Exam 4 - ATI Questions

CV Sys: A nurse is caring for a client who has a new prescription for aliskiren to treat HTN. The nurse should monitor the client for which of the following findings as an adverse effect of the drug? -Hyperkalemia -Throat swelling -Constipation -Cough -Joint pain

-Hyperkalemia is correct. Aliskiren, a direct renin inhibitor, can cause elevated potassium levels, especially when taken in combination with an ACE inhibitor, potassium supplements, or potassium-sparing diuretics. The nurse should obtain a potassium level at baseline and periodically monitor the client's potassium level thereafter. -Throat swelling is correct. Aliskiren can cause angioedema, which is swelling of the mouth and throat. Clients who develop this adverse effect should stop taking the drug and seek medical attention. -Constipation is incorrect. Constipation is not an adverse effect of aliskiren. This drug can cause diarrhea. -Cough is correct. Aliskiren, a direct renin inhibitor, can cause a cough. -Joint pain is incorrect. Joint pain is not an adverse effect of aliskiren. This drug can cause headaches.

CV Sys: A nurse is teaching a client who has a new prescription for gemfibrozil. Which of the following instructions should the nurse include? (Select all that apply.) -Take the drug with food. -Report any new intolerance to fried foods. -Report muscle tenderness. -Expect periodic liver function testing. -Take the drug once each day.

-Take the drug with food is incorrect. Clients should take gemfibrozil, a fibrate, 30 min before a meal, not with food. -Report any new intolerance to fried foods is correct. Because gemfibrozil, a fibrate, can cause gallstones, clients should monitor and report any new intolerance to fried foods, as well as any bloating or upper abdominal discomfort. -Report muscle tenderness is correct. Because gemfibrozil, a fibrate, can cause myopathy, clients should monitor and report any unexplained muscle or joint pain. -Expect periodic liver function testing is correct. Because gemfibrozil, a fibrate, increases the risk for liver toxicity, clients will require liver function testing while taking this drug. -Take the drug once each day is incorrect. Clients should take gemfibrozil, a fibrate, twice each day.

Ch 21: A nurse is teaching a client who has angina how to use nitroglycerin transdermal ointment. The nurse should include which of the following instructions? A) "Remove the prior dose before applying a new dose." B) "Rub the ointment directly into your skin until it is no longer visible." C) "Cover the applied ointment with a clean gauze pad." D) "Apply the ointment to the same skin area each time."

A) "Remove the prior dose before applying a new dose." You answered correctly. When taking actions, the nurse should teach the client to remove the prior dose before applying a new dose to prevent toxicity.

Ch 18: 18.1 Case Study Tracy is developing the plan of care for Mr. Toll. Which of the following interventions should the nurse include in the plan of care? Select all that apply. A) Assess for tinnitus. B) Report urine output 50 mL/hr. C) Monitor blood potassium levels. D) Initiate fall precautions. E) Recommend increasing protein intake.

A) Assess for tinnitus. The nurse should plan to generate solutions to include in Mr. Toll's plan of care. An adverse effect of furosemide is ototoxicity. Manifestations of tinnitus should be reported to the provider. C) Monitor blood potassium levels. A decrease in blood potassium levels is an adverse effect of furosemide, and the provider should be notified. D) Initiate fall precautions. The nurse should initiate fall precautions due to dizziness which Mr. Toll reported. He should also be encouraged to use the call light for assistance when getting out of bed.

Ch 20: A nurse is teaching a client who has a new prescription for digoxin. The nurse should instruct the client to monitor and report which of the following adverse effects that is a manifestation digoxin toxicity? Select all that apply. A) Headache B) Constipation C) Anorexia D) Rash E) Blurred vision

A) Headache C) Anorexia E) Blurred vision You answered incorrectly. When taking actions, the nurse should teach the client that headache, GI disturbances, such as anorexia, and visual changes, such as blurred and yellow-tinged vision, are manifestations of digoxin toxicity. The client should be instructed to notify the provider if these manifestations occur.

Ch 18: 18.1 Case Study Tracy is reviewing the laboratory results from Mr. Toll. Which of the following electrolyte imbalances should she monitor for? A) Hypocalcemia B) Hypermagnesemia C) Hypophosphatemia D) Hyperkalemia

A) Hypocalcemia You answered correctly. Tracy should plan to generate solutions by monitoring for potential electrolyte imbalances. When observing for hypocalcemia, she should monitor for manifestations including muscle twitching, muscle cramps, and tingling in the hands and feet.

Ch 19: A nurse is teaching a client who has a new prescription for verapamil to control hypertension. Which of the following instructions should the nurse include? A) Increase the amount of fiber in the diet. B) Drink grapefruit juice daily to increase vitamin C intake. C) Decrease the amount of calcium in the diet. D) Withhold food for 1 hr after the medication is taken.

A) Increase the amount of fiber in the diet. You answered correctly. When taking actions, the nurse should instruct the client that Increasing dietary fiber intake can help prevent constipation, an adverse effect of verapamil.

