Exam 5 Practice Questions (Ch. 23-30)

The nurse is monitoring a client receiving a calcium channel blocker (CCB) for treatment of angina. Which medication should the nurse anticipate administering if the client becomes severely hypotensive? (Select all that apply.) a. Atropine b. Dobutamine c. Dopamine d. Calcium chloride e. Isoproterenol

b. Dobutamine c. Dopamine d. Calcium chloride -Rationale: Hypotension related to calcium channel blocker overdose may be reversed by a vasopressor such as dopamine or dobutamine. Calcium chloride can be administered by slow IV push to reverse hypotension or heart block induced by CCBs. Atropine or isoproterenol may be used to reverse bradycardia caused by diltiazem overdose.

The nurse is instructing a patient on home use of niacin and will include important instructions on how to take the drug and about its possible adverse effects. Which of the following may be expected adverse effects of this drug? (Select all that apply.) a. Fever and chills b. Intense flushing and hot flashes c. Tingling of the fingers and toes d. Hypoglycemia e. Dry mucous membranes

b. Intense flushing and hot flashes c. Tingling of the fingers and toes -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. Fever, chills, or dry mucous membranes are not adverse effects associated with niacin. Niacin may cause an increase in blood glucose, especially in people with diabetes.

For which condition should the nurse assess before administering chlorothiazide (Diuril)? a. Urinary tract infection b. Low blood pressure c. Congenital malformation d. Hyperkalemia

b. Low blood pressure -Rationale: Thiazide diuretics reduce circulating blood volume, which can cause orthostatic hypotension. The nurse should not administer the drug if the client has low blood pressure.

The client is prescribed digoxin (Lanoxin) for treatment of heart failure (HF). Which statement by the client indicates the need for further teaching by the nurse? a. "I may notice my heart rate decrease." b. "I may feel tired during early treatment." c. "I can continue to take my ginseng supplement." d. "I should not get short of breath anymore."

c. "I can continue to take my ginseng supplement." -Rationale: Ginseng may increase the risk of digoxin toxicity, so the nurse should teach the client to stop taking the supplement. Digoxin may result in a decrease in pulse, because digoxin affects impulse conduction in the heart. Initially the client may experience some fatigue. Symptoms of CHF, such as dyspnea, should improve.

The patient is prescribed digoxin (Lanoxin) for treatment of HF. Which of the following statements by the patient indicates the need for further teaching? a. "I may notice my heart rate decrease." b. "I may feel tired during early treatment." c. "This drug should cure my heart failure." d. "My energy level should gradually improve."

c. "This drug should cure my heart failure." -Rationale: Digoxin helps increase the contractility of the heart, thus increasing cardiac output. But it is not a cure for HF, only a treatment option. Options 1, 2, and 4 are incorrect. The patient is correct that the heart rate will decrease with the use of digoxin, tiredness may be noted in early therapy until the HF has improved, and energy levels will gradually improve.

A patient with heart failure has an order for lisinopril (Prinivin, Zestril). Which of the following conditions in the patients history would lead the nurse to confirm the order with the provider? a. A history of hypertension previously treated with diuretic therapy b. A history of seasonal allergies currently treated with antihistamines c. A history of angioedema after taking enalapril (Vasotec) d. A history of alcoholism, currently abstaining

c. A history of angioedema after taking enalapril (Vasotec) -Rationale: Angioedema is a rare but potentially serious adverse effect of ACE inhibitors; because this patient has had a previous reaction to another drug within the same group (enalapril/Vasotec), the nurse should confirm the order with the provider. Options 1, 2, and 4 are incorrect. The use of diuretics along with ACE inhibitors must be closely monitored, but this patient was previously on diuretic therapy and it may be assumed that the patient is no longer taking it. The use of antihistamines concurrently with lisinopril may help to relieve any dry cough that occurs with the lisinopril. While a history of alcoholism may suggest more frequent hepatic monitoring, the patient is currently abstaining.

The nurse is caring for a client experiencing vasospastic angina. Which assessment finding warrants immediate nursing action regarding the healthcare provider's prescription to administer a calcium channel blocker? a. Diagnosis of decompensated HF b. Glaucoma noted in medical history c. AV heart block noted on ECG d. Active gastrointestinal bleeding

c. AV heart block noted on ECG -Rationale: Diltiazem is contraindicated in patients with AV heart block, sick sinus syndrome, severe hypotension, or bleeding aneurysm, or those undergoing intracranial surgery. This drug should be used with caution in patients with renal or hepatic impairment. Beta blockers, like atenolol, are contraindicated in clients with decompensated heart failure (HF). Nitrates are contraindicated in clients with glaucoma. Thrombolytics are contraindicated in clients with active bleeding.

While planning care for a patient receiving plasma protein fraction (Plasmanate), the nurse will include frequent assessments for which of the following possible adverse effects? a. Electrolyte imbalance b. Hyperglycemia c. Anaphylactic reaction d. Hypotension

c. Anaphylactic reaction -Rationale: Anaphylactic reactions may occur with the use of plasma protein fraction (Plasmanate). Symptoms may include periorbital edema, urticaria, wheezing, and respiratory difficulties. Options 1, 2, and 4 are incorrect. Plasma protein fraction should not cause electrolyte imbalances or hyperglycemia. It is given as a volume expander to increase vascular fluid volume in shock and should not cause hypotension.

