Pharmacology Practice Questions
A client is taking clonidine (Catapres) for treatment of hypertension. The nurse should teach the client about which of the following common adverse effects of this drug? Select all that apply. 1. Dry mouth. 2. Hyperkalemia. 3. Impotence. 4. Pancreatitis. 5. Sleep disturbance.
1. Dry mouth. 3. Impotence. 5. Sleep disturbance. Clonidine (Catapres) is a central-acting adrenergic antagonist. It reduces sympathetic outflow from the central nervous system. Dry mouth, impotence, and sleep disturbances are possible adverse effects. Hyperkalemia and pancreatitis are not anticipated with use of this drug.
A 35-year-old woman has been prescribed enalapril maleate (Vasotec). What should the nurse teach the patient? A. Use effective contraception. B. Double the dose if one is missed. C. If dizziness occurs, it is not a concern. D. There is no change in dose with impaired renal function.
A Enalapril maleate is teratogenic and can cause birth defects or fetal demise. Because this client is of childbearing age, she should be instructed to use effective contraception.
When giving antihypertensive drugs, the nurse will consider giving the first dose at bedtime for which class of drugs? A. Alpha blockers such as doxazosin (Cardura) B. Diurectics such as furosemide (Lasix) C. ACE inhibitors such as hydralazine (Apresoline) D. Vasodilators such as hydralazine (Apresoline)
A Alpha blockers such as doxazosin (Cardura)
Orthostatic hypotension is a potential outcome of hypertensive drugs that places the elderly at risk for injury from falls. Instructions given to the patient to decrease this effect include which of the following? (Check all that apply.) A. Take the dose at bedtime. B. Change position slowly when rising from bed or chair. C. Increase fluid intake by 500 mL per day. D. Decrease the dose until symptoms disappear.
A and B. Taking the dose at bedtime decreases the frequency of ambulation and the upright position. Changing position slowly decreases the occurrence of postural hypotension. A variety of lifestyle modifications to decrease the risk of falls should also be addressed by the nurse.
The nurse is educating a patient taking sublingual nitroglycerin 0.4 mg for anginal pain. Which of the following statements indicate that the patient understands the instructions? (Check all that apply) A. "I should take one nitroglycerin tablet every 5 minute for pain, up to a total of three tablets, as needed." B. "I should expect that the nitroglycerin will cause a stinging sensation when placed under my tongue." C. "I should store my nitroglycerin in the original dark bottle to protect the tablets from light." D. "I should replace my nitroglycerin tablets every month whether the bottle has been opened or not."
A, B, and C. It is necessary to replace nitroglycerin every 6 months or when there is question about the drug's potency. For instance, if the tablet does not sting when placed under the tongue, a fresh bottle may be required. The nurse should instruct the client to keep the drug in the original dark container because the drug can break down on exposure to light. The recommended dose is one tablet sublingually every 5 minutes, up to three tablets
Which of the following drug classes are absolutely contraindicated for use in pregnant women? (Check all that apply.) A. ARBs B. calcium channel blockers C. direct renin inhibitors D. ACE inhibitors
A, C, and D. Drugs that act directly on the renin-angiotensin system, including angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, and direct renin inhibitors, can cause injury and death to a developing fetus. Calcium channel blockers are in pregnancy category C. There is a chance of fetal harm if the drug is administered during pregnancy, but the potential benefits may outweigh the potential risk.
The nurse understands a patient who is treated for hypertension may be switched to an angiotensin receptor blocker (ARB) because of which angiotensin-converting enzyme (ACE) inhibitor adverse effect? A. Dry, nonproductive cough B. Hypokalemia C. Fatigue D. Orthostatic hypotension
A. ACE inhibitors block the breakdown of bradykinins and may cause a dry, nonproductive cough. ARBs do not block this breakdown, thus minimizing this adverse effect. ACE inhibitors and ARBs are equally effective for the treatment of hypertension, but ARBs do not cause cough.
