Evolve Pharm. Exam 4
Which side effect of morphine [Duramorph] does not subside over time? A. Constipation B. Sedation C. Respiratory depression D. Nausea and vomiting
A
The healthcare provider prescribes heparin 2500 units subcutaneous daily. The drug is available in 10,000 units per mL. How may milliliters will the nurse give?
0.25 mL
The patient's heparin is infusing at 11 mL/hr. The bag of fluid is mixed 25,000 units of heparin in 250 mL D5W. What hourly dose is the patient receiving?
1100 units/hr
The patient's heparin is infusing at 28 mL/hr. The bag of fluid is mixed 20,000 units of heparin in 500 mL D5W. What hourly dose is the patient receiving?
1120 units/hr
A postoperative patient has an epidural infusion of morphine sulfate [Astramorph]. The patient's respiratory rate declines to 8 breaths per minute. Which medication would the nurse anticipate administering? A. Naloxone [Narcan] B. Acetylcysteine [Mucomyst] C. Methylprednisolone [Solu-Medrol] D. Protamine sulfate
A
Which drug is the most effective for lowering LDL cholesterol? A. Atorvastatin [Lipitor] B. Cholestyramine [Questran] C. Gemfibrozil [Lopid] D. Ezetimibe [Zetia]
A
The healthcare provider prescribes heparin 900 units/hr. The label on the IV bag reads Heparin 10,000 units in 500 mL D5W. How many mL/hr will deliver the correct dose?
45 mL
A patient with angina is being discharged with a prescription for nitroglycerin sublingual tablets. Which instruction should the nurse include? A. "Store the tablets in the original container and tightly close it after use." B. "The tablets are only good for 1 month after the container is opened." C. "Sublingual nitroglycerin tablets are also effective when swallowed whole." D. "Effects of sublingual nitroglycerin begin in 5 to 10 minutes."
A
A patient with chronic pain has a fentanyl patch applied to his right shoulder. The patient reports that his arm hurts and he requests a warm pack to apply to the area. Which statement by the nurse is correct? A. "Putting a warm pack on the area where the fentanyl patch is located could accelerate fentanyl release." B. "Your arm probably hurts because of the fentanyl patch." C. "I can remove your patch and reapply it after you are done with the warm pack." D. "The fentanyl patch is heat resistant, so I will get you a warm pack."
A
A patient with nonvalvular atrial fibrillation is to be discharged on dabigatran etexilate [Pradaxa]. Which statement should the nurse include in the discharge teaching? A. "The medication must be stored in the manufacturer-supplied bottle." B. "Once a new bottle is opened, the capsules maintain efficacy for 90 days." C. "If you have difficulty swallowing the capsule, you can open it and mix it with food." D. "You will need to learn how to give yourself a subcutaneous injection in your abdomen."
A
Which intravenous (IV) fluid would be most appropriate for treating isotonic volume contraction? A. 0.9% sodium chloride B. 5% dextrose and water C. 0.225% sodium chloride D. 3% sodium chloride and water
A
In the failing heart, arterial pressure falls, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. The nurse understands increased sympathetic activity will produce which response? A. Tachycardia B. Bradypnea C. Hypotension D. Hypoglycemia
A
The laboratory calls to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate? A. Notify the healthcare provider to discuss the reduction or withdrawal of heparin. B. Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level. C. Obtain vitamin K and prepare to administer it by intramuscular (IM) injection. D. Observe the patient and monitor the activated partial thromboplastin time (aPTT) as indicated.
A
The nurse has just administered the initial dose of enalapril [Vasotec] to a newly admitted patient with hypertension. What is the priority nursing intervention over the next several hours? A. Monitor blood pressure. B. Check the heart rate. C. Auscultate lung sounds. D. Draw a potassium level.
A
The nurse is administering intravenous lidocaine [Xylocaine] to a patient with a ventricular dysrhythmia. What is the priority nursing intervention to prevent a potential complication with this drug? A. Monitor the electrocardiogram (ECG). B. Obtain a complete blood count. C. Instruct to report any chest pain. D. Keep naloxone [Narcan] at the bedside.
A
The nurse is caring for a patient who has been receiving intravenous sodium nitroprusside [Nitropress] for 3 days. Which assessment data indicate the patient may be experiencing thiocyanate toxicity? A. Sudden confusion B. Difficulty breathing C. Erythematous rash D. Gastrointestinal bleeding
A
The nurse is caring for a pregnant patient experiencing a new episode of hypertension. Which medication does the nurse anticipate will be prescribed for this patient? A. Methyldopa [Aldomet] B. Propranolol [Inderal] C. Captopril [Capoten] D. Valsartan [Diovan]
A
The nurse is preparing to administer a daily dose of digoxin [Lanoxin]. What is the priority nursing intervention? A. Analyze heart rate and rhythm. B. Assess for Homans' sign. C. Check blood pressure. D. Palpate the pedal pulses.
A
The nurse is preparing to administer an oral dose of digoxin [Lanoxin]. The apical pulse rate is 64. What nursing action is most appropriate? A. Give the medication. B. Obtain a serum digoxin level. C. Notify the healthcare provider. D. Assess for signs of digoxin toxicity.
