Cardiovascular I
The most important long-term goal for a client with hypertension would be to: a. Learn how to avoid stress. b. Explore a job change or early retirement. c. Make a commitment to long-term therapy. d. Lose weight.
c
The nurse is planning to administer hydrochlorothiazide to a client. The nurse understands that which is a concern related to the administration of this medication? A. Hypouricemia, hyperkalemia B. Increased risk for osteoporosis C. Hypokalemia, hyperglycemia, sulfa allergy D. Hyperkalemia, hypoglycemia, penicillin allergy
C
Which of the following drugs should not be coadministered with drugs that may cause hyperkalemia? a. Triamterene(dyrenium) b. Furosemide(Lasix) c. Hydrochlorothiazide(HCTZ) d. Ethacrynic acid(Edecrin)
A
Which of the following is a contraindicated for the use of mannitol (osmitrol)? a. Pulmonary edema b. Asthma c. Hypertension d. Diabetes
A
A nurse is providing patient education to a patient recently prescribed nitroglycerin for chest pain. The nurse knows the patient needs additional education when the patient tells the nurse: a) She will keep her tablets next to her while she lays out at the pool b) She will ensure that her husband, who takes erectile dysfunction medication, will not accidently take her nitroglycerine tablets c) She will place buccal tablets between her cheek and gum d) She will remove her patch for 10-12 hours in a 24hr period. A
A
A patient has a new Rx for metropolol and asks his nurse how it works to lower his blood pressure. The nurse knows that metropolol: a) Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. b) Increases norepinephrine secretion and thus decreases blood pressure and heart rate. c) Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. d) Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.
A
A patient is diagnosed with primary hypertension. When taking the patient's history, the healthcare provider anticipates the patient will report which of the following? a) "I have not noticed any significant changes in my health." b) "Sometimes I get pain in my lower legs when I take my daily walk." c) "Every once in a while I wake up at night covered in sweat." d) "I'm starting to get out of breath when I go up a flight of stairs."
A
All of these collaborative interventions are ordered by the health care provider for a patient stung by a bee who develops severe respiratory distress and faintness. Which one will the nurse administer first? a) Epinephrine (Adrenalin) b) Normal saline infusion c) Dexamethasone (Decadron) d) Diphenhydramine (Benadryl)
A
Furosemide is administered intravenously to a client with heart failure. How soon after administration should the nurse begin to see evidence of the drug's desired effect? a) 5-10 minutes b) 20-60 minutes c) 2-4 hours d) 6-8 hours
A
Thiazide diuretic may cause hypersensitivity in patients with a known history of a. Sulfa drugs b. Penicillin allergy c. Nasal polyps d. Asthma
A
The use of verapamil (Calan) is contraindicated in patients with heart failure due to: a) Tachycardia b) Negative inotropic effects c) Positive dromotrophic effects d) Fluid retention
Answer: B Verapamil is used for treatment of tachycardia-related arrhythmias. Calcium channel blockers, block calcium channels in the heart muscle and cause a negative inotropic effect, not positive. Fluid retention NOT related to heart failure is not a contraindication
A nurse is planning care for a client who is receiving furosemide (Lasix) for peripheral edema. Which of the following should the nurse include in the plan of care? (Select all that apply) A) Assess for tinnitus B) Report urine output of 50 ml/hr C) Monitor serum potassium levels D) Elevate the head of bed slowly before ambulation E) Recommend eating a banana daily
A, C, D, E
Labetolol primarily exerts its effects which adrenergic receptor: a) alpha 1 b) beta 2 c) beta 1 d) alpha 2
Answer: C. Labetolol is a beta blocker. Beta 1 receptors are located in the heart, where Beta 2 receptors are located in the lungs. Alpha 1 receptors stimulate and 2 receptors are not usually a target of pharmaceutical therapy.
Which substance acts as a hormone and a neurotransmitter in the CNS? a) epinephrine b) angiotensin c) acetylcholine d) norepinephine
Answer: D. Norepinephine and epinephrine hormones involved in the direct stimulation or inhibition of adrenergic receptors. NE is neurotransmitter in the CNS.
The nurse is preparing to administer a dose of clonidine (Catapres). Which is the best description of the action of this drug? a. It selectively activates alpha-2 receptors in the central nervous system (CNS) b. It causes peripheral activation of alpha-1 and alpha-2 receptors c. It depletes sympathetic neurons of norepinephrine d. It directly blocks alpha and beta receptors in the periphery
Answer: a. It selectively activates alpha-2 receptors in the central nervous system (CNS)
The nurse is caring for a patient receiving a nitroprusside (Nipride) intravenous infusion. The patient's wife asks why furosemide (Lasix) is being prescribed along with this drug. The nurse's best response is based on which concept? a. Furosemide will help reduce reflex tachycardia b. Many vasodilators cause retention of sodium and water c. Thiocyanate may accumulate in patients receiving nitropursside d. Vasodilators can cause serious orthostatic hypotension
Answer: b. Many vasodilators cause retention of sodium and water
Because of its effect on the heart, verapamil (Calan) should be used with extra caution in patietns with: a. hypertension b. tachycardia c. heart failure d. angina
Answer: c. heart failure Rationale: Calcium channel blockers such as verapamil are used cautiously in patients with heart failure because of the negative inotropic effects on cardiac muscle, which may precipitate or worsen heart failure
Captopril, an ACE-I, has been ordered for a patient. Which condition in the patient's history is a contraindication to this medication? a. hypokalemia b. dysrhythmias c. hypotension d. increased intracranial pressure
Answer: c. hypotension
A client has a history of heart failure and has been on furosemide, digoxin, and potassium chloride. The client has nausea, blurred vision, headache and weakness. The nurse notes that the client is confused. The telemetry strip shows first-degree atrioventricular block. The nurse should assess the client for signs of which of the following? a) hyperkalemia b) digoxin toxicity c) fluid deficit d) pulmonary edema
B
A client is prescribed losartan (Cozaar). The nurse teaches the client that an angiotensin II receptor blocker (ARB) acts by doing what? A. Inhibiting angiotensin-converting enzyme B. Blocking angiotensin II from AT1 receptors C. Preventing the release of angiotensin I D. Promoting the release of aldosterone
B
A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. What type of electrolyte imbalance does the nurse expect to occur? A) Hypocalcemia B) Hypokalemia C) Hyperkalemia D) Hypermagnesemia
B
A patient in septic shock has not responded to fluid resuscitation, as evidenced by a decreasing BP and cardiac output. The nurse anticipates the administration of a) nitroglycerine (Tridil). b) dobutamine (Dobutrex). c) norepinephrine (Levophed). d) sodium nitroprusside (Nipride).
B
A patient presents to the emergency department with a blood pressure of 180/130 mmHg, headache, and confusion. Which additional finding is consistent with a diagnosis of hypertensive emergency? a) Bradycardia b) Retinopathy c) Urinary retention d) Jaundice
B
Nitroprusside (Nitropress) is prescribed for a client admitted with a blood pressure of 220/110. What action by a new nurse would require intervention by the preceptor? a) The nurse cautions the client to call for assistance prior to getting out of bed b) The nurse uses electronic monitor of blood pressure every hour. c) The nurse documents IV rate and status of site every 15 minutes d) The nurse inserts a Foley catheter.
