Exam 2 Review

Nifedipine (Procardia) is being initiated for a patient with elevated blood pressure. What health teaching would be most appropriate? The patient should: Weigh daily at the same time each day. Avoid crowds while taking this medication. Increase intake of calcium-containing foods. Take this medication only when feeling that blood pressure is elevated.

1 Rationale: A major complication associated with the administration of CCBs such as nifedipine is HF. Daily weighing will alert the patient to signs of fluid retention, which may indicate cardiac dysfunction. A weight gain of 1 kg (2 lb) or more in 24 hours indicates possible fluid retention and may signal impending HF. Options 2, 3, and 4 are incorrect. Nifedipine does not affect the immune system, and there is no reason to avoid crowds. The intake of oral or dietary calcium and CCBs has not been shown to be problematic. HTN is asymptomatic, and patients should be instructed to take the medication even when feeling healthy.

The provider orders colestipol (Colestid) in combination with atorvastatin (Lipitor) for a patient with elevated low-density lipoprotein levels. The nurse collaborates with the prescriber about which data related to the patient? Past history of peptic ulcer disease Recent myocardial infarction Laboratory value for serum sodium of 136 mEq/L Allergies to foods high in tyramine

1 Rationale: Although there are few contraindications to the use of bile acid sequestrants such as colestipol, they should be used cautiously in patients with GI disorders such as peptic ulcer disease. Options 2, 3, and 4 are incorrect. MI is not a contraindication for the use of bile acid sequestrants. Bile acid sequestrants do not affect serum sodium levels, and patients allergic to foods high in tyramine may be prescribed bile acid sequestrants

The patient asks how atenolol (Tenormin) helps angina. The response provided by the nurse is based on which concept? This medication: Slows the heart rate and reduces contractility. Increases the heart rate and diminishes contractility. Blocks sodium channels and elevates depolarization. Decreases blood pressure and blocks the alpha2 receptors.

1 Rationale: Atenolol increases blood flow to the myocardium, thereby increasing oxygen supply by reducing the heart rate and decreasing the contractility. Options 2, 3, and 4 are incorrect. Atenolol is a beta-adrenergic blocker, which decreases heart rate. This drug does not affect the sodium channels. Although this drug reduces blood pressure, the mechanism of action is not by blocking the alpha2 receptors.

A patient will begin taking carvedilol (Coreg) for heart failure. Before teaching the patient about this drug, the nurse will discuss the strategy for drug dosage with the healthcare provider because of which recommended routine for beta-adrenergic antagonists in heart failure? Significantly lower dosages are used first and gradually increased to a target dose. A loading dose that is higher than the subsequent daily dose must be given. The beta-adrenergic antagonist dosage must be lowered if the patient is also on ACE inhibitors. Beta-adrenergic antagonists are almost never used in HF and the order must be confirmed.

1 Rationale: Beta-adrenergic blockers such as carvedilol must be started at 1/10 to 1/20 of a usual dose and gradually increased to a target dosage. Options 2, 3, and 4 are incorrect. Because lower dosages are required, a higher loading dose will not be given, and beta-adrenergic blockers are often combined with ACE inhibitors, although dosage will not be directly related to the ACE inhibitor. While caution is required if beta-adrenergic blockers are used to treat HF, they are an important drug group used to treat heart failure.

To avoid the first-dose phenomenon, the nurse knows that the initial dose of prazosin (Minipress) should be: Very low and given at bedtime. Doubled and given before breakfast. The usual dose and given before breakfast. Doubled and given immediately after breakfast.

1 Rationale: Initial doses of drugs that cause a "first-dose phenomenon" should be very low and administered at bedtime. The decline in blood pressure due to prazosin is often marked when beginning pharmacotherapy and when increasing the dose. This "first-dose phenomenon" can lead to syncope due to reduced blood flow to the brain. Options 2, 3, and 4 are incorrect. Doses of antihypertensive medications should never be doubled but should be gradually increased to avoid hypotension, and the best time to give prazosin in the initial phases of therapy is at bedtime.

The nurse is evaluating the therapeutic effects of milrinone (Primacor). The nurse knows that this drug is given to: Increase the force of cardiac contractions and improve cardiac output. Decrease the volume of the cardiac output to reduce hypertension. Relax the myocardial muscle, decreasing myocardial oxygen requirements. Inhibit cardiac irregularities, decreasing the sensation of palpitations.

1 Rationale: Milrinone is a positive inotropic drug and is given to increase the force of the contraction of the heart, which improves cardiac output. Options 2, 3, and 4 are incorrect. Inotropic effects increase the volume of the cardiac output rather than decrease it and do not relax the myocardial muscle. Milrinone may cause cardiac dysrhythmias as an adverse effect.

The nurse is discussing the adverse effects associated with a muscarinic agonist. The nurse knows that reflex tachycardia may occur with this drug because: Baroreceptors acknowledge transient hypotension and signal the medulla to increase the heart rate. This drug stimulates the sinoatrial node in the right atrium. Aortic receptors identify episodes of systolic hypertension and stimulate heart rhythms. This drug stimulates bronchial smooth muscle contraction and a narrowing of the airway.

1 Rationale: Muscarinic agonists may cause reflex tachycardia, which is precipitated by a drop in the patient's blood pressure. When this occurs, the baroreceptors recognize the decline in pressure and alert the medulla to increase the heart rate as a compensatory mechanism. Options 2, 3, and 4 are incorrect. Although the heart rate increases, muscarinic agonists do not directly affect the sinoatrial node. Hypertension is not a problem with this drug therapy; however, hypotension may occur. Muscarinic drugs stimulate bronchial smooth muscles; however, this does not impact the heart rate.

Muscarinic antagonists, such as benztropine (Cogentin), are most often contraindicated in glaucoma because these drugs can: Increase intraocular pressure. Promote ocular infections. Cause miosis, which leads to blindness. Detach the retina.

1 Rationale: Muscarinic drugs affect the intraocular pressure by causing mydriasis and paralysis of the ciliary muscle. Options 2, 3, and 4 are incorrect because the drug does not promote infections, cause miosis, or affect the retina.

A patient who uses over-the-counter phenylephrine (Neo-Synephrine) nasal spray asks the nurse how the medication works. The nurse's response would be: "It helps to shrink the swelling in your nose by tightening the blood vessels there." "It works to locally destroy invading organisms that cause colds and flu." "It coats the nasal passages to reduce swelling." "It is absorbed after you swallow it to act as a decongestant."

1 Rationale: Phenylephrine causes vasoconstriction, reducing the swelling in the nasal passages. Options 2, 3, and 4 are incorrect. The drug does not destroy organisms or coat nasal passages. Whereas some drugs may be swallowed via the nasopharynx, localized action is predominant, and excessive drug use and swallowing may result in adverse effects.

A patient who is taking an adrenergic antagonist for hypertension reports being dizzy when first getting out of bed in the morning. The nurse should advise the patient to: Move slowly from the recumbent to the upright position. Drink a full glass of water before rising to increase vascular circulatory volume. Avoid sleeping in a prone position. Stop taking the medication.

1 Rationale: The nurse should suspect that the patient is describing orthostatic hypotension induced by the medication. Most patients find it helpful to move slowly from a recumbent position to avoid dizziness and syncope. Options 2, 3, and 4 are incorrect. Although drinking a full glass of water with the medication is a health promotion activity that the nurse might suggest, this action does not eliminate orthostatic hypotension. Sleeping positions do not influence the presence of orthostatic hypotension. The patient should never abruptly stop taking antihypertensive medication. Such action could result in hypertensive crisis, stroke, or heart attack

The nurse administering succinylcholine knows that this drug causes: Muscle paralysis; it does not produce anesthesia or loss of consciousness. Loss of consciousness, along with muscle paralysis and anesthesia. Deep muscle relaxation and relief from pain. Increased mental alertness with muscle paralysis.

1 Rationale: The therapeutic effect of succinylcholine is to paralyze skeletal muscles. However, this drug does not produce anesthesia or a loss of consciousness. Options 2, 3, and 4 are incorrect. Succinylcholine produces no change in the patient's sensorium (consciousness) and the patient can still experience pain. The effect of succinylcholine is total muscle paralysis, not muscle relaxation.