CV Sys: A nurse should recognize that milrinone is contraindicated for a client who has which of the following conditions? -Acute myocardial infarction -Peripheral vascular disease -Ulcerative colitis -Ventricular tachycardia

Acute myocardial infarction MY ANSWER Milrinone, a phosphodiesterase inhibitor, is contraindicated for clients who have had an allergic reaction to phosphodiesterase inhibitors and for clients who have an acute myocardial infarction and aortic or pulmonary valve disorders.

Ch 20: A nurse is administering a low dose dopamine infusion to a client who has severe heart failure. Which of the following findings is an expected effect of this medication? A) Lowered heart rate B) Increased urine output C) Decreased conduction through the AV node D) Vasoconstriction of renal blood vessels

B) Increased urine output You answered correctly. When evaluating outcomes the nurse should identify that dopamine increases urinary output because of increased renal perfusion. This occurs due to the activation of the dopamine receptors in the kidneys when dopamine is administered at low doses. An increase in urinary output indicates the client's condition is improving

Ch 22: A nurse is assessing a client who is taking amiodarone to treat atrial fibrillation. Which of the following findings can be an indication of amiodarone toxicity? A) Light yellow urine B) Report of tinnitus C) Productive cough D) Blue-gray skin discoloration

C) Productive cough You answered correctly. The nurse should analyze the cues from the client's manifestations and determine that a productive cough can indicate pulmonary toxicity or heart failure. The nurse should assess for cough, chest pain, and shortness of breath.

Ch 22: A nurse is assessing a client who is taking digoxin to treat heart failure. Which of the following findings is a manifestation of digoxin toxicity? A) Bruising B) Report of metallic taste C) Muscle pain D) Report of anorexia

D) Report of anorexia You answered correctly. The nurse should analyze the cues from the client's manifestations and determine that anorexia, blurred vision, stomach pain, and diarrhea are manifestations of digoxin toxicity.

CV Sys: A nurse is providing teaching to a client who has a new prescription for losartan to treat hypertension. The nurse should instruct the client that which of the following findings could indicate an adverse reaction to the drug and needs to be reported? -Facial edema -Sleepiness -Peripheral edema -Constipation

Facial edema MY ANSWER Losartan, an angiotensin II receptor blocker, can cause angioedema, which often manifests as swelling around the eyes and lips. Clients who develop this adverse effect should stop taking the drug and seek medical attention.

CV Sys: A nurse is caring for a client who is taking amiodarone to atrial fibrillation. Which of the following should the nurse instruct the client to avoid while taking this drug? -Grapefruit juice -Milk -Foods high in vitamin K -NSAIDs

Grapefruit juice MY ANSWER Grapefruit juice, particularly in large amounts, can cause toxicity of potassium channel blockers, such as amiodarone.

CV Sys: A nurse is administering hydrochlorothiazide to a client who has gouty arthritis. The nurse should monitor the client for which of the following findings that indicate an adverse effects of this drug? -Hyperuricemia -Hypernatremia -Hyperkalemia -Hypoglycemia

Hyperuricemia MY ANSWER Hyperuricemia, or increased uric acid levels, along with gouty arthritis, can occur in clients who have a history of these conditions and are taking hydrochlorothiazide.

CV Sys: A nurse is caring for a client who is taking carvedilol and has a prescription for an oral antidiabetic drug to manage their new diagnosis of type 2 DM. By taking both drugs currently, the nurse should identify that the client is at an increased risk for which of the following conditions? -Hyperglycemia -Bradycardia -Hypotension -Hypoglycemia

Hypoglycemia MY ANSWER There are two factors that increase the client's risk for hypoglycemia. Alpha/beta blockers, such as carvedilol, potentiate the hypoglycemic effects of insulin and oral hypoglycemic drugs. Also, carvedilol can mask tachycardia in clients who have hypoglycemia. Carvedilol should be used with caution by clients who have diabetes mellitus.

CV Sys: A nurse is assessing a client who is taking a loop diuretic and is experiencing a thready, irregular pulse orthostatic hypotension, and confusion. The nurse should identify that these are manifestations indicate which of the following adverse effects? -Hypokalemia -Hypoglycemia -Hypouricemia -Hyponatremia

Hypokalemia MY ANSWER Manifestations of hypokalemia include a thready, irregular pulse, orthostatic hypotension, anxiety, confusion, skeletal muscle weakness, hypoactive bowel sounds, polyuria, nausea, and vomiting.

CV Sys: A nurse is caring for a client who has a new prescription for verapamil to treat atrial fibrillation. The nurse should instruct the client to avoid drinking grapefruit juice while taking verapamil because it can cause the client to experience which of the following conditions? -Tachycardia -Dehydration -Diarrhea -Hypotension

Hypotension MY ANSWER Large amounts of grapefruit juice can increase blood levels of verapamil by inhibiting its metabolism. An excess amount of the drug in the body can intensify otherwise therapeutic effects like hypotension, causing serious risk for syncope and dizziness.

