Pharm J2 Exam1 Questions (Hopefully)

The nurse is caring for a patient diagnosed with human immunodeficiency virus (HIV) and newly diagnosed angina. What drug would the nurse question if ordered? A) Ranolazine (Ranexa) B) Nitroglycerin (generic) C) Propranolol D) Diltiazem

Ans: A Feedback: Drug drug interactions can occur with ketoconazole, diltiazem, verapamil, macrolide antibiotics, and HIV protease inhibitors

An individual calls the nurse help line and asks what the drug diphenhydramine is used for. The nurse knows that the medication is prescribed for which conditions? (Select all that apply.) A) Urticaria B) Vasomotor rhinitis C) Productive cough D) Motion sickness E) Angioedema

Ans: A, B, D, E

The student nurse is studying for a pharmacology exam and notices that many of the adrenergic blocking antagonists drugs studied in class have what suffix? A) -aine B) -lol C) -azole D) -triptan

Ans: B

What class of antiarrhythmic agent would the nurse be most likely to administer to a lactating new mother? A) Class Ib B) Class II C) Class III D) Class IV

Ans: B Feedback: Class I, III, and IV agents should not be used during lactation

The nurse is preparing to administer sublingual nitroglycerin to a patient for the first time and warns that the patient may experience what right after administration? A) Nervousness or paresthesia B) Throbbing headache or dizziness C) Drowsiness or blurred vision D) Tinnitus or diplopia

Ans: B Feedback: Headache and dizziness commonly occur at the start of nitroglycerin therapy.

The nurse is preparing digoxin for an infant. What is the nurses priority intervention? A) To perform hand hygiene B) To have another nurse check dosage calculations C) To check the childs apical pulse D) To identify the patient by checking the ID bracelet

Ans: B Feedback: The margin of safety for the dosage of this drug is very narrow in children. The dosage needs to be very carefully calculated and should be double-checked by another nurse before administration.

What class of antiarrhythmics drug blocks potassium channels, prolonging phase 3 of the action potential and slowing the rate and conduction of the heart? A) I B) II C) III D) IV

Ans: C

The nurse is caring for a patient receiving propranolol. What problems, reported by the patient, does the nurse suspect is caused by the drug? (Select all that apply.) A) Seizures B) Rash C) Atrioventricular (AV) block D) Bronchospasm E) Dreams

Ans: C, D, E

In what age group are adrenergic agonists contraindicated? A) Older adults B) Adolescents C) Children D) No age group

Ans: D Feedback: They are used in patients of all ages.

After the patients anginal pain is relieved he says to the nurse, That nitroglycerin works great. How does it do that? What is the nurses best response? A) Nitroglycerin decreases the amount of oxygen needed by the heart to function. B) Nitroglycerin makes the coronary arteries open much wider. C) Nitroglycerin promotes growth of new, smaller arteries to supply oxygen to the heart. D) Nitroglycerin decreases preload and afterload.

Ans: A

Before administering a nonselective adrenergic blocker, what should the nurse assess? A) Pulse and blood pressure B) Bowel sounds and appetite C) Serum albumin level D) Serum sodium and potassium levels

Ans: A

Nonselective adrenergic blocking agents have a variety of therapeutic uses. Which agent is used for the treatment of heart failure? A) Carvedilol (Coreg) B) Sotalol (Betapace) C) Propranolol (Inderal) D) Tamsulosin (Flomax)

Ans: A

The nurse is caring for a child who needs anticoagulation therapy. What drug is approved for pediatric use? A) Heparin B) Dabigatran C) Rivaroxaban D) Low-molecular-weight heparins

Ans: A

The nurse is caring for a patient prescribed ranolazine. The patient asks why this drug is different from the beta-blocker that he was previously taking. What is the nurses best response? A) This drug does not slow your heart rate. B) This drug increases myocardial oxygen demand. C) This drug slows the QT intervals. D) This maintains blood pressure with no hypotensive effects.

Ans: A

When a combination of drugs needs to be incorporated into the drug regimen for a hypertensive patient, what type of diuretic would the nurse expect to administer? A) Thiazide B) Loop C) Potassium-sparing D) Osmotic

Ans: A Feedback: Thiazide diuretic is currently considered the first drug used in the stepped-care management of hypertension.

The nurse is caring for a patient who is receiving an adrenergic blocking agent. While writing the care plan for this patient what nursing diagnoses would be most appropriate concerning comfort? A) Acute pain related to cardiovascular and systemic effects B) Decreased cardiac output related to cardiovascular effects C) Ineffective airway clearance related to lack of bronchodilating effects D) Deficient knowledge regarding drug therapy

Ans: A Feedback: Acute pain would be the only nursing diagnosis related to the patients comfort level.

How does ephedrine act on the body? A) Stimulates the release of norepinephrine B) Acts indirectly on beta-adrenergic receptor sites C) Stimulates the release of dopamine D) Acts indirectly on alpha-adrenergic receptor sites

Ans: A Feedback: Ephedrine stimulates the release of norepinephrine from nerve endings and acts directly on adrenergic receptor sites. Therefore, the other options are incorrect.

The nurse is caring for a patient who is taking a sustained-release (SR) oral nitrate. How should the nurse instruct this patient to take the medication? A) With water B) Sublingually until absorbed C) With milk or milk products D) 1 hour after eating

Ans: A Feedback: Give SR forms with water, and caution the patient not to chew or crush them, because these preparations need to reach the gastrointestinal (GI) tract intact to avoid overdosage. They are not dissolved sublingually but swallowed whole. They are best taken on an empty stomach 1 hour before meals.

The nurse is teaching a class for his or her peers about glucocorticoids. What will the nurse say is initially blocked, resulting in the drugs anti-inflammatory action? A) Arachidonic acid B) Phagocytes C) Lymphocytes D) Antibodies

Ans: A Feedback: Glucocorticoids block the actions of arachidonic acid, which leads to a decrease in the formation of prostaglandins and leukotrienes.

The nurse performs an electrocardiogram and finds the older adult patient is in atrial fibrillation (AF). Time of onset is unknown but could be as long as 3 months earlier when the patient was last assessed. What drug will the nurse expect to be ordered? A) Anticoagulant B) Digoxin C) Quinidine D) Ibutilide

Ans: A Feedback: If the onset of AF is not known and it is suspected that the atria may have been fibrillating for longer than 1 week, the patient is better off staying in AF without drug therapy or electrocardioversion. Prophylactic oral anticoagulants are given to decrease the risk of clot formation and emboli being pumped into the system.

The 86-year-old patient, admitted with thrombophlebitis, is being sent home on enoxaparin (Lovenox). The nurse evaluates that he understands why enoxaparin is being used if he states that it will do what? A) Inhibit the formation of additional clots B) Stimulate production of certain clotting factors C) Prevent the blood from clotting D) Dissolve the clot

Ans: A Feedback: Low-molecular-weight heparins inhibit thrombus and clot formation by blocking factors Xa and IIa.

The nursing instructor is quizzing a student who is preparing to administer an alpha-specific adrenergic agonist to a patient. The instructor asks the student what the student will assess in this patient after administering the drug. What is the students best response? A) Blood pressure B) Respirations C) Mental status D) Vision

Ans: A Feedback: Monitor blood pressure, pulse, rhythm, and cardiac output regularly.

The emergency department nurse is asked to prepare a nitroprusside (Nitropress) infusion for a patient being brought to the hospital in an ambulance. The nurse knows this drug is only used in what circumstances? A) Hypertensive emergencies B) Hypertension in a patient having a myocardial infarction C) Hypertension complicated by symptoms of a stroke D) Hypertension associated with diabetic ketoacidosis

Ans: A Feedback: Most of the vasodilators are reserved for use in severe hypertension or hypertensive emergencies.

The nurse administers prednisone orally at 8 am. When would the nurse expect the drug to reach peak effect? A) 9 to 10 am B) 12 to 1 pm C) 8:30 to 9:00 am D) 4 to 6 pm

Ans: A Feedback: Prednisones peak effect occurs 1 to 2 hours after administering the drug.

A 23-year-old female patient presents at the clinic with a migraine headache. What beta-adrenergic blocking agent might the physician prescribe for the prophylactic prevention of future migraine headaches? A) Propranolol (Inderal) B) Nadolol (Corgard) C) Timolol (Blocadren) D) Sotalol (Betapace)

Ans: A Feedback: Propranolol is indicated for the treatment include prophylaxis of migraine headache.

The home health nurse provides patient teaching to his or her patient who is taking oral prednisolone. The nurse provides what instruction to reduce the occurrence of nausea? A) Take with a meal. B) Take 1 hour before meals. C) Take before bedtime. D) Split the dose into two equal doses.

Ans: A Feedback: Steroids, taken on an empty stomach, would exacerbate the nausea.

