

Answer

• Furosemide - used when rapid or massive mobilization of fluids is needed

Pt is showing signs of CHF with respiratory distress and pulmonary edema and needs immediate mobilization of fluids B & D - not indicated for pulmonary edema because of their less rapid diuretic effects C - used for increased intracranial pressure

• 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?

• Blood glucose level of 120 mg/dL
• Oxygen saturation of 90%
• Potassium level of 3.5 mEq/L
• Sodium level of 140 mEq/L

Answer

• Potassium - patient has an irregular, rapid HR that might be caused by a dysrhythmia. Pt's K

level is low, which can trigger fatal dysrhythmias, especially in patients taking digoxin, furosemide contributes to K loss

• 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?

• Bumetanide [Bumex]
• Furosemide [Lasix]
• Spironolactone [Aldactone] 1 / 3

• Hydrochlorothiazide [HydroDIURIL]

Answer

• Spironolactone - K sparing diuretic, and pt has K level of 6, indicating hyperkalemia, this

drug should be questioned

• A nurse preparing to administer morning medications notes that a patient with a history of

hypertension has been prescribed spironolactone [Aldac- tone].The nurse assesses the patient and notes dyspnea, bilateral crackles, and pitting edema in both feet. Which intervention is appropriate?

• Administer the medications as ordered.
• Ask the patient about the use of salt substitutes.
• Contact the provider to request an order for serum electrolytes.
• Request an order for furosemide [Lasix].

Answer

• furosemide - Spironolactone takes up to 48 hours for its effects to develop, so should not be used

for immediate diuresis. SOB, crackles & edema need short-acting diuretic = furosemide

• A patient who was in a motor vehicle accident sustained a severe head injury and is brought

into the emergency department. The provider orders intravenous mannitol [Osmitrol]. The nurse knows that this is given to

Answer

• reduce intracranial pressure.
• reduce renal perfusion.
• reduce peripheral edema.
• restore extracellular fluid.

Answer

• mannitol is an osmotic diuretic that is used to reduce intracranial pressure by relieving

cerebral edema. It creates an osmotic force that draws edematous fluid from the brain into the blood

• A patient is taking gentamicin [Garamycin] and furosemide [Lasix].The nurse should

counsel this patient to report which symptom? 2 / 3

• Frequent nocturia
• Headaches
• Ringing in the ears
• Urinary retention

Answer

• Ringing - 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

• Besides having diuretic effects for patients with congestive heart failure, thiazides are also

used to treat what?

• Diabetes insipidus, intraocular pressure, increased intracranial pressure
• Diabetes insipidus, hepatic failure, postmenopausal osteoporosis
• Hepatic failure, postmenopausal osteoporosis, increased intracranial pres- sure
• Intraocular pressure, increased intracranial pressure, hepatic failure

Answer B

• A patient with congestive heart failure is admitted to the hospital. During the admission

assessment, the nurse learns that the patient is taking a thiazide diuretic. The nurse notes that the admission electrolyte levels include a sodi- um level of 142 mEq/L, a chloride level of 95 mEq/L, and a potassium level of 3 mEq/L.The prescriber has ordered digoxin to be given immediately.What will the nurse do initially?

• Give the digoxin and maintain close cardiac monitoring.
• Hold the digoxin and report the laboratory values to the provider.
• Hold the thiazide diuretic and give the digoxin.
• Request an order for an electrocardiogram (ECG).

Answer

• Potassium depletion

is common with thiazide diuretics, and hypokalemia is especially dangerous for patients receiving digoxin, because the drug can precipitate a fatal dysrhythmia and digoxin toxicity. The provider should be notified of the serum potassium level so that it can be corrected before the digoxin is administered

• A patient collapses after running a marathon on a hot day and is brought to the emergency
• / 3