CV Sys: A nurse is providing teaching to a client who is taking simvastatin. The nurse should instruct the client to report which of the following manifestations as an indication of a serious adverse reaction that could require discontinuing drug therapy? -Bronchoconstriction -Muscle pain -Lip numbness -Somnolence

Muscle pain MY ANSWER Simvastatin, an HMG-CoA reductase inhibitor (statin), can cause myopathy or pain in muscles and joints that can progress to rhabdomyolysis. With this rare but serious adverse effect, muscle protein breaks down and is excreted, resulting in kidney damage.

CV Sys: A nurse is caring for a client who is taking atorvastatin and has a new prescription for gemfibrozil. The nurse should recognize that this drug combination places the client at risk for which of the following a/e? -Myopathy -Hypoglycemia -Irregular pulse -Kidney failure

Myopathy MY ANSWER When taking a statin drug, it is important to know that concurrent use of fibric acid derivatives, such as gemfibrozil, or other drugs to lower cholesterol, can increase the risk for myopathy.

CV Sys: A nurse is caring for a client who has a new prescription for propranolol to treat tachydysrhythmia. The nurse should instruct the client to avoid taking which of the following types of OTC drugs while taking propranolol? -Antihistamines -Potassium supplements -NSAIDs -Vitamin C

NSAIDs MY ANSWER NSAIDs can interact with propranolol and decrease the anti-hypertensive action because vasoconstriction can occur in some COX-2 inhibitors. The nurse should instruct the client to avoid taking NSAIDs and propranolol at the same time.

CV Sys: A nurse is caring for a client who is taking spironolactone to treat HTN. The nurse should recognize that which of the following client lab values requires immediate intervention? -Sodium 140 mEq/L -Potassium 5.2 mEq/L -Chloride 100 mEq/L -Magnesium 1.9 mEq/L

Potassium 5.2 mEq/L MY ANSWER Spironolactone is a diuretic and an aldosterone antagonist that can cause hyperkalemia and places the client at risk for cardiac dysrhythmias. This potassium level is outside the expected reference range of 3.5 to 5.0 mEq/L and requires immediate intervention.

CV Sys: A nurse should identify that which of the following drugs is used only for the short-term treatment of a cardiac dysrhythmia because of the serious a/e associated with long-term use? -Quinidine -Procainamide -Nitroglycerin -Verapamil

Procainamide MY ANSWER Procainamide is a sodium channel blocker and a broad-spectrum antidysrhythmic. It should not be used for long-term treatment of dysrhythmias because of its risk for serious adverse effects, including cardiotoxicity and arterial embolism.

CV Sys: A nurse is caring for a client who has a depressive disorder and requires a prescription drug to treat HTN. The nurse should recognize that which of the following antihypertensive drugs is contraindicated for this client? -Reserpine -Captopril -Hydralazine -Eplerenone

Reserpine MY ANSWER Severe depression and an increased risk for suicide are adverse effects of adrenergic neuron blockers, such as reserpine. These adverse effects develop because of the depletion of serotonin and norepinephrine and can persist after clients discontinue taking the drug.

CV Sys: A nurse is caring for a client who has a new prescription for verapamil. The nurse should clarify the prescription with the provider if the client has a hx of which of the following conditions? -Migraine headaches -Pancreatitis -Second-degree AV block -Angina pectoris

Second-degree AV block MY ANSWER Verapamil, a calcium channel blocker, can affect AV conduction and is contraindicated for clients who have sick sinus syndrome or second- or third-degree AV block. Verapamil is indicated for hypertension, angina pectoris, and the management of atrial flutter and fibrillation. It is also prescribed for the management of migraine headaches.

Ch 18: A charge nurse is reviewing the use of loop diuretics with a group of nurses. Therapeutic Uses: Identify two. Complications: Describe three adverse effects. Nursing Interventions: Describe two interventions for each of the three adverse effects.

Therapeutic Uses Used when there is an emergent need for rapid mobilization of fluid Pulmonary edema caused by heart failure Liver, cardiac, or kidney disease Hypertension Unlabeled use: Hypercalcemia Complications Dehydration Hypotension Ototoxicity Hypokalemia Nursing Interventions Dehydration: Assess for dry mouth, increased thirst, low urine output, weight loss. Hypotension: Monitor orthostatic blood pressure and pulse; monitor for manifestations of postural hypotension. Ototoxicity: Assess for tinnitus; avoid administering ototoxic medications. Hypokalemia: Monitor laboratory values; offer potassium-rich foods; assess for general weakness, nausea, and vomiting.

CV Sys: A nurse is teaching a client who has a new prescription for quinidine. Which of the following statement should the nurse include? -"Monitor your pulse rate and report changes." -"Remain upright for 30 minutes after taking this medication." -"This medication can decrease digoxin levels." -"This medication can cause urinary incontinence."

"Monitor your pulse rate and report changes." MY ANSWER Sodium channel blockers, like quinidine, can worsen dysrhythmias, or cause new ones. The nurse should teach the client to monitor their pulse rate and report changes from prescribed parameters. It can be helpful to instruct the client to keep a written record of their pulse rate for the provider.