B
Nitroprusside (Nitropress) is the drug of choice in the management of a. Rebound hypotension b. Hypertensive crisis c. Rebound tachycardia d. Bradycardia
B
Patient education for female patients receiving ACE inhibitors or angiotensin II blocking agents must include a. Dietary restriction b. Potential harm to a fetus or an infant child c. Need for supplemental potassium d. Risk for increased menstrual bleeding
B
The nurse knows that which diuretic is most frequently combined with an antihypertensive drug? A. chlorthalidone B. hydrochlorothiazide C. bendroflumethiazide D. potassium-sparing diuretic
B
Tolterodine(Detrol) is used in the management of a. Peripheral edema b. Urinary incontinence c. Hypertension d. Head trauma
B
What will the nurse instruct the client to do to prevent the development of tolerance to nitroglycerin? A. Apply the nitroglycerin patch every other day. B. Switch to sublingual nitroglycerin when the client's systolic blood pressure elevates to more than 140 mm Hg. C. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night. D. Use the nitroglycerin patch for acute episodes of angina only.
C
Which client would the nurse need to assess first if the client is receiving mannitol (Osmitrol)? A. A 67-year-old client with type 1 diabetes mellitus B. A 21-year-old client with a head injury C. A 47-year-old client with anuria D. A 55-year-old client receiving cisplatin to treat ovarian cancer
C
Which intervention will the nurse perform when monitoring a client receiving triamterene (Dyrenium)? a. Assess urinary output hourly. b. Monitor for side effect of hypoglycemia. c. Assess potassium levels. d. Monitor for Hypernatremia.
C
A 35-year old patient is receiveing diuretic therapy. Which of the following assessments would best reflect the patients fluid volume? a) Blood pressure and pulse b) Serum potassium and sodium levels c) Intake, output, and daily weights d) Measurements of abdominal girth and calf circumference
C
A client with a subdural hematoma becomes restless and confused, with dilation of the ipsilateral pupil. The physician orders mannitol for which of the following reasons? a) To reduce intraocular pressure b) To prevent acute tubular necrosis c) To promote osmotic diuresis to decrease ICP d) To draw water into the vascular system to increase blood pressure
C
A client with a subdural hematoma becomes restless and confused, with dilation of the ipsilateral pupil. The physician orders mannitol for which of the following reasons? a) To reduce intraocular pressure b) To prevent acute tubular necrosis c) To promote osmotic diuresis to decrease ICP d) To draw water into the vascular system to increase blood pressure
C
A client with acute pulmonary edema receives furosemide (Lasix). What assessment finding indicates that the intervention is working? A. Potassium level decreased from 4.5 to 3.5 mEq/L. B. Crackles auscultated in the bases. C. Lungs clear. D. Output 30 mL/hr.
C
A nurse in an acute care facility is infusing IV nitroprusside for a client who is in hypertensive crisis. For which of the following adverse reactions should the nurse monitor this client? A. Intestinal ileus B. Neutropenia C. Delirium D. Hyperthermia
C
A nurse is caring for a client who is starting captopril (Capoten) for hypertension. For which of the following adverse effects should the nurse monitor the client? A. Hypokalemia B. Hypernatremia C. Neutropenia D. Anemia
C
A post-MI patient is started on an angiotensin converting enzyme (ACE) inhibitor during his hospital stay. Which of the following is the most common serious side effect that may occur? A) Non-productive cough B) Pedal edema C) Swelling of the tongue and face D) Rhinorrhea
C
Because of its effect on the heart, verapamil (Calan,Covera- HS, Isoptin SR, Verelan) should be used with extra caution or is contraindicated in patients with: a) Hypertension b) Tachycardia c) Heart failure d) Angina
C
Because of the action of captopril (capoen), which of the following electrolytes should be monitored? a. Calcium and chloride b. Chloride and sodium c. Potassium and sodium d. Magnesium and calcium
C
Serious potential adverse effects to eplerenone (Inspra) occur in the _____system. a. Respiratory b. Hematopoietic c. Cardiovascular d. Skeletal
C
Which intervention will the nurse perform when monitoring a client receiving triamterene (Dyrenium)? A) Assess urinary output hourly. B) Monitor for side effect of hypoglycemia. C) Assess potassium levels. D) Monitor for Hypernatremia
D
The nurse is monitoring a client who is taking propanolol (Inderal LA). Which assessment data indicates a potential serious complication associated with this medication? a. The development of complaints of insomnia b. The development of audible expiratory wheezes c. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication d. A baseline resting heart rate of 88 beats/minute followed by a resting heart rate of 72 beats/minute after two doses of the medication
Correct Answer: b; audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. Beta blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are excepted. Insomnia is a frequent mild side effect and should be monitored.
Which of the following effects of calcium channel blockers causes a reduction in blood pressure? a. Increased cardiac output b. Decreased peripheral vascular resistance c. Decreased renal blood flow d. Calcium influx into cardiac muscles
Correct Answer: b; by reducing PVR, the BP is reduced. D is incorrect because this drug blocks calcium from entering cardiac muscles
Which type of diuretic is composed of sugar? a) Thiazide diuretic: Hydrochlorothiazide b) Loop diuretic: Furosemide c) Potassium sparring diuretic: Triamterine d) Osmotic diuretic: Mannitol
D
A patient comes to the ER with a BP of 220/130. The provider orders nitroprusside (Nitropress). After administration, the patient experiences confusion and shortness of breath. The most appropriate nursing intervention is: a. Facilitate a relaxing environment for the patient, as confusion and anxiety are common side effects of this medication b. Administer oxygen to help decrease the patient's respiratory workload c. Notify the provider immediately d. Administer IV fluids
Correct Answer: c; the patient is likely experiencing cyanide toxicity.
A patient with hypertension is started on a new medication for treatment and is reporting a continuous dry cough. Which of the following medications do you suspect is causing the problem? a. Losartan b. Labetalol c. Hydrochlorothiazide d. Lisinopril
Correct Answer: d; an adverse effect of ACE inhibitors is a chronic dry cough
A patient with HTN receives a prescription for Eplerenone. The Nurse can judge that patient education has occurred when the patient states the following? (Select all that apply) a. This medication will take about 8 weeks for it to begin working b. I should avoid eating bananas while using this medication c. I should take this medication with meals d. I will need to have labs done periodically during therapy e. This medication works more effectively if I take it with grapefruit juice
Correct Answers: b, d; a is incorrect because medication takes 4 weeks for effectiveness; b: pt should avoid high-potassium foods and potassium supplements r/t risk of hyperkalemia; c: food does not affect absorption; d: potassium levels should be monitored periodically; e: grapefruit juice and St. John's Wort should be avoided while taking this medication because they affect bioavailability)
"Epinephrine reversal" could occur if epinephrine is administered in the presence of: A) cocaine B) imipramine C) propranolol D) phentolamine E) dopamine
D
. James, a 73 year old patient with atrial fibrillation, has been prescribed Amiodarone. What assessment for complications has the highest priority: a) monitor daily weights b) daily vision tests c) blood pressure q4 d) assess for changes in respiratory status
D
A patient is prescribed a thiazide diuretic for the treatment of hypertension. When teaching the patient about the medication, which of the following will the healthcare provider include? a) "Take this medication each day with a large glass of water after you evening meal." b) "I'll teach you how to teak your radial pulse before taking the medication." c) "Stop taking this mediation if you notice changes in how much you urinate." d) "Be sure to include a number of foods that are rich in potassium in your diet."
