Exam 2 P/P - Medications

The client diagnosed with CHF is prescribed enalapril. Which statement explains the scientific rationale for administering this medication? 1. Enalapril increases the levels of angiotensin II in the blood vessels. 2. Enalapril dilates arteries, which reduces the workload of the heart. 3. Enalapril decreases the effects of bradykinin in the body. 4. Enalapril blocks the intervention of antidiuretic hormone in the kidney.

1. ACE inhibitors decrease the level of angiotensin in the body by blocking the conversion from angiotensin I to angiotensin II. 2. Enalapril (Vasotec) is an ACE inhibitor. By reducing the levels of angiotensin II, ACE inhibitors dilate blood vessels, reduce blood volume, and prevent or reverse angiotensin II pathological changes in the heart and kidneys. 3. ACE inhibitors increase bradykinin levels. 4. ACE inhibitors have no effect on the intervention of the antidiuretic hormone.

The HCP prescribed an angiotensin-converting enzyme (ACE) inhibitor for a client diagnosed with CHF. Which instruction should the nurse provide? 1. "Eat a banana or drink orange juice at least twice a day." 2. "Notify the HCP if you develop localized edematous areas that itch." 3. "Expect to have a dry cough early in the morning on arising." 4. "Your symptoms of CHF should improve rapidly."

1. ACE inhibitors have a side effect of hyperkalemia. The client should not be encouraged to eat potassium-rich foods. 2. A condition with localized edematous areas (wheals), accompanied by intense itching of the skin and mucous membranes, is called angioedema. This is an adverse reaction to an ACE inhibitor and should be reported to the HCP. 3. An intractable dry cough is a reason for discontinuing the ACE inhibitor and should be reported to the HCP. 4. Symptomatic improvement may take weeks to months to develop for a client diagnosed with CHF.

The client diagnosed with stage D CHF has a brain natriuretic peptide (BNP) level greater than 1,500. Which medication should the nurse anticipate the HCP prescribing? 1. Captopril orally 2. Digoxin IV push (IVP) 3. Dobutamine IV 4. Metoprolol orally

1. Captopril (Capoten) is an ACE inhibitor. ACE inhibitors should be prescribed for clients diagnosed with diabetes, hyperlipidemia, and HTN when in stage A heart failure. 2. Digoxin (Lanoxin), a cardiac glycoside, is prescribed in stage C heart failure. 3. Dobutamine (Dobutrex), a synthetic catecholamine, is given for short-term IV therapy for clients in stage D CHF and is preferred to dopamine because it does not increase vascular resistance. Dobutamine increases myocardial contractility and cardiac output. 4. Metoprolol (Lopressor) is a beta blocker. Beta blockers are prescribed in stage C heart failure. The client may not see any improvement of symptoms, but research has demonstrated that beta blockers can prolong life even without clinical improvement.

The client at the outpatient clinic was diagnosed with folic acid deficiency anemia and given a sample of oral folic acid. At the follow-up visit, the nurse assessed the client to determine effectiveness of the treatment. Which data indicates the treatment is effective? 1. The client has gained 2 pounds and has pink buccal mucosa. 2. The client does not have any paresthesia of the hands and feet. 3. The client stopped drinking any alcoholic beverages. 4. The client can tolerate eating green, leafy vegetables.

1. Clinical manifestations of folic acid deficiency include pallor, pale mucous membranes, fatigue, and weight loss. Weight gain and pink buccal mucosa indicate improvement in the client's condition and effective medication. 2. Paresthesia of the hands and feet is a symptom of vitamin B12, not folic acid, deficiency. Lack of neurological symptoms is the differentiating factor used to diagnose folic acid deficiency because the anemias share most other clinical manifestations. 3. A leading cause of folic acid deficiency anemia is chronic alcoholism, but abstaining from alcohol would not indicate the anemia is better. 4. The client should be encouraged to eat green, leafy vegetables, but tolerance of foods does not indicate medication effectiveness. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

The 28-year-old client diagnosed with sickle cell disease (SCD) has been admitted to the medical unit for a vaso-occlusive crisis. Which intervention should the nurse implement first? 1. Elevate the head of the client's bed. 2. Administer a narcotic analgesic. 3. Apply oxygen via nasal cannula. 4. Initiate intravenous fluids.

