Cardio All Pharm Exam 1

8. A nurse is assessing a client with heart failure who is taking prescribed torsemide. Which clinical finding indicates effectiveness of the medication? Symmetrical pulses bilaterally Full strength to bilateral extremities Intact whisper test Absence of peripheral edema

Absence of peripheral edema

687) A client taking multiple medications for hypertension develops a persistent, hacking cough. Which antihypertensive medication class would the nurse identify as the likely cause of the cough? Thiazide diuretics Calcium channel blockers Direct renin inhibitors Angiotensin-converting enzyme (ACE) inhibitors

Angiotensin-converting enzyme (ACE) inhibitors

3. A 42-year-old male client diagnosed with hypertension tells the nurse he no longer wants to take the prescribed propranolol. Which client statement best explains the reason why he does not want to take this medication? "I have difficulty falling asleep." "I'm having problems with my stomach." "I'm experiencing decreased sex drive." "I feel so tired all the time."

"I'm experiencing decreased sex drive."

740) A client is receiving furosemide to relieve edema. The nurse will monitor the client for which adverse effect? Hypernatremia Elevated blood urea nitrogen Hypokalemia Increase in the urine specific gravity

Hypokalemia

13 The nurse is preparing to administer metoprolol to a client with a history of hypertension. Which of the following data is the priority for the nurse to review prior to administration? Potassium level Most recent heart rate Creatinine level Respiratory rate

Most recent heart rate

7. The client is discharged from the hospital with a new prescription for furosemide. During a follow-up visit one week later, the nurse notes the following findings. Which finding is most important to report to the health care provider? Constipation Muscle cramps Occasional lightheadedness Increased urine production

Muscle cramps

9. A nurse is providing education to a client about newly prescribed diltiazem. Which statement will the nurse include in the teaching? "Skip the dose if your systolic blood pressure is less than 120 mmHg." "Hold the dose if your heart rate is less than 50 beats/min." "Call your healthcare provider if you experience any fever." "Notify your healthcare provider if you notice any weight loss."

"Hold the dose if your heart rate is less than 50 beats/min."

652) The nurse prepares discharge instructions for a client who will take enalapril for hypertension. Which instruction would the nurse include in the client's teaching? 'Change to a standing position slowly.' 'This may color your urine green.' 'The medication may cause a sore throat for the first few days.' 'Schedule blood tests weekly for the first 2 months.'

'Change to a standing position slowly.'

981) Hydrochlorothiazide (HCTZ) has been prescribed for a client with hypertension. The client reports hearing that furosemide is more effective and requests a prescription change. How will the nurse respond? 'HCTZ has fewer side effects.' 'HCTZ does not cause dizziness.' 'HCTZ is only taken when needed.' 'HCTZ does not cause dehydration.'

'HCTZ has fewer side effects.'

5.The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker (ARB), for a client with hypertension and heart failure. The nurse reviews the client's laboratory results and notes that the client's serum potassium level is 5.9 mEq/L. Which action should the nurse take first? A. Withhold the scheduled dose. B. Check the client's apical pulse. C. Notify the healthcare provider. D. Repeat the serum potassium level.

A. Withhold the scheduled dose. Rationale: The nurse should first withhold the scheduled dose of Cozaar because the client is hyperkalemic (normal range 3.5 to 5 mEq/l). Although hypokalemia is usually associated with diuretic therapy in heart failure, hyperkalemia is associated with several heart failure medications, including ARBs. Because hyperkalemia may lead to cardiac dysrhythmias, the nurse should check the apical pulse for rate and rhythm, and blood pressure.

675) A client who has atrial fibrillation with rapid ventricular response is started on a continuous heparin infusion. Which clinical finding enables the nurse to conclude that the heparin therapy is effective? Atrial fibrillation converts to a sinus rhythm. The heart rate is stabilized at 70 to 90 beats per minute. The international normalized ratio (INR) is within normal range. An activated partial thromboplastin time (aPTT) is twice the usual value.

An activated partial thromboplastin time (aPTT) is twice the usual value.

485) Which is an appropriate nursing action when caring for a client taking benazepril for hypertension? Assess for dizziness. Assess for dark, tarry stools. Administer the medication after meals. Monitor the electroencephalogram (EEG).

Assess for dizziness.

830) A primary health care provider prescribes atenolol 20 mg by mouth four times a day. Which information is important for the nurse to include in the discharge teaching plan for this client? Drink alcoholic beverages in moderation. Avoid abruptly discontinuing the medication. Increase the medication if chest pain develops. Report a pulse rate less than 70 beats/minute.

Avoid abruptly discontinuing the medication.

890) Which instruction will the nurse include in a teaching plan for a client taking a calcium channel blocker such as nifedipine? Select all that apply. One, some, or all responses may be . Reduce calcium intake. Report peripheral edema. Expect temporary hair loss. Avoid drinking grapefruit juice. Change to a standing position slowly.

Avoid drinking grapefruit juice. Change to a standing position slowly. Report peripheral edema.

69.The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with heart failure. Which intervention should the nurse implement prior to administering the digoxin? A. Observe respiratory rate and depth. B. Assess the serum potassium level. C. Obtain the client's blood pressure. D. Monitor the serum glucose level.