A patient takes a dose of albuterol (Ventolin) prior to bedtime. Which effect would the nurse consider normal for this drug? Insomnia Sleepiness Urticaria Tinnitus

1 Rationale: When beta2-adrenergic agonists such as albuterol are taken too close to bedtime, the patient may experience insomnia. Options 2, 3, and 4 are incorrect because all adrenergic agonists act as stimulators, and urticaria and tinnitus are not adverse effects associated with this drug therapy.

The patient is started on propranolol (Inderal). Which is the most important action to be included in the plan of care for this patient related to this medication? Monitor apical pulse and blood pressure. Elevate the head of the bed during meals. Take the medication after meals. Consume foods high in potassium.

1 Rationale: With beta-adrenergic blockers such as propranolol, the most important action is to monitor the patient for adverse effects associated with the cardiovascular system such as changes in pulse and blood pressure. Options 2, 3, and 4 are incorrect. Elevation of the head of the bed is not specifically required for this drug regimen. Inderal can be taken anytime regardless of meals, and its therapeutic action is not contingent on serum K+ levels

The nurse is monitoring the patient for adverse effects associated with morphine. Which adverse effects would be expected? (Select all that apply.) Respiratory depression Hypertension Urinary retention Constipation Nausea

1 Rationale: With beta-adrenergic blockers such as propranolol, the most important action is to monitor the patient for adverse effects associated with the cardiovascular system such as changes in pulse and blood pressure. Options 2, 3, and 4 are incorrect. Elevation of the head of the bed is not specifically required for this drug regimen. Inderal can be taken anytime regardless of meals, and its therapeutic action is not contingent on serum K+ levels.

What health teaching should the nurse provide for a patient receiving diltiazem (Cardizem)? (Select all that apply.) Avoid driving or performing other activities requiring mental alertness until the effects of the drug are known. Maintain adequate fluid and fiber intake to facilitate stool passage. Report weight gain of 2 kg (5 lb) per week. Rise slowly from prolonged periods of sitting or lying down. Immediately stop taking the medication if sexual dysfunction is noted.

1, 2, 3, 4 Rationale: Diltiazem reduces the patient's blood pressure, which may result in syncope or dizziness. Until the effects of the medication are known, the patient should avoid driving or other activities requiring mental alertness. One of the adverse effects associated with diltiazem and CCBs is constipation, which can be reduced by increasing fluid and dietary fiber intake. Patients should be taught to report a weight gain of 1 kg (2 lb) per day or 2 kg (5 lb) per week. Diltiazem may cause orthostatic hypotension. To ensure safety, patients should be instructed to rise slowly from sitting or lying positions. Option 5 is incorrect. Sudden discontinuation could cause the patient to experience hypertensive crisis

The nurse is aware that the therapeutic uses for cholinergic antagonists include (select all that apply): Ophthalmic procedures. Cardiac rhythm abnormalities. Asthma. Poisonings. Urinary retention.

1, 2, 3, 4 Rationale: These drugs cause mydriasis and paralysis of the ciliary muscle, which is useful in ophthalmic examinations. These drugs are therapeutic in correcting cardiac rhythm abnormalities such as bradycardia. Muscarinic antagonists, most notably ipratropium and tiotropium, are useful in treating asthma due to their ability to dilate the bronchi. These drugs are used to reverse the symptoms of overdose of organophosphate insecticides or ingestion of poison mushrooms. Option 5 is incorrect. Urinary retention is an adverse effect of these drugs.

The nurse is teaching the patient about the use of an adrenergic agonist nasal spray at home. What patient teaching is needed related to this medication? (Select all that apply.) Do not share the nasal spray with another individual. Use this drug only for 3 to 5 days unless directed otherwise by a healthcare provider. Symptoms of excessive use of this drug are lethargy and fatigue. Infants and children should not use this medication unless directed to do so by a healthcare provider. This drug can be safely used by individuals with diabetes.

1, 2, 4 Rationale: Adrenergic agonist nasal sprays should not be shared among individuals due to the risk of spreading infection. Individuals should be taught the dangers of using adrenergic nasal sprays for longer than 3 days. These medications can cause increased blood pressure, increased heart rate, and insomnia. Habitual use of nasal adrenergic drugs can also cause rebound congestion as well as necrosis of the nasal mucosa due to the severe vasoconstriction caused by the drug. Due to the CNS stimulation, nasal adrenergic drugs are not indicated in children and infants. Options 3 and 5 are incorrect. The drug causes CNS stimulation rather than depression. People with diabetes must use caution when using adrenergic drugs and must monitor their blood glucose levels more frequently for hyperglycemia. They are also at higher risk for adverse cardiac effects.

When planning patient education, the nurse knows that patient adherence to beta-adrenergic antagonist therapy in heart failure may be difficult to achieve despite the usefulness of these drugs. What will the nurse need to address in the teaching plan? (Select all that apply.) The dosage must be gradually adjusted over time to a beneficial dose. The patient may not notice significant improvement during early therapy. The drug may require changes to many other medications the patient is taking. The drug has significant benefit in reducing mortality from heart failure. The drug will require extensive lifestyle changes.

1, 2, 4 Rationale: Beta-adrenergic blockers require gradual increases in dosage amount approximately every 2 weeks to a target dosage. Significant improvement may not be noticed in early therapy and the patient may feel worse during initiation of therapy. Overall, however, the therapy has been proven to reduce the number of HF-related hospitalizations and mortalities. Options 3 and 5 are incorrect. Beta-adrenergic blocker therapy may require alterations in dosage for other cardiac drugs but not all drugs will be affected. Lifestyle changes may be advisable in HF but are not necessarily directly related to beta-adrenergic blocker use.

Which of the following assessment findings, if discovered in a patient receiving verapamil (Calan) for angina, would be cause for the nurse to withhold the medication? (Select all that apply.) Bradycardia: heart rate of 40 beats/min Tachycardia: heart rate of 126 beats/min Hypotension: blood pressure 76/46 mmHg Tinnitus with hearing loss Hypertension: blood pressure 156/92 mmHg

1, 3 Rationale: Verapamil decreases blood pressure and heart rate. The administration of this drug may cause significant bradycardia and hypotension in some patients. Options 2, 4, and 5 are incorrect. Verapamil may be used to treat fast heart rates and HTN in addition to angina. Tinnitus and hearing loss are not adverse effects associated with verapamil.

A beta-adrenergic agonist is prescribed for each of the following conditions. A nurse would question the order for which condition? (Select all that apply.) Hyperthyroidism Asthma Shock Dysrhythmias Heart failure

1, 4 Rationale: The nurse should consult with the prescriber when adrenergic drugs are prescribed for individuals with hyperthyroid disease or dysrhythmias. The medication will further increase the already overactive metabolic system in hyperthyroidism and may increase the risk for dysrhythmias due to the cardiac stimulation caused by these medications. Options 2, 3, and 5 are incorrect. These are therapeutic indications for the administration of adrenergic agonists.

The nurse is caring for a patient receiving gemfibrozil (Lopid) for hyperlipidemia. The nurse would validate the order with the prescriber if the patient reported a history of which of the following? (Select all that apply.) Gallbladder disease Angina Hypertension Diabetes Chronic kidney disease

1, 4, 5 Rationale: Fibric acid drugs (fibrates) such as gemfibrozil may cause or worsen gallbladder disease and may enhance the hypoglycemic effects of antidiabetes drugs. Because it is excreted through the kidneys, it may be used cautiously in patients with CKD, but the order should be validated with the provider before giving if the patient has a history of CKD. Options 2 and 3 are incorrect. Angina and hypertension may indicate the existence of atherosclerosis and arteriosclerosis, both of which are indications for a lipid-lowering drug

The nurse is monitoring the patient for which of the common adverse effects associated with bethanechol (Urecholine)? (Select all that apply.) Abdominal discomfort Sweating Flushed skin Constipation Blurred vision

1,2,3,5 Common adverse effects of bethanechol include abdominal discomfort, sweating, flushed skin, and blurred vision. Option 4 is incorrect because bethanechol increases GI peristalsis and promotes bowel evacuation.

