143 Module 1: FEABS Pharmacology (PRACTICE QUESTIONS)

A client diagnosed with shock has been started on a norepinephrine infusion. When assessing for therapeutic effects, the nurse will monitor which assessment parameter(s)? Select all that apply. A. heart rate B. pain level C. urine output D. oxygen saturation E. mean arterial pressure (MAP) F. respiratory rate and pattern

A, C, D, E, F. When administering epinephrine, the nurse should observe for signs of adequate tissue perfusion, including a mean arterial pressure of at least 65 mm Hg, heart rate less than 100 bpm, unlabored breathing, and serum lactate levels and arterial blood gases within normal limits. In addition, urine output should be greater than 30 ml/h. There should be normal mentation and oxygen saturation by pulse oximetry greater than 90%. Pain is not typically associated with shock or norepinephrine administration, so pain assessment is a lower priority.

A patient who is being treated for myasthenia gravis is receiving neostigmine, and her pulse drops to 50 after the administration. Which medication should be administered to treat the bradycardia? A) Atropine B) Pseudoephedrine C) Propranolol (Inderal) D) Bethanechol

A. Atropine will reverse the muscarinic effects of cholinergic crisis. Pseudoephedrine will not affect bradycardia in this patient. Propranolol (Inderal) will not affect the bradycardia. Bethanechol will increase the bradycardia.

Which type of shock occurs from an antigen-antibody response? A. Anaphylactic B. Cardiogenic C. Neurogenic D. Septic

A. During anaphylactic shock, an antigen-antibody reaction provokes mast cells to release potent vasoactive substances, such as histamine or bradykinin, causing widespread vasodilation and capillary permeability. Septic shock is a circulatory state resulting from overwhelming infection causing relative hypovolemia. Neurogenic shock results from loss of sympathetic tone causing relative hypovolemia. Cardiogenic shock results from impairment or failure of the myocardium.

Epinephrine causes relaxation of: A. bronchioles. B. sphincter muscles. C. smooth muscles in the intestinal wall. D. superficial blood vessels.

A. Epinephrine is the adrenergic drug of choice for relieving the acute bronchospasm and laryngeal edema of anaphylactic shock.

Which is an example of a loop diuretic? A. Furosemide (Lasix) B. Hydrochlorothiazide (Microzide) C. Spironolactone (Aldactone) D. Acetazolamide (Diamox)

A. Furosemide (Lasix) is an example of a loop diuretic.

In the field, emergency personnel are quick to treat the signs and symptoms of shock because it can quickly lead to organ failure and death. What causes the generalized metabolic acidosis associated with organ failure? A. Insufficient perfusion B. Insufficient glucose metabolism C. Cardiomyopathy D. GI bleed

A. Inadequate blood flow to tissues results in anaerobic metabolism, which leads to generalized metabolic acidosis. None of the other options are responsible for the generalized metabolic acidosis.

A patient is administered atropine to increase the heart rate. What is the action of atropine? A) It blocks the parasympathetic vagal stimulation. B) It exacerbates the parasympathetic vagal stimulation. C) It provides long-acting antihistamine blockage. D) It blocks cell wall synthesis of gram-negative bacilli.

A. Moderate to large doses of atropine increase the heart rate by blocking parasympathetic vagal stimulation.

A patient is switched from furosemide (Lasix) to spironolactone. The patient asks the nurse why she has been switched to a new medicine. What is the nurse's best response? A) You will lose less potassium with spironolactone than with furosemide. B) You will have greater potassium losses with spironolactone than with furosemide. C) You will have greater water losses with spironolactone than with furosemide. D) You will have greater sodium losses with spironolactone than with furosemide.

A. Spironolactone promotes retention of sodium and water and excretion of potassium by stimulating the sodium-potassium exchange mechanism in the distal tubule. The patient will not have greater potassium losses, water losses, or sodium losses with spironolactone rather than furosemide.

