Pharmacology Exam 5 (part 2 - Chapters 26 and 27)

The nurse is providing education for nonpharmacological interventions to manage hypertension. Which information should the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increase your dietary intake of fruits and vegetables. 2. Decrease the consumption of alcohol. 3. Reduce the dietary intake of potassium. 4. Increase physical activity. 5. Restrict your intake of sodium.

1. Increase your dietary intake of fruits and vegetables. 2. Decrease the consumption of alcohol. 4. Increase physical activity. 5. Restrict your intake of sodium.

For which conditions is a client with hypertension at risk? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Kidney damage 2. Stroke 3. Liver failure 4. Heart failure 5. Blindness

1. Kidney damage 2. Stroke 4. Heart failure 5. Blindness

Which electrolytes should the nurse anticipate monitoring for a client prescribed losartan (Cozaar)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Potassium 2. Sodium 3. Calcium 4. Chloride 5. Magnesium

1. Potassium 2. Sodium

Which intervention is the highest priority for a 30-year-old female with a BMI of 20 who smokes and has a blood pressure of 137/88? 1. Smoking-cessation program 2. Diuretic therapy 3. Weight-loss program 4. Stress management

1. Smoking-cessation program

The nurse is preparing to discuss the use of primary hypertensive agents with a client. Which prescriptions should the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Thiazide diuretics 2. Angiotensin-II receptor blockers (ARBs) 3. Beta-adrenergic antagonists 4. Direct-acting vasodilators 5. Peripheral adrenergic antagonists

1. Thiazide diuretics 2. Angiotensin-II receptor blockers (ARBs)

Which conditions contribute to heart failure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Uncontrolled hypertension 2. Coronary artery disease (CAD) 3. Diabetes (DM) 4. HIV 5. Mitral stenosis

1. Uncontrolled hypertension 2. Coronary artery disease (CAD) 3. Diabetes (DM) 5. Mitral stenosis

Which is the most serious adverse effect associated with milrinone (Primacor)? 1. Ventricular dysrhythmia 2. Nausea 3. Headache 4. Atrial dysrhythmia

1. Ventricular dysrhythmia

Which prescription should the nurse be concerned about a pregnant client receiving? 1. Enalapril (Vasotec) 2. Potassium supplement 3. Doxazosin (Cardura) 4. Hydrochlorothiazide (HCTZ)

1. Enalapril (Vasotec)

The nurse has completed the education for a client prescribed hydrochlorothiazide (Microzide). Which statement made by the client indicates an understanding of the teaching? 1. "I really need to avoid grapefruit juice when I take this medication." 2. "I need to avoid salt substitutes and potassium-rich foods." 3. "I take my medication early in the morning." 4. "If I develop a cough, I should call my physician."

3. "I take my medication early in the morning."

Which client is at greatest risk for developing heart failure? 1. A 50-year-old African American female who smokes 2. A 75-year-old Caucasian male who is overweight 3. A 69-year-old African American male with hypertension 4. A 52-year-old Caucasian female with asthma

3. A 69-year-old African American male with hypertension

Which should the nurse recognize are adverse effects associated with digoxin (Lanoxin)? 1. Tachycardia and hypotension 2. Blurred vision and tachycardia 3. Anorexia and nausea 4. Anorexia and constipation

3. Anorexia and nausea

Which statement is accurate regarding the physiological changes associated with heart failure? 1. Blood backs up into the lungs due to right ventricular hypertrophy. 2. The walls of the heart shrink, leading to lower cardiac output. 3. Cardiac remodeling occurs after prolonged ventricular hypertrophy. 4. Blood pressure increases, resulting in lowered afterload.

3. Cardiac remodeling occurs after prolonged ventricular hypertrophy.

Which is the nurse's priority assessment for a client treated with intravenous hydralazine (Apresoline)? 1. Hypotension and bradycardia 2. Hypotension and hyperthermia 3. Hypotension and tachycardia 4. Hypotension and tachypnea

3. Hypotension and tachycardia

Which describes the action of vasodilators in the relief of symptoms of heart failure? 1. Decrease afterload 2. Reduce preload 3. Improve cardiac contractility 4. Reduce fluid overload

3. Improve cardiac contractility

For which assessment findings should the nurse hold enalapril (Vasotec)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Cough 2. Lightheadedness on ambulation 3. Periorbital edema 4. Sneezing 5. Difficulty swallowing

