When caring for a patient on multiple cardiac medications, the nurse notices signs of hypokalemia.
Which medication is most likely contributing?
Furosemide.
Spironolactone.
Lisinopril.
Metoprolol.
The Correct Answer is A
Choice A rationale
Furosemide is a loop diuretic that inhibits the reabsorption of sodium and chloride in the thick ascending limb of the loop of Henle. This action increases the excretion of these ions, as well as potassium, through the kidneys. The increased urinary potassium loss can lead to hypokalemia, a common and potentially dangerous side effect requiring careful monitoring of serum potassium levels (normal range 3.5-5.0 mEq/L).
Choice B rationale
Spironolactone is a potassium-sparing diuretic that acts as a competitive antagonist of aldosterone in the distal convoluted tubule and collecting duct. By blocking aldosterone's effects, it promotes the excretion of sodium and water while promoting the reabsorption of potassium. This mechanism increases serum potassium levels, and therefore, this medication is more likely to cause hyperkalemia, not hypokalemia.
Choice C rationale
Lisinopril is an ACE inhibitor (angiotensin-converting enzyme inhibitor). It blocks the conversion of angiotensin I to angiotensin II, leading to decreased aldosterone secretion. Decreased aldosterone reduces the retention of sodium and water and the excretion of potassium. Therefore, lisinopril is more likely to cause hyperkalemia rather than hypokalemia, making it an unlikely cause.
Choice D rationale
Metoprolol is a beta-blocker that works by blocking the effects of catecholamines on beta-adrenergic receptors. It primarily affects the heart by slowing the heart rate and reducing contractility, thereby lowering blood pressure. It does not directly impact the renal tubules or the handling of potassium, so it is not a direct cause of hypokalemia. Its effect on potassium is considered negligible.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Taking the medication before bed is incorrect. Thyroid replacement hormones, such as levothyroxine, can increase metabolism and may cause symptoms of insomnia or restlessness if taken too close to bedtime. Therefore, patients are advised to take the medication in the morning to align with the body's natural circadian rhythm and to minimize sleep disturbances.
Choice B rationale
The full therapeutic effects of thyroid replacement medication are not seen after one week. It typically takes several weeks, often four to six, for the medication to reach a steady-state level in the blood and for the patient to experience the full benefits. The dosage may also be adjusted based on subsequent blood tests and symptom assessment.
Choice C rationale
Stopping the drug because of insomnia is incorrect. Insomnia can be a symptom of hyperthyroidism (too much medication) or other factors. The patient should not abruptly stop the medication but should consult their healthcare provider. The provider can then assess the patient's symptoms, check thyroid hormone levels, and adjust the dosage if necessary, rather than ceasing treatment entirely.
Choice D rationale
Taking the medication in the morning on an empty stomach is correct. Levothyroxine absorption is significantly reduced when taken with food, especially those containing calcium, iron, or dietary fiber. Taking it in the morning, at least 30-60 minutes before breakfast, ensures consistent and optimal absorption, which is critical for maintaining stable thyroid hormone levels.
Correct Answer is B
Explanation
Choice A rationale
Benzodiazepines, such as diazepam, are central nervous system depressants. Their primary action is to enhance the effect of the neurotransmitter GABA, which results in sedative, anxiolytic, and muscle-relaxant properties. This mechanism of action often leads to a decrease, not an increase, in blood pressure. Therefore, hypertension is not an anticipated adverse effect.
Choice B rationale
Benzodiazepines enhance the inhibitory effects of GABA throughout the central nervous system, including the brainstem respiratory centers. This can lead to a significant dose-dependent depression of respiratory drive. This effect is particularly dangerous when these medications are combined with other CNS depressants like opioids or alcohol, leading to potentially fatal respiratory arrest.
Choice C rationale
Benzodiazepines are known to cause central nervous system depression, leading to sedation and decreased psychomotor activity. They are prescribed to treat anxiety and insomnia, and their intended effects are calming and sedating. Hyperactivity, which is an increase in activity and restlessness, is the opposite of the expected pharmacological effect and is not a typical adverse reaction.
Choice D rationale
Benzodiazepines are known to decrease alertness and cause drowsiness due to their central nervous system depressant effects. This is a common and expected side effect, especially at higher doses or with initial use. Advising a patient about decreased alertness is essential for safety, as it can impair their ability to perform tasks requiring focus.
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