B. Assess the serum potassium level.

690) A client was prescribed furosemide. The nurse would instruct the client to include which food in the diet? Liver Apples Cabbage Bananas

Bananas

887) A client is receiving hydrochlorothiazide. Which physiological alteration will the nurse monitor to best determine the effectiveness of the client's hydrochlorothiazide therapy? Blood pressure Decreasing edema Serum potassium level Urine specific gravity

Blood pressure

8. A nurse is assessing a client who started taking prescribed olmesartan 2 weeks ago. Which finding indicates an expected response to the medication? Heart rate of 85 beats/min Urinary output of 45 ml/hr Blood pressure of 125/79 mmHg Respiratory rate of 20 breaths/min

Blood pressure of 125/79 mmHg

1. The nurse is monitoring a 4-month-old infant who is prescribed digoxin. The infant's blood pressure is 92/78 mm Hg; resting pulse is 78 beats per minute; respirations are 28 breaths per minute; and serum potassium level is 4.8 mEq/L. The infant is irritable and has vomited twice since receiving the morning dose of digoxin. Which finding is most indicative of digoxin toxicity? Irritability Vomiting Bradycardia Dyspnea

Bradycardia INFANTS

320) Which food would the nurse encourage a client to eat while receiving treatment to prevent hypokalemia? Broccoli Oatmeal Fried rice Canned carrots

Broccoli Rationale: Potassium is plentiful in green leafy vegetables; broccoli provides 207 mg of potassium per half cup. Oatmeal provides 73 mg of potassium per half cup. Rice provides 29 mg of potassium per half cup. Cooked fresh carrots provide 172 mg of potassium per half cup; canned carrots provide only 93 mg of potassium per half cup.

57. Which nursing diagnosis is important to include in the plan of care for a client receiving the angiotensin-2 receptor antagonist irbesartan (Avapro)? A. Fluid volume deficit. B. Risk for infection. C. Risk for injury. D. Impaired sleep patterns.

C. Risk for injury. Rationale: Avapro is an antihypertensive agent, which acts by blocking vasoconstrictor effects at various receptor sites. This can cause hypotension and dizziness, placing the client at high risk for injury.

634) Which medications may be used to severe hyperkalemia resulting from intravenous (IV) administration? Select all that apply. One, some, or all responses may be . Calcium chloride Sodium chloride Calcium gluconate Sodium bicarbonate Dextrose solution with insulin

Calcium chloride Calcium gluconate Sodium bicarbonate Dextrose solution with insulin

1497) Which medication may be useful in managing hypertension in a child with acute glomerulonephritis? Digoxin Diazepam Captopril Phenytoin

Captopril Rationale: Captopril, an angiotensin-converting enzyme inhibitor antihypertensive, blocks the conversion of angiotensin I to the constrictor angiotensin II. Digoxin is not an antihypertensive; it increases the contractility and output of the heart. Diazepam is not an antihypertensive; it relaxes skeletal muscle. Phenytoin is not an antihypertensive; it is an anticonvulsant.

632) Which angiotensin-converting enzyme inhibitors (ACE inhibitors) are appropriate for a client with liver dysfunction? Select all that apply. One, some, or all responses may be . Ramipril Enalapril Quinapril Captopril Lisinopril

Captopril Lisinopril

33. Which change in data indicates to the nurse that the desired effect of the angiotensin II receptor antagonist valsartan has been achieved? A. Dependent edema reduced from +3 to +1. B. Serum HDL increased from 35 to 55 mg/dL. C. Pulse rate reduced from 150 to 90 beats/minute. D. Blood pressure reduced from 160/90 mmHg to 130/80 mmHg.

D. Blood pressure reduced from 160/90 mmHg to 130/80 mmHg.

1546) The client with congestive heart failure is receiving furosemide 80 mg once daily. Which data collection assessment would be performed to evaluate medication effectiveness? Select all that apply. One, some, or all responses may be . Daily weight Intake and output Monitor for edema Daily pulse oximetry Auscultate breath sounds

Daily weight Intake and output Monitor for edema Daily pulse oximetry Auscultate breath sounds

949) A client with hypertension has received a prescription for metoprolol. Which information will the nurse include when teaching this client about metoprolol? Do not abruptly discontinue the medication. Consume alcoholic beverages in moderation. Report a heart rate of less than 70 beats per minute. Increase the medication dosage if chest pain occurs.

Do not abruptly discontinue the medication.

9. A client who has been diagnosed with Raynaud's disease and hypertension is prescribed nifedipine. For which side effect should the nurse monitor the client? Cyanosis of the lips Decreased urine output Increased pain in fingers Facial flushing

Facial flushing

693) Which action describes a therapeutic effect of atenolol? Heart rate decreases Cardiac output increases Bronchospasm is relieved Pulse oximetry improves

Heart rate decreases

982) A client with supraventricular tachycardia (SVT) has a heart rate of 170 beats/minute. After treatment with diltiazem, which assessment indicates to the nurse that the diltiazem is effective? Increased urine output Blood pressure of 90/60 mm Hg Heart rate of 98 beats/minute No longer complaining of heart palpations

Heart rate of 98 beats/minute

14 The nurse is caring for a client diagnosed with heart failure who will begin treatment with digoxin. Which therapeutic effect would the nurse expect to find after administering this medication? Decreased chest pain with decreased blood pressure Increased heart rate with increased respirations Improved respiratory status with increased urinary output Diaphoresis with decreased urinary output

Improved respiratory status with increased urinary output

871) When a client with type 1 diabetes develops heart failure, digoxin is prescribed. Which nursing action is important to include when planning care? Administer the digoxin 1 hour after the client's morning insulin. Monitor the client for cardiac dysrhythmias. Monitor for increased risk of hyperglycemia. Increase digoxin dosage if insulin requirements are increased.

Monitor the client for cardiac dysrhythmias.

0 The nurse only administers carvedilol (Coreg) to a client with an order for benztropine (Cogentin). What is the priority nursing intervention after making this medication error? Complete an incident report Notify the nurse manager Monitor the client's blood pressure Notify the health care provider

Monitor the client's blood pressure

386) Which nursing intervention is important when caring for clients receiving intravenous (IV) digoxin? Select all that apply. One, some, or all responses may be . Monitor the heart rate closely. Check the blood levels of digoxin. Administer the dose over 1 minute. Monitor the serum potassium level. Give the medication with other infusing medications.