A patient newly diagnosed with heart failure following an acute myocardial infarction has a prescription for enalapril (Vasotec). This drug class is frequently used in early heart failure because of what clinical improvement? It strengthens the force of myocardial contraction to improve cardiac output. It decreases peripheral resistance, increasing cardiac output. It slows the heart rate, improving filling time and increasing cardiac output. It has diuretic effects, decreasing peripheral edema and pulmonary congestion.

2 Rationale: ACE inhibitors such as enalapril lower peripheral resistance through the inhibition of angiotensin II formation, and reduce blood volume through inhibition of aldosterone secretion. This reduces arterial blood pressure, decreasing afterload and increasing cardiac output. Options 1, 3, and 4 are incorrect. Enalapril is not a positive inotropic drug and does not strengthen the force of myocardial contraction. It does not slow heart rate (negative chronotropic and dromotropic effects) and it does not have diuretic effects.

Which health teaching concept should the nurse review with a patient receiving tolterodine (Detrol) *anticholinergic* for urge incontinence? Exercise daily to avoid muscle atrophy. Increase dietary fiber and water intake to avoid constipation. Consume foods high in iron to increase red blood cell production. Monitor the heart rate for bradycardia.

2 Rationale: Anticholinergic drugs such as tolterodine can cause constipation by slowing GI motility. Therefore, increases in dietary fiber and water intake will help avoid constipation. Options 1, 3, and 4 are incorrect. Daily exercise helps in avoiding muscle atrophy and anticholinergic drugs are not related to muscle atrophy. Consuming foods high in iron to increase red blood cell production is not related to the effects of anticholinergic drugs. Anticholinergic drugs cause tachycardia, not bradycardia.

To evaluate the effectiveness of high-dose dopamine, the nurse would assess the: Pupillary response. Blood pressure. Level of consciousness. Gag reflex.

2 Rationale: At high dosage, dopamine stimulates alpha1-adrenergic receptors, causing vasodilation and increased blood pressure. Options 1, 3, and 4 are incorrect. Dopamine does not affect the reflexes responsible for pupillary response or the patient's gag reflex, and it does not directly affect the patient's level of consciousness.

Which factor in the patient's history would cause the nurse to question a medication order for atropine? A 42-year-old woman with a history of drug abuse An 85-year-old man with benign prostatic hyperplasia An 18-year-old man with irritable bowel syndrome A 22-year-old woman on the second day of her menstrual cycle

2 Rationale: Atropine causes urinary retention to worsen in patients with BPH. Options 1, 3, and 4 are incorrect because these are not contraindications for using atropine

The emergency department nurse is caring for a patient with a migraine. Which drug would the nurse anticipate administering to abort the patient's migraine? Morphine Dihydroergotamine (Migranal) Propranolol (Inderal) Ibuprofen (Motrin)

2 Rationale: Ergot alkaloids such as dihydroergotamine (Migranal) are one of the two drug classes for aborting migraines. Options 1, 3, and 4 are incorrect. Morphine is an opioid agonist and is not effective in aborting migraines. Propranolol is a beta blocker and is used to prevent migraines. Ibuprofen is a nonopioid analgesic that is used to treat mild to moderate pain.

The nurse determines that the patient understands an important principle in self-administration of nifedipine (Procardia) when the patient makes which statement? "The use of antacids when taking the medication will enhance absorption." "Grapefruit juice may enhance the absorption of nifedipine." "If I miss a dose, I should take two nifedipine capsules when I remember." "This drug will make my birth control pills ineffective."

2 Rationale: Grapefruit juice will enhance the absorption of nifedipine. Options 1, 3, and 4 are incorrect. Nifedipine should not be taken with antacids since this will affect the absorption rate of the drug. Patients should never double the dose of nifedipine because life-threatening hypotension could result. Nifedipine does not affect the efficacy of birth control pills.

**A patient is receiving cholestyramine (Questran) for elevated low-density lipoprotein levels. Which adverse effect should the nurse include in the care plan to monitor the patient? Orange-colored urine Abdominal pain Sore throat and fever Decreased capillary refill

2 Rationale: One of the most serious adverse effects of cholestyramine is obstruction of the GI tract. Options 1, 3, and 4 are incorrect. Cholestyramine does not cause orange urine, sore throat, or fever, nor does it affect capillary refill.

A patient with diabetes reports increasing pain and numbness in his legs. "It feels like pins and needles all the time, especially at night." Which drug would the nurse expect to be prescribed for this patient? Ibuprofen (Motrin) Gabapentin (Neurontin) Naloxone (Narcan, Evzio) Methadone

2 Rationale: The patient is describing neuropathic pain, which is most likely to respond to the adjuvant analgesic gabapentin, an antiseizure drug used for neuropathic pain. Options 1, 3, and 4 are incorrect. Nonopioids such as ibuprofen, or opioids such as methadone, are less effective at relieving pain that is of neurologic origin. Naloxone is an opioid antagonist and will not relieve the patient's pain.

In providing the patient with heart failure information prior to discharge, the nurse will discuss digoxin (Lanoxin) therapy. Which point would the nurse include in the patient's teaching? Take the drug in the morning before rising. Monitor the pulse daily prior to taking the drug. Discontinue the drug if the pulse rate is 70 beats per minute. Eat a diet high in bran fiber and calcium.

2 Rationale: The patient will be taught to take the pulse daily and to contact the prescriber if the pulse rate is less than 60 or greater than 100 beats/min. Options 1, 3, and 4 are incorrect. The medication should be taken at the same time each day, but preferably after the patient has been active for a period of time (midmorning). Typically, the pulse rate will be lower in the morning before the patient rises. Digoxin should be withheld if the pulse rate is below 60 beats/min. A high-fiber diet may decrease the absorption of digoxin, and the drug should not be taken along with meals high in fiber. Furthermore, foods high in calcium may create hypercalcemia, which will potentiate the possibility of digoxin toxicity

Which assessment findings discovered by the nurse would be an expected adverse effect associated with niacin therapy? (Select all that apply.) Fever and chills Intense flushing and hot flashes Tingling of the fingers and toes Dry mucous membranes Hypoglycemia

2, 3 Rationale: Intense flushing and hot flashes occur in almost every patient who is taking niacin. Tingling of the extremities may also occur. Options 1, 4, and 5 are incorrect. Neither fever and chills nor dry mucous membranes are associated adverse effects of niacin therapy. Niacin may cause an increase in fasting blood glucose, especially in people with diabetes

The nurse is caring for a patient with chronic hypertension. The patient is receiving a beta-adrenergic blocker daily. Which patient manifestations would the nurse conclude are adverse effects of this medication? (Select all that apply.) Anorexia Increased serum triglycerides Hypoglycemia Decreased libido Thrombocytopenia

2, 3, 4 Rationale: Beta-adrenergic blockers can have dramatic metabolic effects that produce an increase in serum triglycerides and hypoglycemia. Additionally, these drugs can affect the sexual function of men by decreasing libido. Options 1 and 5 are incorrect. Anorexia and thrombocytopenia are not adverse effects associated with beta-adrenergic antagonists.

A healthcare provider has ordered nifedipine (Procardia XL) for each of the following patients. A nurse will most closely monitor which patient for drug-related problems? A patient who is admitted for an appendectomy in the morning A patient who is receiving renal dialysis 3 times per week A patient who develops pulmonary edema in the intensive care unit A patient who receives psychotropic drugs for bipolar disease

3 Rationale: Nifedipine is a negative inotropic drug and symptoms of pulmonary edema call for discontinuation of the drug. The nurse should also monitor more closely for HF and pulmonary edema if the patient has a medical history of pulmonary edema. Options 1, 2, and 4 are incorrect. An appendectomy does not warrant monitoring the patient any more than usual. Patients receiving renal dialysis should be closely monitored during therapy with nifedipine due to a reduction in renal function. However, these patients are not as high risk as a patient with pulmonary edema. Psychotropic drugs are not known to interact negatively with this drug.

