Pharm Exam I (Ch. 1-6) Questions

Burchum-52. The healthcare provider prescribes heparin 2500 units subcutaneous daily. The drug is available in 10,000 units per mL. How may milliliters will the nurse give?

0.25 mL (2500 units)*(1 mL)/(10,000 units/mL)

HESI. A healthcare provider prescribes a medication to be administered via a metered dose inhaler (MDI) for a young adult with asthma. List in order the steps the nurse teaches the client to follow when using the inhaler. 1. Shake the inhaler for 30 seconds 2. Hold the inhaler upright in the mouth 3. Exhale slowly and deeply to empty the air from the lungs 4. Start breathing in and press down on the inhaler once

1, 3, 2, 4. When using an MDI, the medication should be shaken for 30 seconds to ensure that the medication is mixed. Exhaling completely maximizes emptying the lungs. The inhaler should be held upright in the mouth past the teeth with the lips closed around the mouthpiece (closed mouth method) or held upright 1 to 2 cm in front of the open mouth (open mouth method). Inhalation is begun at the same time that the device is compressed to ensure that maximum medication reaches the lungs.

Burchum-52. The patient's heparin is infusing at 11 mL/hr. The bag of fluid is mixed 25,000 units of heparin in 250 mL D5W. What hourly dose is the patient receiving?

1100 units/hrs (20,000 units)*(11 mL/hr)/(250 mL)

Burchum-52. The patient's heparin is infusing at 28 mL/hr. The bag of fluid is mixed 20,000 units of heparin in 500 mL D5W. What hourly dose is the patient receiving?

1120 units/hr (20,000 units)*(28mL/hr)/(500 mL)

Burchum-52. The healthcare provider prescribes heparin 900 units/hr. The label on the IV bag reads Heparin 10,000 units in 500 mL D5W. How many mL/hr will deliver the correct dose?

45 mL (900 units/hr)*(500mL)/(10,000 units)

Lec 4. A patient comes into your clinic with the following signs: dyspnea, persistent coughing, pulmonary edema, fatigue, tachycardia, confusion, and a loss of appetite. You might suspect the patient to have A) heart failure B) sinusitis c) Common cold D) none of the above

A. heart failure

Lec 4. As a Nursing student, you know that Midodrine is prescribed for a patient only with: A) Orthostatic hypotension B) Severe Hypertension C) Supine hypertension D) CAD

A. orthostatic hypotension

Lec 4. ________________ is a safe and effective calcium channel blocker when it's administered by the nurse as a sustained-release or extended release preparation to treat hypertension

Answer: Diltiazem

Lec 4. An older patient is taking a sustained-release anti-hypertensive drug. Which is the nurse's PRIORITY teaching point that the nurse should include in the plan of care for this patient taking this medication? A) "Take the blood pressure medication only at night" B) "Swallow the drug whole and do not cut, crush, or chew it" C) "Take the drug before bedtime" D) "Use over-the-counter (OTC) drugs to control headache or cold symptoms"

B. "Swallow the drug whole and do not cut, crush, or chew it."

Lec 6. Vitamin D plays an important part in the absorption of calcium by the body. Where is vitamin D activated into a form that promotes calcium absorption? A. Small intestine B. Vitamin D is not activated into another form C. Kidneys D. Large intestine

C. Kidneys Rationale: Vitamin D must be activated in the kidneys to a form that promotes calcium absorption.

Burchum-10. Why are infants especially sensitive to drugs that affect CNS function? a. The blood-brain barrier is especially strong in infants. b. The blood-brain barrier does not exist until 1 year of age. c. The blood-brain barrier is not fully developed at birth. d. The blood-brain barrier is weakened by the birth process.

C. The blood-brain barrier is not fully developed at birth. The other statements are not true.

Lec 4. Losartan is an example of what kind of hypertensive drug? A) ACE inhibitor B) Beta Blocker C) Calcium Channel Blocker D) Angiotensin 2 Receptor Blocker

D. Angiotensin 2 Receptor Blocker

Lec 4. Your patient is prescribed Captopril, an ACE inhibitor. You know that this medication is prescribed for A) Hypertension B) Heart failure C) Diabetic neuropathy D) All the above

D. all of the above

Lec 6. True/False: A breast-feeding mother who needs a diuretic may continue to breast-feed with taking the thiazide diuretic chlorothiazide (Diuril).

FALSE.

Lec 6. True/False: Fluid rebound occurs when patients taking diuretics increase their fluid intake in response to an increased thirst sensation.

FALSE.

Lec 4. True/False: Captopril works by blocking angiotensin-converting enzyme from converting angiotensin 2 to angiotensin 1, leading to, among other things, a decrease in blood pressure

FALSE. Captopril works by blocking angiotensin-converting enzyme from converting ANGIOTENSIN 1 to ANGIOTENSIN 2, leading to, among other things, a decrease in blood pressure

Lec 3. True/False: Cromolyn (Intal) is used to relieve inflammation in patients with COPD and improves airway compliance.

FALSE. Cromolyn (Intal) is used to relieve inflammation in patients with ASTHMA and improves airway compliance.

Lec 2. True/False: Patient teaching for the use of a nasal decongestion spray should include insuring that the tip of the bottle is placed into the nasal passage and forcefully squeezed to ensure that the medication reaches the sinuses.

FALSE. Patient teaching for the use of a nasal decongestion spray should include insuring that the tip of the bottle is placed into the nasal passage and GENTLY squeezed to ensure that the medication reaches the sinuses.

Lec 3. True/False: Premature infants are at risk for alveoli collapse because of an overproduction surfactant, which causes the sacs to stick together.

FALSE. Premature infants are at risk for alveoli collapse because of an UNDERproduction of surfactant, which causes the sacs to stick together.

Lec 2. True/False: The common cold is a lower respiratory infection caused by either a virus or bacteria.

FALSE. The common cold is an UPPER respiratory infection caused by either a virus or bacteria.

Lec 3. True/False: Women taking montelukast (Singulair) for asthma may continue the medication during the preconception period and pregnancy.

FALSE. Women taking montelukast (Singulair) for asthma SHOULD NOT continue the medication during the preconception period and pregnancy.

Lec 2. True/False: Asthma is a chronic disease of the airways that makes breathing difficult by causing inflammation of the air passages that results in a permanent narrowing of the airways that carry oxygen to the lungs.

FALSE. Asthma is a chronic disease of the airways that makes breathing difficult in which there is inflammation of the air passages that results in a TEMPORARY narrowing of the airways that carry oxygen to the lungs

Lec 5. You are the nurse taking care of a patient who is taking digoxin. You assess the patient's Pulse and it is 35bpm. It is safe to give the medication without notifying HCP or Physician?

It is NOT safe because his pulse is less than 60 bpm.

Lec 6. True/False: The body's mechanism for controlling the volume of body fluid is by diluting or concentrating the urine.

TRUE Rationale: The volume of body fluids is controlled by diluting or concentrating the urine.

Lec 3. True/False: Beractant (Survanta), AKA Surfactant, should be instilled directly into the trachea and is indicated for rescue treatment of infants who have developed respiratory distress syndrome.

TRUE. Beractant (Survanta), AKA Surfactant, should be instilled directly into the trachea and is indicated for rescue treatment of infants who have developed respiratory distress syndrome.

Lec 2. True/False: Antitussive agents should be used with caution in patients who have a history of addiction.

TRUE. Caution should also be used in patients who are hypersensitive to or have a history of addiction to narcotics (codeine, hydrocodone).

Lec 2. True/False: Oral decongestants may be helpful in patients with otitis media by opening the nasal passage and improving drainage of the eustachian tube.

TRUE. Oral decongestants may be helpful in patients with otitis media by opening the nasal passage and improving drainage of the eustachian tube.

Lec 3. True/False: Oxygen is considered a medication because it requires a physician's order and if given in a high concentration, it can be toxic.

TRUE. Oxygen is considered a medication because it requires a physician's order and if given in a high concentration, it can be toxic.

Lec 6. True/False: Patients receiving loop diuretics should have regular blood work to monitor sodium levels.

TRUE. Patients receiving loop diuretics should have regular blood work to monitor sodium levels.

Lec 2. True/False: Sinusitis is an infection of the sinuses that, if untreated, can cause infection of the brain.

TRUE. Sinusitis is an infection of the sinuses that, if untreated, can cause infection of the brain.

Lec 6. True/False: Spironolactone's (Aldactone's) potassium-sparing action makes it the drug of choice for treating hyperaldosteronism.

TRUE. Spironolactone's (Aldactone's) potassium-sparing action makes it the drug of choice for treating hyperaldosteronism.

Lec 2. True/False: The nose is a vital part of the respiratory system because it cleans incoming air using hair fibers.

TRUE. The nose is a vital part of the respiratory system because it cleans incoming air using hair fibers.

Lec 2. True/False: Cystic fibrosis is a hereditary disease that results in an accumulation of thick mucus that obstructs the airways and destroys lung tissue.

TRUE. Cystic fibrosis is a hereditary disease that results in an accumulation of thick mucus that obstructs the airways and destroys lung tissue.

Lec 6. True/False: Loop diuretics, like furosemide (Lasix), are the drugs of choice for treating patients with pulmonary edema.

TRUE. Loop diuretics, like furosemide (Lasix), are the drugs of choice for treating patients with pulmonary edema.

Lec 1. True/False: Poisoning occurs when too much of a drug causes damage to multiple systems of the body.

TRUE. Poisoning occurs when too much of a drug causes damage to multiple systems of the body.

Ch 45. A patient who is receiving an antiarrhythmic drug needs a. constant cardiac monitoring until stabilized. b. frequent blood tests, including drug levels. c. an antidepressant to deal with the psychological depression. d. dietary changes to prevent irritation of the heart muscle.

a

Ch 50. During severe exertion, a man may lose up to 4 L of hypotonic sweat per hour. This loss would result in a. decreased plasma volume. b. decreased plasma osmolarity. c. decreased circulating levels of antidiuretic hormone (ADH). d. return of body fl uid balance to normal after ingestion of 100 mL of water.

a

Ch 50. When describing renal reabsorption to a group of students, the instructor would identify it as the movement of which of the following? a. Substances from the renal tubule into the blood b. Substances from the blood into the renal tubule c. Water that is increased in the absence of ADH d. Sodium occurring only in the proximal tubule

a

Ch 51. When developing the plan of care for a patient with hyperaldosteronism, the nurse would expect the physician to prescribe which agent? a. Spironolactone b. Furosemide c. Hydrochlorothiazide d. Acetazolamide

a

Ch 48. Hageman factor is known to activate which of the following? Select all that apply. a. The clotting cascade b. The anticlotting process c. The infl ammatory response d. Platelet aggregation e. Thromboxane A2 f. Troponin coupling

a, b, c

Ch 3. Pregnant women should be advised of the potential risk to the fetus any time they take a drug during pregnancy. What fetal problems can be related to drug exposure in utero? Select all that apply. a. Fetal death b. Nervous system disruption c. Skeletal and limb abnormalities d. Cardiac defects e. Low-set ears f. Deafness

a, b, c, d, e, f

Burchum-8. The nurse understands drug response varies from one individual to another. What are examples of individual variations? (Select all that apply.) a. Age b. Genetic makeup c. Gender d. Diet e. Failure to take medication as prescribed

a, b, c, d, e. All of the responses are examples of individual variations in drug responses.

Burchum-3. Which statement about the Family Smoking Prevention and Tobacco Control Act (2009) would the nurse identify as true? (Select all that apply.) a. All ingredients in tobacco products must be listed on the warning label. b. A gradual reduction of nicotine to nonaddictive levels is required. c. Marketing to youth is prohibited. d. Harmful additives are restricted. e. Purchasers of tobacco products must be age 21 years or older.

a, b, c, d. All of the statements about the Family Smoking Prevention and Tobacco Control Act (2009) are true except that purchasers of tobacco products must be age 21 years or older

Burchum-50. Which are beneficial effects that can be derived from simvastatin [Zocor] and other drugs in this class? (Select all that apply.) a. Reduction of LDLs b. Elevation of HDLs c. Stabilization of the plaque in coronary arteries d. Reduction of risk of cardiovascular events e. Improvement of liver function

a, b, c, d. The statin drugs have many benefits, the most important being reduction of LDLs. They also promote an increase in HDLs, stabilization of atherosclerotic plaque, and reduced inflammation at the plaque site. Among other benefits, they also slow progression of coronary artery calcification. The statins reduce the overall risk of cardiovascular events. - They can have serious adverse effects on the liver, but these are relatively rare.

Burchum-7. The nurse is caring for a patient prescribed Isoniazid for the treatment of tuberculosis. The nurse should assess for which signs and symptoms of drug-induced liver toxicity? (Select all that apply.) a. Nausea b. Malaise c. Jaundice d. Vomiting e. Clear urine

a, b, c, d. nausea, malaise, jaundice, vomiting. Drug toxicity is an adverse drug reaction in which certain drugs are toxic to specific organs. Signs and symptoms of liver toxicity include jaundice, dark urine, light-colored stools, nausea, vomiting, malaise, abdominal discomfort, and loss of appetite.

Ch 43. Pressure within the vascular system is determined by which of the following? Select all that apply. a. Peripheral resistance b. Stroke volume c. Sodium load d. Heart rate e. Total intravascular volume f. Rate of erythropoietin release

a, b, c, e

Ch 45. Arrhythmias or dysrhythmias can be caused by which of the following? Select all that apply. a. Lack of oxygen to the heart muscle cells b. Acidosis near a cell c. Structural damage in the conduction pathway through the heart d. Vasodilation in the myocardial vascular bed e. Thyroid hormone imbalance f. Electrolyte imbalances

a, b, c, e, f

Ch 48. Evaluating a client who is taking an anticoagulant for blood loss would usually include assessing for which of the following? Select all that apply. a. The presence of petechiae b. Bleeding gums while brushing the teeth c. Dark-colored urine d. Yellow color to the sclera or skin e. The presence of ecchymotic areas f. Loss of hair

a, b, c, e, f

Ch 50. Considering the metabolic functions of the kidneys, renal failure would be expected to cause which of the following? Select all that apply. a. Anemia b. Loss of calcium regulation c. Urea buildup on the skin d. Respiratory alkalosis e. Metabolic acidosis f. Changes in the function of blood cells

a, b, c, e, f

Ch 42. The sympathetic nervous system would be expected to have which of the following effects? Select all that apply. a. Stimulate the heart to beat faster b. Speed conduction through the AV node c. Cause the heart muscle to contract harder d. Slow conduction through the AV node e. Decrease overall vascular volume f. Increase total peripheral resistance

a, b, c, f

Ch 48. Antiplatelet drugs block the aggregation of platelets and keep vessels open. These drugs would be useful in which of the following? Select all that apply. a. Maintaining the patency of grafts b. Decreasing the risk of fatal MI c. Preventing reinfarction after MI d. Dissolving a pulmonary embolus and improving oxygenation e. Decreasing damage in a subarachnoid bleed f. Preventing thromboembolic strokes

a, b, c, f

Burchum-52. A patient is being discharged from the hospital on warfarin [Coumadin] for deep vein thrombosis prevention. Which instructions should the nurse include in the patient's discharge teaching plan? (Select all that apply.) a. Wear a medical alert bracelet. b. Check all urine and stool for discoloration. c. Do not start any new medication without first talking to your healthcare provider. d. Enteric-coated aspirin and any aspirin products can be used unless they cause a gastrointestinal ulcer. e. No laboratory or home monitoring of international normalized ratio (INR) is required after the first 6 months.

a, b, c. Advise the patient to wear some form of identification (eg, Medic Alert bracelet) to alert emergency personnel to warfarin use. Bleeding is a major complication of warfarin therapy. Inform patients about the signs of bleeding, which include discolored urine or stools. Inform patients that warfarin is subject to a large number of potentially dangerous drug interactions. Instruct them to avoid all prescription and nonprescription drugs that have not been specifically approved by the prescriber. - Aspirin and aspirin products should be avoided because aspirin can increase the effects of warfarin to promote bleeding and on the gastrointestinal tract to cause ulcers, thereby initiating bleeding. - The INR should be determined frequently: daily during the first 5 days, twice a week for the next 1 to 2 weeks, once a week for the next 1 to 2 months, and every 2 to 4 weeks thereafter.

Burchum-43. What are the primary regulatory systems of arterial pressure? (Select all that apply.) a. Autonomic nervous system b. Renin-angiotensin-aldosterone system c. Renal system d. Pulmonary system e. P450 enzyme system

a, b, c. Arterial pressure is regulated primarily by the autonomic nervous system (provides short-term tone and control), the renin-angiotensin-aldosterone system (constriction and volume), and the renal system (long-term volume control).

HESI. The nurse provides a dietary list to a client who is taking oral anticoagulants with foods that should be avoided because they are high in vitamin K. What foods should be included on the list? Select all that apply. a. Eggs b. Liver c. Cheese d. Squash e. Chicken

a, b, c. Vitamin K decreases clotting time. Egg yolks are high in vitamin K and should be avoided. Liver, an organ meat, is high in vitamin K, as are all organ meats, and should be avoided. Cheese, a dairy product, is high in vitamin K, as are all dairy products, and should be eaten sparingly. - Squash is low in vitamin K and is not limited in the diet of clients who are taking anticoagulants. - Chicken contains about half the vitamin K that green, leafy vegetables contain and is permitted in the diet.

HESI. A client who has been taking spironolactone (Aldactone) is admitted to the hospital with hypokalemia. The nurse will assess the client for which clinical findings? Select all that apply. a. Lethargy b. Thready, weak pulse c. Muscle weakness d. Hyperactive deep tendon reflexes e. Numbness and tingling of the hands and feet

a, b, c. lethargy; thready weak pulse; muscle weakness. Altered mental status, including lethargy, occurs with hypokalemia; a thready, weak pulse occurs in hypokalemia because of an impaired conduction system in cardiac muscle. Muscular weakness may occur with hypokalemia because impulse conduction of skeletal muscles is impaired. An adequate level of potassium is necessary for effective functioning of the sodium-potassium pump. - Hyperactive reflexes and numbness and tingling of the hands and feet indicate hyperkalemia, not hypokalemia.

Ch 43. The renin-angiotensin system is associated with which of the following? Select all that apply. a. Intense vasoconstriction and blood pressure elevation b. Blood flow through the kidneys c. Production of surfactant in the lungs d. Release of aldosterone from the adrenal cortex e. Retention of sodium and water in the kidneys f. Liver production of fi brinogen

a, b, d, e

Burchum-11. Older adult patients are at high risk for adverse drug reactions (ADRs). Which measures can reduce the incidence of ADRs? (Select all that apply.) a. Taking a thorough drug history, including over-the-counter (OTC) medications b. Monitoring clinical response and laboratory results to help determine proper dosage c. Using as many drugs as possible to reduce symptoms and improve outcome d. Regularly monitoring patients for drug-drug and drug-nutrient interactions e. Helping patients to avoid prescriptions for drugs on the Beers list

a, b, d, e. A thorough drug history and careful monitoring can help reduce ADRs. Monitoring patients for interactions reduces ADRs. The Beers list identifies drugs with a high likelihood of causing adverse effects in the elderly. - Nurses should help patients use the simplest regimen possible to reduce the risk of ADRs.

Burchum-76. Which are advantages of a dry-powder inhaler (DPI) over a metered-dose inhaler (MDI)? (Select all that apply.) a. More of the drug is delivered to the lungs and less to the oropharynx. b. Use of a spacer is not necessary. c. Less propellant is needed to deliver the medication. d. Less hand-lung coordination is required. e. DPIs pose no environmental risk.

a, b, d, e. DPIs deliver more drug to the lungs (20% of the total released, compared to 10% for MDIs). Spacers are not necessary with DPIs; they are recommended for use with MDIs to increase the delivery of drug to the lungs rather than the oropharyngeal mucosa. DPIs do not require the hand-lung coordination needed with MDIs. DPIs present no environmental hazard, because no propellant is required for delivery.

Ch 51. Diuretics are currently recommended for the treatment of which of the following? Select all that apply. a. Hypertension b. Renal disease c. Obesity d. Severe liver disease e. Fluid retention of pregnancy f. Heart failure

a, b, d, f.

Burchum-9. A nurse is educating a breast-feeding patient about her medications. Which statements by the nurse are true? (Select all that apply.) a. "Drugs taken by lactating women can be excreted in breast milk." b. "If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant." c. "There is a lot of research regarding drugs taken by lactating women." d. "Most drugs can be detected in milk, but concentrations are usually too low to cause harm." e. "Nearly all drugs can enter breast milk, and the extent of entry is the same for all drugs."

a, b, d. Drugs taken by lactating women can be excreted in breast milk. If drug concentrations in milk are high enough, a pharmacologic effect can occur in the infant, raising the possibility of harm. Most drugs can be detected in milk, but concentrations are usually too low to cause harm. - Unfortunately, very little systematic research has been done on this issue. - Although nearly all drugs can enter breast milk, the extent of entry varies greatly.

Burchum-11. Which factors may contribute to unintentional nonadherence? (Select all that apply.) a. Forgetfulness b. Failure to comprehend instructions c. Unpleasant side effects d. Inability to pay for medications e. Belief that the drug is not needed

a, b, d. Forgetfulness, failure to comprehend instructions (because of intellectual, visual, or auditory impairment), and inability to pay for medications can contribute to unintentional nonadherence. - Unpleasant side effects and the belief that the drug is not needed are factors that contribute to intentional nonadherence.

Burchum-47. Which medications should be used with caution in a hypertensive diabetic patient? (Select all that apply.) a. Furosemide [Lasix] b. Metoprolol [Lopressor] c. Diltiazem [Cardizem] d. Hydrochlorothiazide [HCTZ] e. Enalapril [Vasotec]

a, b, d. Hydrochlorothiazide and furosemide promote hyperglycemia, and metoprolol suppresses glycogenolysis and can mask signs of hypoglycemia. Therefore, these medications should be administered with caution to patients with diabetes. - Diltiazem and enalapril do not cause either of these effects.

Burchum-41. Which of the following statements about mannitol [Osmitrol] are correct? (Select all that apply.) a. Mannitol cannot be given orally. b. Mannitol can cause edema. c. Mannitol can cause renal failure. d. Diuresis begins in 30 to 60 minutes after administration. e. Mannitol is a loop diuretic.

a, b, d. Mannitol does not diffuse across the GI epithelium and cannot be transported by the uptake systems that absorb dietary sugars. Accordingly, to reach the circulation, the drug must be given parenterally. Diuresis begins in 30 to 60 minutes and persists 6 to 8 hours. Mannitol can leave the vascular system at all capillary beds except those of the brain. When the drug exits capillaries, it draws water along, causing edema. - Mannitol is use in prophylaxis of renal failure. - Mannitol is an osmotic diuretic, not a loop diuretic.

Burchum-76. A nurse should establish which outcomes on the care plan for a patient taking oral terbutaline? (Select all that apply.) a. Absence of tachycardia b. No reports of chest pain c. Less irritation of gum tissue d. Decrease in bronchospasm e. No jaundice or dark urine

a, b, d. Terbutaline is an oral beta2 agonist. It promotes bronchodilation through activation of beta2 receptors in the lung, which relieves bronchospasm. It also stimulates the beta receptors of the heart and can result in tachycardia and chest pain if dosing is excessive. - Irritated mucosal tissue of the gums, jaundice, and dark urine are not adverse effects of the medication.

Ch 3. A client is experiencing a reaction to the penicillin injection that the nurse administered approximately ½ hour ago. The nurse is concerned that it might be an anaphylactic reaction. What signs and symptoms would validate her suspicion? Select all that apply. a. Rapid heart rate b. Diaphoresis c. Constricted pupils d. Hypotension e. Rash f. Client report of a panic feeling

a, b, e, f.

Ch 47. Teaching a client who is prescribed an HMG-CoA reductase inhibitor to treat high cholesterol and high lipid levels should include which of the following? Select all that apply. a. The importance of exercise b. The need for dietary changes to alter cholesterol levels c. That taking a statin will allow a full, unrestricted diet d. That drug therapy is always needed when these levels are elevated e. The importance of controlling blood pressure and blood glucose levels f. That stopping smoking may also help to lower lipid levels

a, b, e, f.

Burchum-46. A patient in a hypertensive crisis is being started on a continuous sodium nitroprusside [Nipride] infusion. What interventions are essential before the nurse administers nitroprusside [Nipride]? (Select all that apply.) a. Obtain a baseline weight and weigh daily. b. Prepare for arterial line insertion. c. Discontinue the infusion when blood pressure is controlled. d. Observe for signs of hypertrichosis during the infusion. e. Cover the solution with an opaque bag.

a, b, e. A Nipride infusion is ordered in micrograms/kilogram/minute. Knowing the patient's weight is essential for calculating the appropriate dose. Also, tracking daily weights and comparing them with the baseline values helps the nurse determine whether the adverse effect of fluid retention has developed. An arterial line allows for continuous and accurate measurement of blood pressure. Because light degrades nitroprusside, the infusion solution should be covered. - The infusion should not be discontinued abruptly, because the blood pressure will return to the pretreatment levels within minutes. - Hypertrichosis (excessive hair growth) is a side effect of minoxidil.