Monitor the heart rate closely. Check the blood levels of digoxin. Monitor the serum potassium level.

8. A nurse has administered sublingual nitroglycerin to a client in the emergency department. Which clinical finding indicates an adverse response to the medication? Persistent chest pain Orthostatic hypotension Decreased heart rate Labored breathing

Orthostatic hypotension

10 The nurse is monitoring a client who is receiving the thrombolytic agent alteplase for treatment of an acute myocardial infarction (AMI). What outcome indicates the client is receiving adequate therapy within the first few hours of treatment? Reduction of ST-segment elevation on a 12-lead ECG Stabilization of blood pressure Absence of cardiac arrhythmias Cardiac enzymes are within normal limits

Reduction of ST-segment elevation on a 12-lead ECG

1. A nurse is reviewing a client's medical history. The client has been newly diagnosed with hypertension and has been prescribed oral losartan as treatment. The nurse will clarify the use of losartan if which comorbidity is noted in the client's medical record? Renal stenosis Hyperlipidemia Atrial fibrillation Diabetes

Renal stenosis Rationale: Losartan is an angiotensin II receptor blocker used in the treatment of hypertension. Losartan is contraindicated in clients with renal stenosis due to the risk of kidney injury. Hyperlipidemia, atrial fibrillation, and diabetes are not known to be contraindicated in the use of losartan.

975) Which advice will the nurse include when teaching a client about digoxin for left ventricular failure? Sleep flat in bed. Follow a low-potassium diet. Take the pulse three times a day. Report increasing fatigue.

Report increasing fatigue.

7. The nurse is collecting the health history for a client who reports a sudden onset of generalized weakness and fatigue. The nurse notes the client has a new prescription for spironolactone. Which action should the nurse take first? Review the drug formulary for side effects Request the health care provider to stop the medication Notify the pharmacist of the findings Document the findings

Review the drug formulary for side effects Rationale: During medication administration, it is important for the nurse to assess knowledge of drugs, including adverse effects and physiologic factors that affect drug action. Information about specific drugs is available in pharmacology texts and drug reference books. Calling the health care provider may be an option after reviewing the drug formulary. The nurse should notify the pharmacist if the medication is the cause of the symptoms. The nurse will document the findings, but the priority is to review the formulary.

7 The nurse is providing discharge education to a client who will be starting daily atenolol for the treatment of hypertension. Which side effect is most important for the client to notify their health care provider about? Decreased libido Slow, irregular heart rate Dizziness in the morning Decreased exercise tolerance

Slow, irregular heart rate

5 A client received 40 mg of furosemide by mouth at 10 am. Which information is most important for the nurse to provide to the next nurse in the change-of-shift report? The client lost two pounds in the last 24 hours. The client is to receive another dose of furosemide at 10 pm. The client's potassium level was 4.0 mEq/L prior to administration. The client's urine output was 1500 mL over nine hours.

The client's urine output was 1500 mL over nine hours.

1 A charge nurse is observing a staff nurse prepare 1 ml of intravenous digoxin for a client with heart failure. After the staff nurse prepares the medication, the nurse notices precipitate in the syringe. Which action by the staff nurse likely caused this reaction? D5W was used as the diluent. The medication was not allowed to reach room temperature. The medication was added to 1 mL of diluent. Air was not inserted into the vial.

The medication was added to 1 mL of diluent. Rationale: When administering digoxin, 1 milliliter of digoxin should be mixed into at least 4 milliliters of diluent. Using a smaller amount of diluent will cause precipitation of the medication. Dextrose 5% in water (D5W) is compatible with digoxin and can be used to dilute the medication. Digoxin is not a temperature controlled medication. Precipitation occurs as a result of incompatibilities or improper mixing. The insertion of air into a vial facilitates the withdrawal of the medication. Omission of this does not cause medication precipitation.

436) Which teaching would a nurse give to a client with a prescription for potassium supplements? To report any abdominal distress To use salt substitutes to season food To take the medication on an empty stomach To increase the dosage if muscle cramps occur

To report any abdominal distress

720) Which clinical indicator would the nurse monitor to determine if the client's simvastatin is effective? Heart rate Triglycerides Blood pressure International normalized ratio (INR)

Triglycerides

473) Which nursing assessment would performed by a nurse before administering intravenous (IV) infusion of potassium chloride (KCl) 40 mEq in 100 mL of 5% dextrose and water to be infused over 2 hours? Select all that apply. One, some, or all responses may be . Urinary output Deep tendon reflexes Last bowel movement Arterial blood gas results Last serum potassium level Patency of the intravenous access

Urinary output Last serum potassium level Patency of the intravenous access

734) Which assessment would be brought to the health care provider's attention before administration of intravenous potassium chloride? Progressively worsening muscle weakness Poor tissue turgor with tenting Urinary output of 200 mL during the previous 8 hours Oral fluid intake of 300 mL during the previous 12 hours

Urinary output of 200 mL during the previous 8 hours Rationale: Decreased urinary output may result in the retention of potassium, causing hyperkalemia. Progressively worsening muscle weakness is a manifestation of hypokalemia, which is the reason for prescribing the potassium. Reporting poor tissue turgor with tenting is unnecessary; this may indicate dehydration, which is probably the rationale for the fluid prescribed. Reporting an oral fluid intake of 300 mL during the previous 12 hours is unnecessary; this can precipitate dehydration or can compound an existing dehydration, which can be treated with appropriate hydration.