A
The nurse is reviewing the home medication list with the patient. The nurse recognizes that hydrochlorothiazide is used primarily for which condition? A. Hypertension B. Edema C. Diabetes insipidus D. Protection against postmenopausal osteoporosis
A
The nurse knows that diuretics mostly affect which function of the kidneys? A. Cleansing and maintenance of extracellular fluid volume B. Maintenance of acid-base balance C. Excretion of metabolic waste D. Elimination of foreign substances
A
The nurse reviews the medication treatment regimen for a patient with chronic hypertension. To promote optimal medication adherence, which frequency of drug dosing should the nurse advocate for this patient? A. Once a day B. Three times a day C. Four times a day D. Every 8 hours
A
The nurse should monitor for which adverse effect after administering hydrochlorothiazide [HydroDIURIL] and digoxin [Lanoxin] to a patient? A. Digoxin toxicity B. Decreased diuretic effect C. Dehydration D. Heart failure
A
What is the most common sustained dysrhythmia among the U.S. population? A. Atrial fibrillation B. Atrial flutter Incorrect C. Sustained supraventricular tachycardia (SVT) D. Ventricular premature beats (VPBs)
A
Which acid-base imbalance is caused by retention of CO2secondary to hypoventilation? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
A
Which agent is most likely to cause serious respiratory depression as a potential adverse reaction? A. Morphine [Duramorph] B. Pentazocine [Talwin] C. Hydrocodone [Lortab] D. Nalmefene [Revex]
A
Which discharge instructions should the nurse include for a patient prescribed cholestyramine [Questran]? A. Mix the drug with water or juice. B. Take with all other morning medications. C. Take 325 mg of aspirin 30 minutes before each dose. D. Notify the healthcare provider if upper abdominal discomfort occurs.
A
A patient is being discharged from the hospital on warfarin [Coumadin] for deep vein thrombosis prevention. Which instructions should the nurse include in the patient's discharge teaching plan? (Select all that apply.) A. Wear a medical alert bracelet. B. Check all urine and stool for discoloration. C. Do not start any new medication without first talking to your healthcare provider. D. Enteric-coated aspirin and any aspirin products can be used unless they cause a gastrointestinal ulcer. E. No laboratory or home monitoring of international normalized ratio (INR) is required after the first 6 months.
A, B, C
What are the primary regulatory systems of arterial pressure? (Select all that apply.) A. Autonomic nervous system B. Renin-angiotensin-aldosterone system C. Renal system D. Pulmonary system E. P450 enzyme system
A, B, C
Which are beneficial effects that can be derived from simvastatin [Zocor] and other drugs in this class? (Select all that apply.) A. Reduction of LDLs B. Elevation of HDLs C. Stabilization of the plaque in coronary arteries D. Reduction of risk of cardiovascular events Correct E. Improvement of liver function
A, B, C, D
Constipation is a side effect of opioid medications because of which of the following pathophysiologic reasons? (Select all that apply.) A. Decreasing propulsive intestinal contractions B. Increasing nonpropulsive contractions C. Increasing the tone of the anal sphincter D. Delaying gastric transit time E. Reducing fluid secretion into the intestinal lumen
A, B, C, E
Which medications should be used with caution in a hypertensive diabetic patient? (Select all that apply.) A. Furosemide [Lasix] B. Metoprolol [Lopressor] C. Diltiazem [Cardizem] D. Hydrochlorothiazide [HCTZ] E. Enalapril [Vasotec]
A, B, D
Which of the following statements about mannitol [Osmitrol] are correct? (Select all that apply.) A. Mannitol cannot be given orally. B. Mannitol can cause edema. C. Mannitol can cause renal failure. D. Diuresis begins in 30 to 60 minutes after administration. E. Mannitol is a loop diuretic.
A, B, D
Which patient symptoms should cause the nurse to be concerned about digoxin [Lanoxin] toxicity? (Select all that apply.) A. Fatigue B. Vomiting C. Dizziness D. Blurred vision E. Muscle weakness
A, B, D
A patient in a hypertensive crisis is being started on a continuous sodium nitroprusside [Nipride] infusion. Which interventions are essential beforethe nurse administers nitroprusside [Nipride]? (Select all that apply.) A. Obtain a baseline weight and weigh daily. Correct B. Prepare for arterial line insertion. Correct C. Discontinue the infusion when blood pressure is controlled. D. Observe for signs of hypertrichosis during the infusion. E. Cover the solution with an opaque bag.
A, B, E
The healthcare provider prescribes lovastatin [Mevacor] for a patient discharged from the hospital post-myocardial infarction. Which instructions are most appropriate for the nurse to include in the patient's teaching plan? (Select all that apply.) A. "Do not start any new medications without first talking to your healthcare provider." B. "Before starting this medication a blood test will be done to check your total cholesterol level and to measure liver enzymes." C. "Take your medication in the morning, with a full glass of water for best results." D. "Take one 325-mg aspirin 30 minutes before your dose to lessen the problem of flushing and itching that can occur with this drug." E. "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains."
A, B, E
The nurse is teaching a patient with essential hypertension who has a new prescription for verapamil [Calan]. Which statements by the patient indicate that the teaching was effective? (Select all that apply.) A. "I will increase my intake of fluid and foods high in fiber." B. "I should stay out of direct sunlight to prevent exposing my skin to the sun." C. "I will call my healthcare provider if I notice swelling in my ankles." D. "I need to avoid salt substitutes and potassium supplements." E. "I may notice easy bruising and bleeding with this drug."