What intervention does the nurse include in the plan of care for a patient receiving a continuous intravenous infusion of heparin? A) Avoiding intramuscular injections B) Assessing for symptoms of respiratory depression C) Measuring hourly urinary outputs D) Monitoring BP hourly

Ans: A Feedback: The most commonly encountered adverse effect of the anticoagulants is bleeding, ranging from bleeding gums during toothbrushing to severe internal hemorrhage. Avoid all invasive procedures, including giving IM injections, while the patient is on heparin therapy.

A 71-year-old man with a history of heart disease and diabetes has had an antihistamine prescribed. The nurse is concerned with this prescription because of the risk for what? A) Cardiac arrhythmias B) Increased salivation and choking C) Severe constipation D) Insomnia

Ans: A Feedback: The patient has history of heart disease. Antihistamines have been associated with prolongation of the QT interval, which can lead to potentially fatal cardiac arrhythmias.

What are the therapeutic and adverse effects associated with the adrenergic blocking agents related to? A) Receptor-site specificity B) Sympathetic nervous system manifestations C) Norepinephrine release D) Function of the nerve terminal

Ans: A Feedback: The therapeutic and adverse effects associated with these drugs are related to their adrenergic-receptor-site specificity; that is, the ability to react with specific adrenergic receptor sites without activating them, thus preventing the typical manifestations of sympathetic nervous system (SNS) activation.

The nurse is providing drug teaching for a patient who is to be discharged taking dofetilide (Tikosyn). What drug will the nurse teach the patient to avoid due to a drug-drug interaction? A) Cimetidine B) Furosemide C) Acetaminophen D) Antacids

Ans: A Feedback: There is an increased risk of serious adverse effects if dofetilide is combined with ketoconazole, cimetidine, or verapamil

The nurse admits a patient in acute respiratory distress secondary to pulmonary emboli. What drug will the nurse administer to lyse the clots? A) Urokinase B) Tenecteplase C) Rivaroxaban D) Fondaparinux

Ans: A Feedback: Urokinase is used for lysis of pulmonary emboli and treatment of coronary thrombosis.

When the nurse administers warfarin it is expected that the drug will have what effect on the body? A) Decrease in production of vitamin K dependent clotting factors B) Increase in prothrombin C) Increase in vitamin K Dependent factors in the liver D) Increase in procoagulation factors

Ans: A Feedback: Warfarin, an oral anticoagulant drug, causes a decrease in the production of vitamin K dependent clotting factors in the liver.

The patient taking digoxin (Lanoxin) has developed an infection. What antibiotic can the nurse safely administer to this patient? A) Zithromax B) Erythromycin C) Tetracycline D) Cyclosporine

Ans: A Feedback: Zithromax may be given without impacting the effects of digoxin.

The nurse reviews the patients medical history and determines class II antiarrhythmics are contraindicated due to the patients history of what condition? A) Asthma B) Colitis C) Migraine headache D) Antidiarrheals

Ans: A Feedback: Class II antiarrhythmics are contraindicated in patients with asthma.

A nurse is providing patient education to a patient who has had corticosteroids prescribed. What drug will the nurse teach the patient to avoid while taking the corticosteroids? A) Aspirin B) Dimenhydrinate (Dramamine) C) Ibuprofen (Advil) D) Famotidine (Pepcid)

Ans: A Feedback: Serum levels and effectiveness may decrease if corticosteroids are combined with salicylates.

The nurse evaluates an improvement in the patients heart failure (HF) status based on what assessment finding? A) Using fewer pillows to sleep B) Increased skin turgor C) Heart rate regular D) Improved mental status

Ans: A Feedback: The degree of HF is often calculated by the number of pillows required to get relief (e.g., one-pillow, two-pillow, or three-pillow orthopnea).

The patient was unable to achieve an acceptable blood pressure with just lifestyle changes so in stage 2 of the stepped-care management of hypertension plan, an angiotensin-converting enzyme inhibitor was ordered. In step 3, when inadequate response was obtained from step 2, the nurse anticipates the provider will order what? A) A diuretic B) A beta-blocker C) A calcium channel blocker D) A vasodilator

Ans: A Feedback: A diuretic would be added before adding another class of medication unless the first drug was a diuretic. Vasodilators are generally used only in hypertensive emergencies.

What adverse reaction does the nurse anticipate if the 56-year-old patient takes his beta-blocker with clonidine? A) Hypertension B) Bradycardia C) Angina D) Syncope

Ans: A Feedback: A paradoxical hypertension occurs when clonidine is given with beta-blockers, and an increased rebound hypertension with clonidine withdrawal may also occur.

An asthmatic patient taking beta-blockers should be assessed by the nurse for what potential adverse reaction? A) Bronchospasm B) Hypoglycemia C) Pleural effusion D) Pneumonia

Ans: A Feedback: Bronchospasm can occur with beta blockade. The patient would not have to be observed for hypoglycemia, pleural effusion, or pneumonia.

What drug would the nurse administer to the patient to control angina caused by atherosclerosis that would also slow the development of further plaque buildup on the arterial wall? A) Diltiazem (Cardizem) B) Propranolol (Inderal) C) Amyl Nitrates (generic) D) Isosorbide dinitrate (Isordil)

Ans: A Feedback: Diltiazem is a calcium channel blocker that is indicated to treat Prinzmetals angina, chronic angina, effort-associated angina, and hypertension.

A patient has been prescribed losartan (Cozaar) for hypertension. What patient teaching points will the nurse include about this drug include? A) Report onset of a cough or fever to health care provider. B) Limit fluid intake to decrease urinary output. C) Monitor blood pressure once a week. D) Take the drug late in the day to prevent sleepiness.

Ans: A Feedback: Losartan is an angiotensin II receptor blocker that is associated with a cough, back pain, fever, muscle weakness, and upper respiratory tract infections, so the patient should be taught to report a fever or cough to his health care provider.

The patient is diagnosed with secondary hypertension. What will be the focus of nursing care to treat this patient? A) Administering epinephrine B) Administering antihypertensives C) Promoting healthy lifestyle D) Treating the cause

Ans: A Feedback: Most people have essential, or primary, hypertension with no known cause that is treated with medications and lifestyle changes. Patients with secondary hypertension means there is a known cause of the blood pressure elevation.

The nurse is caring for a patient who takes nitroglycerin sublingually. When providing patient education, the nurse would tell the patient that she can expect relief of chest pain within what period of time? A) 1 to 3 minutes B) 5 to 10 minutes C) 15 to 20 minutes D) 30 to 60 minutes

Ans: A Feedback: Nitroglycerin acts within 1 to 3 minutes. Other options are incorrect.

The nurse is caring for a patient who takes metoprolol for angina. The patient asks how long it takes for the medicine to work. What is the nurses best response? A) 15 minutes B) 30 minutes C) 1 hour D) 90 minutes

Ans: A Feedback: Oral metoprolol has an onset of action of 15 minutes. Other options are incorrect.

The nurse, caring for a patient taking a beta-blocker and a nitrate to treat angina, recognizes the need for careful monitoring as the result of what secondary diagnosis? A) Chronic obstructive pulmonary disease (COPD) B) Rheumatoid arthritis (RA) C) Irritable bowel syndrome (IBS) D) Chronic urinary tract infection (UTI)

Ans: A Feedback: The nurse should assess for COPD, because the effect of beta-blockers in reducing effects of the sympathetic nervous system could exacerbate the respiratory condition.

The nurse recognizes blood pressure is determined by three elements including what? A) Peripheral resistance B) Pulse pressure C) Renal blood flow D) Preload

Ans: A Feedback: The pressure in the cardiovascular system is determined by three elements: heart rate, stroke volume, and peripheral resistance.

The nurse is caring for a postpartum patient admitted to the intensive care unit with a diagnosis of disseminated intravascular coagulation (DIC). What is the drug of choice to treat this problem? A) Heparin B) Urokinase C) Aspirin D) Warfarin

Ans: A Feedback: The treatment of choice for DIC is heparin, an anticoagulant. It prevents the clotting phase from being completed, thus inhibiting the breakdown of fibrinogen.

The nurse cares for a diabetic patient with uncontrolled hypertension who has been prescribed losartan (Cozaar). The health care provider changes this patients prescription to losartan with hydrochlorothiazide (Hyzaar). What benefits does the nurse anticipate this patient will receive from this drug therapy? (Select all that apply.) A) Slows progression of diabetic nephropathy in type 2 diabetes B) Increases excretion of fluid and sodium resulting in lower blood volume C) Alters electrolyte and acidbase balance D) Improves control of blood pressure due to combination therapy E) Produces far fewer adverse effects resulting from the combination

Ans: A, B Feedback: . Losartan slows the progression of diabetic nephropathy in patients with hypertension and type 2 diabetes. Hydrochlorothiazide is a diuretic that will increase excretion of fluid and sodium resulting in a lower circulating blood volume that will help to reduce blood pressure, preload, and afterload.