A nurse is caring for a client who has renal failure and will be starting diuretic therapy with furosemide (Lasix). Which baseline assessment should the nurse obtain prior to initiation of the therapy? a. Coagulation panel b. Serum albumin level c. Audiology screening d. Deep tendon reflexes

c. Audiology screening -Rationale: Although rare, ototoxicity may result with use of loop diuretics and can lead to permanent hearing deficit. Therefore, the nurse should obtain a baseline hearing screening/test. Other ototoxic drugs, such as the aminoglycoside antibiotics, should be avoided during loop diuretic therapy. Furosemide has no effect on serum albumin level, clotting times, or deep tendon reflexes.

A nurse is caring for an African-American client diagnosed with hypertension related to heart failure. The nurse anticipates which drug therapy to help manage this client's condition? a. Nifedipine extended-release (Procardia XL) b. Doxasozin extended-release (Cardura XL) c. BiDil (hydralazine with isosorbide dinitrate) d. Dyazide (hydrochlorothiazide and triamterene)

c. BiDil (hydralazine with isosorbide dinitrate) -Rationale: BiDil is a fixed-dose combination of hydralazine with isosorbide dinitrate used to treat heart failure and hypertension in African-American patients, who appear to show an enhanced response to this medication.

The nurse is caring for a client receiving Dextran 70 (Macrodex) for treatment of shock. For which adverse effect should the nurse monitor in the client? a. Dehydration b. Dysrhythmias c. Bleeding d. Hypertension

c. Bleeding -Rationale: Colloid solutions, like dextran, may reduce normal blood coagulation. Therefore, the nurse should assess the client for unusual bleeding during and after drug administration.

A client receiving furosemide (Lasix) as an adjunct to treatment of hypertension returns for follow-up. Which objective data should the nurse consider when determining the effectiveness of the drug therapy? a. Absence of edema in lower extremities b. Weight loss of 6 pounds in the past month c. Blood pressure 120/70-134/88 since discharge d. Frequent voiding at least six times per day

c. Blood pressure 120/70-134/88 since discharge. -Rationale: Maintenance of blood pressure within normal limits indicates that treatment goals are achieved. Absence of edema, weight loss, and urinating all indicate that the diuretic has promoted fluid loss, but are not the best measure of the drug's effectiveness for hypertension.

A patient has been ordered gemfibrozil (Lopid) for hyperlipidemia. The nurse will first validate the order with the health care provider if the patient reports a history of which disorder? a. Hypertension b. Angina c. Gallbladder Disease d. Tuberculosis

c. Gallbladder Disease -Rationale: Fibric acid agents (fibrates) may cause or worsen gallbladder disease and the order should be checked with the provider before giving. Options 1, 2, and 4 are incorrect. Hypertension and angina may indicate the existence of atherosclerosis and arteriosclerosis; both are indications for lipid-lowering therapy. A history of tuberculosis would not be a rationale for withholding the drug.

Verapamil (Calan, Covera-HS, Verelan) should be used with extra caution or is contraindicated in patients with which cardiovascular condition? a. Hypertension b. Tachycardia c. Heart failure d. Angina

c. Heart failure -Rationale: CCBs such as verapamil (Calan) are used cautiously or are contraindicated in patients with HF because they may cause decreased contractility, which may precipitate or worsen HF. Options 1, 2, and 4 are incorrect. Verapamil and CCBs are often prescribed to treat HTN, tachycardia, and angina.

The nurse notes third-degree heart block on the EKG of a client receiving diltiazem (Cardizem) for treatment of a supraventricular dysrhythmia. Which is the most appropriate action by the nurse? a. Administer the next dose as prescribed, and continue cardiac monitoring. b. Treat the heart block, and continue administration of prescribed diltiazem. c. Hold the next dose, document the EKG finding, and notify the physician. d. Increase infusion of the IV fluids, and administer half the dose of diltiazem.

c. Hold the next dose, document the EKG finding, and notify the physician. -Rationale: Because of its depressive effects on the heart, propranolol is contraindicated in patients with greater than first-degree heart block.

A nurse is caring for a client receiving hydrochlorothiazide (Microzide) therapy for management of hypertension. For which adverse effect should the nurse closely monitor in the client? a. Hepatic coma b. Diminished libido c. Joint pain and swelling d. Menstrual irregularity

c. Joint pain and swelling -Rationale: Hydrochlorothiazide may precipitate gout attacks due to its tendency to cause hyperuricemia. The nurse should monitor the client for warmth, pain, tenderness, swelling, and redness around joints; arthritis-like symptoms; and limited movement in affected joints. Hepatic coma is a contraindication for use of loop diuretics. Diminished libido and menstrual irregularity are adverse effects of spironolactone (Aldactone).

A client is started on lisinopril (Zestril) 10 mg once daily by mouth. Which intervention should the nurse implement during initial therapy with this medication? a. Monitoring cardiac rhythm b. Monitoring intake and output c. Monitoring blood pressure d. Monitoring serum levels

c. Monitoring Blood Pressure -Rationale: Lisinopril is an ACE inhibitor, which can cause severe hypotension with initial doses, known as first-dose phenomenon. The nurse should monitor the client's blood pressure closely to keep the client safe from falls and injury.

A client taking a loop diuretic comes to the clinic with reports of muscle weakness and heart palpitations. The nurse anticipates administration of which supplement to treat this client's condition? a. Sodium b. Magnesium c. Potassium d. Calcium

c. Potassium -Rationale: The client is experiencing hypokalemia, which is a frequent adverse effect resulting from high doses of loop diuretics such as furosemide (Lasix). The nurse should anticipate administering potassium supplement to correct the client's hypokalemia.