CV Sys: A nurse is caring for a client who will begin using transdermal nitroglycerin to treat angina pectoris. When speaking to the client about the drug, which of the following instructions should the nurse include? (Select all that apply.) -"Apply a new patch at the onset of anginal pain." -"Apply the patch to dry skin and cover the area with plastic wrap." -"Apply the patch to a hairless area and rotate sites." -"Apply a new patch when you start your day." -"Remove patches for 10 to 12 hours each day."

-"Apply a new patch at the onset of anginal pain" is incorrect. Nitroglycerin patches provide ongoing prevention of angina episodes. They do not treat the acute onset of anginal pain. -"Apply the patch to dry skin and cover the area with plastic wrap" is incorrect. These instructions apply to topical nitroglycerin ointment, not to nitroglycerin patches. -"Apply the patch to a hairless area and rotate sites" is correct. Hair can interfere with the adhesion of the patch. Rotating patch application sites helps prevent skin irritation. -"Apply a new patch when you start your day" is correct. The therapeutic preventive effects of transdermal nitroglycerin patches begin 30 to 60 min after application and last for up to 14 hr. Because angina pain is more likely to occur with activity, most clients require this protection during waking hours. -"Remove patches for 10 to 12 hr each day" is correct. Removing the patches for 10 to 12 hr each day helps prevent the development of tolerance to the drug. For most clients, sleeping hours are the best time to remove the patch and go "patch-free," because angina pain is more likely during activity.

CV Sys: A nurse is caring for a client who has a new prescription for dobutamine. The nurse should clarify the prescription with the provider if the client is receiving which of the following types of drugs? (Select all that apply.) -ACE inhibitor -MAOI -General anesthetic -Tricyclic antidepressant -Beta blocker

-ACE inhibitor is incorrect. ACE inhibitors can cause lithium toxicity in clients who also take lithium; however, they do not interact with dobutamine, which is a sympathomimetic drug. -MAOI is correct. MAOIs can cause toxicity when clients take them while also taking dobutamine. This significantly increases the client's risk for tachydysrhythmias. -General anesthetic is correct. General anesthetics can cause dysrhythmias when clients take them while also taking dobutamine. -Tricyclic antidepressant is correct. Tricyclic antidepressants can cause toxicity when clients take them while also taking dobutamine. This significantly increases the client's risk for tachydysrhythmias. -Beta blocker is correct. Beta blockers, such as propranolol, can decrease the effects of dobutamine.

CV Sys: A nurse is caring for a client who is about to begin captopril therapy. Which of the following adverse effects should the nurse instruct the client to report because it can indicate a need to dx therapy? (Select all that apply.) -Rash -Distorted taste -Swelling of the tongue -Photosensitivity -Dry cough

-Rash is correct. Captopril, an ACE inhibitor, can cause a persistent rash. This often indicates the need to discontinue drug therapy. -Distorted taste is correct. Captopril can cause distortions in taste sensations and loss of taste, which can lead to anorexia and weight loss. This often indicates the need to discontinue drug therapy. -Swelling of the tongue is correct. Captopril can cause angioedema, often manifesting as edema of the tongue, pharynx, and glottis. Clients who develop this adverse effect should discontinue the drug and seek medical attention. -Photosensitivity is incorrect. Captopril can cause photosensitivity, a relatively benign adverse effect that does not require the client to discontinue drug therapy. Clients who experience this adverse effect should be especially careful about wearing sunscreen and protective clothing when outdoors and should limit their exposure to sunlight. -Dry cough is correct. Captopril can cause a dry cough because of an accumulation of bradykinin. This often indicates the need to discontinue drug therapy.

Ch 19: A nurse is reviewing the medical record of a client who asks about using propranolol to treat hypertension. The nurse should recognize which of the following conditions is a contraindication for taking propranolol? A) Asthma B) Glaucoma C) Hypertension D) Tachycardia

A) Asthma You answered correctly. The nurse should analyze the cues from the client's medical record and determine that propranolol is a nonselective beta-adrenergic blocker that blocks both beta1 and beta2 receptors. Blockade of beta2 receptors in the lungs causes bronchoconstriction, so it is contraindicated in clients who have asthma.

Ch 22: A nurse is caring for a client who received IV verapamil to treat supraventricular tachycardia (SVT). The client's pulse rate is now 98/min, and the blood pressure is 74/44 mm Hg. The nurse should expect a prescription for which of the following IV medications? A) Calcium gluconate B) Sodium bicarbonate C) Potassium chloride D) Magnesium sulfate

A) Calcium gluconate You answered correctly. The nurse should plan to generate solutions to address the client's hypotension which includes the administration of calcium gluconate, given slowly IV. The calcium counteracts vasodilation caused by verapamil. Other measures to increase blood pressure can include IV fluid therapy and placing the client in a modified Trendelenburg position.

Ch 20: A nurse is teaching a client who has a new prescription for digoxin to treat heart failure. Which of the following instructions should the nurse include in the teaching? A) Contact provider if heart rate is less than 60/min. B) Check pulse rate for 30 seconds and multiply result by 2. C) Increase intake of sodium. D) Take with food if nausea occurs.