The nurse is caring for a patient who has been noncompliant with treatment for hypertension. The nurse explains that untreated hypertension increases the risk of what? (Select all that apply.) A) Renal disease B) Cerebral infarction C) Heart failure D) Cholecystitis E) Migraine headache

Ans: A, B, C

The nurse suspects the patient may have toxic levels of digoxin in the bloodstream when what is assessed? (Select all that apply.) A) Irregular heart rhythms B) Nausea C) Anorexia D) Headache E) Peripheral edema

Ans: A, B, C

The labor and delivery nurse assists with the delivery of a newborn to a woman taking an adrenergic blocker for a congenital heart defect. What organ systems may be affected in the newborn by these drugs? (Select all that apply.) A) Cardiovascular B) Respiratory C) Central nervous system (CNS) D) Gastrointestinal (GI) E) Genitourinary (GU)

Ans: A, B, C Feedback: Adrenergic blockers can affect labor, and babies born to mothers taking these drugs may exhibit adverse cardiovascular, respiratory, and CNS effects.

The nurse is preparing to administer a digitalizing dosage of digoxin to a geriatric patient. What factors will the nurse assess for first to avoid digoxin toxicity? (Select all that apply.) A) Renal function B) Low body mass C) Hydration D) Assessment of pulse E) Cognitive function

Ans: A, B, C Feedback: Factors that may contribute to elevated digoxin levels include impaired renal function, low body mass, and dehydration.

The home care nurse is caring for a patient newly prescribed a nonselective beta-blocking agent. What would the nurse include in the teaching plan related to this drug? (Select all that apply.) A) Take with meals. B) Change position slowly. C) Avoid driving or operating hazardous machinery. D) Warn of possible increase in libido. E) Increase activity levels as much as possible.

Ans: A, B, C Feedback: Patients should be taught to change position slowly, avoid driving or operating hazardous machinery, and to pace activities as a result of potential dizziness from orthostatic hypotension in order to avoid injury. Patients should take medicine with meals when possible.

The nurse teaches the patient how to use topical nitroglycerin and includes what teaching points in the teaching plan? (Select all that apply.) A) Rotate application sites. B) Assess the skin for signs of breakdown. C) Make sure no one touches the side with the medication. D) Do not shower with the patch in place. E) Increase fluid intake to avoid hypotension.

Ans: A, B, C Feedback: Rotate the sites of topical forms of nitroglycerin to lower the risk of skin abrasion and breakdown; monitor for signs of skin breakdown to arrange for appropriate skin care as needed. Care should be taken not to touch the side of the patch with the medication by the patient or anyone assisting in applying the patch. The patient may shower with the patch in place. There is no need to increase fluid intake but patients should be encouraged to maintain adequate intake.

When studying for a pharmacology exam, a student asks her peers which agents affect both alpha- and beta-receptor sites. What would be an appropriate response to this student? (Select all that apply.) A) Dobutamine (Dobutrex) B) Epinephrine (Adrenalin, Sus-Phrine) C) Dopamine (Intropin) D) Clonidine (Catapres) E) Albuterol (Proventil)

Ans: A, B, C Feedback: Agents that affect both alpha- and beta-receptor sites include dobutamine, dopamine, ephedrine, epinephrine, and norepinephrine.

What would the nurse teach the patient about potency of nitroglycerin? (Select all that apply.) A) The tablet should fizzle or burn when placed under the tongue. B) Protect the drug from heat and light. C) Always replace when past the expiration date. D) Older tablets may require you to use two tablets at one time. E) Nitroglycerin does not lose its potency easily.

Ans: A, B, C Feedback: Ask the patient if the tablet fizzles or burns, which indicates potency. Always check the expiration date on the bottle and protect the medication from heat and light because these drugs are volatile and lose potency easily.

When doing a shift assessment on the patient, the nurse would report what symptoms as a possible adverse effect of intranasal methylprednisolone? (Select all that apply.) A) Headache B) Impaired wound healing C) Epistaxis D) Hypotension E) Nasal irritation

Ans: A, B, C, D, E

The nurse is sending a patient home who will remain on anticoagulant therapy. What teaching point does the nurse make when teaching the patient about the drug? (Select all that apply.) A) Brush teeth gently with soft bristle brush. B) Wear or carry a MedicAlert notification. C) Warning signs of bleeding include fatigue, pallor, and increased heart rate. D) Treat minor side effects with over-the-counter (OTC) medications. E) Obtain follow-up lab work regularly as ordered.

Ans: A, B, C, E

The nurse works in a clinic that has many African American patients. What would the nurse need to consider when caring for patients with hypertension? (Select all that apply.) A) African American men are at highest risk for hypertension. B) African Americans respond best to single-drug therapy. C) African Americans are most responsive to angiotensin-converting enzyme inhibitors. D) Increased adverse effects occur when using thiazide and thiazide-like diuretics. E) First-line use of a calcium channel blocker with changes to lifestyle is best in African Americans.

Ans: A, B, D Feedback: In the United States, African Americans are at highest risk for developing hypertension, with men more likely than women to develop the disease. African Americans are most responsive to single-drug therapy (as opposed to combination drug regimens). African Americans are less responsive to angiotensin-converting enzyme inhibitors and beta-blockers. Because African Americans are more responsive to diuretics, the treatment approach should include the first-line use of a diuretic in combination with diet and other lifestyle changes.

While studying the antihypertensive drugs, the nursing students learn that the pressure in the cardiovascular system is determined by three elements. What are they? (Select all that apply.) A) Heart rate B) Stroke volume C) Preload D) Total peripheral resistance E) Pulse pressure

Ans: A, B, D Feedback: The pressure in the cardiovascular system is determined by three elements: heart rate, stroke volume, or the amount of blood that is pumped out of the ventricle with each heartbeat (primarily determined by the volume of blood in the system), and total peripheral resistance, or the resistance of the muscular arteries to the blood being pumped through.

The nurse assesses blood in the urine of the 73-year-old patient receiving warfarin (Coumadin) this morning. What actions will the nurse take? (Select all that apply.) A) Assess prothrombin time (PT). B) Assess international normalized ratio (INR). C) Expect to administer protamine sulfate. D) Expect to administer vitamin K. E) Assess partial thromboplastin time (PTT).

Ans: A, B, D Feedback: Vitamin K is the antidote for warfarin. PT and INR are used to assess therapeutic levels of warfarin. PTT is used to assess therapeutic levels of heparin. Protamine sulfate is given as an antidote for heparin.

What medication, if ordered for an 8-year-old patient, should the nurse question? (Select all that apply.) A) Amiodarone (Cordarone) 400 mg orally per 24 hours B) Labetalol (Normodyne) 100 mg orally b.i.d. C) Phentolamine (Regitine) 1 mg intramuscularly 1 to 2 hours before surgery D) Prazosin (Minipress) 3 mg orally t.i.d. E) Carvedilol (Coreg) 6.25 mg orally b.i.d.

Ans: A, B, E Feedback: Amiodarone, labetalol, and carvedilol are not indicated for pediatric use and do not have established pediatric dosages.

A patient has been prescribed an antihistamine for treatment of allergic rhinitis. What statements by the patient indicate an understanding of this medication? (Select all that apply.) A) This medication will work best if I take it before I eat anything. B) I need to drink less fluid while I take this medication to help reduce the amount of mucus I have. C) I will use sugarless candies to help with the feelings of a dry mouth. D) I will use a humidifier in the bedroom while I sleep. E) This medication will probably cause my appetite to increase.

Ans: A, C, D

The nurse is caring for a patient who is scheduled to receive acetylcysteine because of an acetaminophen overdose. The nurse would notify the physician before administering the medication if the patient had which condition? (Select all that apply.) A) Bronchospasm B) Hypertension C) Nephrotic syndrome D) Peptic ulcer E) Esophageal varices

Ans: A, D, E

What agents are used primarily to treat cardiac-related conditions? (Select all that apply.) A) Nonselective adrenergic blocking agents B) Nonselective alpha-adrenergic blocking agents C) Alpha1-selective adrenergic blocking agents D) Nonselective beta-adrenergic blocking agents E) Beta1-selective adrenergic blocking agents

Ans: A, D, E Feedback: Drugs that block both alpha- and beta-adrenergic receptors are primarily used to treat cardiac-related conditions.

The patient does not want to take medication to treat his or her hypertension if he or she can avoid it and asks the nurse if there is anything else he or she can do? What lifestyle changes will the nurse recommend? (Select all that apply.) A) Increase time spent exercising. B) Eliminate all salt from your diet. C) Reduce intake of fluids. D) Lose some weight. E) Try meditation.

Ans: A, D, E Feedback: Exercising, losing weight, and meditation to reduce stress are all effective changes the patient can make in her lifestyle.