The patient admitted for heart has been receiving hydrochlorothiazide (Microzide). Which of the following laboratory levels should the nurse carefully monitor? (Select all that apply.) a. Platelet count b. White Blood Cell count c. Potassium d. Sodium e. Uric Acid

c. Potassium d. Sodium e. Uric Acid -Rationale: Thiazide diuretics such as hydrochlorothiazide (Microzide) cause loss of sodium and potassium and may cause hyperuricemia. Options 1 and 2 are incorrect. Hydrochlorothiazide does not have a direct effect on blood cells.

A nurse is participating in a health-promotion event at a community health fair. Which recommendation should the nurse provide to assist clients in reducing lipid levels? a. Increasing complex carbohydrate intake b. Reducing sodium intake and exercise c. Reducing intake of total dietary fat d. Increasing intake of antioxidants

c. Reducing intake of total dietary fat -Rationale: Nutritionists recommend that the consumption of total dietary fat be less than 35 percent of the caloric intake (a maximum of 10 percent from saturated fats). To reduce serum cholesterol, the patient must reduce saturated fat and refined carbohydrates in the diet. The 2013 ACC/AHA guidelines call for a reduction of saturated fat in the diet to 5 percent to 6 percent of total calories. In addition, levels of trans fatty acids from meat and dairy fat should be reduced.

A nurse is caring for a 37-year-old female client who is prescribed an angiotensin-converting enzyme (ACE) inhibitor for management of hypertension. Which question should the nurse include during health assessment of the client? a. "Were you ever diagnosed with systemic lupus?" b. "Do you take hawthorn for high blood pressure?" c. "Do you have a history of rheumatic heart disease?" d. "Are you pregnant or do you think you may be pregnant?"

d. "Are you pregnant or do you think you may be pregnant?" -Rationale: Fetal injury and death may occur when ACE inhibitors are taken during pregnancy. If pregnancy is detected, the medication should be discontinued as soon as possible. Hydralazine is contraindicated in patients with rheumatic heart disease and lupus. Hawthorn should be avoided in clients taking direct-acting vasodilators.

BiDil (fixed-dose combination of hydralazine 37.5 mg with 20 mg of isosorbide dinitrate) is prescribed as treatment regimen for a client with heart failure. The nurse should monitor the client for which serious adverse effect of the drug? a. Hyponatremia b. Agranulocytosis c. Gynecomastia d. Lupus-like reaction

d. Lupus-like reaction -Rationale: Adverse effects specific to hydralazine include lupus-like reaction. Hyponatremia is a serious side effect of loop and thiazide diuretics. Gynecomastia is a common adverse effect in male clients taking potassium-sparing diuretics. Agranulocytosis is a serious adverse effect of beta blockers.

When caring for a client receiving milrinone (Primacor), the nurse places priority on which nursing action? a. Monitor electrolytes for hyperkalemia. b. Monitor neurologic status for headaches. c. Monitor blood pressure for hypertension. d. Monitor heart rhythm for dysrhythmia.

d. Monitor heart rhythm for dysrhythmia. -Rationale: The most serious adverse effect of milrinone is ventricular dysrhythmia, which may occur in 1 of every 10 patients taking the drug. The patient's heart rhythm should be monitored continuously during the infusion of the drug. Blood pressure is also continuously monitored during the infusion to prevent hypotension. Less serious side effects include headache, nausea, and vomiting.

Which is the priority nursing intervention for a client receiving quinidine sulfate (Quinidex) for treatment of dysrhythmias? a. Monitoring for GERD b. Monitoring for constipation c. Monitoring blood glucose d. Monitoring blood dyscrasias

d. Monitoring blood dyscrasias -Rationale: Serious adverse effects of quinidine include blood dyscrasias and hypotension, as well as development of new or worsening of existing dysrhythmias.

What health teaching should the nurse provide for the client receiving nadolol (Corgard)? a. Increase fluids and fiber to prevent constipation b. Report a weight gain of 1 kg per month or more c. Immediately stop taking the medication if sexual dysfunction occurs d. Rise slowly after prolonger periods of sitting or lying down

d. Rise slowly after prolonger periods of sitting or lying down -Rationale: Nadolol (Corgard) may increase the risk of orthostatic hypotension, and the patient should be taught to rise slowly to standing from a sitting or lying position. Options 1, 2, and 3 are incorrect. The drug does not cause constipation, and extra fluids and fiber are not required. A weight gain of over 1 kg per day should be reported but a gain of 1 kg per month may be insignificant or unrelated to the drug. The drug should never be stopped abruptly because of possible HTN and tachycardia.

A nurse is providing discharge teaching with a client who is prescribed colestipol (Colestid). Which information should the nurse include during client education? a. Limit fluid intake to 1,000 mL/day. b. Limit fiber intake to 25 grams/day. c. Take the drug with high-protein meals. d. Take vitamins 4 hours after taking the drug. .

d. Take vitamins 4 hours after taking the drug. -Rationale: Bile acid sequestrants interfere with the absorption of vitamins and minerals, especially when taken with food. Therefore, the nurse should teach the client to take vitamin and mineral supplements 2 hours before or 4 hours after taking the drug.

The nurse reviews the teaching plan with a client receiving nifedipine (Procardia). Which client behavior indicates understanding of the information? a. The client monitors blood pressure every week. b. The client consumes three servings of alcohol daily. c. The client chews capsules for ease of swallowing. d. The client avoids taking the drug with grapefruit juice.

d. The client avoids taking the drug with grapefruit juice. -Rationale: Grapefruit juice enhances absorption of nifedipine, which can result in increased effects of the medication. Blood pressure ideally should be monitored daily. Alcohol intake three times a day is excessive. Nifedipine capsules or tablets should be swallowed whole. If capsules or extended-release tablets are chewed, divided, or crushed, the entire dose will be delivered all at once.