A nurse is monitoring the vital signs of a client who has received epinephrine. The nurse would report which assessment findings? A. Systolic blood pressure below 100 mm Hg B. Temperatures reading of 97.6°F C. Pulse rate of 60 beats/min D. A diastolic blood pressure of 75 mm Hg

A. The nurse must immediately report a fall in systolic blood pressure below 100 mm Hg. Epinephrine should raise the blood pressure, so a continued low systolic pressure indicates the medication has not been effective. A diastolic blood pressure of 75 mm Hg, a pulse rate of 60 beats/min, and a temperature reading of 97.6°F are normal and need not be reported immediately.

A nurse is preparing to administer an adrenergic agent for shock. Which nursing assessment should be completed quickly and accurately? A. vital signs B. physical assessment C. pain evaluation D. urinary output

A. When a client is to receive an adrenergic agent for shock, obtain the blood pressure, pulse rate and quality, and respiratory rate and rhythm. Urinary output, pain, and the physical assessment are not a priority in shock.

An older adult patient has been receiving treatment for heart failure and has been experiencing frequent episodes of peripheral edema. As a result her care provider has added furosemide (Lasix) to her medication regimen. What assessment should the nurse perform on a daily basis for the duration of treatment? A) Body weights B) Arterial blood gases C) Magnesium level D) Pupillary response

A. When a patient is being treated with furosemide, the nurse weighs the patient daily and reports any increase in weight of greater than 2 pounds in 24 hours to the health care provider. Electrolyte levels must be assessed but sodium and potassium levels are the priority.

A nurse is reviewing a newly admitted patient's medication administration record and notes that the patient takes a loop diuretic as well as a thiazide diuretic. The nurse understands what primary rationale for the concurrent use of these two drugs? A) Increased diuretic effect B) Reduced risk of potassium imbalances C) Decreased blood pressure without a risk of bradycardia D) Increased adherence to treatment

A. When an inadequate diuretic response occurs with one drug, people sometimes take two potassium-losing diuretics concurrently. The combination of a loop and a thiazide diuretic has synergistic effects because the drugs acct in different segments of the renal tubule.

You are caring for an 88-year-old client who was admitted to the ICU. The patient is suspected of being in cardiogenic shock. Which of the following observations would indicate that the patient is in shock? A. Systolic blood pressure of 80 mm Hg B.Heart rate of 85 bpm C. Urine output of 45 mL/hr D. Temperature of 38.2°C

A. When monitoring patients for signs of shock, the nurse should check blood pressure, skin temperature, urine output, heart rate, orientation, and respiration. Patients in shock may exhibit a significant decrease in blood pressure (e.g., systolic blood pressure < 90 mm Hg), tachycardia, decreased respiratory rate and urine output (e.g., < 30 mL/hr), disorientation, and cold, clammy skin.

A patient is admitted to the emergency department and is unconscious as a result of a head injury. The patient's intracranial pressure is increased. What type of diuretic will the nurse most likely administer to the patient? A) Loop diuretic B) Potassium-sparing diuretic C) Thiazide diuretic D) OSmotic diuretic

An osmotic diuretic is used to reduce intracranial pressure related to a head injury. Loop diuretics, potassium-sparing diuretics, and thiazide diuretics do not reduce intracranial pressure.

A patient is experiencing anaphylaxis. Which of the following medications will most likely be administered? A) Epinephrine B) Norepinephrine C) Acetylcysteine (Mucomyst) D) Dantrolene sodium (Dantrium)

Ans: A Feedback: Epinephrine is the adrenergic drug of choice for relief of anaphylactic shock, the most serious allergic reaction, as well as in treatment of cardiac arrest. Norepinephrine is not administered. Acetylcysteine (Mucomyst) is used for acetaminophen overdose. Dantrolene sodium is used to treat malignant hyperthermia. B) Norepinephrine C) Acetylcysteine (Mucomyst) D) Dantrolene sodium (Dantrium) Ans: A Feedback: Epinephrine is the adrenergic drug of choice for relief of anaphylactic shock, the most serious allergic reaction, as well as in treatment of cardiac arrest. Norepinephrine is not administered. Acetylcysteine (Mucomyst) is used for acetaminophen overdose. Dantrolene sodium is used to treat malignant hyperthermia.