3. Periorbital edema 5. Difficulty swallowing

Which client prescribed metoprolol (Toprol-XL) is most at risk for adverse effects? 1. The client with an apical pulse rate of 100 2. The client with compensated heart failure 3. The client with chronic bronchitis 4. The client with a history of migraines

3. The client with chronic bronchitis

Which client has the greatest risk for developing heart disease? 1. A 35-year-old with diabetes mellitus and prehypertension 2. A 75-year-old with Parkinson's disease and normal blood pressure 3. A 52-year-old with osteoporosis and stage 1 hypertension 4. A 68-year-old with stage 2 hypertension and recent myocardial infarction

4. A 68-year-old with stage 2 hypertension and recent myocardial infarction

A client experiencing syncope is suspected of taking a losartan (Cozaar) overdose? Which intervention should the nurse anticipate? 1. Administer a calcium infusion 2. Administer a loop diuretic 3. Administer a vasopressor 4. Administer an intravenous solution of normal saline

4. Administer an intravenous solution of normal saline

The nurse notes that a client experiencing heart failure has been receiving nifedipine (Procardia). Which is a priority assessment for the nurse? 1. Review recent lab results for hypokalemia. 2. Assess urinary output. 3. Assess level of orientation. 4. Auscultate breath sounds for crackles.

4. Auscultate breath sounds for crackles.

A client prescribed furosemide (Lasix) and digoxin (Lanoxin) reports using an over-the-counter antacid for recurrent heartburn. Based on this information, which effect should the nurse be concerned about? 1. Hyponatremia 2. Hypermagnesemia 3. Increased effectiveness of furosemide (Lanoxin) 4. Decreased effectiveness of digoxin (Lanoxin)

4. Decreased effectiveness of digoxin (Lanoxin)

Which factor increases cardiac output? 1. Reduced cardiac contractility 2. Hypovolemia 3. Peripheral vascular resistance 4. Increase in preload

4. Increase in preload

The nurse reviewing the records of a client diagnosed with hypertension notes a weight of 200 lbs, height 5' 4", dietary intake includes primarily starches, an alcohol intake of three beers per week, and stressors include 60-hour workweeks. Based on this information, which should the nurse identify as a priority outcome? 1. Patient will eliminate alcohol from the diet. 2. Patient will decrease stress by limiting work to 40 hours/week. 3. Patient will balance diet according to the food pyramid. 4. Patient will achieve and maintain optimum weight.

4. Patient will achieve and maintain optimum weight.

Which electrolyte imbalance should the nurse be concerned about for the client who is prescribed a thiazide diuretic? 1. Magnesium 2. Calcium 3. Chloride 4. Potassium

4. Potassium

Which statement is accurate regarding the use of beta-adrenergic blockers for use in clients with heart failure? 1. Higher doses are used initially until optimal vital signs are achieved. 2. Dosage changes are done on a daily basis for the first 2 weeks. 3. This drug class does not have an effect on the bronchioles of the lungs. 4. They are generally used in combination with other heart-failure drugs.

4. They are generally used in combination with other heart-failure drugs.

The nurse is preparing to administer clevidipine (Cleviprex) to a client experiencing a hypertensive crisis. Which interventions should the nurse implement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Monitor bowel sounds 2. Administer the drug intravenously 3. Continually monitor blood pressure 4. Crush caplets for administration 5. Infuse prescription in normal saline at 125 mL/h

2. Administer the drug intravenously 3. Continually monitor blood pressure

Which medical condition should the nurse be concerned about for a client prescribed hydralazine? 1. Asthma 2. Angina 3. Diabetes 4. Hyperthyroidism

2. Angina

The nurse completes the dietary education for a client prescribed digoxin (Lanoxin). Which dietary choice indicates the client understood the teaching? 1. Cottage cheese, peach salad, and blueberry pie 2. Baked fish, sweet potatoes, and banana pudding 3. Green bean soup, whole-wheat bread, and an apple 4. Hamburger, French fries, and chocolate chip cookies

2. Baked fish, sweet potatoes, and banana pudding

Which changes are sensed by the baroreceptors and relayed to the vasomotor center? 1. Oxygenation 2. Blood pressure 3. Carbon dioxide 4. Blood pH