The nurse is administering reteplase (Retavase) to a client experiencing an acute myocardial infarction (AMI). Which nursing action is most appropriate? a. Reconstitute the drug in 1 liter normal saline solution. b. Shake the reconstituted solution for proper mixing. c. Prepare the mixture immediately prior to administration. d. Administer the drug in the same IV line as the heparin.

c. Prepare the mixture immediately prior to administration. -Rationale: Reteplase should be reconstituted immediately prior to use with diluent provided by the manufacturer. Swirl to mix the solution and do not shake. Do not give any other drug simultaneously through the same IV line. Reteplase and heparin are incompatible and must never be combined in the same solution.

During an assessment, a client reports muscle twitching, paresthesia, and cramping of the lower extremities. Which action should the nurse take next? a. Administer a vitamin D supplement. b. Discontinue the IV infusion of 0.9% NaCl. c. Hold any prescribed pain medications. d. Check the client's potassium level.

d. Check the client's potassium level. -Rationale: The client is experiencing symptoms of hyperkalemia, which include muscle twitching, paresthesias, and cramping. The nurse should check the client's serum potassium level to determine the extent of the problem and notify the healthcare provider of the issue.

The teaching plan for a patient receiving hydralazine (Apresoline) should include which of the following points? a. Returning for monthly urinalysis testing b. Including citrus fruits, melons, and vegetables in the diet c. Decreasing potassium-rish food in the diet d. Rising slowly to standing from a lying or siting position

d. Rising slowly to standing from a lying or siting position -Rationale: Hydralazine (Apresoline) commonly causes orthostatic hypotension, and the patient should be taught to rise slowly from a lying or sitting position to standing. Options 1, 2, and 3 are incorrect. Hydralazine does not require monthly urinalysis testing. Potassium levels will be monitored along with other electrolytes, but the patient does not need to decrease the amount of potassium-rich foods in the diet, and a healthy balance of all foods is encouraged.

A patient is receiving cholestyramine (questran) for elevated low-density lipoprotein (LDL) levels. As the nurse completes the nursing care plan, which of the following adverse effects will be included for continued monitoring? a. Abdominal pain b. Orange-red urine and saliva c. Decreased capillary refill time d. Sore throat and fever

a. Abdominal Pain -Rationale: Obstruction of the GI tract is one of the most serious complications of bile acid sequestrants. Abdominal pain may signal the presence of obstruction. Options 2, 3, and 4 are incorrect. Cholestyramine (Questran) does not cause orange-red urine and saliva, sore throat or fever, or affect capillary refill.

The client is prescribed captopril (Capoten) for treatment of heart failure (HF). The nurse should monitor the client for which serious adverse effect of the drug? a. Angioedema b. Dysrhythmia c. Hypokalemia d. Bradycardia

a. Angioedema -Rationale: Though rare, angioedema is a serious adverse effect of ACE inhibitors like captopril (Lisinopril). Dysrhythmia and bradycardia are side effects of beta blockers. Hyperkalemia, not hypokalemia, may occur during therapy with ACE inhibitors.

A nurse is preparing to administer amiodarone (Cordarone) to a client with resistant ventricular tachycardia. Which client assessment must the nurse perform prior to administering the medication? a. Lung sounds b. Urine output c. Glucose level d. Bowel sounds

a. Lung sounds. -Rationale: Amiodarone causes a pneumonia-like syndrome in the lungs. Because the pulmonary toxicity may be fatal, baseline and periodic assessment of lung function is essential.

A client with an episode of myocardial infarction (MI) is prescribed atenolol (Tenormin). What should the nurse monitor while the client is on this drug? a. Flushed skin b. Dysrhythmias c. Hepatotoxicity d. Peripheral edema

b. Dysrhythmias -Rationale: Atenolol is a beta-adrenergic blocker. If the drug is abruptly withdrawn, life-threatening dysrhythmias, rebound hypertension, or MI may occur. Flushed skin, hepatotoxicity, and peripheral edema are adverse effects associated with calcium channel blockers.

The patients serum sodium value is 152 mEq/L. Which of the following nursing interventions is most appropriate for this patient? (Select all that apply.) a. Assess for inadequate water intake or diarrhea b. Administer a 0.45% NaCl intravenous solution c. Hold all doses of glucocorticoids d. Notify the healthcare provider e. Have the patient drink as much water as possible

a. Assess for inadequate water intake or diarrhea d. Notify the healthcare provider -Rationale: Hypernatremia is defined as serum sodium levels higher than 145 mEq/L. Elevated levels may be associated with inadequate fluid intake, diarrhea, fever, or after burns when fluid is lost from the burn site. Because this laboratory value is significantly increased, the health care provider should be notified. Options 2, 3, and 5 are incorrect. Depending on the cause, an IV with dextrose or other fluid may be ordered to increase fluid intake but further sodium will not be given. Fluid intake should be encouraged but the patient should not be told to drink "as much fluid as possible" to avoid the possibility of fluid overload. Although glucocorticoids may be a causative factor of hypernatremia, the health care provider should be consulted before withholding any dosages.

A nurse is preparing to administer serum albumin to a client for treatment of shock. Which nursing action is most appropriate prior to giving the medication? a. Assess lung sounds. b. Check glucose level. c. Monitor potassium level. d. Determine hepatitis status.

a. Assess lung sounds. -Rationale: Baseline assessment of lung sounds is essential in determining if the patient may be experiencing fluid overload. Albumin increases the oncotic pressure of the blood and causes fluid to move from the tissues to the general circulation. Rapid increase in circulating volume places the client at risk for fluid overload.