Burchum-50. The healthcare provider prescribes lovastatin [Mevacor] for a patient discharged from the hospital post-myocardial infarction. Which instructions are most appropriate for the nurse to include in the patient's teaching plan? (Select all that apply.) a. "Do not start any new medications without first talking to your healthcare provider." b. "Before starting this medication a blood test will be done to check your total cholesterol level and to measure liver enzymes." c. "Take your medication in the morning, with a full glass of water for best results." d. "Take one 325-mg aspirin 30 minutes before your dose to lessen the problem of flushing and itching that can occur with this drug." e. "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains."

a, b, e. Lovastatin, simvastatin, and atorvastatin levels may be elevated when these drugs are combined with other drugs that inhibit CYP3A4. If these drugs are combined, caution is warranted. Before starting a statin, obtain a baseline lipid profile that includes total cholesterol and obtain baseline LFTs. A diet low in total fat and saturated fat is recommended when antilipemic drugs are prescribed. - The statins are taken once daily with food. It is recommended to take them with the evening meal because endogenous cholesterol synthesis increases during the night. - The statins do not typically cause flushing and itching; that effect occurs with niacin.

Burchum-9. For a drug to be a proven teratogen, which criteria must be met? (Select all that apply.) a. The drug must cause a characteristic set of malformations b. The drug must act only during a specific window of vulnerability. c. The drug should be tested in pregnant women. d. The drug causes malformation in animal testing. e. The incidence of malformations should increase with increasing dosage and duration of drug exposure.

a, b, e. To prove that a drug is a teratogen, three criteria must be met: The drug must cause a characteristic set of malformations; the drug must act only during a specific window of vulnerability (eg, weeks 4 through 7 of gestation); and the incidence of malformations should increase with increasing dosage and duration of exposure. - Drugs are not tested in pregnant women. - Studies in animals may be of limited value, in part because teratogenicity may be species-specific.

Ch 3. A patient is taking a drug that is known to be toxic to the liver. The patient is being discharged to home. What teaching points related to liver toxicity and the drug should the nurse teach the patient to report to the physician? Select all that apply. a. Fever; changes in the color of urine b. Changes in the color of stool; malaise c. Rapid, deep respirations; increased sweating d. Dizziness; drowsiness; dry mouth e. Rash, black or hairy tongue; white spots in the mouth or throat f. Yellowing of the skin or the whites of the eyes

a, b, f

Ch 47. .A bile acid sequestrants is a drug of choice for a client who has which of the following? Select all that apply. a. A high LDL concentration b. A high triglyceride concentration c. Biliary obstruction d. Vitamin K defi ciency e. A high high-density lipoprotein (HDL) concentration f. Intolerance to statins

a, b, f

Burchum-9. When a pregnant woman has been exposed to a known teratogen, what is the first step in identifying risks for malformation? (Select all that apply.) a. Determine exactly when the drug was taken. b. Determine exactly when the pregnancy began. c. Determine why the woman was taking the medication. d. Determine who prescribed the medication.

a, b. When a pregnant woman has been exposed to a known teratogen, the first step is to determine exactly when the drug was taken and exactly when the pregnancy began. - Other information is helpful but not necessary.

Ch 50. During severe diarrhea, there is a loss of water, bicarbonate, and sodium from the gastrointestinal tract. Physiological compensation for this would probably include which of the following? a. Increased alveolar ventilation b. Decreased hydrogen ion secretion by the renal tubules c. Decreased urinary excretion of sodium and water d. Increased renin secretion e. Increased hydrogen ion secretion by the renal tubules f. Increased ADH levels

a, c, d, e, f

Burchum-10. Which statements about transdermal absorption are correct? (Select all that apply.) a. The stratum corneum of the infant's skin is very thin. b. Transdermal administration is the safest route of administration. c. Blood flow to the skin is greater in infants than in older patients. d. Infants are at increased risk of toxicity from topical drugs. e. Absorption through the skin is more rapid and complete with infants.

a, c, d, e. Drug absorption through the skin is more rapid and complete with infants than with older children and adults because the stratum corneum of the infant's skin is very thin and blood flow to the skin is greater in infants than in older patients. Because of this enhanced absorption, infants are at increased risk of toxicity from topical drugs.

Ch 45. The conduction system of the heart includes which of the following? Select all that apply. a. The sinoatrial node b. The sinuses of Valsalva c. The atrial bundles d. The Purkinje fi bers e. The coronary sinus f. The bundle of His

a, c, d, f

Ch 1. A patient asks what generic drugs are and if he should be using them to treat his infection. Which of the following statements should be included in the nurse's explanation? Select all that apply. a. A generic drug is a drug that is sold by the name of the ingredient, not the brand name. b. Generic drugs are always the best drugs to use because they are never any different from the familiar brand names. c. Generic drugs are not available until the patent expires on a specific drug. d. Generic drugs are usually cheaper than the wellknown brand names, and some insurance companies require that you receive the generic drug if one is available. e. Generic drugs are forms of a drug that are available over the counter and do not require a prescription. f. Your physician may want you to have the brand name of a drug, not the generic form, and DAW, or "dispense as written," will be on your prescription form. g. Generic drugs are less likely to cause adverse effects than brand-name drugs.

a, c, d, f.

Ch 50. Maintenance of blood pressure is important in maintaining the fragile nephrons. Reflex systems that work to ensure blood fl ow to the kidneys include a. the renin-angiotensin system causing vasoconstriction. b. baroreceptor monitoring of the renal artery. c. aldosterone release secondary to angiotensin stimulation. d. ADH release in response to decreased blood volume with increased osmolarity. e. release of erythropoietin. f. local response of the afferent arterioles.

a, c, d, f.

Ch 51. Routine nursing care of a client receiving a diuretic would include which of the following? Select all that apply. a. Daily weighing b. Tight fl uid restrictions c. Periodic electrolyte evaluations d. Monitoring of urinary output e. Regular intraocular pressure testing f. Teaching the patient to report muscle cramping

a, c, d, f.

Burchum-10. The nurse is teaching young parents about medication administration in their child. Which statements are appropriate to include in the teaching plan? (Select all that apply.) a. "Guard against spills and spitting to ensure that your child gets an accurate dose." b. "Do not mix your child's medication with food or drink." c. "This calibrated spoon will help your child get an accurate dose." d. "Keep a medication record to make sure you do not give more than one dose at a time." e. "If your child spits some medication out, give another full dose at that time."

a, c, d. Spills and spitting are common causes of inaccurate dosing in children. Calibrated spoons and medication records can improve accuracy. - It is often helpful to mix medication with food or juice to mask the taste when allowed. - To prevent overdosing, parents should estimate the amount a child spits out and replace only that amount.

Burchum-45. Which instructions should the nurse include when developing a teaching plan for a patient prescribed diltiazem [Cardizem] for atrial fibrillation? (Select all that apply.) a. Weigh yourself daily at the same time each day. b. The medication will not cause dizziness or headache. c. Notify the healthcare provider if a skin rash develops. d, Do not take daily oral calcium supplements. e. Rise slowly from a lying to a sitting position.

a, c, e. An adverse effect of diltiazem is heart failure. Daily weighing monitors for signs of fluid retention, which may indicate cardiac dysfunction. Chronic eczematous rash may occur, especially in older patients. Orthostatic hypotension is an adverse effect; patients must be taught to rise slowly from lying to sitting positions. -Diltiazem causes vasodilation, which can cause dizziness or headache. - Daily calcium supplements do not affect the action of diltiazem.

Burchum-52. The nurse is caring for a group of patients taking warfarin [Coumadin]. Which patients are at moderate to high risk for harm as a result of warfarin therapy? (Select all that apply.) a. A patient with variant genes that code for VKORC1 and CYP2CP b. A patient with a current INR of 2.2 treated for deep vein thrombosis c. A pregnant woman with a new onset of symptoms of a pulmonary embolus d. A patient on day 4 after hip replacement with a new order for warfarin e. A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen

a, c, e. Patients with genetic alterations in VKORC1 and CYP2CP are at increased risk of warfarin-induced bleeding. Warfarin can cause fetal hemorrhage and is listed as Pregnancy Risk Category X. Warfarin interacts with many other agents. The greatest risk for harm is when an interacting drug is being added to or deleted from the regimen. - An INR of 2.2 indicates a therapeutic warfarin level. - Warfarin could be prescribed for the prevention of deep vein thrombosis after hip replacement surgery. The day of prescription would not likely be a day to expect a dangerous adverse effect from warfarin, because its half-life is 1.5 to 2 days.

HESI. he nurse is providing teaching to a client with atrial flutter who has received a prescription for an oral anticoagulant. The client asks the nurse to provide a list of foods that are high in vitamin K and that should be avoided. What should the nurse include on the list? Select all that apply. a. Spinach b. Oranges c. Broccoli d. Chicken breast e. Sweet potatoes

a, c. The amount of vitamin K in spinach is 266 mcg/100 g; the recommended daily allowance of vitamin K is 80 mcg/100 g for men and 65 mcg/100 g for women when a person is receiving an oral anticoagulant. The amount of vitamin K in broccoli is 132 mcg/100 g. - Fruit, including oranges, contains minimal vitamin K. - Chicken breast is high in protein, not vitamin K. - Sweet potatoes are high in vitamin A, not vitamin K.

Burchum-45. The nurse is teaching a patient with essential hypertension who has a new prescription for verapamil [Calan]. Which statements by the patient indicate that the teaching was effective? (Select all that apply.) a. "I will increase my intake of fluid and foods high in fiber." b. "I should stay out of direct sunlight to prevent exposing my skin to the sun." c. "I will call my healthcare provider if I notice swelling in my ankles." d. "I need to avoid salt substitutes and potassium supplements." e. "I may notice easy bruising and bleeding with this drug."

a, c. Verapamil often causes constipation and can also cause peripheral edema. Patients should take measures to prevent constipation and should call about new symptoms of peripheral edema. - Patients taking verapamil should not experience photosensitivity, hyperkalemia, or increased bruising and bleeding.

Burchum-8. The nurse is reading a genetic research study. The study discusses how genetic variants can directly affect the metabolism of clopidogrel [Plavix], reducing the antiplatelet response. The nurse understands reduced efficacy of clopidogrel can increase the risk of which cardiovascular event? (Select all that apply.) a. Stroke b. Cancer c. Myocardial infarction d. Pulmonary embolism e. Palpitations

a, c. stroke, myocardial infarction A variant in the gene code for CYP2C19 reduces clopidogrel antiplatelet effects, which increases the patient's risk of cardiovascular events such as stroke and myocardial infarction. {natasha's note: i don't know if i agree with not including [d: pulmonary embolism] as one of the answers. thoughts?}

Ch 2. When considering the pharmacokinetics of a drug, what points would the nurse need to consider? Select all that apply. a. How the drug will be absorbed b. The way the drug affects the body c. Receptor-site activation and suppression d. How the drug will be excreted e. How the drug will be metabolized f. The half-life of the drug

a, d, e, f

Burchum-3. Which statement about over-the-counter (OTC) drugs would the nurse identify as true? (Select all that apply.) a. Most illnesses initially are treated with an OTC agent. b. More prescription drugs than OTC agents are administered each year in the United States. c. The average home medicine cabinet contains eight OTC preparations. d. Forty percent of Americans take at least one OTC drug every 2 days. e. Some drugs that originally were sold by prescription are now OTC.

a, d, e. Most illnesses are initially treated with an OTC agent. Forty percent of Americans take at least one OTC drug every 2 days. Some drugs that were originally sold only by prescription are now sold over the counter. - OTC drugs are administered more than prescription drugs. OTC drugs account for 60% of all doses administered. - The average home medicine cabinet contains 24 OTC preparations.

Burchum-45. A patient with angina pectoris has been prescribed nifedipine [Procardia].Which possible adverse effects should the nurse expect with this medication? (Select all that apply.) a. Headache b. Constipation c. Nausea and vomiting d. Edema of ankles and feet e. Overgrowth of gum tissue

a, d, e. Some adverse effects of nifedipine are headache, edema of ankles and feet, and gingival hyperplasia (overgrowth of gum tissue). - Nifedipine causes very little constipation. - Nausea and vomiting are common side effects of clevidipine.

Burchum-52. The nurse is assessing a patient with hemophilia for complications of clotting factor administration. Which assessment findings would indicate an adverse effect of this treatment? (Select all that apply.) a. Hives and urticaria b. Potassium level of 3.2 mEq/L c. Creatinine level of 2.5 mg/dL d. Bethesda titer of 40 units e. Alkaline phosphatase of 303 units/L

a, d. Complications of clotting factor administration include allergic reactions, which can range from mild to anaphylactic, and the development of antibodies against the factor (known as inhibitors). Hives and urticaria indicate an allergic reaction. The Bethesda assay titers are used to detect the presence of inhibitors. - Clotting factor administration is not associated with hypokalemia, renal dysfunction (elevated creatinine), or liver dysfunction (elevated alkaline phosphatase).

Burchum-52. The nurse is teaching a patient with severe hemophilia A about the disease. Which statements by the nurse are appropriate to include in the teaching plan? (Select all that apply.) a. "You will need to be vaccinated for hepatitis A and B." b. "Take aspirin [Bayer] when you have mild pain." c. "You will receive prophylactic blood transfusions to manage your disease." d. "You will learn to reconstitute powdered medication with saline." d. "It will be important to get regular testing for HIV."

a, d. People with hemophilia need to follow the normal childhood immunization schedule. In addition, they should be vaccinated for hepatitis A and B to minimize their risk. Factor VIII [Bioclate] administration is the cornerstone of treatment for a patient with hemophilia A. The drug comes in powdered form and is reconstituted with sterile saline. Most patients do this at home. - Aspirin should not be given to patients with hemophilia, because it inhibits platelet aggregation and can promote gastrointestinal (GI) ulceration and bleeding. - Prophylactic blood transfusions are not part of routine care for patients with hemophilia. - The risk of human viral transmission using newer generation factor VIII products is essentially zero. Transmission of the human immunodeficiency virus (HIV) has not been reported.

Burchum-52. A patient is receiving a continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor? (Select all that apply.) a. Platelets b. Vitamin K c. Prothrombin time (PT) d. International normalized ratio (INR) e. Activated partial thromboplastin time (aPTT)

a, e. To reduce the risk of heparin-induced thrombocytopenia (HIT), platelet counts should be monitored. Heparin therapy is monitored by measuring the laboratory test activated partial thromboplastin time (aPTT). - Warfarin therapy is monitored by measuring prothrombin time (PT) and results are expressed as an international normalized ratio (INR). - Vitamin K is not monitored for a heparin infusion.

HESI. After a short hospitalization for an episode of a transient ischemic attack (TIA) related to hypertension, a client is discharged on a regimen that includes chlorothiazide (Diuril). What should the nurse instruct the client to do regarding nutrition? Select all that apply. a. Eat more citrus fruits b. Take protein supplements c. Return to previous eating habits d. Increase intake of dairy products e. Increase intake of dried cooked beans

a, e. more citrus, more dried cooked beans. The client should increase the dietary intake of potassium because of potassium loss associated with chlorothiazide. Citrus fruits are high in potassium and should be encouraged. Legumes, such as dried beans, are high in potassium and low in saturated fats. - Protein should be obtained from foods, such as fish and fowl. - Returning to previous eating habits is unsafe; the client should be taught about medication-induced deficiencies and how to try to prevent future TIAs. - Dairy products should be limited, unless fat free, because they are high in saturated fats.

Ch 1. The Food and Drug Administration (FDA) pregnancy categories a. indicate a drug's potential or actual teratogenic effects. b. are used for research purposes only. c. list drugs that are more likely to have addicting properties. d. are tightly regulated by the Drug Enforcement Agency (DEA).

a.

Ch 1. The generic name of a drug is a. the name assigned to the drug by the pharmaceutical company developing it. b. the chemical name of the drug based on its chemical structure. c. the original name assigned to the drug at the beginning of the evaluation process. d. the name that is often used in advertising campaigns

a.

Ch 6. Over-the-counter (OTC) drugs are drugs that are a. deemed to be safe when used as directed. b. harmless to the public. c. too old to be tested. d. cheaper to use than prescription drugs.

a.

The half-life of a drug a. is determined by a balance of all pharmacokinetic processes. b. is a constant factor for all drugs taken by a patient. c. is influenced by the fat distribution of the patient. d. can be calculated with the use of a body surface nomogram.

a.

Burchum-6. The nurse is teaching a patient prescribed felodipine [Plendil] (a calcium channel blocker) for the treatment of hypertension. Which statement is the most appropriate for the nurse to include in the teaching session? a. "Avoid grapefruit juice while you are taking this medication." b. "Do not eat foods high in tyramine such as aged cheese." c. "Herbal agents can help this drug work more effectively." d. "This drug is free of dangerous drug interactions."

a. "Avoid grapefruit juice while you are taking this medication." Grapefruit juice can raise levels of felodipine by as much as 406% because of the effect grapefruit juice has on the CYP3A4 isoenzyme.

Burchum-5. Which statement by the nursing student indicates a need for further instruction about drug selectivity? a. "Botulinum toxin is very selective and therefore very safe for administration." b. "Selective drug action is made possible by many types of receptors in the body." c. "The more selective a drug is, the fewer side effects it will produce." d. "Even though a drug is selective, it can produce nonselective results."

a. "Botulinum toxin is very selective and therefore very safe for administration." Selectivity does not guarantee safety. Botulinum toxin can cause paralysis of respiratory muscles, resulting in death from respiratory arrest. All of the remaining statements about receptors and selectivity of drug action are correct.

Burchum-76. Which instruction should be included in the teaching for a patient for whom fluticasone propionate [Flovent] MDI has been ordered? a. "Gargle after using your inhaler." b. "Take the medication immediately at the onset of an attack." c. "Take your albuterol first, followed by the Flovent 5 minutes later." d. "Make sure you monitor your fingerstick blood glucose level each morning."

a. "Gargle after using your inhaler." Patients should be taught to gargle after using inhaled glucocorticoids, such as fluticasone propionate, to minimize dysphonia and oropharyngeal candidiasis. - The medication is not used to abort an acute attack. - Short-acting bronchodilators, such as albuterol, should be administered 5 minutes before inhaled glucocorticoids to enhance delivery to the bronchial tree. - Oral glucocorticoids pose a risk of hyperglycemia.

Burchum-4. The nurse should instruct a patient complaining of pain to do what to reduce fluctuations in drug levels? a. "Take pain medication around the clock at specified intervals and doses." b. "Take pain medication when the pain level reaches an 8 or 9 on a 1 to 10 scale." c. "Take pain medication at night before bed and avoid daytime dosing because of drowsiness." d. "Take pain medication after breakfast and dinner to reduce stomach upset."

a. "Take pain medication around the clock at specified intervals and doses." One technique to reduce drug level fluctuations is to take a specified dose at reduced dosing intervals. - A patient who waits for the pain to peak will have to wait longer for the pain medicine to reach a plateau level of pain control. - Avoiding daytime dosing because of drowsiness and avoiding stomach upset does not address the question of how to reduce fluctuations in drug levels.

Burchum-52. A patient with nonvalvular atrial fibrillation is to be discharged on dabigatran etexilate [Pradaxa]. Which statement should the nurse include in the discharge teaching? a. "The medication must be stored in the manufacturer-supplied bottle." b. "Once a new bottle is opened, the capsules maintain efficacy for 90 days." c. "If you have difficulty swallowing the capsule, you can open it and mix it with food." d. "You will need to learn how to give yourself a subcutaneous injection in your abdomen."

a. "The medication must be stored in the manufacturer-supplied bottle." Dabigatran is unstable, especially when exposed to moisture, and should be stored in the manufacturer-supplied bottle, which has a desiccant cap. - Current labeling of the pill bottle indicates that once the bottle is opened, the pills should be used within 30 days. However, recent evidence indicates that they maintain efficacy for 60 days, provided they have been stored in the original container. - Capsules should be swallowed intact, because chewing, crushing, or opening enhances absorption by 75% and increases the risk of bleeding. - The medication is administered orally, not subcutaneously.

Burchum-10. When administering a medication known to be metabolized by the liver, the nurse will closely monitor for adverse drug reactions in which patient? a. A 3-month-old infant b. A 12-month-old infant c. An 18-month-old toddler d. A 13-year-old adolescent

a. A 3-month-old infant. Neonates are especially sensitive to drugs that are eliminated primarily by hepatic metabolism. When these drugs are used, dosages must be reduced. The capacity of the liver to metabolize many drugs increases rapidly about 1 month after birth and approaches adult levels a few months later. The liver has matured completely by 1 year of age.

Burchum-4. When administering a central nervous system depressant, the nurse should closely observe for drug toxicity in which patient? a. A 3-week-old neonate b. A 12-year-old boy c. A 25-year-old woman d. A 15-month-old infant

a. A 3-week-old neonate. The blood-brain barrier is not fully developed at birth. As a result, newborns are much more sensitive than older children or adults to medicines that act on the brain.

Burchum-9. The nurse is preparing to give a drug that is not classified according to a Pregnancy Risk Category. What should the nurse do? a. Administer the medication, because the nurse knows that it was in use before 1983. b. Notify the healthcare provider before administering the drug, because it should be considered a teratogen. c. Hold the medication, because the drug has a proven risk of fetal harm. d. Return the medication to the pharmacy to be assigned a Pregnancy Risk Category.

a. Administer the medication, because the nurse knows that it was in use before 1983. Many drugs are not classified according to the U.S. Food and Drug Administration (FDA) Pregnancy Risk Categories. These drugs were in use before the classification system came into use in 1983. They are considered safe but may not have been studied in controlled trials. The pharmacy cannot assign a pregnancy risk category to a drug.

Burchum-76. The parent of a pediatric patient with nasal stuffiness and congestion asks a nurse about cold remedies. Which additional information is the priority for the nurse to obtain? a. Age b. Developmental stage c. Body weight d. Swallowing ability

a. Age Cold remedies should not be used for children younger than 2 years because of the risk of harm with little evidence of efficacy. In 2008, the U.S. Food and Drug Administration (FDA) recommended that over-the-counter (OTC) cold remedies no longer be given to children younger than 2 years because of the risk of life-threatening events. Safety is still being reviewed for children ages 2 to 11 years. - Developmental stage, body weight, and swallowing ability are secondary considerations with dosing of cold remedies for children.

HESI. A client's cardiac monitor indicates ventricular tachycardia. The nurse assesses the client and identifies an increase in apical pulse rate from 100 to 150 beats per minute. An appropriate treatment plan includes: a. Amiodarone bolus b. Intracardiac epinephrine c. Insertion of a pacemaker d. Cardiopulmonary resuscitation (CPR)

a. Amiodarone suppresses ventricular activity; therefore, it is used for treatment of premature ventricular complexes (PVCs). It works directly on the heart tissue and slows the nerve impulses in the heart. - Epinephrine HCl (Adrenalin) is not used for ventricular tachycardia (VT) with a pulse; it is used for cardiac arrest and may even precipitate ventricular fibrillation. - A pacemaker is used for symptomatic bradycardia and heart blocks. - The client has a pulse; CPR is not indicated.

Burchum-5. The nurse prepares to give a drug that will prevent receptor activation. Which term would describe this drug? a. Antagonist b. Selective c. Agonist d. Potent

a. Antagonist. An antagonist is a drug that prevents receptor activation. - An agonist is a molecule that activates receptors. - A selective drug has only the desired response but may not activate receptors. - A potent drug requires a lower dose to achieve its effect.

Burchum-7. The nurse is reviewing the laboratory value for a patient prescribed atorvastatin [Lipitor]. Which laboratory value is most useful for monitoring this drug? a. Aspartate aminotransferase (AST) b. Blood urea nitrogen (BUN) c. International normalized ratio (INR) d. C-reactive protein (CRP)

a. Aspartate aminotransferase (AST). AST is a liver enzyme that is helpful for monitoring liver function (hepatotoxicity). Lipitor, a lipid-lowering drug, is a commonly prescribed example of a hepatotoxic drug. - The BUN is a measure of kidney function. - The INR is a comparative rating of prothrombin time ratios that is used to monitor patients taking the anticoagulant agent warfarin. - The CRP is elevated in inflammatory and neoplastic disease, myocardial infarction, and the third trimester of pregnancy. It is used as a cardiac risk marker.

Burchum-6. The nurse reviews all of the patient's prescriptions. Which prescribed medications may cause a detrimental potentiative drug interaction? a. Aspirin and warfarin b. Sulbactam and ampicillin c. Propranolol and albuterol d. Isoniazid and rifampin

a. Aspirin and warfarin both suppress clotting. As a result, if aspirin and warfarin are taken concurrently, the risk of bleeding is significantly increased.