D
Nitroprusside is available in which of the following formulations? A) Capsules B) B) Sublingual Tablets C) Topical Ointment D) Intravenous Solution
D
The drug of choice to control premature ventricular contractions, ventricular tachycardia, or ventricular fibrillation is A. quinidine B. procainamide C. bretylium D. lidocaine
D
A major side effect of angiotensin-converting enzyme (ACE) inhibitors is intractable cough. The nurse recognizes which ethnic group to be at highest risk for this side effect? A. Asians B. Hispanics C. Native Americans D. Whites
Explanation: Answer A. Intractable dry cough is a common side effect of ACE inhibitors. It is thought to be related to the accumulation of kinins. Asians, especially those of Chinese descent have a high risk (15%-50%) for ACE inhibitor-related cough. Persons of African descent are also at high risk of developing cough and angioedema.
The nurse is planning to administer furosemide (Lasix) 40 mg IV directly. The nurse uses which of the following techniques in administering this medication? a. Pushes the medication rapidly b. Gives the medication slowly diluted in 50 mL of NS c. Injects the medication slowly over two to three minutes d. Dilutes the medication with sterile water and inject over five minutes
RATIONALE: C. Most IV medications should be injected slowly. Rapid injection of furosemide can cause hearing loss as a result of ototoxicity. It does not need to be further diluted before injection
Bethanechol chloride (Urecholine) is prescribed for a patient with urinary retention. Which disorder would be a contraindication to this medication? a. Gastric atony b. Urinary strictures c. Neurogenic atony d. Gastroesophageal reflux
RATIONALE: B. Bethanechol can be hazardous to patients with urinary obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder, thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract can rupture the bladder in patients with these conditions
The nurse is planning to administer hydrochlorothiazide to a patient. The nurse understands that which is a concern related to the administration of this medication? a. Hypouricemia, hyperkalemia b. Increased risk of osteoporosis c. Hypokalemia, hyperglycemia, sulfa allergy d. Hyperkalemia, hypoglycemia, penicillin allergy
RATIONALE: C. Thiazide diuretics such as hydrochlorothiazide are sulfa based medications and a patient with a sulfa allergy is at risk for an allergic reaction. Also, patients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia
A nurse is planning dietary counseling for the client taking triamterene (Dyrenium). The nurse plans to include which of the following in a list of foods that are acceptable? a. baked potato b. bananas c. oranges d. pears canned in water
RATIONALE: D. Triamterene is a potassium-sparing diuretic, and clients taking this medication should be cautioned against eating foods that are high in potassium, including many vegetables, fruits, and fresh meats. Because potassium is very water-soluble, foods that are prepared in water are often lower in potassium
Your patient has a new order for hydrochlorothiazide, however upon examination of the patient's chart, which finding would indicate you holding the medication and calling the physician? a. The patient has an allergy to sulfa drugs b. The patient has had hypertension for the past 15 years c. The patient has recently begun an exercise program d. The patient is female and African American
a
What is the purpose of antiarrhythmic drugs? A. To change the flow of blood through the heart B. To substitute for implantable cardioverter defibrillators C. To prevent, suppress, or treat a disturbance in cardiac rhythm D. To increase or decrease the contractility of the heart muscle
c
A 72 yo patient has been prescribed sublingual nitroglycerin PRN for chest pain. You recognize that all of the statements by the patient indicate understanding of the drug EXCEPT: A. After 5 minutes, I can chew the pill. B. I won't drink coffee or tea while the pill is in my mouth. C. I will place the pill in the pouch between my cheek and gum. D. I can take one tablet every 5 minutes, up to 3 tablets in 15 minutes.
a
The drug of choice for treating increased intracranial pressure is: a. Mannitol b. Hydrochlorothiazide c. Furosemide d. Tolterodine
a
Which of the following adverse effects may occur with all antihypertensive medications a. Orthostatic hypotension b. Hypokalemia c. Hyperkalemia d. Hypovolemia
a
Which of the following patients should be monitored carefully while receiving lidocaine therapy? A. Henry, with migraine headaches B. Calvin, with hypothyroidism C. Molly, with congestive heart failure D. Leslie, with diabetes
c
. The nurse is caring for a client receiving digoxin (Lanoxin). Which of the following manifestations correlate with a digoxin level of 2.3 ng/dl? Select all that apply. A. Nausea B. Drowsiness C. Photophobia D. Increased appetite E. Increased energy level F. Seeing halos around bright objects
a, b, c, f
Your patient is to begin a regimen of propranolol, a beta blocker, for treatment of cardiac arrhythmia. Before administering the first dose of the drug, the nurse should assess the patient's health status and confirm that the patient does not have: A. Hypertension B. Angina C. Asthma D. All of the above
c
Furosemide has the potential to cause a. Nephrotoxicity b. Otoxocity c. Hepatotoxicity d. Cardiotoxicity
b
Why would it be necessary to use caution when giving metoprolol to a diabetic? a. It raises blood sugar b. It masks the signs of hypoglycemia c. It can likely cause palpitations in diabetics d. It inhibits the activity of insulin
b
Your patient begun treatment with a diuretic a few weeks ago. You would be sure to check which of the following patient's lab values before administering? a. CBC b. Electrolyte levels c. HgbA1c d. Liver Enzymes
b
Your patient has been prescribed eplerenone and you are educating the patient on the drug. Which of the following should be included in the teaching? a. Increase intake of green leafy vegetables b. Avoid salt substitutes that contain potassium c. Avoid dairy products d. Make sure to take it concurrently with spironolactone (Aldactone)
b
ACE inhibitors are associated with which unique adverse effect? a. Hyperkalemia b. Hypotension c. Cough d. Peripheral edema
c
Amiodarone is labeled for use only in the treatment of documented life-threatening recurrent ventricular arrhythmias because of its: A. Prohibitive cost B. Extremely long half-life C. Potentially adverse effects D. Ability to interact with any other medication
c
Mr. Brown takes sublingual nitroglycerine PRN for chest pain. Which drug may produce hypotension if taken in combination with nitro? A. Losartan B. Verapamil C. Sildenafil D. Metoprolol
c
Mr. Smith has been experiencing tolerance to transdermal nitroglycerin. Which of the following suggestions would be appropriate? A. You should change the patch every 24 hours. B. You should only use the patch at the first sign of chest pain. C. You should remove the patch when you go to bed and put on a new patch in the morning. D. You should only use sublingual tablet from now on.
c
A nurse is assessing a bedridden client and notes sacral edema. The nurse determines that the edema is most likely the result of which of the following? A. Diabetes mellitus B. Pulmonary emboli C. Chronic kidney failure D. Right-sided heart failure
d
Monitor for signs of hyperkalemia when administering which drug? a. Furosemide b. Hydrochlorothiazide c. Mannitol d. Triameterine
d
Which of the following drug classes should be administered to a client with heart failure to maximize cardiac performance? A. Beta-adrenergic blockers B. Calcium channel blockers C. Diuretics D. Inotropic agents
d
A client has been taking lisinopril (Prinivil) for 3 months. The client complains to the nurse of a persistent dry cough that began about 1 month ago. The nurse interprets that which is the most likely reason for the client's complaint? a) Caused by neutropenia as a result of therapy b) Caused by a concurrent upper respiratory infection c) An expected, though bothersome, side effect of therapy d) An indication that the client will show signs of heart failure
Rationale: A frequent side effect of therapy with any of the ACE inhibitors, such as lisinopril, is the appearance of a persistent, dry cough. The cough generally does not improve while the client is taking the medication. Clients are advised to notify the health care provider if the cough becomes very troublesome to them.
