Question

Multiple-choice question: Furosemide (Lasix) is ordered in combination with the sodium nitroprusside (Nitropress) in order to: A. Decrease cardiac workload by decreasing aft erload. B. Increase potassium excretion by the kidney to prevent hyperkalemia. C. Decreased systolic blood pressure by decreasing preload. D. Prevent sodium and water retention caused by sodium nitroprusside.

Short answer

D. Prevent sodium and water retention caused by sodium nitroprusside.

Step-by-step solution

Understanding the Function of Furosemide

Furosemide (Lasix) is a potent diuretic which is medically used to eliminate water and salt from the body. Through this mechanism, it decreases the volume of blood, which in turn decreases blood pressure.

Understanding the Function of Sodium Nitroprusside

Sodium Nitroprusside (Nitropress) is a powerful vasodilator used to reduce blood pressure. However, one of its side effects is sodium and water retention.

Finding Their Combined Effect

When Furosemide and Sodium Nitroprusside are ordered in combination, the diuretic helps to counteract the sodium and water retention caused by Sodium Nitroprusside. Hence, the reason for their combined application is to prevent water and salt retention.

Choosing the Correct Answer

Based on this analysis, the correct answer is 'D. Prevent sodium and water retention caused by sodium nitroprusside' as this statement fully aligns with the interaction between these two drugs.

Key concepts

Furosemide (Lasix) Medication

Furosemide, commonly known by its brand name Lasix, is a powerful loop diuretic utilized in the medical field to promote the excretion of water and electrolytes from the body. Its primary effect is on the loop of Henle within the kidneys, where it inhibits the reabsorption of sodium and chloride. This action leads to an increase in urine production, effectively lowering fluid volume in the blood vessels and reducing the overall blood pressure.

When discussing pharmacology, especially in the context of the NCLEX-RN examination, it’s essential to understand the implications of furosemide’s mechanism. By prompting the kidneys to remove excess fluid, furosemide can relieve symptoms associated with fluid overload such as those found in congestive heart failure, edema, and hypertension.

Potential Side Effects

While furosemide's diuretic action is valuable, it can also lead to certain side effects, notably hypokalemia (low potassium levels), dehydration, and electrolyte imbalances. As a result, nursing management must involve vigilant monitoring of a patient's electrolyte levels, hydration status, and renal function.

It's crucial for nursing interventions to educate patients on maintaining an adequate diet rich in potassium and ensuring proper hydration to combat these side effects. Additionally, nurses must be prepared to address any complications swiftly, such as adjusting the medication dosage or suggesting potassium supplements if necessary.

Sodium Nitroprusside (Nitropress) Use

Sodium Nitroprusside, known by the brand name Nitropress, is an agent that causes powerful and immediate vasodilation, mainly by its action on arterial smooth muscle. It is frequently used in hypertensive crises and to manage acute heart failure because it can drastically reduce afterload and preload—meaning it eases the blood exiting from the heart as well as the blood returning to it.

Monitoring and Administration

An important part of pharmacological nursing management with Nitropress involves close and continuous monitoring of blood pressure and cardiac output to prevent excessive hypotension and to ensure therapeutic effectiveness. Due to Nitropress's rapid onset, any administration must be done in a controlled setting, such as an intensive care unit, with an IV drip and a reliable infusion device to adjust the dosage in real-time.

Risks and Precautions

Due to its potency, Sodium Nitroprusside can have significant side effects, including thiocyanate or cyanide toxicity, especially with prolonged use or increased doses. Therefore, nurses must be especially cognizant of signs of toxicity, such as disorientation, fatigue, or metabolic acidosis, and be prepared to cease the medication if necessary.

Pharmacological Nursing Management

Pharmacological nursing management encompasses the responsibilities and actions that nurses undertake to ensure safe and effective medication administration and patient care. It involves a comprehensive understanding of medication interactions, monitoring of therapeutic effects, managing side effects, and patient education.

Ensuring Therapeutic Effectiveness

In the case of combining medications like Furosemide and Sodium Nitroprusside, a nurse must understand how these drugs interact and the rationale behind their use together. This knowledge serves as the basis for assessing the therapeutic outcomes and deciding necessary interventions when managing a patient's treatment plan.

Educational Responsibilities

Nurses also play a critical role in educating patients about their medications. This includes explaining why the medication is needed, how it works, potential side effects, and the importance of adherence to the prescribed regimen. Education is vital for patient safety and can significantly influence treatment success.

Finally, pharmacological nursing management requires staying current with evidence-based practices and understanding regulatory guidelines. Nurses must stay informed of updates in medication protocols, especially regarding high-alert medications like Sodium Nitroprusside, to maintain the highest level of care for their patients.