Which of the following actions by the nurse is most important when caring for a patient with renal disease who has an order for furosemide (Lasix)? a. Assess urine output and renal laboratory values for signs of nephrotoxicity b. Check the specific gravity of the urine daily c. Eliminate potassium-rich foods from the diet d. Encourage the patient to void every 4 hours

a. Assess urine output and renal laboratory values for signs of nephrotoxicity -Rationale: Because the kidneys excrete most drugs, patients with renal failure may need a lower dosage of furosemide (Lasix) to prevent further damage to the kidneys. Options 2, 3, and 4 are incorrect. Urine specific gravity will not adequately assess renal status and may be altered by the diuresis secondary to the furosemide. Potassium should be increased when furosemide, a potent loop diuretic, is ordered and not eliminated. If diuresis is occurring, the patient may need to void more often than every 4 hours.

Nursing assessment of a patient receiving normal serum albumin for treatment of shock should include which of the following assessments? a. Breath sounds b. Serum glucose levels c. Potassium level d. Hemoglobin and hematocrit

a. Breath Sounds -Rationale: Albumin is a colloid solution. Colloids pull fluid into the vascular space. Circulatory overload may occur due to this fluid shift. The nurse should assess the patient for symptoms of heart failure such as an increase in adventitious breath sounds, edema, bounding pulses, or tachycardia. Options 2, 3, and 4 are incorrect. Albumin is given to increase vascular volume and should not directly affect glucose or potassium levels or hemoglobin or hematocrit concentration.

In providing client teaching, the nurse should include which nonpharmacological treatments for dysrhythmias? (Select all that apply.) a. Cardiac pacemakers b. Cardioversion c. Electrocardiography d. Exercise stress test e. Defibrillation f. Catheter ablation

a. Cardiac pacemakers b. Cardioversion e. Defibrillation f. Catheter ablation -Rationale: Healthcare providers use several nonpharmacologic strategies to eliminate dysrhythmias. The more serious types of dysrhythmias are corrected through electrical shock of the heart, with treatments such as elective cardioversion and defibrillation. Other types of nonpharmacologic treatment include identification and destruction of the myocardial cells responsible for the abnormal conduction through a surgical procedure called catheter ablation. Cardiac pacemakers are sometimes implanted to correct the types of dysrhythmias that cause the heart to beat too slowly. Electrocardiography is a diagnostic test used to measure the wave of electrical activity across the myocardium. An exercise stress test is used to diagnose angina or myocardial infarction.

Which nursing intervention is most important when caring for a client with renal failure? a. Cautious administration of nephrotoxic drugs b. Check the specific gravity of the urine daily. c. Eliminate potassium-rich foods from the diet. d. Encourage the client to void every 4 hours.

a. Cautious administration of nephrotoxic drugs -Rationale: Nurses play a key role in recognizing and responding to renal failure. Once a diagnosis is established, all nephrotoxic medications should be either discontinued or used with extreme caution. Medications dosages need to be adjusted because administering the "average" dose to a patient in severe renal failure can have fatal consequences.

A client with congestive heart failure (CHF) is prescribed digoxin (Lanoxin) and furosemide (Lasix). Which interventions should the nurse include in the plan of care? (Select all that apply.) a. Check apical pulse before administering digoxin. b. Encourage intake of water and fruit juices. c. Monitor serum electrolyte levels. d. Monitor hemoglobin and hematocrit levels. e. Restrict intake of green, leafy vegetables.

a. Check apical pulse before administering digoxin c. Monitor serum electrolyte levels. -Rationale: Digoxin is a cardiac glycoside, which can slow heart rate, and an apical heart rate is checked prior to administration. Lasix is a loop diuretic used in treatment of CHF, which promotes not only water loss but also loss of electrolytes. A low potassium level increases risk of digoxin toxicity. Fluids are often restricted with CHF. Monitoring hemoglobin and hematocrit levels is not warranted with the administration of these drugs. Green, leafy vegetables would not need to be restricted.

A nurse is caring for a client receiving niacin along with a statin for management of high cholesterol. Which health history finding would require immediate notification of the healthcare provider? a. Diabetes mellitus b. Cardiovascular disease c. Gallbladder disease d. Enlarged prostate

a. Diabetes mellitus -Rationale: Niacin is not usually prescribed for patients with diabetes mellitus, because the drug can raise fasting blood glucose levels. Fibric acid derivatives are contraindicated in patients with gallbladder disease. Niacin is indicated for cardiovascular disease as a lipid-lowering agent. The drug has no known indication or contraindication in patients with enlarged prostate.

A client is receiving medication therapy to correct the condition of hypokalemia. Which is an important nursing consideration for administration of potassium therapy? a. Do not administer IV preparations as a bolus dose. b. Have the client sit upright when giving an oral dose. c. Dilute liquid forms of the medication in juice or water. d. Instruct the client to swallow capsules or tablets whole.

a. Do not administer IV preparations as a bolus dose. -Rationale: Potassium (KCl) should never be administered as IV push or in concentrated amounts. Potassium IV infusion should not exceed an IV rate of 10 mEq/hr. Always give oral medication while the patient is upright to prevent esophagitis. In addition, the drug can cause GI irritation, so liquid forms should be diluted before giving PO or through a nasogastric tube. For the same reason, the client should be instructed not to crush tablets or to chew tablets.