A) Contact provider if heart rate is less than 60/min. You answered correctly. When taking actions, the nurse should teach the client to contact the provider for a heart rate less than 60/min prior to taking the medication.

Ch 21: A nurse is taking a medication history from a client who has angina and is to begin taking ranolazine. The nurse should report which of the following medications in the client's history that can interact with ranolazine? Select all that apply. A) Digoxin B) Simvastatin C) Verapamil D) Amlodipine E) Nitroglycerin transdermal patch

A) Digoxin The nurse should analyze the cues from the client's medication history and determine that ranolazine should not be given concurrently with digoxin because it can increase blood levels of digoxin, increasing the risk of developing digoxin toxicity can result. B) Simvastatin Ranolazine increases blood levels of simvastatin, so liver toxicity can result when administered concurrently. C) Verapamil Verapamil is an inhibitor of CYP3A4, which can increase levels of ranolazine and lead to the dysrhythmia torsades de pointes when administered concurrently.

Ch 21: A nurse is teaching a client who has a new prescription for nitroglycerin transdermal patch for angina pectoris. Which of the following instructions should the nurse include? A) Remove the patch for at least 10 hr daily. B) Cut each patch in half if angina attacks are under control. C) Take off the nitroglycerin patch for 30 min if a headache occurs. D) Apply a new patch every 48 hr.

A) Remove the patch for at least 10 hr daily. You answered correctly. When taking actions, the nurse should instruct the client to prevent tolerance to nitroglycerin, the client should remove the patch for 10 to 12 hr during each 24-hr period.

Ch 18: A nurse is providing information to a client who has a new prescription for hydrochlorothiazide. Which of the following information should the nurse include? A) Take the medication with food. B) Plan to take the medication at bedtime. C) Expect increased swelling of the ankles. D) Fluid intake should be limited in the morning.

A) Take the medication with food. You answered correctly. When taking actions the nurse should instruct the client to take hydrochlorothiazide with or after meals to prevent gastrointestinal upset.

Ch 21: A nurse is teaching a client who is starting simvastatin. Which of the following information should the nurse include? A) Take this medication in the evening. B) Change position slowly when rising from a chair. C) Maintain a steady intake of green leafy vegetables. D) Consume no more than 1 L/day of fluid.

A) Take this medication in the evening. You answered correctly. When taking actions, the nurse should teach the client to take simvastatin in the evening because nighttime is when the most cholesterol is synthesized in the body. Taking statin medications in the evening increases medication effectiveness

CV Sys: A nurse is caring for a patient who is taking digoxin and develops changes on their ECG tracing and other manifestations that indicate the client has severe digoxin toxicity. Which of the following drugs should the nurse expect to administer to treat this complication? -Acetylcysteine -Flumazenil -Antigen-binding fragments -Deferoxamine

Antigen-binding fragments MY ANSWER Antigen-binding fragments, also called digoxin immune Fab, binds to digoxin and blocks its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity.

Ch 21: A nurse is teaching a client who has angina pectoris and is learning how to treat acute anginal attacks. The client asks, "What is my next step if I take one nitroglycerin tablet, wait 5 minutes, but still have anginal pain?" Which of the following responses should the nurse make? A) "Take two more sublingual tablets at the same time." B) "Call for emergency medical assistance." C) "Take a sustained-release nitroglycerin capsule." D) "Wait another 5 minutes then take a second sublingual tablet."

B) "Call for emergency medical assistance." You answered correctly. When taking actions, the nurse should inform the client that the next step is to call 911 and then take a second sublingual tablet. If the first tablet does not work, the client might be having a myocardial infarction. The client can take a third tablet if the second one has not relieved the pain after waiting an additional 5 minutes.

Ch 23: A nurse is monitoring a client who takes aspirin daily. The nurse should identify which of the following manifestations as adverse effects of aspirin? Select all that apply. A) Hypertension B) Coffee-ground emesis C) Tinnitus D) Paresthesia of the extremities E) Nausea

B) Coffee-ground emesis C) Tinnitus E) Nausea You answered incorrectly. The nurse should analyze the cues from the client's manifestations and determine that dark stools or coffee-ground emesis can indicate GI bleeding, tinnitus and hearing loss, and nausea, vomiting, and abdominal pain can indicate adverse effects of aspirin therapy.

Ch 19: A nurse is planning to administer a first dose of captopril to a client who has hypertension. Which of the following medications can intensify first dose hypotension? Select all that apply. A) Simvastatin B) Hydrochlorothiazide C) Phenytoin D) Clonidine E) Aliskiren

B) Hydrochlorothiazide The nurse should plan to generate solutions to identify the medications that can affect the client's first-time taking captopril. These can include the following medications. Hydrochlorothiazide, a thiazide diuretic, is often used to treat hypertension. Diuretics can intensify first-dose orthostatic hypotension caused by captopril and can continue to interact with antihypertensive medications to cause hypotension. Monitor clients carefully for hypotension, especially after the first dose of captopril and keep the client safe from injury. D) Clonidine Clonidine, a centrally acting alpha2 agonist, is an antihypertensive medication that can interact with captopril to intensify first-dose orthostatic hypotension. E) Aliskiren Aliskiren, a direct renin inhibitor, is an antihypertensive medication that can interact with captopril to intensify its first-dose orthostatic hypotension.

