Pharm prep you chapter 51, 43, 47

By inhibiting the transformation of angiotensin I to angiotensin II

A 46-year-old client with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension after serial blood pressure readings. The clinician has opted to begin the client on captopril (Capoten). The nurse should recognize that the therapeutic effect of this drug is achieved in what way? By directly relaxing vascular smooth muscle By blocking aldosterone from binding to mineralocorticoid receptors By blocking the movement of calcium ions into arterial smooth muscles By inhibiting the transformation of angiotensin I to angiotensin II

Changes in heart contraction

A 54-year-old client with CHF is admitted to the unit. The nurse knows that what physiologic changes will affect a client's stroke volume? Changes in heart contraction Changes in heparin dose Changes in walking pattern Changes in respiratory rate

"The bleeding may be coming from hemorrhoids. We should check this out."

A client calls the clinic and talks to the nurse. The client tells the nurse the client has been taking colesevelam (Welchol) for six months and that the client is having small amounts of bright red rectal bleeding and is concerned. What would an appropriate response from the nurse be? "I should let your physician know immediately!" "Don't worry about it. This can happen some time." "Stop taking the medication now! This is a serious adverse effect." "The bleeding may be coming from hemorrhoids. We should check this out

inhibits cholesterol syntheses.

A client has been prescribed lovastatin for high cholesterol. The nurse's teaching plan will include a basic explanation of how the drug produces its therapeutic effect. The nurse will explain that lovastatin lowers cholesterol levels in which manner? is a hormone. is a bile-acid resin. inhibits cholesterol syntheses. consists of a fibric acid derivative.

Instant bronchodilation

A client has not responded normally to rescue inhaler therapy. When subcutaneous epinephrine is prescribed, the nurse should anticipate what reaction to occur? Increased level of consciousness within 2 to 5 minutes Immediate reduction of anxiety An immediate increase in respiratory rate Instant bronchodilation

Risk for injury

A client is experiencing orthostatic hypotension that is due to antihypertensive therapy. Which nursing diagnosis would be mostappropriate? Risk for injury Ineffective airway clearance Impaired peripheral tissue perfusion Fluid volume deficit

Hydrochlorothiazide

A client is receiving a diuretic as the first-line treatment of mild hypertension. The nurse monitors the client for signs and symptoms of hypokalemia with which agent? Amiloride Spironolactone Triamterene Hydrochlorothiazide

2 hours

A client is receiving hydrochlorothiazide. The nurse would expect this drug to begin acting within which time frame? 1 hour 2 hours 3 hours 4 hours

Oral

A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route? Oral Subcutaneous Intramuscular Intravenous

Osmotic diuretic

A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed? Loop diuretic Potassium-sparing diuretic Thiazide diuretic Osmotic diuretic

"Drugs like ramipril often cause a cough in clients; we should speak to the health care provider."

A client prescribed ramipril earlier in the week states, "Now I have a nagging, dry cough." How should the nurse best follow-up the client's statement? "We should speak to the health care provider about immediately discontinuing the medication." "Coughing is an adverse effect of the medication that may lead to pneumonitis." "We need to obtain a sputum sample to see whether you have developed a respiratory infection." "Drugs like ramipril often cause a cough in clients; we should speak to the health care provider."

Hypokalemia

A client who has been taking hydrochlorothiazide arrives at the clinic for his 1-month follow-up appointment. The client tells the nurse that he feels weaker since he began taking the drug. What should the nurse consider as a possible cause of these symptoms? Hypercalcemia Hypocalcemia Hyperkalemia Hypokalemia

lowered

A client who is malnourished and hypertensive client is being treated with losartan. Considering the client's nutritional status, how should the dose of the medication be adjusted in this client? Increased Lowered Prescribed according to normal dosages Discontinued

muscle pain.

A client will begin taking atorvastatin, and the nurse is conducting relevant health education. The nurse should emphasize the need to report any new onset of: muscle pain. dry mouth. pruritus (itching) increased thirst.