The home care nurse is visiting a patient who has a history of heart failure. The patient is taking digoxin (Lanoxin) 0.125 mg orally each day. During the assessment, the patient states he has been nauseated since the home care visit 3 days ago. The nurse suspects he has developed digoxin toxicity. Which of the following factors makes this patient more prone to the development of digoxin toxicity? A. creatinine level of 2.0 mg/dL B. potassium level of 4.0 mEq/L C. calcium level of 8.5 mg/100 mL D. magnesium level of 2.0 mg/100 mL
A. A creatinine level of 2.0 mg/dL is indicative of impaired renal function. Impaired renal function requires the dosage of digoxin to be reduced to prevent toxicity
A patient taking nitroglycerin for angina reports developing a headache after taking more than one tablet. The nurse should inform him that A. headache is a common side effect due to the vasodilating effects of the medication. B. a headache indicates that a person is allergic to the nitroglycerin. C. the experience of headache means that the levels of nitroglycerin are toxic. D. the experience of a headache likely means that the tablets have passed their expiration date.
A. Headache is an anticipated adverse effect from the venodilation that occurs with nitroglycerin. The headache is commonly relieved with acetaminophen.
A 72-year-old woman with angina pectoris, who is being discontinued from beta-adrenergic blockers, asks the nurse, "Why can't I just stop taking the drug today if it's not working anyway?" The nurse instructs the patient that failure to taper the drug slowly may lead to A. worsening of her angina symptoms. B. significant bronchoconstriction. C. development of heart failure. D. drug fever
A. The nurse needs to teach the client that when a betablocker is being discontinued after prolonged use, it should be tapered in dosage and gradually discontinued, or rebound angina can occur.
Which statement is the most appropriate to include in the teaching plan for a 30-year-old woman beginning a new prescription of clonidine (Catapres)? A. "If you stop taking this drug abruptly, your blood pressure might go up very high." B. "You will need to have your blood drawn regularly to check for anemia." C. "Take this medication first thing in the morning to reduce nighttime wakefulness." D. "This medication often is used to manage hypertension during pregnancy."
A. "If you stop taking this drug abruptly, your blood pressure might go up very high."
An older adult patient has been discharged following treatment for a mild case of heart failure. He will be taking a loop diuretic. Which instruction(s) from the nurse are appropriate? (Select all that apply) A. "Take the diuretic at the same time each morning" B. "Take the diuretic only if you notice swelling in your feet" C. "Be sure to stand up slowly because the medication may make you feel dizzy if you stand up quickly" D. "Drink at least 8 glasses of water each day" E. "Here is a list of foods that are high in potassium; you need to avoid these" F. "Please call your doctor immediately if you notice muscle weakness or increased dizziness"
A. "Take the diuretic at the same time each morning" C. "Be sure to stand up slowly because the medication may make you feel dizzy if you stand up quickly" F. "Please call your doctor immediately if you notice muscle weakness or increased dizziness"
The nurse is reviewing drug interactions with a male patient who has a prescription for isosorbide dinitrate (Isordil) as treatment for angina symptoms. Which substances listed below could potentially result in a drug interaction? (Select all that apply) A. A glass of wine B. Thyroid replacement hormone C. Tadalafil (Cialis), an erectile dysfunction drug D. Metformin (Glucophage), an antidiabetic drug E. Carvedilol (Coreg), a beta blocker
A. A glass of wine C. Tadalafil (Cialis), an erectile dysfunction drug E. Carvedilol (Coreg), a beta blocker
When monitoring laboratory test results for patients receiving loop and thiazide diuretics, the nurse knows to look for? A. Decreased serum levels of potassium B. Increased serum levels of calcium C. Decreased serum levels of glucose D. Increased serum levels of sodium
A. Decreased serum levels of potassium
Potassium-sparing diuretics may cause which common adverse reactions? (Select all that apply.) A. Dizziness B. Headache C. Hyperkalemia D. Mental confusion E. Muscle weakness
A. Dizziness B. Headache C. Hyperkalemia Hyperkalemia, dizziness, and headache are common adverse effects associated with potassium-sparing diuretics.