A nurse in a three drops with respiratory problems has received orders for four patients. What medication order will the nurse question? A) Tetrahydrozoline (Tyzine) three drops in each nostril for an 8-year-old child B) Hydrocodone (Hycodan) 10 mg PO for a 5-year-old child C) Pseudoephedrine (Dorcol) 15 mg PO for a 2-year-old child D) Diphenhydramine (Benadryl) 5 mg/kg IM for a 10-year-old child

Ans: B

The nurse is providing patient teaching to a patient who has been prescribed digoxin. The patient tells the nurse that she occasionally use herbals and other alternative therapies. What herb would the nurse warn the patient to avoid taking with digoxin? A) Black cohosh B) Ginseng C) Saw palmetto D) Valerian

Ans: B

The nurse provides drug teaching to the patient prescribed captopril (Capoten). What statement made by the patient does the nurse interpret to mean teaching has been effective? A) I will limit my fluid intake to 1,200 mL daily. B) I will call my doctor if I bruise easily or become extremely tired. C) I will move from a reclining to a standing position slowly. D) I will increase my intake of foods high in potassium.

Ans: B

A patient who works on road construction has been diagnosed with hypertension. After attempting to decrease his blood pressure with lifestyle changes and a mild diuretic, it is determined that he will need to be placed on an angiotensin-converting enzyme (ACE) inhibitor. Based on his occupation, what is the nurses priority assessment? A) Chronic constipation B) Excessive sweating on the job C) Three large meals a day D) One beer every night

Ans: B Feedback: A patient taking an ACE inhibitor should be sure to maintain fluid intake, so excessive sweating on the job places him at risk for a drop in fluid volume.

The nurse administers an adrenergic blocking agent in order to prevent release of what neurotransmitter? A) Epinephrine B) Norepinephrine C) Serotonin D) Gamma-aminobutyric acid (GABA)

Ans: B Feedback: Adrenergic blocking agents prevent norepinephrine from being released from the adrenal medulla or from the nerve terminal from activating the receptor, which blocks sympathetic nervous system effects. .

The nurse is administering an intravenous infusion of amiodarone (Cordarone). What should the nurse be aware of? A) The possible drugdrug interaction with nonsteroidal anti-inflammatory drugs (NSAIDs) B) The possible development of very serious cardiac arrhythmias C) The possible development of peripheral edema D) The possible development of a fatal renal toxicity

Ans: B Feedback: Amiodarone has been associated with a potentially fatal liver toxicity rather than a renal toxicity, ocular abnormalities, and the development of very serious cardiac arrhythmias.

After administering digoxin, what assessment finding would indicate to the nurse that the drug was having the desired effect? A) Increased heart size B) Increased urinary output C) Decreased respiratory rate D) Increased heart rate

Ans: B Feedback: As cardiac output improves, so does urinary output due to increased renal perfusion.

In what patient is propranolol (Inderal) contraindicated? A) 26-year-old man with viral myocarditis B) 45-year-old woman with heart failure who suffered a myocardial infarction C) 42-year-old man with hypertension D) 65-year-old woman with persistent migraines

Ans: B Feedback: Beta-adrenergic blocking agents are contraindicated in patients with bradycardia, heart failure, and heart block.

The home care nurse is providing teaching for a 59-year-old patient taking a nonselective beta-blocker. The nurse teaches the patient the importance of notifying the prescribing physician when what occurs related to this medication? A) If the patients pulse stays above 100 bpm for 3 or more days B) If the patient has a sudden onset of a cough C) If the patient falls D) If the patients pulse falls below 60 bpm for 3 or more days

Ans: B Feedback: Bronchospasm, cough, rhinitis, and bronchial obstruction are related to loss of bronchodilation of the respiratory tract and vasodilation of mucous membrane vessels so a sudden onset of a cough or difficulty breathing should be immediately reported to the health care provider.

A patient is diagnosed with Prinzmetals angina. What drug would the nurse expect to administer to this patient? A) Nadolol B) Diltiazem C) Propranolol D) Metoprolol

Ans: B Feedback: Calcium channel blockers are indicated for the treatment of Prinzmetals angina because these drugs relieve coronary artery vasospasm, increasing blood flow to the muscle cells. Diltiazem is a calcium channel blocker.

What class of antiarrhythmics will the nurse administer to the patient in symptomatic paroxysmal tachycardia because it markedly depresses phase 0 with extreme slowing of conduction? A) Class Ib B) Class Ic C) Class II D) Class III

Ans: B Feedback: Class Ic drugs markedly depress phase 0, with a resultant extreme slowing of conduction, but have little effect on the duration of the action potential. As a result, they are indicated for the treatment of paroxysmal tachycardia.

The nurse administers clopidogrel (Plavix) appropriately to the patient with what condition? A) Maintaining the patency of grafts B) Treating peripheral artery disease C) Preventing emboli from valve replacements D) Dissolving a pulmonary embolus and improving oxygenation

Ans: B Feedback: Clopidogrel is used to inhibit platelet aggregation, decreasing the formation of clots in narrowed or injured blood vessels like those found in peripheral artery disease.

An older adult patient taking high-dose corticosteroids to treat arthritis requests a pneumonia vaccine. What is the nurse's best response? A) Pneumonia vaccines are only given if you are at risk for serious pulmonary problems. B) Live virus vaccines cannot be given to people who are significantly immunosuppressed. C) Patients taking corticosteroids are well protected from viruses and do not need vaccines. D) Corticosteroids interact with the pneumococcal vaccine to create serious adverse effects.

Ans: B Feedback: Corticosteroids block the inflammatory response and are very helpful in conditions such as arthritis. However, they also block the immune response, making a person immunosuppressed.

A triage nurse in the emergency department is assessing a 78-year-old man. It is determined that the patient is experiencing severe digoxin toxicity. What drug will the nurse administer immediately? A) Inamrinone (Inocor) B) Digoxin immune Fab (Digibind) C) Verapamil hydrochloride (Calan) D) Quinidine sulfate

Ans: B Feedback: Digoxin immune Fab is an antigen-binding fragment derived from specific antidigoxin antibodies.

What order for a digitalizing dose of digoxin (Lanoxin) for a 62-year-old man would the nurse consider appropriate and safe to administer? A) 1.25 mg IV now B) 0.75 mg orally now C) 0.25 mg orally every day D) 1 mg intramuscularly every 4 hours 24 hours

Ans: B Feedback: Digoxin: Adult: loading dose 0.75 to 1.25 mg orally or 0.125 to 0.25 mg IV, then oral maintenance dose of 0.125 to 0.25 mg/d.

The nurse teaches the patient receiving propranolol (Inderal) at home for management of a ventricular dysrhythmia to monitor what parameter? A) Daily fluid intake B) Daily blood pressure C) Weekly weight D) Weekly pulse

Ans: B Feedback: Hypotension can occur with propranolol, which is a beta-blocker, so patients should check their blood pressure and pulse every day.

The nurse suspects drug toxicity in the patient who has been receiving lidocaine by infusion over the past 2 days to control a ventricular arrhythmia. What assessment would the nurse perform to determine the accuracy of the suspicion of toxicity? A) Neurological assessment B) Serum lidocaine level C) Renal function studies D) Hepatic function studies

Ans: B Feedback: If lidocaine is used for ventricular arrhythmias related to cardiac surgery or digoxin toxicity, serum levels should be monitored regularly to determine the appropriate dose and to avoid the potential for serious proarrhythmias and other adverse effects.

An older adult patient who is taking metformin (Glucophage) has just been seen in the clinic. The doctor has ordered metoprolol (Toprol) for angina. What assessment data should the nurse monitor due to this drug combination? A) Blood pressure B) Blood glucose C) Heart rate D) Intake and output

Ans: B Feedback: Metformin is an antidiabetic drug and the nurse should monitor the patients blood glucose frequently throughout the day. The patient will not have the usual signs and symptoms of hypoglycemia or hyperglycemia.

The nurse is caring for a 55-year-old patient receiving metoprolol (Lopressor). What statement by the patient would lead the nurse to believe that he needs additional instruction? A) If I have side effects from the medication, I will contact my physician before I stop taking it. B) I can take over-the-counter (OTC) cold medication while on metoprolol. C) I will take the medication on an empty stomach. D) I will report a weight gain of 2 pounds or more in 1 week.

Ans: B Feedback: OTC medications can interact to increase or decrease the effects of antiadrenergic drugs.

The nurse is caring for a patient who takes an antiarrhythmic agent and is reporting a complete lack of appetite. Which cardiac antiarrhythmic agent would the nurse suspect the patient is taking? A) Diltiazem (Cardizem) B) Propranolol (Inderal) C) Lidocaine (Lidocaine Parenteral) D) Amiodarone (Cordarone)

Ans: B Feedback: Propranolol frequently causes gastrointestinal (GI) problems such as nausea, vomiting, anorexia, constipation, and diarrhea.