Burchum-50. Which drug is the most effective for lowering LDL cholesterol? a. Atorvastatin [Lipitor] b. Cholestyramine [Questran] c. Gemfibrozil [Lopid] d. Ezetimibe [Zetia]

a. Atorvastatin (Lipitor) The statin drugs, such as atorvastatin, are the most effective drugs for lowering LDL cholesterol. They are better tolerated, have fewer adverse effects, and produce better clinical outcomes than any other agents available for lowering LDL.

Burchum-49. What is the most common sustained dysrhythmia among the U.S. population? a. Atrial fibrillation b. Atrial flutter c. Sustained supraventricular tachycardia (SVT) d. Ventricular premature beats (VPBs)

a. Atrial fibrillation Atrial fibrillation is the most common dysrhythmia, affecting approximately 2.6 million in the United States. This problem not only disrupts cardiac function but also carries a high risk of embolic stroke.

Burchum-76. Which medication is indicated for suppression of cough? a. Benzonate [Tessalon] b. Guaifenesin [Mucinex] c. Acetylcysteine [Mucomyst] d. Fluticasone furoate [Veramyst]

a. Benzonate [Tessalon] Benzonatate suppresses cough by reducing the sensitivity of respiratory stretch receptors (components of the cough reflex pathway). - Acetylcysteine reacts directly with mucus to make it more watery and is administered by inhalation treatment. - Guaifenesin is an expectorant. - Fluticasone furoate is an intranasal glucocorticoid used to treat the clinical manifestations of allergic rhinitis.

Burchum-8. The nurse is caring for a 12-year-old boy who weighs 72 pounds. The healthcare provider should make the most precise dosage adjustments for this patient's medications based on what? a. Body surface area b. Body mass index c. Body weight d. Body fat percentage

a. Body surface area. Adjustments based on the body surface area account not only for the patient's weight but also for the patient's relative amount of body adiposity.

Burchum-41. The nurse knows that diuretics mostly affect which function of the kidneys? a. Cleansing and maintenance of extracellular fluid volume b. Maintenance of acid-base balance c. Excretion of metabolic waste d. Elimination of foreign substances

a. Cleansing and maintenance of extracellular fluid volume. Most diuretics block sodium and chloride reabsorption, thus affecting the maintenance of extracellular fluid volume.

HESI. A client diagnosed with asthma has received a prescription for an inhaler. The nurse teaches the client how to determine when the inhaler is empty, instructing the client to: a. Count the number of doses taken b. Taste the medication when sprayed into the air c. Shake the canister d. Place the canister in water to see if it floats

a. Count. The only way to determine if the canister is empty is to count the number of doses taken. The client is tracking the number of daily doses. - It is wasteful to spray medication into the air; tasting it from the air is not an effective method of determining if the canister is empty. - Shaking the canister is not effective; even if there is no more medication, some propellant may be left. - It is futile to place the canister in water; the flotation test is ineffective.

Burchum-11. Which statement about drug use among older adults is true? a. Drug use among older adults is disproportionately high. b. Older adults consume 20% of the nation's prescribed drugs. c. Older patients are less sensitive to drugs than younger adults. d. Older adults experience fewer adverse drug reactions.

a. Drug use among older adults is disproportionately high. - Older adults consume 33% of the nation's prescribed drugs. - Older patients are more sensitive to drugs than are younger adults. - Older adults experience more adverse drug reactions.

Burchum-1. Why is it important for drugs to have ease of administration? a. Fewer administration errors b. Less risk of side effects d. Greater chemical stability d. Greater likelihood of reversibility

a. Fewer administration errors Ease of administration increases convenience and adherence and can reduce administration errors. Ease of administration is not related to side effects, chemical stability, or reversibility.

Burchum-41. The nurse is reviewing the home medication list with the patient. The nurse recognizes that hydrochlorothiazide is used primarily for which condition? a. Hypertension b. Edema c. Diabetes insipidus d. Protection against postmenopausal osteoporosis

a. Hypertension. The primary indication for hydrochlorothiazide is hypertension, a condition for which thiazides are often the drugs of first choice. Hydrochlorothiazides are used for the other conditions, but the primary indication is hypertension.

Burchum-4. The nurse is administering warfarin, an anticoagulant, to a patient with a low albumin level. Which effect of this medication should the nurse expect to observe? a. Increased PT/INR levels b. Deep vein thromboses c. Reduced risk of bruising d. Increased platelet aggregation

a. Increased PT/INR levels Warfarin is an anticoagulant with a high affinity for binding with albumin. If the albumin level is low, more free drug is available for action, resulting in an increased prothrombin time/international normalized ratio (PT/INR). - Deep vein thromboses can be prevented with warfarin. - An increased risk of bruising and bleeding would occur with more free drug available. - Warfarin acts on vitamin K, not on platelets. Aspirin is an example of an antiplatelet aggregator.

Burchum-5. The drug dobutamine acts as an agonist of norepinephrine (NE) receptors. Which effect is the nurse most likely to observe in a patient receiving this medication? a. Increased heart rate b. Atrioventricular heart block c. Sinus bradycardia d. Reduced cardiac output

a. Increased heart rate Dobutamine mimics the action of NE at receptors on the heart, thereby causing an increase in the heart's rate and force of contraction.

Burchum-6. Which response would the nurse anticipate when giving two drugs that have a potentiative effect, such as meperidine and Phenergan? a. Increased pain relief b. Increased nausea and vomiting c. Decreased itching d. Increased alertness

a. Increased pain relief A potentiative effect occurs when one drug intensifies the effects of another. An inhibitory effect would cause reduced therapeutic effects or reduced adverse effects. Potentiative effects are not unique responses. Meperidine is a morphine derivative for pain relief. Phenergan is an antiemetic that potentiates the effect of meperidine. The patient should experience decreased pain and also may be drowsy.

HESI. A client with a history of benign prostatic hypertrophy asks whether cranberry juice prevents bladder infections. The nurse replies that cranberry juice may be helpful because it: a. Increases acidity of the urine b. Soothes irritated bladder walls c. Improves glomerular filtration rate d. Destroys microorganisms in the bladder

a. Increases urine acidity. An acid-ash diet, including cranberries, lowers the pH of the urine and discourages pathogenic growth. - Acid urine does not soothe bladder walls. - The glomerular filtration rate is not affected. - An acid medium will discourage further growth but will not kill existing organisms.

Burchum-1. What is the ultimate concern for the nurse when administering a drug? a. Intensity of the response b. Dosage c. Route of administration d. Timing of administration

a. Intensity of the response The ultimate concern for the nurse when administering a drug is the intensity of the response, which is determined by the dosage size, route of administration, and timing of administration.

Burchum-6. The nurse is concerned with minimizing adverse drug-drug interactions for the patient. Which drug characteristic could result in the most serious consequences from a drug-drug interaction? a. Low therapeutic range b. High biologic half-life c. Low potency d. First-pass effect

a. Low therapeutic range Interactions are especially important with drugs that have a narrow therapeutic range, because an interaction that produces a modest increase in drug levels can cause toxicity.

Burchum-7. The nurse is preparing a staff education inservice about specific safety measures that reduce patient medication errors. Which measure improves safety for patients during care transition? a. Medication reconciliation b. MEDWATCH program c. Risk Evaluation and Mitigation Strategy d. Regional Medication Safety Program

a. Medication reconciliation is a widely used specific patient safety measure that reduces medication errors during transitions of care (eg, hospital admission and discharge, and moving to a different level of care within a hospital). Medication reconciliation has resulted in decreasing medication errors by 70% and reducing adverse drug reaction by 15%.

Burchum-47. The nurse is caring for a pregnant patient experiencing a new episode of hypertension. Which medication does the nurse anticipate will be prescribed for this patient? a. Methyldopa [Aldomet] b. Propranolol [Inderal] c. Captopril [Capoten] d. Valsartan [Diovan]

a. Methyldopa [Aldomet]. Hypertension is the most common complication of pregnancy, occurring in about 10% of pregnant patients. When drug therapy is initiated during pregnancy, methyldopa is the traditional agent of choice because of its limited effects on the fetus. - Patients with preexisting hypertension typically can continue taking the antihypertensives they previously were prescribed except for angiotensin-converting enzyme (ACE) inhibitors, such as captopril; angiotensin II receptor blockers (ARBs), such as valsartan; and direct renin inhibitors, such as aliskiren.

Burchum-50. Which discharge instructions should the nurse include for a patient prescribed cholestyramine [Questran]? a. Mix the drug with water or juice. b. Take with all other morning medications. c. Take 325 mg of aspirin 30 minutes before each dose. d. Notify the healthcare provider if upper abdominal discomfort occurs.

a. Mix the drug with water or juice. Cholestyramine [Questran] is supplied in powdered form. Mix the powder with liquids that include water, fruit juices, and soups because swallowing it can cause esophageal irritation. - Certain oral medications should be administrated 1 hour before the sequestrant or 4 hours after. - Flushing can occur with niacin and can be reduced by taking 325 mg of aspirin 30 minutes before each dose. - Gemfibrozil and fenofibrate increase the risk of gallstones manifested with symptoms such as upper abdominal discomfort.

Burchum-44. The nurse has just administered the initial dose of enalapril [Vasotec] to a newly admitted patient with hypertension. What is the priority nursing intervention over the next several hours? a. Monitor blood pressure. b. Check the heart rate. c. Auscultate lung sounds. d. Draw a potassium level.

a. Monitor BP. First-dose hypotension is a serious potential adverse effect of ACE inhibitors, such as enalapril. Monitoring the blood pressure is the priority nursing intervention. If hypotension develops, the nurse will place the patient in the supine position and possibly increase intravenous fluids. The other interventions may be appropriate for this patient; however, in the hours immediately after the first dose of an ACE inhibitor, monitoring of the blood pressure is most important.

Burchum-49. The nurse is administering intravenous lidocaine [Xylocaine] to a patient with a ventricular dysrhythmia. What is the priority nursing intervention to prevent a potential complication with this drug? a. Monitor the electrocardiogram (ECG). b. Obtain a complete blood count. c. Instruct to report any chest pain. d. Keep naloxone [Narcan] at the bedside.

a. Monitor the electrocardiogram (ECG). Continuous ECG monitoring is required during lidocaine infusions to evaluate cardiac response and adjust dosage accordingly and detect toxicity. - Blood counts are not necessary, because lidocaine is not linked to blood dyscrasias. Lidocaine preferably is given intravenously (IV) rather than intramuscularly (IM). - Sudden onset of chest pain is a sign of arterial embolism, which is a possible adverse effect of quinidine, not lidocaine. - Naloxone is a reversal agent for opioids and is not used with lidocaine.

Burchum-8. The nurse is caring for a group of female patients receiving medication therapy. Which factor is of greatest concern with regard to drug therapy in these patients? a. Most drug research has been carried out exclusively in male subjects. b. Hormonal differences make managing drug therapy more difficult in most women. c. Overall, women tend to be less compliant with medication therapy. d. Women tend to be caregivers and may not take time to care for themselves.

a. Most drug research has been carried out exclusively in male subjects. For most drugs, not much is known about gender-related differences, because until recently all drug research was done in men.

Burchum- 3. What is a result of the Prescription Drug User Fee Act (PDUFA) of 1992? a. New drugs reach the market sooner than ever before. b. Controlled substances are categorized into schedules. c. Drugs for acquired immunodeficiency syndrome (AIDS) receive accelerated approval. d. More research is conducted on drug safety in children.

a. New drugs reach the market sooner than ever before. PDUFA was a response to complaints about the length of time required for approval of new drugs by the U.S. Food and Drug Administration (FDA). Under this act, drug sponsors pay fees to the FDA that are used to fund additional reviewers. The FDA then must adhere to strict turnaround times for drug review processes.

Burchum-52. The laboratory calls to report a drop in the platelet count to 90,000/mm^3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate? a. Notify the healthcare provider to discuss the reduction or withdrawal of heparin. b. Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level. c. Obtain vitamin K and prepare to administer it by intramuscular (IM) injection. d. Observe the patient and monitor the activated partial thromboplastin time (aPTT) as indicated.

a. Notify the healthcare provider to discuss the reduction or withdrawal of heparin. Heparin-induced thrombocytopenia (HIT) is a potential immune-mediated adverse effect of heparin infusions that can prove fatal. HIT is suspected when the platelet counts fall significantly. A platelet count below 100,000/mm^3 would warrant discontinuation of the heparin.

Burchum-47. The nurse reviews the medication treatment regimen for a patient with chronic hypertension. To promote optimal medication adherence, which frequency of drug dosing should the nurse advocate for this patient? a. Once a day b. Three times a day c. Four times a day d. Every 8 hours

a. Once a day A major cause of treatment failure in patients with chronic hypertension is lack of adherence to a prescribed regimen. To promote adherence, the dosing schedule should be as simple as possible, just once or twice daily dosing.

HESI. After administering a loop diuretic, a nurse monitors the client for increased urine output. What principle explains the secondary water loss (diuresis) of a loop diuretic? a. Osmosis b. Filtration c. Diffusion d. Active transport

a. Osmosis. Loop diuretics inhibit the reabsorption of sodium and water in the ascending loop of Henle. The increased sodium load in the distal tubule causes the passive transfer of water from the glomerular filtrate to urine through the process of osmosis. - Filtration refers to solutes; solutes are not being passed into the urine. - Diffusion is not specific to fluid; osmosis is. - Active transport requires energy; water is passively moved from tubule cells to the urine.

Burchum-1. What is the objective of drug therapy? a. Provide maximum benefit with minimal harm b. Provide minimum benefit with maximum harm c. Provide total relief of symptoms regardless of harm d. Provide as much benefit as possible

a. Provide maximum benefit with minimal harm. The objective of drug therapy is to provide maximum benefit with minimal harm. All drugs have the potential to produce side effects. Because drugs are not ideal, we must exercise skill and care if treatment is to result in more good than harm.

Burchum-76. A nurse should monitor more frequently the blood pressure of a patient with a history of hypertension who takes which medication for allergic rhinitis? a. Pseudoephedrine [Sudafed] b. Montelukast [Singulair] c. Mometasone [Nasonex spray] d. Oxymetazoline [Afrin spray]

a. Pseudoephedrine [Sudafed] Pseudoephedrine is a sympathomimetic that activates alpha1 receptors and causes vasoconstriction. Only oral agents cause widespread vasoconstriction that warrants caution in patients with hypertension. - Montelukast blocks leukotrienes and has no adverse effects. - Oxymetazoline spray is a topical sympathomimetic that causes rebound congestion with prolonged use. - Mometasone spray is a glucocorticoid intranasal spray for which systemic side effects are rare.

Burchum-10. Which intervention would the nurse choose to minimize the risk of drug toxicity in neonates and infants? a. Reduce the amount of drug given. b. Administer the medication before meals. c. Shorten the interval between doses. d. Administer the medication intravenously.

a. Reduce the amount of drug given. The albumin in neonates and infants has a lower binding capacity for medication. A lower binding capacity leaves more of the free drug available for action; therefore, a lower dose is required to prevent toxicity.

HESI. The nurse provides medication teaching to a client on diuretic therapy who receives a prescription for potassium supplements. The nurse concludes that the teaching was effective when the client states, "I should: a. Report any abdominal distress." b. Use salt substitutes to season food." c. Take the drug on an empty stomach." d. Increase the dosage if I have muscle cramps."

a. Report abdominal distress. Potassium supplements can cause gastrointestinal ulceration and bleeding. - Most salt substitutes contain potassium, and their use with potassium supplements can cause hyperkalemia. - Because they can be irritating to the stomach, potassium supplements should not be taken on an empty stomach. - Although muscle cramps may indicate hypokalemia, clients should not adjust their own dosage.

Burchum-46. The nurse is caring for a patient who has been receiving intravenous sodium nitroprusside [Nitropress] for 3 days. Which assessement data indicate the patient may be experiencing thiocyanate toxicity? a. Sudden confusion b. Difficulty breathing c. Erythematous rash d. Gastrointestinal bleeding

a. Sudden confusion. When nitroprusside is given for several days, thiocyanate may accumulate, which can cause adverse effects. These effects, which involve the central nervous system (CNS), include disorientation, psychotic behavior, and delirium. - Difficulty breathing, erythematous rash, and gastrointestinal bleeding are not adverse effects related to thiocyanate toxicity.

Burchum-11. When preparing a teaching session for residents at an assisted living facility, the nurse will include what? a. The importance of avoiding intentional underdosing b. The importance of using multiple pharmacies for cost-effective savings on prescription drugs c. The importance of taking double amounts of missed doses to maintain therapeutic levels of medications d. The importance of reducing protein intake while taking prescription medications

a. The importance of avoiding intentional underdosing. Underdosing, with resulting therapeutic failure, is much more common (90%) than overdosing among the elderly. In most cases (75%), the nonadherence is intentional because of the patient's conviction that the drug is simply not needed or because of unpleasant side effects. - Using multiple pharmacies should be avoided, as should doubling missed doses. - Doubling a dose could result in intentional overdosing. - Reducing protein intake can result in decreased drug binding to albumin; consequently, the amount of free drug is increased, which could result in drug toxicity.

HESI. While receiving an adrenergic beta2 agonist drug for asthma, the client complains of palpitations, chest pain, and a throbbing headache. What is the most appropriate nursing action? a. Withhold the drug until additional prescriptions are obtained. b. Tell the client not to worry; these are expected side effects from the medicine. c. Ask the client to relax, then give instructions to breathe slowly and deeply for several minutes. d. Explain that the effects are temporary and will subside as the body becomes accustomed to the drug.

a. These drugs cause increased heart contraction (positive inotropic effect) and increased heart rate (positive chronotropic effect). If toxic levels are reached, side effects occur and the drug should be withheld until the health care provider is notified. - Telling the client not to worry; these are expected side effects from the medicine, is false reassurance and a false statement. - Controlled breathing may be helpful in allaying a client's anxiety; however, the drug may be producing adverse effects and should be withheld.

Burchum-4. A nurse prepares to administer acetaminophen [Tylenol] to a patient with an oral temperature of 101.7°F. Which preparation would the nurse expect to have the most rapid onset of action? a. Tylenol elixir b. Tylenol tablets c. Tylenol capsules d. Tylenol gel caps

a. Tylenol elixir. A liquid does not have to dissolve first to allow absorption; therefore, the onset of action occurs more quickly than with capsules, tablets, or gel caps.

HESI. A client is receiving phenytoin (Dilantin) for a seizure disorder and heparin for a deep vein thrombosis. Warfarin (Coumadin) is added in preparation for discontinuing the heparin. Why must the nurse observe the client closely during the initial days of treatment with warfarin? a. Warfarin affects the metabolism of phenytoin. b. Phenytoin decreases warfarin's anticoagulant effect. c. Warfarin's action is greater in clients with seizure disorders. d. Seizures increase the metabolic degradation rate of warfarin.

a. Warfarin has been shown to inhibit metabolism of phenytoin, which results in an accumulation of phenytoin in the body. - Warfarin potentiates the anticoagulant effect of heparin. - That warfarin's action is greater in clients with seizure disorders is true only if the client is receiving phenytoin to control the seizure disorder. - Seizures do not have a significant effect on the metabolism of warfarin.

Burchum-76. Using a stepwise approach to managing asthma, a nurse teaches a patient who is at step 1 to use albuterol MDI [Proventil] at which of these times? a. Whenever needed (PRN) as a quick-relief agent b. Twice daily combined with an inhaled glucocorticoid c. Only with a long-acting beta2 agonist (LABA) d. If nighttime awakenings occur more than 2 days a week

a. Whenever needed (PRN) as a quick-relief agent For patients at step 1 in the stepwise approach to managing asthma, albuterol is a short-acting beta2 agonist (SABA) used only PRN to relieve ongoing asthma attacks and prevent exercise-induced bronchospasm. For patients at steps 2 to 6, albuterol is considered a quick-relief medication taken PRN. - For patients at step 1, no long-term control medications are taken. - A patient is at a higher step than 1 in the stepwise approach if the patient requires a daily inhaled glucocorticoid or LABA or awakens at night more often than 2 days a week.

Burchum-5. The nursing student learns that not all drugs produce effects binding to a receptor. Which drugs do not act through receptors? a. Antacids b. Analgesics c. Antihistamines d. Steroid hormones

a. antacids Antacids do not act through receptors. Antacids neutralize gastric activity by direct chemical interaction with stomach acid.

HESI. A client has chronic asthma. For which complication should the nurse monitor this client? a. Atelectasis b. Pneumothorax c. Pulmonary edema d. Respiratory alkalosis

a. atelactasis. As a result of narrowed airways, adequate ventilation of lung tissue is compromised and alveoli may collapse. - Pneumothorax is not a common complication of asthma; a collapsed lung is referred to as a pneumothorax. - Pulmonary edema is not a common complication of asthma; pulmonary edema is caused by left-sided heart failure. - Respiratory alkalosis is not a common complication of asthma; with narrowed air passages, the client with asthma is at risk for hypoxia and respiratory acidosis.

Burchum-41. The nurse should monitor for which adverse effect after administering hydrochlorothiazide [HydroDIURIL] and digoxin [Lanoxin] to a patient? a. Digoxin toxicity b. Decreased diuretic effect c. Dehydration d. Heart failure

a. digoxin toxicity. Digoxin levels have an inverse relationship with potassium levels. Because hydrochlorothiazide can lower potassium levels, combined use of hydrochlorothiazide and digoxin poses a risk for elevated digoxin levels and ensuing digoxin toxicity.

HESI. A client who is receiving multiple medications for a myocardial infarction complains of severe nausea, and the client's heartbeat is irregular and slow. The nurse determines that these signs and symptoms are toxic effects of: a. Digoxin (Lanoxin) b. Captopril (Capoten) c. Morphine sulfate (MS Contin) d. Furosemide (Lasix )

a. digoxin. Signs of digoxin toxicity include cardiac dysrhythmias, anorexia, nausea, vomiting, and visual disturbances. - Although nausea and heart block may occur with lidocaine, these symptoms rarely are seen; drowsiness and central nervous system disturbances are more common. - Toxic effects of morphine are slow, deep respirations, stupor, and constricted pupils; nausea is a side effect, not a toxic effect. - Toxic effects of furosemide are renal failure, blood dyscrasias, and loss of hearing.

HESI. A client reports nausea, vomiting, and seeing a yellow light around objects. A diagnosis of hypokalemia is made. Upon a review of the client's prescribed medication list, the nurse determines that what is the likely cause of the clinical findings? a. Digoxin (Lanoxin) b. Furosemide (Lasix) c. Propranolol (Inderal) d. Spironolactone (Aldactone)

a. digoxin. These are signs of digitalis toxicity, which is more likely to occur in the presence of hypokalemia. - Although furosemide most likely contributed to the hypokalemia, the client's symptoms are consistent with digitalis toxicity. - Although propranolol can cause nausea, vomiting, and blurred vision, the presence of hypokalemia and yellow vision are more suggestive of digitalis toxicity. - A side effect of spironolactone is hyperkalemia, not hypokalemia.