To treat a patient with pulmonary edema, the nurse prepares to administer which diuretic to this patient? A. Furosemide (Lasix) B. Amiloride (Midamor) C. Triamterene (Dyrenium) D. Spironolactone (Aldactone)
A. Furosemide (Lasix) Correct Furosemide is a potent, rapid-acting diuretic that would be the drug of choice to treat pulmonary edema. The other medications are not potent enough to cause the diuresis necessary to treat this condition.
Which laboratory test result is a common adverse effect of furosemide (Lasix)? A. Hypokalemia B. Hypernatremia C. Hyperchloremia D. Hypophosphatemia
A. Hypokalemia Correct Furosemide is a potent loop diuretic, and the most common adverse effect of loop diuretics is electrolyte imbalances. This results in major electrolyte losses of potassium and sodium and, to a lesser extent, calcium.
A patient prescribed spironolactone (Aldactone) asks the nurse to assist with food choices that are low in potassium. The nurse would recommend which food choices? (Select all that apply.) A. Apples B. Bananas C. Pineapple D. Lean meat E. Winter squash
A.Apples C.Pineapple D. Lean meat Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Bananas and winter (not summer) squash are high in potassium and should be avoided in patients taking spironolactone.
A client is receiving cholestyramine (Questran) for elevated low-density lipoprotein (LDL) levels. As the nurse completes the nursing care plan, which of the following adverse effects will be included for continued monitoring? 1. Abdominal pain 2. Orange-red urine and saliva 3. Decreased capillary refill time 4. Sore throat and fever
Answer: 1 Obstruction of the GI tract is one of the most serious complications of bile acid sequestrants. Abdominal pain may signal the presence of obstruction. Options 2, 3, and 4 are incorrect. Cholestyramine (Questran) does not cause orange-red urine and saliva, sore throat, or fever, or affect capillary refill.
A client has been on long-term therapy with colestipol (Colestid). To prevent adverse effects related to the length of therapy and lack of nutrients, which of the following supplements may be required? (Select all that apply.) 1. Folic acid 2. Vitamins A, D, E, and K 3. Potassium, iodine, and chloride 4. Protein 5. B vitamins
Answer: 1, 2 Long-term use of bile acid sequestrants such as colestipol (Colestid) may cause depletion or decreased absorption of folic acid and the fat-soluble vitamins. Options 3, 4, and 5 are incorrect. Decreases in protein, potassium, iodine, chloride, and the B vitamins are not a direct effect of bile acid sequestrant therapy.
The client is to begin taking atorvastatin (Lipitor) and the nurse is providing education about the drug. Which symptom related to this drug should be reported to the health care provider? 1. Constipation 2. Increasing muscle or joint pain 3. Hemorrhoids 4. Flushing or "hot flash"
Answer: 2 "Statins" (HMG-CoA reductase inhibitors) such as atorvastatin (Lipitor) may cause rhabdomyolysis, a rare but serious adverse effect. Options 1, 3, and 4 are incorrect. Constipation and hemorrhoids may result from bile acid sequestrants. A feeling of flushing or hot flash-type effects may result from nicotinic acid.
The nurse is instructing a client on home use of niacin and will include important instructions on how to take the drug and about its possible adverse effects. Which of the following may be expected adverse effects of this drug? (Select all that apply.) 1. Fever and chills 2. Intense flushing and hot flashes 3. Tingling of the fingers and toes 4. Hypoglycemia 5. Dry mucous membranes
Answer: 2, 3 Rationale: Intense flushing and hot flashes occur in almost every client who is taking niacin. Tingling of the extremities may also occur. Options 1, 4, and 5 are incorrect. Fever, chills, or dry mucous membranes are not adverse effects associated with niacin. Niacin may cause an increase in blood glucose, especially in people with diabetes.