2. Blood pressure

Which laboratory values should the nurse assess for the client receiving lisinopril (Prinivil)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Uric acid 2. Blood urea nitrogen (BUN) 3. Serum bilirubin 4. ALT/AST 5. Serum drug levels

2. Blood urea nitrogen (BUN) 3. Serum bilirubin 4. ALT/AST

Which classifications of prescriptions are used to increase cardiac output by increasing the force of myocardial contractions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Angiotensin receptor blockers 2. Cardiac glycosides 3. Adrenergic blockers 4. Phosphodiesterase inhibitors 5. Angiotensin-converting enzyme inhibitor

2. Cardiac glycosides 4. Phosphodiesterase inhibitors

Which factors are responsible for blood pressure? 1. Blood volume, heart rate, and stroke volume 2. Cardiac output, blood volume, and peripheral vascular resistance 3. Age, weight, and race 4. Body mass index, diet, and genetics

2. Cardiac output, blood volume, and peripheral vascular resistance

A client is prescribed an intravenous infusion of milrinone (Primacor) for acute heart failure. Which is a priority nursing assessment during the infusion? 1. Monitor for symptoms of atrial fibrillation 2. Continuous ECG monitoring 3. Vital signs every 15 minutes 4. Monitor for hypertension

2. Continuous ECG monitoring

Which action of Lisinopril (Prinivil) results in a decrease in the blood volume? 1. Antagonistic effect on angiotensin-converting enzyme. 2. Decrease aldosterone secretion. 3. Causes hypernatremia and increased renal tubule permeability resulting in a diuretic effect. 4. Causes a diuretic effect by lowering the amount of sodium lost in the urine.

2. Decrease aldosterone secretion.

The nurse has prescribed dietary education for a client prescribed nifedipine (Procardia XL). Which dietary choice should the nurse recognize requires further education? 1. Whole-wheat pancakes with syrup, and bacon, oatmeal, and orange juice 2. Eggs, whole-wheat toast with butter, cereal, milk, and grapefruit juice 3. Eggs and sausage, a biscuit with margarine, coffee with cream, and cranberry juice 4. Egg and cheese omelet, tea with sugar and lemon, hash brown potatoes, and prune juice

2. Eggs, whole-wheat toast with butter, cereal, milk, and grapefruit juice

Which statement is accurate in regard to secondary hypertension? 1. There is no known cause. 2. It can result from chronic renal impairment. 3. It is also known as idiopathic. 4. It accounts for 90% of all hypertensive cases.

2. It can result from chronic renal impairment.

Which should the nurse anticipate to be included in the treatment plan for a client with stage A heart failure? 1. Angiotensin-converting enzyme (ACE) inhibitor 2. Lifestyle modifications 3. Beta-blocker 4. Cardiac glycoside

2. Lifestyle modifications

Which is a priority nursing intervention for a client who is newly prescribed enalapril (Vasotec)? 1. Monitor the client for headaches. 2. Take the client's blood pressure. 3. Order a sodium-restricted diet for the client. 4. Review the client's lab results for hypokalemia.

2. Take the client's blood pressure.

A client asks the nurse how hypertension can lead to heart failure. Which response should the nurse provide the client? 1. "Hypertension increases the resistance in the blood vessels causing the heart to work harder to pump the blood out against the resistance of the arteries." 2. "Hypertension limits the ability of the heart to stretch before emptying resulting in the heart working harder to pump the blood out into the arterial system." 3. "Hypertension causes resistance in the venous system requiring the heart to work harder to pump the blood forward." 4. "Hypertension limits the amount of blood entering the left ventricle increasing the workload of the heart to pump an adequate amount of blood into the circulatory system."

1. "Hypertension increases the resistance in the blood vessels causing the heart to work harder to pump the blood out against the resistance of the arteries."

The nurse is educating a patient whose blood pressure is 140/90 mmHg on ways to lower blood pressure and avoid hypertension. Which lifestyle choices may eliminate the need for pharmacotherapy in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I have incorporated yoga into my exercise program." 2. "I will monitor my daily sodium intake." 3. "I will drink a glass of red wine daily to help lower my blood pressure." 4. "I am receiving acupuncture to help me stop smoking."

1. "I have incorporated yoga into my exercise program." 2. "I will monitor my daily sodium intake." 4. "I am receiving acupuncture to help me stop smoking."