What are common drug classes for drug therapy for Heart Failure? (Select all that apply) ACE inhibitors Beta adrenergic antagonists Calcium channel blockers Diuretics Organic nitrates Angiotensin receptor blockers

A, B, D, F A (Ace inhibitors), B (Beta adrenergic antagonists, D (Diuretics), F (Angiotensin receptor blockers) are drug classes used to treat HF. Calcium channel blockers are used for HTN and angina. Organic nitrates are used for angina.

A healthcare provider has ordered neostigmine for each of these patients. A nurse should question the order for which patient? A patient with postoperative abdominal distention A patient who is experiencing urinary retention A patient who has chronic obstructive pulmonary disease A patient who has received nondepolarizing muscle relaxants

3 Rationale: Because of the potential for bronchoconstriction, patients with COPD should be treated cautiously with cholinergic agonists. Options 1, 2, and 4 are incorrect. Neostigmine is used to reduce postoperative abdominal distention. Urinary retention may also be relieved with the administration of neostigmine. Neostigmine may be used to reverse the effects of nondepolarizing muscle relaxants.

A patient who has migraines self-administered sumatriptan (Imitrex) for the first time yesterday. Today, the patient informs the nurse that after taking the medication, the patient began to experience chest pain. The patient further states that the drug was effective in relieving the headache. The nurse should: Encourage the patient to continue using the drug because it was effective. Advise the patient to tell the healthcare provider about the chest pain at the next visit. Instruct the patient to contact the healthcare provider to report the chest pain today and to not use the sumatriptan until the healthcare provider has been consulted. Encourage the patient to lie down in a quiet room and use cold packs during the next migraine.

3 Rationale: Chest pain is a serious adverse effect of sumatriptan and needs to be differentiated from angina, which can also be caused by the drug. Options 1, 2, and 4 are incorrect. The patient should not use the drug again until being evaluated by the provider and should report the chest pain immediately. Reclining in a quiet room with cold packs is a nondrug treatment for migraines, but reporting the chest pain is most important at this time.

The patient will be taking cholinergic antagonists following discharge from the healthcare agency. Which statement, made by the patient, would indicate that additional teaching is needed? "To relieve dry mouth, I should drink plenty of water." "I will avoid activities requiring mental alertness until I know the effects of this drug." "The use of lubricating eyedrops should be avoided. I should see an eye doctor for dry eyes." "I will not breastfeed while taking this drug without consulting my healthcare provider."

3 Rationale: Cholinergic antagonists typically cause dry eyes and the patient should be encouraged to use lubricating eyedrops. Options 1, 2, and 4 are incorrect. These statements suggest that the patient has understood the teaching. Patients receiving anticholinergic antagonists frequently report extreme dry mouth discomfort and increased fluid intake may ease this symptom. Many anticholinergic antagonists may cause drowsiness initially. Women receiving anticholinergic therapy should be advised to avoid breastfeeding until the medication is discontinued.

A patient with chest pain is receiving sublingual nitroglycerin. The nurse would include in the care plan to monitor the patient for which adverse effect? Photosensitivity Elevated blood pressure Vomiting and diarrhea Decreased blood pressure

4 Rationale: A decline in blood pressure is an expected adverse effect. The nurse should always assess the blood pressure prior to and 5 minutes after administering nitroglycerin. Options 1, 2, and 3 are incorrect. Photosensitivity, vomiting, and diarrhea are not expected adverse effects. Nitroglycerin will cause a decline in blood pressure, not an increase.

The nurse is caring for a patient with chronic angina pectoris. The patient is receiving isosorbide dinitrate (Isordil) oral tablets. Which patient manifestations would the nurse conclude are common adverse effects of this medication? Flushing and headache Tremors and anxiety Lightheadedness and dizziness Sleepiness and lethargy

3 Rationale: Patients may experience lightheadedness or dizziness as a result of the hypotensive effects of isosorbide. Options 1, 2, and 4 are incorrect. Because the oral form of isosorbide has a slower onset than sublingual forms, a flushing sensation and headache are not usually experienced as they are with sublingual nitroglycerin. Tremors and anxiety are not associated adverse effects with this drug. Isosorbide does not usually cause sleepiness or lethargy, and if these occur they should be evaluated.

Nitroglycerin topical ointment is being initiated for a patient with angina. Which health teaching would be most appropriate? Keep the medication in the refrigerator. Take this medication only when chest pain is severe. Remove the old paste before applying the next dose. Apply the ointment on the chest wall only.

3 Rationale: Patients should be taught to remove the old ointment before applying the next dose. Options 1, 2, and 4 are incorrect. Nitroglycerin should be kept at room temperature, not in the refrigerator. Patients should take the medication before chest pain becomes severe. Nitroglycerin can be applied to any skin surface. However, absorption is decreased when applied to hairy areas, soles of feet, and palms.

The nurse is preparing a plan of care for a patient with myasthenia gravis. Which of the following outcome statements would be appropriate for a patient receiving a cholinergic agonist such as pyridostigmine (Mestinon) for this condition? The patient will exhibit: An increase in pulse rate, blood pressure, and respiratory rate. Enhanced urinary elimination. A decrease in muscle weakness, ptosis, and diplopia. Prolonged muscle contractions and proprioception.

3 Rationale: Pyridostigmine is used primarily for myasthenia gravis, a neurologic disorder characterized by muscle weakness and ptosis. A decrease in these symptoms is an expected therapeutic outcome for this drug. Options 1, 2, and 4 are incorrect because the symptoms listed are not usual problems faced by the patient with MG and would therefore be inappropriate outcome statements.

A patient with primary hypertension has started therapy with verapamil (Calan). The nurse performs what important intervention during the initial course of this treatment? Uses an electric razor to shave the patient Monitors the patient for increased thrombocyte levels Administers the medication only during waking hours Measures intake and output ratio and daily weight

4 Rationale: An adverse effect of verapamil is HF, which will be reflected in the patient's intake and output ratio and weight gain of more than 1 kg (2 lb) per 24 hours. Options 1, 2, and 3 are incorrect. Verapamil does not affect coagulation or thrombocytes. Verapamil is usually given during hours that the patient is awake; however, it can be administered at any time.

Which of the following should the nurse instruct a patient with diabetes who is prescribed a beta-adrenergic blocker for the treatment of hypertension to do? Increase insulin intake by 2 to 3 units daily each morning. Decrease the intake of carbohydrates while on the antihypertensive medications. Elevate the lower extremities to promote venous drainage. Monitor blood glucose levels frequently and report hypoglycemia.

4 Rationale: Beta-adrenergic antagonists may cause hypoglycemic episodes in patients with diabetes. The patient should be instructed to monitor blood glucose levels frequently initially and to notify the prescriber of a decrease. Options 1, 2, and 3 are incorrect. Insulin dosages are never arbitrarily increased without checking with a healthcare provider. Patients with diabetes should remain on their normal diabetic diets even though they may be taking antihypertensive medications. Elevation of the extremities is not relevant to a patient with diabetes taking beta-adrenergic blocker drugs

The nurse is discussing the therapeutic effects of bethanechol (Urecholine) with a patient who is receiving this drug for urinary retention. The nurse understands that bethanechol: Changes the diameter of the urethral opening. Increases the amount of urine made in the kidneys. Improves blood flow to the kidney. Increases the contractions of the bladder and structures that promote urination.

4 Bethanechol works on the muscles needed for urination by increasing ureteral peristalsis and promoting urinary bladder elimination. Options 1, 2, and 3 are incorrect. Bethanechol does not cause changes to urinary structures, nor does it increase urine production or renal blood flow

The healthcare provider prescribes epinephrine (Adrenalin) to a patient who was stung by several wasps 30 minutes ago. The nurse knows that the primary purpose of this medication for this patient is to: Stop the systemic release of histamine produced by the mast cells. Counteract the formation of antibodies in response to an invading antigen. Increase the number of white blood cells produced to fight the primary invader. Increase a declining blood pressure and dilate constricting bronchi associated with anaphylaxis.

4 Rationale: Epinephrine is used during anaphylaxis to prevent hypotension and bronchoconstriction. Options 1, 2, and 3 are incorrect because the administration of epinephrine for anaphylaxis does not prevent the formation of histamine or antibodies in response to an invading antigen nor does it affect white blood cell function.