The nurse should question a prescription for a calcium channel blocker in a patient with which condition? A. Dysrhythmia B. Hypotension C. Angina pectoris D. Increased intracranial pressure
B. Calcium channel blockers cause smooth muscle vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension.
When administering nitroprusside (Nipride) by continuous intravenous infusion, the nurse monitors for which symptom of drug toxicity? A. Wheezing B. Hypotension C. Fever D. Hyperglycemia
B. The main symptom of sodium nitroprusside overdose or toxicity is excessive hypotension.
Which of the following drugs is first administered by the nurse to treat an anaphylactic reaction to penicillin? A. diphenhydramine (Benadryl) B. epinephrine (Adrenalin) C. isoproterenol (Isuprel) D. dexamethasone (Decadron)
B. Epinephrine is indicated in anaphylactic reactions and other allergic reactions, cardiac arrest, hypotension and shock, local vasoconstriction, bronchodilation, cardiac stimulation, and ophthalmic conditions.
Which statement needs to be included when the nurse provides patient education for a patient with heart failure who is taking daily doses of spirinolactone (Aldactone)? A. "Be sure to eat foods that are high in potassium" B. "Avoid foods that are high in potassium" C. "Avoid grapefruit juice while taking this medication" D. "A low-fiber diet will help prevent adverse effects of this medication"
B. "Avoid foods that are high in potassium"
A 68-year-old patient has been taking the nitrate isosorbide dinitrate (Isordil) for 2 years for angina. He recently has been experiencing erectile dysfunction and whats a prescription for sildenafil (Viagra). Which response would the nurse most likely hear from the prescriber? A. "He will have to be switched to isosoride mononitrate if he wants to take sildenafil" B. "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists" C. "I'll write a prescription, but if he uses it, he needs to stop taking the isosorbide for one dose" D. "These drugs are compatible with each other, and so I'll write a prescription"
B. "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists"
When preparing to administer intravenous furosemide (Lasix) to a patient with renal dysfunction, the nurse will administer the medication no faster than which rate? A. 2 mg/min B. 4 mg/min C. 6 mg/min D. 8 mg/min
B. 4 mg/min Correct Furosemide controlled infusion rate should not exceed at a rate of 4 mg/min in patients with renal failure.
A nurse administering niacin would implement which action to help to reduce adverse effects? A. Give the medication with grapefruit juice B. Administer a small dose of aspirin or an NSAID 30 minutes before the niacin dose C. Administer the medication on an empty stomach D. Have the patient increase dietary fiber intake
B. Administer a small dose of aspirin or an NSAID 30 min before the niacin dose
In administering a newly initiated order for captopril, an ACE inhibitor, discharge instructions should indicate that which of the following adverse effects is most common? A. tinnitus B. dry, nonproductive, persistent cough C. muscle weakness D. constipation
B. All angiotensin-converting enzyme inhibitors can commonly cause a nonproductive cough and a tickling in the throat. Approximately 10% to 20% of clients experience this minor but annoying side effect. The cough resolves when the drug is discontinued
When teaching the patient about the signs and symptoms of cardiac glycoside toxicity, the nurse should alert the patient to watch for? A. Visual changes such as photophobia B. Flickering lights or halos around lights C. dizziness when standing up D. Increased urine output
B. Flickering lights or halos around lights
When assessing a patient taking Potassium-sparing diuretic , the nurse would monitor for which possible adverse effect? A. Hypokalemia B. Hyperkalemia C. Hypoglycemia D. Hypernatremia
B. Hyperkalemia Potassium-sparing diuretic causes hyperkalemia is a possible adverse effect.
The nurse is providing education to a patient on why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together. What information does the nurse provide to the patient? A. Moderate doses of two different types of diuretics are more effective than a large dose of one type. B. This combination promotes diuresis but decreases the risk of hypokalemia. Correct C. This combination prevents dehydration and hypovolemia. D. Using two drugs increases osmolality of plasma and the glomerular filtration rate. Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.