Take the medication at bedtime.

A client with a long history of hypertension has just been prescribed an alpha1-adrenergic receptor blocker. To reduce this client's risk of orthostatic hypotension and falls, the nurse should encourage the client to implement what intervention? Take the medication at bedtime. Take the medication with a high-fat meal. Increase fluid intake for 48 hours before taking the first dose. Start with a low dose and increase gradually over 2 to 3 weeks.

"I will change positions slowly if I feel dizzy."

A client with heart failure is prescribed a loop diuretic. Which client statement indicates that teaching provided by the nurse about this medication was effective? "I will weigh myself once a week." "I should reduce my fluid intake every day." "I will change positions slowly if I feel dizzy." "I am to take this medication on an empty stomach."

"Many clients require two or more drugs for high blood pressure."

A client with primary hypertension asks the nurse why the prescriber added another medication to assist with lowering the blood pressure. What is the nurse's best response? "The prescriber has not read the current guidelines and needs an update." "Your diet and exercise are not effective and adding another drug is ideal." "Many clients require two or more drugs for high blood pressure." "You should talk to the prescriber for clarification about the medications. "

pulmonary edema

A client, diagnosed with left-sided heart failure, should be taught to recognize the signs and symptoms of the onset of what classic manifestation of this condition? pulmonary edema venous ulcers chest pain palpitations

Persistent cough

A client, newly diagnosed with hypertension is started on captopril, an ACE inhibitor. The client should be informed of the possibility of what adverse effect? Sedation Persistent cough Sweating Hypokalemia

Losartan

A group of students are reviewing the various antihypertensive agents. The students demonstrate understanding of the information when they identify what as an example of an angiotensin II receptor blocker? Moexipril Losartan Minoxidil Amlodipine

Increased blood glucose levels

A health care provider has prescribed a loop diuretic for a client with hypertension. The client also has diabetes mellitus. What condition should the nurse monitor for in this client after administering the prescribed drug? Sudden pain in the joints Increased blood glucose levels Occurrence of gout attacks Sudden increase in weight

hyperkalemia

A health care provider prescribes spironolactone, a potassium-sparing diuretic, for a client with cirrhosis. For which category of clients is the use of potassium-sparing diuretics contraindicated? hyperkalemia liver disease gout diabetes

Flushing of the skin

A nurse is caring for a client prescribed nicotinic acid for hyperlipidemia. The nurse would assess the client for which findings as a possibility? Weakness Flushing of the skin Tachycardia Dyspnea

By blocking the angiotensin II receptors

A nurse is educating a patient with hypertension who is prescribed losartan on the mechanism of action of the drug. Which mode of action helps losartan to bring about its antihypertensive effect? By blocking the aldosterone receptors By preventing the conversion of angiotensin I By blocking the angiotensin II receptors By preventing renin secretion

Heart disease

A nurse is providing care to a client who has elevated levels of low-density lipoprotein (LDL). A review of the client's history reveals a sedentary lifestyle and a history of being overweight. The nurse understands that this combination of factors places the client at risk for which condition? Heart disease Diabetes Glaucoma Hypertension

"A decrease in blood pressure is expected." "A persistent cough may develop.

A nurse is providing medication teaching to a client prescribed captopril. Which statement(s) should be included to describe potential adverse effects? Select all that apply. "A decrease in blood pressure is expected." "A persistent cough may develop." "You can be expected to urinate more frequently." "Decreased heart rate warrants a call to the prescriber." "Your diabetes medication will interfere with the effectiveness of captopril."

Increased diuretic effect

A nurse notes that a newly admitted client is currently prescribed both a loop diuretic as well as a thiazide diuretic. The nurse understands what primary rationale for the concurrent use of these two drugs? Increased diuretic effect Reduced risk of potassium imbalances Decreased blood pressure without a risk of bradycardia Increased adherence to treatment

cause a greater diuresis.