A client is prescribed captopril. What adverse effect should the client be instructed on that can occur with angiotensin-converting enzyme (ACE) inhibitors? Persistent cough Tachycardia Rash Sedation
Rationale: A persistent cough can develop with the use of ACE inhibitors like captopril. Sedation, tachycardia, and rash are not generally associated as adverse effects of ACE inhibitors
A client is receiving an ACE inhibitor. The nurse ensures that the client's hydration status is maintained to prevent what adverse effect? Cardiac arrhythmias Excessive hypotension Renal failure ACE inhibitor toxicity
Rationale: Any condition that might lead to a drop in fluid volume could lead to excessive hypotension.
The nurse is caring for a patient who is receiving furosemide (Lasix) and an aminoglycoside antibiotic. The nurse will be most concerned if the patient reports which symptom? Dizziness Dysuria Nausea Tinnitus
. Rationale: Ototoxicity and even deafness have been reported with these drugs, but the loss of hearing is usually reversible after the drug is stopped. The rapid loss of fluid can result in hypotension and dizziness if it causes a rapid imbalance in fluid levels.
What is the most important ongoing assessment while IV nitroprusside is infusing? a) Blood pressure monitoring b) EKG pattern c) Fluid balance d) Urinary output
A
The emergency department nurse is asked to prepare a nitroprusside (Nitropress) infusion for a patient being brought to the hospital in an ambulance. The nurse knows this drug is only used in what circumstances? A) Hypertensive emergencies B) Hypertension in a patient having a myocardial infarction C) Hypertension complicated by symptoms of a stroke D) Hypertension associated with diabetic ketoacidosis
Ans: A- Hypertensive emergencies Rationale: Most of the vasodilators are reserved for use in severe hypertension or hypertensive emergencies. These include hydralazine, minoxidil, and nitroprusside. The presence of absence of a comorbidity does not increase the likelihood of use. These drugs are used when blood pressure is extremely high and needs to be reduced quickly.
A patient has been prescribed losartan (Cozaar) for hypertension. What patient teaching points will the nurse include about this drug include? A) Report onset of a cough or fever to health care provider. B) Limit fluid intake to decrease urinary output. C) Monitor blood pressure once a week. D) Take the drug late in the day to prevent sleepiness.
Ans: A- Report onset of a cough or fever to health care provider. Rationale: Losartan is an angiotensin II receptor blocker that is associated with a cough, back pain, fever, muscle weakness, and upper respiratory tract infections, so the patient should be taught to report a fever or cough to his health care provider. Fluid intake should be normal, and the drug is best taken in the morning. Blood pressure should be monitored daily, especially when first starting the drug when adverse effects are not yet known.
After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states A) "I need to take the drug on an empty stomach." B) "I need to make sure I don't eat too many high potassium foods." C) "I can still use my salt substitute if I want to." D) "I should take the medicine around dinner time for the best effect"
Ans: B- "I need to make sure I don't eat too many high potassium foods." Rationale: the drug is a potassium sparing diuretic placing the patient at risk for hyperkalemia, especially if the patient consumes foods high in potassium. The patient should take the medication in the morning to prevent interfering with sleep by having to get up at night to void. The patient can take the drug with meals if GI upset occurs. Many salt substitutes contain potassium, which could increase the patient's risk for hyperkalemia
The nurse is caring for a patient with hypertension who is preparing to be discharged from the hospital after suffering a myocardial infarction. What drug might the nurse administer that will both treat his hypertension and reduce myocardial oxygen consumption? A) Captopril B) Losartan C) Diltiazem D) Nitroprusside
Ans: C- Diltiazem Rationale: Diltiazem inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells, depressing the impulse and leading to slowed conduction, decreased myocardial contractility, and dilation of arterioles, which lowers blood pressure and decreases myocardial oxygen consumption. Captopril, losartan, and nitroprusside do not have actions to reduce myocardial oxygen consumption.
After teaching a group of nursing students about diuretics, the instructor determines that the teaching was successful when the group identifies which as a loop diuretic? A) Hydrochlorothiazide B) Spironolactone C) Furosemide D) Acetazolamide
Ans: C- Furosemide Rationale: Hydrochlorothiazide is a thiazide diuretic. Acetazolamide is a carbonic anhydrase inhibitor. Spironolactone is a potassium-sparing diuretic.
The nurse administers an IV phosphodiesterase inhibitor. What drug will result in forming a precipitate if given via the same IV line without adequate flushing? A) Albuterol (Proventil) B) Nifedipine (Procardia) C) Furosemide (Lasix) D) Lovastatin (Mevacor)
Ans: C- Furosemide (Lasix) Rationale: Furosemide, when given with a phosphodiesterase inhibitor, forms precipitates; therefore, this combination should be avoided. Use alternate lines if both of these drugs are being given IV. There are no known drug-to-drug interactions with albuterol, nifedipine, or lovastatin.
The nurse is planning to administer hydrochlorothiazide to a client. The nurse should monitor for which adverse effects related to the administration of this medication? A) Hypouricemia, hyperkalemia B) Increased risk of osteoporosis C) Hypokalemia, hyperglycemia, sulfa allergy D) Hyperkalemia, hypoglycemia, penicillin allergy
Ans: C- Hypokalemia, hyperglycemia, sulfa allergy Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.
patient taking diltiazem (Cardizem) for hypertension has come to the clinic for a follow-up appointment. What adverse effects would the nurse assess the patient for? A) Chest pain and pale skin B) Shortness of breath and wheezing C) Peripheral edema and bradycardia D) Tachycardia and increased energy level
Ans: C- Peripheral edema and bradycardia Rationale: Cardiovascular adverse effects of diltiazem include bradycardia, peripheral edema, and hypotension. Skin flushing and rash may occur. There should be no effect on the lungs and usually this drug causes fatigue rather than increased energy levels.
A patient taking a calcium channel blocker is seen in the clinic and diagnosed with drug toxicity. When collecting the nursing history, what finding would indicate the likely cause of this drug toxicity? A) Intake of alcohol B) The use of eggs in the diet C) The ingestion of grapefruit juice D) Intake of aged cheese
Ans: C- The ingestion of grapefruit juice Rationale: The calcium channel blockers are a class of drugs that interact with grapefruit juice. When grapefruit juice is present in the body, the concentrations of calcium channel blockers increase, sometimes to toxic levels. Advise patients to avoid drinking grapefruit juice taking a calcium channel blocker. If a patient on a calcium channel blocker reports toxic effects, ask whether he or she is drinking grapefruit juice. Use of alcohol could be important if the patient was ingesting large amounts, but that would not be the most likely cause of drug toxicity. Eggs and cheese should not exert any food drug interaction
What does the clinic nurse anticipate as initial drug therapy for a 39-year-old African American man who is 25 pounds overweight and newly diagnosed with hypertension? A) An ACEI B) A Beta-blocker C) A calcium channel blocker D) A diuretic
Ans: D- A calcium channel blocker Rationale: African Americans are at highest risk for developing hypertension with men more likely than women to develop the disease. African Americans have documented differences in response to antihypertensive therapy. They are most responsive to single-drug therapy and diuretics. The first line use of a diuretic is in combination with diet and other lifestyle changes. The use of a calcium channel blocker and/or alpha-adrenergic blocker should follow. African Americans are less responsive to ACE inhibitors and beta-blocker.
