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NUR 2474 Pharm Exam 2 (NCLEX) – Questions With Answers (Pass!)
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NUR 2474 Pharm Exam 2 (NCLEX) – Questions With Answers (Pass!)
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NUR 2474 Pharm Exam 2 (NCLEX) – Questions WithAnswers (Pass!)
Which condition would cause the nurse to withhold a PRN order for
magnesium hydroxide?
a.Chronic renal failure
b.Cirrhosis
c.Hemorrhoids
d.Prostatitis Right Ans - a.Chronic renal failure
Magnesium can accumulate to toxic levels in patients with renal dysfunction.
The nurse should withhold the medication. Magnesium hydroxide is not
contraindicated for patients with hemorrhoids, prostatitis, or cirrhosis.
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) Right Ans - 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). Right Ans - 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) Right Ans - 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?
a.Frequent nocturia
b.Headaches
c.Ringing in the ears
d.Urinary retention Right Ans - 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 Right Ans -
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."
d."I should watch closely for dehydration." Right Ans - 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 Right Ans - 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. Right Ans - 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?
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