A nurse is reviewing a patient’s medications before administration. Which drug-to-drug interactions will most concern the nurse in a patient with a history of heart failure and a potassium level of 5.5 mEq/L?
Metoprolol [Lopressor] and furosemide [Lasix]
Furosemide [Lasix] and enalapril [Vasotec]
Captopril [Capoten] and spironolactone [Aldactone]
Amlodipine [Norvasc] and propranolol [Inderal]
The Correct Answer is C
Choice A reason: Metoprolol (beta-blocker) and furosemide (loop diuretic) are commonly used in heart failure. Furosemide may lower potassium, counteracting hyperkalemia (5.5 mEq/L), and metoprolol doesn’t significantly affect potassium. This combination poses less risk for hyperkalemia exacerbation, making it less concerning than potassium-sparing combinations.
Choice B reason: Furosemide promotes potassium excretion, potentially reducing hyperkalemia (5.5 mEq/L), while enalapril (ACE inhibitor) may increase potassium. However, furosemide’s effect often offsets enalapril’s, making this combination less likely to worsen hyperkalemia significantly compared to two potassium-sparing drugs, so this choice is less critical.
Choice C reason: Captopril (ACE inhibitor) and spironolactone (potassium-sparing diuretic) both increase potassium levels by reducing aldosterone activity, exacerbating hyperkalemia (5.5 mEq/L). In heart failure, this combination risks severe hyperkalemia, causing arrhythmias, making it the most concerning interaction requiring close monitoring or adjustment.
Choice D reason: Amlodipine (calcium channel blocker) and propranolol (beta-blocker) primarily affect blood pressure and heart rate, not potassium levels. Their interaction may cause bradycardia or hypotension but doesn’t worsen hyperkalemia (5.5 mEq/L), making this combination less concerning for the patient’s current electrolyte status.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Insulin does not stimulate the liver to convert glycogen to glucose; instead, it promotes glycogenesis and inhibits glycogenolysis. By facilitating glucose uptake and storage, insulin lowers blood glucose levels, counteracting the process of glycogen breakdown into glucose, which is regulated by glucagon and other hormones, making this choice incorrect.
Choice B reason: Insulin does not promote amino acid synthesis into glucose (gluconeogenesis). It inhibits gluconeogenesis in the liver, reducing glucose production from amino acids and other substrates. By enhancing glucose uptake and storage, insulin maintains glucose homeostasis, making this option incorrect as it misrepresents insulin’s role in glucose metabolism.
Choice C reason: Insulin does not stimulate the pancreas to reabsorb glucose. The pancreas produces insulin, which acts on target tissues like muscle and fat to facilitate glucose uptake. Glucose reabsorption occurs in the kidneys, regulated by sodium-glucose cotransporters, not insulin, making this choice scientifically inaccurate for insulin’s function.
Choice D reason: Insulin promotes glucose uptake into cells by facilitating GLUT4 transporter translocation to cell membranes in muscle and adipose tissue. This allows glucose to enter cells for energy production via glycolysis and the Krebs cycle. This is insulin’s primary role in maintaining blood glucose homeostasis, making it the correct choice for its action.
Correct Answer is A
Explanation
Choice A reason: Meperidine, an opioid, crosses the placenta, risking neonatal respiratory depression. Monitoring breathing is critical post-delivery, making this the correct observation for the infant.
Choice B reason: Hypothyroidism is not associated with meperidine exposure. Opioids primarily affect respiration, so this is irrelevant and incorrect for the expected effect.
Choice C reason: Tremors and hyperreflexia are not typical meperidine effects in newborns; respiratory depression is the primary concern. This is incorrect for the nurse’s focus.
Choice D reason: Congenital anomalies result from chronic exposure, not acute labor analgesia. Meperidine’s immediate risk is respiratory, so this is incorrect for monitoring.
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