A, C
The nurse understands patients receiving nitroglycerin are at risk for which adverse effects? (Select all that apply.) A. Headache B. Wheezing C. Dizziness D. Tachycardia E. Bradycardia
A, C, D
The nurse is caring for a group of patients taking warfarin [Coumadin]. Which patients are at moderate to high risk for harm as a result of warfarin therapy? (Select all that apply.) A. A patient with variant genes that code for VKORC1 and CYP2CP B. A patient with a current INR of 2.2 treated for deep vein thrombosis C. A woman with a new onset of symptoms of a pulmonary embolus D. A patient on day 4 after hip replacement with a new order for warfarin E. A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen
A, C, E
The nurse is caring for a patient who is being treated with opioids for cancer pain. The patient has become agitated and is reporting visual disturbances. The nurse suspects opioid-induced neurotoxicity. The nurse anticipates which management actions? (Select all that apply.) A. IV fluids B. Naloxone (Narcan) C. Decreasing the dose of the opioid D. Using NSAIDs instead of opioids E. Rotating different opioids
A, C, E
Which instructions should the nurse include when developing a teaching plan for a patient prescribed diltiazem [Cardizem] for atrial fibrillation? (Select all that apply.) A. Weigh yourself daily at the same time each day. B. The medication will not cause dizziness or headache. C. Notify the healthcare provider if a skin rash develops. D. Do not take daily oral calcium supplements. E. Rise slowly from a lying to a sitting position.
A, C, E
A patient with angina pectoris has been prescribed nifedipine [Procardia].Which possible adverse effects should the nurse expect with this medication? (Select all that apply.) A. Headache B. Constipation C. Nausea and vomiting D. Edema of ankles and feet E. Overgrowth of gum tissue
A, D, E
A patient is receiving continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor? (Select all that apply.) A. Platelets B. Vitamin K C. Prothrombin time (PT) D. International normalized ratio (INR) E. Activated partial thromboplastin time (aPTT)
A, E
A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine? I don't have any pain." The nurse's response is based on the knowledge that codeine also has which effect? A. Immunostimulant B. Antitussive C. Expectorant D. Decongestant
B
A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. What medication would be appropriate for this patient who has a history of heparin-induced thrombocytopenia (HIT)? A. Warfarin [Coumadin] B. Lepirudin [Refludan] C. Bivalirudin [Angiomax] D. Eptifibatide [Integrilin]
B
A patient develops supraventricular tachycardia (SVT) and is hypotensive. Which medication should the nurse anticipate will be administered? A. Lidocaine [Xylocaine] B. Adenosine [Adenocard] C. Amiodarone [Cordarone] D. Phenytoin [Dilantin]
B
A patient is admitted to the unit in a hypertensive emergency and examination reveals papilledema. The nurse should expect which IV medications to be administered to achieve rapid, controlled reduction of the patient's blood pressure? A. Furosemide [Lasix] B. Sodium nitroprusside [Nitropress] C. Metoprolol [Lopressor] D. Diltiazem [Cardizem]
B
A patient is prescribed lisinopril [Prinivil] 40 mg by mouth once a day for hypertension. For which therapeutic effect will the nurse monitor? A. Slowing of the heart rate B. Decrease in blood pressure C. Symptoms such as dizziness and fainting D. Pulse oximetry oxygen saturation of 100%
B
A patient is receiving isosorbide dinitrate [Isordil] 20 mg 3 times/day for management of newly diagnosed stable angina. Which assessment finding would require an immediate nursing intervention? A. A change in blood pressure from 122/70 to 108/66 mm Hg B. An increase in the resting heart rate to 110 beats/min from baseline rates of 68 to 72 beats/min C. A headache the patient rates as a 5 on a pain scale of 0 to 10 D. Report of increased frequency of urination
B
A patient with chronic pain was admitted to the hospital. The physician orders morphine PO 5 mg every 4 hours. The patient states that he usually takes his home morphine prescription 10 mg every 4 hours and has been for several months. This patient is at risk for which of the following? A. Physical dependence B. Abstinence syndrome C. Addiction D. Tolerance
B
A patient with deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response? A. Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting factors. B. Heparin suppresses coagulation by helping antithrombin perform its natural functions. C. Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot matrix. D. Heparin inhibits the enzyme responsible for platelet activation and aggregation within vessels.
B
About which patient should the nurse notify the healthcare provider immediately? A. A patient who takes digoxin [Lanoxin] 0.125 mg orally daily with a serum digoxin level of 0.8 ng/mL B. A patient who takes oral spironolactone [Aldactone] 25 mg daily and enalapril [Vasotec] 5 mg daily with a serum potassium level of 5.5 mEq/L C. A patient who takes digoxin [Lanoxin] 0.25 mg orally daily with a serum potassium level of 4.0 mEq/L D. A patient who takes oral lisinopril [Zestril] 5 mg daily and digoxin 0.125 mg daily with a serum digoxin level of 0.5 ng/mL
B
In which part of the conduction pathway in a healthy heart is the electrical impulse delayed to provide time for the blood to fill the ventricles? A. Bundle of His B. AV node C. Purkinje system D. Internodal pathways
B
The healthcare provider orders celecoxib [Celebrex] 200 mg PO every day for pain in the postoperative patient. The medication available is celecoxib [Celebrex] 200 mg. How many capsules will the nurse administer? A. 0.5 B. 1 C. 2 D. 3
B
The healthcare provider orders celecoxib [Celebrex] 200 mg PO every day for pain in the postoperative patient. The nurse knows that this medication is which classification? A. Opioid analgesic B. Selective COX-2 inhibitor C. Propionic acid derivative D. Salicylate
B
The healthcare provider prescribes an intravenous dose of diltiazem [Cardizem] for treatment of a patient with atrial fibrillation. What is the priority nursing intervention? A. Assist with cardioversion. B. Monitor electrocardiogram. C. Obtain baseline coagulation studies. D. Assess for increased urinary output.