Ch 23: A nurse is planning to administer subcutaneous enoxaparin 40 mg using a prefilled syringe of enoxaparin 40 mg/0.4 mL to an adult client following hip arthroplasty. Which of the following actions should the nurse plan to take? A) Expel the air bubble from the prefilled syringe before injecting. B) Insert the needle completely into the client's tissue. C) Administer the injection in the client's thigh. D) Aspirate carefully after inserting the needle into the client's skin.

B) Insert the needle completely into the client's tissue. You answered correctly. The nurse should plan to generate solutions to address the client's need for enoxaparin subcutaneously which includes the need to inject the needle on the prefilled syringe completely when administering enoxaparin to administer the medication by deep subcutaneous injection.

Ch 23: A nurse is planning to administer IV alteplase to a client. Which of the following interventions should the nurse plan to take? A) Administer IM enoxaparin along with the alteplase dose. B) Obtain the client's weight. C) Administer aminocaproic acid IV prior to alteplase infusion. D) Prepare to administer alteplase within 8 hr of manifestation onset.

B) Obtain the client's weight. You answered correctly. When generating solutions to address the client's need for alteplase administration, which includes obtaining an accurate weight which is required to calculate the dosage for alteplase administration.

Ch 20: A nurse is caring for a client who has a new prescription for digoxin and takes multiple other medications. The nurse should identify that concurrent use of which of the following medications increases the client's risk for developing digoxin toxicity? A) Phenytoin B) Verapamil C) Warfarin D) Aluminum hydroxide

B) Verapamil You answered correctly. The nurse should analyze the findings and determine that the priority hypothesis is that the client is at risk for a medication interaction which could lead to digoxin toxicity. Verapamil, a calcium-channel blocker, can increase digoxin levels. If these medications are given concurrently, the digoxin dosage may need to be decreased, and the nurse should monitor digoxin levels carefully.

Ch 22: A nurse is assessing a client who has taken quinidine to treat dysrhythmias for the last 12 months. The nurse should assess the client for which of the following manifestations as an adverse effect of this medication? Select all that apply. A) Hypertension B) Widened QRS complex C) Narrowed QT interval D) Tinnitus E) Diarrhea

B) Widened QRS complex When taking actions, the nurse should assess the client for manifestations of potential adverse effects of this medication. On the ECG, quinidine can cause a widened QRS complex, which is a manifestation of cardiotoxicity if the QRS complex becomes widened by more than 50% of the expected reference range. D) Tinnitus It can cause cinchonism which is characterized by tinnitus, headache, nausea, vertigo, and disturbed vision. E) Diarrhea The nurse should assess the client for diarrhea as an adverse effect of quinidine. It can be intense and lead to discontinuation of the medication.

Ch 22: A nurse is preparing to administer propranolol to a client who has a dysrhythmia. Which of the following actions should the nurse plan to take? A) Hold propranolol for an apical pulse greater than 100/min. B) Administer propranolol to increase the client's blood pressure. C) Assist the client when sitting up or standing after taking this medication. D) Check for hypokalemia frequently due to the risk for propranolol toxicity.

C) Assist the client when sitting up or standing after taking this medication. You answered correctly. The nurse should plan to generate solutions to address the client's potential orthostatic hypotension following administration of propranolol which includes assessing for dizziness during ambulation or when moving to a standing or sitting position.

Ch 18: A nurse is monitoring a client who is receiving spironolactone. Which of the following findings should the nurse report to the provider? A) Blood sodium 144 mEq/L B) Urine output 120 mL in 4 hr C) Blood potassium 5.2 mEq/L D) Blood pressure 140/82 mm Hg

C) Blood potassium 5.2 mEq/L You answered correctly. When evaluating outcomes the nurse should identify that a potassium level of 5.2 mEq/L indicates hyperkalemia. Because spironolactone causes potassium retention, the nurse should withhold the medication and notify the provider.

Ch 19: A nurse is caring for a client who is receiving IV nitroprusside for hypertensive crisis. Which of the following conditions should the nurse monitor as an adverse effect of this medication? A) Intestinal ileus B) Neutropenia C) Delirium D) Hyperthermia

C) Delirium You answered correctly. The nurse should analyze the findings and determine that the client is at risk for developing delirium. This and other mental status changes can occur in thiocyanate toxicity when IV nitroprusside is infused at a high dosage. The nurse should monitor thiocyanate level during therapy to remain below 10 mg/dL.

Ch 21: A nurse is assessing a client who is taking gemfibrozil. Which of the following findings should the nurse identify as an adverse effect of this medication? A) Mental status changes B) Tremor C) Diarrhea D) Pneumonia

C) Diarrhea You answered correctly. The nurse should analyze the cues from the client's manifestations and determine that diarrhea, nausea, flatulence, and abdominal pain can be GI adverse effects of this medication.