34. A client with coronary artery disease who is taking digoxin (Lanoxin) receives a new prescription for atorvastatin (Lipitor). Two weeks after initiation of the Lipitor prescription, the nurse assesses the client. Which finding requires the most immediate intervention? A. Heartburn. B. Headache. C. Constipation. D. Vomiting.

Vomiting

326) Which response would a nurse monitor for when a client is receiving furosemide to relieve edema? Select all that apply. One, some, or all responses may be . Weight loss Negative nitrogen balance Increased urine specific gravity Pronounced retention of sodium ions Excessive loss of potassium ions

Weight loss Excessive loss of potassium ions

941) Which dietary choices will the nurse instruct the client taking spironolactone to avoid increasing? Select all that apply. One, some, or all responses may be . Potatoes Red meat Cantaloupe Wheat bread Yogurt

cantaloupe potatoes

186) Which instruction regarding nutrition will the nurse give a client discharged after a short hospitalization for an episode of a transient ischemic attack (TIA) related to hypertension who is on a regimen that includes chlorothiazide? "Eat more dark green, leafy vegetables such as spinach." "Substitute a potassium-based salt substitute for table salt." "Return to previous eating habits." "Increase intake of dairy products."

"Eat more dark green, leafy vegetables such as spinach." Rationale: The client should increase the dietary intake of potassium because of potassium loss associated with chlorothiazide. Leafy green vegetables are high in potassium and should be encouraged. Salt substitutes should only be used if prescribed by the provider; otherwise, they should be discouraged because electrolyte abnormalities may occur without close monitoring. Returning to previous eating habits may be unsafe for those who do not consume a nutritional diet; the client should be taught about medication-induced deficiencies and how to try to prevent future TIAs. Dairy products should be limited, unless fat-free, because they are high in saturated fats.

306) Which response would a nurse give to a client who takes furosemide and digoxin and reports that everything looks yellow? "This is related to your heart problems, not to the medication." "I will hold the medication until I consult with your health care provider." "It is a medication that is necessary, and that side effect is only temporary." "Take this dose, and when I see your health care provider, I will ask about it."

"I will hold the medication until I consult with your health care provider." dig tox

18 A client has been taking rosuvastatin for six weeks as part of a treatment plan to reduce hyperlipidemia. The clinic nurse is reviewing and reinforcing information about the medication with the client. Which statements by the client indicates an understanding about the medication? Select all that apply. "I will need to call my doctor if I have any muscle weakness or pain, especially in my legs." "I will need to come back to have my liver and kidney labs checked." "I need to be careful when I get up because this medication can make my blood pressure drop." "I add some nuts and fresh fruit to my oatmeal in the morning and I can't remember when I last ate a steak." "This medication has to be taken first thing in the morning, before I eat breakfast."

"I will need to call my doctor if I have any muscle weakness or pain, especially in my legs." "I add some nuts and fresh fruit to my oatmeal in the morning and I can't remember when I last ate a steak." "I will need to come back to have my liver and kidney labs checked."

300) Which instruction would the nurse include when teaching about hydrochlorothiazide given to a client diagnosed with a transient ischemic attack (TIA) related to hypertension? "Resume regular eating habits." "Drink a protein supplement daily." "Avoid eating foods high in insoluble fiber." "Increase the intake of potassium-rich foods."

"Increase the intake of potassium-rich foods." Rationale: The client must increase the dietary intake of potassium because of potassium loss associated with hydrochlorothiazide. The client should be taught about medication-induced deficiencies, which may necessitate a change in diet, and not just return to regular eating habits once home. Protein supplements are not necessary, and protein may be obtained from meat, fish, and dairy products in the diet or complementary vegetable and grain proteins. Foods high in insoluble fiber are part of the food pyramid and should be included in the diet.

390) Which information would the nurse include when preparing a teaching plan for a client prescribed sublingual nitroglycerin? "Place the tablet under the tongue or between the cheek and gums." "It takes 30 to 45 minutes for the nitroglycerin to achieve its effect." "If dizziness occurs, take a few deep breaths and lean the head back." "To facilitate absorption, drink a large glass of water after taking the medication."

"Place the tablet under the tongue or between the cheek and gums."

11. The nurse is collecting the health history of a client with heart disease who reports experiencing episodes of diarrhea. The client reports taking loperamide at home. Which of the following statements should the nurse make? "Taking this medication may increase your risk of an abnormal heart rhythm." "It is safe to drink alcohol while using this medication." "Using this medication may cause dependence." "Stop taking this medication if your symptoms do not improve by tomorrow."

"Taking this medication may increase your risk of an abnormal heart rhythm." Rationale: Loperamide decreases GI motility and is a nonprescription drug. It does not cause the central nervous system effects associated with opiate derivatives and lacks the potential for abuse. Loperamide should not be continued after 48 hours if improvement has not occurred. Loperamide has a black box warning because torsades de pointes, cardiac arrest, and death have been reported in people using higher than recommended dosages. Alcohol can increase the nervous system side effects of loperamide, such as dizziness, drowsiness, and difficulty concentrating.

2 The nurse is talking with a client who was admitted with an acute myocardial infarction due to coronary artery disease. The clients asks what the purpose for the prescribed carvedilol is. How should the nurse respond? "A beta blocker will prevent postural hypotension." "Most people develop hypertension after a heart attack." "This drug will decrease the workload on your heart." "Beta blockers will help to increase your heart rate."

"This drug will decrease the workload on your heart."

694) Which instruction would the nurse include when teaching the client about sublingual nitroglycerin? 'Once the tablet is dissolved, spit out the saliva.' 'Take tablets 3 minutes apart up to a maximum of five tablets.' 'Common side effects include headache and low blood pressure.' 'Once opened, the tablets should be refrigerated to prevent deterioration.'