A nurse understands that loop diuretics are considered high ceiling diuretics because they: cause a greater diuresis. are associated with more adverse effects. cause a greater loss of potassium. require large doses to achieve effect.

"Actually, patients with renal failure usually can't take hydrochlorothiazide."

A patient with a longstanding diagnosis of chronic renal failure has experienced a significant decline in urine output in recent days, prompting him to seek care at a local clinic. A nurse at the clinic has suggested to a colleague that the administration of a diuretic such as hydrochlorothiazide may improve the patient's urine output. How should the colleague best respond to this suggestion? "That would probably help, but we'd have to do blood work first." "Actually, patients with renal failure usually can't take hydrochlorothiazide." "That would only work if he could come in twice a day to get it intravenously." "Maybe, but hydrochlorothiazide affects the bladder more than the kidneys."

true

A patient with metabolic syndrome usually has increased plasminogen activator levels. True False

Baseline renal function

A staff nurse on a renal unit knows that most patients require treatment for hypertensive disease. What would the nurse expect to assess prior to the beginning of antihypertensive treatment? A temporary increase in renal function A sustained increase in renal dysfunction Baseline renal function A sustained decrease in renal function

Triglyceride level above 150 mg/dL

After teaching a group of students about metabolic syndrome, the instructor determines that the teaching was successful when the students identify which characteristic? Triglyceride level above 150 mg/dL Blood pressure below 130/85 mm Hg Fasting blood glucose below 110 mg/dL Waist measurement over 35 inches in men

"I need to make sure I don't eat too many high potassium foods."

After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states: "I need to make sure I don't eat too many high potassium foods." "I should take the medicine around dinnertime for the best effect." "I need to take the drug on an empty stomach." "I can still use my salt substitute if I want to."

Falls

An older adult client who resides in a care facility has been prescribed antihypertensives for the first time following many years of generally good health. When administering the first dose of the prescribed antihypertensive medication to an older adult, the nurse should recognize the related risk to which possible side effect? Falls Infection Acute confusion Impaired oxygenation

Elevated LDL levels

As part of a routine physical examination, a 60-year-old client's primary care provider has ordered blood work that includes cholesterol levels. What result would strongly suggest the need for an antihyperlipidemic drug? Elevated LDL levels Elevated HDL levels A high ratio of HDL to LDL Low VLDL levels

Gemfibrozil

After reviewing information about antihyperlipidemic drugs, a group of nursing students demonstrate understanding when they identify which medication as a fibric acid derivative (fibrate)? Gemfibrozil Colesevelam Niacin Ezetimibe

Pregnancy Category X

HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category? Pregnancy Category X Pregnancy Category A Pregnancy Category B Pregnancy Category C

diet

In addition to being synthesized in the liver and intestine, from where are blood lipids derived? diet exercise kidneys medications

peripheral vascular resistance.

Medications with alpha-adrenergic activity are prescribed during shock to raise blood pressure. The drugs achieve this by acting on what process? peripheral vascular resistance. myocardial activity. heart rate. cardiac stroke volume.

rhabdomyolysis.

The client has been taking rosuvastatin for hyperlipidemia. The client now presents with severe weakness and states barely being able to move the extremities. The nurse suspects the client has which? pruritis. rhabdomyolysis. cholelithiasis. cholecystitis.

HMG-CoA reductase inhibitors

The pharmacology instructor is discussing medications used in the treatment of dyslipidemia. Which drug class would the instructor identify as the most widely used dyslipidemia drugs? HMG-CoA reductase inhibitors Bile acid sequestrants Fibrates Niacin

Gemfibrozil

The three major classes of drugs used to control blood lipids are statins, bile acid resins (or sequestrants), and fibrates. Which is a fibrate? Cholestyramine Colesevelam Colestipol Gemfibrozil

Aliskiren

Upon review of the lab findings, the nurse identifies the client's potassium level is 5.9 mEq/L. The nurse recognizes that which antihypertensive may be the cause? Aliskiren Olmesartan Azilsartan Valsartan

HMG-CoA reductase inhibitors

Which drug is most effective in reducing most major types of dyslipidemia in patients at risk or who have already developed CAD? HMG-CoA reductase inhibitors Bile acid sequestrants Fibrates Niacin

"When was your last menstrual period?"

