EXAM 2 End of Chapter Questions

The patient receiving heparin therapy asks how the "blood thinner" works. What is the best response by the nurse?

"Heparin does not thin the blood but prevents clots from forming as easily in the blood vessels."

The patient is being discharged with nitroglycerin (Nitrostat) for sublingual use. While planning patient education, what instruction will the nurse include?

"Put one tablet under your tongue for chest pain. If pain does not subside, call 911."

The community health nurse is working with a patient taking simvastatin (Zocor). Which patient statement may indicate the need for further teaching about this drug?

"I take my pill with grapefruit juice. I've always taken my medications that way."

The patient is prescribed digoxin (Lanoxin) for treatment of heart failure. Which statement by the patient indicates the need for further teaching?

"This drug should cure my heart failure."

A patient diagnosed with pernicious anemia is to start cyanocobalamin (Nascobal) injections. Which patient statements demonstrates an understanding of the nurse's teaching? (Select all that apply.)

- "I will need to take this drug for the rest of my life." - "I may be able to switch over to nasal sprays once my vitamin B12 levels are normal."

What health teaching should the nurse provide for a patient receiving diltiazem (Cardizem)? Select all that apply.

- Avoid driving or performing other activities requiring mental alertness until the effects of the drug are known. - Maintain adequate fluid and fiber intake to facilitate stool passage. - Report weight gain of 2 kg (5 lb) per week. - Rise slowly from prolonged periods of sitting or lying down.

A patient has been on long-term therapy with colestipol (Colestid). To prevent adverse effects related to the length of therapy and lack of nutrients, which supplements may be required? (Select all that apply.)

- Folic acid - Vitamins A, D, E, and K

The nurse is instructing a patient on home use of niacin and will include important instructions on how to take the drug and about its possible adverse effects. Which of the following may be expected adverse effects of this drug? (Select all that apply.)

- Intense flushing and hot flashes - Tingling of the fingers and toes

The patient admitted for heart failure has been receiving hydrochlorothiazide (Microzide). Which laboratory levels should the nurse carefully monitor? (Select all that apply.)

- Potassium - Sodium - Uric acid

An older adult patient diagnosed with iron-deficiency anemia will be taking ferrous sulfate (Feosol). The nurse will teach which of the required administration guidelines to the patient? (Select all that apply.)

- Take the tablets on an empty stomach if possible. - Increase fluid intake and increase dietary fiber while taking this medication. - If liquid preparations are used, dilute with water or juice and sip through a straw placed in the back of the mouth.

What patient education should be included for a patient receiving enoxaparin (Lovenox)? (Select all that apply.)

- Teach the patient or caregiver to give subcutaneous injections at home. - Teach the patient or caregiver not to take any over-the-counter drugs without first consulting with the healthcare provider. - Teach the patient to observe for unexplained bleeding, such as pink, red, or dark brown urine or bloody gums. - Teach the patient to monitor for the development of deep vein thrombosis.

Which factor in the patient's history would cause the nurse to question a medication order for atropine?

A 65-year-old man with benign prostatic hyperplasia

The nurse is preparing a plan of care for a patient with myasthenia gravis. Which outcome statement would be appropriate for a patient receiving a cholinergic agonist such as pyridostigmine (Mestinon) for this condition? The patient will exhibit:

A decrease in muscle weakness, ptosis, and diplopia.

A patient with heart failure has an order for lisinopril (Prinivil, Zestril). Which condition in the patient's history would lead the nurse to confirm the order with the provider?

A history of angioedema after taking enalapril (Vasotec)

Darbepoetin (Aranesp) is ordered for each of the following patients. The nurse would question the order for which condition?

A patient with hypertension

A patient is receiving cholestyramine (Questran) for elevated low-density lipoprotein (LDL) levels. As the nurse completes the nursing care plan, which adverse effects will be included for continued monitoring?

Abdominal pain

A patient with deep vein thrombosis is receiving an infusion of heparin and will be started on warfarin (Coumadin) soon. While the patient is receiving heparin, what laboratory test will provide the nurse with information about its therapeutic effects?

Activated partial thromboplastin time (aPTT)

A patient with a congenital coagulation disorder is given aminocaproic acid (Amicar) to stop bleeding following surgery. The nurse will carefully monitor this patient for development of which adverse effects? (Select all that apply.)

Anaphylaxis Headache Hypotension

A patient with a history of heart failure will be started on spironolactone (Aldactone). Which drug group should not be used, or used with extreme caution in patients taking potassium-sparing diuretics?

Angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers

Which action by the nurse is most important when caring for a patient with chronic kidney disease who has an order for furosemide (Lasix)?

Assess urine output and renal laboratory values for signs of nephrotoxicity.

The patient has been given a prescription of hydrochlorothiazide (Microzide) as an adjunct to treatment of hypertension and returns for a follow-up check. Which is the most objective data for determining the therapeutic effectiveness of the furosemide?

Blood pressure log notes blood pressure 120/70 mmHg to 134/88 mmHg since discharge

Propranolol (Inderal) has been ordered for a patient with hypertension. Because of adverse effects related to this drug, the nurse would carefully monitor for which adverse effect?

Bradycardia

A patient is receiving a thrombolytic drug, alteplase (Activase), following an acute myocardial infarction. Which effect is most likely attributed to this drug?

Bruising and epistaxis

Which of the following clinical manifestations may indicate that the patient taking metolazone (Zaroxolyn) is experiencing hypokalemia?