The nurse is writing a plan of care for a patient receiving an alpha-specific adrenergic agonist. What should this plan of care include? A) Monitoring the patient for diarrhea B) Monitoring blood pressure and heart rate every 2 to 4 hours C) Assessing skin turgor for dehydration D) Assessing for fatigue and lethargy

Ans: B Feedback: Sympathetic stimulation will cause hypertension and increased heart rate so it is important these be monitored.

The nurse frequently administers propranolol (Inderal) as treatment for what condition? A) Hypotension B) Angina C) Prevent first myocardial infarction (MI) D) Cluster headaches

Ans: B Feedback: The beta-adrenergic blocking agents are used to treat cardiovascular problems (hypertension, angina, migraine headaches) and to prevent reinfarction after MI.

What drug is a safe and effective calcium channel blocker only if the nurse administers them as sustained-release or extended-release preparations to treat hypertension? A) Aliskiren (Tekturna) B) Diltiazem (Cardizem) C) Atenolol (Tenormin) D) Metoprolol (Lopressor)

Ans: B Feedback: The calcium channel blockers available in immediate-release and sustained-release forms that are used in treating hypertension include amlodipine (Norvasc), felodipine (Plendil), isradipine (DynaCirc, DynaCirc CR), and nicardipine (Cardene, Cardene SR).

The 96-year-old patient is receiving digoxin (Lanoxin) and furosemide (Lasix). In the morning, the patient complains of a headache and nausea. What will the nurse do first? A) Contact the patients physician immediately. B) Check her laboratory values and vital signs. C) Administer acetaminophen and Maalox. D) Give her clear liquids and have her lie down.

Ans: B Feedback: The nurse will check the patients digoxin level and electrolytes. Assessing vital signs is important because the risk of cardiac arrhythmias could increase due to the patients receiving furosemide, which is a potassium-losing diuretic.

A 4-year-old girl is prescribed an albuterol (Proventil) inhaler for her asthma. What is the recommended safe dosage for this patient? A) 1.25 to 2.5 mg q.i.d B) 1.25 to 2.5 mg b.i.d C) 2 mg q.i.d D) 0.5 to 1 mg b.i.d

Ans: B Feedback: The recommended dosage for albuterol when given via inhaler is 1.25 to 2.5 mg b.i.d.

A patient has been started on losartan (Cozaar), an angiotensin IIreceptor blocker (ARB), for hypertension. After 6 weeks of therapy, it is decided that the losartan alone is not controlling the patients hypertension. What does the nurse anticipate will be added to the losartan regimen for better control of this patients hypertension? A) Candesartan (Atacand) B) Hydrochlorothiazide (Hyzaar) C) Captopril (Capoten) D) Antidiuretic hormone (ADH)

Ans: B Feedback: When losartan therapy is started, maximal effects on blood pressure usually occur within 3 to 6 weeks. If losartan alone does not control blood pressure, a low dose of a diuretic may be added.

The emergency department nurse is administering IV lidocaine to a patient. What adverse effect of lidocaine therapy should the nurse assess for? A) Dysphagia B) Dizziness C) Excessive bruising D) Tinnitus

Ans: B Feedback: Adverse effects include dizziness, light-headedness

The nurse reviews the patients lab results and recognizes the patient is at risk for digoxin toxicity due to what electrolyte imbalance? A) Hyperkalemia B) Hypokalemia C) Hypernatremia D) Hyponatremia

Ans: B Feedback: Hypokalemia and hypomagnesemia increase cardiac excitability and ectopic pacemaker activity leading to dysrhythmias.

A 66-year-old female patient is on long-term oral glucocorticoid therapy to treat chronic obstructive pulmonary disease. When providing drug teaching, the nurse will inform this patient that she is at particular risk for what? A) Hyponatremia B) Spontaneous fractures C) Respiratory depression D) Ineffective temperature regulation

Ans: B Feedback: Only spontaneous fractures are considered an adverse effect of glucocorticoids.

A patient who has been taking cyclosporine to prevent rejection of a kidney transplant has had diltiazem ordered. Why would the nurse question this order? A) Serious diltiazem toxicity could occur. B) The combination may result in elevated or even toxic cyclosporine levels. C) The combination could lead to kidney rejection. D) A kidney recipient would not effectively excrete the diltiazem.

Ans: B Feedback: Potentially serious adverse effects to keep in mind include increased serum levels and toxicity of cyclosporine if they are taken with diltiazem.

What hormones does the adrenal medulla secrete? A) Renin and erythropoietin B) Norepinephrine and epinephrine C) Epinephrine and dopamine D) Dopamine and serotonin

Ans: B Feedback: The adrenal medulla is actually part of the sympathetic nervous system (SNS). It is a ganglion of neurons that releases the neurotransmitters norepinephrine and epinephrine into circulation when the SNS is stimulated.

After administering an IV dose of digoxin, the nurse would expect to see effects within what period of time? A) 30 to 120 minutes B) 5 to 30 minutes C) 1 hour D) 2 hours

Ans: B Feedback: The drug has a rapid onset of action and rapid absorption (30 to 120 minutes when taken orally, 5 to 30 minutes when given IV).

The nurse is providing drug teaching for a patient who is prescribed enalapril (Vasotec). What drug specific adverse effect will the nurse include in the drug teaching? A) Sedation B) Persistent cough C) Tachycardia D) Rash

Ans: B Feedback: Benazepril, enalapril, and fosinopril are generally well tolerated but cause an unrelenting cough, possibly related to adverse effects in the lungs, where the angiotensin-converting enzyme is inhibited

When the nurse administers heparin it is anticipated the drug will have what action on the patients body? A) Binds to factor X B) Blocks the formation of thrombin C) Binds to factor Xa D) Promotes the inactivation of factor VIII

Ans: B Feedback: Heparin blocks the formation of thrombin from prothrombin. Heparin does not bind to factors X and Xa. Heparin does not inactivate factor VIII.

A nurse is preparing to discharge a patient newly prescribed warfarin (Coumadin). While assessing the patients knowledge of the drug, what would indicate that the patient needs further instruction concerning drug therapy? A) I love to eat homegrown tomatoes in the summer. B) I take aspirin for my arthritis. C) I walk 2 miles a day. D) I drink a glass of wine about once a week.

Ans: B Feedback: Increased bleeding can occur if a salicylate is taken in combination with warfarin.

The nurse administers a bolus of lidocaine and follows it with a continuous infusion at what rate? A) 0.25 to 0.75 mg/min B) 1 to 4 mg/min C) 6 to 8 mg/min D) 10 to 20 mg/min

Ans: B Feedback: Lidocaine may be delivered at 1 to 4 mg/min after a bolus.

The nurse cautions the patient taking nadolol (Corgard) for angina that they may experience what adverse effect? A) Dry mouth B) Decreased exercise tolerance C) Constipation D) Problems with urination

Ans: B Feedback: Nadolol is a beta-blocker that can cause a decreased tolerance to exercise because of the inability to experience the effects of the stress reaction.

The patient asks the nurse, Will I have to take this antiarrhythmic agent for the rest of my life? The nurse, having reviewed the CAST study, responds by saying what? A) Yes, you will have to take this drug for life. B) The drug is indicated for short-term treatment of life-threatening ventricular arrhythmias. C) This drug may need to be changed but youll take an antiarrhythmic for life. D) After the arrhythmia is corrected, the drug will be stopped.

Ans: B Feedback: The CAST study, a large research study run by the National Heart and Lung Institute, found that long-term treatment of arrhythmias may have an uncertain effect on mortality, and in some cases may actually lead to increased cardiac death, which is the basis for the current indication for antiarrhythmics to be used only short-term to treat life-threatening ventricular arrhythmias.

The nurse is caring for a patient who is taking a calcium-channel blocker. What adverse effects would the nurse caution this patient about? A) Hypertension and tachycardia B) Headache and dizziness C) Itching and rash D) Nausea and diarrhea

Ans: B Feedback: The adverse effects associated with these drugs are related to their effects on cardiac output and on smooth muscle. Central nervous system (CNS) effects include dizziness, light-headedness, headache, and fatigue.

Prior to beginning anticoagulant therapy, the nurse will question the female patient about what? A) Last menstrual period B) Peptic ulcers C) Urinary tract infection D) Weight

Ans: B Feedback: The nurse should screen for conditions that could be exacerbated by increased bleeding tendencies, including hemorrhagic disorders, recent trauma, spinal puncture, gastrointestinal (GI) ulcers ...

The nurse reviews the patients lab values and determines warfarin therapy is at therapeutic levels with what lab result? A) Partial thromboplastin time (PTT) 1.5 to 2.5 times the control B) Prothrombin time (PT) 1.3 to 1.5 times the control C) International normalized ratio (INR) of 3 to 4 D) Activated partial thromboplastin time (aPTT) 3 to 4 times the control

Ans: B Feedback: Warfarin is at therapeutic level when the INR is 2 to 3.5 and the PT is 1.3 to 1.5 times control. PTT and aPTT should be 1.5 to 2.5 to indicate heparin dosage is at therapeutic level.