Which question would be most important for a nurse to ask a female client who is starting on an angiotensin II receptor blocker for hypertension? "Do you eat something when you take your medications?" "How much physical exercise do you get?" "When was your last menstrual period?" "Have you always weighed 150 pounds?"

High

A 54-year-old client has a cholesterol level of 240 mg/dL (6.2064 mmol/L). What serum concentration of cholesterol would this client have? Optimal Desirable High Very high

Mannitol

A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered? Mannitol Furosemide Amiloride Bumetanide

Digoxin

A client is taking cholestyramine to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which medication? Digoxin Ibuprofen Aspirin Acetaminophen

pregnancy

A female client is prescribed a carbonic anhydrase inhibitor to manage glaucoma. The nurse stresses the importance of reporting which change in health status to the primary health care provider immediately? pregnancy endometriosis gestational diabetes breast cancer

Avocados

A nurse is providing patient teaching for a 62-year-old woman who is taking triamterene. The nurse will teach the patient to avoid what in her diet? Avocados Bell peppers Mushrooms Fresh pineapple

Frequently monitor blood cholesterol.

A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment? Take a dietary history of the patient. Inspect skin and eyelids for evidence of xanthomas. Obtain reports of fasting blood sugar levels. Frequently monitor blood cholesterol.

Metolazone

After reviewing the different classes of diuretics available, a student demonstrates understanding when able to identifiy which medication as a thiazide-like diuretic? Metolazone Chlorothiazide Furosemide Triamterene

Liver panel

An elderly client with dyslipidemia has had fenofibrate added to the existing medication regimen. In addition to having the lipid profile drawn on a regular basis, the nurse should educate the client about the need for what ongoing laboratory testing during therapy? Complete blood count (CBC) Liver panel INR and aPTT Reticulocyte count

His dietary intake of saturated fat

What is the most common reason for an elevated cholesterol level in a client who does not have a genetic disorder of lipid metabolism? His dietary intake of saturated fat His sedentary lifestyle His waist size His alcohol intake

Monitoring for drug effects Promoting compliance with the prescribed pharmacologic modifications Promoting compliance with the prescribed lifestyle modifications

How can the home care nurse assist the client or the client's family members who have hypertension? (Select all that apply.) Modification of drug dosage Monitoring for drug effects Promoting compliance with the prescribed pharmacologic modifications Promoting compliance with the prescribed lifestyle modifications Providing financial assistance with daily expenses

Lifelong

A client develops primary hypertension and asks the nurse, "How long will I need to receive therapy?" The nurse responds based on the understanding that therapy would be required for how long? Lifelong Until blood pressure is 120/80 mmHg One year 5 years

Smoking cessation

What should the nurse suggest to assist a client to improve his cholesterol levels? Smoking cessation Diet high in polysaturated fats Limit exercise to the weekends Weight lifting

sodium

What substance is reabsorbed in the ascending limb of the loop of Henle? sodium water glucose amino acids

Renal disease

What would contraindicate the use of indapamide? Diabetes Systemic lupus erythematosus Renal disease Gout

Mild abdominal pain

Which adverse effect would a nurse expect to assess in a client taking ezetimibe? Mild abdominal pain Bloating Flatulence Constipation

Digoxin toxicity

A 75-year-old client is diagnosed with atrial fibrillation and chronic congestive heart failure. The health care provider orders a combination of digoxin and diuretics to treat the client's diseases. Recent laboratory results indicate that the client's potassium level is 2 mEq/L. This client is at risk for which problem? Exacerbation of the atrial fibrillation Subtherapeutic levels of serum digoxin Digoxin toxicity Congestive heart failure