Clinical indications for the use of adrenergic drugs stem mainly from their effects on the heart, blood vessels, and bronchi. They are often used as emergency drugs. For which of the following conditions would these drugs be used? Choose all that apply. A. Fractures B. Respiratory conditions C. Allergic disorders D. Acute cardiovascular disorders E. Liver failure

B, C, D. Clinical indications for the use of adrenergic drugs stem mainly from their effects on the heart, blood vessels, and bronchi. They are often used as emergency drugs in the treatment of acute cardiovascular, respiratory, and allergic disorders.

A patient has edema of the lower extremities with crackles in the e lung bases. What diuretic is the nurse most likely to administer? A) Hydrochlorothiazide B) Furosemide C) Spironolactone D) Mannitol

B. Acute pulmonary edema is an indication for the use of Lasix. The others are not used for this purpose, largely due to their slower onset of action.

An older adult client who is experiencing hypovolemic shock is prescribed intravenous (IV) dopamine. Which action would the nurse take while monitoring the client while receiving this medication? A. Place the client in the supine position. B. Monitor the client's cardiac rhythm. C. Assist the client to sit in a chair. D. Elevate the client's lower extremities.

B. Older adult clients commonly experience the adverse effects of adrenergic drugs. Older adult clients may need to be on lower doses of the drug because they are more prone to having a toxic level of the drug due to changes in renal or hepatic metabolism and excretion. The client should have cardiac rhythm monitored because serious arrhythmias could occur while receiving this medication. The client is acutely ill and should not be out of bed in a chair. The supine position is not needed, and the lower extremities do not need to be elevated when receiving this drug.

Which client is most likely to benefit from the administration of an adrenergic agonist? A. A woman who is in labor and may require a cesarean section B. A man who is in cardiogenic shock following a myocardial infarction C. A man who has a diagnosis of primary hypertension D. A woman who has been admitted with a suspected ischemic stroke

B. One of the most frequent indications for adrenergic agonist drugs is shock. Their use is contraindicated in labor, and they would exacerbate hypertension.

The health care provider indicates that a client experiencing renal failure is not a candidate for therapy with potassium-sparing diuretics. How will the nurse respond when the client's family member asks why this is the case? A.They are the strongest form of diuretics. B. They may cause hyperkalemia. C. They promote excretion of potassium. D. They may cause rebound edema.

B. Potassium-sparing diuretics accumulate in renal insufficiency and present the risk for hyperkalemia. For this reason, health care practitioners typically avoid the drug in this population. Potassium-sparing diuretics decrease potassium excretion, and, by themselves, they are weak diuretics. Rebound edema may be a concern when a diuretic is discontinued, but it is not the reason this client is a poor candidate for a potassium-sparing diuretic.

A student asks the instructor what the goal of drug therapy is in hypotension and shock. What would the instructor respond? A. Replace fluids the patient has lost. B. Restore and maintain adequate tissue perfusion. C. Restore life to the patient. D. Resuscitate the client.

B. The goal of adrenergic drug therapy in hypotension and shock is to restore and maintain adequate tissue perfusion, especially to vital organs.

A patient is administered a sulfonamide for a urinary tract infection. Which of the following nursing interventions is most appropriate to increase the alkalinity of the patient's urine? A) Provide at least 2000 mL of water daily B) Administer sodium bicarbonate C) Recommend a tub bath every evening D) Provide orange juice daily

B. The urine can be alkalinized by giving sodium bicarbonate. The administration of water is important but will not increase alkalinity. The taking of tub baths is not recommended due to the fact that doing so increases the risk of UTI. The administration of orange juice increases acid, not alkalinity.