A patient is receiving felodipine (Plendil) for hypertension. In the care plan the nurse includes the need to monitor the patient for which adverse effect? Rash and chills Increased urinary output Weight loss Reflex tachycardia

4 Rationale: Felodipine may cause hypotension with associated reflex tachycardia. Options 1, 2, and 3 are incorrect. Rash and chills, increased urine output, and weight loss are not adverse effects of CCBs.

The community health nurse visits a patient who has been prescribed lovastatin (Mevacor). Which statement, if made by the patient, indicates that further teaching is necessary concerning this drug therapy? "I should try to maintain my body weight at an optimal level." "Most patients with lipid disorders don't have any symptoms." "The best time for me to take this medication is before I go to bed." "I will take my drug with beverages that contain grapefruit juice."

4 Rationale: Grapefruit juice inhibits the metabolism of statins such as lovastatin, allowing them to reach high serum levels. Options 1, 2, and 3 are incorrect. Most patients with lipid disorders are asymptomatic. A patient should be instructed that maintenance of optimal body weight will help reduce unhealthy lipid levels. Because cholesterol biosynthesis in the liver is higher at night, statins are usually best taken in the evening.

The patient is receiving hydralazine with isosorbide (BiDil) for heart failure. The nurse should monitor this patient for: Confusion and agitation. Bleeding. Tingling or cramping in the legs. Dizziness and rapid heart rate.

4 Rationale: Hydralazine with isosorbide may cause hypotension with reflex tachycardia, resulting in dizziness and rapid heart rate. Options 1, 2, and 3 are incorrect. Hydralazine with isosorbide does not cause confusion, agitation, bleeding, tingling, or cramping of the extremities. If these occur, other causes should be investigated

The nurse is caring for several patients who are receiving opioids for pain relief. Which patient is at the highest risk of developing hypotension, respiratory depression, and mental confusion? A 23-year-old woman, postoperative ruptured appendix A 16-year-old adolescent, post-motorcycle injury with lacerations A 54-year-old woman, post-myocardial infarction An 86-year-old man, postoperative femur fracture

4 Rationale: Older adult patients are at highest risk for hypotension, respiratory depression, and increased incidence of adverse CNS effects such as confusion. Options 1, 2, and 3 are incorrect. Most 23-year-old patients can tolerate opioids without adverse effects. Individuals who have experienced a traumatic injury may receive narcotic analgesia. However, caution should be taken if the individual has also experienced any type of head injury. Opioids are often used with individuals who have had an MI. No adverse effects such as hypotension or respiratory depression are usually present if the dose is appropriate for the size of the patient.

A healthcare provider has ordered an alpha1-adrenergic antagonist for each of these patients. A nurse should question the order for the patient with which disorder? Benign prostatic hyperplasia Pheochromocytoma Raynaud's disease Tachycardia

4 Rationale: One adverse effect of alpha1-adrenergic antagonists is tachycardia. Patients experiencing tachycardia should not receive alpha1-adrenergic antagonists. Options 1, 2, and 3 are incorrect. Alpha1-adrenergic antagonists are often prescribed for BPH because they relax muscles in the prostate. A pheochromocytoma is a benign tumor of the adrenal medulla that secretes catecholamines. Alpha1-adrenergic antagonists help to reduce the HTN associated with these tumors. Alpha1-adrenergic antagonists diminish the vasospasms associated with Raynaud's disease.

Several days postoperative bowel surgery, the patient is eating soft food, ambulating regularly, and using hydrocodone (Vicodin) for pain. What should the nursing care plan include? Monitoring vital signs for respiratory depression Inserting a urinary catheter for urinary retention Weaning pain medication to prevent addiction Increasing dietary fiber and fluids and administering a stool softener if needed

4 Rationale: Opioids decrease peristalsis, and bowel surgery may produce a temporary cessation of peristalsis (paralytic ileus). Both lead to constipation. Once sufficient bowel function has returned for the patient to start eating, constipation is still likely and needs to be prevented by increased dietary fiber and fluids as well as taking a stool softener. Options 1, 2, and 3 are incorrect. Respiratory depression and urinary retention are not likely after several days with decreasing opioid use. Addiction is not a concern in the treatment of acute pain in this scenario

The patient states, "I always put my nitroglycerin patch in the same place so I do not forget to take it off." The nurse's response would be based on which of the following physiologic concepts? Patients are more likely to remember to apply the patch if the same site is used daily. Repeated use of the same application site will enhance medication absorption. Rebound phenomenon is likely to occur when the same site is used more than once. Skin irritation due to the nitroglycerin ointment can occur if the same site is used repeatedly.

4 Rationale: Skin irritation due to the nitroglycerin ointment can occur if the same site is used repeatedly. Options 1, 2, and 3 are incorrect. Patients should be instructed to rotate the site of application when using nitroglycerin ointment. Repeated use of the same application site may actually decrease absorption. Rebound phenomenon is not an expected occurrence with nitroglycerin.

A patient has been treated with pyridostigmine (Mestinon) for myasthenia gravis and has been well managed until today. He is taken to the emergency department with symptoms of a cholinergic crisis. As the nurse caring for this patient, what symptom would be indicative of this complication? Nausea and vomiting Miosis Drooling Progressively severe muscle weakness

4 Rationale: Symptoms of a cholinergic crisis include tachycardia, hyperglycemia, and muscle weakness progressing to paralysis, which may require intubation and mechanical ventilation if profound. Options 1, 2, and 3 are incorrect. Nausea, vomiting, miosis, drooling, and involuntary muscle twitching are common adverse effects and may be treated with atropine. Atropine is also the antidote for cholinergic crisis

Which statement made by a student learning the action of calcium channel blockers requires further teaching? An action potential travels across the myocardium during repolarization and causes calcium channels to open Depolarization of the myocardium causes the storage of calcium within the sarcoplasmic reticulum to be released into the cytoplasm The influx of cytoplasmic calcium removes the inhibition of myosin and actin filaments, causing them to contract Repolarization occurs when free cytoplasmic calcium is reduced, either by pumping calcium out of the cell or into the sarcoplasmic reticulum

A "The action potential causes a depolarization that opens voltage-gated channels in the sarcolemma, allowing ions to enter and leave the muscle cell." "Contraction of these muscle types requires the movement of calcium ions"

Which surgical patient should Atropine not be administered to: 59 year old with history of COPD 89 year old with history of uncontrolled diabetes 32 year old with a concussion 61 year old with IBS

A Atropine should not be administered to patients with COPD because of its ability to dry bronchial mucosa causing viscous mucous plugs. IBS is an indication for Atropine. Concussions and diabetes do not affect the action of Atropine.

A patient presents to the ED with a BP of 187/109, with severe chest pain, headache, and blurred vision. What will the nurse keep in mind as she administers sodium nitroprusside to treat this crisis? Treatment of the blood pressure should be gradually reduced over a 12 to 48 hr period, until the blood pressure is reduced to the normal range Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night Place the patient on NPO status to prevent aspiration caused by nausea and the associated vomiting Assist the patient up in the chair for meals to avoid complications associated with immobility.

A In hypertensive crisis, care must be taken to not decrease blood pressure too quickly because rapid and intense vasodilation can result in serious hypoperfusion of the cerebral, coronary, or renal vascular capillaries. The patient will require frequent assessments, so allowing 6 to 8 hours of undisturbed sleep is not appropriate. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary. When patients are receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting.

Which statement by a patient with HTN will show the nurse a need for further teaching? Hypertension will go away on its own. "I may decrease my need for HTN medications if I make therapeutic lifestyle changes." "I should try to reduce high stress situations in my life." "If I don't manage my hypertension, I could end up with a stroke, heart failure, or myocardial infarction.