The nurse is assessing a client who is being treated with a beta-adrenergic blocker. Which assessment findings would indicate that the client may be experiencing dose-related side effects of the medication? Select all that apply. A. Dizziness B. Bradycardia C. Chest pain D. Reflex tachycardia E. Sexual dysfunction F. Cardiac dysrhythmias
Answer: A,B,E; Beta-adrenergic blockers, commonly called beta blockers, are useful in treating cardiac dysrhythmias, mild hypertension, mild tachycardia, and angina pectoris. Side effects commonly associated with beta blockers are usually dose related and include dizziness (hypotensive effect), bradycardia, hypotension, and sexual dysfunction (impotence). Options 3, 4, and 6 are reasons for prescribing a beta blocker; however, these are general side effects of alpha-adrenergic blockers.
A client has been prescribed metoprolol for hypertension. The nurse monitors client compliance carefully because of which common side effect of the medication? A. Impotence B. Mood swings C. Increased appetite D. Complete atrioventricular (AV) block
Answer: A; A common side effect of beta-adrenergic blocking agents, such as metoprolol, is impotence. Other common side effects include fatigue and weakness. Central nervous system side effects occur rarely and include mental status changes, nervousness, depression, and insomnia. Mood swings, increased appetite, and complete AV block are not reported side effects.
The nurse performs an assessment on a client with a history of heart failure who has been taking diuretics on a long-term basis. The nurse reviews the medication record, knowing that which medication, if prescribed for this client, would place the client at risk for hypokalemia? A. Bumetanide B. Triamterine C. Spironolactone D. Hydrochlorothiazide
Answer: A; Bumetanide is a loop diuretic. The client on this medication would be at risk for hypokalemia. Triamterene, spironolactone, and hydrochlorothiazide are potassium-retaining diuretics.
A client has received a prescription for lisinopril. The nurse teaches the client that which frequent side effect may occur? A. Cough B. Polyuria C. Hypothermia D. Hypertension
Answer: A; Cough is a frequent side effect of therapy with any of the angiotensin-converting enzyme (ACE) inhibitors. Fever is an occasional side effect. Proteinuria is another common side effect, but polyuria is not. Hypertension is the reason to administer the medication rather than a side effect.
A client being treated for heart failure is administered IV bumetanide (Bumex). Which outcome indicates that the medication has achieved the expected effect? a) Cough becomes productive of frothy pink sputum b) Urine output increases from 10 ml/hour to greater than 50 ml hourly c) The serum potassium level changes from 3.8 to 3.1 mEq/L d) B-type natriuretic peptide (BNP) factor increases from 200 to 262 pg/ml.
Answer: B Rationale: Bumetanide is a diuretic and expected outcomes include increased urine output, decreased crackles, and decreased weight
The nurse correlates the amount of urine production after administration of a diuretic with the amount of ________ reabsorption that is blocked. A. Glucose B. Sodium C. Calcium D. Potassium
Answer: B Rationale: Most diuretics share the same basic mechanism of action: blockade of sodium and chloride reabsorption. By blocking the reabsorption of these solutes, diuretics create osmotic pressure within the nephron that prevents the passive reabsorption of water. The increase in urine flow that a diuretic produces is directly related to the amount of sodium and chloride reabsorption that it blocks. Diuretics cause water and solutes to be retained within the nephron and thereby promote the excretion of both water and sodium
The nurse is planning to administer hydrochlorothiazide to a client. The nurse should monitor for which adverse effects related to the administration of the medication? a) Hypouricemia, hyperkalemia b) Increased risk of osteoporosis c) Hypokalemia, hyperglycemia, sulfa allergy d) Hyperkalemia, hypoglycemia, penicillin allergy
Answer: C Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, hyperuricemia
The nurse is monitoring a client who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this medication? a) The development of complaints of insomnia b) The development of audible expiratory wheezes c) A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication d) A baseline resting heart rate of 88 beats/minute followed by a resting heart rate of 72 beats/minute after 2 doses of the medication
Answer: B. Rationale: Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasms. Beta blockers may induce this reaction, particularly in clients with COPD or asthma. Normal decreases in BP and HR are expected. Insomnia is a frequent mild side effect and should be monitored
A client has been taking lisinopril for 3 months. The client reports to the nurse a persistent dry cough that began about 1 month ago. The nurse interprets that the most likely reason for the client's complaint is what? A. Neutropenia as a result of therapy B. An expected side effect of therapy C. Undiagnosed existence of heart failure D. A concurrent upper respiratory infection
Answer: B; A frequent side effect of therapy with any of the angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril, is the appearance of a persistent, dry cough. The cough generally does not improve while the client is taking the medication. Clients are advised to notify the primary health care provider if the cough becomes very troublesome to them. The other options are incorrect interpretations.
The client is prescribed sotalol 80 mg orally twice daily. Which assessment finding indicates that the client is experiencing an adverse effect of the medication? A. Dry mouth B. Palpitations C. Diaphoresis D. Difficulty swallowing
Answer: B; Sotalol is a beta-adrenergic blocking agent that may be prescribed to treat chronic angina pectoris. Adverse effects include palpitations, bradycardia, an irregular heartbeat, difficulty breathing, signs of heart failure, and cold hands and feet. Gastrointestinal disturbances, anxiety and nervousness, and unusual tiredness and weakness can also occur. Options 1, 3, and 4 are not adverse effects of this medication.
The nurse teaches the patient who has hypokalemia caused by diuretic therapy to increase intake of which food? A. Milk B. Lean meats C. Bananas D. Aged meats/cheeses
Answer: C Rationale: Potassium is lost through increased secretion in the distal nephron. If serum Potassium falls below 3.5, fatal dysrhythmias may result. The consumption of potassium-rich foods (ex. Dried fruits, nuts, spinach, citrus fruits, potatoes, bananas) can help prevent or treat hypokalemia.
A client with heart failure and secondary hyperaldosteronism is started on spironolactone (Aldactone) to manage this disorder. The nurse informs the client that the need for dosage adjustment may be necessary if which medication is also being taken? a) Alprazolam (Xanax) b) Warfarin sodium (Coumadin) c) Potassium chloride (Klor-Con) d) Verapamil hydrochloride (Calan SR)
Answer: C Rationale: Spironolactone is a potassium-retaining diuretic. If the client is also taking potassium chloride or another potassium supplement, the risk for hyperkalemia exists. Potassium doses would need to be adjusted while the client is taking this medication
A client has a new prescription for timolol and the nurse provides medication instructions to the client. Which statement by the client indicates a need for further teaching regarding the instructions? A. I should change positions slowly B. I need to report shortness of breath to the doctor C. I need to taper or discontinue the medication when I feel well D. I have enough medication on hand to last through weekends and vacations
Answer: C; Timolol is a beta-adrenergic blocking agent. The client should not discontinue or change the medication dose. Common client teaching points about beta-adrenergic blocking agents include taking the pulse daily, holding it if the rate is less than 60 beats/min (and notifying the primary health care provider); changing positions slowly; and reporting shortness of breath. The client is also instructed to keep enough medication on hand, not take over-the-counter medications (especially decongestants, cough, and cold preparations) without consulting the primary health care provider, and carry medical identification that states that a beta-blocker is being taken.