B
The heart undergoes cardiac remodeling during the initial phase of heart failure. Which cardiac geometric change occurs during heart failure? A. Ventricular constriction B. Ventricular wall thickening C. Ventricular atrophy D. Ventricles become more cylindric
B
The nurse is caring for a patient prescribed a cholesterol-lowering drug. Which drug is least likely to cause systemic side effects? A. Simvastatin [Zocor] Incorrect B. Colesevelam [Welchol] C. Nicotinic acid [Niaspan] D. Gemfibrozil [Lopid]
B
The nurse is caring for a patient receiving a nitroprusside [Nipride] intravenous infusion. The patient's wife asks why furosemide [Lasix] is being prescribed along with this drug. The nurse's response is based on which concept? A. Furosemide will help reduce reflex tachycardia. B. Many vasodilators cause retention of sodium and water. C. Thiocyanate may accumulate in patients receiving nitroprusside. D. Vasodilators can cause serious orthostatic hypotension.
B
The nurse is caring for a patient receiving amiodarone [Cordarone]. Which body system should the nurse assess for serious adverse effects of this medication? A. Musculoskeletal B. Respiratory C. Integumentary D. Gastrointestinal
B
The nurse is caring for a patient receiving clopidogrel [Plavix] to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel? A. Aspirin [Bayer] B. Omeprazole [Prilosec] C. Acetaminophen [Tylenol] D. Warfarin [Coumadin]
B
The nurse is caring for a patient who has diabetes and hypertension. Which medication is most likely to be prescribed to treat this patient's hypertension? A. Hydrochlorothiazide [HCTZ] B. Enalapril [Vasotec] C. Propranolol [Inderal] D. Methyldopa [Aldomet]
B
The nurse is caring for a patient who is receiving enteral feedings because of dysphagia. The healthcare provider prescribes isosorbide mononitrate [Imdur] 60 mg SR daily via the enteral tube. What is the most appropriate action by the nurse? A. Have the patient swallow the pill, because it cannot be crushed. B. Call the healthcare provider about an alternate form of nitrate for administration. C. Crush the Imdur into a fine powder, dilute it with water, and administer it via the enteral tube. D. Place the nitrate under the patient's tongue and let it dissolve, because the person has dysphagia.
B
The nurse is caring for a patient with bipolar disorder treated with lithium [Eskalith]. The patient has a new prescription for captopril [Capoten] for hypertension. The combination of these two drugs makes which assessment particularly important? A. Potassium level B. Lithium level C. Creatinine level D. Blood pressure
B
The nurse is interpreting an electrocardiogram (ECG). Which component represents the depolarization of the ventricles? A. P wave B. QRS complex C. ST segment D. T wave
B
The nurse is planning care for a patient receiving morphine sulfate [Duramorph] by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug? A. Administering a cough suppressant B. Inserting a Foley catheter C. Administering an antidiarrheal D. Monitoring liver function tests
B
The nurse is providing discharge teaching for a patient with a new prescription for a nitroglycerin transdermal patch. Which statement by the patient indicates a need for further teaching? A. "I will remove my patch at bedtime each evening." B. "I will limit my alcohol to one drink per day." C. "I will not use Viagra as long as I am on nitroglycerin." D. "I will move slowly when changing positions."
B
The nurse is ready to begin a heparin infusion for a patient with evolving stroke. The baseline activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved? A. 50 B. 70 C. 90 D. 110
B
The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? A. "I can take this medication in the morning to reduce nighttime urination." B. "I will rise slowly when changing from a sitting to a standing position." C. "My heart rate may slow down with this drug. I will call if my pulse is below 60." D. "I need to increase my intake of fluids and foods that are high in fiber."
B
The nurse is working on a postoperative unit in which pain management is part of routine care. Which statement is the most helpful in guiding clinical practice in this setting? A. At least 30% of the U.S. population is prone to drug addiction and abuse. B. The development of opioid dependence is rare when opioids are used for acute pain. C. Morphine is a common drug of abuse in the general population. D. The use of PRN (as needed) dosing provides the most consistent pain relief without risk of addiction.