An 80-year-old patient has been brought to the emergency department in shock. The patient is receiving dopamine (Intropin). What potentially serious adverse effect will the nurse monitor for? A) Blood dyscrasia B) Cardiac arrhythmia C) Hepatic toxicity D) Renal insufficiency

Ans: B Feedback: Dopamine therapy can result in cardiac arrhythmias, which can be life-threatening. Older patients are more likely to experience the adverse effects associated with adrenergic agonists and should be started on lower doses and monitored closely for arrhythmias and blood pressure changes.

A 31-year-old male patient has been prescribed propranolol to reduce and prevent angina. What will the nurse assess this patient for related to the medication? (Select all that apply.) A) Sleep disturbance B) Impotence C) Bronchospasm D) Gastric pain E) Tachycardia

Ans: B, C, D

The mother asks the nurse for a steroid cream to put on her infants diaper rash. What teaching will the nurse provide the mother? (Select all that apply.) A) Topical corticosteroids are very effective treatment for diaper rash. B) Topical corticosteroid application should not be occluded with a diaper. C) Topical corticosteroids should not be applied to open lesions. D) Use of topical corticosteroids should be limited in children. E) Topical corticosteroids should be applied in a thick coat to the rash.

Ans: B, C, D Feedback: Topical use of corticosteroids should be limited in children because their body surface area is comparatively large and the amount of the drug absorbed in relation to weight is greater than in an adult, should not be occluded with a diaper.

Indications for the nurse to administer heparin include what? (Select all that apply.) A) Treatment of hemophilia B) Prevention and treatment of pulmonary emboli C) Treatment of atrial fibrillation with embolization D) Prevention and treatment of venous thrombosis E) Diagnosis and treatment of disseminated intravascular coagulation (DIC)

Ans: B, C, D, E

The clinic nurse is teaching a patient about transdermal clonidine (Catapres). What information would be included in the nurses teaching plan? (Select all that apply.) A) Change the patch in the morning. B) Rotate the site where the patch is placed. C) Monitor blood pressure daily. D) Stop the drug immediately if adverse effects occur. E) Keep the physician informed of any new diagnoses or medications.

Ans: B, C, E Feedback: Transdermal patches should not be placed in the same site repeatedly so it is important to instruct the patient to rotate sites to improve absorption of drug. Blood pressure should be monitored daily and the patient should be provided with acceptable ranges versus when to notify the physician because severe hypertension can occur. Due to drug drug interactions, contraindications, and cautions related to specific diagnosis, it is important for the patient to inform the physician if another physician prescribes a medication or a new diagnosis for decisions to be made about whether to continue the drug or change the dosage. The patch is changed weekly and not every morning.

A patient is being discharged home on warfarin. The discharge teaching by the nurse should include a warning to avoid what? A) St. Johns wort B) Tarragon C) Ginkgo D) Saw palmetto

Ans: C

What is the nurses priority to assess before giving a female patient her prescription for an angiotensin II receptor blocker (ARB)? A) Do you eat something when you take your medications? B) How much physical exercise do you get? C) When was your last menstrual period (LMP)? D) Have you always weighed 130 pounds since you grew up?

Ans: C

A nurse is providing discharge instructions to a patient who is taking atenolol (Tenormin) to treat hypertension. What would the nurse teach the patient regarding a possible drug drug interaction? A) Antibiotics B) Oral contraceptives C) Nonsteroidal anti-inflammatory drugs (NSAIDs) D) Antifungal agents

Ans: C Feedback: A decreased hypertensive effect can occur if a beta-selective adrenergic blocking agent is used in combination with NSAIDs.

The nurse is caring for a patient who does not have a respiratory disorder but has been prescribed acetylcysteine. What is an additional indication for acetylcysteine (Mucomyst)? A) Conversion of cardiac dysrhythmias B) Treatment of peptic ulcer disease C) Antidote for acetaminophen poisoning D) Decreased bronchospasm

Ans: C Feedback: Acetylcysteine is used orally to protect liver cells from being damaged during episodes of acetaminophen toxicity

The nurse administers what drug to terminate supraventricular tachycardia? A) Lidocaine (Lidocaine Parenteral) B) Flecainide (Tambocor) C) Adenosine (Adenocard) D) Dronedarone (Multaq)

Ans: C Feedback: Adenosine depresses conduction at the atrioventricular node and is used to restore NSR (normal sinus rhythm) in patients with paroxysmal supraventricular tachycardia.

The nurse administers an IV phosphodiesterase inhibitor. What drug will result in forming a precipitate if given via the same IV line without adequate flushing? A) Albuterol (Proventil) B) Nifedipine (Procardia) C) Furosemide (Lasix) D) Lovastatin (Mevacor)

Ans: C Feedback: Furosemide, when given with a phosphodiesterase inhibitor, forms precipitates

The nurse is caring for a patient who has digoxin toxicity. As the nurse assesses the changes in the patients daily activities, what finding could indicate the cause of the toxic level? A) The patient has been sleeping more lately. B) The patient took nitroglycerin for chest pain twice yesterday. C) The patients daughter brought her a bag of licorice that she has been enjoying. D) The patients intake of sodium increased lately because shes been eating seafood.

Ans: C Feedback: Increased digoxin toxicity has been reported with ginseng, hawthorn, and licorice.

What would the nurse teach the diabetic patient to monitor for when beginning a class II antidysrhythmic drug regimen in addition to insulin? A) Weight loss B) Reduced peripheral perfusion C) Hypoglycemia D) Exercise intolerance

Ans: C Feedback: Increased hypoglycemia is possible if these drugs are combined with insulin; so patients should be taught to monitor their blood sugar levels often.

For what condition would the nurse expect to administer lidocaine via IV drip? A) Decrease in arterial oxygen saturation (SaO2) B) Increase in blood pressure C) Multiple premature ventricular contractions (PVCs) D) Increase in intracranial pressure (ICP)

Ans: C Feedback: Lidocaine drips are indicated for the treatment of life-threatening ventricular arrhythmias such as long or frequent runs of PVCs.

The nurse is serving a breakfast tray to the patient receiving an alpha- and beta-adrenergic agonist medication. The nurse notifies dietary of the error with the patients diet when finding what on the tray? A) Eggs B) Bacon C) Coffee D) Milk

Ans: C Feedback: Patients being treated with any adrenergic agonists who are also taking ma huang, guarana, or caffeine are at increased risk for overstimulation, including increased blood pressure, stroke, and death.

What glucocorticoids could the nurse only administer orally? A) Cortisone (Cortone Acetate) B) Hydrocortisone (Cortef) C) Prednisone (Deltasone) D) Triamcinolone (Aristocort)

Ans: C Feedback: Prednisone is available in oral form only.

The nurse admits a patient to the constant care unit with a digoxin level of 11 ng/mL and a serum potassium level of 5.2 mEq/L. Digoxin immune Fab is administered. The next day, the patients digoxin level remains elevated. What action does the nurse anticipate? A) Administer digoxin immune Fab again. B) Administer a reduced dosage of digoxin. C) Continue to monitor the patients digoxin level daily. D) Notify the health care provider of the elevated level.

Ans: C Feedback: Serum digoxin levels will be very high and unreliable for about 3 days after the digoxin immune Fab infusion because of the high levels of digoxin in the blood.

A patient is admitted to the hospital with deep vein thrombosis. A 10,000-unit dose of heparin is administered subcutaneously. What drug does the nurse keep on hand to reverse the effects of heparin if the patient begins to bleed? A) Antithrombin (Thrombate III) B) Desirudin (Iprivask) C) Protamine sulfate D) Vitamin K

Ans: C Feedback: The antidote for heparin is protamine sulfate. Vitamin K reverses the effect of warfarin.

You are caring for a patient who takes an antiarrhythmic agent. What would be a priority nursing assessment before administering this drug? A) Assess mental status. B) Assess breath sounds. C) Assess pulses and blood pressure. D) Assess urine output.

Ans: C Feedback: The nurse should continually monitor cardiac rate and rhythm when administering an antiarrhythmic agent to detect potentially serious adverse effects and to evaluate drug effectiveness.

A nurse is teaching the patient newly prescribed sublingual nitroglycerin how to take the medication. What will the nurse instruct the patient to do first? A) To check his radial pulse B) To place the tablet in the buccal cavity C) To take a sip of water D) To lie down for 15 minutes before administration

Ans: C Feedback: The nurse should instruct the patient to take a sip of water to moisten the mucous membranes so the tablet will dissolve quickly.

The nurse sees a patient in an outpatient setting who is given a new prescription for an antiarrhythmic medication to treat premature atrial contractions (PAC). The nurse has limited time with the patient and addresses what priority nursing diagnosis? A) Decreased cardiac output B) Alteration in comfort C) Deficient knowledge D) Potential for injury

Ans: C Feedback: The patient received a new prescription and needs information about how to take the medication, when to call the provider, and potential adverse effects so the priority nursing diagnosis is deficient knowledge.

