| Course | NR 293 Pharmacology for Nursing Practice |
|---|---|
| Week | 2 |
| Paper type | Drug card |
| Length | About 1,120 words, 3 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 293 Week 2
Drug Card: Spironolactone 25 mg Daily for a 64-Year-Old Man With Heart Failure, With the Potassium Row That Stops a Dose
Student Name
College of Nursing, Chamberlain University
NR 293: Pharmacology for Nursing Practice
Instructor Name
Month Day, Year
Drug Card: Spironolactone 25 mg Daily for a 64-Year-Old Man With Heart Failure, With the Potassium Row That Stops a Dose
The Patient on the Card
The card is written for Mr. E., 64, who has heart failure with an ejection fraction of 30%. He also takes lisinopril 20 mg daily, carvedilol and furosemide. His most recent labs show potassium 4.4 mmol/L and creatinine 1.3 mg/dL, with an estimated filtration rate of 58. Spironolactone 25 mg by mouth once daily was started yesterday. Details are composite. A card written for a generic patient would miss the two things that matter most for him: he is already on another drug that raises potassium, and his kidneys are mildly impaired.
The Card
Table 1 is the card as it would be carried on the unit.
Table 1
Drug Card for Spironolactone, Written for Mr. E.
| Row | Entry |
|---|---|
| Generic and brand | Spironolactone (Aldactone) |
| Class | Mineralocorticoid (aldosterone) receptor antagonist; potassium-sparing diuretic |
| Action | Blocks aldosterone at its receptor, so the kidney excretes more sodium and water and keeps more potassium; also reduces aldosterone's harmful effects on the heart |
| Why he is receiving it | Weak left ventricle, pumping at 30%, already on an ACE inhibitor and beta-blocker |
| Dose and route | 25 mg by mouth once daily, morning |
| Measure before the dose | Potassium and creatinine from the most recent draw; blood pressure |
| The row that stops a dose | Hold and call if potassium is above 5.0 mmol/L, if creatinine has risen by 0.5 mg/dL or more from baseline, or if systolic blood pressure is below 90 |
| Adverse effect, promoted | Hyperkalemia: muscle weakness, palpitations, slow or irregular pulse |
| Other adverse effects | Breast tenderness or enlargement in men; dizziness; rising creatinine |
| Interactions that matter for him | Lisinopril (also raises potassium); potassium supplements; salt substitutes containing potassium chloride; NSAIDs such as ibuprofen (raise potassium and harm the kidneys) |
| Teaching line | "Don't use salt substitutes, and don't take ibuprofen or naproxen. Get your blood test on the days we've marked." |
Note. Hold parameters follow the unit's heart failure order set; the provider may set different thresholds.
Why the Patient Belongs on the Card
The row reading "why he is receiving it" separates this card from a textbook summary. Spironolactone is also used for high blood pressure, fluid in the abdomen from liver disease and other conditions. For Mr. E., it is given because it improves survival in heart failure with reduced ejection fraction. In the RALES trial, patients with severe heart failure given spironolactone had a 30% lower risk of death than those given placebo, 35% against 46%, and 35% fewer hospitalizations for worsening heart failure (Pitt et al., 1999). Knowing that tells the nurse, and him, why this pill matters even though he will not feel any different from taking it.
Generic First, Brand Beside It
The generic name leads because it is what appears on the hospital's medication record. The brand name sits beside it because the bottle he has at home, or the one his pharmacy fills next month, may carry either one. A patient who thinks Aldactone and spironolactone are two different medicines might take both.
The Row That Stops a Dose, and the Adverse Effect Promoted
The hold row carries numbers, because "monitor potassium" does not tell a nurse what to do at 0900. Potassium is the number that matters most for Mr. E. In RALES, serious hyperkalemia was uncommon, but the trial's patients were carefully selected and closely monitored. After the trial was published, prescribing of spironolactone in Ontario rose sharply among older patients with heart failure taking ACE inhibitors, and hospitalizations for hyperkalemia rose from 2.4 to 11.0 per 1,000 patients, with associated deaths rising as well (Juurlink et al., 2004). Mr. E. is exactly that kind of patient: older, on an ACE inhibitor, with mildly reduced kidney function. That is why hyperkalemia is promoted above the other adverse effects on his card, and why the interaction row names lisinopril first.
Breast enlargement or tenderness is listed but not promoted. It occurred in 10% of men given spironolactone in RALES (Pitt et al., 1999). It carries no danger, yet it often leads men to stop the drug without telling anyone, so the nurse asks about it at follow-up.
How the Card Is Used at 0900
The card is only useful if it changes what happens at the medication cart, so here is how it is used on a normal morning. Before pulling the tablet, the nurse opens the morning labs. If the potassium is 4.8, the dose is given, because it is within the limit, but the value is noted as close to it and mentioned in the handover so the next nurse watches the trend. If the potassium is 5.3, the dose is held, the time and value are charted, and the provider is called with both numbers, the potassium and the creatinine, in one sentence. If this morning's labs have not resulted, the nurse checks whether a draw was ordered and, if the last potassium is more than two days old in the first week of the drug, asks whether the provider wants a level before the dose.
The blood pressure check happens at the same time. Spironolactone adds to the blood pressure lowering of his other three medicines, and a first-week drop in pressure can make him dizzy when he stands. A systolic pressure below 90 is a reason to hold and call; a pressure above 90 with dizziness on standing is a reason to give the dose but teach him to rise slowly and to check with the provider about the timing of his medicines.