The nurse is providing instructions to a client regarding Captopril. The nurse should give which instruction to the client? a) Take the medication with food only. b) Expect a therapeutic effect immediately c) Discontinue the medication if nausea occurs. d) Rise slowly from a lying to a sitting position.
Answer: D Rationale: Captopril is an ACE inhibitor. It is used in the treatment of hypertension. The client should be instructed to rise slowly from a lying to sitting position and permit the legs to dangle from the bed momentarily before standing to reduce the hypotensive effect.
A client has been taking furosemide (Lasix) for the past week. The nurse recognizes which finding may indicate the client is experiencing a negative side effect from the medication? A. Weight gain of 5 lbs B. Edema of ankles C. Gastric irritability D. Loss of hearing
Answer: D Rationale: Ototoxicity and even deafness have been reported with these drugs, but the loss of hearing is usually reversible after the drug is stopped. This may be an effect of the electrolyte changes on the conduction of fragile nerves in the central nervous system.
The nurse has developed a teaching plan about side effects for the client taking spironolactone (Aldactone). Which psychological side effect of the medication should the nurse base the teaching plan? a) Edema b) Hair loss c) Alopecia d) Decreased libido
Answer: D Rationale: The nurse should be aware of the fact that the client taking spironolactone may experience body image changes that result from threatened sexual identity. These are related to decreased libido, gynecomastia in males, and hirsutism in females. Edema and hair loss are not associated with this medication.
A client has been taking a prescribed calcium channel blocker therapy for approximately 2 months. The home care nurse monitoring the effects of therapy should determine that drug tolerance has developed if which is noted in the client? A. Decrease in weight B. Increased joint pain C. Output greater than intake D. Gradual rise in blood pressure
Answer: D; Drug tolerance can develop in a client taking an antihypertensive such as a calcium channel blocker, which is evident by rising blood pressure levels. The primary health care provider should be notified, who may then increase the medication dosage, change medication, or add a diuretic to the medication regimen. The client is also at risk of developing fluid retention, which would be manifested as dependent edema, intake greater than output, and an increase in weight. This would also warrant adding a diuretic to the course of therapy. Joint pain is not associated with this form of tolerance.
The nurse should give which medication instructions to the client prescribed quinapril hydrochloride? A. Take the medication with food only B. Expect a therapeutic effect immediately C. Discontinue the medication if nausea occurs D. Rise slowly from a lying to a sitting position
Answer: D; Quinapril hydrochloride is an angiotensin-converting enzyme (ACE) inhibitor. It is used in the treatment of hypertension. The client should be instructed to rise slowly from a lying to sitting position and to permit the legs to dangle from the bed momentarily before standing to reduce the hypotensive effect. The medication does not need to be taken with meals. It may be given without regard to food. A full therapeutic effect may be noted in 1 to 2 weeks. If nausea occurs, the client should be instructed to take a noncola carbonated beverage and salted crackers or dry toast.
The nurse is developed a teaching plan for a client prescribed spironolactone. On which psychosocial side effect of the medication should the nurse base the teaching plan? A. Edema B. Hair loss C. Weight loss D. Decreased libido
Answer: D; The nurse should be aware of the fact that the client taking spironolactone, a potassium-sparing diuretic, may experience body image changes that result from a threatened sexual identity. These are related to decreased libido, gynecomastia in males, and hirsutism in females. Edema, weight loss, and hair loss are not specifically associated with the use of this medication.
Initiation of early management in a client with severe sepsis is essential. The goals are to improve organ perfusion and prevent the progression to septic shock. Which of the following is not consistent with these objectives? a. Vasopressor administration b. Vasodilator administration c. Administration of intravenous fluid boluses d. Administration of antibiotics within 1 hour of recognition
Correct Answer: b; infection and sepsis are caused by microorganisms; early antibiotic administration is fundamental to ameliorate the infection. In sepsis, vasodilation reduces blood flow to vital organs. Maintaining blood pressure and blood flow to vital organs is essential, and therefore a vasodilator would not be administered. Intravenous fluid administration is needed to increase blood volume. A vasopressor can increase blood pressure through vasoconstrictor effects given that fluid administration does not achieve adequate blood pressure
A nurse is caring for a client receiving acetazolamide (Diamox). Which assessment finding will require immediate nursing intervention? a. A decrease in bicarbonate level b. An increase in urinary output c. A decrease in arterial pH d. An increase in PaO2
Correct Answer: c; acetazolamide (Diamox) causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat metabolic alkalosis, edema, seizures, and acute glaucoma. A decrease in blood pH would indicate that the client was becoming more acidotic.
A client is placed on dobutamine, a positive inotropic agent. The nurse determines that the desired outcome for administering this drug has been reached when which response is noted? a. Decreased heart rate b. Increased preload c. Increased cardiac output d. Decreased afterload
Correct Answer: c; positive inotropes increase myocardial contractility and therefore increase cardiac output
Which intervention will the nurse perform when monitoring a client receiving spironolactone? a. Assess urinary output hourly. b. Monitor for side effect of hypoglycemia. c. Assess potassium levels. d. Monitor for Hypernatremia.
Correct Answer: c; spironolactone is a potassium-sparing diuretic. The nurse should monitor potassium for potential hyperkalemia.
The Nurse understands that aliskiren (Tekturna) is a medication approved for the treatment of HTN. The nurse explains to the patient that this medication works by: a. Preventing calcium ions from entering the heart b. Stimulating receptors in the body that promote dilation of the arteries c. Causing rapid diuresis d. Inhibiting an enzyme that regulates the body's blood pressure
Correct Answer: d; this agent directly inhibits renin
A patient asks a nurse what the main differences are between Eplerenone and spironolactone (Aldactone). The nurse is correct to state which of the following? (Select all that apply) a. While spironolactone (Aldactone) acts on specific receptors on the body, Eplerenone acts on several different receptors in the body b. Both agents impose a risk of Hyperkalemia c. Spironolactone (Aldactone) may cause a patient's voice to become high-pitched d. Adverse reactions are not commonly seen in patients taking Eplerenone
Correct Answers: b, d; a: this should be in reverse, eplerenone is selective for aldosterone and spironolactone (Aldactone) is non-selective; c: spironolactone (Aldactone) may cause deepening of the voice); d: this drug is generally well tolerated, but serious side effects are possible (esp. hyperkalemia)
A patient has a heart rate of 34 BPM, blood pressure of 76/48 mmHg, and complains of dizziness and blurred vision. The nurse must prepare to emergently administer which medication? A. Atropine B. Epinephrine C. Dobutamine Dopamine
Explanation: Answer A. Atropine is the only drug listed that is used for symptomatic bradycardia by increasing heart rate and conduction velocity. Hypotension, dizziness, and blurred vision are all symptoms of bradycardia.
A male client with hypertension was prescribed amlodipine. Which of these adverse effects is most important to teach the client to watch for? A. Erectile dysfunction B. Dizziness C. Dry cough D. Leg edema
Explanation: Answer B. CCB's are vasodilators used to treat hypertension and chronic stable angina. They promote relaxation of vascular smooth muscles leading to decreased systemic vascular resistance and arterial blood pressure. The most important adverse effects of CCB's include dizziness, flushing, headache, peripheral edema, and constipation. The reduced blood pressure may initially cause orthostatic hypotension. The client should be taught to change positions slowly to prevent falls.
