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]

Answer and Explanation

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.

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Correct Answer is B

Explanation

Choice A reason: Glucuronidation does not primarily involve fecal excretion; it conjugates drugs for urinary excretion. Hydrolysis is unrelated, and fecal routes are secondary, so this is incorrect for glucuronidation’s role.

Choice B reason: Glucuronidation conjugates drugs, making them water-soluble for transport across renal tubules and excretion in urine. This is the primary mechanism, making it the correct choice for drug elimination.

Choice C reason: Enterohepatic recirculation involves some drugs, but glucuronidation aims for excretion, not recycling. Prolonging drug presence is not the goal, so this is incorrect for the process.

Choice D reason: Glucuronidation facilitates excretion, not reabsorption. Reabsorbing drugs would counteract its purpose of eliminating metabolites, making this incorrect compared to urinary excretion.

A. An allergic reaction B. An idiosyncratic drug effect on the bone marrow C. Iatrogenic disease of the skin D. Drug toxicity of the liver

Correct Answer is D

Explanation

Choice A reason: Allergic reactions typically present with symptoms like rash, itching, or anaphylaxis, not jaundice, dark urine, or light stools. These symptoms indicate hepatobiliary dysfunction, not an immune-mediated response. Allergic reactions don’t typically affect liver function or bile excretion, making this choice inconsistent with the patient’s clinical presentation.

Choice B reason: Idiosyncratic drug effects on bone marrow cause hematologic issues like anemia or leukopenia, not jaundice or light stools. These symptoms suggest liver dysfunction, as bile pigment changes cause dark urine and pale stools. Bone marrow effects don’t explain the hepatobiliary symptoms, making this choice incorrect.

Choice C reason: Iatrogenic skin disease might involve rashes or lesions, but jaundice, dark urine, and light stools point to liver or bile duct issues. These symptoms result from impaired bilirubin metabolism, not cutaneous pathology. This choice doesn’t align with the systemic hepatobiliary symptoms described, making it incorrect.

Choice D reason: Drug-induced liver toxicity, such as from acetaminophen or statins, impairs bilirubin metabolism, causing jaundice, dark urine (bilirubinuria), and light stools (reduced bile). Malaise, nausea, and vomiting reflect systemic effects of liver dysfunction. This matches the patient’s symptoms, making it the most likely diagnosis and correct choice.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is explaining drug metabolism to a nursing student who asks about glucuronidation. The nurse knows that this is a process that allows drugs to be:

Correct Answer is B

Explanation

The nurse is caring for a patient who has jaundice, dark urine, malaise, light-colored stools, nausea, and vomiting. What is this patient most likely experiencing?

Correct Answer is D

Explanation

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