'Common side effects include headache and low blood pressure.'

731) Which client statements indicate that the teaching about furosemide is understood? Select all that apply. One, some, or all responses may be . 'It may take 2 or 3 days for this medication to take effect.' 'I should wear dark glasses when outdoors during the day.' 'I should avoid lying flat in bed.' 'I need to change my position slowly.' 'I should eat more food that is high in potassium.'

'I need to change my position slowly.' 'I should eat more food that is high in potassium.'

1194) A client diagnosed with a transient ischemic attack (TIA) related to hypertension is discharged with a prescription of hydrochlorothiazide. Which instruction would the nurse include when teaching about this medication? 'Resume regular eating habits.' 'Drink a protein supplement daily.' 'Avoid eating foods high in insoluble fiber.' 'Increase the intake of potassium-rich foods.'

'Increase the intake of potassium-rich foods.'

1078) A client with hypertension is prescribed an angiotensin II receptor blocker (ARB). Which instructions will the nurse provide about this medication? Select all that apply. One, some, or all responses may be . 'Monitor the blood pressure daily.' 'Stop treatment if a cough develops.' 'Stop the medication if swelling of the mouth, lips, or face develops.' 'Have blood drawn for potassium levels 2 weeks after starting the medication.' 'Do not take nonsteroidal anti-inflammatory drugs (NSAIDs) concurrently with this medication.'

'Stop the medication if swelling of the mouth, lips, or face develops.' 'Have blood drawn for potassium levels 2 weeks after starting the medication.'

12. The nurse is transcribing a new prescription for spironolactone (Aldactone) for a client who receives an angiotensin-converting enzyme (ACE) inhibitor. Which action should the nurse implement? A. Verify both prescriptions with the healthcare provider. B. Report the medication interactions to the nurse manager. C. Hold the ACE inhibitor and give the new prescription. D. Transcribe and send the prescription to the pharmacy.

A. Verify both prescriptions with the healthcare provider. Rationale: The concomitant use of an angiotensin-converting enzyme (ACE) inhibitor and a potassium-sparing diuretic such as spironolactone, should be given with caution because the two drugs may interact to cause an elevation in serum potassium levels. Although the client is currently receiving an ACE inhibitor, verifying both prescriptions alerts the healthcare provider about the client's medication regimen and provides the safest action before administering the medication.

15 The inpatient hospital nurse is caring for a client with hypokalemia. The health care provider prescribed a potassium intravenous (IV) infusion of 40 mEq potassium chloride in 250 mL normal saline to be infused over 4 hours. The nurse receives the infusion from the pharmacy. Which action should the nurse take next? Confirm patency of the peripheral venous access device and start the infusion Notify the health care provider of the inappropriate dose of the prescribed IV potassium Ask another nurse to verify the prescription, IV solution and serum potassium level Ask another nurse to witness the addition of the prescribed potassium to the IV solution

Ask another nurse to verify the prescription, IV solution and serum potassium level

884) A client with an intravenous (IV) infusion containing 40 mEq of potassium reports a stinging pain at the IV site. Which actions will the nurse take? Select all that apply. One, some, or all responses may be . Restart the IV in a different vein. Assist the client through guided imagery. Assess the IV site. Ask the health care provider for pain medication. Verify that the potassium is adequately diluted and not infusing too rapidly.

Assess the IV site. Verify that the potassium is adequately diluted and not infusing too rapidly.

16 Propranolol is prescribed for a client with coronary artery disease (CAD). The nurse should consult with the health care provider (HCP) before giving this medication when the client reports a history of which condition? Asthma Deep vein thrombosis Myocardial infarction Peptic ulcer disease

Asthma

1079) A client is admitted to the hospital with a diagnosis of heart failure and acute pulmonary edema. The health care provider prescribes furosemide 40 mg intravenous (IV) stat to be repeated in 1 hour. Which nursing action will best evaluate the effectiveness of the furosemide in managing the client's condition? Performing daily weights Auscultating breath sounds Monitoring intake and output Assessing for dependent edema

Auscultating breath sounds

987) Which instructions will the nurse include in the teaching plan for a client who will be taking simvastatin? Select all that apply. One, some, or all responses may be . Increase dietary intake of potassium. Avoid prolonged exposure to the sun. Schedule regular ophthalmic examinations. Take the medication at least half an hour before meals. Contact your health care provider if skin becomes gray-bronze.

Avoid prolonged exposure to the sun. Schedule regular ophthalmic examinations. Contact your health care provider if skin becomes gray-bronze. RHABDO

13. The nurse is reviewing prescribed medications with a client. Which information should the nurse reinforce about captopril? Take the medication with meals. Avoid using salt substitutes. Restrict fluids to 1000 mL/day. Avoid green leafy vegetables.

Avoid using salt substitutes. Rationale: Captopril is an angiotensin converting enzyme (ACE) inhibitor. It reduces aldosterone secretion, thereby reducing sodium and water retention. Captopril is used to treat hypertension and heart failure. Because it can cause an accumulation of serum potassium (i.e., hyperkalemia), clients should avoid the use of salt substitutes, which often contain potassium instead of sodium chloride. The other information does not apply to captopril.

37. The nurse is providing care for a client prescribed propranolol. Which symptoms should the nurse report to the healthcare provider immediately? A. Headache, hypertension, and blurred vision. B. Wheezing, hypotension, and AV block. C. Vomiting, dilated pupils, and papilledema. D. Tinnitus, muscle weakness, and tachypnea.