B
The nurse knows that which organ is primarily responsible for maintaining fluid volume and osmolality? A. Liver B. Kidneys C. Blood vessels D. Heart
B
The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising the blood pressure? A. Angiotensin I B. Angiotensin II C. Angiotensin III D. Renin
B
What is the primary benefit of spironolactone [Aldactone] in patients with heart failure? A. Increase in diuresis and fluid loss B. Blockage of aldosterone receptors C. Inhibition of beta activation by norepinephrine D. Stimulation of the renin-angiotensin-aldosterone system
B
Which acid-base imbalance is caused by hyperventilation? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
B
Which classes of medications are prescribed as initial therapy for hypertension after a myocardial infarction (MI)? A. Diuretic and beta blocker B. Beta blocker and ACE inhibitor C. ACE inhibitor and calcium channel blocker D. Diuretic and calcium channel blocker
B
Which condition do the natriuretic peptides serve to protect the cardiovascular system? A. Hypovolemia B. Volume overload C. Myocardial infarction D. Hypotension
B
Which condition should the nurse anticipate when the patient has received an intraspinal opioid medication to control cancer pain? A. Reduced risk of nausea, vomiting, and constipation B. Potential for delayed respiratory depression and catheter-related infections C. Less need for rescue medication to control breakthrough pain D. Greater risk of paresthesias and numbness in the lower extremities
B
Which needle length and gauge should the nurse choose to administer subcutaneous heparin? A. ½ inch; 20 gauge B. ⅝ inch; 25 gauge C. 1½ inch; 18 gauge D. 1 inch; 26 gauge
B
Which physiologic mechanism helps to ensure venous return despite low pressure in the venules? A. Positive pressure in the right atrium B. Negative pressure in the right atrium C. Vasodilation in the periphery D. Cardiac muscle relaxation
B
A patient diagnosed with a pulmonary embolism is receiving a continuous heparin infusion at 1000 units/hr. Of which findings should the nurse immediately notify the healthcare provider? (Select all that apply.) A. aPTT of 65 seconds B. aPTT of 40 seconds C. Nosebleeds D. aPTT of 100 seconds E. Platelet count of 300,000/mcL
B, C, D
A patient is prescribed hydralazine [Apresoline] for the treatment of essential hypertension. Which expected adverse effects should the nurse discuss with the patient? (Select all that apply.) A. Nausea B. Fatigue C. Dizziness D. Headache E. Joint pain
B, C, D
Which are the main types of drugs used to prevent or relieve anginal pain? (Select all that apply.) A. Platelet inhibitors B. Beta blockers C. Nitrates D. Calcium channel blockers E. Statins
B, C, D
Which statements accurately reflect Starling's law as applied to a healthy heart? (Select all that apply.) A. When venous return increases, stroke volume decreases. B. The right and left ventricles pump the same amount of blood. C. Cardiac output is equal to the volume of blood delivered by the veins. D. When venous return increases, cardiac output increases. E. As cardiac muscle fibers increase in length, their contractile force decreases.
B, C, D
A patient with end-stage breast cancer is experiencing ineffective pain management. Which statements represent the most likely cause of this problem? (Select all that apply.) A. Most cancer pain is neuropathic and difficult to relieve. B. Many cancer patients are reluctant to take pain medication. C. Healthcare professionals often fear patient addiction to pain medication. D. Nociceptive pain does not respond well to traditional pain medications. E. The healthcare system often places a low priority on pain management.
B, C, E
A nurse administers naloxone [Narcan] to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication? A. Drowsiness B. Tics and tremors C. Increased pain D. Nausea and vomiting
C
A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug? A. + 2 edema of the lower extremities B. Potassium level of 3.5 mEq/L C. Crackles in the lungs are no longer heard D. Jugular vein distention
C
A patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which finding by the nurse most likely indicates an adverse reaction to this drug? A. Urticaria, itching, and flushing B. Blood pressure of 90/50 mm Hg C. Decreasing level of consciousness D. Potassium level of 5.5 mEq/L
C
A patient with an acute myocardial infarction is prescribed an intravenous (IV) bolus of tenecteplase [TNKase]. The patient weighs 160 lb. The nurse will administer what dosage? A. 30 mg B. 35 mg C. 40 mg D. 45 mg
C
A patient with an elevated triglyceride level is prescribed a sustained-release form of nicotinic acid [Slo-Niacin]. Which laboratory value is most important for the nurse to monitor for in this patient? A. Blood urea nitrogen (BUN) B. Complete blood count (CBC) C. Alanine aminotransferase (ALT) D. Creatine kinase (CK)
C
A patient with hypertensive emergency is admitted to the hospital. Which medication should the nurse be prepared to administer to this patient? A. Minoxidil [Loniten] B. Hydralazine [Apresoline] C. Sodium nitroprusside [Nipride] D. Hydralazine and isosorbide dinitrate [BiDil]
C
Amiodarone [Cordarone] is prescribed for a patient with atrial fibrillation. What is the most important nursing intervention before administering this medication? A. Document an ophthalmic examination was performed. B. Explain a dermatologic evaluation is needed. C. Obtain baseline serum thyroid and liver function studies. D. Maintain NPO for transesophageal echocardiogram (TEE).
C
An adult male patient is taking medication for blood pressure management. The patient states to the nurse, "I'm not going to take these drugs anymore, because they are interfering with my sex life." What is the most appropriate response by the nurse? A. "It is unfortunate these drugs can cause erectile dysfunction but managing your blood pressure is more important than your sexual performance." B. "I understand how discouraging it must be to live with this adverse effect, but you could have a stroke if you do not take your blood pressure medications." C. "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect." D. "I am glad you told me about your experience with this common side effect. Sexual performance can be a difficult subject to discuss."