A patient who is steroid dependent due to adrenocortical insufficiency calls the clinic and is very upset, telling the nurse of the extreme stress he or she is experiencing right now. What does the nurse expect the health care provider will order concerning his or her medication? A) The dosage may continue as ordered. B) The medication may be discontinued until stress declines. C) The dosage of the medication may be increased. D) The dosage of the medication may be decreased.

Ans: C Feedback: A patient with adrenocortical insufficiency may not be able to supplement the increased need for ACTH. The stress reaction may block the immune and inflammatory systems, making the body more susceptible to pathogens. Therefore, an increase in medication may be necessary to prevent further adrenal insufficiency and to meet the increased demands for corticosteroids in the body under stress.

The clinic nurse receives a call from the mother of a 4-year-old child on long-term corticosteroid therapy saying the child woke up with a cold and is pulling on his ear. What instructions will the nurse provide? A) Encourage fluids, monitor his temperature, and he will be better in 3 days. B) Take him to the emergency room (ER) immediately. C) Bring him to the clinic to be seen today. D) Hang up and call 911.

Ans: C Feedback: Children receiving long-term therapy should be protected from exposure to infection. Special precautions should be instituted to avoid injury. If injuries or infections do occur, the child should be seen by a primary care provider as soon as possible. There is no need to treat this as an emergency so the mother need not rush the child to the ER or call 911, but she should be encouraged to have the child seen today at the clinic.

The 2-year-old patient with asthma is placed on a short-term dose of prednisone. What important instruction will the nurse provide the patient about this drug? A) Increase intake of carbohydrates. B) The child may receive immunizations while on this drug. C) Do not stop this medication suddenly; you will have to taper dosage gradually. D) Reduce intake of protein until drug therapy is complete.

Ans: C Feedback: Prednisone is usually ordered for short-term use with tapering dosage. It is important to instruct the parent to taper doses and to not just stop the drug suddenly when discontinuing from high doses so as to give the adrenal glands a chance to recover and produce adrenocorticoids.

The clinic nurse assesses a patient taking benazepril (Lotensin) to control hypertension. What is the priority nursing assessment related to this drug? A) Mental illness B) Hepatic disease C) Renal disease D) Peptic ulcer disease

Ans: C Feedback: Benazepril is an angiotensin-converting enzyme inhibitor; drugs in this class are contraindicated in the presence of impaired renal function.

When the nurse administers a beta-adrenergic blocker to the patient with angina, the nurse expects the drug will help to control angina, but it also has what other effect? A) Increased heart rate B) Increased oxygen consumption C) Decreased strength of heart muscle contraction D) Decreased urinary output

Ans: C Feedback: Beta-blockers competitively block beta-adrenergic receptors in the heart and kidneys, decreasing the influence of the sympathetic nervous system on these tissues and the excitability of the heart.

A 49-year-old patient is admitted with uncontrolled chest pain. He is currently taking nitroglycerin (Nitrostat). His physician orders nifedipine (Adalat) added to his regimen. The nurse should observe the patient for what adverse effects? A) Hypokalemia B) Renal insufficiency C) Hypotension D) Hypoglycemia

Ans: C Feedback: Both nitroglycerin and nifedipine have hypotension as a potential adverse effect so frequent assessment of blood pressure is important.

A patient taking diltiazem (Cardizem) for hypertension has come to the clinic for a follow-up appointment. What adverse effects would the nurse assess the patient for? A) Chest pain and pale skin B) Shortness of breath and wheezing C) Peripheral edema and bradycardia D) Tachycardia and increased energy level

Ans: C Feedback: Cardiovascular adverse effects of diltiazem include bradycardia, peripheral edema, and hypotension.

The nurse is caring for a patient with hypertension who is preparing to be discharged from the hospital after suffering a myocardial infarction. What drug might the nurse administer that will both treat his hypertension and reduce myocardial oxygen consumption? A) Captopril B) Losartan C) Diltiazem D) Nitroprusside

Ans: C Feedback: Diltiazem inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells, depressing the impulse and leading to slowed conduction, decreased myocardial contractility, and dilation of arterioles, which lowers blood pressure and decreases myocardial oxygen consumption. Captopril, losartan, and nitroprusside do not have actions to reduce myocardial oxygen consumption.

The nurse is caring for a patient who is going home on warfarin (Coumadin). What lab test will the patient require to evaluate therapeutic effects of the drug? A) Activated partial thromboplastin time (APTT) only B) International normalized ratio (INR) only C) Prothrombin time (PT) and INR D) PT and APTT

Ans: C Feedback: PT and INR are ordered to evaluate for therapeutic effects of warfarin. Normal values of PT is 1.3 to 1.5 times the control value and the ratio of PT to INR is 2 to 3.5.

The nurse is caring for a patient who received protamine sulfate in error. The patient is not receiving, and has never received, heparin. What effect does the nurse assess for in this patient? A) Coagulation effects B) No effect C) Anticoagulant effects D) Antiplatelet effects

Ans: C Feedback: Paradoxically, if protamine is given to a patient who has not received heparin, it has anticoagulant effects. Protamine is normally used as an antidote to heparin overdose but if heparin was not administered, it does not have coagulation or antiplatelet effects. Since it has anticoagulant effects it cannot be said to have no effect.

A patient has an important presentation to make in 4 hours and he needs relief from the congestion of seasonal rhinitis. The patient calls the nurse, explains the situation, and tells the nurse that he cannot afford to be drowsy. Which antihistamine would be a good choice for this patient? A) Diphenhydramine (Benadryl) B) Dexchlorpheniramine (Polaramine) C) Loratadine (Claritin) D) Hydroxyzine (Atarax)

Ans: C Loratadine is one of the second-generation antihistamines, which have fewer anticholinergic effects and are less likely to cause drowsiness.

An adult patient who experiences angina pectoris with exertion is informed by the nurse that the leading cause of angina is what? A) Smoking B) Inadequate cardiac output C) Infarction of the myocardium D) Coronary atherosclerosis

Ans: D

Other than angina, what other medical condition might the nurse treat by administering nitroglycerin? A) Muscular dystrophy B) Pulmonary embolisms C) Polycythemia D) Anal fissures

Ans: D

The nurse evaluates that additional patient teaching is needed regarding anticoagulants when the patient states that he will do what? A) Carry a Medic Alert card with him. B) Report to the lab once a month. C) Use acetaminophen for arthritis pain. D) Use a disposable safety razor to shave.

Ans: D

The nurse is caring for a patient in a state of shock. The family asks the nurse why the patient is so sick. What is the nurses best response? A) The patient probably has an infection that is making him look so sick. B) The coronary arteries are not supplying adequate blood flow to the myocardium. C) The pumping action of the ventricles is diminished, resulting in blood backing up in his lungs. D) Low blood pressure means inadequate supply of oxygen to the bodys tissues.

Ans: D

Which drug is in the class of drugs called human B-type natriuretic peptides? A) Bosentan (Tracleer) B) Milrinone (Primacor) C) Digoxin (Lanoxin) D) Nesiritide (Natrecor)

Ans: D

The nurse provides teaching about digoxin to the 62-year-old patient. The nurse evaluates patient understanding and determines further teaching is needed when the patient says she will do what? A) Take the medication daily in the morning. B) Take her pulse before taking her dose. C) Weigh herself daily at the same time. D) Take the medication with a meal.

Ans: D Feedback: Avoid administering the oral drug with food or antacids to avoid delays in absorption.

What would be the teaching priority for a diabetic patient being treated with a nonselective beta-blocker? A) To take his own pulse B) To weigh himself once a week at the same time of day C) To avoid smoke-filled rooms D) To understand signs and symptoms of hypo- or hyperglycemic reaction

Ans: D Feedback: Because the beta-blockers stop the signs and symptoms of a sympathetic stress reaction, the signs and symptoms associated with hypo- or hyperglycemia, the diabetic patient taking a beta-blocker will need to understand this and learn new indicators of these reactions.

The 64-year-old patient has smoked since age 15 and has been diagnosed with chronic obstructive pulmonary disease. What classification of adrenergic blocking antagonist would be safest for this patient to treat angina? A) Nonselective adrenergic blocking agents B) Nonselective alpha-adrenergic blocking agents C) Alpha1-selective adrenergic blocking agents D) Beta1-selective adrenergic blocking agents

Ans: D Feedback: Beta1-selective adrenergic blocking agents have an advantage over the nonselective beta-blockers because they do not usually block beta2-receptor sites, they do not block the sympathetic bronchodilation that is so important for patients with lung diseases or allergic rhinitis.

The nurse expects the patients heart failure (HF) is caused by what diagnosis that is responsible for 95% of the cases diagnosed? A) Cardiomyopathy B) Hypertension C) Congenital anomaly D) Coronary artery disease (CAD)

Ans: D Feedback: CAD is the leading cause of HF, accounting for approximately 95% of the cases diagnosed.