B. This combination promotes diuresis but decreases the risk of hypokalemia. Correct Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.
The nurse is providing education to a patient prescribed spironolactone (Aldactone) and furosemide (Lasix). What information does the nurse explain to the patient? A. Using two drugs increases blood osmolality and the glomerular filtration rate. B. This combination promotes diuresis but decreases the risk of low levels of potassium. C. The lowest dose of two different types of diuretics are more effective than a large dose of one type. D. This combination maintains water balance to protect against dehydration and electrolyte imbalance.
B. This combination promotes diuresis but decreases the risk of low levels of potassium. Correct Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes potassium loss.
A patient has been taking simvastatin (Zocor) for 6 months. Today he received a call that he needs to come to the office for a "laboratory check". The nurse expects which laboratory studies to be ordered at this time? (Select all that apply) A. PT/INR B. Total cholesterol C. Triglyceride D. Liver function studies E. Complete blood count F. HDL and LDL levels
B. Total cholesterol C. Triglyceride D. Liver function studies F. HDL and LDL levels
Which medication should the nurse question if prescribed together with ACE inhibitors? A. Docusate sodium (Colace) B. Furosemide (Lasix) C. Potassium chloride (K-Dur) D. Morphine
C. ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion; thus, a decrease in aldosterone production can result in an increase in serum potassium.
When the nurse responds to hypotension due to hypovolemic shock, which of the following should be administered first? A. epinephrine (Adrenalin) B. isoproterenol (Isuprel) C. normal saline (IV) D. ephedrine (generic)
C. In hypovolemic shock, adrenergics are second-line agents that may be used if adequate fluid volume replacement does not restore sufficient blood pressure and circulation to maintain organ perfusion
A nurse with adequate knowledge about the administrations of intravenous nitroglycerin will recognize that which statement is correct? A. The intravenous form is given by IV push injection B. Because the intravenous forms are short-lived, the dosing must be every 2 hours C. Intravenous nitroglycerin must be protected from exposure to light through use of special tubing D. Intravenous nitroglycerin can be given via gravity drip infusions
C. Intravenous nitroglycerin must be protected from exposure to light through use of special tubing
The nurse is assessing the patient's knowledge regarding drug therapy prescribed for the treatment of hypertension. Which statement by the patient indicates the need for further teaching by the nurse? A. "I will move slowly from a sitting to standing position." B. "Blood pressure drugs can cause changes in sexual functioning." C. "When my blood pressure is over 140/90, I will take my medication." D. "I will wear a medical alert bracelet."
C. Patients must adhere to prescribed antihypertensive regimen to prevent end-organ damage. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, but the medication may produce unwanted adverse effects. Patient teaching is essential.
A patient is taking furosemide (Lasix), 40 mg daily, to decrease extracellular fluid related to heart failure. During patient teaching, which of the following points is most important for the nurse to convey? A. Sodium intake should be increased due to fluid loss. B. Administration of the medication with food will decrease absorption. C. The skin should be protected from sun exposure using sunscreen. D. Foods that contain potassium should be limited to prevent hyperkalemia.
C. An adverse effect of the administration of furosemide is photosensitivity
When a patient is being taught about the potential adverse effects of an ACE inhibitor, which of these effects should the nurse mention as possibly occurring when this drug is taken to treat hypertension? A. Diarrhea B. Nausea C. Dry, non-productive cough D. Sedation
C. Dry, non-productive cough
Concurrent use of nitrates in any form or route of administration with phosphodiesterase enzyme inhibitors produces A. enhanced erectile potential. B. significant tachycardia. C. severe hypotensive effects. D. mild bronchodilation.