B. Wheezing, hypotension, and AV block.

979) A client who is receiving atenolol for hypertension frequently reports feeling dizzy. Which effect of atenolol is responsible for this response? Depleting acetylcholine Stimulating histamine release Blocking the adrenergic response Decreasing adrenal release of epinephrine

Blocking the adrenergic response

11 The nurse on a cardiac unit is caring for a client who is receiving nitroglycerin intravenously for unstable angina. During administration of the medication, which assessment is the priority? Respiratory rate Cardiac enzymes Cardiac rhythm Blood pressure

Blood pressure

816) Which client response indicates to the nurse that a vasodilator medication is effective? Absence of adventitious breath sounds Increase in the daily amount of urine produced Pulse rate decreases from 110 to 75 beats/minute Blood pressure changes from 154/90 to 126/72 mm Hg

Blood pressure changes from 154/90 to 126/72 mm Hg

919) A client with hypertensive heart disease who had an acute episode of heart failure is to be discharged on a regimen of metoprolol and digoxin. Which outcome would the nurse anticipate when metoprolol is administered with digoxin? Headaches Bradycardia Hypertension Junctional tachycardia

Bradycardia

630) Which lifestyle advice does the nurse give to a client when oral digoxin therapy is initiated? Select all that apply. One, some, or all responses may be . Bran can decrease digoxin absorption. Digoxin should not be taken with hawthorn supplements. Ginseng may cause a dangerous increase in digoxin levels in the blood. St. John's Wort can increase digoxin levels in the blood. Medications that lower serum potassium or magnesium can cause digoxin toxicity.

Bran can decrease digoxin absorption. Ginseng may cause a dangerous increase in digoxin levels in the blood. Digoxin should not be taken with hawthorn supplements. Medications that lower serum potassium or magnesium can cause digoxin toxicity.

701) The nurse is administering 40 mg of furosemide intravenously. Which sensation reported by the client would the nurse consider when determining that it is being administered too quickly? Full bladder Buzzing ears Fast heartbeat Numb arms and legs

Buzzing ears

56. A client who was prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs. Which statement reflects the drug-specific teaching the nurse should provide to this client? A. Increase consumption of potassium-rich foods since low potassium levels can cause muscle spasms. B. Have serum electrolytes checked at the next scheduled appointment to assess hyponatremia, a cause of cramping. C. Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. D. Be sure to consume a low-cholesterol diet while taking the drug to enhance the effectiveness of the drug.

C. Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. RHABDO

860) A client receives a cardiac glycoside, a diuretic, an angiotensin-converting enzyme (ACE) inhibitor, and a vasodilator. The client's apical pulse rate is 44 beats/minute. The nurse concludes that the decreased heart rate is caused by which medication? Diuretic Vasodilator ACE inhibitor Cardiac glycoside

Cardiac glycoside Dig! slows and increases force of myocardial contractions

699) Atenolol is prescribed for a client with moderate hypertension. Which information would the nurse include when teaching the client about this medication? Select all that apply. One, some, or all responses may be . Change to standing positions slowly. Take the medication before going to bed. Count the pulse before taking the medication. Mild weakness and fatigue are common side effects. It is safe to take over-the-counter (OTC) medications.

Change to standing positions slowly. Count the pulse before taking the medication. Mild weakness and fatigue are common side effects.

672) How would the nurse determine if a client is experiencing the therapeutic effect of valsartan? Check a lipid profile. Assess an apical pulse. Measure urinary output. Check the blood pressure.

Check the blood pressure.

. A nurse is reviewing new prescriptions for a client diagnosed with heart failure. The nurse notes captopril 25mg PO. Which action does the nurse perform next? Administer the medication before meals Clarify the prescription with the healthcare provider Take the client's weight Check the client's latest creatinine level

Clarify the prescription with the healthcare provider

16. During morning rounds, a healthcare provider informs a client with hypertension that a calcium channel blocker will be added to their treatment regimen. The nurse notes a new prescription for amiloride 10 mg PO daily. Which action does the nurse perform next? Clarify the prescription with the healthcare provider Educate the client on the new prescription Administer the medication with food Assess the client's blood pressure

Clarify the prescription with the healthcare provider

15. A nurse is providing care to an older adult client with newly diagnosed heart failure. The nurse receives a prescription for digoxin PO 1.5 mg daily. Which action does the nurse perform next? Instruct the client to take the heart rate before administration the client on the purpose of digoxin Educate the client on the purpose of digoxin Administer the medication to the client Clarify the prescription with the healthcare provider

Clarify the prescription with the healthcare provider Too high Rationale: Older adult clients (geriatric) have a high sensitivity to the toxic effects of digoxin. A dose of 1.5 mg daily is above the recommended range for adults. The initial daily dose for a geriatric client should not exceed 0.125 mg. Educating the client on the purpose of digoxin and performing related assessments are expected interventions. However, the nurse should clarify the dose first. Administering the prescribed medication dose to the client may result in significant side effects.

1. The nurse is caring for a client who has taken atenolol for 2 years. The healthcare provider recently changed the medication to enalapril to manage the client's blood pressure. Which instruction should the nurse provide the client regarding the new medication? A. Take the medication at bedtime. B. Report presence of increased bruising. C. Check pulse before taking medication. D. Rise slowly when getting out of bed or chair

D. Rise slowly when getting out of bed or chair

7 The nurse is caring for a client who has been taking furosemide for the past week. Which manifestation would indicate that the client may be experiencing a negative side effect? Edema of the ankles Gastric irritability Weight gain of five pounds Decreased appetite

Decreased appetite

673) Captopril is prescribed for a client. Which effect would the nurse anticipate? Increased urine output Decreased anxiety Improved sleep Decreased blood pressure

Decreased blood pressure

952) A client who had a myocardial infarction receives a prescription for a nitroglycerin patch. Which statement would the nurse identify as the purpose of the nitroglycerin patch? Decreased heart rate lowers cardiac output. Increased cardiac output increases oxygen demand. Decreased cardiac preload reduces cardiac workload. Peripheral venous and arterial constriction increases peripheral resistance.