A Primary HTN cannot be cured with medication, the disease can be managed-TLC- such that the risk of serious, long-term con-sequences can be reduced. Research has clearly demonstrated that failure to control HTN can have serious consequences. Prolonged or improperly controlled HTN damages blood vessels, particularly small arteries and arterioles. Because sustained HTN may affect any artery in the body, damage may be widespread and symptoms vary greatly according to which vessels are affected. (pg. 583)

A patient with past medical history of M.I. is presenting with hypertension and tachycardia. Which medication would you expect the patient to receive? Tenormin Dopamine Atropen Adrenalin

A The answer is Tenormin, because Tenormin is a selective beta 1 adrenergic-antagonist, which would slow heart rate and decrease force of contraction, lowering the patient's blood pressure and heart rate. Atropen and Adrenalin would increase the heart rate because it blocks PSNS activity. Dopamine has a positive inotropic effect, which causes more intense contractions, and therefore an increase in blood pressure. (Sources: Table 16.2 Beta-Adrenergic Antagonists; Table 14.1 Muscarinic Antagonists; Table 12.2 Types of Autonomic Receptors)

What are the two first line of defense drugs for Aftrican American pts with HTN? Thiazide diuretics and CCBs K sparing diuretics and ACE inhibitors Beta blockers and CCBs Thiazide diuretics and ACE inhibitors

A Some research studies have suggested that certain antihypertensive drug classes are less effective in African Americans. Monotherapy with ACE inhibitors, ARBs, or beta-adrenergic antagonists does not reduce blood pres-sure as much in African Americans compared to other ethnic groups. Thiazide diuretics and CCBs seem to provide the greatest blood pressure reduction in this population. The JNC-8 report recommends initiating therapy with two drugs to ensure an adequate response. (pg 588)

The patient has orders due for a 9am dose of Digoxin. What situation below is a contraindication for this medication? (select all that apply) a. Patient with diet high in garlic b. Patient with AV block or ventricular dysrhythmias unrelated to HF c. Patient with a heart rate of 90 BPM d. Patient with serum potassium level of 3.2

A/D "Patients with AV block or ventricular dysrhythmias unrelated to HF should not receive digoxin, because the drug may worsen these conditions (p633)" "The most common cause of digoxin-induced dysrhythmias is hypokalemia due to diuretic use... Frequent serum digoxin levels should be obtained during therapy (p632)" Normal potassium levels at 3.5- 5.0." This will allow the dose to be adjusted based on the lab results (therapeutic Digoxin levels are 0.5-2 ng/mL) and can help to avoid toxic levels.

Which statement by a nursing student requires further education about anticoagulants? Heparin must be monitored closely and given as IV drip Foods such as green tea, garlic, and ginger should be avoided with anticoagulants Apixaban should be given to break up and dissolve a thrombus Dabigatran may be preferable because it doesn't require high degree lab monitoring

Apixaban is factor Xa inhibitor, it does not affect platelet aggregation directly, instead it prolongs clotting time. Apixaban is not a thrombolytic and should not be given to dissolve a thrombus. Pg. 670

In patients with renal disease, dosage adjustments are required for some statin medications. Which statin does not need a dosage adjustment and has research evidence that has shown to be greatest in preventing a cardiovascular adverse event? Lovastatin Atorvastatin Simvastatin Fluvastatin

B "In renal patients, dosage adjustments are needed for lovastatin, pravastatin, simvastatin, and rosuvastatin but not for fluvastatin or atorvastatin. Research evidence for cardiovascular adverse event prevention is greatest for atorvastatin and rosuvastatin. "(pg. 496)

W.S. A 60 year old Caucasian male was brought to the emergency room by his wife due to him suddenly becoming dizzy and fainting during their walk this morning. Per the wife, W.S. has been taking Pyridostigmine for Myasthenia Gravis. He accidentally doubled his dose today. BP is 100/70 and HR is 40. Which antidote would be the best choice for his current symptoms? PO Atropine IV Atropine IV Prazosin PO Succinylcholine

B IV Atropine is standard antidote for Pyridostigmine because it will address his low heart rate. Because his heart rate is 40, it is urgent, so IV is more appropriate than PO. Prazosin is an alpha adrenergic blocker. This will worsen his lowered blood pressure. Succinylcholine is a nicotinic antagonist but because it affects the sympathetic nervous system as well, it may lower his heart rate and blood pressure even more.

May Christine Ines: The nurse is taking care of a patient with chronic hypertension. The patient is on combination antihypertensive therapy of Metoprolol (Lopressor) and Lisinopril (Prinivil). Upon assessment, the nurse noted that the patient's blood pressure was 144/86, but the heart rate was 55, regular. Which action by the nurse is the most appropriate? Call the healthcare provider and hold two medications until further notice. Hold metoprolol (Lopressor) and administer lisinopril (Prinivil) Give both medications. Assess the patient for signs and symptoms of bradycardia.

B Metoprolol (Lopressor) is a beta1-blocker which will further slowdown the heart rate while lisinopril (Prinivil) is an ACE inhibitor which reduces blood pressure with minimal effect on heart rate.

The nurse will be administering IV Nitropress. In which patient should Nitropress not be administered to? A patient with a BP of 190/135 A patient with a history of stage 3 CKD A patient with acute HF A patient with a need for controlled hypotension during surgery

B Nitropress would be contraindicated in a patient with CKD because it is metabolized to thiocyanates, which is a toxic metabolite excreted through the kidneys. Indications of Nitropress include hypertensive emergencies, acute HF, and the promotion of controlled hypotension to reduce bleeding during surgery. Hypertensive emergencies are defined as SBP greater than 180 and/or DBP greater than 120.

The nurse will be administering Thiazide diuretics to a diabetic patient which adverse effect should the nurse include in the plan of care. Hyperkalemia Hyperglycemia Bradycardia Hypercalcemia

B Thiazide diuretics can cause hyperglycemia especially in diabetic patients. Therefore it is important to monitor blood glucose levels in a diabetic patient.

A patient is scheduled for Prazosin (minipress) at 9:00am and has never taken this before. Which intervention is most important for the nurse to do after administering this medication? Call the doctor immediately and report a medication error Initiate falls precaution, have the patient's call light near them, inform the patient not to get out of bed on their own, and to dangle on the side of the bed before they are assisted to stand up. No action is needed to be taken because it was already cleared and ordered by the doctor for this time. Take the patient's vitals

B Due to the first dose effect the patient is prone to syncope. Initiating a falls precaution is the most important at this time to prevent further injuries related to falls.

A 35 year old diabetic patient newly diagnosed with hypertension has a blood pressure of 145/92. Which antihypertensive medication order would you question? Angiotensin-converting enzyme inhibitor (ACEI) Beta-adrenergic blocker Calcium Channel blocker Thiazide diuretic

B The first-line drugs for patients of all ages who have diabetes mellitus present are thiazide diuretics, ACE inhibitors, Angiotensin receptor blockers (ARBs), and calcium channel blockers. Beta-adrenergic blockers are no longer considered first-line drugs, except for patients with angina.

For which patient would the administration of epinephrine be contraindicated in? 17 year old male who has an anaphylactic reaction 60 year old male with severe dehydration 32 year old female that has episodes of bradycardia 80 year old female that became hypotensive due to septic shock

B If hypovolemic, you would have to correct the fluid volume first before epinephrine administration. If epinephrine was given before fluid replacement, constriction would not necessarily be effective in raising blood pressure, as the result would be little to no pressure increase from the lack of blood volume.

Which of these can help to reduce the adverse effects of flushing in a patient taking niacin? Instruct patient to stop administration of niacin immediately if experiencing flushing Give patient one aspirin tablet 30 minutes prior to niacin administration If flushing occurs, place a cool towel on face Administer niacin medication with Atorvastatin (Lipitor)

B Taking one aspirin tablet 30 minutes prior to niacin administration can reduce uncomfortable flushing in many patients. (Chapter 29, pp. 502)

What situation would prompt you to have a patient immediately discontinue Atorvastatin (Lipitor)? Patient complains of diarrhea occurring several times a week after starting Atorvastatin Patient reports muscle pain although she can't recall doing anything strenuous Patient is has a new finding of Stage 2 chronic kidney disease Patient would like to start trying to get pregnant this year

B Unexplained muscle pain can indicate rhabdomyolysis, a serious adverse effect that could lead to acute renal failure. GI symptoms can be reduced by taking Atorvastatin with food. Atorvastatin is okay to take in chronic kidney disease because it is not excreted by the kidneys; primary excretion is biliary. Atorvastatin is pregnancy category X (VERY CONTRAINDICATED TO TAKE) but the question is asking what is the most immediate concern. The patient will need to stop taking the drug to get pregnant but the possibility of current rhabdomyolysis is a bigger priority.