The nurse is caring for a patient who reports insomnia since starting the antiarrhythmic agent prescribed for him or her. What antiarrhythmic agent would the nurse expect this patient is taking? A) Disopyramide (Norpace) B) Amiodarone (Cordarone) C) Procainamide (Pronestyl) D) Propranolol (Inderal)

Ans: D Feedback: Class II antiarrhythmics can cause insomnia.

The nurse is providing patient education to a patient taking a glucocorticoid and advises the patient to take his or her medication at what time of the day? A) At bedtime B) With the noon meal C) At 3:00 PM D) Immediately on awakening in the morning

Ans: D Feedback: Glucocorticoids should be taken immediately on awaking in the morning to mimic the normal diurnal pattern.

A patient presents to the emergency department with rales, wheezing, and blood-tinged sputum. What does the nurse recognize that these symptoms indicate? A) Cardiomyopathy B) Cardiomegaly C) Valvular heart disease D) Pulmonary edema

Ans: D Feedback: In left-sided heart failure, the left ventricle pumps inefficiently resulting in a backup of blood into the lungs causing pulmonary vessel congestion and fluid leaks into the alveoli and lung tissue.

A patient in shock is receiving an infusion of dopamine when it is discovered that an extravasation has occurred. What drug should be on standby for this occurrence? A) Phenylephrine B) Propranolol C) Phenylalanine D) Phentolamine

Ans: D Feedback: Maintain phentolamine on standby in case extravasation occurs.

A busy patient with many responsibilities is to have a medication ordered to treat her hypertension. To increase compliance with drug therapy, what drug would be a good choice for this patient? A) Acebutolol (Sectral) B) Atenolol (Tenormin) C) Bisoprolol (Zebeta) D) Metoprolol (Lopressor)

Ans: D Feedback: Metoprolol would be the best choice because it has an extended release form that only needs to be taken once a day.

The nurse is caring for a well-known stage actor who has suddenly developed severe stage fright that is preventing him from working. What drug does the nurse suspect will be prescribed for this patient? A) Carteolol (Cartrol) B) Nebivolol (Bystolic) C) Nadolol (Corgard) D) Propranolol (Inderal)

Ans: D Feedback: One of the indications for use of propranolol is prevention of stage fright

A nurse is caring for a neonate born with a congenital heart anomaly. To better help the parents understand the impact of this disorder, the nurse begins by describing the usual flow of blood through the heart which takes what course? A) Deoxygenated blood from the lungs enters the left atrium through the pulmonary artery. B) Oxygenated blood from the lungs enters the right atrium through the pulmonary veins. C) Deoxygenated blood from the lungs enters the right atrium through pulmonary veins. D) Oxygenated blood from the lungs enters the left atrium through the pulmonary veins.

Ans: D Feedback: Oxygenated blood from the lungs enters the left atrium through the pulmonary veins and passes through the mitral valve into the left ventricle.

When developing a plan of care for the patient receiving a glucocorticoid, what nursing diagnosis would be of highest priority? A) Deficient fluid volume related to water retention B) Risk for injury related to muscle weakness C) Imbalanced nutrition: less than body requirements D) Risk for infection related to immunosuppression

Ans: D Feedback: Steroids suppress the immune system, which puts the patient at risk for infection.

What class of antiarrhythmic agents does the nurse administer to slow the outward movement of potassium during phase 3 of the action potential? A) Class Ib B) Class Ic C) Class II D) Class III

Ans: D Feedback: The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, prolonging it.

What class of antiarrhythmic agents does the nurse administer to depress generation of the action potentials and delaying phases 1 and 2 of repolarization? A) Class Ib B) Class II C) Class III D) Class IV

Ans: D Feedback: The class IV antiarrhythmics block the movement of calcium ions across the cell membrane, depressing the generation of action potentials and delaying phases 1 and 2 of repolarization, which slows automaticity and conduction.

A priority nursing assessment for a patient who is to receive an alpha- or beta-adrenergic blocking agent would be what? A) Monitoring respiratory rate B) Checking blood glucose level C) Measuring urine output D) Assessing heart rate

Ans: D Feedback: The most serious adverse effect would be severe bradycardia, so the nurses priority would be assessing the heart rate.

The clinic nurse is caring for a patient who has been prescribed fexofenadine for hay fever. When the nurse is assessing this patients medication history, what drug would make the nurse question the order for fexofenadine? A) Tetracycline B) Penicillin C) Gentamicin D) Ketoconazole

Ans: D Feedback: the interaction of fexofenadine with ketoconazole or erythromycin may raise fexofenadine concentrations to toxic levels.

The nurse is caring for an African American patient who received a kidney transplant and receives methylprednisolone for immunosuppression. What is the nurses priority assessment specific to this patient? A) Assessing capillary refill time B) Assessing cardiac rhythm C) Assessing white blood cell count D) Assessing blood glucose levels

Ans: D Feedback: African Americans develop increased toxicity to the corticosteroid methylprednisolone particularly when it is used for immunosuppression after renal transplantation. This toxicity can include severe steroid-induced diabetes mellitus. A priority intervention with this patient is monitoring blood glucose levels.

No antihypertensive medication is safe during pregnancy but if the benefit for the mother outweighs the risk to the fetus, what classification of medication can the nurse administer to the hypertensive pregnant woman? A) Angiotensin-converting enzyme (ACE) inhibitor B) Angiotensin-receptor blocker (ARB) C) Renin inhibitor D) Calcium channel blocker

Ans: D Feedback: ACE inhibitors, ARBs, and renin inhibitors should not be used during pregnancy

What does the clinic nurse anticipate as initial drug therapy for a 39-year-old African American man who is 25 pounds overweight and newly diagnosed with hypertension? A) An angiotensin-converting enzyme (ACE) inhibitor B) A beta-blocker C) A calcium channel blocker D) A diuretic

Ans: D Feedback: African Americans have documented differences in response to antihypertensive therapy. They are most responsive to single-drug therapy and diuretics. The first line use of a diuretic is in combination with diet and other lifestyle changes.

The nurse is providing discharge teaching for a patient prescribed prednisone to be taken on alternate days. The patient asks why he cannot take half a pill every day. What is the nurses best response? A) To eliminate adverse side effects B) To prolong therapeutic effects C) To prevent steroid tolerance D) To decrease adrenal suppression

Ans: D Feedback: Alternate-day maintenance therapy is used with short-acting drugs whenever possible to decrease the risk of adrenal suppression. Alternate-day therapy would not eliminate adverse effects or prolong therapeutic effects. There is no such thing as steroid tolerance.

The nurse is caring for a female patient who is nursing her 3-month-old infant. What will the nurse instruct the patient to do prior to starting heparin to treat venous thrombosis? A) Wait an hour after taking the anticoagulant before feeding the infant. B) Push fluids to clear the drug from her system before feeding the infant. C) Find another method of feeding the infant while taking this drug. D) Continue breast-feeding because heparin does not enter breast milk.

Ans: D Feedback: Although some adverse fetal effects have been reported with its use during pregnancy, heparin does not enter breast milk, and so it is the anticoagulant of choice if one is needed during lactation. As a result, there is no need to wait an hour, push fluids, or find another method of feeding the baby.

The nursing instructor is discussing the administration of nasal spray with the nursing students. What information is most important to include in this discussion? A) Finish the bottle of nasal spray to clear the infection effectively. B) Nasal spray can be shared between family members only. C) Administer the nasal spray in a prone position. D) Overuse of nasal spray may cause rebound congestion.

Ans: D Feedback: An adverse effect that accompanies frequent or prolonged use of decongestants is rebound vasodilation, clinically called rhinitis medicamentosa.

What nursing assessment will the nurse perform to determine the hemodynamic effect of the patients arrhythmia? A) Obtain an electrocardiographic rhythm strip. B) Obtain a serum drug level. C) Assess the patients level of consciousness. D) Assess the patients blood pressure (BP) and pulse rate.

Ans: D Feedback: BP and pulse rate are indicators of the hemodynamic effect of arrhythmias and are nursing measures that do not require a physicians order.

A patient with a history of atrial fibrillation has had a worsening of his or her condition. The nurse knows that the drug of choice for long-term stabilization of atrial fibrillation following electrocardioversion is what? A) Disopyramide (Norpace) B) Moricizine (Ethmozine) C) Procainamide (Pronestyl) D) Quinidine (generic)

Ans: D Feedback: Quinidine is often the drug of choice for long-term stabilization of atrial fibrillation

The nurse is caring for a 3-year-old awaiting a heart transplant who requires an antiarrhythmic agent to control a supraventricular arrhythmia. What drug, if ordered, would the nurse question? A) Digoxin B) Propranolol C) Procainamide D) Verapamil

Ans: D Feedback: Verapamil should be avoided in children and, if ordered, would require the nurse to question the drug.