Ch 19: A nurse is caring for a client who has a new prescription for captopril for hypertension. The nurse should monitor the client for which of the following as an adverse effect of this medication? A) Hypokalemia B) Hypernatremia C) Neutropenia D) Bradycardia

C) Neutropenia You answered correctly. The nurse should analyze the findings and determine that the priority hypothesis is that the client is at risk for developing neutropenia which can be a serious adverse effect for clients taking an ACE inhibitor. Monitor the client's CBC and teach the client to report indications of infection to the provider.

Ch 23: A nurse is caring for a client who has atrial fibrillation and a new prescription for dabigatran. Which of the following medications is prescribed concurrently to treat an adverse effect of dabigatran? A) Vitamin K1 B) Protamine C) Omeprazole D) Probenecid

C) Omeprazole You answered correctly. The nurse should plan to generate solutions to address the client's potential GI adverse effects from taking dabigatran which includes the concurrent administration of omeprazole or another proton pump inhibitor. Advise the client who has GI effects to take dabigatran with food.

Ch 20: A nurse is reviewing laboratory results of electrolytes for four clients who take digoxin. Which of the following electrolyte values increases a client's risk for digoxin toxicity? A) Calcium 9.2 mg/dL B) Calcium 10.3 mg/dL C) Potassium 3.4 mEq/L D) Potassium 4.8 mEq/L

C) Potassium 3.4 mEq/L You answered correctly. The nurse should analyze the cues from the client's laboratory results and determine that a potassium level of 3.4 mEq/L is below the expected reference range and increases a client's risk for developing digoxin toxicity. Low potassium can cause fatal dysrhythmias, especially in older clients who take digoxin.

Ch 23: A nurse is caring for a client who is receiving heparin by continuous IV infusion. The client begins vomiting blood. After the heparin has been stopped, which of the following medications should the nurse prepare to administer? A) Vitamin K1 B) Atropine C) Protamine D) Calcium gluconate

C) Protamine You answered correctly. The nurse should plan to generate solutions to address the client's vomiting of blood which includes the administration of protamine which reverses the anticoagulant effect of heparin.

CV Sys: A nurse is teaching a client who has a new prescription for nitroglycerin. The nurse should instruct the client that which of the following manifestations is a potential adverse effect of this drug? -Headache -Constipation -Hypertension -Hyperglycemia

Headache MY ANSWER Adverse effects of nitrates, such as nitroglycerin, include headaches, which can be severe at the beginning of nitrate therapy but decrease in severity with continued exposure to nitrates.

CV Sys: A nurse is caring for a client who is taking a diuretic. The nurse should instruct the client to include which of the following foods in their diet to increase potassium intake? -Raisins -Cabbage -Cheese -Eggs

Raisins MY ANSWER Diuretics can deplete the body of potassium, so the nurse should instruct the client to include potassium-rich foods in their diet, such as raisins and other dried fruits.

CV Sys: A nurse is reviewing new prescriptions with a client who has heart disease. The nurse should instruct the client that which of the following drugs is prescribed to treat hypocholesteremia? -Simvastatin -Furosemide -Losartan -Nitroglycerin

Simvastatin MY ANSWER Simvastatin is an HMG-CoA reductase inhibitor. It blocks synthesis of cholesterol by the body to help lower cholesterol levels.

CV Sys: A nurse caring for a client who has glomerular filtration rate of 10 mL/min and a reduced urine output. The nurse should clarify a prescription for hydrochlorothiazide for this client because of which of the following characteristics of the drug? -The drug can cause hypoglycemia in clients who have a low urine output. -The drug does not reduce blood pressure for clients who have a low urine output. -The drug can increase the risk of pulmonary edema for clients who have renal insufficiency. -The drug does not promote diuresis for clients who have renal insufficiency.

The drug does not promote diuresis for clients who have renal insufficiency. MY ANSWER Adequate kidney function is essential for clients who take hydrochlorothiazide, a thiazide diuretic, to promote urine production and effective excretion.

Ch 19: A nurse in an outpatient facility is teaching a client who has a new prescription for aliskiren to treat hypertension. What should the nurse teach the client about this medication? Therapeutic Uses: Identify the therapeutic use for aliskiren. Complications: List two adverse effects of this medication. Nursing interventions: Describe one test to monitor. Client education: Identify two teaching points.

Therapeutic Uses: Aliskiren binds with renin to inhibit production of angiotensin I, thus decreasing production of both angiotensin II and aldosterone. Aliskiren is used solely for treating hypertension alone or in combination with other antihypertensives. Complications Diarrhea: dose-related, occurs most frequently in females and older adult clients Risk for angioedema and rash caused by allergy to the medication Hyperkalemia Hypotension Nursing interventions: Monitor blood electrolytes, paying close attention to potassium levels, because the client is at risk for hyperkalemia. This is especially important when the client takes ACE inhibitors concurrently, because these medications also raise potassium levels. Client education Do not take aliskiren with foods high in fat, which decreases absorption of the medication. Do not take potassium supplements or salt substitutes containing potassium. Clients should not take aliskiren during pregnancy. If a rash or angioedema occurs, discontinue aliskiren and notify the provider. Call 911 if severe manifestations of allergy are present.