1. Elevating the head of the client's bed would assist with dyspnea, but would not help the client's pain, which is the priority, along with reversing the sickling process. 2. Pain medication is administered intravenously; therefore, the first intervention would be to initiate IV fluids and then administer pain medication. 3. Oxygen is usually administered, but the best method of promoting oxygenation is the reversal of sickling, which is accomplished by administering IV fluids. 4. IV fluids help reverse the sickling process, which is the priority. This reversal will relieve the pain and increase the oxygenation to the cells.

The client diagnosed with arterial HTN is receiving furosemide. Which data indicates the medication is effective? 1. The client's 8-hour intake is 1,800 mL, and the output is 2,300 mL. 2. The client's blood pressure went from 144/88 to 154/96. 3. The client has had a weight loss of 1.3 kg in 7 days. 4. The client reports occasional lightheadedness and dizziness.

1. Furosemide (Lasix) is a loop diuretic. The client has had 500 mL (2,300 - 1,800 = 500) excess urinary output. This indicates the medication is effective—the diuretic is causing an increase in urinary output. 2. Blood pressure has increased; therefore, the medication is not effective. 3. A weight loss of 1.3 kg (2.6 pounds) in 7 days would not indicate a loss of fluid, it could be a loss of fat. Remember, 1,000 mL equals about 1 kg (2.2 pounds). 4. These are findings of orthostatic hypotension and do not indicate the medication is effective. MEDICATION MEMORY JOGGER: The nurse determines a medication's effectiveness by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

The nurse is teaching the client diagnosed with angina about sublingual nitroglycerin (NTG). Which statement indicates the client needs more medication teaching? guidance? 1. "I will always carry my nitroglycerin in a dark-colored bottle." 2. "If I have chest pain, I will put a tablet underneath my tongue." 3. "If my pain is not relieved with one tablet, I will get medical help." 4. "I should expect to get a headache after taking my nitroglycerin."

1. If the NTG, a coronary vasodilator, is not kept in a dark-colored bottle, it will lose its potency. This statement shows the client's understanding of the medication teaching and that more teaching on that topic is not necessary. 2. Sublingual NTG is placed under the client's tongue when chest pain first occurs. The client understands the teaching. 3. The client should put one tablet under the tongue every 5 minutes and, if the chest pain is not relieved after taking three tablets, the client should seek medical attention. This statement indicates the client needs more teaching about the medication. 4. NTG causes vasodilation and will cause a headache. The client understands this.

The client diagnosed with angina and prescribed NTG tells the nurse, "I don't understand why I can't take my sildenafil. I need to take it so that I can make love to my partner." Which statement is the nurse's best response? 1. "If you take the medications together, they may cause you to have very low blood pressure." 2. "You are worried your partner will be concerned if you cannot make love?" 3. "If you wait at least 8 hours after taking your nitroglycerin, you can take your sildenafil." 4. "You should get clarification with your HCP about taking sildenafil."

1. Life-threatening hypotension can result from concurrent NTG and sildenafil (Viagra), a peripheral vasodilator erectile agent. 2. This is a therapeutic response, which is inappropriate because the nurse must make sure the client understands the importance of not taking the medications together. 3. The client should not take sildenafil (Viagra) within 24 hours of taking nitrates. Still, the client should be instructed not to take sildenafil (Viagra) while taking Nitrobid, a vasodilator, an oral medication taken daily. 4. The nurse should provide the client with correct medication information and not rely on the HCP for medication teaching.