A Teaching Line, Not a Warning Label
The last row is written as a sentence the nurse can say, not a list of warnings. It picks the three things he can control: salt substitutes, which many heart failure patients use in place of salt without knowing they contain potassium; over-the-counter anti-inflammatory painkillers, which he mentioned he takes for his knees; and the blood tests. His provider has scheduled potassium and creatinine three days and one week after starting, and the card's teaching line ends with those dates written on his discharge sheet.
When the line was used with Mr. E. this morning, he said he had a shaker of salt substitute at home, bought when he was told to cut down on salt. He agreed to throw it out. That single answer justified writing the card for him rather than for heart failure in general.
References
Juurlink, D. N., Mamdani, M. M., Lee, D. S., Kopp, A., Austin, P. C., Laupacis, A., & Redelmeier, D. A. (2004). Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. New England Journal of Medicine, 351(6), 543-551. https://doi.org/10.1056/NEJMoa040135
Pitt, B., Zannad, F., Remme, W. J., Cody, R., Castaigne, A., Perez, A., Palensky, J., & Wittes, J. (1999). The effect of spironolactone on morbidity and mortality in patients with severe heart failure. New England Journal of Medicine, 341(10), 709-717. https://doi.org/10.1056/NEJM199909023411001
The Chamberlain NR 293 Week 2 instructions
The Week 2 assignment asks for a drug card, often on a template your section provides, covering a medication's class, action, indications, dosing, adverse effects, nursing assessments, interventions and teaching. Expect at least one drug reference source and APA citation. Many prompts supply a patient or ask you to choose one, and the strongest cards are written for that person rather than copied from a reference. Hold parameters should carry numbers. Adverse effects should be ranked, with the most important ones given nursing actions. Generic and brand names usually both belong on the card. The teaching line should be words a patient would understand, not chart language.
Inside the NR 293 Week 2 example
The card starts with the patient: Mr. E., 64, his ejection fraction, his other medicines and his labs, including potassium of 4.4. Table 1 is the card itself, from generic and brand name to class, action, why he receives it, dose, holds and teaching. Sections then explain the card's choices. The why row ties the drug to survival in heart failure. Generic comes first because it appears on the record. The hold row carries numbers, supported by Juurlink et al. (2004) on hyperkalemia after RALES. Breast tenderness is listed from Pitt et al. (1999) but not promoted. A morning walk-through shows the card at 0900. The teaching line catches a salt substitute at home.
Reading the NR 293 Week 2 grading rubric
Drug card rubrics usually grade accuracy of drug information, completeness of required sections, nursing assessments and hold parameters, adverse effects with actions, patient teaching and references. The assessment and hold rows tend to decide the grade, so the potassium and blood pressure rows have numbers. Accuracy rests on primary trial data for benefits and risks. Adverse effects score when they are ranked and paired with what the nurse does. Patient-specific entries, such as why he receives the drug, separate a strong card from a copied one. A teaching line in plain words meets the education criterion. The card's use at the cart shows application many sections reward. Correct generic spelling matters too.
Common NR 293 Week 2 mistakes, and how to avoid them
The heaviest loss is a card that could have been written before any patient was named, correct and generic. Twelve unranked adverse effects show reading, not deciding. An assessment row reading assess the patient names no measurement. Holds with no figure, adverse effects with no action, brand names alone when both were asked for, expected effects with no timing and teaching copied from the reference all lose points. Use your section's layout if one is required. A card usually lists the most important three to five adverse effects with actions. Pass along the drug and the patient you were given, and an NR 293 card can be drafted for that person.
Get a NR 293 Week 2 example written to your instructions
Send the card template your classroom publishes, the prompt, and the drug you were assigned. We fill it as a worked example for a patient built to your prompt, returned inside 24-48h with the first one free. If your section marks a particular row heavily, tell us which, and the example will show what a full version of that row contains.
More NR 293 papers and pre-licensure samples
- NR 293 Week 1: Nurse's Medication Responsibility Post
- NR 293 Week 3: Dosage Calculation Set
- NR 293 Week 4: Medication Safety Analysis
- NR 293 Week 5: Drug Class Write-up
- NR 293 Week 6: Patient Case Response
- NR 293 Week 7: Patient Teaching Script
- NR 293 Week 8: Medication Care Plan
- NR 302 Week 2: Health History Interview
- NR 283 Week 2: Acute Inflammation Write-Up
- NR 304 Week 2: Focused Exam Write-up
- NR 228 Week 2: Three-Day Diet Analysis
NR 293 Week 2 questions, answered
Can I use the card layout my classroom hands out?
Use it. Layout is rarely where points sit; what fills the boxes is. Where a published card has no box for the assessment before a dose, or none for what you would do about an adverse effect, most sections accept that reasoning written into the nearest available row rather than dropped. Our example is built on the standard field set and pours into whatever grid you are given.
How many adverse effects should the card list?
Fewer than you are tempted to write, with one of them clearly promoted. A grader is looking for evidence that you decided which effect matters for this patient, and a long even list is evidence that you did not. Three or four, ranked, with the top one carrying the nursing response beside it, generally reads stronger than a dozen given equal weight.
Do drug cards need references?
Most sections want at least the drug reference you worked from, and some want a course text as well. Put the source on the card itself, since a card gets used away from the assignment it was submitted with. Where a value you quote differs between references, name the one you followed, because parameters that stop a dose are exactly where a difference shows up.
Where can I find a free NR 293 Week 2 sample paper?
The whole Week 2 drug card for spironolactone, written for Mr. E. with the potassium hold row and the teaching line, is reproduced further down this page.
Why does the NR 293 Week 2 card warn about salt substitutes?
Many salt substitutes contain potassium, and spironolactone keeps potassium in the body; Mr. E. had a shaker at home and agreed to throw it out when the teaching line was used.