A patient with a history of heart failure is prescribed furosemide (Lasix). Several days after the aggressive diuretic therapy started, the patient began to exhibit confusion, tremors, muscle cramps, and nausea.
What does the nurse suspect?

Hypokalemia.

Renal failure.

Hyperkalemia.

Heart failure.

Answer and Explanation

The Correct Answer is A

Hypokalemia is a condition of low potassium levels in the blood, which can be caused by diuretics such as furosemide (Lasix) that increase the excretion of potassium in the urine. Potassium is an important electrolyte that helps regulate the function of nerves and muscles, including the heart. Low potassium levels can cause symptoms such as confusion, tremors, muscle cramps, and nausea, which are consistent with the patient’s presentation.

Choice B, renal failure, is wrong because furosemide is used to treat fluid retention and edema caused by kidney disease, not to cause it. Renal failure would also cause symptoms such as decreased urine output, swelling, fatigue, and shortness of breath, which are not mentioned in the question.

Choice C, hyperkalemia, is wrong because hyperkalemia is a condition of high potassium levels in the blood, which can be caused by kidney disease or certain medications that decrease the excretion of potassium in the urine. Hyperkalemia can cause symptoms such as weakness, irregular heartbeat, paralysis, and chest pain, which are different from the patient’s symptoms.

Choice D, heart failure, is wrong because furosemide is also used to treat fluid retention and edema caused by heart failure, not to cause it. Heart failure would also cause symptoms such as shortness of breath, coughing, fatigue, and rapid weight gain, which are not mentioned in the question.

Normal ranges for potassium levels in the blood are 3.5 to 5.0 milliequivalents per liter (mEq/L) for adults and 3.4 to 4.7 mEq/L for children.

A level below 3.5 mEq/L is considered hypokalemic and a level above 5.0 mEq/L is considered hyperkalemic.

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Correct Answer is D

Explanation

This is because nitroglycerin patches can cause tolerance if they are used continuously, which reduces their effectiveness in preventing angina attacks. Removing the patch each evening allows the body to restore its sensitivity to the drug.

Choice A is wrong because nitroglycerin patches should be applied every 24 hours, not every 48 hours.

Applying a new patch every 48 hours would result in inadequate blood levels of the drug and increased risk of angina.

Choice B is wrong because nitroglycerin patches should not be cut in half or altered in any way.

Cutting the patch would compromise the integrity of the drug delivery system and could lead to unpredictable or excessive doses of the drug.

Choice C is wrong because nitroglycerin patches should not be taken off for 30 minutes if a headache occurs.

Headache is a common side effect of nitroglycerin due to its vasodilating action, but it usually subsides with continued use.

Taking off the patch for 30 minutes could increase the risk of angina by interrupting the steady blood levels of the drug.

The nurse should advise the client to take an analgesic such as acetaminophen for headache relief.

A. To avoid allergic response. B. To prevent tolerance. C. To prevent overdosage. D. To prevent the patient from forgetting to remove the patch in the morning.

Correct Answer is B

Explanation

Nitroglycerin is a medication that dilates the blood vessels and improves blood flow to the heart. It is used to treat angina, a condition that causes chest pain due to reduced oxygen supply to the heart. However, nitroglycerin can lose its effectiveness over time if it is used continuously. This is called tolerance, and it means that the patient will need higher doses of the medication to achieve the same relief. To avoid tolerance, patients who use transdermal nitroglycerin patches are instructed to remove the patch at bedtime and apply a new one in the morning. This creates a nitrate-free interval of about 8 to 12 hours, which allows the body to restore its sensitivity to nitroglycerin.

Choice A is wrong because an allergic response is not a common side effect of nitroglycerin. Some patients may experience skin irritation or rash at the site of application, but this is usually mild and does not require discontinuation of the medication.

Choice C is wrong because overdosage is unlikely with transdermal nitroglycerin patches. The patches deliver a controlled amount of nitroglycerin through the skin over a period of time. The risk of overdosage is higher with other forms of nitroglycerin, such as tablets or sprays, which are taken as needed for acute angina attacks.

Choice D is wrong because forgetting to remove the patch in the morning is not a serious problem. The patch will continue to deliver nitroglycerin until it is removed, but it will not cause harm to the patient. However, it may reduce the effectiveness of the next patch if there is no nitrate-free interval between them.

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A patient with a history of heart failure is prescribed furosemide (Lasix). Several days after the aggressive diuretic therapy started, the patient began to exhibit confusion, tremors, muscle cramps, and nausea. What does the nurse suspect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching with a client who has a new prescription for nitroglycerin transdermal patch for angina pectoris. Which of the following instructions should the nurse include?

Correct Answer is D

Explanation

Why is a patient who is using a transdermal nitroglycerin patch instructed to remove the patch at bedtime and apply a new one in the morning?

Correct Answer is B

Explanation

Match the following drug classification with the appropriate drug,

Which of the following diuretic agents will the nurse teach the patient to avoid food sources that are high in potassium?

Which of the following Alpha adrenergic class has a vasodilating effect and can be used for the management of hypertension?

In which condition is leg pain produced upon increased activity and ischemia to tissues, but then the pain is reduced with rest?

A patient has been placed on a loop diuretic to reduce the fluid that has been accumulating in the lungs. Which statement made by the patient indicates a need for further teaching about the medication by the nurse?

Which laboratory test measures the effectiveness of warfarin?

A client is prescribed a thiazide diuretic for the management of hypertension. The nurse plans to assess the client for allergy to?

A patient with a history of heart failure is prescribed furosemide (Lasix). Several days after the aggressive diuretic therapy started, the patient began to exhibit confusion, tremors, muscle cramps, and nausea.
What does the nurse suspect?