Which medication should the nurse question administering? 1. Lisinopril to a client with a blood pressure of 118/84 2. Carvedilol to a client with an apical pulse of 62 3. Verapamil to a client diagnosed with angina 4. Furosemide to a client reporting leg cramps

1. Lisinopril (Zestril) is an ACE inhibitor. The blood pressure is above 90/60, so there is no reason for the nurse to question administering an ACE inhibitor in this situation. 2. Carvedilol (Coreg) is a beta blocker. The apical pulse is above 60 bpm, so the nurse would not question administering a beta blocker in this situation. 3. Verapamil (Calan) is a CCB. CCBs are prescribed to treat angina, so there is no reason for the nurse to question the medication. 4. Furosemide (Lasix) is a loop diuretic. Leg cramps may indicate a low blood potassium level. The nurse should hold the medication until the potassium level can be checked. Loop diuretics cause the kidneys to excrete potassium. Hypokalemia can cause life-threatening dysrhythmias.

The nurse is preparing to administer a calcium channel blocker, a loop diuretic, and a beta blocker to a client diagnosed with arterial HTN. Which intervention should the nurse implement? 1. Hold the medication and notify the HCP on rounds. 2. Check the client's pulse and blood pressure. 3. Contact the pharmacist to discuss the medications. 4. Double-check the HCP's orders.

1. Many clients diagnosed with HTN are prescribed multiple medications to help decrease blood pressure. There is no need to hold the medication or notify the HCP. 2. These medications all work on different parts of the body to help decrease the client's blood pressure. The nurse should realize the HCP is having difficulty controlling the client's blood pressure and should monitor the client's blood pressure before administering. 3. Multiple antihypertensive medications are prescribed to help control a client's blood pressure; therefore, the nurse would not need to contact the pharmacist. 4. The nurse should not question administering multiple antihypertensive medications that work on different parts of the body. This is an accepted standard of care.

The nurse is caring for a client diagnosed with sickle cell disease (SCD). Which medication would the nurse question? 1. Morphine sulfate IVP 2. Fentanyl patch 3. Epoetin subcutaneously (SQ) 4. Piperacillin and tazobactam combination medication IVPB

1. Morphine is a narcotic analgesic. The nurse would not question administering morphine to a client subject to painful infarcts of organs and infiltrations of the joints. 2. Fentanyl (Duragesic) is a narcotic agonist. The nurse would not question administering a sustained-release medication for pain to a client subject to painful infarcts of organs and infiltrations of the joints. 3. Epoetin (Procrit) is a biological response modifier. It stimulates the bone marrow to produce RBCs (erythropoiesis). The client diagnosed with SCD produces RBCs that "sickle," increasing the levels of hemoglobin S. The client does not need more RBCs; therefore, the nurse would question administering this medication. 4. Piperacillin and tazobactam (Zosyn) is an antibiotic combination. Clients diagnosed with SCD may go into a crisis situation for several reasons, including dehydration and infection. The nurse would not question an antibiotic. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for disease processes and conditions. If the nurse administers a medication the HCP has prescribed, and it harms the client, the nurse could be held accountable. Remember, the nurse is a client advocate.

The client is diagnosed with folic acid deficiency anemia and Crohn's disease. Which medication should the nurse anticipate being prescribed? 1. Oral folic acid 2. Cyanocobalamin intramuscularly 3. B complex vitamin therapy orally 4. Intramuscular folic acid

1. Oral folic acid preparations are administered to clients diagnosed with a folic acid deficiency with no malabsorption problem, such as Crohn's disease. 2. A vitamin B12 (Cyanocobalamin) deficiency is not the problem for this client. 3. B complex vitamins are not folic acid. 4. Crohn's disease is the second most common cause of folic acid deficiency anemia. Crohn's disease is a malabsorption syndrome of the small intestines. The client must receive the medication via the parenteral route.

The client with gastric bypass surgery asks the nurse, "Why do I need to take vitamin B12 injections?" Which statement is the nurse's best response? 1. "You have pernicious anemia, and the injections will cure the problem." 2. "Your body cannot absorb the vitamins from the food you eat." 3. "Because of the surgery, you cannot eat enough food to get the amount you need." 4. "You will need to take the injections daily until your body begins to make B12."