Lec 2. Acetylcysteine (Mucomyst) is used as both a respiratory medication and, in cases of _____________ overdoses, to prevent organ damage.

answer: acetaminophen (Tylenol)

Lec 2. Codeine is classified as a(n) ________________ because it acts directly on the medullary cough center of the brain.

answer: antitussive

Lec 3. Patients prescribed montelukast (Singular) should be taught to take the drug at ______________.

answer: bedtime

Lec 6. Thiazide diuretics work by blocking the ___________ pump to prevent the reabsorption of chloride and sodium into the vascular system.

answer: chloride

Lec 6. Diuretics are used to treat ______________ commonly found in patients with congestive heart failure.

answer: edema

Lec 3. The drug of choice for treating acute bronchospasm in both adults and children is __________.

answer: epinephrine

Lec 2. Medications like guaifenesin (Mucinex) that liquefy lower respiratory tract secretions and make them easier to cough up are called _________________.

answer: expectorants

Lec 3. Fluticasone (Flovent) is an example of a(n) ______________ steroid that is helpful in decreasing the inflammatory response in the airway.

answer: inhaled

Lec 6. Furosemide (Lasix) is an example of a(n) __________ diuretic which works in the ______________.

answer: loop; loop of Henle

Lec 6. Mannitol (Osmitrol) is an example of a(n) ___________ diuretic that relieves edema by pulling water into the renal tubule without sodium loss.

answer: osmotic

Lec 3. Atrovent is contraindicated in patients with an allergy to ________________.

answer: peanuts

Lec 6. Spironolactone (Aldactone) is a diuretic that spares _______________ instead of wasting it.

answer: potassium

Lec 2. Patients who use decongestants for a prolonged period of time are at risk for _______________.

answer: rebound decongestion

Lec 2. Patients who need decongestants but cannot tolerate an oral systemic medication may be prescribed a(n) _______ _______ decongestant

answer: topical nasal

Lec 3. Theophylline (Slo-bid, Theo-Dur) is an example of a(n) _____________, which is used in patients with asthma and COPD to improve respiratory gas exchange by dilating the airways.

answer: xanthine bronchodilator

Ch 43. A client taking an ACE inhibitor is scheduled for surgery. The nurse should a. stop the drug. b. alert the surgeon and mark the client's chart prominently. c. cancel the surgery and consult with the prescriber. d. monitor fluid levels and make the sure the fluids are restricted before surgery.

b

Ch 43. Essential hypertension is the most commonly diagnosed form of high blood pressure. Essential hypertension is a. caused by a tumor in the adrenal gland. b. associated with no known cause. c. related to renal disease. d. caused by liver dysfunction

b

Ch 43. The baroreceptors are the most important factor in continual control of blood pressure. The baroreceptors a. are evenly distributed throughout the body to maintain pressure in the system. b. sense pressure and immediately send that information to the medulla in the brain. c. are directly connected to the sympathetic nervous system. d. are as sensitive to oxygen levels as to pressure changes.

b

Ch 45. Ibutilide (Corvert) is a class III antiarrhythmic drug that is used for a. sedation during electrocardioversion. b. conversion of recent-onset atrial fibrillation (AF) and flutter. c. treatment of life-threatening ventricular arrhythmias. d. treatment of arrhythmias complicated by HF.

b

Ch 47. After describing to a community group the ways in which the body uses cholesterol, which of the following, if stated by the group as such as a way, indicates successful teaching? a. The production of water-soluble vitamins b. The formation of steroid hormones c. The mineralization of bones d. The development of dental plaques

b

Ch 47. Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors work in the a. process of bile secretion. b. process of cholesterol formation in the cell. c. intestinal wall to block fat absorption. d. kidney to block fat excretion.

b

Ch 47. The formation of atheromas in blood vessels precedes the signs and symptoms of a. hepatitis. b. coronary artery disease (CAD). c. diabetes mellitus. d. chronic obstructive pulmonary disease (COPD).

b

Ch 48. A thrombolytic agent could be safely used in a. cerebrovascular accident within the last 2 months. b. acute myocardial infarction (MI) within the last 3 hours. c. recent, serious gastrointestinal bleeding. d. obstetric delivery.

b

Ch 48. Warfarin, an oral anticoagulant, acts a. to directly prevent the conversion of prothrombin to thrombin. b. to decrease the production of vitamin K clotting factors in the liver. c. as a catalyst in the conversion of plasminogen to plasmin. d. immediately, so it is the drug of choice in emergency situations.

b

Ch 50. Women tend to have more problems with bladder infections than men because a. women have Escherichia coli in the urinary tract. b. women have a short urethra, making access to the bladder easier for bacteria. c. the prostate gland secretes a substance that protects men from bladder infections. d. women's urine is more acidotic, encouraging the growth of bladder bacteria.

b

Ch 51. Most diuretics act in the body to cause a. loss of calcium. b. loss of sodium. c. retention of potassium. d. retention of chloride

b

Ch 51. Thiazide diuretics are considered mild diuretics because a. they block the sodium pump in the loop of Henle. b. they cause loss of sodium and chloride but little water. c. they do not cause a fluid rebound when they work in the kidneys. d. they have little or no effect on electrolyte levels.

b

Ch 48. Plasminogen is converted to plasmin, a clot dissolving substance, by which of the following? Select all that apply. a. Nicotine b. Hageman factor c. Tenecteplase d. Pyrogens e. Thrombin f. Christmas factor

b, c, d

Ch 3. A client is experiencing a serum sickness reaction to a recent rubella vaccination. Which of the following interventions would be appropriate when caring for this client? Select all that apply. a. Administration of epinephrine b. Cool environment c. Positioning to provide comfort d. Ice to joints as needed e. Administration of anti-infl ammatory agents f. Administration of topical corticosteroids

b, c, d, e.

Burchum-52. A patient diagnosed with a pulmonary embolism is receiving a continuous heparin infusion at 1000 units/hr. Of which findings should the nurse immediately notify the healthcare provider? (Select all that apply.) a. aPTT of 65 seconds b. aPTT of 40 seconds c. Nosebleeds d. aPTT of 100 seconds e. Platelet count of 300,000/mcL

b, c, d. Measurement of the aPTT is essential to determine whether the heparin infusion is having the desired effect. If the normal value of the aPTT is 40 seconds, the goal is to achieve a therapeutic range of a factor of 1.5 to 2 (60 to 80 seconds). Because 40 seconds is too short (increases the risk for clotting) and 100 seconds is too long (increases the risk for bleeding), the physician requires notification for adjustment of the infusion rate. Evidence of bleeding, such as nosebleeds, hematuria, and red or tarry stools, warrant a call to the physician. - An aPTT of 65 seconds indicates that a therapeutic effect has been achieved, and a platelet count of 300,000/mcL is within normal limits, indicating no evidence of thrombocytopenia.

Burchum-46. A patient is prescribed hydralazine [Apresoline] for the treatment of essential hypertension. Which expected adverse effects should the nurse discuss with the patient? (Select all that apply.) a. Nausea b. Fatigue c. Dizziness d. Headache e. Joint pain

b, c, d. Some of the common adverse effects of hydralazine include fatigue, dizziness, and headache. - Nausea is associated with minoxidil. - Joint pain is not a common adverse effect of hydralazine.

Burchum-43. Which statements accurately reflect Starling's law as applied to a healthy heart? (Select all that apply.) a. When venous return increases, stroke volume decreases. b. The right and left ventricles pump the same amount of blood. c. Cardiac output is equal to the volume of blood delivered by the veins. d. When venous return increases, cardiac output increases. e. As cardiac muscle fibers increase in length, their contractile force decreases.

b, c, e. Starling's law states that the force of ventricular contraction is proportional to muscle fiber length. Therefore, as muscle fibers increase in length, the force of the heart contraction increases. In this situation, the right and left ventricles pump the same amount of blood, and overall cardiac output is equivalent to the volume delivered by the veins. As venous return increases, stroke volume increases accordingly.

Burchum-3. Which is a true statement about new drug development? (Select all that apply.) a. Preclinical testing of drugs is always performed in healthy, nonpregnant adults. b. Drug trials require that those involved not know which subjects are receiving the drug or control. c. During preclinical testing, drugs are evaluated for toxicities, kinetic properties, and useful effects. d. When a new drug is released, all adverse effects are known.

b, c. During the testing process, randomized controlled trials are used, in which the participants are unaware of which subjects are getting drug, placebo, or control. Kinetics, toxicities, and effectiveness are tested during the preclinical phase of drug testing. - Preclinical drug testing is not performed in humans; it is done mostly in animals. - Because drug testing occurs in a relatively small number of patients, those patients are carefully selected, the drug is taken for a relatively short time, and not all adverse effects are detected during the drug testing process.

Burchum-45. The nurse is caring for a patient with hypertension who is receiving verapamil [Calan]. The patient has a healthy heart. What pharmacodynamic effects does the nurse expect from this drug? (Select all that apply.) a. Peripheral vasoconstriction b. Peripheral vasodilation c. Coronary vasodilation d. Increased heart rate e. Increased force of contraction

b, c. Verapamil causes peripheral vasodilation and coronary vasodilation, which lead to decreased blood pressure and improved coronary perfusion. - It does not cause vasoconstriction and usually has little effect on the heart rate or contractility in healthy hearts.

Ch 6. A nurse is caring for a patient who has been diagnosed with type 2 diabetes. The patient has reported that he frequently uses herbal remedies. Before administering any antidiabetic medications, the nurse should caution the patient about the use of which of the following herbal therapies? a. Glucosamine b. Ginseng c. St. John's wort d. Juniper berries e. Garlic f. Kava

b, d, e.

HESI. A nurse is administering intravenous aminophylline to a client with asthma. Which clinical findings support the conclusion that the client is experiencing an adverse reaction to aminophylline? Select all that apply. a. Bradycardia b. Hypotension c. Hypoventilation d. Cardiac dysrhythmia e. Muscle hyperactivity

b, d, e. Aminophylline acts as a vasodilator, and hypotension results when vessels are dilated. This is an adverse reaction. Cardiac dysrhythmias are an adverse effect of aminophylline as a result of central nervous system stimulation. Muscle hyperactivity is an adverse effect of aminophylline as a result of central nervous system stimulation. - Tachycardia, not bradycardia, is a common side effect of aminophylline. - Tachypnea, not hypoventilation, is a common side effect of aminophylline.

Ch 2. Drug-drug interactions are important considerations in clinical practice. When evaluating a patient for potential drug-drug interactions, what would the nurse expect to address? Select all that apply. a. Bizarre drug effects on the body b. The need to adjust drug dose or timing of administration c. The need for more drugs to balance the effects of the drugs being given d. A new therapeutic effect not encountered with either drug alone e. Increased adverse effects f. The use of herbal or alternative therapies

b, e, f.

HESI. A client has a decreased serum sodium level. The nurse should assess the client for which signs of hyponatremia? Select all that apply. a. Dry skin b. Confusion c. Tachycardia d. Pallor e. Muscle weakness

b, e. Confusion is a classic sign of hyponatremia because of its effect on the cerebral cortex; additional symptoms are apprehension and irritability. Sodium is a component of the sodium-potassium pump, which is essential for the functioning of cells, especially in relation to muscle contraction. A deficiency in either sodium or potassium will result in weakness. - Dry skin is associated with aging and dehydration. - Tachycardia is associated with hypovolemia. - Pale coloring is associated with shock and anemia.

Ch 1. Clinical pharmacology is the study of a. the biological effects of chemicals. b. drugs used to treat, prevent, or diagnose disease. c. plant components that can be used as medicines. d. binders and other vehicles for delivering medication.

b.

Ch 1. Healthy young women are not usually involved in phase I studies of drugs because a. male bodies are more predictable and responsive to chemicals. b. females are more apt to suffer problems with ova, which are formed only before birth. c. males can tolerate the unknown adverse effects of many drugs better than females. d. there are no standards to use to evaluate the female response.

b.

Ch 2. Jack B. has Parkinson's disease that has been controlled for several years with levodopa. After he begins a health food regimen with lots of vitamin B6, his tremors return, and he develops a rapid heart rate, hypertension, and anxiety. The nurse investigating the problem discovers that vitamin B6 can speed the conversion of levodopa to dopamine in the periphery, leading to these problems. The nurse would consider this problem a. a drug-laboratory test interaction. b. a drug-drug interaction. c. a cumulation effect. d. a sensitivity reaction

b.

Ch 2. Receptor sites a. are a normal part of enzyme substrates. b. are protein areas on cell membranes that react with specific chemicals. c. can usually be stimulated by many different chemicals. d. are responsible for all drug effects in the body

b.

Ch 2. When trying to determine why the desired therapeutic effect is not being seen with an oral drug, the nurse should consider a. the blood flow to muscle beds. b. food altering the makeup of gastric juices. c. the weight of the patient. d. the temperature of the peripheral environment

b.

Ch 3. A patient with a severe infection is given gentamicin, the only antibiotic shown to be effective in culture and sensitivity tests. A few hours after the drug is started intravenously, the patient becomes very restless and develops edema. Blood tests reveal abnormal electrolytes and elevated blood urea nitrogen. This reaction was most likely caused by a. an anaphylactic reaction. b. renal toxicity associated with gentamicin. c. superinfection related to the antibiotic. d. hypoglycemia.

b.

Ch 3. A woman has had repeated bouts of bronchitis throughout the fall and has been taking antibiotics. She calls the clinic with complaints of vaginal pain and itching. When she is seen, it is discovered that she has developed a yeast infection. You would explain to her that a. her bronchitis has moved to the vaginal area. b. she has developed a superinfection because the antibiotics kill bacteria that normally provide protection. c. she probably has developed a sexually transmitted disease related to her lifestyle. d. she will need to take even more antibiotics to treat this new infection.

b.

Ch 6. Herbal treatments and alternative therapies a. are considered drugs and regulated by the FDA. b. are considered dietary supplements and are not regulated by the FDA. c. have no restrictions on claims and advertising. d. contain no drugs, only natural substances

b.

Ch 6. The cost of drug therapy is a major consideration in most areas because a. generic drugs are always cheaper. b. the high cost of drugs combined with more fixed income consumers puts constraints on drug use. c. pharmacies usually carry only one drug from each class. d. patients like to shop around and get the best drug for their money

b.

Burchum-9. The nurse is caring for a patient with epilepsy who is on anticonvulsant therapy and is also breast-feeding. Which patient teaching instruction should minimize the risk to the baby? a. "Give the dose just before breast-feeding." b. "Avoid drugs that have a long half-life." c. "Discontinue the drug until you have stopped breast-feeding." d. "Increase your fluid intake."

b. "Avoid drugs that have a long half-life." Drugs with a shorter half-life are excreted by the mother more quickly. - Dosing immediately after breast-feeding minimizes the drug concentration in milk. - If possible, drugs should be avoided during breast-feeding; however, patients with chronic illnesses, such as epilepsy, may require medication for their own health. - The maternal fluid intake is not related to medication safety during breast-feeding.

Burchum-76. Which statement should the nurse include in the teaching for a patient who is to be started on zileuton [Zyflo]? a. "Use your zileuton [Zyflo] inhaler every 12 hours." b. "Have your blood drawn once a month for the next 3 months so that your liver function can be checked." c. "Take the zileuton [Zyflo] 2 hours before eating breakfast each day." d. "Take an extra dose of zileuton [Zyflo] if you have an asthmatic attack."

b. "Have your blood drawn once a month for the next 3 months so that your liver function can be checked." Zileuton can injure the liver, as evidenced by increased plasma levels of alanine aminotransferase (ALT). Therefore, ALT should be monitored once a month for 3 months, then every 2 to 3 months for the remainder of the first year, and periodically thereafter. - Zileuton is an oral, not an inhaled, medication that is rapidly absorbed with or without food. - The timing of administration with regard to meals is insignificant. - Zileuton is used for asthma prophylaxis and cannot be used to abort an attack.

Burchum-46. The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? a. "I can take this medication in the morning to reduce nighttime urination." b. "I will rise slowly when changing from a sitting to a standing position." c. "My heart rate may slow down with this drug. I will call if my pulse is below 60." d. "I need to increase my intake of fluids and foods that are high in fiber."

b. "I will rise slowly when changing from a sitting to a standing position." Vasodilators may cause postural hypotension and reflex tachycardia. Patients should be taught to move slowly when changing positions to prevent dizziness.

Burchum-76. Which instruction should the nurse include in the teaching for a patient prescribed cetirizine [Zyrtec] for seasonal allergic rhinitis? a. "Clean the nasal applicator after use to prevent contamination." b. "Take the medication daily throughout the allergy season." c. "Expect a decrease in your nasal congestion in a day or two." d. "Take a stool softener daily to avoid the side effect of constipation."

b. "Take the medication daily throughout the allergy season." For treatment of allergic rhinitis, antihistamines such as cetirizine are most effective when taken prophylactically throughout the allergy season, even when symptoms are absent. - The medication is taken orally, not intranasally. - Oral antihistamines relieve sneezing, rhinorrhea, and nasal itching but not nasal congestion. - Constipation is rare in patients taking second-generation agents, such as cetirizine.

Burchum-76. Which statement by a patient indicates understanding of a nurse's teaching about fluticasone nasal spray [Flonase]? a. "I'll gradually stop taking this so I don't have any problems with withdrawal." b. "This drug will help prevent the inflammation and irritation from my allergies." c. "I'll have to be more careful about not falling, because my bones may break more easily." d. "I realize that I only need to take this when my symptoms are really bad."

b. "This drug will help prevent the inflammation and irritation from my allergies." Fluticasone nasal spray is a steroid drug used to prevent the symptoms of allergy. Its effect is localized; therefore, the patient does not have systemic adverse effects with normal use and does not have to wean down the medication, as with oral corticosteroids. Intranasal glucocorticoids are most effective for preventing and treating allergic rhinitis.

Burchum-76. A nurse is teaching a patient about montelukast [Singulair]. Which statement by the patient would indicate that the nurse's teaching was effective? a. "I'll take a dose as soon as I feel short of breath and start to cough." b. "While taking this medicine, I may be able to reduce my steroid medication." c. "This is the priority medication for preventing exercise-induced asthma symptoms." d. "If I have nosebleeds or excessive bruising, I'll stop the medication immediately."

b. "While taking this medicine, I may be able to reduce my steroid medication." Montelukast is an antileukotriene agent. Combining montelukast with an inhaled glucocorticoid medication can improve asthma symptoms and thus may allow a reduction in the glucocorticoid dosage. - The effects of montelukast develop slowly, so it cannot be used as a quick-relief agent. - Short-acting beta2 agonists are preferred for exercise-induced asthma. - Montelukast does not affect coagulation, so bleeding and bruising do not occur.

Burchum-52. Which needle length and gauge should the nurse choose to administer subcutaneous heparin? a. ½ inch; 20 gauge b. 5/8 inch; 25 gauge c. 1½ inch; 18 gauge d. 1 inch; 26 gauge

b. 5/8 inch; 25 gauge Heparin should be administered subcutaneously into the fatty layer of the abdomen with a ½- to -inch needle, 25 or 26 gauge. The only appropriate option for injection in the list shown is the -inch, 25-gauge needle.

Burchum-52. The nurse is ready to begin a heparin infusion for a patient with evolving stroke. The baseline activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved? a. 50 b. 70 c. 90 d. 110

b. 70 The therapeutic level of heparin is achieved when the aPTT reaches 1.5 to 2 times normal. Thus, a range of 60 to 80 seconds would be appropriate for this patient.

Lec 3. A patient presents to the emergency department (ED) having an acute asthma attack. The emergency department (ED) physician has ordered a sympathomimetic agent - epinephrine. Which is the expected therapeutic effect of this medication in this patient? a. A decrease in the inflammatory response in the airways b. A dilation of the bronchi with increased rate and depth of respiration c. A reduction in the surface tension within the alveoli allowing for gas exchange d. Inhibition of the release of histamine to prevent the allergic asthmatic response

b. A dilation of the bronchi with increased rate and depth of respiration

HESI. A client who develops heart failure has a serum potassium level of 2.3 mEq/L. Digoxin (Lanoxin) and potassium chloride are prescribed. What action should the nurse take? a. Double the dose of potassium chloride and administer it with the prescribed digoxin. b. Hold the dose of digoxin, administer the potassium chloride, and call the health care provider immediately. c. Give the digoxin and potassium chloride as prescribed and report the laboratory results to the health care provider. d. Administer the prescribed digoxin and potassium chloride with a glass of orange juice and continue to monitor the client.

b. A low potassium level with the administration of digoxin can cause digitalis toxicity, resulting in life-threatening dysrhythmias. - Doubling the dose of potassium chloride and administering it with the prescribed digoxin has the potential of causing digitalis toxicity. Changing the dose of a medication is not within the legal role of the nurse and requires a health care provider's prescription. - Giving the digoxin and potassium chloride as prescribed and reporting the laboratory results to the health care provider has the potential of causing digitalis toxicity, especially when the potassium level is less than 3 mEq/L. - Administering the prescribed digoxin and potassium chloride with a glass of orange juice and continuing to monitor the client has the potential of causing digitalis toxicity. One glass of orange juice and one dose of potassium chloride will not change the potassium level significantly.

Burchum-49. In what part of the conduction pathway in a healthy heart is the electrical impulse delayed to provide time for the blood to fill the ventricles? a. Bundle of His b. AV node c. Purkinje system d. Internodal pathways

b. AV node Impulses originate in the SA node and then travel through the AV node to reach the ventricles. The impulse is delayed at the AV node to provide time for the ventricles to fill before they contract.

Burchum-49. A patient develops supraventricular tachycardia (SVT) and is hypotensive. Which medication should the nurse anticipate will be administered? a. Lidocaine [Xylocaine] b. Adenosine [Adenocard] c. Amiodarone [Cordarone] d. Phenytoin [Dilantin]

b. Adenosine [Adenocard] The drug of choice for terminating SVT is adenosine. - Lidocaine is used for ventricular dysrhythmias; - - amiodarone is used for atrial and ventricular dysrhythmias; and - phenytoin is used for digoxin-induced dysrhythmias.

Burchum-52. Which medication promotes hemostasis in hemophilia A and B by inhibition of fibrinolysis? a. Desmopressin [DDAVP] b. Aminocaproic acid [Amicar] c. Celecoxib [Celebrex] d. Diphenhydramine [Benadryl]

b. Aminocaproic acid [Amicar] Aminocaproic acid inhibits fibrinolysis by blocking the production of plasmin. Consequently, it promotes hemostasis in patients with hemophilia A or hemophilia B. - Desmopressin may be useful for stopping bleeding in mild hemophilia A, because it promotes the release of stored factor VIII. - Celecoxib is a cylcooxygenase-2 (COX-2) inhibitor that does not suppress platelet aggregation; however, its safety for pain management in hemophilia has not been proven. - Diphenhydramine may be administered to treat symptoms of mild reaction to administration of factor VIII.

Burchum-44. The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising the blood pressure? a. Angiotensin I b. Angiotensin II c. Angiotensin III d. Renin

b. Angiotensin II is a potent vasoconstrictor. It participates in all the pathways regulated by the renin-angiotensin-aldosterone system. - Angiotensin I is a precursor to angiotensin II - angiotensin III is formed by degradation of angiotensin II and is less potent. - Renin catalyzes the conversion of angiotensinogen to angiotensin I.

Burchum-9. A nurse prepares to administer a newly prescribed medication to a 22-year-old woman. The insert in the medication package states, "Category X." Select the nurse's best action. a. Ask the patient, "Have you been sexually active during the past year?" b. Ask the patient, "When was your last menstrual period?" c. Inform the patient of the primary actions of the medication. d. Assess the patient for a history of sexually transmitted disease.

b. Ask the patient, "When was your last menstrual period?" Category X means that the drug will be harmful to the fetus if the patient is pregnant. The patient may not know she is pregnant; therefore, asking her when her last menstrual period occurred gives the nurse a better indication of whether the patient might be pregnant. {natasha's note: don't agree with this one. the only way to be certain is to ask the doctor to order a pregnancy test. i mean, even option A seems like a safer bet...}

Burchum-47. Which classes of medications are prescribed as initial therapy for hypertension after a myocardial infarction (MI)? a. Diuretic and beta blocker b. Beta blocker and ACE inhibitor c. ACE inhibitor and calcium channel blocker d. Diuretic and calcium channel blocker

b. Beta blocker and ACE inhibitor Beta blockers and ACE inhibitors, as well as aldosterone antagonists, are the drug classes recommended for initial therapy of hypertension after an MI. Diuretics and calcium channel blockers are not part of initial therapy for hypertension after an MI.

HESI. What should the nurse include in a teaching plan to help reduce the side effects associated with diltiazem (Cardizem)? a. Lie down after meals. b. Change positions slowly. c. Avoid dairy products in diet. d. Take the drug with an antacid.

b. Changing positions slowly will help prevent the side effect of orthostatic hypotension. - Lying down after meals can relax the esophagus and lead to acid reflux. - Avoiding dairy products and taking the drug with an antacid are not necessary.

Burchum-3. N-acetyl-para-aminophenol is an example of which type of drug name? a. Proprietary b. Chemical c. Generic d. Trade

b. Chemical. The chemical name is a description of a drug using the nomenclature of chemistry. - The proprietary or trade name of the drug is the brand name under which the drug is marketed by one or more companies. - The generic name is the name assigned by the U.S. Adopted Names Council and is the same regardless of who manufactures the drug.

Burchum-1. When studying the effects of drugs in humans, the nurse is learning about what? a. Pharmacology b. Clinical pharmacology c. Therapeutics d. Effectiveness

b. Clinical pharmacology. Clinical pharmacology is the study of the effects of drugs in humans. - Pharmacology can be defined as the study of drugs and their interactions with living systems. - Therapeutics, also known as pharmacotherapeutics, is the use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy. - The term effectiveness indicates that the drug elicits the intended response or responses.

Burchum-52. The nurse is monitoring therapy for a patient with hemophilia B. Which evaluation criterion is most important to determine whether the medication dosage is effective? a. Clotting factor VIII levels b. Clinical response c. Clotting factor IX levels d. PT and INR

b. Clinical response Clotting factor IX levels are monitored in patients with hemophilia B. However, the dosage ultimately is determined by the clinical response.

Burchum-50. The nurse is caring for a patient prescribed a cholesterol-lowering drug. Which drug is least likely to cause systemic side effects? a. Simvastatin [Zocor] b. Colesevelam [Welchol] c. Nicotinic acid [Niaspan] d. Gemfibrozil [Lopid]

b. Colesevelam [Welchol] Colesevelam, a bile acid sequestrant, is a nonabsorbable resin that works directly in the gastrointestinal tract. Because it and other bile acid sequestrants (eg, cholestyramine [Questran] and colestipol [Colestid]) are not absorbed, they do not have systemic effects. The bile acid sequestrants' most common complication is constipation. The other agents have potential systemic adverse effects.