C. Nitrates and phosphodiesterase enzyme type 5 inhibitors decrease blood pressure. Concurrent use of nitrates in any form or route of administration is contraindicated with phosphodiesterase enzyme inhibitors because the combination may potentiate severe hypotensive effects.
A patient asks the nurse about using potassium supplements while taking spironolactone (Aldactone). What is the nurse's best response? A. "I will call your health care provider and discuss your concern." B. "I would recommend that you take two multivitamins every day." C. "This diuretic is potassium sparing, so there is no need for extra potassium." D. "You will need to take potassium supplements for the medication to be effective."
C. "This diuretic is potassium sparing, so there is no need for extra potassium." Correct Spironolactone is a potassium-sparing diuretic, and thus the patient does not need potassium supplementation. Intake of excess potassium may lead to hyperkalemia.
To evaluate the therapeutic effects of mannitol (Osmitrol), the nurse should monitor the patient for which clinical finding? A. Increase in urine osmolality B. Decrease in serum osmolality C. Decrease in intracranial pressure D. Increase in cerebral blood volume
C. Decrease in intracranial pressure Mannitol is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This decreases intracranial pressure and cerebral blood volume, increases excretion of medications, decreases urine osmolality, and increases serum osmolality.
The nurse is assessing a patient in a clinic who has been taking clonidine (Catapres) for hypertension. Which findings are most indicative of an adverse effect of this drug? A. Cough and wheezing B. Epigastric pain and diarrhea C. Drowsiness and dry mouth D. Positive Coombs' test result and anemia
C. Drowsiness and dry mouth
Which point will the nurse emphasize to a patient who is taking an antilipemic medication in the "statin" class? A. The drug needs to be taken on an empty stomach before meals B. A low-fat diet is not necessary while taking these medications C. It is important to report muscle pain immediately D. Improved cholesterol levels will be evident within 2 weeks
C. It is important to report muscle pain immediately
During assessment of a patient who is receiving digoxin, the nurse monitors for findings that would indicate an increased possibility of toxicity, such as: A. Apical pulse rate of 62 bpm B. Digoxin level of 1.5 ng/mL C. Serum potassium level of 2.0 mEq/L D. Serum calcium level of 9.9 mEq/L
C. Serum potassium level of 2.0 mEq/L NORMALS K+ = 3.5-5.3 Ca+ = 8.5-10.2 mg/dL digoxin = 0.5 - 2.0 ng/mL apical = 60-100 bpm
When the nurse is checking the laboratory data for a patient taking spironolactone (Aldactone), which result would be a potential concern? A. Serum sodium level of 140 mEq/L B. Serum calcium level of 10.2 mg/dL C. Serum potassium level of 5.8 mEq/L D. Serum magnesium level of 2.0 mg/dL
C. Serum potassium level of 5.8 mEq/L NORMALS Sodium = 135 and 145 Calcium = 8.5-10.2 mg/dL Potassium = 3.5-5.3 mEq/L Magnesium = 1.5-2.5 mEq/L
A patient has a new prescription for transdermal nitroglycerin patches. The nurse teaches the patient that these patches are most appropriately used for which reason? A. to relieve exertional angina B. To prevent palpitations C. To prevent the occurrence of angina D. To stop an episode of angina
C. To prevent the occurrence of angina
During discharge teaching, which statement by the nurse would be MOST appropriate for a patient prescribed a transdermal clonidine (Catapres)? A. "Prolonged sitting or standing does not cause hypotension symptoms." B. "Occasional drooling is a common adverse effect of this medication." C. "Your blood pressure should be checked by your health care provider two to three times a week." D. "The patch should be applied to a nonhairy site, and you should not suddenly stop using this drug."