A client is prescribed isosorbide dinitrate (Isordil) 10 mg by mouth three times a day to prevent episodes angina. Which adverse effects of the drug should the nurse emphasize during client teaching? (Select all that apply.) a. Drug tolerance b. Reflex bradycardia c. Postural hypotension d. Urinary retention e. Decreased libido

a. Drug tolerance c. Postural hypotension -Rationale: Tolerance is a common and potentially serious problem with the long-acting organic nitrates. Postural hypotension can occur as a result of vasodilation, and the nurse should instruct the patient on nitrates to rise slowly from lying or sitting to standing to avoid dizziness, syncope, or falls. Reflex tachycardia, not reflex bradycardia, is an adverse effect of nitrates. Urinary retention and decreased libido are not associated with the use of organic nitrates.

Which drug should the nurse anticipate to administer for managing the client's anemia related to renal failure? a. Epoetin alfa (Epogen) b. Sevelamer (Renagel) c. Calcium acetate (PhosLo) d. Polystyrene sulfate (Kayexalate)

a. Epoetin alfa (Epogen) -Rationale: Erythropoietin production is impaired in clients with renal failure, leading to anemia. Epoetin alfa (Epogen, Procrit) is prescribed clients with renal failure to manage the anemia and promote production of red blood cells. Sevelamer (Renagel) and calcium acetate (PhosLo) are used to manage hyperphosphatemia in clients with renal failure. Polystyrene sulfate (Kayexalate) is administered to renal failure clients experiencing hyperkalemia.

A patient has been on long-term therapy with colestipol (Colestid). To prevent adverse effects related to the length of therapy and lack of nutrients, which of the following supplements may be required? (Select all that apply.) a. Folic acid b. Vitamins A, D, E, and K c. Potassium, iodine, and chloride d. Protein e. B Vitamins

a. Folic acid b. Vitamins A, D, E, and K -Rationale: Long-term use of bile acid sequestrants such as colestipol (Colestid) may cause depletion or decreased absorption of folic acid and the fat-soluble vitamins. Options 3, 4, and 5 are incorrect. Decreases in protein, potassium, iodine, chloride, and the B vitamins are not a direct effect of bile acid sequestrant therapy.

Which of the following assessment findings in a patient who is receiving atenolol (Tenormin) for angina would be cause for the nurse to hold the drug and contact the provider? (Select all that apply.) a. Heart rate of 50 beats/ minute b. Heart rate of 124 beats/ minute c. Blood pressure 86/56 d. Blood pressure 156/88 e. Tinnitus and vertigo

a. Heart rate of 50 beats/ minute c. Blood pressure 86/56 -Rationale: Atenolol (Tenormin) decreases blood pressure and heart rate. The administration of this drug may cause significant hypotension and bradycardia in some patients. Options 2, 4, and 5 are incorrect. Atenolol is given to treat tachycardia and HTN as well as angina. Tinnitus and vertigo are not adverse effects associated with atenolol.

A client is prescribed atenolol (Tenormin) for treatment of angina. What should the nurse include in the teaching plan for this client? a. Hold dose if heart rate is less than 50 bpm. b. Expect mood changes with use of the drug. c. Exercise heart rate should be 110-120 bpm. d. Monitor blood sugar for hyperglycemia.

a. Hold dose if heart rate is less than 50 bpm. -Rationale: Because atenolol slows heart rate, the patient should not take the dose with severe bradycardia (pulse less than 50 bpm). Changes in mood are an adverse effect associated with calcium channel blockers. Atenolol does not affect blood sugar levels. Exercise heart rate is calculated based on age and level of intensity, not a fixed rate.

A nurse is preparing to administer HCTZ (Hydrodiuril) 25 mg to a client, and notes that the client's potassium level is 2.8 mEq. Which is the most appropriate action for the nurse to take? a. Hold the medication, and notify the healthcare provider. b. Administer the drug with orange juice for optimum absorption. c. Administer the drug as ordered, and monitor the potassium level. d. Give the client a banana, and recheck the potassium level.

a. Hold the medication, and notify the healthcare provider. -Rationale: The drug should be held until a consultation with the healthcare provider takes place. The normal serum potassium level is 3.5-5.0 mEq. HCTZ is a potassium-depleting drug, and if administered can further lower the client's potassium level.

Lisinopril (Prinivil) is part of the treatment regimen for a client with Heart Failure. The nurse monitors the client for the development of which of the following adverse effects of this drug? (Select all that apply.) a. Hyperkalemia b. Hypocalcemia c. Cough d. Dizziness e. Heartburn

a. Hyperkalemia c. Cough d. Dizziness -Rationale: Common adverse effects of lisinopril (Prinvil) and other ACE inhibitors include cough, headache, dizziness, change in sensation of taste, vomiting and diarrhea, and hypotension. Hyperkalemia may occur, especially when the drug is taken concurrently with potassium-sparing diuretics. Options 2 and 5 are incorrect. Hypercalcemia and heartburn are not adverse effects associated with the ACE inhibitors.

Common adverse effects of antidysrhythmic medications include which of the following? (Select all that apply.) a. Hypotension b. Hypertension c. Dizziness d. Weakness e. Panic attacks

a. Hypotension c. Dizziness d. Weakness -Rationale: Because antidysrhythmics can slow the heart rate, the patient may experience hypotension, dizziness, or weakness. Options 2 and 5 are incorrect. Some antidysrhythmic classes, such as beta blockers and CCBs, are used in the treatment of HTN, which is a therapeutic rather than adverse effect of the drug. Antidysrhythmics are not used in the treatment of panic disorder.