Burchum-11. The nurse will monitor which laboratory result closely when administering medications to an older adult patient while assessing for adverse drug reactions (ADRs)? a. Serum creatinine levels b. Creatinine clearance c. Serum albumin levels d. Liver function tests

b. Creatinine clearance Drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the elderly. Creatinine clearance, not serum creatinine levels, is the proper index of renal function in older adult patients.

Burchum-44. A patient is prescribed lisinopril [Prinivil] 40 mg by mouth once a day for hypertension. For which therapeutic effect will the nurse monitor? a. Slowing of the heart rate b. Decrease in blood pressure c. Symptoms such as dizziness and fainting d. Pulse oximetry oxygen saturation of 100%

b. Decrease in BP. The therapeutic effect of ACE inhibitors is to reduce blood pressure in patients with hypertension. - ACE inhibitors do not affect patients' heart rate. - Dizziness and fainting are symptoms of hypotension. - ACE inhibitors do not affect oxygen saturation.

Burchum-6. Before administrating the dosage of a prescribed medication, the nurse observes precipitation formation of the intravenous (IV) solution. What is the priority nursing action? a. Verify the prescription. b. Discard the IV solution. c. Prepare another dose to administer. d. Check the expiration date of the drug.

b. Discard the IV solution. If a precipitate appears in the IV solution, that solution should be discharged.

Burchum-1. The nurse teaches a patient not to consume alcohol with nitroglycerine, because the blood pressure often drops significantly when nitroglycerine is taken with alcohol. Which drug property does this illustrate? a. Chemical instability b. Drug interaction c. Reversible action d. Drug selectivity

b. Drug interaction When two or more drugs are taken together, they can interact, causing either increased or decreased drug responses. In this case, alcohol would increase the nitroglycerine response. Chemical instability, reversible action, and drug selectivity are not related to this situation.

Burchum-10. The nurse is caring for a group of very young patients receiving a variety of medications. Which concept guides the nurse's care of these patients? a. Drugs given intravenously (IV) leave the body more quickly in infants than in adults. b. Drugs given subcutaneously (SC) remain in the body longer in infants than in adults. c. Gastric emptying time is shorter in infants than in children and adults. d. The blood-brain barrier protects the infant's brain from toxic drugs.

b. Drugs given subcutaneously (SC) remain in the body longer in infants than in adults. The very young are at risk for drug effects that are more intense and prolonged than those seen in adults. Drugs given by the SC route reach higher levels and remain in the system longer than in adults. - Drugs given IV leave the body more slowly in infants than in adults. - Gastric emptying time is prolonged in infants. - The blood-brain barrier is not fully developed in infants.

Burchum-47. The nurse is caring for a patient who has diabetes and hypertension. Which medication is most likely to be prescribed to treat this patient's hypertension? a. Hydrochlorothiazide [HCTZ] b. Enalapril [Vasotec] c. Propranolol [Inderal] d. Methyldopa [Aldomet]

b. Enalapril [Vasotec] Preferred antihypertensives for patients with diabetes include ACE inhibitors (enalapril), ARBs, and calcium channel blockers. ACE inhibitors are particularly useful, because they slow the progression of diabetic nephropathy in addition to lowering blood pressure. - Thiazide diuretics promote hyperglycemia and are used with caution.

Burchum-4. The nurse administers 100 mg of drug X by mouth. After the drug moves through the hepatic system, very little active drug is left in the general circulation as a result of what? a. Therapeutic range b. First-pass effect c. Drug half-life d. Plasma protein binding

b. First-pass effect. The term first-pass effect refers to the rapid hepatic inactivation of certain oral drugs. Drugs that undergo the first-pass effect often are administered parenterally. - The therapeutic range is the range of drug level between the minimum effective concentration (MEC) and the toxic concentration. - The drug half-life is the time required for the amount of drug in the body to decrease by 50%. - Plasma protein binding is involved with the transport of drugs through the bloodstream.

Burchum-52. A patient with a deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response? a. Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting factors. b. Heparin suppresses coagulation by helping antithrombin perform its natural functions. c. Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot matrix. d. Heparin inhibits the enzyme responsible for platelet activation and aggregation within vessels.

b. Heparin is an anticoagulant that works by helping antithrombin inactivate thrombin and factor Xa, reducing the production of fibrin and thus decreasing the formation of clots.

HESI. A health care provider prescribes verapamil (Calan) to be administered intravenously to an older adult client with hypertension. Which nursing intervention is specific to the intravenous administration of verapamil? a. Monitor the ECG for a prolonged PR interval on initial administration. b. Keep the client in the recumbent position for one hour after administration. c. Instill the dose in 50 mL of normal saline and administer it over 15 minutes. d. Assess the client's respiratory rate and rhythm before administering the drug.

b. Hypotension is a common side effect of intravenously administered verapamil. Keeping the client in the recumbent position for one hour after administration provides for the safety of the client. - A prolonged PR interval may occur during prolonged therapy, not on initial administration of verapamil. - Verapamil should be administered undiluted when given intravenously. It is administered over two minutes for adults and over three minutes for older adults. - The client's heart rate and blood pressure should be assessed before administration to provide a baseline for comparison. Verapamil will decrease the blood pressure and dysrhythmias.

Burchum-52. A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. What medication would be appropriate for this patient who has a history of heparin-induced thrombocytopenia (HIT)? a. Warfarin [Coumadin] b. Lepirudin [Refludan] c. Bivalirudin [Angiomax] d. Eptifibatide [Integrilin]

b. Lepirudin [Refludan] Lepirudin [Refludan] and argatroban are indicated for the treatment of thrombosis in patients with a history of HIT. Because these medications are given as an initial IV bolus followed by a continuous infusion, the desired effect of direct thrombin inhibition is achieved more quickly. - Because of warfarin's delayed onset of effects, it is not useful in emergency situations, such as pulmonary embolism (PE). - Intravenous bivalirudin given in combination with aspirin helps prevent clot formation in patients undergoing coronary angioplasty. - Eptifibatide [Integrilin], a glycoprotein IIb/IIIa receptor inhibitor, is an antiplatelet drug that is used short term to prevent ischemic events in patients who have acute coronary syndrome or who are undergoing percutaneous coronary intervention.

Burchum-44. The nurse is caring for a patient with bipolar disorder treated with lithium [Eskalith]. The patient has a new prescription for captopril [Capoten] for hypertension. The combination of these two drugs makes which assessment particularly important? a. Potassium level b. Lithium level c. Creatinine level d. Blood pressure

b. Lithium level. ACE inhibitors, such as captopril, can cause lithium accumulation. Lithium levels should be monitored on a regular basis. ACE inhibitors can cause hyperkalemia, renal insufficiency in some patients, and hypotension. However, the combination of lithium and captopril would not increase the risk of these effects.

Burchum-46. 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 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 nitroprusside. d. Vasodilators can cause serious orthostatic hypotension.

b. Many vasodilators cause retention of sodium and water. Nitroprusside is a potent vasodilator that can cause retention of sodium and water. - Furosemide, a diuretic, often is combined with nitroprusside to reduce the risk of edema and fluid retention. Furosemide does not reduce reflex tachycardia. - Thiocyanate can accumulate in patients receiving nitroprusside, but furosemide does not help prevent or treat that. - Vasodilators can cause serious orthostatic hypotension, but that is not the rationale for adding furosemide to the regimen.

Lec 1. Which prescription is written correctly? a. Captopril (capoten) 25.0mg TID b. Metoprolol (Lopressor) 0.5mg IV q6h c. Insulin Glargine (Lantus) 4.0 Units QHS d. Benzotropine (Cogentin) .5mg BID

b. Metoprolol (Lopressor) 0.5mg IV q6h - option A lacks route - option C has trailing zero ("4.0") - option D has no leading zero (".5mg")

Burchum-45. The healthcare provider prescribes an intravenous dose of diltiazem [Cardizem] for treatment of a patient with atrial fibrillation. What is the priority nursing intervention? a. Assist with cardioversion. b. Monitor electrocardiogram. c. Obtain baseline coagulation studies. d. Assess for increased urinary output.

b. Monitor electrocardiogram. Monitor the electrocardiogram (ECG) continuously during IV administration of diltiazem for AV block, sudden reduction in heart rate, and prolongation of the PR or QT interval. - Cardioversion is not necessary; however, have equipment for cardioversion available. - Baseline laboratory studies are needed for liver and kidney function. - Increased urinary output is not an adverse effect of diltiazem.

Burchum-5. Why does the nurse administer naloxone to a patient receiving morphine sulfate who has a respiratory rate of 8 breaths per minute? a. Naloxone causes hypersensitivity of the opioid receptors. b. Naloxone prevents the activation of opioid receptors. c. Naloxone is a partial agonist, requiring a lesser dose to achieve pain relief. d. Naloxone is an agonist, leading to desensitization of the opioid receptors.

b. Naloxone prevents the activation of opioid receptors. Naloxone is an antagonist, which prevents the activation of opioid receptors, reversing the respiratory depression effects of morphine. - Continuous exposure of cells to antagonists can result in hypersensitivity. - Continuous exposure of cells to agonists can lead to desensitization, refractoriness, or down-regulation.

Burchum-43. Which physiologic mechanism helps to ensure venous return despite low pressure in the venules? a. Positive pressure in the right atrium b. Negative pressure in the right atrium c. Vasodilation in the periphery d. Cardiac muscle relaxation

b. Negative pressure in the right atrium. The three mechanisms that help ensure venous return are negative pressure in the right atrium, constriction of veins, and the combination of venous valves and contraction of skeletal muscles.

Burchum-52. The nurse is caring for a patient receiving clopidogrel [Plavix] to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel? a. Aspirin [Bayer] b. Omeprazole [Prilosec] c. Acetaminophen [Tylenol] d. Warfarin [Coumadin]

b. Omeprazole [Prilosec] . Omeprazole and other proton pump inhibitors may reduce the antiplatelet effects of clopidogrel. Patients sometimes take them to reduce gastric acidity and the risk of gastrointestinal (GI) bleeding.

Burchum-76. To achieve therapeutic effectiveness, a nurse teaches a patient with chronic asthma to use an inhaled glucocorticoid medication according to which schedule? a. Only in an emergency b. On a continuing, daily basis c. To abort an asthma attack d. 2 weeks on, 2 weeks off

b. On a continuing, daily basis Glucocorticoid medications are the first-line therapy for asthma to reduce symptoms of inflammation. They should be taken for prophylaxis on a daily basis. - Therapeutic effects develop slowly, so these drugs cannot be taken to abort an asthma attack or in an emergency. - They are most effective when administered on a fixed schedule, not PRN.

Burchum-76. A history of allergy to which substance is a contraindication to the use of ipratropium/albuterol [Combivent]? a. Mold b. Peanuts c. Penicillin d. Dairy products

b. Peanuts Patients with peanut allergy should avoid Combivent, which contains soya lecithin as a carrier. Soya is in the same plant family as peanuts, and about 10% of people with peanut allergy are cross-allergic to soya. - Allergy to the remainder of the options is not a contraindication.

Burchum-52. The nurse reviews the prescribed medication for a patient with hemophilia who complains of bleeding-related pain. Which medication should the nurse question if ordered for this patient? a. Codeine b. Percodan c. MS Contin d. Tylenol

b. Percodan The nurse should question the order for Percodan, because this drug contains 325 mg of aspirin. Aspirin is avoided in bleeding-related pain management, because it causes irreversible inhibition of platelet aggregation and thus increases the risk of bleeding. - Severe pain can be treated with opioids, such as codeine and MS Contin. - Mild pain can be treated with Tylenol.

Burchum-49. The nurse is interpreting an electrocardiogram (ECG). Which component represents the depolarization of the ventricles? a. P wave b. QRS complex c. ST segment d. T wave

b. QRS complex An electrocardiogram has several components. The P wave is caused by depolarization in the atria; the QRS complex is caused by depolarization of the ventricles; and the T wave is caused by repolarization of the ventricles. The ST segment may be depressed in some clinical conditions.

Burchum-4. The nurse is preparing to give a medication for pain. The label states that the drug is "lipid soluble." How soon should the nurse expect to observe the effects of the drug? a. Slowly b. Rapidly c. Unpredictably d. Variably

b. Rapidly. Cell membranes are composed of lipids; therefore, a lipid-soluble drug passes through rapidly. A water-soluble drug passes through more slowly. The nurse would expect to observe the effects of a lipid-soluble drug more quickly, because the drug is absorbed more rapidly.

Burchum-76. A nurse is planning care for a patient who takes fexofenadine [Allegra] for allergic rhinitis. Which outcome should the nurse anticipate? a. No complaints of dry mouth b. Relief of sneezing and itching c. Use limited to allergy season d. Absence of rebound congestion

b. Relief of sneezing and itching Fexofenadine, a second-generation antihistamine, is prescribed as a first-line medication for allergic rhinitis to relieve sneezing, rhinorrhea, and nasal itching. - Anticholinergic effects (dry mouth, constipation) are uncommon with second-generation antihistamines. - Antihistamines are most effective when taken prophylactically. - Rebound congestion develops in topical sympathomimetic agents.

Burchum-49. The nurse is caring for a patient receiving amiodarone [Cordarone]. Which body system should the nurse assess for serious adverse effects of this medication? a. Musculoskeletal b. Respiratory c. Integumentary d. Gastrointestinal

b. Respiratory Pulmonary toxicity is the most serious potential adverse effect of amiodarone. It may manifest as pneumonitis or pulmonary fibrosis, with symptoms such as dyspnea, cough, and chest pain.

Burchum-47. A patient is admitted to the unit in a hypertensive emergency and examination reveals papilledema. The nurse should expect which IV medications to be administered to achieve rapid, controlled reduction of the patient's blood pressure? a. Furosemide [Lasix] b. Sodium nitroprusside [Nitropress] c. Metoprolol [Lopressor] d. Diltiazem [Cardizem]

b. Sodium nitroprusside [Nitropress] Hypertensive emergency associated with papilledema, intracranial hemorrhage, myocardial infarction, or acute heart failure is a severe emergency, and the BP must be lowered rapidly (within 1 hour). Intravenous sodium nitroprusside [Nitropress] usually is the drug of choice first used, because its effects begin within seconds of initiation of the continuous IV infusion, and they fade rapidly when the infusion is stopped. - Furosemide, metoprolol, and diltiazem are not used for rapid reduction of BP in hypertensive crisis.

Burchum-76. Which complaint indicates that a patient is experiencing an adverse effect of beclomethasone [Beconase AQ] nasal spray? a. Sneezing b. Sore throat c. Runny nose d. Rebound congestion

b. Sore throat Sore throat is an adverse effect associated with intranasal glucocorticoids, such as beclomethasone. More common adverse effects include drying of the nasal mucosa and a burning or itching sensation. - Sneezing and runny nose are two of the symptoms of allergic rhinitis for which intranasal glucocorticoids are used. - Rebound congestion is an adverse effect of intranasal sympathomimetics.

Burchum-76. A nurse teaches a patient with chronic obstructive pulmonary disease (COPD) about the adverse effects of tiotropium [Spiriva]. Which behavior by the patient would indicate that the teaching has been effective? a. Combines tiotropium with an antacid b. Sucks on hard candy as needed c. Prevents constipation with a stool softener d. Wears long sleeves and a wide-brim hat

b. Sucks on hard candy as needed Tiotropium is an anticholinergic medication used to relieve bronchospasm associated with COPD. The most common adverse effect is dry mouth, and patients can suck on hard candy for symptomatic relief. - It is not necessary to take an antacid medication, use a daily stool softener, or wear protective clothing when taking tiotropium.

Burchum-11. What is the Beers list? a. Drugs with a low likelihood of causing adverse effects in older adults b. Drugs with a high likelihood of causing adverse effects in older adults c. Drugs with zero likelihood of causing adverse effects in older adults d. Drugs that are recommended to be used for older adults

b. The Beers list identifies drugs with a high likelihood of causing adverse effects in older adults.

Burchum-4. A new graduate nurse preparing to administer medications knows that which of the following is required for a drug to move through the body? a. Selectivity and effectiveness b. The ability to cross membranes c. Development of an electric charge d. A transporter protein

b. To move throughout the body, drugs must cross membranes. They cross membranes to enter the bloodstream, to exit the bloodstream and reach the site of action, and to undergo metabolism and excretion. - Selectivity and effectiveness are not related to drug movement. - Development of an electric charge (ionization) reduces a drug's ability to be absorbed. - Transporter proteins are not required for drugs to move through the body.

Burchum-7. The nurse is caring for a patient who is experiencing a respiratory rate of 6 breaths per minute as a result of a large dose of pain medication. Which term most accurately describes this reaction? a. Side effect b. Toxicity c. Allergic reaction d. Idiosyncratic effect

b. Toxicity. Toxicity is the degree of detrimental physiologic effects caused by excessive drug dosing. - A side effect is a nearly unavoidable secondary drug effect produced at a therapeutic dose. - An allergic reaction is an immune response. - An idiosyncratic effect is an uncommon drug response resulting from a genetic predisposition.

HESI. A health care provider prescribes cholestyramine (Questran), an anion exchange resin, to treat a client's persistent diarrhea. What vitamin does the nurse anticipate may become deficient because cholestyramine reduces the absorption of fat? a. Thiamine b. Vitamin A c. Riboflavin d. Vitamin B6

b. Vitamin A. Cholestyramine is a fat-binding agent; it binds with and interferes with all the fat-soluble vitamins (A, D, E, and K). - Thiamine is not a fat-soluble vitamin and is unaffected. - Riboflavin is not a fat-soluble vitamin and is unaffected. - Vitamin B6 is not a fat-soluble vitamin and is unaffected.

HESI. A client is receiving furosemide (Lasix). For which sign of hypokalemia should the nurse monitor the client? a. Chvostek sign b. Flabby muscles c. Anxious behavior d. Abdominal cramping

b. flabby muscles. With hypokalemia, failure occurs in myoneural conduction and smooth muscle functioning, resulting in fatigue, muscle weakness, and soft, flabby muscles. - Chvostek sign, the contraction of the facial muscles in response to a light tap over the facial nerve in front of the ear, is associated with hypocalcemia; low calcium levels allow sodium to move into excitable cells, increasing depolarization and nerve excitability. - Anxiety and irritability are associated with hyperkalemia. Hyperkalemia affects the nervous and muscular systems; fatigue, weakness, and lethargy are associated with hypokalemia. - Decreased gastrointestinal motility occurs with hypokalemia; abdominal cramping is associated with hyperkalemia and is caused by hyperactivity of smooth muscles.

Ch 43. A patient who is hypertensive becomes pregnant. The drug of choice for this patient is a. an angiotensin II-receptor blocker. b. an ACE inhibitor. c. a diuretic. d. a calcium channel blocker

c

Ch 43. ACE inhibitors work on the renin-angiotensin system to prevent the conversion of angiotensin I to angiotensin II. Because this blocking occurs in the cells in the lung, which is usually the site of this conversion, use of ACE inhibitors often results in a. spontaneous pneumothorax. b. pneumonia. c. unrelenting cough. d. respiratory depression

c

Ch 45. A patient is brought into the emergency room with a potentially life-threatening ventricular arrhythmia. Immediate treatment might include a. a loading dose of digoxin. b. injection of quinidine. c. bolus and titrated doses of lidocaine. d. loading dose of propafenone.

c

Ch 45. Antiarrhythmic drugs alter the action potential of the cardiac cells. Because they alter the action potential, antiarrhythmic drugs often a. cause heart failure (HF). b. alter blood fl ow to the kidney. c. cause new arrhythmias. d. cause electrolyte disturbances.

c

Ch 47. Hyperlipidemia is considered to be a. a normal finding in adult males. b. related to stress levels. c. a treatable CAD risk factor. d. a side effect of cigarette smoking.

c

Ch 47. Which of the following would the nurse expect the health care provider to prescribe for a patient who has high lipid levels and cannot take fibrates or HMG-CoA reductase inhibitors? a. Nicotine b. Vitamin C c. Niacin d. Nitrates

c

Ch 47. Which of the following would the nurse include when teaching a patient about HMG-CoA reductase inhibitors? a. The patient will not have a heart attack. b. The patient will not develop CAD. c. The patient might develop cataracts as a result. d. The patient might stop absorbing fat-soluble vitamins

c

Ch 48. Antihemophilic agents are used to replace missing clotting factors to prevent severe blood loss. The most common side effect or side effects associated with the use of these drugs are a. bleeding. b. dark stools and urine. c. hepatitis and AIDS. d. constipation.

c

Ch 48. Blood coagulation is a complex reaction that involves a. vasoconstriction, platelet aggregation, and plasminogen action. b. vasodilation, platelet aggregation, and activation of the clotting cascade. c. vasoconstriction, platelet aggregation, and conversion of prothrombin to thrombin. d. vasodilation, platelet inhibition, and action of the intrinsic and extrinsic clotting cascades.

c

Ch 48. Heparin reacts to prevent the conversion of prothrombin to thrombin. Heparin a. is available in oral and parenteral forms. b. takes about 72 hours to have a therapeutic effect. c. has its effects reversed with the administration of protamine sulfate. d. has its effects reversed with the injection of vitamin K.

c

Ch 50. Blood flow to the nephron differs from blood flow to other tissues in that a. the venous system is not involved in blood fl ow around the nephron. b. there are no capillaries in the nephron allowing direct fl ow from artery to vein. c. efferent and afferent arterioles allow for autoregulation of blood flow. d. the capillary bed has a fenestrated membrane to allow passage of fluid and small particles.

c

Ch 50. Considering the functions of the kidney, if a patient lost kidney function, a nurse would expect to see a. increased red blood cell count. b. decreased fl uid volume. c. electrolyte disturbances. d. decreased blood pressure.

c

Ch 51. Diuretics cause a loss of fl uid volume in the body. The drop in volume activates compensatory mechanisms to restore the volume, including a. suppression of antidiuretic hormone (ADH) release and stimulation of the countercurrent mechanism. b. suppression of aldosterone release and increased ADH release. c. activation of the renin-angiotensin-aldosterone system with increased ADH and aldosterone. d. stimulation of the countercurrent mechanism with reflex drop in renin release.

c

Ch 51. The nurse would anticipate an order for a loop diuretic as the drug of choice for a patient with a. hypertension. b. shock. c. pulmonary edema. d. fl uid retention of pregnancy

c

Ch 51. The nurse would instruct a patient receiving a loop diuretic to report a. yellow vision. b. weight loss of 1 pounds/d. c. muscle cramping. d. increased urination.

c

Ch 1. When teaching a patient about over-the-counter (OTC) drugs, which points should the nurse include? Select all that apply: a. These drugs are very safe and can be used freely to relieve your complaints. b. These compounds are called drugs, but they aren't really drugs. c. Some of these drugs were once prescription drugs, but are now thought to be safe when used as directed. d. Reading the label of these drugs is very important; the active ingredient is very prominent; you should always check the ingredient name. e. It is important to read the label and to see what the recommended dose of the drug is; some of these drugs can cause serious problems if too much of the drug is taken. f. It is important to report the use of any OTC drug to your health care provider because many of them can interact with drugs that might be prescribed for you.

c, d, e, f

Ch 2. When reviewing a drug to be given, the nurse notes that the drug is excreted in the urine. What points should be included in the nurse's assessment of the patient? Select all that apply: a. The patient's liver function tests b. The patient's bladder tone c. The patient's renal function tests d. The patient's fl uid intake e. Other drugs being taken that could affect the kidney f. The patient's intake and output for the day

c, d, e.

HESI. What clinical indicators should the nurse expect a client with hyperkalemia to exhibit? Select all that apply. a. Tetany b. Seizures c. Diarrhea d. Weakness e. Dysrhythmias

c, d, e. Because of potassium's role in the sodium/potassium pump, hyperkalemia will cause diarrhea, weakness, and cardiac dysrhythmias. - Tetany is caused by hypocalcemia. - Seizures caused by electrolyte imbalances are associated with low calcium or sodium levels.

Burchum-49. What should the nurse include in the discharge teaching for a patient prescribed amiodarone [Cordarone]? (Select all that apply.) a. "Take amiodarone with grapefruit juice." b. "Take the medication on an empty stomach." c. "Wear sunblock and protective clothing when you are outdoors." d. "Check your pulse daily and report excessive slowing to your healthcare provider immediately." e. "Immediately notify your healthcare provider of shortness of breath, cough, or chest pain."

c, d, e. Patients frequently experience photosensitivity reactions while taking amiodarone. To reduce this risk, patients should avoid sunlamps and wear sunblock and protective clothing when outdoors. Excessive slowing of the heart rate may indicate that the patient is experiencing sinus bradycardia or an AV block. Dyspnea, cough, and chest pain may indicate pulmonary toxicity. - Grapefruit juice should be avoided, because it may increase amiodarone levels and thus the risk of toxicity. - Gastrointestinal side effects of amiodarone can be reduced by taking the drug on a full stomach.