D. Transdermal clonidine patches should be applied to nonhairy areas of the skin, and application sites should be rotated. When the patch dosage form is used, it is important to remove the old patch before applying a new one. It must not be discontinued abruptly because it will lead to severe rebound hypertension (sudden high elevation of blood pressure). Prolonged standing can cause venous pooling and hypotension. Dry mouth, not drooling, is a common adverse effect of clonidine.
The nurse removes a patient's transdermal nitroglycerin disk at bedtime as ordered to minimize nitrate tolerance. The patient awakens during the night and complains of anginal symptoms. The nurse's first action is to: A. notify the health care provider. B. apply a new transdermal disk. C. obtain further history of complaints. D. administer a short-acting nitrate as ordered
D. Clients taking one or more antianginal drugs in longacting formations such as discs should carry or have administered a drug in short-acting formation as well to be used for acute attacks. To minimize tolerance to hemodynamic effects after prolonged use, it is necessary to use the lowest effective dose and an intermittent dosage schedule. High-dose uninterrupted treatment causes tolerance to the vasodilating effects of the drug, and although tolerance reduces adverse effects, the therapeutic effects decrease, and short-acting nitrates may be less effective at relieving acute pain.
In caring for a patient with chronic angina who has been prescribed the new drug, ranolazine (Ranexa), the nurse is correct in counseling that this drug A. may be crushed if necessary B. must not be taken with beta-adrenergic blockers C. must not be taken with meals D. should not be taken with grapefruit juice
D. Clients taking ranolazine should not take it with grapefruit juice, which affects hepatic enzymes. They may take the drug with or without meals, should not crush the tablets, and may take it with beta-adrenergic blockers
A patient is taking digoxin (Lanoxin) for atrial fibrillation. Which of the following assessment findings would indicate that the digoxin should be held and the health care provider should be notified? A. respiratory rate of 20 breaths/min B. pulse rate of 80 beats/min C. respiratory rate of 12 breaths/min D. pulse rate of 52 beats/min
D. Digoxin decreases the heart rate to increase myocardial contractility and output. If the client's heart rate is less than 60 beats/min, the digoxin should be withheld and the health care provider should be notified due to potential toxicity
A patient is admitted to the emergency department with uncontrolled shortness of breath and is diagnosed with acute heart failure. The patient is given nesiritide (Natrecor), 140 mcg by IV bolus. Which of the following symptoms would result in the discontinuation of nesiritide? A. bradycardia B. tachycardia C. hypertension D. hypotension
D. The development of hypotension (systolic blood pressure less than 90 mm Hg) necessitates discontinuation of nesiritide
A patient with diabetes has a new prescription for a thiazide diuretic. Which statement will the nurse include when teaching the patient about the thiazide drug? A. "There is nothing for you to be concerned about when you are taking the thiazide diuretic" B. "Be sure to avoid foods that are high in potassium" C. "You need to take the thiazide at night to avoid interactions with the diabetes medicine" D. "Monitor your blood glucose level closely, because the thiazide diuretic may cause the levels to increase"
D. "Monitor your blood glucose level closely, because the thiazide diuretic may cause the levels to increase"
The nurse would question the use of mannitol (Osmitrol) for which patient condition? A. Increased intraocular pressure B. Oliguria from acute renal failure C. Cerebral edema from head trauma D. Anuria related to end-stage kidney disease
D. Anuria related to end-stage kidney disease Correct Mannitol does not influence urine production; it only increases existing urine output. It is not metabolized but excreted unchanged in the urine by the kidneys. Thus, if no urine is produced (anuria), mannitol is not excreted, which increases
Why does the health care provider prescribe furosemide (Lasix) 40 mg twice a day by mouth for a patient with a history of renal insufficiency? A. Furosemide is effective in treating patients withhypoaldosteronism. B. Furosemide helps the kidney with reabsorption of sodium and water. C. Furosemide has an antagonist effect to prevent respiratory alkalosis. D. Furosemide is effective in treating patients with impaired kidney function.