Cardiac dysrhythmias

The patient taking benztropine (Cogentin) should be provided education on methods to manage which common adverse effect?

Constipation

Older adult patients taking bethanechol (Urecholine) need to be assessed more frequently because of which adverse effect?

Dizziness

The nurse is caring for a patient with chronic hypertension. The patient is receiving losartan (Cozaar) daily. Which patient manifestations would the nurse conclude is an adverse effect of this medication? (Select all that apply.)

Dizziness Hypoglycemia Angioedema

The patient is receiving hydralazine with isosorbide (BiDil) for heart failure. The nurse should monitor this patient for:

Dizziness and rapid heart rate

The patient who has not responded well to other therapies has been prescribed milrinone (Primacor) for treatment of his heart failure. What essential assessment must the nurse make before starting this drug?

Electrolytes, especially potassium

The patient or caregiver of a patient taking neostigmine (Prostigmin) should be taught to be observant for which adverse effect that may signal a possible overdose has occurred?

Excessive sweating, salivation, and drooling

The nursing plan of care for a patient receiving oprelvekin (Neumega) should include careful monitoring for symptoms of which adverse effect?

Fluid retention

When planning to teach the patient about the use of epoetin alfa (Epogen, Procrit), which instructions would the nurse give?

Frequent rest periods should be taken to avoid excessive fatigue.

A patient has been ordered gemfibrozil (Lopid) for hyperlipidemia. The nurse will first validate the order with the healthcare provider if the patient reports a history of which disorder?

Gallbladder disease

Which assessment findings in a patient who is receiving atenolol (Tenormin) for angina would be cause for the nurse to hold the drug and contact the provider? (Select all that apply.)

Heart rate of 50 beats/minute Blood pressure 86/56

Lisinopril (Prinivil) is part of the treatment regimen for a patient with heart failure. The nurse monitors the patient for the development of which adverse effects of this drug? (Select all that apply.)

Hyperkalemia Cough Dizziness

The healthcare provider prescribes epinephrine (Adrenalin) for a patient who was stung by several wasps 30 minutes ago and is experiencing an allergic reaction. The nurse knows that the primary purpose of this medication for this patient is to:

Increase a declining blood pressure and dilate constricting bronchi associated with anaphylaxis.

The patient is to begin taking atorvastatin (Lipitor) and the nurse is providing education about the drug. Which symptom related to this drug should be reported to the healthcare provider?

Increasing muscle or joint pain

Following administration of phenylephrine (Neo-Synephrine), the nurse would assess for which adverse drug effects?

Insomnia, nervousness, and hypertension

The nurse is caring for a patient with chronic stable angina who is receiving isosorbide dinitrate (Isordil). Which of the following are common adverse effects of isosorbide?

Light-headedness and dizziness

The patient is taking atenolol (Tenormin) and doxazosin (Cardura). What is the rationale for combining two antihypertensive drugs?

Lower doses of both drugs may be given with fewer adverse effects.

A patient is started on atenolol (Tenormin). Which is the most important action to be included in the plan of care for this patient related to this medication?

Monitor apical pulse and blood pressure.

A patient who is taking an adrenergic-blocker for hypertension reports being dizzy when first getting out of bed in the morning. The nurse should advise the patient to:

Move slowly from the recumbent to the upright position.

Anticholinergics may be ordered for which conditions? (Select all that apply.)

Peptic ulcer disease Bradycardia Irritable bowel syndrome

Nifedipine (Procardia XL) has been ordered for a patient with hypertension. In the care plan, the nurse includes the need to monitor for which adverse effect?

Reflex tachycardia

Nitroglycerin patches have been ordered for a patient with a history of angina. What teaching will the nurse give to this patient?

Remove the old patch and wait 6-12 hours before applying a new one.

While planning for a patient's discharge from the hospital, which teaching points would be included for a patient going home with a prescription for chlorothiazide (Diuril)?

Report muscle cramping or weakness to the healthcare provider.

What health teaching should the nurse provide for the patient receiving nadolol (Corgard)?

Rise slowly after prolonged periods of sitting or lying down.

The nurse is providing teaching to a patient who has been prescribed furosemide (Lasix). Which of the following should the nurse teach the patient?

Rise slowly from a lying or sitting position to standing.

The teaching plan for a patient receiving hydralazine (Apresoline) should include which point?

Rising slowly to standing from a lying or sitting position

A patient with significant hypertension unresponsive to other medications is given a prescription for hydralazine. An additional prescription of propranolol (Inderal) is also given to the patient. The patient inquires why two drugs are needed. What is the nurse's best response?

The hydralazine may cause tachycardia and the propranolol will help keep the heart rate within normal limits.

Erectile dysfunction drugs such as sildenafil (Viagra) are contraindicated in patients taking nitrates for angina. What is the primary concern with concurrent administration of these drugs?

They also decrease blood pressure through vasodilation and may result in prolonged and severe hypotension when combined with nitrates.

A patient has started clopidogrel (Plavix) after experiencing a transient ischemic attack. What is the desired therapeutic effect of this drug?

To reduce the risk of a stroke from a blood clot

To avoid the first-dose phenomenon, the nurse knows that the initial dose of prazosin (Minipress) should be:

Very low and given at bedtime.

To best monitor for therapeutic effects from filgrastim (Granix, Neupogen), the nurse will assess which laboratory finding?

White blood cell or absolute neutrophil counts