A nurse is caring for a 25-year-old client who has been prescribed an adrenergic drug for shock. Which action should the nurse implement? A. Prepare the family by telling them how sick their loved one is and that he may die. B. Continually assess the client for physiological changes and notify the primary care provider with changes. C. Leave the room so that the client can sleep and not risk sleep deprivation psychosis. D. Observe the client closely for seizures, hypothermia, and dementia; if seen, stop the infusion immediately.

B. When caring for a client receiving an adrenergic medication for shock, the nurse will continually assess the client for changes in his vital signs, perfusion, and any adverse reactions. Telling a family that their loved one might die is not an appropriate nursing action at that time. Seizures, hypothermia, and dementia are not common side effects of adrenergic medications, and an adrenergic medication should not be abruptly stopped. The nurse needs to stay close to a client to do frequent assessments; sleep deprivation may occur, but it is not the primary concern when a client is in shock.

The nurse cares for a client living in a long-term care facility. The client has been prescribed furosemide 40 mg by mouth daily. When beginning this drug therapy, what are appropriate nursing actions? Select all that apply. A. Remove foods high in potassium from the client's meal trays. B. Provide meals low in sodium until the client's response is known. C. Ensure the client has easy access to a toilet or commode. D. Monitor the client's blood pressure frequently. E. Limit the client's fluid intake to 1 L/day.

C, D. The client is likely to need to void frequently; the nurse should facilitate this so that incontinent episodes or falls are prevented. As well, the client is at risk for hypotension, so blood pressure monitoring is necessary. Increasing potassium intake is beneficial, not harmful, and there is no direct need for a low-sodium diet. Fluid restriction is potentially dangerous and should not be used as a strategy for managing increased voiding.

Adrenergic drugs mimic the effects of stimulating what part of the nervous system? A. central B. parasympathetic C. sympathetic D. autonomic

C. An adrenergic drug is an agent that produces effects like those produced by stimulation of the sympathetic nervous system and therefore has widespread effects on body tissues. These drugs do not mimic the effect of the parasympathetic nervous system. The autonomic nervous system comprises the sympathetic and parasympathetic systems.

A client with significant burns develops shock and requires adrenergic drug therapy. The nurse interprets this as which type of shock? A. Cardiogenic-obstructive B. Septic C. Hypovolemic D. Neurogenic

C. Burns result in massive fluid losses, leading to hypovolemic shock. Cardiogenic-obstructive shock occurs when cardiac output is insufficient and perfusion to the vital organs cannot be maintained. Septic shock results from an overwhelming infection. Neurogenic shock occurs when there is an interference with the peripheral nervous system control of blood vessels such as with spinal cord injury.

When teaching a class about diuretics, a nursing instructor describes a class of drugs that increases the density of the filtrate in the glomerulus. Which medication would the instructor cite as an example? A. Metolazone B. Furosemide C. Mannitol D. Triamterene

C. Mannitol is an osmotic diuretic that exerts its diuretic effects by increasing the density of the filtrate in the glomerulus. Furosemide is a loop diuretic. Metolazone is a thiazide-like diuretic. Triamterene is a potassium-sparing diuretic.

A patient with a history of angina has sustained a mild head injury in a motor vehicle accident. He has nitroglycerin tablets for chest pain and asks the nurse for one due to chest pain. What effect will the nitroglycerin have on the patient's current status? A) Nitroglycerin will raise the patient's blood pressure B) Nitroglycerin will cause decreased cerebral edema C) Nitroglycerin will increase intracranial pressure D) Nitroglycerin will decrease blood glucose

C. Nitroglycerin should be used cautiously in the presence of a head injury or cerebral hemorrhage because it may increase intracranial pressure. Nitroglycerin will lower blood pressure. Nitroglycerin can increase cerebral edema. Nitroglycerin does not have a direct effect on blood glucose.