C
Calcium channel blockers work by reducing calcium influx into the cells of the heart and blood vessels. Calcium channels are coupled to which type of autonomic nervous system receptors? A. Alpha1 B. Alpha2 C. Beta1 D. Beta2
C
The healthcare provider orders furosemide [Lasix] 20 mg IV twice daily. The medication available is furosemide [Lasix] 10 mg/mL. How many mL will the nurse administer with each dose? A. 0.5 mL B. 1 mL C. 2 mL D. 4 mL
C
The healthcare provider orders mannitol 72 gm infusion over 24 hours. The nurse plans to set the infusion pump for how many grams per hour? A. 1 gm B. 2 gm C. 3 gm D. 4 gm
C
The nurse is caring for a patient prescribed aliskiren [Tekturna]. How does this medication lower blood pressure? A. It blocks the conversion of angiotensin I to angiotensin II. B. It prevents angiotensin II from binding to its receptors. C. It inhibits the conversion of angiotensinogen into angiotensin I. D. It selectively blocks aldosterone receptors in the kidneys.
C
The nurse is caring for a patient prescribed digoxin [Lanoxin] for heart failure. Which finding would require immediate attention by the nurse? A. Potassium level of 3.7 mEq/L B. Digoxin level of 0.7 ng/mL C. Vomiting and diarrhea D. Heart rate of 68 beats/min
C
The nurse is caring for a patient prescribed quinidine [Quinaglute] for a supraventricular dysrhythmia. What is a common adverse effect of this drug? A. Constipation B. Urinary retention C. Diarrhea D. Blurred vision
C
The nurse is caring for a patient receiving IV therapy with a 3% sodium chloride infusion at 75 mL/hr. The nurse should closely monitor for which adverse effect of treatment? A. Blood urea nitrogen of 22 mg/dL B. Tenting of the skin and dry mucous membranes C. Distended neck veins and ankle edema D. Sodium level of 140 mEq/L
C
The nurse is caring for a patient receiving nitrates for relief of angina. What pharmacodynamic action is responsible for the relief of anginal pain with nitrates? A. Vasoconstriction leads to improved cardiac output. B. Decreased force of contraction leads to decreased oxygen demand. C. Vasodilation leads to decreased preload, which decreases oxygen demand. D. Influx of calcium ions leads to relaxation of vascular smooth muscle.
C
The nurse is caring for a patient receiving oral magnesium gluconate. Which symptom indicates a common adverse effect of this medication? A. Headache B. Wheezing C. Loose stools D. Urinary retention
C
The nurse is caring for a patient who takes spironolactone [Aldactone] and quinapril [Accupril] for treatment of heart failure. What finding indicates a potential interaction between these two drugs? A. Elevated serum quinapril level B. Heart rate of 58 beats/min C. Potassium level of 5.7 mEq/L D. Glucose level of 180 mg/dL
C
The nurse is caring for a patient with heart failure who needs a diuretic. Which agent is likely to be chosen, because it has been shown to greatly reduce mortality in patients with heart failure? A. Furosemide [Lasix] B. Hydrochlorothiazide [HydroDIURIL] C. Spironolactone [Aldactone] D. Mannitol [Osmitrol]
C
The nurse is caring for a patient with renal artery stenosis who has been prescribed benazepril [Lotensin]. Which laboratory result indicates an adverse effect of this drug? A. Potassium level of 3.2 mEq/L B. Blood glucose level of 180 mg/dL C. Serum creatinine level of 2.3 mg/dL D. Uric acid level of 10 mg/dL
C
The nurse is caring for several patients. For which patient diagnosis would a prescription for nifedipine [Adalat] be least appropriate? A. Angina pectoris B. Essential hypertension C. Atrial fibrillation D. Vasospastic angina
C
The nurse is conducting a pain assessment for a patient with cancer. Which data will be the most helpful in assessing the patient's current level of pain? A. Vital signs and surgical history B. Pain pump attempt history C. Patient's description of pain D. Patient's nonverbal behavior
C
The nurse is evaluating the teaching done with a patient who has a new prescription for fosinopril [Monopril]. Which statement by the patient indicates a need for further teaching? A. "I can take this medicine with breakfast each morning." B. "I will call if I notice a rash or wheals on my skin." C. "I will use a salt substitute to lower my sodium intake." D. "I will call if I develop a bothersome cough."
C
The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin? A. Heart rate of 60 beats/min B. Blood pressure of 160/88 mm Hg C. Discolored urine D. Inspiratory wheezing
C
The nurse is monitoring a patient receiving ranolazine [Ranexa] for angina. Which assessment finding indicates an adverse effect of this drug? A. Blood pressure of 90/50 mm Hg B. Frequent bloody stools C. QT prolongation on the electrocardiogram D. Respiratory rate of 11 breaths per minute
C
The nurse is planning care for a patient at risk for dysrhythmias. The nurse understands that the Cardiac Arrhythmia Suppression Trial (CAST) confirmed which finding? A. Most atrial rhythm problems should be treated with medication. B. After a myocardial infarction, all dysrhythmias should be treated.Incorrect C. Dysrhythmias should be treated only when they are symptomatically significant. D. Most rhythm problems result in bradydysrhythmias.
C
The nurse is preparing to administer IV potassium to a patient with hypokalemia. Which prescription is the most appropriate? A. Potassium chloride 30 mEq in 100 mL IV over 1 hour B. Potassium chloride 10 mEq in 100 mL IV over 30 minutes C. Potassium chloride 10 mEq in 100 mL IV over 1 hour D. Potassium chloride 10 mEq IV push over 1 minute
C
The nurse is teaching a group of patients about dietary approaches to reduce cholesterol levels. Which statement is most important to include in the teaching? A. "Lower your cholesterol to 300 mg/day." B. "Eliminate red meat and pork from your diet." C. "Read food labels and reduce your intake of saturated fats." D. "Reduce salt consumption to keep your sodium intake to 2400 mg/day."