Burchum-44. The nurse is teaching a patient prescribed captopril [Capoten] for the treatment of hypertension. Which instructions should the nurse include? (Select all that apply.) a. Take the medication with food. b. Expect a sore throat and fever. c. Avoid potassium salt substitutes. d. A persistent dry cough may occur. e. Report difficulty in breathing immediately.

c, d, e. Salt substitutes contain potassium and may increase the risk of hyperkalemia with ACE inhibitors. A persistent, dry, nonproductive cough may develop. Angioedema includes edema of the tongue, glottis, and pharynx that may cause difficulty breathing which requires immediate medical attention. - Captopril [Capoten] must be taken at least one hour before meals. - A sore throat and fever are not expected adverse effects. ACE inhibitors can lower white cell count and decrease the body's ability to fight an infection. Early signs of infection include fever and sore throat.

Ch 6. When taking a health history, the nurse should include specific questions about the use of OTC drugs and alternative therapies. This is an important aspect of the health history because: (Select all that apply) a. many insurance policies cover these drugs. b. patients should be reprimanded about the use of these products. c. patients often do not consider them to be drugs and do not report their use. d. patients should never use these products when taking prescription drugs. e. these products can mask or alter presenting signs and symptoms. f. many of these products interact with traditional prescription drugs.

c, e, f.

HESI. A client is admitted with severe diarrhea that resulted in hypokalemia. The nurse should monitor for what clinical manifestations of the electrolyte deficiency? Select all that apply. a. Diplopia b. Skin rash c. Leg cramps d. Tachycardia e. Muscle weakness

c, e. leg cramps, muscle weakness. Leg cramps occur with hypokalemia because of potassium deficit. Muscle weakness occurs with hypokalemia because of the alteration in the sodium potassium pump mechanism. - Diplopia does not indicate an electrolyte deficit. - A skin rash does not indicate an electrolyte deficit. - Tachycardia is not associated with hypokalemia; bradycardia is.

8. A patient has been taking fluoxetine (Prozac) for several years, but when picking up the prescription this month, found that the tablets looked different and became concerned. The nurse, checking with the pharmacist, found that fluoxetine had just become available in the generic form and the prescription had been filled with the generic product. The nurse should tell the patient a. that the new tablet may not work at all and the patient should carefully monitor response. b. that generic drugs are available without a prescription and they are just as safe as the brand-name medication. c. that the law requires that prescriptions be filled with the generic form if available to cut down the cost of medications. d. that the pharmacist filled the prescription with the wrong drug and it should be returned to the pharmacy for a refund.

c.

Ch 1. An orphan drug is a drug that a. has failed to go through the approval process. b. is available in a foreign country but not in this country. c. has been tested but is not considered to be financially viable. d. is available without a prescription

c.

Ch 2. Chemotherapeutic agents are drugs that a. are used only to treat cancers. b. replace normal body chemicals that are missing because of disease. c. interfere with foreign cell functioning, such as invading microorganisms or neoplasms. d. stimulate the normal functioning of a cell.

c.

Ch 2. Much of the biotransformation that occurs when a drug is taken occurs as part of a. the protein-binding effect of the drug. b. the functioning of the renal system. c. the first-pass effect through the liver. d. the distribution of the drug to the reactive tissues.

c.

Ch 3. An example of a drug allergy is a. dry mouth occurring with use of an antihistamine. b. increased urination occurring with use of a thiazide diuretic. c. breathing difficulty after an injection of penicillin. d. urinary retention associated with atropine use

c.

Ch 3. Knowing that a patient is taking a loop diuretic and is at risk for developing hypokalemia, the nurse would assess the patient for a. hypertension, headache, and cold and clammy skin. b. decreased urinary output and yellowing of the sclera. c. weak pulse, low blood pressure, and muscle cramping. d. diarrhea and flatulence.

c.

Ch 6. An off-label use of a drug means that the drug a. was found without a label and its actual contents are not known. b. has been found to be safe when used as directed and no restrictions are needed. c. is being used for an indication not listed in the approved indications noted by the FDA. d. has expired but is still found to be useful when used as directed.

c.

Ch 6. Drugs can be advertised in the mass media only if a. the FDA indication is clearly stated. b. the actual use is never stated. c. adverse effects and precautions are stated if the use is stated. d. all adverse effects are clearly stated

c.

Ch 6. The home health care industry is booming because a. there is a shortage of hospital beds. b. patients feel safer at home and prefer to be cared for at home. c. patients are going home sooner and becoming responsible for their own care sooner than in the past. d. the nursing shortage makes it diffi cult to care for patients in hospitals.

c.

Burchum-52. Which instruction about clopidogrel [Plavix] should the nurse include in the discharge teaching for a patient who has received a drug-eluting coronary stent? a. "Constipation is a common side effect of clopidogrel, so take a stool softener daily." b. "If you see blood in your urine or black stools, stop the clopidogrel immediately." c. "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." d. "Keep the amounts of foods containing vitamin K, such as mayonnaise, canola and soybean oil, and green, leafy vegetables, consistent in your diet."

c. "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." Proton pump inhibitors (PPIs), such as omeprazole [Prilosec], and CYP2C1 inhibitors, such as cimetidine [Tagamet], can be purchased over the counter to treat heartburn. However, patients taking clopidogrel should consult their healthcare provider before using them. PPIs and CYP2C1 inhibitors can reduce the antiplatelet effects of clopidogrel. - Diarrhea (5% incidence), not constipation, is a side effect of clopidogrel. - Patients should immediately contact their healthcare provider if signs of bleeding occur, such as bloody urine, stool, or emesis. The drug should not be stopped until the prescriber advises it, because this could lead to coronary stent restenosis. - Consistency of vitamin K intake is indicated while taking warfarin [Coumadin].

Burchum-41. The nurse is teaching a patient who has a new prescription for spironolactone [Aldactone]. Which statement by the patient indicates that the teaching was effective? a. "I will use salt substitutes to lower my sodium intake." b. "I will increase my intake of foods that are high in potassium." c. "I will call my doctor if I begin having menstrual irregularities." d. "I will take this medication at bedtime each evening."

c. "I will call my doctor if I begin having menstrual irregularities." Spironolactone is a potassium-sparing, aldosterone-blocking diuretic. As such, it can cause endocrine effects, such as gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of the voice. - Patients taking spironolactone should avoid salt substitutes because they contain potassium - High-potassium foods should be avoided with this drug. - Ideally, all diuretics should be taken in the morning to prevent nocturia.

Burchum-76. A nurse is teaching a patient who is to start taking an expectorant. The nurse provides the patient with which of these instructions? a. "Restrict cold fluids to promote reduced mucus production." b. "Take the medication once a day only, usually at bedtime." c. "Increase your fluid intake to reduce the viscosity of secretions." d. "Increase your fiber and fluid intake to prevent constipation."

c. "Increase your fluid intake to reduce the viscosity of secretions." Expectorant drugs are used to reduce the viscosity of secretions, allowing them to be more easily expectorated. - Reduction of mucus production is unrelated to an expectorant. - Expectorants may be taken several times a day and do not cause constipation.

Burchum-47. An adult male patient is taking medication for blood pressure management. The patient states to the nurse, "I'm not going to take these drugs anymore, because they are interfering with my sex life." What is the most appropriate response by the nurse? a. "It is unfortunate these drugs can cause erectile dysfunction but managing your blood pressure is more important than your sexual performance." b. "I understand how discouraging it must be to live with this adverse effect, but you could have a stroke if you do not take your blood pressure medications." c. "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect." d. "I am glad you told me about your experience with this common side effect. Sexual performance can be a difficult subject to discuss."

c. "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect." Many antihypertensive medications can produce adverse sexual side effects, including impotence. It is important for the nurse to listen to the patient's concerns and to avoid making value judgments. Other antihypertensive medications may manage this patient's blood pressure without causing adverse sexual effects. Reducing the undesired effects of antihypertensive medication will improve the patient's adherence.

Burchum-6. The nurse is preparing a discharge teaching plan to a patient prescribed phenobarbital and oral contraceptives which are known to induce CYP isoenzymes of the liver. What patient teaching should the nurse include in the discharge plan? a. "Continue taking your medications as prescribed." b. "Condoms are not necessary while taking phenobarbital. It is not an antibiotic." c. "Plan to use another form of birth control while taking phenobarbital." d. "Your dose of birth control pills will be reduced while you are taking phenobarbital."

c. "Plan to use another form of birth control while taking phenobarbital." Phenobarbital induces CYP isoenzymes; therefore, it will increase the metabolism of other drugs. Because phenobarbital is an inducing agent, it will increase the metabolism of oral contraceptives. The nurse should anticipate that this will likely reduce the blood levels of birth control pills. The patient should use another form of birth control while taking phenobarbital.

Burchum-50. The nurse is teaching a group of patients about dietary approaches to reduce cholesterol levels. Which statement is most important to include in the teaching? a. "Lower your cholesterol to 300 mg/day." b. "Eliminate red meat and pork from your diet." c. "Read food labels and reduce your intake of saturated fats." d. "Reduce salt consumption to keep your sodium intake to 2400 mg/day."

c. "Read food labels and reduce your intake of saturated fats." Because the body uses dietary saturated fats to make cholesterol, an increase in saturated fat intake can produce a significant increase in blood cholesterol levels. To lower blood cholesterol, it is most important to lower saturated fat intake. - An increase in dietary cholesterol intake does not produce a large increase in blood cholesterol because of the body's feedback system. When cholesterol intake increases, endogenous production decreases. - Although red meat and pork should be limited, it is not necessary to eliminate them from the diet. - Sodium intake is not directly related to lowering cholesterol levels.

Burchum-76. Which instruction by the nurse should be the priority for a patient scheduled to start intranasal cromolyn [NasalCrom]? a. "It is only moderately effective." b. "There are few adverse reactions." c. "Relief may take a week or two." d. "It suppresses histamine release."

c. "Relief may take a week or two." Cromolyn is best suited for prophylaxis and should be given before symptoms start, because responses may take a week or 2 to develop. It is important for the patient to know about cromolyn's moderate effectiveness, few adverse reactions, and suppression of histamine release, but it is more important that the patient be informed of the delay in response.

Lec 3. A patient, newly diagnosed with chronic obstructive pulmonary disease (COPD), calls the clinic and asks the nurse to explain what the newly prescribed medications are for. Which would be the most appropriate response by the nurse to the patient? a. "The medications that have been ordered for you are what the physician thinks will help you the most." b. "The medications that have been ordered for you are to help you breathe easier." c. "The medications that have been ordered for you are to help relieve the inflammation and promote dilation of the bronchi." d. "The medications that have been ordered for you are designed to work together to help you feel better."

c. "The medications that have been ordered for you are to help relieve the inflammation and promote dilation of the bronchi."

Burchum-56.A patient with asthma is scheduled to start taking a glucocorticoid medication with a metered-dose inhaler (MDI). The nurse should give the patient which instruction about correct use of the inhaler? a. "After you inhale the medication once, repeat until you obtain symptomatic relief." b. "Wait no longer than 30 seconds after the first puff before taking the second one." c. "Use a spacer with the inhaler and rinse your mouth after each dose administration." d. "Breathe in through the nose and hold for 2 seconds just before activating the inhaler."

c. "Use a spacer with the inhaler and rinse your mouth after each dose administration." Spacers are available for use with MDIs to prevent the patient from swallowing the dose and to allow for maximum delivery of medication to the lungs. Rinsing the mouth after administration is important for inhaled glucocorticoids to prevent candidiasis. - Glucocorticoid inhalers are used for long-term prophylaxis of asthma, not for symptomatic relief. - When two puffs are needed, an interval of at least 1 minute should separate the first puff from the second. - Inhaling through the mouth just before activating the MDI is the proper technique.

Burchum-76. Which instruction should be included in the teaching for a patient being started on the antihistamine azelastine [Astelin]? a. "Take the pill in the morning before breakfast." b. "Headache may be a side effect of the medication." c. "You may experience an unpleasant taste in your mouth when using azelastine." d. "You will experience a decrease in nasal congestion if the medication is working."

c. "You may experience an unpleasant taste in your mouth when using azelastine." With both formulations of azelastine [Astelin and Astepro], patients often complain of an unpleasant taste. -Azelastine is administered as an intranasal metered spray. - Headache is a side effect of the intranasal antihistamine olopatadine. - Antihistamines do not reduce nasal congestion.

Burchum-41. The healthcare provider orders furosemide [Lasix] 20 mg IV twice daily. The medication available is furosemide [Lasix] 10 mg/mL. How many mL will the nurse administer with each dose? a. 0.5 mL b. 1 mL c. 2 mL d. 4 mL

c. 2 mL The healthcare provider has ordered 20 mg of furosemide [Lasix], which is available in 10 mg/mL. Multiply 10 mg/mL by 2 to equal 20 mg/2 mL. The nurse will administer 2 mL of furosemide to equal 20 mg with each dose.

Burchum-41. The healthcare provider orders mannitol 72 gm infusion over 24 hours. The nurse plans to set the infusion pump for how many grams per hour? a. 1 gm b. 2 gm c. 3 gm d. 4 gm

c. 3 gm. To infuse 72 grams over 24 hours, divide 72 by 24 for the total per hour. 72 divided by 24 equals 3 grams per hour

Burchum-52. A patient with an acute myocardial infarction is prescribed an intravenous (IV) bolus of tenecteplase [TNKase]. The patient weighs 160 pounds. The nurse will administer what dosage? a. 30 mg b. 35 mg c. 40 mg d. 45 mg

c. 40 mg 160 lbs is 72.72 kg. Body weight of 70 to 79.9 kg is prescribed 40 mg of tenecteplase as a single IV bolus.

Burchum-4. The nurse is preparing to administer an intravenous (IV) medication. What is the minimum injection time to reduce the risk of harm to the patient? a. 10 seconds b. 30 seconds c. 60 seconds d. 30 minutes

c. 60 seconds. Most IV drugs should be injected slowly over at least 1 minute or longer, because all the blood in the body is circulated about once every minute. This allows the drug to be diluted in the largest volume of blood possible.

Burchum-7. The nurse is monitoring for adverse drug reactions (ADRs) of assigned patients. Which patient is most at risk for the development of drug toxicity? a. A 30-year-old man admitted for altered mental status b. A 55-year-old woman with abnormal arterial blood gas values c. A 70-year-old woman with an elevated creatinine level d. A laboring 25-year-old woman with a positive Homans' sign

c. A 70-year-old woman with an elevated creatinine level. The liver, kidneys, and bone marrow are important sites of drug toxicity. Creatinine is a measure of kidney function and would be the most helpful for monitoring for ADRs. In addition, patients over age 65 are at greater risk for ADRs. - Mental status is a measure of the function of the central nervous system (CNS), which may be affected by drugs but is not one of the most important and common sites of drug toxicity. - Arterial blood gas measurements reflect respiratory and acid-base function.

Burchum-10. Which statement about renal excretion in infants is true? a. Renal blood flow is high during infancy. b. Renal drug excretion is significantly increased at birth. c. Adult levels of renal function are achieved by 1 year. d. Drugs that are eliminated primarily by renal excretion must be given in higher doses.

c. Adult levels of renal function are achieved by 1 year. - Renal blood flow, glomerular filtration, and active tubular secretion are low during infancy. - Renal drug excretion is significantly reduced at birth. - Drugs that are eliminated primarily by renal excretion must be given in reduced dosage and/or at longer dosing intervals.

Burchum-50. A patient with an elevated triglyceride level is prescribed a sustained-release form of nicotinic acid [Slo-Niacin]. Which laboratory value is most important for the nurse to monitor for in this patient? a. Blood urea nitrogen (BUN) b. Complete blood count (CBC) c. Alanine aminotransferase (ALT) d. Creatine kinase (CK)

c. Alanine aminotransferase (ALT) The alanine aminotransferase (ALT or SGPT) would receive priority, because nicotinic acid is hepatotoxic and severe liver injury has been reported. Hepatotoxicity is more common with the sustained-release, controlled-release, or timed-released formulation.

HESI. A client with a history of excessive alcohol use develops hepatic portal hypertension and an elevated serum aldosterone level. For which complications should the nurse assess this client? a. Chloride depletion and hypovolemia b. Potassium retention and dysrhythmias c. Sodium retention and fluid accumulation d. Calcium depletion and pathological fractures

c. Aldosterone, a corticosteroid, causes sodium and water retention and potassium excretion by the kidneys. - Hypovolemia will not occur with increased aldosterone levels because sodium and water are retained. - Potassium is excreted in the presence of aldosterone and therefore will not accumulate and cause dysrhythmias. - Calcium is unaffected by aldosterone.

Burchum-11. Which statement about the percentage of oral drug absorption is true? a. The percentage absorbed increases with age. b. The percentage absorbed decreases with age. c. The percentage absorbed does not usually change with age. d. The percentage absorbed severely declines with age.

c. As a rule, the percentage of an oral dose that becomes absorbed does not usually change with age.

Burchum-5. The nurse understands that the dose-response relationship is graded and should expect to observe what response? a. Once a drug is given, the response is predictably all-or-nothing. b. The response is maintained at a specific level when the therapeutic objective is achieved. c. As the dosage increases, the response becomes progressively greater. d. A graded response is based on relative potency and maximal efficacy.

c. As the dosage increases, the response becomes progressively greater. - If drug responses were all-or-nothing instead of graded, drugs could produce only one intensity level of response. - The response may be maintained at a specific level when the therapeutic objective is achieved, but that option does not pertain to a dose-response relationship that is graded.

Burchum-5. The nurse demonstrates the concept of maximal efficacy by administering which drug for a headache that the patient describes as a "mild dullness" and as a 2 on a 1 to 10 scale? a. Meperidine [Demerol] b. Pentazocine [Talwin] c. Aspirin d. Morphine sulfate

c. Aspirin Maximal efficacy is the largest effect a drug can produce. Potency is the amount of drug that must be given to elicit an effect. Maximal efficacy illustrates the fact that all drugs have a maximal effect, and dosages beyond this do not increase the effect. The goal is to match the intensity of the response to the patient's needs; therefore, a drug with high maximal efficacy is not always most desirable. Demerol, Talwin, and morphine all have a higher maximal efficacy than aspirin; therefore, aspirin is the most desirable drug for a headache rated as "mild."

Burchum-45. The nurse is caring for several patients. For which patient diagnosis would a prescription for nifedipine [Adalat] be least appropriate? a. Angina pectoris b. Essential hypertension c. Atrial fibrillation d. Vasospastic angina

c. Atrial fibrillation Nifedipine produces very little blockade of the calcium channels of the heart; therefore, it is ineffective for treating dysrhythmias, such as atrial fibrillation. Therapeutic uses for nifedipine include the treatment of angina pectoris, essential hypertension, and vasospastic angina.

Burchum-45. Calcium channel blockers work by reducing calcium influx into the cells of the heart and blood vessels. Calcium channels are coupled to which type of autonomic nervous system receptors? a. Alpha1 b. Alpha2 c. Beta1 d. Beta2

c. Beta1 Calcium channels are coupled to beta1-adrenergic receptors in the heart. For that reason, calcium channel blockers affect the heart in ways similar to the beta blockers. Both types of drugs cause a decrease in the force of contraction, heart rate, and cardiac impulse conduction.

Burchum-46. Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]? a. Peripheral pulses b. Homans' sign c. Blood pressure d. Capillary refill

c. Blood pressure Hydralazine is a vasodilator that causes arteriolar dilation, decreased resistance, and decreased blood pressure. Monitoring of the blood pressure and heart rate is the highest assessment priority.

Burchum-3. Why are trade names much easier to say and remember than generic names? a. The FDA assigns every drug's generic name. b. Trade names must be the same regardless of which drug company manufactures the drug. c. Companies have a marketing advantage when the trade name is easier to recognize. d. Trade names improve oral and written communication in the healthcare system.

c. Companies have a marketing advantage when the trade name is easier to recognize. - The U.S. Adopted Names Council assigns a drug's generic name. - Generic names, not trade names, are the same regardless of which company manufactures the drug. - Trade names do not contribute to ease and clarity of communication in the healthcare system, because healthcare professionals do not always know what compound is described by the trade name.

Burchum-76. Which finding in a patient taking oxymetazoline [Afrin] nasal spray every 2 hours would indicate that the patient has developed an adverse effect? a. Dry mouth and constipation b. Drowsiness and sedation c. Congestion and stuffiness d. Itching and skin rash

c. Congestion and stuffiness Oxymetazoline is an effective nasal decongestant, but overuse results in worsening, or rebound, congestion. It should not be used more often than every 4 hours for several days. - Dry mouth and constipation, drowsiness and sedation, and itching and skin rash are not adverse effects of oxymetazoline.

Burchum-3. Which legislation set rules for the manufacture and distribution of drugs considered to have the potential for abuse? a. Food, Drug, and Cosmetic Act of 1938 b. Harris-Kefauver Amendments of 1962 c. Controlled Substances Act of 1970 d. Food and Drug Administration Modernization Act of 1997

c. Controlled Substances Act of 1970 The Controlled Substances Act of 1970 set rules covering drugs of abuse and defined categories of controlled substances.

Burchum-44. A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug? a. + 2 edema of the lower extremities b. Potassium level of 3.5 mEq/L c. Crackles in the lungs are no longer heard d. Jugular vein distention

c. Crackles in the lungs are no longer heard. Because ACE inhibitors promote venous dilation, they provide the therapeutic effect of reducing pulmonary congestion and peripheral edema. Absence of previously heard crackles would be an indicator of effectiveness. - Edema and jugular vein distention are manifestations of heart failure. - A potassium level of 3.5 mEq/L is a normal value.

Burchum-41. The nurse plans to closely monitor for which clinical manifestation after administering furosemide [Lasix]? a. Decreased pulse b. Decreased temperature c. Decreased blood pressure d. Decreased respiratory rate

c. Decreased blood pressure High-ceiling loop diuretics, such as furosemide, are the most effective diuretic agents. They produce more loss of fluid and electrolytes than any others. A sudden loss of fluid can result in decreased blood pressure. When blood pressure drops, the pulse probably will increase rather than decrease. Lasix should not affect respirations or temperature. The nurse should also closely monitor the patient's potassium level.

Burchum-52. A patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which finding by the nurse most likely indicates an adverse reaction to this drug? a. Urticaria, itching, and flushing b. Blood pressure of 90/50 mm Hg c. Decreasing level of consciousness d. Potassium level of 5.5 mEq/L

c. Decreasing level of consciousness The greatest risk with this drug is bleeding, with intracranial bleeding being the greatest concern. A decreasing level of consciousness indicates intracranial bleeding. - Alteplase does not cause an allergic reaction or hypotension. - Thrombolytic agents, such as alteplase, do not typically cause an elevated potassium level.

Burchum-8. The healthcare provider prescribes a medication that is renally eliminated for a patient with acute renal failure. The nurse recognizes the patient is at risk for which altered drug response? a. Increased drug excretion b. Decreased drug levels in the blood c. Development of drug toxicity d. Increased tolerance to the medication

c. Development of drug toxicity Kidney disease can reduce drug excretion, causing drugs to accumulate in the body. If the dosage is not lowered, the drug may accumulate to toxic levels.

Burchum-49 The nurse is caring for a patient prescribed quinidine [Quinaglute] for a supraventricular dysrhythmia. What is a common adverse effect of this drug? a. Constipation b. Urinary retention c. Diarrhea d. Blurred vision

c. Diarrhea Diarrhea and other gastrointestinal problems occur in approximately one third of patients who take quinidine. This is the most common reason patients stop taking the drug.

Burchum-49. Which medication is not associated with prolongation of the QT interval? a. Dofetilide [Tikosyn] b. Sotalol [Betapace] c. Diltiazem [Cardizem] d. Dronedarone [Multaq]

c. Diltiazem [Cardizem] Diltiazem does not prolong the QT interval. - Dofetilide, sotalol, and dronedarone prolong the QT interval, putting the patient at risk for torsades de pointes.

Burchum-52. The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin? a. Heart rate of 60 beats per minute b. Blood pressure of 160/88 mm Hg c. Discolored urine d. Inspiratory wheezing

c. Discolored urine The primary and most serious adverse effect of heparin is bleeding. Bleeding can occur from any site and may be manifested in various ways, including reduced blood pressure, increased heart rate, bruises, petechiae, hematomas, red or black stools, cloudy or discolored urine, pelvic pain, headache, and lumbar pain.

Burchum-7. The nurse is caring for a patient who has jaundice, dark urine, malaise, light-colored stools, nausea, and vomiting. What is this patient most likely experiencing? a. An idiosyncratic drug effect on the bone marrow b. Iatrogenic disease of the kidneys c. Drug toxicity of the liver d. An allergic reaction

c. Drug toxicity of the liver. Drug toxicity is an adverse drug reaction in which certain drugs are toxic to specific organs. Signs and symptoms of liver toxicity include jaundice, dark urine, light-colored stools, nausea, vomiting, malaise, abdominal discomfort, and loss of appetite.

Burchum-1. Which statement by a new nurse indicates that further study is indicated? a. Effectiveness is the most important property a drug can have. b. There is no such thing as a safe drug. c. Drugs are defined as illegal substances. d. There is no such thing as a selective drug; all medications cause side effects.

c. Drugs are defined as illegal substances. A drug is any chemical that can affect living processes. All the other statements are correct.