1. Pernicious anemia is a disease caused by the body's lack of intrinsic factor needed to absorb vitamin B12 from ingested food. There is no cure for the disease; there is only treatment with cyanocobalamin, vitamin B12. This client has not been identified as having pernicious anemia. 2. The rugae in the stomach produce intrinsic factor, which is necessary for the absorption of vitamin B12 from the food eaten. A gastric bypass surgery eliminates much of the surface area of the stomach and rugae, so the client cannot absorb vitamin B12. The client will need to replace vitamin B12, which is needed for RBC production. 3. The problem is not in the amount of food eaten; it is the lack of rugae in the stomach lining. 4. Injections are given on a weekly or monthly schedule depending on the severity of the vitamin deficit. The body does not make vitamin B12 on its own; it absorbs the vitamin from ingested foods.

The nurse in the HCP's office is completing an assessment on a client prescribed digoxin for CHF. Which data indicates the medication has been effective? 1. The client's sputum is pink and frothy. 2. The client has 2+ pitting edema of the sacrum. 3. The client's breath sounds bilateral are clear. 4. The client's heart rate is 78 bpm.

1. Pink, frothy sputum indicates that the client's lungs are filling with fluid. This indicates the client's condition is becoming worse. 2. Pitting edema of the sacrum would be seen in clients on bedrest. This is a symptom of CHF and would only indicate the client is getting better if the client had 3+ or 4+ edema initially. 3. Digoxin (Lanoxin) is a cardiac glycoside. Clear lung sounds bilaterally indicate the treatment is effective. The nurse assesses for the clinical manifestations of the disease for which the medication is being administered. If the symptoms are resolving, then the medication is effective. 4. The client's heart rate must be 60 bpm or above to administer digoxin safely, but the heart rate does not indicate the client diagnosed with CHF is getting better.

The nurse is administering 0900 medications to the following clients. Which client should the nurse question administering the medication? 1. The client receiving a calcium channel blocker (CCB) after drinking grapefruit juice 2. The client receiving a beta blocker with an apical pulse of 62 beats per minute (bpm) 3. The client receiving a NTG patch with a blood pressure of 148/92 4. The client receiving an antiplatelet medication with a platelet count of 150,000

1. The client receiving a CCB should avoid grapefruit juice because it can cause the CCB to rise to toxic levels. 2. The apical heart rate should be greater than 60 bpm before a beta blocker is administered. Because the apical pulse is 62 bpm, the nurse should administer this medication. 3. The NTG patch should be held if the client's blood pressure is less than 90/60. Because the blood pressure reading is above that, the nurse should not question administering this medication. 4. The client's platelet count is not monitored when administering medication. MEDICATION MEMORY JOGGER: Grapefruit juice can inhibit the metabolism of certain medications. Specifically, grapefruit juice inhibits cytochrome P450-3A4 found in the liver and the intestinal wall. The nurse should investigate any medications the client is taking if the client drinks grapefruit juice.

The client diagnosed with coronary artery disease (CAD) is prescribed atorvastatin. Which statement by the client warrants the nurse notifying the HCP? 1. "I really haven't changed my diet, but I am taking my medication every day." 2. "I am feeling pretty good, except I am having muscle pain all over my body." 3. "I am swimming at the local pool about three times a week for 30 minutes." 4. "I am taking this medication first thing in the morning with a bowl of oatmeal."

1. The client should adhere to a low-fat, low-cholesterol diet, and the nurse can teach the client about diet; therefore, the HCP does not need to be notified. 2. Atorvastatin (Lipitor) is an HMG-CoA reductase inhibitor, also referred to as a statin. Statins can cause muscle injury, leading to myositis, fatal rhabdomyolysis, or myopathy. Muscle pain or tenderness should be reported to the HCP immediately; usually, the medication is discontinued. 3. Sedentary lifestyle is a risk factor for developing atherosclerosis; therefore, exercising should be praised and not be reported to the HCP. 4. The medication should not be taken in the morning, but the nurse can teach this, and there is no need to notify the HCP. MEDICATION MEMORY JOGGER: If the client verbalizes a symptom, the nurse assesses data, or if laboratory data indicates that an adverse effect is secondary to a medication, the nurse must intervene. The nurse must implement an independent intervention or notify the HCP because medications can result in serious or life-threatening complications.