Hyperkalemia

A 91-year-old client, who is being prepared for discharge, has been prescribed the diuretic spironolactone. While teaching the client about the drug, what major adverse effect should the nurse be sure to mention? Hypokalemia Hyperkalemia Angina Hypertension

Decrease in serum cholesterol and LDL levels

A client asks the nurse what the atorvastatin (Lipitor) prescribed for the client will do. What is an expected outcome for this client? Decrease in serum cholesterol only Decrease in serum cholesterol and LDL levels Decrease in sitosterol and serum cholesterol Decrease in campesterol and LDL levels

Digoxin toxicity

A client has been prescribed both digoxin and furosemide. The nurse should monitor the client for development of what adverse effect? Hyperkalemia Hyperglycemia Tachycardia Digoxin toxicity

Call the health care provider if muscle pain develops.

A client is taking atorvastatin calcium to reduce serum cholesterol. Which aspect of client teaching is most important? Call the health care provider if muscle pain develops. It is acceptable to eat saturated fats. Decrease the dose if lethargy occurs. Eat two eggs per day to increase protein stores.

falls.

An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for: constipation. falls. xerostomia (dry mouth). depression.

lowering blood pressure

Losartan focuses on what aspect of the cardiac process to address the pathophysiology of heart failure? lowering blood pressure reducing preload increasing stroke volume increasing heart rate

headache and flatulence.

The client is diagnosed with hyperlipidemia and prescribed lovastatin. Which is the most common adverse effects of lovastatin? headache and flatulence. increased appetite and blood pressure. fatigue and mental disorientation. hiccups, sinus congestion, and dizziness.

Enhanced drug effectiveness

The nurse instructs a patient to take his prescribed simvastatin at bedtime to promote: Enhanced drug effectiveness A decreased risk for adverse effects Improved compliance with therapy Increase absorption of the drug

Promoting exercise Preventing obesity Reducing dietary sodium

The nurse is leading an educational discussion on childhood hypertension at a local school board meeting. A particular focus of the discussion is the promotion of nonpharmacologic treatment measures. Which of the following is appropriate for managing hypertension in children? Select all that apply. Promoting exercise Preventing obesity Reducing dietary sodium Taking a daily multivitamin

"The most common side effects of atorvastatin include some mild gastrointestinal upset."

The nurse is providing education to an older adult client who has been prescribed atorvastatin. How should the nurse describe the common adverse effects of the drug? "Some clients experience mild chest pain initially." "Most people who experience side effects from atorvastatin report stiffness in their joints." "The more serious side effects of atorvastatin involve a risk of bleeding." "The most common side effects of atorvastatin include some mild gastrointestinal upset."

"I will need to stand slowly."

The nurse is teaching a 62-year-old client about hydrochlorothiazide, which the health care provider has prescribed for treatment of hypertension. What statement, made by the client, suggests that the client understands the teaching? "I will need to stand slowly." "I will need to make sure that I am consuming enough sodium." "I must take my medication on an empty stomach." "I can jump right into action!"

Total cholesterol Triglycerides LDL

What information would be included in a lipoprotein profile? Select all that apply: Total cholesterol Triglycerides LDL ALT AST

Therapeutic lifestyle changes are the preferred method for lowering blood lipids.

What is the basis for a nurse's recommendation of a period of intensive diet therapy and lifestyle modification before initiation of drug therapy for a client newly diagnosed with dyslipidemia? Therapeutic lifestyle changes are the preferred method for lowering blood lipids. Continued therapeutic lifestyle changes during drug therapy will guarantee success. Therapeutic lifestyle changes are easier to comply with than medication therapies. Nonpharmacologic interventions are cheaper than using medications.

