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 B
Explanation
Choice A reason: Salt substitutes contain potassium, which risks hyperkalemia with spironolactone, a potassium-sparing diuretic. This is dangerous, so it’s incorrect for understanding.
Choice B reason: Spironolactone spares potassium, so stopping supplements prevents hyperkalemia, a serious risk. This shows correct understanding, making it the correct choice.
Choice C reason: Spironolactone reduces fluid, not causes overhydration. Monitoring for dehydration is more relevant, so this is incorrect for the medication’s effects.
Choice D reason: Spironolactone’s effects take days to weeks, not hours. Immediate improvement is unrealistic, so this is incorrect for proper patient understanding.
Correct Answer is C
Explanation
Choice A reason: Bananas do not interact with acetaminophen. They are a potassium-rich food without impact on acetaminophen metabolism or hepatotoxicity. Acetaminophen’s primary risk is liver damage, especially with alcohol or overdose, making bananas irrelevant to its safe use, so this choice is incorrect.
Choice B reason: Leafy green foods, rich in vitamin K, may affect anticoagulants like warfarin but have no significant interaction with acetaminophen. They don’t influence acetaminophen’s metabolism or liver toxicity risk, making this choice irrelevant for patient instructions regarding safe acetaminophen use post-surgery.
Choice C reason: Alcohol increases acetaminophen’s hepatotoxicity by inducing CYP2E1 enzymes, which metabolize acetaminophen into toxic NAPQI, depleting liver glutathione and causing damage. Avoiding alcohol prevents severe liver injury, especially post-surgery when liver function is critical, making this the correct choice for patient safety.
Choice D reason: Dairy products do not interact with acetaminophen’s metabolism or toxicity. They may slow gastric emptying, slightly delaying absorption, but this isn’t a significant concern. Acetaminophen’s primary risk is hepatotoxicity, unaffected by dairy, making this choice incorrect for discharge instructions.
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