The nurse is discussing chlorothiazide with a client diagnosed with essential HTN. Which discharge instruction should the nurse discuss with the client? 1. Encourage the client to eat sodium-rich foods. 2. Instruct the client to drink adequate fluids. 3. Teach the client to keep strict intake and output records. 4. Explain about taking the medication at night only.

1. The client should be discouraged from eating sodium-rich foods and be encouraged to increase their intake of potassium-rich food. 2. Chlorothiazide (Diuril) is a thiazide diuretic. The client should drink adequate amounts of fluids to replace the insensible loss of fluids and to help prevent dehydration. 3. To ask the client to keep strict intake and output is unrealistic. This would be done in the hospital, but not in the client's home. 4. The medication should be taken in the morning to prevent nocturia.

Which data indicates to the nurse that simvastatin is effective? 1. The client's blood pressure is 132/70. 2. The client's cholesterol level is 180 mg/dL. 3. The client's LDLC level is 180 mg/dL. 4. The client's HDLC level is 35 mg/dL.

1. The client's blood pressure is within normal limits, but that does not indicate that the medication is effective. 2. Simvastatin (Zocor) is an HMG-CoA reductase inhibitor or a statin that lowers cholesterol levels. A cholesterol level less than 200 mg/dL is desirable and indicates the medication is effective. 3. The client's optimal low-density lipoprotein cholesterol (LDLC) is less than 100 mg/dL. Greater than 200 mg/dL is considered very high. A level of 180 mg/dL is high. 4. High-density lipoprotein cholesterol (HDLC) promotes cholesterol removal, and the level should be greater than 60 mg/dL. The client's HDLC is low, less than 40 mg/dL, which indicates the medication is not effective.

The nurse is administering iron dextran to a client diagnosed with iron-deficiency anemia. Which intervention should the nurse implement? 1. Make sure the client is well hydrated. 2. Give the medication subcutaneously in the deltoid. 3. Check for allergies to fish or other seafood. 4. Administer the medication by the Z-track method.

1. The client's hydration status will not affect the medication. 2. The medication is black and will stain the skin, sometimes permanently. It is never given in the upper extremities or subcutaneously. 3. Knowledge of seafood allergies is important when administering any iodine preparation, not iron. 4. Iron dextran (Imferon) is an iron preparation. Iron is black and stains the skin. The medication is administered deep IM in the dorsogluteal muscle in adults and the lateral thigh in small children. It is given by the Z-track method to trap the medication in the deep tissues and prevent leakage back into the shallow tissues.

Which assessment data should the nurse obtain before administering a calcium channel blocker? 1. The serum calcium level 2. The client's radial pulse 3. The current telemetry reading 4. The client's blood pressure

1. The client's serum calcium level is not affected by this medication. Calcium levels would be monitored for clients taking calcium supplements. 2. The nurse should assess the client's apical pulse before administering any medication that affects the heart rate. The client should be taught to check the radial pulse when taking the medication at home. 3. The client's telemetry reading would not affect the nurse administering this medication. 4. The nurse should not administer this medication if the client's blood pressure is less than 90/60 because it will further decrease the blood pressure, resulting in the brain not being perfused with oxygen.

The client diagnosed with essential hypertension (HTN) is prescribed metoprolol. Which assessment data should make the nurse question administering this medication? 1. The client's blood pressure is 112/90. 2. The client's apical pulse is 56 bpm. 3. The client has an occipital headache. 4. The client is reporting a yellow haze.

1. The nurse would question administering a beta blocker if the client's blood pressure was less than 90/60 because this medication would lower blood pressure even more. 2. Metoprolol (Lopressor) is a beta blocker. The nurse would question administering a beta blocker if the client's apical pulse was less than 60 bpm because this medication decreases the heart rate. 3. An occipital headache could signify high blood pressure; therefore, the nurse would administer the medication. 4. A yellow haze is a common symptom of a client exhibiting digoxin (a cardiac glycoside) toxicity.

The client diagnosed with high blood pressure is prescribed captopril. Which statements by the client indicate to the nurse the discharge teaching has been effective? Select all that apply. 1. "I should get up slowly when getting out of bed." 2. "I should check and record my blood pressure once a day." 3. "If I get leg cramps, I should increase my potassium supplements." 4. "If I forget to take my medication, I will take two doses the next day." 5. "I can eat anything I want as long as I take my medication every day."