Cholestyramine

Which would be classified as a bile acid sequestrant? Lovastatin Ezetimibe Cholestyramine Gemfibrozil

Discontinue the drug

A 35-year-old female client controls the symptoms of her cardiovascular disease with ACE inhibitors. She discovers that she is pregnant and contacts her primary care provider regarding her medication regimen. What would the nurse expect the provider to do? Discontinue the drug Increase the dosage of the drug Decrease the dosage of the drug Maintain the current dosage of the drug

eat potassium-rich foods.

A 49-year-old client reports frequent muscle cramps while on hydrochlorothiazide therapy. The nurse would advise the client to do which? drink plenty of fluids. eat potassium-rich foods. take calcium supplements. include high-sodium foods in her diet.

Gallbladder

After teaching a group of students about fats and biotransformation, the instructor determines that the teaching was successful when the students identify what as the storage location of bile acids? Liver Gallbladder Small intestine Stomach

Left ventricle

After teaching a group of students about the cardiovascular system and pressures, the students demonstrate understanding of the information when they identify which area as having the highest pressure? Left ventricle Right ventricle Right atrium Left atrium

Hyperkalemia

An older adult client has a complex medical history that includes heart failure, type 1 diabetes, and diabetic nephropathy. The nurse has questioned a health care provider's prescription for oral spironolactone because the client's health problems would contribute to a high risk of which adverse reaction? Metabolic acidosis Hypocalcemia Hemolytic anemia Hyperkalemia

Pregnancy Category X

HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category? Pregnancy Category X Pregnancy Category A Pregnancy Category B Pregnancy Category C

"With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease."

The female client states that her father has had high blood pressure all of his life and he is healthy. She does not understand why the care provider has prescribed medication for her blood pressure. What is the nurse's best response? "Maybe you do not need medication with your history." "With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease." "The effects of high blood pressure are different for different people." "We always treat high blood pressure with medicine to prevent further damage to your body."

Central adiposity Elevated triglycerides Reduced high density lipoprotein cholesterol

What cardiac risk factors are related to metabolic syndrome? (Select all that apply.) Central adiposity Elevated triglycerides Reduced high density lipoprotein cholesterol Postural hypotension

"It's okay to take it with food."

Which instruction would be most appropriate for a client who is taking a diuretic? "Take the daily dose around dinnertime." "It's okay to take it with food." "Lie down after taking the drug." "Limit the amount of fluids you drink."

LDL cholesterol of 190 mg/dL

Which lipid level would the nurse interpret as being high? LDL cholesterol of 190 mg/dL Total cholesterol of 200 mg/dL Triglyceride level of 160 mg/dL HDL cholesterol of 48 mg/dL

Fruit juices Soups Cereals Water

Which of the following would the nurse suggest to use when administering cholestyramine? Select all that apply. Fruit juices Soups Cereals Water Soda Seltzer water

They may cause hyperkalemia.

The health care provider indicates that a client experiencing renal failure is not a candidate for therapy with potassium-sparing diuretics. How will the nurse respond when the client's family member asks why this is the case? They may cause hyperkalemia. They are the strongest form of diuretics. They promote excretion of potassium. They may cause rebound edema.

Mannitol

The nurse is caring for a client who is experiencing elevated intracranial pressure following neurosurgery. The health care provider orders an osmotic diuretic to reduce pressure. Which medication would the nurse expect to be ordered? Spironolactone Bumetanide Mannitol Ethacrynic acid

spironolactone

The nurse is caring for a client with hyperaldosteronism. For which diuretic would the nurse prepare teaching for the client? amiloride eplerenone triamterene spironolactone

"I take my scale with me when I stay overnight with friends." "I weigh myself in the same clothes every day." "I weigh myself immediately before breakfast every day."

The nurse is providing education to a client who has been prescribed long-term diuretic therapy. Which client statement demonstrates an understanding of self-monitoring to identify fluid-related issues? Select all that apply. "I make sure to weigh myself sometime before lunch each day." "I take my scale with me when I stay overnight with friends." "I weigh myself in the same clothes every day." "I weigh myself immediately before breakfast every day." "I'm weighing myself because my health care provider said that I should."