Ch 21: A nurse is caring for a client who has elevated total cholesterol, LDL, and triglycerides, and has a new prescription for atorvastatin once daily. The client has type 2 diabetes mellitus and hypertension. What should the nurse instruct the client about atorvastatin? Therapeutic Uses: Identify for atorvastatin. Complications: Identify two adverse effects. Nursing interventions: Describe three two tests to monitor. Client education: Include two education points.

Therapeutic Uses: Atorvastatin decreases LDL and triglycerides and elevates HDL. It reduces the risk for cardiovascular events (myocardial infarction) and also provides secondary prevention in clients who have had a cardiovascular event. In clients who have diabetes mellitus and hypertension, atorvastatin can reduce mortality by controlling cholesterol levels. Complications Muscle pain/tenderness (myopathy) Liver toxicity with findings (jaundice, upper abdominal pain, anorexia, and nausea) Nursing interventions: Monitor baseline and periodic cholesterol levels (including LDL, HDL, and triglycerides), creatine kinase levels for myopathy, and liver function tests for liver toxicity. Client education Perform additional ways to help decrease cholesterol and improve health (exercise, low-fat diet, weight control, and smoking cessation). Take atorvastatin in the evening without regard to meals. (Antilipemic agents are given in the evening because cholesterol is mostly synthesized during the night.)

Ch 23: A nurse is teaching a client who has a new prescription for clopidogrel following a myocardial infarction. Therapeutic Uses: Identify the intended effect. Complications: Identify two adverse effects for this medication. Nursing interventions: Describe three, including one test the nurse should monitor periodically.

Therapeutic Uses: Clopidogrel inhibits platelet aggregation and prolongs bleeding time. It is used to prevent myocardial infarction (MI) or stroke in clients who have already had an MI or stroke. Complications: Like other platelet inhibitors, clopidogrel can cause bleeding due to thrombocytopenia. It can also cause GI effects (abdominal pain, nausea, diarrhea). Nursing interventions The nurse should plan to monitor the platelet count periodically while the client takes clopidogrel. Teach the client to monitor for bleeding. The client should watch for black stools, coffee-ground emesis, blood in the urine, nose bleeds, unusual bruising, or petechiae. The client should inform the provider if these occur and about GI effects. The nurse should be aware of all medications the client is taking because risk for bleeding increases if the medication is taken with anticoagulants or antiplatelet medications. Clopidogrel is sometimes administered concurrently with aspirin, and that increases the risk for bleeding. The medication should be discontinued 7 days before any elective surgery.

Ch 20: A nurse is caring for a client who has heart failure and a new prescription for digoxin 0.125 mg PO daily. What should the nurse teach the client about this medication? Therapeutic Uses Complications: Identify two adverse effects. Nursing interventions: Describe two diagnostic tests to monitor. Client education: Include three teaching points.

Therapeutic Uses: Digoxin improves the heart's pumping effectiveness and increases cardiac output and stroke volume. It decreases heart rate by slowing depolarization through the SA node, thus allowing more time for the ventricles to fill with blood. Due to these effects, digoxin is used to treat heart failure, atrial fibrillation, and some other tachydysrhythmias. Complications: The client should monitor for manifestations of digoxin toxicity, which include GI effects (nausea, vomiting, diarrhea), CNS effects (fatigue, weakness), visual effects (yellow-tinged vision, halos around lights, diplopia), heart rate less than 60/min in adults, or skipped beats when checking the pulse. Nursing interventions Monitor digoxin blood levels periodically during treatment. The expected reference range is 0.5 to 0.8 ng/mL. Monitor blood potassium levels because hypokalemia can cause cardiac dysrhythmias, especially in older adult clients. Monitoring ECG is also important to check for dysrhythmias. Client education Take oral digoxin at the same time each day. Do not skip a dose or take more than the prescribed dose each day. Monitor for manifestations of toxicity. Report any new prescriptions and to contact provider before taking OTC medications, because digoxin interacts with many other substances.

Ch 22: A nurse is preparing to provide teaching to a client who has a new prescription for verapamil for recurrent supraventricular tachycardia. What should the nurse teach the client about this medication? Therapeutic Uses Complications: Identify three adverse effects. Nursing interventions: Describe three, including diagnostic tests the nurse should monitor.

Therapeutic Uses: Verapamil is a calcium channel blocker and a class IV antidysrhythmic medication that decreases heart rate, slows conduction through both the SA and AV nodes, and decreases force of contraction of the heart. It is used to treat supraventricular tachycardia (SVT). Complications Bradycardia Hypotension Heart failure Constipation Nursing interventions Monitor both kidney and liver function because the medication dosage might need to be lowered if either kidney or liver impairment are present. Monitor blood pressure and pulse. Monitor periodic ECG testing for dysrhythmias and for improvement of SVT. Assess for manifestations of heart failure, such as dyspnea and crackles in the lungs. Question the client about dizziness, which can occur due to hypotension. Teach the client to move slowly from lying to sitting or standing and to avoid driving or operating heavy machinery until effects of verapamil are known.