Beta-1-adrenergic antagonist will act on which receptors to disrupt the RAAS system and lower blood pressure? bind to angiotensin II receptor type 1 [AT1] in vascular smooth muscle, adrenal gland, and myocardium to inhibit actions of angiotensin II act on the juxtaglomerular cell receptor to inhibit the release of renin block receptors in the distal tubule and collecting ducts of the nephron to prevent actions of aldosterone bind to angiotensin converting enzyme [ACE] in the lung capillaries and prevent the conversion of angiotensin I to angiotensin II

B Juxtaglomerular cells have beta-adrenergic receptors to which beta-1 adrenergic receptors bind to and inhibit the release of renin. With no renin, there is no conversion of angiotensinogen into angiotensin I, reducing serum level of angiotensin II and leads to lowering the blood pressure

Which antihypertensive drug does the nurse recognize as the drug that does not require a dose adjustment and would be the best option for a patient who has a hepatic impairment. Losartan Lisinopril Nifedipine Verapamil

B The correct answer is lisinopril because it is the only drug that is not metabolized by the liver, is not a prodrug and does not experience the first pass effect. All the other drugs would require consideration of hepatic function as an inability to metabolize them can lead to toxicity. This would be a good question to include in the test because it requires an understanding of the first pass effect as well as if the drug is a prodrug or not, and what a prodrug is.

A patient is given a muscarinic agonist drug. In general, of this type of drug class, what will be a likely contraindication for not administering this drug. Patient with xerostomia Obstructive disease of GI tract Urinary retention Closed angle glaucoma

B Obstructive disease of GI tract. Rationale: Due to muscarinic agonist acts like a "rest and digest" response, and effect of increased peristalsis contractions. This will cause further injury and rupture. Patient with xerostomia is one of the indications of this class of drug. Urinary retention is an indication for Bethanechol (Urecholine), a muscarinic agonist. Closed angle glaucoma is a contraindication for a type of adrenergic agonist.

Select all that apply. When would you hold a sublingual nitrate medication? a) Pt. has a blood pressure of 130/80 b) Pt. has a blood pressure of 80/55 c) Pt. has a pulse of 80 beats/min d)Pt. has a pulse rate of 120 beats/min

B/D Rationale: Continue frequent monitoring of blood pressure and pulse whenever IV nitrates are used or when giving SL nitrates. With SL nitrates, take blood pressure before and 5 minutes after giving dose and hold the drug if blood pressure is less than 90/60 mmHg, pulse over 100 beats/min, and check with health care provider before continuing to give the drug.

Which of the following will the nurse teach a patient who is receiving atropine IV therapy? a. this medication may cause intense flushing in the face and trunk b. constipation can occur so you must take it with stool softeners c. sugarless gum or hard candies can help relieve dry mouth d. keep a urinal/bedpan/etc. nearby because you may feel the urge to urinate often

C An adverse reaction to atropine is drying of the oral and nasal mucosa. Instruct the patient that sips of water, ice chips, oral rinses free of alcohol, or hard candies may ease mouth dryness. (Alcohol-based rinses will worsen mouth dryness.) (Ch. 14, pg. 174 & 181)

The nurse is monitoring a patient who is taking propanolol (Inederal). Which assessment finding indicates a potential adverse complication associated with this medication? The development of complaints of insomnia A baseline blood pressure of 150/80 followed by a blood pressure of 138/72 after 2 doses of the medication The development of audible expiratory wheezes A baseline resting heart rate of 87 BPM followed by a resting heart rate of 69 after 2 doses of the medication

C Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. Beta blockers may induce this reaction, particularly in those with COPD or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effects and should be monitored.

A patient who just began taking oral calcium supplements for osteoporosis prevention is concerned that her Amlodipine (Norvasc) will no longer be effective. What is the best response by the nurse? "As long as you monitor your calcium levels daily, you can continue taking your calcium supplements with your Amlodipine (Norvasc)." "You must stop taking your calcium supplements immediately because they will cause your Amlodipine (Norvasc) to be ineffective." "As long as you take your calcium supplements in the suggested dose, the antihypertensive effects of your Amlodipine (Norvasc) should not be affected." "You can only continue to take your calcium supplements if you decrease the dose of your Amlodipine (Norvasc)."

C Calcium and magnesium supplements, may help to maintain a normal BP and lower a high BP in some cases. CCBs reduce the amount of calcium available in the heart to contract blood vessels but do not prevent calcium in the blood from being absorbed into the bone. Only high doses of IV calcium supplements may affect CCB but not usual oral doses. (Ch. 30, p. 513)

A 54 year-old female patient arrived at the hospital with a hypertensive emergency. Before administering, the nurse begins to prepare nitroprusside sodium (Nitropress) as a first-line drug to treat the crisis. Which of the following phrases from the nurse shows the need for additional teaching? "The drug will create a direct relaxation of arteriolar smooth muscle and blood pooling in the veins." "I am going to monitor for adverse effects like hypotension, headache, dizziness, and flushing of skin." "After the 5 med rights, checking for IV site, tracing the line, I am now ready to directly administer Nitropress." "Nitropress needs to be weaned off with an oral antihypertensive after BP stabilization."

C Nitroprusside requires dilution prior to infusion and is not suitable for direct injection. The black box warning states that the drug could potentially cause irreversible ischemic injury and death due to significant drops in blood pressure if given directly. Additionally, accumulation of cyanide ion may occur (Ch. 34, p. 595).

A 56-year-old female patient on Propranolol for hypertension asks how the medication works to lower blood pressure. What response from the nurse would be most appropriate? It is an alpha 1 adrenergic receptor antagonist that works by causing vasodilation, thus decreasing peripheral vascular resistance It is a nonselective alpha adrenergic antagonist that works by decreasing the HR, thereby decreasing cardiac output It is a nonselective beta adrenergic antagonist that decreases blood pressure by decreasing cardiac output and suppressing renin activity It is a beta 1 adrenergic antagonist that decreases blood pressure by decreasing cardiac output

C Propranolol is a nonselective beta adrenergic antagonist that decreases blood pressure by decreasing cardiac output and suppressing renin activity

A nurse is educating a patient on therapeutic lifestyle changes to reduce cholesterol levels. Which statement by the patient requires further teaching? I must quit smoking and tobacco use completely I will maintain optimal weight and implement a medically supervised exercise plan The most important lifestyle factor is to restrict dietary cholesterol intake I should refrain from eating beef, poultry, and dairy foods

C Restriction of dietary cholesterol alone will not result in significant reduction of blood cholesterol levels. Cutting back on cholesterol consumption may actually increase the amount of circulating cholesterol. The most important lifestyle factor contributing to dyslipidemia is high saturated fats in the diet.

A patient is prescribed bethanechol (Urechline) PO 10 mg. What assessment would the nurse find most alarming relating to this? Temp of 100.6 F BP of 130/89 HR of 45 BPM Urinary output of 400 mL in the last 6 hrs

C Serious adverse effects of bethanechol includes orthostatic hypotension with possible syncope, bradycardia, reflex tachycardia, complete heart block, acute bronchospasm. (Chapter 13, pg 158)

A patient is newly prescribed Tamsulosin, an alpha-1 antagonist due to BPH. Which finding is most significant for the nurse to address? Dizziness Nausea Orthostatic hypotension Increased urine output

C The patient would be experiencing orthostatic hypotension due to the first dose phenomenon. This is an adverse effect when first starting treatment for alpha antagonists. "A" and "b" are common side effects of tamsulosin, not as serious as orthostatic hypotension and "d" is an intended therapeutic effect of tamsulosin.