Burchum-49. The nurse is planning care for a patient at risk for dysrhythmias. The nurse understands that the Cardiac Arrhythmia Suppression Trial (CAST) confirmed which finding? a. Most atrial rhythm problems should be treated with medication. b. After a myocardial infarction, all dysrhythmias should be treated. c. Dysrhythmias should be treated only when they are symptomatically significant. d. Most rhythm problems result in bradydysrhythmias.

c. Dysrhythmias should be treated only when they are symptomatically significant. The Cardiac Arrhythmia Suppression Trial (CAST) confirmed that all dysrhythmia drugs have prodysrhythmic effects and can worsen existing dysrhythmias and generate new ones. In this study, patients who received encainide and flecainide to prevent rhythm problems after myocardial infarction actually had higher rates of mortality than the control group.

Burchum-76. A nurse instructs a patient that which nonprescription medication requires patient identification and a signature for purchase? a. Chlorpheniramine [Chlor-Trimeton] b. Cetirizine [Zyrtec] c. Ephedrine d. Ipratropium bromide [Atrovent]

c. Ephedrine Ephedrine is a sympathomimetic agent associated with abuse, because it can be converted to methamphetamine. Legal availability has been reduced by having the product behind the counter, and patients must present identification and sign a log for purchase. - Chlorpheniramine and cetirizine are first- and second-generation antihistamines that are available without legal constraints. - Ipratropium bromide, an anticholinergic intranasal agent for allergic rhinitis, also does not require patient identification.

HESI. A nurse is evaluating the results of treatment with erythropoietin (Epogen). Which client response is considered significant? a. Elevation in liver panel b. Increase in white blood cell (WBC) counts c. Elevation in hematocrit level d. Decrease in Kaposi sarcoma lesions

c. Erythropoietin stimulates red blood cell production, thereby elevating hematocrit levels. - An increased liver panel may signify liver disease; it is not affected by erythropoietin. - WBC counts are not affected by erythropoietin. - Kaposi sarcoma lesions signify progression of human immunodeficiency virus (HIV) and are not affected by erythropoietin.

HESI. A client is receiving furosemide (Lasix) to relieve edema. The nurse should monitor the client for which response to the medication? a. Retention of sodium ions b. Negative nitrogen balance c. Excessive loss of potassium ions d. Increase in the urine specific gravity

c. Excessive loss of potassium ions. Furosemide is a potent diuretic used to provide rapid diuresis; it acts in the loop of Henle and causes depletion of electrolytes, such as potassium and sodium. - Furosemide inhibits the reabsorption, not retention, of sodium. - Furosemide does not affect protein metabolism. - With edema, the specific gravity of the fluid more likely will be low.

Burchum-44. The nurse is caring for a patient prescribed aliskiren [Tekturna]. How does this medication lower blood pressure? a. It blocks the conversion of angiotensin I to angiotensin II. b. It prevents angiotensin II from binding to its receptors. c. It inhibits the conversion of angiotensinogen into angiotensin I. d. It selectively blocks aldosterone receptors in the kidneys.

c. Inhibits angiotensinogen -> angiotensin I. Aliskiren is the first direct renin inhibitor on the market. It binds with renin and thus inhibits the conversion of angiotensinogen to angiotensin I. The other items describe ACE inhibitors, ARBs, and selective aldosterone receptor blockers.

Burchum-52. The nurse knows that which statement is accurate for enoxaparin [Lovenox]? a. It equally reduces the activity of thrombin and factor Xa. b. It has selective inhibition of factor Xa and no effect on thrombin. c. It reduces the activity of factor Xa more than the activity of thrombin. d. It has a lower bioavailability and shorter half-life than unfractionated heparin.

c. It reduces the activity of factor Xa more than the activity of thrombin. Enoxaparin acts primarily on factor Xa and also, but to a lesser degree, on thrombin. - Unfractionated heparin equally reduces the action of thrombin and factor Xa. - Fondaparinux [Arixtra] causes selective inhibition of factor Xa. - dLow-molecular-weight (LMW) heparins, such as enoxaparin, have greater bioavailability and a longer half-life than unfractionated heparin.

Burchum-76. A patient who takes cromolyn for exercise-induced bronchospasm should follow which approach for maximum therapeutic effectiveness? a. It should be used infrequently because of systemic adverse effects. b. One 10-mg tablet should be taken at least 2 hours before exercising. c. It should be administered by inhalation 15 minutes before anticipated exertion. d. It should be used as a quick-relief agent if exercise triggers asthma symptoms.

c. It should be administered by inhalation 15 minutes before anticipated exertion. Cromolyn suppresses inflammation through inhibition of histamine release. It must be administered at least 15 minutes before exertion to prevent exercise-induced bronchospasm. - It is administered by inhalation only. - It is not a bronchodilator and cannot abort an ongoing attack. - It is one of the safest antiasthma medications and has no systemic adverse effects.

Burchum-52. What condition increases the patient's risk for the development of myocardial infarction (MI) and disseminated intravascular coagulation (DIC) when receiving anti-inhibitor coagulant complex (AICC)? a. Diabetes b. Chronic renal disease c. Liver disease d. Hypothyroidism

c. Liver disease Because AICC contains multiple coagulation factors, it poses a risk of thrombotic complications, specifically MI and DIC. Although rare, the risk is increased in patients who have liver disease and those who have received repeated dosing.

Burchum-50. The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? a. Very-low-density lipoprotein (VLDL) b. Apolipoprotein B-100 c. Low-density lipoprotein (LDL) d. High-density lipoprotein (HDL)

c. Low-density lipoprotein (LDL) Cholesterol is the primary core lipid of LDLs, which are responsible for carrying cholesterol to tissues outside the liver. Of all the lipoproteins, LDLs are the most significant contributors to coronary atherosclerosis. When pharmacologic agents are used to lower cholesterol, the primary goal is to reduce elevated LDL levels.

Burchum-52. Hemophilia is a genetically based bleeding disorder seen almost exclusively in which patients? a. Caucasian b. Hispanic c. Male d. Female

c. Male Hemophilia is a genetically based bleeding disorder seen almost exclusively in males. Because males have only one X chromosome, a male with a defective gene has hemophilia. In contrast, a female with a defective gene on just one X chromosome is an asymptomatic carrier.

Burchum-45. What is the most appropriate nursing consideration for a patient who is prescribed verapamil [Calan] and digoxin [Lanoxin]? a. Restrict intake of oral fluids and high-fiber food. b. Take an apical pulse for 30 seconds before administration. c. Notify the healthcare provider of nausea, vomiting, and visual changes. d. Hold the medications if the heart rate is greater than 110 beats per minute.

c. Notify the healthcare provider of nausea, vomiting, and visual changes. Verapamil can raise digoxin blood serum levels, increasing the risk of digoxin toxicity. Symptoms of digoxin toxicity may include nausea, vomiting, and visual changes. - Increase intake of oral fluids and high-fiber food to decrease the adverse effect of constipation. - An apical pulse should be taken for a full minute prior to administering digoxin. - Verapamil and digoxin can cause bradycardia not tachycardia.

Burchum-49. Amiodarone [Cordarone] is prescribed for a patient with atrial fibrillation. What is the most important nursing intervention before administering this medication? a. Document an ophthalmic examination was performed. b. Explain a dermatologic evaluation is needed. c. Obtain baseline serum thyroid and liver function studies. d. Maintain NPO for transesophageal echocardiogram (TEE).

c. Obtain baseline serum thyroid and liver function studies. Amiodarone may cause hypothyroidism or hyperthyroidism and may also injure the liver. Serum thyroid and liver function levels should be assessed before treatment with amiodarone is started and periodically during treatment. - Patients who develop changes in visual acuity or peripheral vision while taking amiodarone should have an ophthalmologic evaluation, but this is not necessary before starting therapy. - A dermatologic examination and TEE are not necessary before initiation of amiodarone therapy. - Although patients with atrial fibrillation are at risk for mural thrombus, amiodarone therapy itself does not pose a risk of systemic embolization.

Burchum-3. What term is commonly used for nonprescription drugs? a. Legend b. Generic c. Over-the-counter d. Pharmaceutical

c. Over-the-counter Over-the-counter (OTC) drugs are also known as nonprescription drugs.

Burchum-3. Which is a true statement about new drug development in the United States? a. Development and testing of new drugs take about 3 to 5 years. b. About 50% of drugs undergoing clinical trials gain approval. c. Randomized controlled trials are the best way to assess drug therapy. d. The cost of developing a new drug is usually around $1 million.

c. Randomized controlled trials are the best way to assess drug therapy. Randomized controlled trials are the most reliable way to objectively assess drug therapies and are used to evaluate all new drugs. - New drug development takes about 10 to 15 years, and costs can exceed $1.2 billion. -Only about one in five drugs undergoing clinical trials gains approval.

Burchum-76. Which outcome would be most appropriate for a nurse to establish for a patient with a cough who takes an antitussive with codeine? a. Warm, dry, pink skin b. Oriented to time, place, and person c. Respiratory rate of 12 to 24 breaths per minute d. Effective productive cough

c. Respiratory rate of 12 to 24 breaths per minute Codeine, an opioid analgesic that acts through the CNS, effectively suppresses the frequency and intensity of cough. However, it also can suppress respiration, and overdose can be fatal. - Doses are small (one tenth those needed to relieve pain), so orientation and peripheral effects are minimal.

Burchum-44. The nurse is evaluating the teaching done with a patient who has a new prescription for fosinopril [Monopril]. Which statement by the patient indicates a need for further teaching? a. "I can take this medicine with breakfast each morning." b. "I will call if I notice a rash or wheals on my skin." c. "I will use a salt substitute to lower my sodium intake." d. "I will call if I develop a bothersome cough."

c. Salt substitutes contain potassium and may increase the risk of hyperkalemia with ACE inhibitors, such as fosinopril. The patient should not take potassium supplements or use salt substitutes. The other statements are appropriate for this patient.

Burchum-1. A nurse is preparing to give an oral dose of drug X to treat a patient's high blood pressure. After giving the drug, the nurse finds that it reduces the blood pressure without serious harmful effects, but it also causes the patient to have nausea and a headache. Based on this information, which property of an ideal drug is this drug lacking? a. Effectiveness b. Safety c. Selectivity d. Ease of administration

c. Selectivity The drug is effective in lowering the blood pressure and safe in that it does not cause harmful effects. However, as do most drugs, it causes other effects besides the one response desired; therefore, it lacks selectivity. The oral form provides ease of administration.

Burchum-5. Which drug property is most enhanced by the presence of many different types of receptors throughout the body? a. Potency b. Safety c. Selectivity d. Convenience

c. Selectivity. Because each receptor regulates just a few processes, selective drug action is possible. Multiple types of receptors do not have as much effect on potency, safety, or convenience.

Burchum-44. The nurse is caring for a patient with renal artery stenosis who has been prescribed benazepril [Lotensin]. Which laboratory result indicates an adverse effect of this drug? a. Potassium level of 3.2 mEq/L [low] b. Blood glucose level of 180 mg/dL [high] c. Serum creatinine level of 2.3 mg/dL [high] d. Uric acid level of 10 mg/dL [high]

c. Serum creatinine level of 2.3 mg/dL . Patients with bilateral renal artery stenosis are at increased risk for renal insufficiency and failure with angiotensin-converting enzyme (ACE) inhibitors, such as benazepril. - ACE inhibitors do not typically cause hypokalemia, hyperglycemia, or hyperuricemia.

Burchum-46. A patient with hypertensive emergency is admitted to the hospital. Which medication should the nurse be prepared to administer to this patient? a. Minoxidil [Loniten] b. Hydralazine [Apresoline] c. Sodium nitroprusside [Nipride] d. Hydralazine and isosorbide dinitrate [BiDil]

c. Sodium nitroprusside [Nipride]. Intravenous sodium nitroprusside has an immediate effect and is the drug of choice for hypertensive emergencies. - Minoxidil and hydralazine are used for blood pressure control.

Burchum-41. The nurse is caring for a patient with heart failure who needs a diuretic. Which agent is likely to be chosen, because it has been shown to greatly reduce mortality in patients with heart failure? a. Furosemide [Lasix] b. Hydrochlorothiazide [HydroDIURIL] c. Spironolactone [Aldactone] d. Mannitol [Osmitrol]

c. Spironolactone is a potassium-sparing diuretic used to treat both hypertension and edema. It is a preferred drug in heart failure, because it has been shown to have a cardioprotective effect, reducing mortality in patients with heart failure.

Burchum-76. Which outcome should a nurse establish as a priority for a patient taking an oral glucocorticoid for long-term treatment of asthma? a. Increases the daily intake of vitamin D and calcium b. Records daily peak expiratory flow rates c. Supplements additional doses at times of stress d. Uses alternate-day therapy to reduce adverse effects

c. Supplements additional doses at times of stress Adrenal suppression can be profound with oral glucocorticoid use. It is a priority that patients take supplemental oral or intravenous doses at times of stress; failure to do so can be fatal. - Alternate-day dosing, using a peak flowmeter, and minimizing bone loss with vitamin D and calcium intake are important; however, they are not as important as supplemental doses of glucocorticoid at times of stress.

Burchum-1. When studying the impact a drug has on the body, the nurse is reviewing what? a. The drug's pharmacokinetics b. The drug's selectivity c. The drug's pharmacodynamics d. The drug's predictability

c. The drug's pharmacodynamics Pharmacodynamics can be thought of as the impact of drugs on the body. - Pharmacokinetics describes the movement of drugs through the body. - Selectivity is the ability of a drug to elicit only the response for which it is given. - Predictability is the degree of certainty about how a patient will respond to a certain drug.

Burchum-5. hy does the nurse monitor the patient closely when administering a drug with a low therapeutic index? a. The average lethal dose of the drug is much higher than the therapeutic dose. b. The dose required to produce a therapeutic response in 50% of patients is low. c. The highest dose needed to produce a therapeutic effect is close to the lethal dose. d. There is a low variability of responses to this drug.

c. The highest dose needed to produce a therapeutic effect is close to the lethal dose. A low therapeutic index indicates that the high doses needed to produce therapeutic effects in some people may be large enough to cause death. A high therapeutic index is more desirable, because the average lethal dose is higher than the therapeutic dose. Low variability of responses to a drug is not the definition of a low therapeutic index.

HESI. The nurse instructs a client that, in addition to building bones and teeth, calcium is also important for: a. Bile production. b. Blood production. c. Blood clotting. d. Digestion of fats.

c. blood clotting. Calcium is important for blood coagulation. When tissue damage occurs, serum calcium is necessary to promote coagulation by activating certain clotting factors. Calcium acts as a catalyst in the clotting process in both the extrinsic and intrinsic pathways. - Calcium is responsible for a number of body functions such as bone health, blood clotting, and muscle contraction and nerve impulses; however it is not directly related to bile and blood production or digestion of fats.

HESI. A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone (Aldactone). What should the nurse monitor the client for? a. Bruising b. Tachycardia c. Hyperkalemia d. Hypoglycemia

c. hyperkalemia. Spironolactone (Aldactone) is a potassium-sparing diuretic that is used to treat clients with ascites; therefore, the nurse should monitor the client for signs and symptoms of hyperkalemia. - Bruising and purpura are associated with cirrhosis, not with the administration of spironolactone. - Spironolactone does not cause tachycardia. - Spironolactone does not cause hypoglycemia.

Ch 43. Hypertension is associated with a. loss of vision. b. strokes. c. atherosclerosis. d. all of the above.

d

Ch 43. Midodrine, an antihypotensive drug, should be used a. only with patients who are confined to bed. b. in the treatment of acute shock. c. in patients with known pheochromocytoma. d. to treat orthostatic hypotension in patients whose lives are impaired by the disorder.

d

Ch 43. The stepped-care approach to the treatment of hypertension includes a. lifestyle modification, including exercise, diet, and decreased smoking and alcohol intake. b. use of a diuretic, beta-blocker, or angiotensin-converting-enzyme (ACE) inhibitor to supplement lifestyle changes. c. a combination of antihypertensive drug classes to achieve desired control. d. all of the above.

d

Ch 45. A client stabilized on quinidine for the regulation of AF would be cautioned to avoid which of the following? a. Potassium-rich foods b. Foods containing tyrosine c. High-sodium-containing foods d. Foods that alkalinize the urine

d

Ch 45. Because of the results of the Cardiac Arrhythmia Suppression Trial study, a. antiarrhythmics are now more widely used. b. antiarrhythmics are used as prophylactic measures in situations that might lead to an arrhythmia. c. antiarrhythmics are no longer used in the United States. d. antiarrhythmics are reserved for use in cases of life-threatening arrhythmias

d

Ch 45. Cardiac contraction and relaxation are controlled by a. a specific area in the brain. b. the sympathetic nervous system. c. the autonomic nervous system. d. spontaneous impulses arising within the heart.

d

Ch 45. The drug of choice for the treatment of a supraventricular tachycardia associated with Wolff- Parkinson-White syndrome is a. digoxin. b. verapamil. c. lidocaine. d. adenosine

d

Ch 47. The bile acid sequestrants a. are absorbed into the liver. b. take several weeks to show an effect. c. have no associated adverse effects. d. prevent bile salts from being reabsorbed.

d

Ch 47. Which of the following would alert the nurse to suspect that a patient receiving HMG-CoA reductase inhibitors is developing rhabdomyolysis? a. Flatulence and abdominal bloating b. Increased bleeding and bruising c. The development of cataracts and blurred vision d. Muscle pain and weakness

d

Ch 48. The low-molecular-weight heparin of choice for preventing deep venous thrombosis after hip replacement therapy is a. tinzaparin. b. dalteparin. c. heparin. d. enoxaparin

d

Ch 50. Concentration and dilution of urine is controlled by a. afferent arterioles. b. the renin-angiotensin system. c. aldosterone release. d. the countercurrent mechanism.

d

Ch 50. Urine passes through the ureter by a. osmosis. b. air pressure. c. fi ltration. d. peristalsis

d

Ch 51. A patient with severe glaucoma who is about to undergo eye surgery would benefit from a decrease in intraocular fluid. This is often best accomplished by giving the patient a. a loop diuretic. b. a thiazide diuretic. c. a carbonic anhydrase inhibitor. d. a potassium sparing diuretic.

d

Ch 51. When providing care to a patient who is receiving a loop diuretic, the nurse would determine the need to regularly monitor which of the following? a. Sodium levels b. Bone marrow function c. Calcium levels d. Potassium levels

d

Ch 1. Phase I drug studies involve a. the use of laboratory animals to test chemicals. b. patients with the disease the drug is designed to treat. c. mass marketing surveys of drug effects in large numbers of people. d. healthy human volunteers who are often paid for their participation.

d.

Ch 1. The storing, prescribing, and distributing of controlled substances—drugs that are more apt to be addictive—are monitored by a. the FDA. b. the Department of Commerce. c. the Federal Bureau of Investigation. d. the DEA.

d.

Ch 2. Selective toxicity is a. the ability of a drug to seek out a specific bacterial species or microorganism. b. the ability of a drug to cause only specific adverse effects. c. the ability of a drug to cause fetal damage. d. the ability of a drug to attack only those systems found in foreign or abnormal cells.

d.

Ch 3. A patient taking glyburide (an antidiabetic drug) has his morning dose and then does not have a chance to eat for several hours. An adverse effect that might be expected from this would be a. a teratogenic effect. b. a skin rash. c. an anticholinergic effect. d. hypoglycemia.

d.

Ch 3. Patients receiving antineoplastic drugs that disrupt cell function often have adverse effects involving cells that turn over rapidly in the body. These cells include a. ovarian cells. b. liver cells. c. cardiac cells. d. bone marrow cells.

d.

Burchum-45. The nurse provides discharge instructions to a patient prescribed verapamil [Calan] SR 120 mg PO daily for essential hypertension. Which statement by the patient indicates understanding of the medication? a. "I will take the medication with grapefruit juice each morning." b. "I should expect occasional loose stools from this medication." c. "I'll need to reduce the amount of fiber in my diet." d. "I must make sure I swallow the pill whole."

d. "I must make sure I swallow the pill whole." "SR" indicates that the drug is sustained release; therefore, the patient must swallow the pill intact, without chewing or crushing, which would result in a bolus effect. - Grapefruit juice should be avoided, because it can inhibit intestinal and hepatic metabolism of the drug, thereby raising the drug level. - Constipation, not loose stools, is a common side effect of Calan; increasing fluids and dietary fiber can help prevent this adverse effect.

Burchum-8. A nursing student is caring for a patient who has been taking morphine sulfate for pain for 2 weeks. The nursing student shows an understanding of pharmacodynamic tolerance by describing it to the instructor in what way? a. "It is a form of tolerance that is a reduction in drug responsiveness brought on by repeated dosing over a short period." b. "It affects the minimum effective concentration." c. "It is a drug response caused by psychologic factors, not by biochemical or physiological properties." d. "It is a condition in which the patient requires increased doses of morphine sulfate to achieve pain relief."

d. "It is a condition in which the patient requires increased doses of morphine sulfate to achieve pain relief." Pharmacodynamic tolerance is the phenomenon of decreased responsiveness to a drug as a result of repeated drug administration. - Tachyphylaxis is a reduction in drug responsiveness as a result of repeated dosing over a short time. - Metabolic tolerance results from accelerated drug metabolism and not repeated dosages; therefore, the minimum effective concentration is not affected. - The placebo effect is a drug response caused by psychologic factors and not by the drug's biochemical or physiologic properties.

Burchum-4. The nurse should provide which teaching point when administering an enteric-coated oral tablet to a patient? a. "Chew the tablet before swallowing." b. "Break the tablet in half before swallowing." c. "Allow the tablet to be absorbed under the tongue." d. "Swallow the tablet whole after double-checking the dose."

d. "Swallow the tablet whole after double-checking the dose." Enteric-coated tablets are covered with a material designed to dissolve in the intestine instead of the stomach. They should not be chewed or broken before administration. Sublingual tablets are placed under the tongue for absorption and are not enteric coated.

Burchum-47. The nurse is teaching a patient about the side effects associated with doxazosin [Cardura]. Which statement by the patient indicates an understanding of the nurse's instructions? a. "I may experience an increase in hair growth as a side effect." b. "I'll notify the healthcare provider if I develop a persistent cough." c. "I'll make sure I include extra sources of potassium in my diet, such as bananas and baked potatoes." d. "When getting out of bed in the morning, I will sit on the side of the bed for several minutes before standing."

d. "When getting out of bed in the morning, I will sit on the side of the bed for several minutes before standing." The most disturbing side effect of alpha blockers, such as doxazosin, is orthostatic hypotension, because it can affect the patient's safety. Patients should change positions slowly and carefully. - Excessive hair growth is a side effect of minoxidil. - Persistent cough is an adverse effect of ACE inhibitors. - Hypokalemia is a side effect of thiazide and loop diuretics, so additional sources of potassium should be incorporated into the diet.

Burchum-52. A patient received desmopressin preoperatively to maintain hemostasis during a surgical procedure. Which postoperative assessment finding indicates the patient has experienced an adverse effect of the drug? a. Serum sodium level of 150 mEq/L b. Blood glucose level of 220 mg/dL c. Serum potassium level of 5.5 mEq/L d. +2 edema of the extremities

d. +2 edema of the extremities Principal adverse effects of desmopressin are fluid retention and hyponatremia. Edema of the extremities is a sign of fluid retention. A sodium level below 135 mEq/L is considered low.

Burchum-50. The nurse is caring for a patient prescribed gemfibrozil [Lopid]. For which patient should the nurse question the use of this drug? a. A patient with cardiovascular disease and elevated triglycerides b. A patient with elevated very-low-density lipoprotein (VLDL) levels c. A patient with elevated triglycerides who has not responded to dietary changes d. A patient with history of gallstones and elevated triglycerides

d. A patient with history of gallstones and elevated triglycerides Gemfibrozil increases the risk of gallstone formation and should not be used in patients with preexisting gallbladder disease. - Gemfibrozil is indicated to reduce elevated triglycerides and very-low-density lipoprotein levels primarily in patients who have not responded adequately to diet modification. - It can also raise HDL but does not reduce LDL to a significant degree.

Burchum-10. Which statement about intramuscular (IM) administration is incorrect? a. Drug absorption following IM injection in the neonate is slow and erratic. b. Absorption of IM drugs becomes more rapid in infancy than in neonates. c. Neonates experience low blood flow through muscle during the first days of postnatal life. d. Absorption of IM drugs becomes slower and more erratic in infancy than in neonates.

d. Absorption of IM drugs becomes slower and more erratic in infancy than in neonates. Drug absorption following IM injection in the neonate is slow and erratic. Delayed absorption is due in part to low blood flow through muscle during the first days of postnatal life. By early infancy, absorption of IM drugs becomes more rapid than in neonates and adults.

