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 C

Explanation

Choice A reason: Diphenhydramine, an antihistamine, does not significantly interact with aspirin’s antiplatelet effects. It primarily blocks histamine receptors, affecting allergies, not platelet aggregation. While it may cause drowsiness, it doesn’t increase bleeding risk or counteract aspirin’s cardiovascular benefits, making it safe to use concurrently with low-dose aspirin.

Choice B reason: Loratadine, a second-generation antihistamine, targets histamine receptors to relieve allergy symptoms. It has no known interaction with aspirin’s antiplatelet mechanism or bleeding risk. Its minimal side effect profile makes it compatible with low-dose aspirin for cardiovascular protection, so avoiding it is unnecessary in this context.

Choice C reason: Ibuprofen, an NSAID, competes with aspirin for COX-1 binding sites, reducing aspirin’s antiplatelet effect critical for preventing myocardial infarction and stroke. It also increases gastrointestinal bleeding risk when combined with aspirin, making it contraindicated for patients on low-dose aspirin therapy, thus the correct choice to avoid.

Choice D reason: Multivitamins do not interfere with aspirin’s antiplatelet action or increase bleeding risk. They provide supplemental nutrients without affecting COX-1 inhibition or platelet aggregation. There’s no pharmacological basis for avoiding multivitamins with low-dose aspirin, making this choice irrelevant for the patient’s cardiovascular regimen.

A. “Beta blockers decrease the release of renin.” B. “Beta blockers decrease peripheral vascular resistance.” C. “Beta blockers decrease heart rate and contractility.” D. “Beta blockers block the actions of angiotensin II.”

Correct Answer is B

Explanation

Choice A reason: Beta blockers decrease renin release, reducing angiotensin II and aldosterone, which lowers blood pressure. This statement is accurate, reflecting correct understanding, so it does not indicate a need for further teaching.

Choice B reason: Beta blockers do not primarily decrease peripheral vascular resistance; they reduce heart rate and contractility. Peripheral resistance is more affected by alpha blockers or vasodilators, so this incorrect statement indicates a need for further teaching.

Choice C reason: Beta blockers reduce heart rate and myocardial contractility, decreasing cardiac output and blood pressure. This statement is correct, showing proper understanding, so it does not require additional teaching.

Choice D reason: While beta blockers do not directly block angiotensin II, they reduce its production by decreasing renin. The statement is imprecise but not entirely wrong, making it less indicative of a teaching need than choice B.

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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

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Correct Answer is C

Explanation

A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching?

Correct Answer is B

Explanation

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