Correct answers are 1 and 2. 1. Captopril (Capoten) is an ACE inhibitor. Antihypertensive medications generally cause orthostatic hypotension; therefore, the client should be taught to get up slowly from lying to sitting and standing to help prevent dizziness and lightheadedness. 2. Blood pressure must be checked daily. 3. ACE inhibitors do not require potassium supplements. 4. The client should never make up doses of medication missed, as that may cause hypotension. 5. The client should be on a low-salt, low-fat, low-carbohydrate diet for HTN, along with taking medication.

The home health nurse is caring for a client diagnosed with congestive heart failure (CHF) and prescribed digoxin and furosemide. Which statements by the client indicate the medications are effective? Select all that apply. 1. "I can walk next door now without being short of breath." 2. "I keep my feet propped up as much as I can during the day." 3. "I have not gained any weight since my last doctor's visit." 4. "My blood pressure has been within normal limits." 5. "I am staying on my diet, and I don't salt my foods anymore."

Correct answers are 1 and 3. 1. Digoxin (Lanoxin), a cardiac glycoside, and furosemide (Lasix), a loop diuretic, are administered for clients diagnosed with CHF to improve the contractility of the cardiac muscle and to decrease the fluid volume overload. A symptom of CHF is shortness of breath. The fact that the client can ambulate without being short of breath is an improvement of clinical manifestations, which shows that the medications are effective. 2. This statement indicates compliance with treatment guidelines, not effectiveness of a medication. 3. Weight gain would indicate that the client is retaining fluid and the medications are not effective. No weight gain indicates the medication is effective. 4. A client diagnosed with CHF does not have HTN; therefore, a normal blood pressure does not indicate the medications are effective. 5. This statement indicates compliance with treatment guidelines, not effectiveness of a medication. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

The client is reporting severe chest pain radiating down the left arm and is nauseated and diaphoretic. The HCP suspects the client is having an MI and has ordered morphine sulfate for the pain. Which interventions should the nurse implement? Select all that apply. 1. Instruct the client not to get out of the bed without notifying the nurse. 2. Administer the morphine sulfate intramuscularly (IM) in the ventral gluteal muscle. 3. Dilute the morphine sulfate to a 10-mL bolus with normal saline. 4. Administer the morphine sulfate slowly over 5 minutes. 5. Question the order because morphine sulfate should not be administered to a client diagnosed with an MI.

Correct answers are 1 and 4. 1. The client should not get out of the bed without assistance due to the drowsiness that may occur after receiving morphine sulfate, a narcotic analgesic. Also, the client is having chest pain and should not get out of the bed without assistance. 2. Morphine sulfate, a narcotic analgesic, should not be administered intramuscularly to a client with a suspected MI because it will take longer for the medication to take effect, and it can skew cardiac enzyme results. 3. Morphine sulfate, a narcotic analgesic, is given undiluted. 4. Morphine sulfate, a narcotic analgesic, is the drug of choice for chest pain, and it is administered IV so that it acts as soon as possible, within 10 to 15 minutes. An IVP also allows the nurse to inject the medication more accurately over the 5-minute administration time. 5. Morphine sulfate, a narcotic analgesic, should not be questioned. It is the medication of choice, and the nurse should know it is always administered intravenously for a client diagnosed with an MI.

The nurse is administering the combination medication chlorthalidone and atenolol to a client diagnosed with chronic HTN. Which interventions should the nurse implement? Select all that apply. 1. Do not administer if the client's blood pressure is less than 90/60. 2. Do not administer if the client's apical pulse is less than 60 bpm. 3. Teach the client how to prevent orthostatic hypotension. 4. Encourage the client to eat potassium-rich foods. 5. Monitor the client's oral intake and urinary output.