A client with septic shock has been administered norepinephrine IV. When assessing for therapeutic effect, the nurse will prioritize which assessment or diagnostic finding? A. white cell indices B. heart rhythm C. blood pressure D. level of consciousness

C. Norepinephrine is used to treat severe hypotension and shock that persists after adequate fluid volume replacement. The drug is recommended as the first-choice vasopressor for the management of sepsis and septic shock. Consequently, blood pressure assessment would be prioritized over other assessments such as heart rhythm, LOC, and laboratory values.

Your 69-year-old patient is started on IV dopamine for management of hypotension following open-heart surgery. As you care for the patient, you monitor him for adverse effects of the drug, including A. bradycardia. B. cyanosis. C. tachycardia. D. fever.

C. Potential adverse effects of dopamine include tachycardia, arrhythmia, and angina.

A patient is admitted to the hospital with hyperkalemia. The patient is prescribed sodium polystyrene sulfonate (Kayexalate). How does this medication lower the patient's potassium level? A) It decreases the absorption of exogenous potassium. B) It increases urinary excretion of potassium C) It combines with potassium ions for elimination in the stool. D) It releases sodium to acidify urine with potassium.

C. Sodium polystyrene sulfonate (Kayexalate), a cation exchange resin, administered orally, removes potassium from the body in the stool.

A nurse is aware that increased aldosterone is a major factor in the pathophysiology of heart failure. Which of the following medications reduces aldosterone-induced retention of sodium and water? A) Hydrochlorothiazide B) Enalapril maleate C) Spironolactone D) Losartan potassium

C. Spironolactone is an aldosterone antagonist that reduces aldosterone-induced retention of sodium and water and impaired vascular function.

A hospital patient with peripheral edema has been prescribed furosemide (Lasix). How should the nurse best determine the extent o f the patient's desired fluid loss? A) Assess the patient's skin turgor on a daily basis B) Test the osmolarity of the patient's urine regularly C) Weigh the patient daily D) Auscultate the patient's chest each morning

C. The nurse should measure and record weights to assist in determining the amount of mobilization of excess fluid. This is a more accurate gauge of changes in fluid status than skin turgor, urine osmolarity, or chest auscultation.

The nurse is caring for a client who is experiencing pulmonary edema. The client is treated with furosemide. What will the nurse monitor most closely? A. sodium levels B. calcium levels C. bone marrow function D. potassium levels

D. Furosemide is associated with a loss of potassium, so the client will need to be monitored carefully for low potassium levels, which could cause cardiac arrhythmias and further aggravate pulmonary edema. The nurse would not monitor sodium or calcium levels or bone marrow function because of the effects of the drug during the acute treatment of pulmonary edema.

A client with heart failure has developed acute shortness of breath and pulmonary edema. The nurse will prepare for administration of what medication and via what route? A. spironolactone PO B. combination spironolactone and furosemide PO C. mannitol IV D. furosemide IV

D. Furosemide is the drug of choice when significant, rapid diuresis is required, such as in cases of pulmonary edema. IV administration achieves the most rapid effect. PO combination medications are used for ongoing therapy rather than immediate intervention. Osmotic diuretics such as mannitol do not achieve sufficient diuresis in cases of pulmonary edema.

A patient has increased intracranial pressure and is ordered to receive a diuretic. Which of the following diuretics does not act on receptor sites to produce sinersis? A) Furosemid (Lasix) B) Hydrochlorothiazide (HCTZ) C) Spironolactone (Aldactone) D) Mannitol (Osmitrol)

D. Mannitol (Osmitrol) is an osmotic diuretic that increases the osmolarity of plasma and pulls water out of the tissues into the bloodstream. It does not act on receptor sites. Furosemide (Lasix) is a loop diuretic that inhibits the reabsorption of sodium and chloride in the loop of Henle. Hydrochlorothiazide is associated with drug interference with absorption of sodium ions across the distal renal tubule. Spironolactone acts by competing with aldosterone for cellular receptor sites.