D. Furosemide is effective in treating patients with impaired kidney function. Correct Furosemide effectiveness continues in impaired renal function. When creatinine clearance decreases below 25 L/min (normal is 125 L/min), the loop diuretics can still work.
When teaching a patient about symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which symptom occurs? A. Diaphoresis B. Constipation C. Blurred vision D. Muscle weakness
D. Muscle weakness Muscle weakness is a common symptom of hypokalemia. The other answers are incorrect.
The nurse is assessing a patient who will be starting antihypertensive therapy with an ACE inhibitor. Which condition, if present in the patient, would be a reason for cautious use? A. Asthma B. Rheumatoid Arthritis C. Hyperthyroidism D. Renal insufficiency
D. Renal insufficiency
A patient complains to the nurse that the clonidine (Catapres) recently prescribed for hypertension is causing drowsiness. Which response by the nurse to this concern is appropriate? a. "Drowsiness is a common side effect initially, but it will lessen with time." b. "You may also experience orthostatic hypotension along with the drowsiness." c. "You may be at risk for addiction if you have central nervous system side effects." d. "You should discontinue the medication and contact your prescriber."
a. "Drowsiness is a common side effect initially, but it will lessen with time." CNS depression, evidenced in this patient by drowsiness, is common in about 35% of the population. These responses become less intense with continued drug use. Orthostatic hypotension is less likely with clonidine, because its antihypertensive effects are not posture dependent. The experience of drowsiness does not indicate abuse potential. The patient should not discontinue the medication abruptly because of the potential for rebound hypertension; the patient should contact the prescriber before stopping the medication.
A prescriber has ordered clonidine (Catapres) for a patient who has hypertension. The nurse teaches the patient about side effects of this drug. Which statement by the patient indicates understanding of the teaching? a. "I should chew sugar-free gum or drink water to reduce dry mouth." b. "I should not drive as long as I am taking this drug." c. "I should stand up slowly when taking this medication." d. "I should stop taking this drug if I feel anxious or depressed."
a. "I should chew sugar-free gum or drink water to reduce dry mouth." Xerostomia is a common side effect of clonidine and is often uncomfortable enough that patients stop using the drug. Counseling patients to chew sugar-free gum and take frequent sips of liquid can help alleviate this discomfort. Drowsiness is common, but this side effect becomes less intense over time. Patients should be counseled to avoid hazardous activities in the first weeks of therapy if they feel this effect. The hypertensive effects of clonidine are not posture dependent, as they are with the peripheral alpha-adrenergic blockers, so orthostatic hypotension is minimal with this drug. Clonidine causes euphoria, hallucinations, and sedation in high doses and can cause anxiety or depression, although the last two effects are less common. The drug should not be stopped abruptly because of the risk of rebound hypertension, so patients experiencing unpleasant central nervous system (CNS) effects should consult their provider about withdrawing the medication slowly.
A patient with hypertension has a previous history of opioid dependence. Which medication would the nurse question? a. Clonidine (Catapres) b. Guanabenz (Wytensin) c. Methyldopa d. Reserpine (Serpasil)
a. Clonidine (Catapres) Patients who abuse cocaine, opioids, and other such drugs also frequently abuse clonidine, so this agent would not be the best choice for this patient. The other drugs do no share this abuse potential.
A 62-year-old patient who has just arrived in the emergency department complaining of a sudden-onset severe headache and nausea has a BP of 240/118 mm Hg. The patient gives a history of taking clonidine (Catapres) and hydrochlorothiazide (HydroDIURIL) for 10 years for hypertension. The most appropriate question by the nurse at this time is a. Have you recently taken any antihistamine medications? b. Have you been taking the Catapres and HydroDIURIL lately? c. Do you have any recent stressful events in your life? d. Did you take any acetaminophen (Tylenol) yet today?
b. Have you been taking the Catapres and HydroDIURIL lately? Rationale: Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP, but not usually to the level in this patient.