Correct answers are 1, 2, 3, 4, and 5. 1. Tenoretic (chlorthalidone and atenolol in combination) is a thiazide diuretic and a beta blocker. If the client's blood pressure is less than 90/60, the medication should be held so that the client will not experience profound hypotension. 2. Tenoretic (chlorthalidone and atenolol in combination) is a thiazide diuretic and a beta blocker. If the client's apical pulse is less than 60 bpm, the medication should be held so that the client's pulse will not plummet to less than 60 bpm, which is sinus bradycardia. 3. Tenoretic (chlorthalidone and atenolol in combination) is a thiazide diuretic and a beta blocker. A side effect of antihypertensive medications is orthostatic hypotension, and the nurse should discuss how to prevent episodes. 4. Tenoretic (chlorthalidone and atenolol in combination) is a thiazide diuretic and a beta blocker. Thiazide diuretics do not cause excessive loss of potassium. Still, the client should be encouraged to eat potassium-rich foods to prevent hypokalemia, which may occur due to increased urination. 5. Tenoretic (chlorthalidone and atenolol in combination) is a thiazide diuretic and a beta blocker. The nurse should monitor the client's intake and output to determine if the medication is effective.

The nurse is administering digoxin to a client diagnosed with CHF. Which interventions should the nurse implement? Select all that apply. 1. Assess the client's carotid pulse for 1 full minute. 2. Check the client's current potassium level. 3. Ask the client if they see a yellow haze around objects. 4. Have the client squeeze the nurse's fingers. 5. Teach the client to get up slowly from a sitting position.

Correct answers are 2 and 3. 1. The client's apical pulse, not the carotid pulse, should be assessed. 2. Digoxin (Lanoxin) is a cardiac glycoside used to treat heart failure. The client's potassium and digoxin levels are monitored because high levels of potassium impair therapeutic response to digoxin, and low levels can cause toxicity. The most common cause of dysrhythmias in clients receiving digoxin is hypokalemia from diuretics that are often given simultaneously. 3. Yellow haze indicates the client may have high serum digoxin levels. The therapeutic range for digoxin is relatively small (0.5 to 1.2), and levels of 2.0 or greater are considered toxic. 4. This is part of a neurological assessment and not needed for digoxin. 5. This would be an intervention to prevent orthostatic hypotension. Digoxin does not affect blood pressure.

The client being discharged after sustaining an acute MI is prescribed lisinopril. Which instruction should the nurse include when teaching about this new medication? Select all that apply. 1. Instruct the client to monitor the blood pressure monthly. 2. Encourage the client to take medication on an empty stomach. 3. Discuss the need to rise slowly from lying to a standing position. 4. Teach the client to take the medication at night only. 5. Tell the client to avoid salt substitutes. 6. Advise the client that taste changes should resolve in 3 months.

Correct answers are 3, 5, and 6. 1. The client is taking lisinopril (Zestril), an ACE inhibitor, to improve survival after an acute MI, and the blood pressure should be monitored daily or weekly, not monthly. 2. The client can take the medication with food to help decrease gastric distress. 3. This medication causes orthostatic hypotension, and the client should be instructed to rise slowly from lying to sitting to standing position to prevent falls and injury. 4. There is no reason for the medication to be taken at night; it is usually taken in the morning. 5. Lisinopril can increase blood potassium levels. Salt substitutes or eating high potassium foods can cause hyperkalemia. 6. Lisinopril can cause taste impairment that generally resolves in 8-12 weeks.

The client diagnosed with iron-deficiency anemia is being discharged with a prescribed oral iron preparation. For each intervention, specify if the intervention is indicated or not indicated for the client's care. Teach the client to perform a fecal occult blood test daily. Demonstrate how to crush the tablets and mix them with pudding. Inform the client to take the medication at night. Tell the client that their stools will be greenish-black. Instruct the client to avoid caffeinated beverages. Take antacids and calcium 1 hour before or 2 hours after the iron.

Teach the client to perform a fecal occult blood test daily. Not Indicated Demonstrate how to crush the tablets and mix them with pudding. Not Indicated Inform the client to take the medication at night. Not Indicated Tell the client that their stools will be greenish-black. Indicated Instruct the client to avoid caffeinated beverages. Indicated Take antacids and calcium 1 hour before or 2 hours after the iron. Indicated