C
The nurse is teaching a patient who has a new prescription for spironolactone [Aldactone]. Which statement by the patient indicates that the teaching was effective? A. "I will use salt substitutes to lower my sodium intake." B. "I will increase my intake of foods that are high in potassium."Incorrect C. "I will call my doctor if I begin having menstrual irregularities." D. "I will take this medication at bedtime each evening."
C
The nurse is teaching a patient with cancer about a new prescription for a fentanyl [Sublimaze] patch, 25 mcg/hr, for chronic back pain. Which statement is the most appropriate to include in the teaching plan? A. "You will need to change this patch every day, regardless of your pain level." B. "This type of pain medication is not as likely to cause breathing problems." C. "With the first patch, it will take about 24 hours before you feel the full effects." D. "Use your heating pad for the back pain. It will also improve the patch's effectiveness."
C
The nurse knows that which statement is accurate for enoxaparin [Lovenox]? A. It equally reduces the activity of thrombin and factor Xa. B. It has selective inhibition of factor Xa and no effect on thrombin. C. It reduces the activity of factor Xa more than the activity of thrombin. D. It has a lower bioavailability and shorter half-life than unfractionated heparin.
C
The nurse plans to closely monitor for which clinical manifestation after administering furosemide [Lasix]? A. Decreased pulse B. Decreased temperature C. Decreased blood pressure D. Decreased respiratory rate
C
The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? A. Very-low-density lipoprotein (VLDL) B. Apolipoprotein B-100 C. Low-density lipoprotein (LDL) D. High-density lipoprotein (HDL)
C
What is the most appropriate nursing consideration for a patient who is prescribed verapamil [Calan] and digoxin [Lanoxin]? A. Restrict intake of oral fluids and high-fiber food. B. Take an apical pulse for 30 seconds before administration. C. Notify the healthcare provider of nausea, vomiting, and visual changes. D. Hold the medications if the heart rate is greater than 110 beats/min.
C
Which acid-base imbalance is caused by chronic renal failure, loss of bicarbonate during severe diarrhea, or metabolic disorders that result in overproduction of lactic acid? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
C
Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]? A. Peripheral pulses B. Homans' sign C. Blood pressure D. Capillary refill
C
Which instruction about clopidogrel [Plavix] should the nurse include in the discharge teaching for a patient who has received a drug-eluting coronary stent? A. "Constipation is a common side effect of clopidogrel, so take a stool softener daily." B. "If you see blood in your urine or black stools, stop the clopidogrel immediately." C. "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." D. "Keep the amount of food containing vitamin K, such as mayonnaise, canola and soybean oil, and green, leafy vegetables, consistent in your diet."
C
Which medication combination is useful in the treatment of variant angina? A. Metoprolol [Lopressor] and ranolazine [Ranexa] B. Isosorbide dinitrate [Isordil] and metoprolol [Lopressor] C. Diltiazem [Cardizem] and isosorbide mononitrate [Imdur] D. Propranolol [Inderal] and diltiazem [Cardizem]
C
Which medication is not associated with prolongation of the QT interval? A. Dofetilide [Tikosyn] B. Sotalol [Betapace] C. Diltiazem [Cardizem] D. Dronedarone [Multaq]
C
The nurse is teaching a patient prescribed captopril [Capoten] for the treatment of hypertension. Which instructions should the nurse include? (Select all that apply.) A. Take the medication with food. B. Expect a sore throat and fever. C. Avoid potassium salt substitutes. D. A persistent dry cough may occur. E. Report difficulty in breathing immediately
C, D, E
A patient is admitted to the hospital with a diagnosis of hypertension. The nurse understands that which medication works by preventing angiotensin II from binding with its receptor sites? A. Quinapril [Accupril] B. Aliskiren [Tekturna] C. Eplerenone [Inspra] D. Candesartan [Atacand]
D
What should the nurse include in the discharge teaching for a patient prescribed amiodarone [Cordarone]? (Select all that apply.) A. "Take amiodarone with grapefruit juice." B. "Take the medication on an empty stomach." Incorrect C. "Wear sunblock and protective clothing when you are outdoors."Correct D. "Check your pulse daily and report excessive slowing to your healthcare provider immediately." Correct E. "Immediately notify your healthcare provider of shortness of breath, cough, or chest pain."
C, D, E
A nurse is caring for a patient receiving dronedarone [Multaq] for treatment of atrial fibrillation. What electrocardiogram (ECG) change indicates an adverse effect of this medication? A. Previously upright T waves now are inverted. B. Previously rounded, upright P waves now are notched. C. ST segments previously on the baseline now are depressed.Incorrect D. The QT-interval measurement changes from 400 to 520 msec.
D
A patient takes oxycodone [OxyContin] 40 mg PO twice daily for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects? A. The patient should take an antacid with each dose. B. The patient should eat foods high in lactobacilli. C. The patient should take the medication on an empty stomach. D. The patient should increase fluid and fiber in the diet.