The client's arterial blood gases (ABG) reveal respiratory acidosis. The nurse determines which conditions as possible causes? (Select all that apply.) a. Hypoventilation b. Airway obstruction c. Damage to the medulla d. Excess alcohol ingestion e. Severe malnutrition

a. Hypoventilation b. Airway obstruction c. Damage to the medulla -Rationale: Origins of acidosis related to respiratory involve conditions that affect airway and breathing.

The nurse evaluates the effectiveness of dopamine therapy for a patient in shock. Which of the following may indicate treatment is successful? (Select all that apply.) a. Improved urine output b. Increased blood pressure c. Breath sounds are diminished d. Slight hypotension occurs e. Peripheral pulses are intact

a. Improved urine output b. Increased blood pressure -Rationale: With increased cardiac output, renal function should improve, and there should be an increase in urine output. Blood pressure should increase with the increase in cardiac output and as the drug is titrated to normal or near-normal parameters. Options 3, 4, and 5 are incorrect. Dopamine does not have direct effects on breath sounds. Blood pressure should rise with improving hemodynamics, and although peripheral pulses may be felt, the absence of peripheral pulses may be due to other conditions such as arterial or venous insufficiency and do not indicate a therapeutic response to dopamine.

A client is scheduled for surgical placement of an implantable cardioverter defibrillator (ICD) for treatment of a dysrhythmia. Which explanation by the nurse about the purpose of the ICD is most appropriate? a. It triggers electrical impulses to the heart. b. It takes over the SA node function. c. It blocks AV node transmission of impulses. d. It increases ventricular conduction.

a. It triggers electrical impulses to the heart. -Rationale: Implantable cardioverter defibrillators (ICD) are placed in patients to restore normal rhythm by either pacing the heart or giving it an electric shock when dysrhythmias occur. In addition, the ICD is capable of storing information regarding the heart rhythm for the healthcare provider to evaluate.

The nurse is caring for a client receiving nitroprusside (Nitropress) IV drip for severe hypertension related to a head injury. Which intervention is most appropriate to include in the nursing plan of care? a. Monitor the client for signs of cyanide poisoning. b. Stop IV infusion when blood pressure normalizes. c. Frequently assess lung sounds for presence of crackles. d. Check serum levels of potassium for hypokalemia.

a. Monitor the client for signs of cyanide poisoning. -Rationale: It is essential to continuously monitor patients receiving this drug because the drug is metabolized to cyanide (thiocyanate), which is very toxic to the body. The medication should not be stopped abruptly to prevent occurrence of rebound hypertension and tachycardia. Nitroprusside does not cause heart failure, or affect potassium levels.

A client has been started on gemfibrozil (Lopid) in combination with a statin for treatment of severely elevated triglyceride levels. When the client develops bruising, the nurse anticipates which collaborative intervention? a. Obtaining an international normalized ratio (INR) b. Reducing the dose of the statin drug c. Performing an electrocardiogram d. Administering an analgesic on as-needed basis

a. Obtaining an international normalized ratio (INR) -Rationale: Concurrent use of gemfibrozil (Lopid) with oral anticoagulants (e.g., warfarin) may potentiate anticoagulant effects. The INR or prothrombin time will help in evaluating the client's clotting state. The statin is not the cause of the problem. An analgesic or ECG would not help to correct the underlying problem.

A nurse working in the emergency department is preparing to administer propranolol. With which client conditions should the nurse anticipate administering this drug? (Select all that apply.) a. Portal hypertension b. Asthma c. Thyroid crisis d. Angina e. Panic attack f. Migraine headache

a. Portal hypertension c. Thyroid crisis d. Angina e. Panic attack f. Migraine headache -Rationale: Propranolol has several off-label indications, including reducing portal HTN and bleeding due to esophageal varices; reducing the tachycardia, tremor, and nervousness associated with thyroid crisis (storm); panic attacks; post-traumatic stress disorder (PTSD); chronic agitation; aggressive behavior; and involuntary movements of essential tremor. Because it constricts smooth muscle in the airways, the drug is contraindicated in patients with COPD or asthma.

A nurse is gathering history and physical assessment from a client receiving atorvastatin (Lipitor). Which finding requires immediate attention? a. Possibility of pregnancy b. Coronary artery disease c. History of glaucoma d. Diabetes mellitus

a. Possibility of pregnancy -Rationale: Lipitor is a pregnancy Category X drug and should not be used by clients who are planning to become pregnant, are pregnant, or are breast-feeding. The drug should be stopped if the client becomes pregnant while taking it.

The client admitted for congestive heart failure (CHF) is receiving digoxin (Lanoxin) and furosemide (Lasix). Which laboratory test should the nurse carefully monitor? a. Potassium b. Creatinine c. Calcium d. Sodium

a. Potassium -Rationale: Furosemide (Lasix) is a potent diuretic that may lead to profound diuresis with water and electrolyte depletion, particularly potassium. Combination therapy with digoxin must be carefully monitored, because hypokalemia may cause lethal dysrhythmias.

