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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Nonselective beta blockers can mask the symptoms of hypoglycemia, such as tachycardia and tremors, in patients with type 1 diabetes. This poses a significant risk as it can delay recognition and treatment of a dangerously low blood sugar level, which can lead to seizures, coma, and death.
Choice B rationale
Nonselective beta blockers block both beta-1 and beta-2 adrenergic receptors. Blocking beta-2 receptors in the lungs leads to bronchoconstriction, which can trigger a severe, life-threatening asthma attack (status asthmaticus) by narrowing the airways and making breathing extremely difficult.
Choice C rationale
Nonselective beta blockers can decrease lower esophageal sphincter tone and may worsen acid reflux symptoms. While uncomfortable, this effect is not typically considered an immediately life-threatening adverse event and can be managed by diet, lifestyle changes, and other medications.
Choice D rationale
While nonselective beta blockers are used to treat hypertension, they can cause adverse effects like bradycardia or hypotension. However, these effects are usually manageable and not as immediately life-threatening as the bronchoconstriction that can be induced in a patient with asthma.
Correct Answer is ["B","C"]
Explanation
Choice A rationale
While adequate fluid intake is important for overall health, it does not directly counteract the sedative or unsteady side effects of an anxiolytic medication. Increasing fluid intake will not improve drowsiness or unsteadiness caused by central nervous system depression, and it is not a standard or effective nursing intervention for these specific adverse effects.
Choice B rationale
Anxiolytics, particularly benzodiazepines, are central nervous system depressants that cause drowsiness and impair coordination and judgment. Due to the sedative effects and potential for unsteadiness and ataxia, it is crucial to advise patients to avoid activities that require alertness and precise motor skills, such as driving or operating heavy machinery, to prevent accidents.
Choice C rationale
Alcohol and anxiolytics are both central nervous system depressants. Taking them together has a synergistic effect, meaning their combined depressive effects are greater than the sum of their individual effects. This can significantly increase the risk of severe drowsiness, respiratory depression, and even coma or death. Patients must be warned to avoid alcohol completely.
Choice D rationale
Abruptly discontinuing an anxiolytic, especially a benzodiazepine, can lead to severe withdrawal symptoms, including rebound anxiety, insomnia, tremors, and even seizures. The medication should not be stopped immediately by the patient without consulting a healthcare provider. The dose should be tapered slowly under medical supervision to prevent these dangerous effects.
Choice E rationale
While light exercise can be beneficial for mood and anxiety, it is not a primary or safe recommendation for a patient experiencing drowsiness and unsteadiness due to anxiolytic medication. Engaging in physical activity while feeling unsteady could increase the risk of falls and injury. The priority is to ensure the patient's safety by avoiding risky activities.
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