You are waiting at the airport for your flight when suddenly S.P., an adult male passenger, drops to the floor clutching his chest in agonizing pain. Which action is most appropriate as a nurse during this suspected MI? Administer an epipen, offered by another passenger, into the right quadricep of S.P. Immediately give S.P. two 325 mg enteric coated aspirin tablets Give S.P. two 10mg tablets of atorvastatin followed by sips of grapefruit juice once the pain subsides Ask S.P. about any allergies and give him four 81mg aspirin chewable tablets unless contraindicated.

D

What statement by a nursing student requires further teaching when asked about the antihypertensive losartan? Losartan reduces blood volume by blocking aldosterone release Losartan prevents the development of diabetic nephropathy A losartan overdose can be treated by NS or a Vasopressor A losartan overdose can be treated by hemodialysis

D "Overdose will cause hypotension which may be treated by an infusion of NS or a vasopressor. Hemodialysis does not remove the drug."

The nurse administering propranolol knows that the adverse effect of bronchoconstriction is due to the inhibition of which receptors? Alpha-1 Alpha-2 Beta-1 Beta-2

D Beta-2 receptors are located in the lungs (as well as the smooth muscle in arterioles and GI tract) and activation of beta-2 receptors results in dilation of the bronchioles. Therefore, when the beta-2 receptors are inhibited, bronchoconstriction occurs and can cause acute shortness of breath in patients with COPD and asthma

A patient with a history of asthma was admitted with shortness of breath, chest tightness, and wheezing. When administering a medication, the nurse should know that the activation of which receptor would be best for treating this patient? Nicotinic cholinergic Muscarinic cholinergic Beta1 Adrenergic Beta2 Adrenergic

D Beta2 adrenergic receptors are located in the bronchioles of the lungs and would be activated to treat asthma because it causes bronchodilation. Beta1 adrenergic receptors are located in the heart and contribute to vasoconstriction. Muscarinic cholinergic receptors would be blocked instead of activated because it causes bronchoconstriction. Nicotinic receptors are primarily related to voluntary muscle control.

Which of the following tasks should the nurse educate the patient on after taking an Albuterol inhalant? Sit down until feeling of dizziness fades away Drink a glass of water before and after taking the dose Consider the use of stool softeners Rise mouth with water after taking dose

D Mouth should be rinsed after the use of an inhaled corticosteroid such as Albuterol to prevent the growth of fungus in the oral cavity.

What is one possible outcome that may occur after giving a muscarinic antagonist, and what would be the treatment for overdose? Bradycardia; succinylcholine Decrease glandular secretions; pyridostigmine Increase GI motility; atropine Bronchodilation; physostigmine

D Muscarinic antagonists produce a sympathetic effect since muscarinic receptors are specific for the parasympathetic NS. As an antagonist, the drugs in this class will prevent ACh from binding to the muscarinic receptor, preventing any parasympathetic outcomes, and enhancing fight/flight responses. Physostigmine is the treatment for overdose of muscarinic antagonists because it acts as a reversible cholinesterase inhibitor; cholinesterase's function is to destroy ACh, so reversing a cholinesterase inhibitor will allow for the destruction of ACh.

The patient has been prescribed bethanechol and is experiencing decreased urine output. What is the nurse's priority intervention? Catheterize the patient to drain the bladder and measure output Administer hydrochlorothiazide Encourage the patient to relax when urinating. Notify health care provider with current intake and output values

D Bethanechol is used to treat urinary retention but will not be effective and shouldn't be used in the case of mechanical obstruction. If this patient was prescribed bethanechol for urinary retention and output is decreasing, the health care provider should be notified to investigate another cause.

Following doctors orders, a nurse is switching a patient from heparin to warfarin. Which statement is the correct way to administer this change in therapy? Immediately discontinue heparin and begin warfarin therapy. Administer heparin and warfarin concurrently for 2-3 days. Heparin and warfarin administered every other day for 4 days as ordered. Wait 90 minutes for heparin half life to be completed before beginning warfarin.

In order to reach optimal anticoagulation therapy, nurses must be sure to administer heparin and warfarin concurrently for 2-3 days because heparin has a brief half life (90 minutes), while warfarin takes 1-3 days to reach optimal anticoagulation.

Which is not a mechanism of action of adrenergic agonists? Stimulating the release of norepinephrine from storage vesicles on the presynaptic neuron Competing with norepinephrine at adrenergic receptors sites Inhibiting the reuptake of norepinephrine from the synaptic cleft to the presynaptic neuron Inhibiting the destruction of norepinephrine by monoamine oxidase

RATIONALE: "b." is the mechanism of action of adrenergic antagonists. "a.", "c.", "d." are all indirect mechanisms of action of adrenergic agonists and increase the amount of norepinephrine at the synapse (Chapter 15).

The patient taking atorvastatin (Lipitor) reports weakness and fatigue, pain in the shoulders, and aching joints. The nurse initially assesses the patient for which condition? Rhabdomyolysis Renal failure Rheumatoid arthritis Hepatic insufficiency

Rhabdomyolysis is a serious adverse effect of the statins. Early signs include unexplained fatigue or muscle weakness, pain in joints or muscles, and an increase in CK level. In rheumatoid arthritis, pain is often present but tends to be greatest in the mornings and associ-ated with red, hot, swollen joints.

A patient is brought to the hospital via ambulance complaining of chest pain and pain in the jaw. The patient appears anxious and diaphoretic. Which change in blood value would be the quickest way to diagnose an acute myocardial infarction? CK-MB Creatinine Kinase Myoglobin Troponin T

The correct answer is Troponin T because the initial elevation after an MI is 1-3 hours and it's normal range is small and very specific (less than 0.2 mcg/L. The necrosis of the oxygen deprived myocardial tissue creates the markers of Troponin T and creatinine kinase, but creatinine kinase is elevated 3-8 hours after an MI (so cTn is faster). Although it is released quickly, Myoglobin lacks cardiac specificity so it is not used in a diagnostic capacity. CK-MB is less sensitive to cardiac injury compared to Troponin T.

A patient admitted to the hospital 4 days ago is recently prescribed an monoamine oxidase inhibitor by her PCP. Which medication in the patient's MAR would require the nurse to contact the PCP: Metformin Propranolol Glyburide Acetaminophen

b "Monoamine oxidase inhibitors (MAOIs) deplete endogenous catecholamines, concurrent administration with propranolol could result in severe bradycardia and hypotension"

Connie Lu: Administering satin to slow the progression of CVD and reduce mortality in patients with a history of cardiovascular disease is Primary intention Secondary intention Third intention Tertiary intention

b Secondary prevention because patient is already at risk for increased mortality

A patient has been recently prescribed Clopidogrel (Plavix), an antiplatelet drug. Which of the following statements made by the patient indicates the need for further teaching? "This medication will help reduce the risk of a stroke." "When taking this medication, I should be careful of bleeding." "I will have to stop taking this medication 3 days before surgery" "This medication is like aspirin."

c Clopidogrel (Plavix) should be discontinued at least 5 days prior to surgery to avoid excessive bleeding. (pg 675

The nurse is scheduled to give a dose of propranolol to her patient. Which assessment finding would cause the nurse to hold the medication and call the physician? Migraine headache Angina pectoris Blood sugar 217 mg/dL pulse 115 beats/min

c propranolol is a beta adrenergic blocking agent that lowers blood pressure. It should be used cautiously in patients with diabetes since it interferes with glucose metabolism and can cause hypoglycemia. Since it decreases tachycardia, it also masks signs of hypoglycemia. Propranolol is also used to prevent migraines and are used to treat chronic angina

What answer by a nursing student requires further teaching when asked about the side effects of the adrenergic drug, Phenylephrine (Neo-Synephrine), when given through an IM injection? Reflex Bradycardia Anxiety Tremors Hypotension

d RATIONALE: Parenteral administration of Phenylephrine causes systemic vasoconstriction that can prevent or reverse acute hypotension caused by spinal anesthesia or vascular shock. Its lack of significant cardiac effects gives it an advantage over Norepinephrine and Epinephrine in treating acute hypotension. Reflex bradycardia is an adverse effect of Phenylephrine. Parenteral use can lead to symptoms of CNS stimulation such as anxiety and tremors. (Chapter 15, pp. 193)