Burchum-46. The patient is admitted for the management of a hypertensive emergency. The healthcare provider prescribes sodium nitroprusside [Nipride] drug therapy. What is the priority nursing action during this treatment? a. Observe for respiratory depression. b. Monitor the electrocardiogram for tachycardia. c. Initiate oxygen therapy via nasal cannula at 2 L/min. d. Adjust the intravenous infusion rate to the blood pressure response.

d. Adjust the intravenous infusion rate to the blood pressure response. The nurse will adjust the rate of infusion based on the patient's blood pressure. - Respiratory depression is not associated with administion of this drug. - Oxygen therapy is not necessary. - and nitroprusside causes very little tachycardia.

Burchum-7. Which nursing action results in the most common cause of fatal medication errors? a. Miscalculation of dosage b. Miscommunication of drug orders c. Misreads the healthcare provider's handwriting d. Administers a drug intravenously (IV) instead of intramuscular (IM)

d. Administers a drug intravenously (IV) instead of intramuscular (IM) According to the Institute of Medicine (IOM), among fatal medication errors, the most common cause are human factors. Of the human factors, the main causes of errors are performance deficits (29.8%), such as administering a drug IV instead of IM, followed by knowledge deficits (14.2%) and miscalculation of dosage (13%).

Burchum-9. The nurse is caring for a pregnant patient who has chronic asthma. When administering medications to this patient, the nurse should do what? a. Give the medications as ordered, because most drugs do not cross the placenta. b. First assess the creatinine level, because renal blood flow decreases during pregnancy. c. Hold the medications and notify the ordering physician, because drugs that are not known teratogens may not be safe during pregnancy. d. Advise the patient that taking asthma medications during pregnancy improves fetal outcomes.

d. Advise the patient that taking asthma medications during pregnancy improves fetal outcomes. Essentially all drugs can cross the placenta. Renal blood flow increases during pregnancy, which increases the clearance of some drugs, such as lithium. Lack of proof of teratogenicity does not mean that a drug is safe; it only means that the available data are insufficient to make a definitive judgment. Uncontrolled maternal asthma is more dangerous to the fetus than the drugs used to treat it.

HESI. A nurse teaches a client about Coumadin (warfarin) and concludes that the teaching is effective when the client states, "I must not drink: a. ...apple juice." b. ... grape juice." c. ... orange juice." d. ... cranberry juice."

d. Antioxidants in cranberry juice may inhibit the mechanism that metabolizes Coumadin, causing elevations in the international normalized ratio (INR), resulting in hemorrhage. - Apple juice, grape juice, and orange juice are fine to drink.

Burchum-10. For medications that do not have established pediatric doses, the most common method of extrapolating the appropriate dose is based on which measurement? a. Age b. Weight c. Height/length d. Body surface area

d. Body surface area Pediatric doses have been established for a few drugs but not for most. For drugs that do not have an established pediatric dose, dosage can be extrapolated from adult doses. The method of conversion employed most commonly is based on body surface area.

Burchum-52. The nurse is caring for a patient who takes warfarin [Coumadin] for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate? a. Administer intravenous (IV) push protamine sulfate. b. Continue with the current prescription. c. Prepare to administer vitamin K. d. Call the healthcare provider to increase the dose.

d. Call the healthcare provider to increase the dose. An INR in the range of 2 to 3 is considered the level for warfarin therapy. For a level of 1.2, the nurse should contact the healthcare provider to discuss an order for an increased dose.

Burchum-44. A patient is admitted to the hospital with a diagnosis of hypertension. The nurse understands that which medication works by preventing angiotensin II from binding with its receptor sites? a. Quinapril [Accupril] b. Aliskiren [Tekturna] c. Eplerenone [Inspra] d. Candesartan [Atacand]

d. Candesartan is an angiotensin II receptor blocker (ARB) and thus prevents the binding of angiotensin II at its receptor sites. - Quinapril is an ACE inhibitor - aliskiren is a direct renin inhibitor - eplerenone is a selective aldosterone receptor blocker.

Burchum-49. In which situation is dronedarone [Multaq] contraindicated? a. PR intervals of 240 msec b. QT intervals of less than 500 msec c. Resting heart rate of 55 beats per minute d. Concomitant administration of amitriptyline [Elavil]

d. Concomitant administration of amitriptyline [Elavil] Drugs and supplements that prolong the QT interval (eg, phenothiazines, tricyclic antidepressants, amitriptyline, class I and class III antidysrhythmics) can intensify dronedarone-induced QT prolongation, thereby increasing the risk of torsades de pointes. These drugs are contraindicated for use with dronedarone. - Dronedarone is contraindicated when the PR intervals are greater than 280 msec; - the QT interval is greater than 500 msec; - and the heart rate is less than 50 beats per minute.

HESI. A nurse is caring for a client with albuminuria resulting in edema. What pressure change does the nurse determine to be the cause of the edema? a. Decrease in tissue hydrostatic pressure b. Increase in plasma hydrostatic pressure c. Increase in tissue colloid osmotic pressure d. Decrease in plasma colloid oncotic pressure (COP)

d. Decrease in COP. Because the plasma COP is the major force drawing fluid from the interstitial spaces back into the capillaries, a drop in COP caused by albuminuria results in edema. - Hydrostatic tissue pressure is unaffected by alteration of protein levels; colloidal pressure is affected. - Hydrostatic pressure is influenced by the volume of fluid and the diameter of the blood vessel, not directly by the presence of albumin. - The osmotic pressure of tissues is unchanged.

Burchum-11. Which is not a reason for the decline in hepatic drug metabolism with age? a. Reduced hepatic blood flow b. Reduced liver mass c. Decreased activity of some hepatic enzymes d. Poor diet

d. Diet. Diet is important but is not a principal reason for reduced hepatic drug metabolism. Rates of hepatic drug metabolism tend to decline with age. Principal reasons are reduced hepatic blood flow, reduced liver mass, and decreased activity of some hepatic enzymes.

Burchum-45. Which medication is most likely to cause the side effect of constipation? a. Nifedipine [Adalat] b. Amlodipine [Norvasc] c. Isradipine [DynaCirc] d. Diltiazem [Cardizem]

d. Diltiazem [Cardizem] Nifedipine, amlodipine, and isradipine, which are dihydropyridine calcium channel blockers, cause less risk of constipation than diltiazem and verapamil.

Burchum-11. When assessing for drug effects in the older adult, which phase of pharmacokinetics is the greatest concern? a. Absorption b. Distribution c. Metabolism d. Excretion

d. Excretion Although pharmacokinetic changes in older adults affect all phases of kinetics, drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the older adult.

HESI. A client with chronic liver disease reports, "My gums have been bleeding spontaneously." The nurse identifies small hemorrhagic lesions on the client's face. The nurse concludes that the client needs additional: a. Bile salts b. Folic acid c. Vitamin A d. Vitamin K

d. Fat-soluble vitamin K is essential for synthesis of prothrombin by the liver; a lack results in hypoprothrombinemia, inadequate coagulation, and hemorrhage. - Although cirrhosis may interfere with production of bile, which contains the bilirubin needed for optimum absorption of vitamin K, the best and quickest manner to counteract the bleeding is to provide vitamin K intramuscularly. - Folic acid is a coenzyme with vitamins B12 and C in the formation of nucleic acids and heme; thus, a deficiency may lead to anemia, not bleeding. - Vitamin A deficiency contributes to development of polyneuritis and beriberi, not hemorrhage.

Burchum-8. The nurse is caring for a patient prescribed abacavir [Ziagen] to treat human immunodeficiency virus (HIV) infection. To reduce the potential fatal hypersensitivity reaction, which recommendation is suggested prior to initiating abacavir drug therapy? a. Administer a test dose b. Obtain liver function studies c. Drug skin testing d. Genetic screening

d. Genetic screening Gene variants that affect the immune system can increase the risk of severe hypersensitivity reaction to the drug abacavir [Ziagen]. The FDA recommends screening for the variant gene code HLA-B*5701 before a patient uses this drug. If the test is positive, abacavir should be avoided.

Burchum-43. Complete the equation: Cardiac output = Volume of blood ejected at each heartbeat × ____. a. Stroke volume b. Preload c. Afterload d. Heart rate

d. Heart rate. The amount of blood ejected with each heartbeat is known as the stroke volume. To determine the cardiac output, multiply the stroke volume by the number of beats per minute.

Burchum-76. A patient is admitted to the emergency department with acute severe exacerbation of asthma. Which drug should the nurse anticipate will be included in the treatment plan? a. Oral theophylline [Elixophyllin] b. Subcutaneous omalizumab [Xolair] c. Inhaled mometasone furoate [Asmanex] d. High-dose albuterol [Proventil] via nebulizer treatment

d. High-dose albuterol [Proventil] via nebulizer treatment Nebulized high-dose SABAs, such as albuterol, are administered to relieve airflow obstruction. - Oral theophylline is used for maintenance therapy of chronic stable asthma, not for treatment of exacerbation. - Omalizumab is a second-line agent indicated for allergy-related asthma and only when preferred options have failed. - Inhaled glucocorticoids, such as mometasone furoate, are not used to abort an acute attack. During an exacerbation they are administered systemically.

Burchum-4. For which reason should the nurse follow safe medication administration for intravenous (IV) medications? a. The IV route can result in delayed absorption of the medication. b. The IV route results in a delayed onset of action. c. Control over the levels of drug in the body is unpredictable. d. IV administration is irreversible.

d. IV administration is irreversible. The IV route allows precise control over levels of drug in the blood and results in rapid onset of action. Absorption of IV medication is instantaneous and complete. Once a drug has been injected, there is no turning back; the drug is in the body and cannot be retrieved.

Burchum-52. The nurse knows that which statement is most accurate? a. Individuals with severe hemophilia A have less of a risk of developing inhibitors than those with the mild form. b. The risk of inhibitor development is higher in Caucasians than in Hispanics. c. Antibodies to factor VIII develop after 20 to 30 treatments. d. Immune tolerance therapy is more successful in eliminating inhibitor production in hemophilia A than in hemophilia B.

d. Immune tolerance therapy is more successful in eliminating inhibitor production in hemophilia A than in hemophilia B. The success rate of immune tolerance therapy in eliminating inhibitor production in patients with hemophilia A is high (63% to 83%), but it is very low for those with hemophilia B. - Individuals with mild hemophilia A have a 3% to 13% risk of developing antibodies to factor VIII, whereas those with the severe form have a 20% to 30% risk. - The risk for inhibitor (antibody) development is unusually high in African Americans and Hispanics. - Antibodies to treatment with factor VIII or factor IX typically develop after only 9 to 12 courses of treatment.

HESI. The nurse provides instructions about how to use a nebulizer to a client with chronic obstructive pulmonary disease (COPD). The nurse concludes that additional teaching is needed when the client: a. Places the tip of the mouthpiece an inch beyond the lips b. Holds the inspired breath for at least three seconds c. Exhales slowly through the mouth with lips pursed slightly d. Inhales with the lips tightly sealed around the mouthpiece of the nebulizer

d. Inhaling with the lips tightly sealed around the mouthpiece of the nebulizer results in nasal breathing, which negates the effects of aerosol medication. - The mouthpiece should be gently held in the mouth just past the lips. The nebulizer tip should be past the lips to deliver the medication. - Holding the inspired breath for at least three seconds promotes contact of the medication with the bronchial mucosa. - Exhaling slowly through the mouth with lips pursed slightly prolongs and improves delivery of the medication to the respiratory mucosa.

Burchum-76. Which class of drugs is most effective in preventing and treating seasonal and allergic rhinitis? a. Antitussives b. Oral antihistamines c. Oral sympathomimetics d. Intranasal glucocorticoids

d. Intranasal glucocorticoids Intranasal glucocorticoids are the most effective drugs for preventing and treating seasonal and allergic rhinitis. They reduce nasal congestion, rhinorrhea, sneezing, nasal itching, and erythema. - Antihistamines are less effective than glucocorticoids, because histamine is only one of several mediators of allergic rhinitis. - Sympathomimetics relieve only nasal congestion. - Antitussives are used to suppress cough.

Burchum-5. The nurse is preparing to administer a drug with a high therapeutic index. What does this mean about the drug? a. It is very potent. b. It has a low efficacy. c. It is probably lethal. d. It is relatively safe.

d. It is relatively safe. Therapeutic index is a measure of a drug's safety. It is the ratio between the therapeutic and lethal dose of the drug. A large or high therapeutic index indicates that the drug is relatively safe.

Burchum-50. A patient with cardiovascular disease is taking rosuvastatin [Crestor]. The nurse is monitoring for potential adverse effects. Which finding indicates a potential adverse effect of this drug? a. Blood pressure of 140/90 mm Hg b. Wheezing and shortness of breath c. Platelet count of 100 × 10^3/mm^3 d. Muscle pain and tenderness

d. Muscle pain and tenderness The statins typically are well tolerated; however, in rare cases they can cause the serious adverse effect of myopathy and rhabdomyolysis. If unexplained muscle pain and tenderness develop, the prescriber should be notified. The other effects would not likely be caused by rosuvastatin.

HESI. A nurse is caring for a postoperative client who has a nasogastric tube attached to low continuous suction. What clinical findings indicate that the client may be experiencing hypokalemia? a. Tingling of the fingertips and toes b. Dry and sticky mucous membranes c. Abdominal cramping and irritability d. Muscle weakness and cardiac dysrhythmias

d. Muscle weakness and cardiac dysrhythmias are related to potassium depletion in the skeletal and cardiac muscles; the sodium-potassium pump facilitates conduction of nerve impulses and muscle activity. - Tingling of the fingertips and toes is related to hypocalcemia, not hypokalemia. - Dry and sticky mucous membranes are related to hypernatremia, not hypokalemia. - Abdominal cramping and irritability are related to hyperkalemia, not hypokalemia.

Burchum-52. On-demand therapy is indicated for which type of patient? a. Patient with mild hemophilia b. Patient with severe hemophilia c. Patient who is allergic to factor VIII (Bioclate) d. Patient who is bleeding or about to undergo surgery

d. On-demand therapy is indicated for patients who are bleeding or about to undergo surgery. The dosage depends primarily on the site and severity of the bleeding.

Burchum-9. Which statement regarding adverse reactions during pregnancy is false? a. Not only are pregnant women subject to the same adverse effects as everyone else, but they may also suffer effects unique to pregnancy. b. Drugs taken during pregnancy can adversely affect the patient as well as the fetus. c. The drug effect of greatest concern is teratogenesis. This is the production of birth defects in the fetus. d. One in five children is born with a malformation related to drug use during pregnancy.

d. One in five children is born with a malformation related to drug use during pregnancy. Less than 1% of all birth defects are caused by drugs. All of the other statements are true.

Burchum-52. Fondaparinux [Arixtra] is not approved for use in which circumstance? a. Prevention of deep vein thrombosis (DVT) after knee replacement b. Treatment of acute pulmonary embolism (PE) (in conjunction with warfarin) c. Prevention of deep vein thrombosis (DVT) after abdominal surgery d. Prevention of ischemic complications in patients with unstable angina

d. Prevention of ischemic complications in patients with unstable angina Enoxaparin [Lovenox], not Arixtra, is approved for use in preventing ischemic complications in patients with unstable angina, non-Q-wave myocardial infarction (MI), and ST-segment elevation myocardial infarction (STEMI). - Arixtra is approved for (1) preventing DVT after hip surgery, knee replacement, and abdominal surgery and (2) treating acute PE and acute DVT in conjunction with warfarin.

Burchum 11. The nurse is caring for a group of older adult patients who are all receiving multiple medications. The nurse understands that it is essential to individualize each patient's therapy. Which is the best rationale for this practice? a. The percentage of drug absorbed often is decreased in older adults. b. Most older adults have decreased body fat and increased lean mass. c. Hepatic metabolism tends to increase in older adults, resulting in decreased drug levels. d. Renal function declines with age, leading to decreased drug excretion.

d. Renal function declines in older adults, leading to decreased excretion and potential drug accumulation. - Although absorption may be delayed in older adults, the percentage absorbed does not change. - Most older adult patients have increased body fat and decreased lean mass. - Hepatic metabolism tends to decline with age.

Burchum-9. A teratogenic drug, such as methotrexate, is most likely to cause learning deficits during which phase of fetal development? a. Conception through week 2 b. Weeks 3 to 8 c. First trimester d. Second and third trimesters

d. Second and third trimesters. Exposure to teratogens during the second and third trimesters usually disrupts function rather than producing obvious anatomic abnormalities. - Exposure to teratogens during the first 2 weeks of pregnancy usually results in an "all-or-nothing" response that may result in fetal death. - Exposure during the remainder of the first trimester may result in anatomic malformations.

Burchum-47. Which laboratory result may be a consequence of therapy with a thiazide diuretic? a. Serum glucose level of 58 mg/dL [low] b. Serum potassium level of 5.3 mEq/L [high] c. Serum sodium level of 135 mEq/L [normal] d. Serum uric acid level of 10.4 mg/dL [high]

d. Serum uric acid level of 10.4 mg/dL. Hyperuricemia is a side effect of thiazide diuretics. Normal uric acid levels typically range from 3.6 to 8.5 mg/dL. - Hyperglycemia, not hypoglycemia, and hypokalemia, not hyperkalemia, are side effects of thiazides. A serum sodium of 135 mEq/L is a normal value.

Burchum-46. The nurse is preparing to administer minoxidil [Loniten] 5 mg orally. What is the only cardiovascular indication for this mediacation? a. Heart failure b. Myocardial infarction c. Angina pectoris d. Severe hypertension

d. Severe hypertension Because of its serious adverse effects, minoxidil is reserved for patients who have failed to respond to safer drugs. The only cardiovascular indication for minoxidil is severe hypertension.

HESI. A health care provider prescribes simvastatin (Zocor) 20 mg daily for elevated cholesterol and triglyceride levels for a female client. Which is most important for the nurse to teach when the client initially takes the medication? a. Take the medication with breakfast. b. Have liver function tests every six months. c. Wear sunscreen to prevent photosensitivity reactions. d. Inform the health care provider if the client wishes to become pregnant.

d. Simvastatin is contraindicated in pregnancy because it is capable of causing fetal damage (teratogenic). It is a Pregnancy Category X teratogen. - Simvastatin should be taken in the evening because most cholesterol is synthesized between 12 midnight and 3:00 AM. - Liver function tests should be done at 6 to 12 weeks initially and only then every 6 months. - Although wearing sunscreen should be taught, sensitivity reactions are a rare occurrence; it is not as important as an action in another option.

Burchum-49. A nurse is caring for a patient receiving dronedarone [Multaq] for treatment of atrial fibrillation. What electrocardiogram (ECG) change indicates an adverse effect of this medication? a. Previously upright T waves now are inverted. b. Previously rounded, upright P waves now are notched. c. ST segments previously on the baseline now are depressed. d. The QT-interval measurement changes from 400 msec to 520 msec.

d. The QT-interval measurement changes from 400 msec to 520 msec. Dronedarone prolongs the QT interval by about 10 msec. A QT-interval measurement of 400 msec in a normal heart rate (60 to 100 beats per minute) is normal. Prolongation to 520 msec would increase the risk of torsades de pointes. - Newly inverted T waves and ST-segment depression can be signs of ischemia or infarction and warrant further investigation through analysis of troponin levels. - Notched P waves can be a sign of valvular heart disease and are unrelated to treatment with dronedarone.

Burchum-3. A new medication becomes available for treatment of a debilitating neurologic disease. What would the nurse expect about the safety of the drug? a. The drug is safe for administration to children. b. The drug has been tested in pregnant women. c. All possible adverse effects have been identified by animal testing. d. The drug has passed the FDA approval process.

d. The drug has passed the FDA approval process. A new medication must meet the FDA's stringent requirements before it comes to market. - Most drugs have not been tested in women (including pregnant women) or children. - Animal testing cannot identify all possible adverse effects.

Burchum-1. The nurse is preparing to give a drug with certain properties. Which property of the drug is the most compelling indication that it should not be given? a. The drug produces an unwanted side effect. b. The drug is difficult to administer. c. The drug's effects are reversible. d. The drug is not effective for its intended purpose. If a drug is not effective, there is no justification for giving it. Some drugs may be given even though they produce unwanted side effects or are difficult to administer. Reversible action is a desired property for most drugs.

d. The drug is not effective for its intended purpose. If a drug is not effective, there is no justification for giving it. Some drugs may be given even though they produce unwanted side effects or are difficult to administer. Reversible action is a desired property for most drugs.

Burchum-41. The nurse caring for a patient taking furosemide [Lasix] is reviewing the patient's most recent laboratory results, which are: sodium, 136 mEq/L [normal]; potassium, 3.2 mEq/L [low]; chloride, 100 mEq/L [normal]; blood urea nitrogen, 15 mg/dL [normal]. What is the nurse's best action? a. Administer Lasix as ordered. b. Place the patient on a cardiac monitor. c. Begin a 24-hour urine collection. d. Hold the Lasix and notify the physician.

d. The nurse's best action is to hold the Lasix and notify the physician. Loop diuretics, such as furosemide, can cause significant potassium loss. The normal potassium level is 3.5 to 5 mEq/L. The remaining electrolyte levels are normal. - Administering the Lasix could result in a critically low potassium level. Effects of low potassium include cardiac dysrhythmias. - Placing a patient on a cardiac monitor requires a physician's order and would warrant further assessment first, such as taking vital signs and asking the patient whether he or she is having any cardiac-related symptoms. - Collecting a 24-hour urine specimen is not appropriate in this case.

HESI. The nurse provides discharge teaching to a client who has received prescriptions for digoxin (Lanoxin), furosemide (Lasix), and a 2-gram sodium diet. The nurse evaluates that further teaching is needed when the client states: a. "I must check my pulse every day." b. "I can gradually increase my exercise as long as I take rest periods." c. "I should call my health care provider if I have difficulty breathing when I am lying flat." d. "I can use a little table salt on my food as long as I do not use it when cooking."

d. The response "I can use a little table salt on my food as long as I do not use it when cooking" demonstrates that the client did not understand the discharge teaching. Table salt and foods high in sodium should be avoided. Sodium intake causes fluid retention, which can precipitate a fluid volume excess, which contributes to heart failure. - Digoxin should be withheld if the client's pulse is less than a preset rate (e.g., 60 beats per minute) because this is a sign of digoxin toxicity; the risk of digoxin toxicity is increased if the client develops hypokalemia as a result of receiving furosemide. - Slowly increasing activities while ensuring rest periods limits the stress on the heart and is desirable. - Orthopnea is a sign of pulmonary edema related to heart failure, and the health care provider should be notified.

Burchum-46. The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare 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

d. To protect against reflex tachycardia Hydralazine is a vasodilator that lowers blood pressure, but it also can trigger reflex tachycardia. Beta blockers, such as propranolol, are added to the regimen to normalize the heart rate.

Burchum-43. Which hemodynamic system serves as a reservoir for circulating blood? a. Heart b. Lungs c. Arteries d. Veins

d. Veins. Most of the circulating blood is in the veins, venules, and venous sinuses. The venous system serves as a reservoir for circulating blood.

Burchum-76. A patient is taking oral theophylline for maintenance therapy of stable asthma. A nurse instructs the patient to avoid using which substance to prevent a complication? a. Echinacea b. Cimetidine [Tagamet] c. Sunscreen products d. Caffeine

d. caffeine Theophylline is a methylxanthine that provides benefits through bronchodilation. It is used to reduce the frequency and severity of asthma attacks, especially those occurring at night. Caffeine also is a methylxanthine, and its pharmacologic actions may intensify the adverse effects of theophylline on the central nervous system (CNS) and heart. Sources of caffeine should be avoided. - It is not necessary to avoid taking cimetidine or echinacea or using sunscreen products while taking theophylline.

Burchum-10. Which of the following is not an example of age-related adverse drug effects? a. Growth suppression b. Discoloration of developing teeth c. Kernicterus d. Toxicity

d. toxicity. Like adults, pediatric patients are subject to adverse reactions when drug levels rise too high. In addition, pediatric patients are vulnerable to unique adverse effects related to organ system immaturity and to ongoing growth and development. Among these age-related effects are growth suppression (caused by glucocorticoids), discoloration of developing teeth (caused by tetracyclines), and kernicterus (caused by sulfonamides).

Burchum-43. Which condition do the natriuretic peptides serve to protect the cardiovascular system? a. Hypovolemia b. Volume overload c. Myocardial infarction d. Hypotension

d. volume overload. Natriuretic peptides protect the cardiovascular system in the event of volume overload. They work by reducing blood volume and promoting the dilation of arterioles and veins.

Burchum-9. According to the FDA Pregnancy Risk categories, which category represents the greatest risk for fetal harm? a. A b. B c. C d. D e. X

e. Drugs in Category X are the most dangerous; these drugs are known to cause human fetal harm, and their risk to the fetus outweighs any possible therapeutic benefit. - Drugs in Categories B, C, and D are progressively more dangerous than drugs in Category A and less dangerous than drugs in Category X.