Decreased cardiac preload reduces cardiac workload.

886) A client with left ventricular heart failure and supraventricular tachycardia is prescribed digoxin 0.25 mg daily. Which changes would the nurse expect to find if this medication is therapeutically effective? Select all that apply. One, some, or all responses may be . Diuresis Tachycardia Decreased edema Decreased pulse rate Reduced heart murmur Jugular vein distention

Decreased edema Decreased pulse rate Diuresis

848) Amlodipine is prescribed for a client with hypertension. Which response to the medication will the nurse instruct the client to report to the health care provider? Blurred vision Dizziness on rising Difficulty breathing Excessive urination

Difficulty breathing

564) An infant with congenital heart disease is prescribed digoxin and furosemide upon discharge. Which sign would the nurse instruct the parents to be alert for? Difficulty feeding with vomiting Cyanosis during periods of crying Daily naps lasting more than 3 hours A pulse rate faster than 100 beats/min

Difficulty feeding with vomiting

696) A client who takes multiple medications complains of severe nausea, and the client's heartbeat is irregular and slow. The nurse determines that these signs and symptoms are toxic effects of which medication? Digoxin Morphine Sulfate Captopril Furosemide

Digoxin

67. A client with heart failure is being discharged with a new prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten). The nurse's discharge instructions should include reporting which problem to the healthcare provider? A. Weight loss. B. Dizziness. C. Muscle cramps. D. Dry mucous membranes.

Dizziness Rationale: Angiotensin-converting enzyme (ACE) inhibitors are used in heart failure to reduce afterload by reversing vasoconstriction common in heart failure. This vasodilation can cause hypotension and resultant dizziness. Weight loss is desired if fluid overload is present, and may occur as the result of effective combination drug therapy such as diuretics with ACE inhibitors. It does not require reporting to the healthcare provider. Unlike ACE inhibitors, diuretics may result in hypokalemia and excessive diuretic administration may result in fluid volume deficit manifested by symptoms of dehydration.

4. The nurse is assessing a postpartum client who is taking labetalol. Which client report should the nurse identify as a potential adverse effect of the medication? Nausea Ankle edema Abdominal pain Dizziness

Dizziness Rationale: Labetalol is a beta-blocker that is used for blood pressure management in postpartum clients. The mechanism of action for labetalol is to vasodilate, which could lead to a decrease in blood pressure. A client with a sudden drop in blood pressure could report dizziness. Report of nausea or ankle edema is normal during pregnancy. Abdominal pain in pregnancy could be from active labor or constipation.

A client is receiving metoprolol. Which potential effect will the nurse teach the client to expect? Dizziness with strenuous activity Acceleration of the heart rate after eating a heavy meal Flushing sensations after taking the medication Pounding of the heart

Dizziness with strenuous activity

523) Hypertension develops in a school-age child with acute glomerulonephritis. Which medication would the nurse anticipate providing teaching for? Digoxin Furosemide Diazepam Phenytoin

Furosemide Rationale: Furosemide inhibits the reabsorption of sodium and chloride from the loop of Henle and distal tubule, increasing urine output and thereby decreasing blood pressure. Digoxin increases the contractility and output of the heart; it is not an antihypertensive. Diazepam is inappropriate; it relaxes skeletal muscle, not the smooth muscle of the arterioles. Phenytoin is an anticonvulsant; it does not reduce blood pressure.

343) Which diuretic would the nurse anticipate administering to a client admitted with acute pulmonary edema? Furosemide Chlorothiazide Spironolactone Acetazolamide

Furosemide most effective

730) After the nurse provides education about hydrochlorothiazide, the client will agree to notify the health care provider regarding the development of which symptom? Insomnia Nasal congestion Increased thirst Generalized weakness

Generalized weakness

2 The nurse is caring for a client who was recently prescribed atropine as a treatment for symptomatic bradycardia. Which condition should the nurse question as a contraindication when taking this medication? Urinary incontinence Right-sided heart failure Glaucoma Increased intracranial pressure

Glaucoma CAD BPH

4. The nurse is assisting a client who is taking amlodipine with meal planning. Which fluid selected by the client would require follow up by the nurse? Black coffee Grapefruit juice Green tea Chocolate Milk

Grapefruit juice ABSOLUTELY NOT

438) Which adverse medication effect will a nurse monitor for in a client with cirrhosis of the liver who develops ascites and is prescribed spironolactone? Bruising Tachycardia Hyperkalemia Hypoglycemia

Hyperkalemia

978) Valsartan, an angiotensin II receptor antagonist, is prescribed for a client. The nurse will monitor the client for which adverse effect? Constipation Hyperkalemia Hypertension Change in visual acuity

Hyperkalemia Rationale: Hyperkalemia may occur with valsartan. Angiotensin II receptor antagonists, such as valsartan, block vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites to decrease blood pressure. Hypotension, not hypertension, may occur. Diarrhea, not constipation, may occur with valsartan. Valsartan does not cause altered visual acuity.