. The health care provider has prescribed spironolactone to be given in addition to hydrochlorothiazide to a client with hypertension. Which finding by the nurse would indicate that the new medication is having the desired effect? A. Blood glucose of 95 mg/dL B. Potassium level of 4.2 mEq/L C. Reduction in dizziness D. Sodium level of 138 mEq/L
Explanation: Answer B. Spirinolactone is a potassium-sparing diuretic. In general, these are very weak diuretics and antihypertensives and are used mainly in combination with thiazide diuretics to reduce potassium (K+) loss. The K+ level of 4.2 mEq.L would indicate that this medication has been effective in preventing hypokalemia in a client receiving a thiazide diuretic such as hydrochlorothiazide or chlorthalidone.
To evaluate whether the administration of an antihypertensive medication has caused a therapeutic effect, which action should the nurse implement? A. Ask the client about the onset of any dizziness since taking the medication. B. Measure the client's blood pressure while the client is lying, sitting, and then standing. C. Compare the client's blood pressure before and after the client takes the medication. D. Interview the client about any past or recent history of high blood pressure.
Explanation: Answer C. Antihypertensive medications are administered to lower blood pressure, so to determine if the effects have been achieved, the nurse should compare the client's blood pressure before and after the client takes the medication. Options A and B provide data related to the side effect of hypotension, which may occur following the administration of an antihypertensive medication. Option D provides useful data but does not evaluate the medications effectiveness.
An African American client comes to the clinic for a follow-up visit 2 months after starting enalapril for hypertension. Which data collected during the health history should be reported to the health care provider immediately? A. Blood pressure taken in the clinic is 158/84 mm Hg B. Client has a dry hacking cough C. Client has noticed that the tongue is swelling slightly Client has occasional dizziness upon rising in the morning
Explanation: Answer C. Swelling of the tongue can be a sign of angioedema. It often starts in the face and then progresses to the airways, which can be life-threatening. The nurse should report this immediately to the HCP.
A client is started on lisinopril therapy. Which assessment finding requires immediate action? A. Blood pressure 129/80 mm Hg B. Heart rate 100/min C. Serum creatinine 2.5 mg/dL D. Serum potassium 3.5 mEq/L
Explanation: Answer C. The dosage of ACE inhibitors should be adjusted for clients with renal impairment. A serum creatinine of 2.5 indicates renal impairment. The nurse should notify the health care provider so that the dosage can be decreased or held.
A nurse in the cardiac intermediate care unit is caring for a client with acute decompensated heart failure. The client also has a history of coronary artery disease and peripheral vascular disease. The nurse is preparing to administer medications. Based on the assessment data, the nurse should question which medication? A. Aspirin B. Atorvastatin C. Furosemide D. Metoprolol
Explanation: Answer D. Beta blockers are the mainstay of therapy for clients with chronic heart failure as these improve survival rates for both systolic and diastolic heart failure. However, in certain situations beta blockers can worsen heart failure by decreasing normal compensatory sympathetic nervous system responses and myocardial contractility.
A client with chronic heart failure developed an intractable cough and an incident of angioedema after starting enalapril. Which prescription does the nurse anticipate for this client? A. Alprazolam B. Dextromethorphan C. Lisinopril D. Valsartan
Explanation: Answer D. For clients that are unable to tolerate ACE inhibitors, ARBs such as valsartan or losartan are recommended. ARBs prevent the vasoconstrictor and aldosterone-secreting effects of angiotensin II by binding to the angiotensin II receptor sites.
A nurse is preparing to administer 160 mg of furosemide via IV piggyback to a client with chronic kidney disease and fluid overload. The nurse plans to give the dose slowly over 40 minutes to prevent which adverse effect? A. Bradycardia B. Hypokalemia C. Nephrotoxicity Ototoxicity
Explanation: Answer D. IV furosemide may cause ototoxicity, particularly when high doses are administered in clients with compromised renal function. The rate of administration should not exceed 4 mg/min in doses >120 mg.
Captopril therapy has a potentially adverse effect of neutropenia. When taking captopril, which patient would be at the greatest risk for developing this side effect? Angela, who is in her first trimester of pregnancy Mark, who is suffering from impaired renal function Hilda, who is showing symptoms of chronic cough Karl, who is showing symptoms of angioedema confined to the face and lip
Rationale: Because the patient suffers from impaired renal function, the nurse must closely monitor Mark for neutropenia, the most common side effect in such patients. Also at risk are patients with heart failure and collagen vascular diseases. Neutropenia generally resolves quickly after captopril is discontinued. Captopril should be administered cautiously to patients who are showing symptoms of chronic cough or angioedema. If the patient becomes pregnant while taking captopril, therapy should be discontinued as soon as possible. However, such patients do not face as much of a risk of neutropenia as patients with impaired renal function.
What would be a contraindication to the use of carbonic anhydrase inhibitors? Cataracts Fluid volume excess Active infection Allergy to sulfonamides
Rationale: Carbonic anhydrase inhibitors are sulfonamides, and as such are contraindicated in patients who have an allergy to sulfonamides. Cataracts and infections do not prevent their use. Fluid volume excess would be an indication, not a contraindication.
A client is prescribed a thiazide diuretic that is to be administered intravenously. Which agent would this most likely be? Methylchlorothiazide Hydroflumethiazide Hydrochlorothiazide Chlorothiazide
Rationale: Chlorothiazide is administered orally or intravenously. The other agents are administered orally.
A client is receiving a diuretic as the first-line treatment of mild hypertension. The nurse monitors the client for signs and symptoms of hypokalemia with which agent? Spironolactone Hydrochlorothiazide Triamterene Amiloride
Rationale: Hydrochlorothiazide is a thiazide diuretic that promotes the loss of sodium as well as potassium from the body. Subsequently, the client is at risk for hypokalemia. Amiloride, spironolactone, and triamterene are potassium-sparing diuretics. The client using these diuretics would need to be monitored for hyperkalemia because potassium is not lost along with sodium.
An African-American client with hypertension is receiving lisinopril. What is the nurse's priority assessment? Airway patency Skin integrity Serum electrolyte levels Nutritional status
Rationale: Lisinopril is associated with airway obstruction and it occurs more commonly in African-Americans; airway patency is always top priority. GI irritation and upset, also rash and photosensitivity can occur but is not the highest priority. Pancytopenia is also a problem that can occur and will require close monitoring; altered serum electrolyte levels are not associated with lisinopril use.
The patient has been placed on a nitroprusside drip for the treatment of a hypertensive crisis. Which mechanism of action does the nurse know is true for nitroprusside? It blocks the action of angiotensin II from all the different pathways where it is formed, not just the single substrate altered by ACE inhibitors It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins It binds selectively to the mineralocorticoid receptors It inhibits the movement of calcium ions across cell membranes
Rationale: Nitroprusside, which is used in hypertensive crisis, directly relaxes vascular smooth muscle, allowing the dilation of peripheral arteries and veins. Angiotensin II receptor blockers block the action of angiotensin II from all the different pathways where it is formed, not just the single substrate altered by ACE inhibitors. Selective aldosterone blockers bind selectively to the mineralocorticoid receptors, thereby blocking aldosterone from binding to these receptors, while calcium channel blockers inhibit the movement of calcium ions across cell membranes.
A client has been diagnosed with hypertension and will begin taking valsartan. What safety education should the nurse provide? "Avoid foods that are high in potassium and avoid salt substitutes, which often have potassium in them." "Try to avoid standing up too quickly until you know how the drug affects you." "You'll need to avoid drinking grapefruit juice while you're taking this medication." "You'll need to have blood drawn to ensure that the drug is at a safe level in seven days."