A client began taking hydrochlorothiazide 1 week ago and is reporting occasional dizziness when standing up quickly from sitting or lying. What is the nurse's best action? A. Educate the client about the need for bed rest until the body adjusts to the new medication. B. Arrange for the client's potassium levels to be assessed as soon as possible. C. Tell the client to withhold the medication until the client can be assessed by the primary health care provider. D. Teach the client about the blood pressure effects of the medication and relevant safety measures.

D. Mild dizziness upon rapid position changes is expected as a result of lowered blood pressure. The nurse should teach the client about this phenomenon and associated falls prevention. This is more likely a result of hypotension than changes in potassium levels. Bed rest would not be necessary and causes many other potential health problems. The nurse should not tell the client to withhold the medication since there is no evidence of severe adverse effects or an emergency.

A client has been admitted to the emergency department with signs and symptoms of shock and the client's hypotension has not responded adequately to fluid volume replacement. The nurse will prepare to administer: A. digoxin. B. ivabradine C. sacubitril/valsartan D. norepinephrine.

D. Norepinephrine is used to treat severe hypotension and shock that persists after adequate fluid volume replacement. The other listed medications are normally administered to treat heart failure.

A client with renal impairment is in need of a diuretic. Because of the renal problem, potassium-sparing diuretics are contraindicated but may be used if there is no other option. If they are used at all, what nursing intervention would be most important for this client? A. Monitoring of CBC and serum albumin B. Administration of a thiazide diuretic C. Administration of concurrent potassium D. Monitoring of serum electrolytes, creatinine, and BUN

D. Potassium-sparing diuretics are contraindicated in clients with renal impairment because of the high risk of hyperkalemia. If they are used at all, frequent monitoring of serum electrolytes, creatinine, and BUN is needed.

A patient is prescribed a potassium-sparing diuretic. What electrolyte imbalance would the patient be prone to develop? A) Hypernatremia B) Hyponatremia C) Hypokalemia D) Hyperkalemia

D. Potassium-sparing diuretics may precipitate hyperkalemia. Potassium-sparing diuretics would not precipitate hypernatremia, hyponatremia, or hypokalemia.

A patient with a longstanding diagnosis of chronic renal failure has experienced a significant decline in urine output in recent days, prompting him to seek care at a local clinic. A nurse at the clinic has suggested to a colleague that the administration of a diuretic such as hydrochlorothiazide may improve the patient's urine output. How should the colleague best respond to this suggestion? A. That would probably help, but we'd have to do blood work first. B. Maybe, but hydrochlorothiazide affects the bladder more than the kidneys. C. That would only work if he could come in twice a day to get it intravenously. D. Actually, patients with renal failure usually can't take hydrochlorothiazide.

D. Renal disease and severe renal impairment contraindicate the use of hydrochlorothiazide. HCTZ affects the kidneys, not the bladder, and is not administered intravenously.

The nurse is caring for a client with hyperaldosteronism. For which diuretic would the nurse prepare teaching for the client? A. triamterene B. eplerenone C. amiloride D. spironolactone

D. Spironolactone, the most frequently prescribed potassium-sparing diuretic, is the drug of choice for treating hyperaldosteronism, a condition seen in cirrhosis of the liver and nephrotic syndrome of excessive output of aldosterone from the adrenal gland, leading to increased sodium and water retention and loss of potassium. Neither amiloride, eplerenone, nor triamterene are identified as being the drug of choice to treat hyperaldosteronism.

An older adult patient has a complex medical history that includes heart failure, type 1 diabetes, and diabetic nephropathy. The nurse has questioned a care provider's order for oral spironolactone because the patient's health problems would contribute to a high risk of A) metabolic acidosis B) hypocalcemia C) hemolytic anemia D) hyperkalemia

D. The presence of renal insufficiency is also a contraindication to the use of spironolactone because use of spironolactone may cause hyperkalemia through the inhibition of aldosterone and the subsequent retention of potassium. This patient does not face a greatly increased risk of anemia, hypocalcemia, or acidosis.