688) A client is given a prescription for bumetanide. The nurse will teach the client to watch for symptoms of which condition? Hypokalemia Hyperchloremia Hypernatremia Hypoglycemia

Hypokalemia

718) A client with a myocardial infarction receives intravenous nitroglycerin to relieve pain. The nurse will assess for which medication side effect? Nausea Delirium Bradycardia Hypotension

Hypotension

818) The health care provider prescribes atenolol for a client with angina. Which potential side effect will the nurse mention when instructing the client about this medication? Headache Tachycardia Constipation Hypotension

Hypotension

1069) A client presents to the emergency department with chest pain. A myocardial infarction is suspected, and 500 mL of 5% dextrose in water (D 5W) with 50 mg of nitroglycerin intravenously (IV) has been prescribed. The nurse will monitor the client for which common side effect of nitroglycerin? Bradycardia Hypotension Nausea and vomiting Leg cramps

Hypotension Rationale: The major action of intravenous nitroglycerin is venous and then arterial dilation, leading to a decrease in blood pressure; orthostatic hypotension can occur. Bradycardia is not an anticipated response. Nausea and vomiting may occur but are not the most common side effects of IV nitroglycerin. Leg cramps are not a side effect of this medication.

926) A health care provider prescribes enalapril for a client. Which nursing action is important? Assess the client for hypokalemia. Monitor for adverse effects on renal function. Monitor the client's blood pressure during therapy. Assess the client for hypoglycemia.

Monitor the client's blood pressure during therapy. Rationale: Enalapril is an antihypertensive. A lowering of the client's blood pressure reflects a therapeutic response and needs to be monitored regularly. The client may be at risk for hyperkalemia, not hypokalemia. Enalapril has renal protective effects rather than adverse renal effects. Although an antihypertensive of choice for some clients with diabetes, it does not affect glucose levels.

215) Which sign of hypokalemia will the nurse monitor for in a client receiving furosemide? Chvostek sign Muscle weakness Anxious behavior Abdominal cramping

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

18. The nurse is teaching a client with stable angina about their new prescription for nitroglycerin transdermal patch. Which instructions should the nurse include? Select all that apply. Remove the patch if ankle edema occurs Apply the patch to a hairless area of the body Notify your provider for persistent dizziness or any fainting episode Apply a second patch with chest pain Plan for patch-free time, usually overnight Rotate the application area

Notify your provider for persistent dizziness or any fainting episode Rotate the application area Apply the patch to a hairless area of the body Plan for patch-free time, usually overnight

43) Which instruction would the nurse give an unlicensed assistive personnel (UAP) to perform while caring for a client prescribed captopril? Select all that apply. One, some, or all responses may be . Obtain blood pressure. Measure intake and output. Weigh the client every morning. Notify the nurse if the client has a dry cough. Assist the client to change positions slowly.

Obtain blood pressure. Measure intake and output. Weigh the client every morning. Assist the client to change positions slowly. Notify the nurse if the client has a dry cough. Rationale: ACE inhibitors such as captopril are prescribed for the management of hypertension, heart failure, and diabetic nephropathy. The nurse would ask the UAP caring for a client taking captopril to perform several tasks. The UAP would obtain the client's blood pressure. The UAP would also measure the client's intake and output as well as obtain a daily weight in the morning. This data would help the nurse determine the client's fluid volume status and is an important component of heart failure management. The UAP would be aware that a dry cough is a common side effect of ACE inhibitors. Because of the blood pressure-lowering effects of this medication, the nurse would instruct the UAP to assist the client to make sure the client changes positions slowly.

924) A client who has type 1 diabetes and chronic bronchitis is prescribed atenolol for the management of angina pectoris. Which clinical manifestation will alert the nurse to the fact that the client may be developing a life-threatening response to the medication? Paroxysmal nocturnal dyspnea Supraventricular tachycardia Malignant hypertension Hyperglycemia

Paroxysmal nocturnal dyspnea

481) Which reason would an intravenous infusion of 5% dextrose with 0.45% sodium chloride and 20 mEq of potassium be prescribed for a client with a nasogastric (NG) tube set to low intermittent suction? Prevent constipation Prevent electrolyte imbalance Prevent dehydration Prevent vomiting

Prevent electrolyte imbalance

501) When the nurse is administering intravenous potassium to a client with hypokalemia, which finding is most important to communicate to the health care provider? U waves on cardiac monitor QRS duration of 0.28 seconds Decreased bowel sounds Weakened grip strength

QRS duration of 0.28 seconds

1 The nurse is assessing a client with hypertension who reports experiencing dizziness after taking prescribed diltiazem. It is most important that the nurse assesses for which client characteristic? Schedule for taking medication Appearance of feet and ankles Activity and rest patterns Daily intake of potassium

Schedule for taking medication Rationale: A critical focus is whether the client has complied with the prescribed medication schedule and dose. Although diltiazem (Cardizem, Cartia, Dilacor, Diltia, Taztia, Tiazac) can be taken either in the morning or evening, taking the medication in the evening might help with this common side effect.

923) When a client's cells are deprived of oxygen during a cardiac arrest, which medication s for deleterious effects of anaerobic energy production? Regular insulin Calcium gluconate Potassium chloride Sodium bicarbonate

Sodium bicarbonate Rationale: In the absence of oxygen, the body derives its energy anaerobically; this results in a buildup of lactic acid. Sodium bicarbonate, an alkaline medication, will help neutralize the acid, raising the pH. Insulin is used to treat diabetes; it lowers blood sugar by facilitating transport of glucose across cell membranes. Calcium gluconate is used to treat hypocalcemia. Although potassium is essential for cardiac function, it will not acidosis. With acidosis, serum hydrogen ions will exchange with intracellular potassium, leading to a temporary hyperkalemic state; therefore potassium chloride is contraindicated until acidosis is ed.

225) Which information will the nurse include when teaching a client about potassium chloride effervescent tablets? Chew the tablet completely. Take the medication with food. Take the medication at bedtime. Use warm water to dissolve the tablet.

Take the medication with food. decreases gastric irritation