Rationale: Valsartan, like most antihypertensives can cause syncope and dizziness resulted from lower blood pressure. The client should be cautious when beginning the medication in order to avoid falls. Grapefruit juice and other sources of potassium are not contraindicated. Follow up blood work is not necessary.
What is the most serious adverse effect of nitroprusside? a) Cyanide toxicity b) Skin rash c) Nausea d) Irritation around IV needle
A
Lozartan(cozaar) , and angiotensin II blocking agent, works by blocking the a. Conversion of angiotensin I to angiotensin II. b. Release of renin c. Binding of angiotensin I to angiotensin II d. Symphatetic response to alpha-I receptors.
A
A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the nurse should perform and document what assessments? A. Oxygen saturation & respiratory rate B. Heart rate & blood pressure C. Level of consciousness & pain level D. Temperature & respiratory rate
B
Carbonic anhydrase inhibitors are primarily used for what? a) GI stimulant b) Chronic open angle glaucoma c) Overactive bladder d) Edema
B
Before administering hydralazine (Apresoline), it is most important for the nurse to obtain which assessment? a. Peripheral pulses b. Homan's sign c. Blood pressure d. Capillary refill
Answer: c. Blood pressure
The nursing is providing education for a patient who has been prescribed losartan (Cozaar), an angiotensin II receptor blocker (ARB). The patient demonstrates understanding of the teaching when she states a. "If I become pregnant, I will continue to take the medication." b. "I will eat more foods that contain potassium to reduce the risk of adverse effects." c. "I will stop taking the medication if I have diarrhea." d. "I will not use salt substitutes."
Answer: d. "I will not use salt substitutes." Rationale: Salt substitutes often contain potassium, which increases the risk of hyperkalemia when taking losartan. Pregnancy and breast-feeding are contraindications for losartan. Patients should not increase their intake of potassium while taking losartan. Diarrhea is a common adverse reaction of losartan
The nurse is caring for a patient receiving hydralazine (Apresoline). The primary care provider prescribes propranolol (Inderal). The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? a. To reduce the risk of headache b. To improve hypotensive effects c. To prevent heart failure d. To protect against reflex tachycardia
Answer: d. To protect against reflex tachycardia
After suffering an acute myocardial infarction (MI), a client with a history of type 1 diabetes is prescribed metroprolol (Lopressor) IV. Which nursing interventions are associated with IV metroprolol administration? a. Monitor glucose levels closely. b. Monitor for heart block and bradycardia. c. Monitor blood presure closely d. b and c e. All of the above
Answer: e. All of the above Rationale: Metoprolol can cause alterations in blood glucose levels. Metoprolol has adverse reactions that include heart block, bradycardia, and hypotension
The client newly prescribed with Losartan (Cozaar) tells the nurse that this medication has made him feel dizzy in the morning. Which of the following would be an appropriate response by the nurse? a) Take this medication during lunchtime to decrease the symptoms b) This is a side effect of the medication, sit down for awhile before standing up in the morning or slowly change positions to prevent lightheaded. c) Stop taking this medication whenever you feel dizzy and prop your feet up with one pillow underneath. d) Do not take the medication on days that you feel lightheaded.
B
The health care provider is planning to discontinue a client's beta blocker. What instruction should the nurse give the client regarding the beta blocker? A. The beta blocker should be abruptly stopped when another cardiac drug is prescribed. B. The beta blocker should NOT be abruptly stopped; the dose should be tapered down. C. The beta blocker dose should be maintained while taking another antianginal drug. D. Half the beta blocker dose should be taken for the next several weeks.
B
The nurse recognizes that calcium channel blockers prescribed for the treatment of angina exert their effect by: a) Increasing preload b) Decreasing afterload c) Positive chronotropic effect d) Positive inotropic effect
B
The patient is taking tolterodine (Detrol). The nurse should teach the patient to report which condition? a) Alkaline urine b) Urinary retention c) Excessive tearing d) Reddish orange urine
B
What is the best information for the nurse to provide to the client who is receiving spironolactone (Aldactone) and furosemide (Lasix) therapy? a) "Moderate doses of two different diuretics are more effective than a large dose of one." b)"This combination promotes diuresis but decreases the risk of hypokalemia." c) "This combination prevents dehydration and hypovolemia." d) "Using two drugs increases the osmolality of plasma and the glomerular filtration rate."
B
What steps must be taken when administering an osmotic diuretic, mannitol? a) Place on ice directly before administering. b) Warm to body temperature and use an in-line filter to draw up the medication. c) Food must be administered with the medication. d) A full glass of water should be consumed at this time.
B
The nurse determines that further education is needed for a patient receiving the antihypertensive medication, Verapamil, when the patient states he is trying to eat healthier and adding new foods and drinks to his diet. He stated he will eat which of the following for breakfast: A) Omelet & coffee B) Oatmeal, coffee & a banana C) Omelet, toast & grapefruit juice D) Oatmeal, & prune juice
C
The nurse is aware that which group(s) of antihypertensive drugs are less effective in African-American clients? a) Diuretics b) Calcium channel blockers and vasodilators c) Beta blockers and ACE inhibitors d) Alpha blockers
C
A patient with hypertension is to take an angiotensin II receptor blockers (ARB). What information related to the need to stop the medication should the nurse plan to include when teaching the client about this medication? Select all that apply. a. Monitor BP daily b. Avoid the use of NSAIDs c. Stop treatment if a cough develops d. Stop the medication if swelling of the mouth, lips, or face develops e. Have blood drawn for potassium levels 2 weeks after starting the medication
Correct Answers: d, e; important nursing considerations for patients taking ARBs include assessing for signs of CHF, angioedema, and hyperkalemia.
A patient was admitted from the emergency department after receiving treatment for dysrhythmias and will be started on amiodarone (Cordarone, Pacerone) because of lack of therapeutic effects from his other antidysrhythmic therapy. When the nurse checks with him in the afternoon, he complains of feeling lightheaded and dizzy. The nurse will first assess: A. Whether there is the possibility of sleep deprivation from the stress of admission to the hospital B. Whether an allergic reaction is occurring with anticholinergic-like symptoms C. Whether the amiodarone level is not yet therapeutic enough to treat the dysrhythmias D. Whether the patient's pulse and blood pressure are within normal limits
D
The nurse is caring for a client with hypertension who is prescribed Clonidine transdermal preparation. What is the correct information to teach this client? A) Change the patch daily at the same time. B) Remove the patch before taking a shower or bath. C) Do not take other antihypertensive medications while on this patch. D) Get up slowly from a sitting to a standing position.
D
The results of an adult patient's blood pressure screening on three occasions are: 120/80 mmHg, 130/76 mmHg, and 118/86 mmHg. How will the healthcare provider interpret this information? a) Normal blood pressure b) Hypertension stage 2 c) Hypertension stage 1 d) Prehypertension
D
The teaching plan for a client being started on long acting nitroglycerin includes the action of this drug. The nurse teaches that this drug relieves chest pain by which action? A. Dilating just the coronary arteries B. Decreasing the blood pressure C. Increasing contractility of the heart D. Dilating arteries and veins
D
When discussing hypertension with a student, which of the following will the healthcare provider identify as a factor related to hypertension? a) Hypovolemia b) Decreased cardiac output c) Hypervolemia d) Increased afterload
D