D
A patient with cardiovascular disease is taking rosuvastatin [Crestor]. The nurse is monitoring for potential adverse effects. Which finding indicates a potential adverse effect of this drug? A. Blood pressure of 140/90 mm Hg B. Wheezing and shortness of breath C. Platelet count of 100 × 103/mm3 D. Muscle pain and tenderness
D
A patient with heart failure has developed a cough while taking an angiotensin-converting enzyme (ACE) inhibitor. The health care provider discontinued the ACE inhibitor and prescribed an angiotensin II receptor blocker (ARB) as an alternative to the ACE inhibitor. The patient continues to have symptoms of heart failure despite using an ARB. Which medication should the nurse anticipate will be prescribed? A. Eplerenone [Inspra] B. Triamterene [Dyrenium] C. Hydrochlorothiazide [Microzide] D. BiDil [Isosorbide Dinitrate and Hydralazine]
D
Complete the equation: Cardiac output = Volume of blood ejected at each heartbeat × ____. A. Stroke volume B. Preload C. Afterload D. Heart rate
D
Fondaparinux [Arixtra] is not approved for use in which circumstance? A. Prevention of deep vein thrombosis (DVT) after knee replacement B. Treatment of acute pulmonary embolism (PE) (in conjunction with warfarin) C. Prevention of deep vein thrombosis (DVT) after abdominal surgery D. Prevention of ischemic complications in patients with unstable angina
D
In which situation is dronedarone [Multaq] contraindicated? A. PR intervals of 240 msec B. QT intervals of less than 500 msec C. Resting heart rate of 55 beats/min Incorrect D. Concomitant administration of amitriptyline [Elavil]
D
The home health nurse observes the patient for proper use of topical nitroglycerin ointment. Which action by the patient indicates the need for further teaching? A. Rotates the application sites to minimize skin irritation. B. Uses the applicator paper to measure the prescribed dose. C. Removes ointment from a previous dose before applying the next dose. D. Applies the prescribed ribbon of ointment to the applicator paper and places it on the chest.
D
The nurse caring for a patient taking furosemide [Lasix] is reviewing the patient's most recent laboratory results, which are: sodium, 136 mEq/L; potassium, 3.2 mEq/L; chloride, 100 mEq/L; blood urea nitrogen, 15 mg/dL. What is the nurse's best action? A. Administer Lasix as ordered. B. Place the patient on a cardiac monitor. C. Begin a 24-hour urine collection. D. Hold the Lasix and notify the physician.
D
The nurse is caring for a patient prescribed gemfibrozil [Lopid]. For which patient should the nurse question the use of this drug? A. A patient with cardiovascular disease and elevated triglycerides B. A patient with elevated very-low-density lipoprotein (VLDL) levelsIncorrect C. A patient with elevated triglycerides who has not responded to dietary changes D. A patient with history of gallstones and elevated triglycerides
D
The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? A. To reduce the risk of headache B. To improve hypotensive effects C. To prevent heart failure D. To protect against reflex tachycardia
D
The nurse is caring for a patient who takes warfarin [Coumadin] for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate? A. Administer intravenous (IV) push protamine sulfate. B. Continue with the current prescription. C. Prepare to administer vitamin K. D. Call the healthcare provider to increase the dose.
D
The nurse is preparing to administer minoxidil [Loniten] 5 mg orally. What is the only cardiovascular indication for this medication? A. Heart failure B. Myocardial infarction C. Angina pectoris D. Severe hypertension
D
The nurse is teaching a patient about the side effects associated with doxazosin [Cardura]. Which statement by the patient indicates an understanding of the nurse's instructions? A. "I may experience an increase in hair growth as a side effect." B. "I'll notify the healthcare provider if I develop a persistent cough." C. "I'll make sure I include extra sources of potassium in my diet, such as bananas and baked potatoes." D. "When getting out of bed in the morning, I will sit on the side of the bed for several minutes before standing."
D
The nurse provides discharge instructions to a patient prescribed verapamil [Calan] SR 120 mg PO daily for essential hypertension. Which statement by the patient indicates understanding of the medication? A. "I will take the medication with grapefruit juice each morning." B. "I should expect occasional loose stools from this medication." C. "I'll need to reduce the amount of fiber in my diet." D. "I must make sure I swallow the pill whole."
D
The patient is admitted for the management of a hypertensive emergency. The healthcare provider prescribes sodium nitroprusside [Nipride] drug therapy. What is the priority nursing action during this treatment? A. Observe for respiratory depression. B. Monitor the electrocardiogram for tachycardia. C. Initiate oxygen therapy via nasal cannula at 2 L/min. D. Adjust the intravenous infusion rate to the blood pressure response.
D
Which acid-base imbalance is characterized by increases in both the pH and bicarbonate content of plasma? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
D
Which hemodynamic system serves as a reservoir for circulating blood? A. Heart B. Lungs C. Arteries D. Veins
D
Which laboratory result may be a consequence of therapy with a thiazide diuretic? A. Serum glucose level of 58 mg/dL B. Serum potassium level of 5.3 mEq/L C. Serum sodium level of 135 mEq/L D. Serum uric acid level of 10.4 mg/dL
D
Which medication is most likely to cause the side effect of constipation? A. Nifedipine [Adalat] B. Amlodipine [Norvasc] C. Isradipine [DynaCirc] D. Diltiazem [Cardizem]
D
Which prescription would be the most appropriate for treating persistent cancer pain? A. Morphine [Duramorph] 10 mg orally (PO) as needed (PRN) B. Meperidine [Demerol] 100 mg PO every 4 hours C. Pentazocine [Talwin] 75 mg intramuscularly (IM) every 3 to 4 hours PRN D. Morphine [Duramorph] 30 mg every 3 to 4 hours
D