A male client states to the nurse, "I am going to stop taking my metoprolol (Lopressor). I have been experiencing problems having sex." Which responses should the nurse include in the discussion with the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I understand sexual dysfunction can be a common problem with this drug." 2. "Perhaps it would be better if you took atenolol (Tenormin)." 3. "I cannot stop you from discontinuing the drug." 4. "Stopping the prescription abruptly may cause your blood pressure to elevate even higher." 5. "Try taking the drug early in the morning."

1. "I understand sexual dysfunction can be a common problem with this drug." 4. "Stopping the prescription abruptly may cause your blood pressure to elevate even higher."

Which prescription should the nurse anticipate to increase the myocardial contractility for a client with heart failure? 1. Digoxin (Lanoxin) 2. Lisinopril (Prinivil) 3. Carvedilol (Coreg) 4. Furosemide (Lasix)

1. Digoxin (Lanoxin)

The nurse has provided education for a client prescribed nifedipine (Adalat CC). Which statement made by the client indicates an understanding of the teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "If I drink alcohol while taking this medication, I will get very sick to my stomach." 2. "I should stop taking my melatonin sleep medication." 3. "I should no longer drink grapefruit juice." 4. "I should no longer drink sports drinks with caffeine in them." 5. "I should stop taking my vitamin C supplement."

1. "If I drink alcohol while taking this medication, I will get very sick to my stomach."

Which statements made by the client indicate an understanding of the compensatory mechanisms associated with heart failure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "My heart enlarged in order to compensate for the effects of heart failure." 2. "My nervous system kicks in to compensate for the effects of heart failure." 3. "My body will decrease blood flow to other organs in order to compensate for heart failure." 4. "My body will increase urine output in order to compensate for the effects of heart failure." 5. "My body will produce anti-inflammatory agents to compensate for heart failure."

1. "My heart enlarged in order to compensate for the effects of heart failure." 2. "My nervous system kicks in to compensate for the effects of heart failure." 3. "My body will decrease blood flow to other organs in order to compensate for heart failure."

Which classification of prescription should the nurse anticipate to be prescribed to a client newly diagnosed with chronic heart failure? 1. Angiotensin-converting enzyme (ACE) inhibitor 2. Beta-adrenergic blockers 3. Cardiac glycosides 4. Diuretics

1. Angiotensin-converting enzyme (ACE) inhibitor

Which findings should the nurse anticipate when assessing a client developing right-sided heart failure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Ankle edema 2. Enlarged liver 3. Displaced apical heart rate 4. Shortness of breath 5. Coughing

1. Ankle edema 2. Enlarged liver 3. Displaced apical heart rate

Which vital sign is of the greatest concern to the nurse prior to administering digoxin (Lanoxin)? 1. Apical pulse 2. Temperature 3. Blood pressure 4. Respiratory rate

1. Apical pulse

Which physiological systems should the nurse recognize are most at risk for a client in a hypertensive crisis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Cardiac 2. Respiratory 3. Integumentary 4. Gastrointestinal 5. Renal

1. Cardiac 5. Renal

Which adverse effect of lisinopril (Prinivil) should be reported to the healthcare provider? 1. Cough 2. Fever 3. Increased urine output 4. Facial flushing

1. Cough

A client receiving hydrochlorothiazide (Microzide) asks the nurse why they are urinating so frequently. Which statement should the nurse provide the client? 1. "Hydrochlorothiazide (Microzide) enhances kidney function causing you to urinate more and that decreases your blood pressure." 2. "Hydrochlorothiazide (Microzide) decreases the fluid in your bloodstream and this lowers your blood pressure." 3. "Hydrochlorothiazide (Microzide) dilates your blood vessels so you urinate more and your blood pressure decreases." 4. "Hydrochlorothiazide (Microzide) increases your heart rate; this pumps blood faster to your kidneys so you urinate more and your blood pressure decreases."

2. "Hydrochlorothiazide (Microzide) decreases the fluid in your bloodstream and this lowers your blood pressure."

The nurse educator is reviewing the physiological regulation blood pressure. Which should the educator identify as initially involved? 1. Production of angiotensin II 2. Action of renin 3. Antidiuretic hormone 4. Production of angiotensin I

2. Action of renin

Which clients should the nurse anticipate will require a pharmacological intervention to manage their blood pressure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A 30-year-old female whose blood pressure is 138/88 mmHg who is otherwise healthy 2. A 61-year-old man whose blood pressure is 144/90 mmHg who also has type 2 diabetes 3. A 56-year-old woman whose blood pressure is 135/84 mmHg who also has Cushing's disease 4. A 65-year-old man whose blood pressure is 148/88 mmHg who is otherwise healthy 5. A 61-year-old woman whose blood pressure is 153/92 mmHg who is otherwise healthy

2. A 61-year-old man whose blood pressure is 144/90 mmHg who also has type 2 diabetes 5. A 61-year-old woman whose blood pressure is 153/92 mmHg who is otherwise healthy

A client prescribed doxazosin (Cardura) asks how the medication works. Which information should the nurse provide the client? 1. "Doxazosin causes the kidneys to excrete more urine." 2. "Doxazosin helps the heart work more efficiently." 3. "Doxazosin helps dilate the blood vessels." 4. "Doxazosin decreases the release of the stress hormones."

3. "Doxazosin helps dilate the blood vessels."

The nurse has discussed lifestyle modifications to help manage the client's hypertension. Which statement made by the client indicates an understanding of the information? 1. "I need to get started on my medications right away." 2. "My father had hypertension, did nothing, and lived to be 90 years old." 3. "I know I need to give up my cigarettes and alcohol." 4. "I won't be able to run in the marathon race anymore."

3. "I know I need to give up my cigarettes and alcohol."

The nurse has provided education for a client with diabetes mellitus prescribed metoprolol (Lopressor) for hypertension. Which statement made by the client indicates an understanding of the information? 1. "I might not need to check my blood sugars as often with metoprolol (Lopressor)." 2. "I might be able to change from insulin to a pill with metoprolol (Lopressor)." 3. "I might need less insulin when I take metoprolol (Lopressor)." 4. "I might need more insulin when I take metoprolol (Lopressor)."

3. "I might need less insulin when I take metoprolol (Lopressor)."

Which information should the nurse include in the discharge plan for a client prescribed digoxin (Lanoxin)? 1. "Report the development of a metallic taste in the mouth." 2. "Report mental changes such as feelings of depression." 3. "Stop the prescription if your pulse is irregular." 4. "If you miss a dose, take two doses."

3. "Stop the prescription if your pulse is irregular."

A client in heart failure asks the nurse how difficulty breathing is related to a heart problem. Which information should the nurse provide the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The right side of your heart has weakened and blood has entered your lungs." 2. "The right side of your heart has enlarged and cannot effectively pump blood." 3. "What you have is called congestive heart failure." 4. "The left side of your heart is weak and pumps blood too quickly." 5. "The left side of your heart has weakened and blood has entered your lungs."

3. "What you have is called congestive heart failure." 5. "The left side of your heart has weakened and blood has entered your lungs."

Which statements made by a client indicates an understanding of the education provided by the nurse regarding digoxin (Lanoxin) toxicity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I should limit my fluids while taking this medication." 2. "It is okay to keep taking my ginseng." 3. "If I have nausea, it means I must stop the medication." 4. "I can drink orange juice every morning." 5. "I must check my pulse and not take the medication if it is less than 60."

4. "I can drink orange juice every morning." 5. "I must check my pulse and not take the medication if it is less than 60."

Which statement made by a client newly prescribed a beta-adrenergic blocker should the nurse be concerned about? 1. "I don't handle stress well; I have a lot of diarrhea." 2. "When I have a migraine headache, I need to have the room darkened." 3. "My father died of a heart attack when he was 48 years old." 4. "I have always had problems with my asthma."

4. "I have always had problems with my asthma."

The nurse has provided education for a client prescribed lisinopril (Prinivil). Which statement made by the client indicates further teaching is required? 1. "I will monitor my blood pressure until my next appointment." 2. "I will avoid using salt substitutes for seasoning." 3. "It takes a while for this medication to take effect." 4. "I will not need to worry about having additional blood tests done."

4. "I will not need to worry about having additional blood tests done."

Which statement made by the client indicates an understanding of self-care while taking prescriptions to treat their heart failure? 1. "I will cut back on my smoking." 2. "I will check my pulse every few days." 3. "I will schedule my lab work if I am not feeling well." 4. "I will weigh myself every day in the morning after I wake up."

4. "I will weigh myself every day in the morning after I wake up."