Which nursing actions are most appropriate when administering cholestyramine (Questran) powder? (Select all that apply.) a. Prepare the medication in 60-180 mL of liquid. b. Mix the medication with a carbonated drink. c. Allow the mixture to sit for 5 minutes prior to administration. d. Administer the medication with an ounce of applesauce. e. Give the medication 4 hours following meals.

a. Prepare the medication in 60-180 mL of liquid d. Administer the medication with an ounce of applesauce e. Give the medication 4 hours following meals. -Rationale: When administering bile acid resins such as cholestyramine, the nurse should thoroughly mix the powder form of the medication with 60-180 mL of water, noncarbonated beverages, highly liquid soups, or pulpy fruits (applesauce, crushed pineapple). The nurse should have the patient drink the medication preparation immediately to avoid potential irritation or obstruction in the GI tract. Taking cholestyramine with food may interfere with the absorption of essential nutrients; therefore, giving the medication 2 hours before meals or 4 hours after meals is advised, as it will not interfere with GI absorption.

A client's serum sodium level is 149 mEq/L. Which nursing intervention is most appropriate for this client? a. Provide a low-salt diet. b. Start a 0.45% NaCl IV infusion. c. Hold all doses of glucocorticoids. d. Administer a dose of a diuretic.

a. Provide a low-salt diet. -Rationale: Hypernatremia is defined as serum sodium levels > 145 mEq/L. For minor hypernatremia, a low-salt diet may be effective in returning serum sodium to normal levels. An infusion of 0.45% NaCl is warranted for hyponatremic clients who are also hypovolemic. On the other hand, administration of a diuretic is given when the client is hypervolemic and hyponatremic.

When monitoring for therapeutic effect of any antidysrhythmic drug, the nurse would be sure to assess which essential parameter? a. Pulse b. Blood pressure c. Drug Level d. Hourly urine output

a. Pulse -Rationale: In the absence of ECG monitoring, the nurse would assess the pulse for rate, regularity, quality, and volume, noting any changes. The nurse should also teach the patient to monitor the pulse for rate and regularity before sending the patient home. Options 2, 3, and 4 are incorrect. The nurse is monitoring for the therapeutic effects of antidysrhythmic therapy. Al- though BP and drug level may also be monitored, they do not evaluate the therapeutic effects of the drug. Urine output may change related to the type of drug given and any effects on cardiac output. However, frequent output monitoring is not indicated in routine antidysrhythmic therapy and will not assess for therapeutic drug effects.

A nurse is assisting a client receiving hydrochlorothiazide (Microzide) therapy with a nutrition plan. Which foods should the client include in the plan? (Select all that apply.) a. Red meat b. Shellfish c. Alcoholic drinks d. Whole grains e. Fruit juices

a. Red meat d. Whole grains -Rationale: Hydrochlorothiazide may precipitate gout attacks due to its tendency to cause hyperuricemia. Red meat and whole grains are appropriate to include in the nutrition plan. The nurse should teach the patient who is prone to gout to increase fluid intake and to avoid shellfish, organ meats (e.g., liver, kidneys), alcohol, and high-fructose beverages.

Administration of potassium supplements is contraindicated in clients taking which diuretic? a. Spironolactone (Aldactone) b. Furosemide (Lasix) c. Chlorothiazide (Diuril) d. Bumetanide (Bumex)

a. Spironolactone (Aldactone) -Rationale: Spironolactone is a potassium-sparing diuretic. Clients taking potassium-sparing diuretics should not take potassium supplements due to the increased risk for developing hyperkalemia.

In preparing client education regarding use of loop diuretics, the nurse should include goals of therapy and which information? (Select all that apply.) a. Take in the morning to avoid nocturia. b. Expect a decrease in overall urine output. c. Take potassium supplements, if prescribed. d. Serum lipid levels may be elevated. e. Adjunct therapy with ginseng is appropriate.

a. Take in the morning to avoid nocturia c. Take potassium supplements, if prescribed d. Serum lipid levels may be elevated. -Rationale: Client education should include information about drug administration, as well as what the client can expect as therapeutic effects and adverse effects of the drug therapy. The drug works by removing large amounts of fluid from the body in a short period; therefore, the client can expect an increase in urine output, not a decrease. The drug should be administered early in the day to prevent nocturia. Potassium supplements may be prescribed to prevent hypokalemia. Furosemide may increase values of serum cholesterol and triglycerides. Ginseng may decrease the effectiveness of loop diuretics, so it is not appropriate to take these medications concurrently.

The patient in hypovolemic shock is prescribed an infusion of lactated Ringer's. What is the purpose for infusing this solution in shock? (Select all that apply.) a. The solution will help to replace fluid and promote urine output b. The solution will draw water into cells c. The solution will draw water from cells to blood vessels d. The solution will help to maintain vascular volume e. The solution is used to provide adequate calories for metabolic needs

a. The solution will help to replace fluid and promote urine output d. The solution will help to maintain vascular volume -Rationale: Crystalloid solutions such as lactated Ringer's closely approximate the electrolytes and concentration of blood plasma. They help increase vascular volume, replacing fluid and promoting adequate urine output, and help maintain normal intravascular volume. Options 2, 3, and 5 are incorrect. Lactated Ringer's is an isotonic fluid and should not cause fluid shifting into or out of the cells. It does not contain enough calories to meet the body's metabolic needs, especially in shock, which is an extremely stressful condition in the body.

A nurse is taking a health history of a client. Which factors may contribute to the client's hyperlipidemia? (Select all that apply.) a. Tobacco use b. Moderate alcohol use c. Restricted saturated fats in diet d. Minimal intake of dietary fiber e. Overweight by 30 pounds

a. Tobacco use d. Minimal intake of dietary fiber e. Overweight by 30 pounds -Rationale: Excess weight, tobacco use, and lack of soluble fiber can contribute to increased lipid and cholesterol levels. Moderate alcohol intake can raise HDL levels, and saturated fat should be restricted.

A nurse is caring for a client receiving propranolol therapy. During assessment of the client, the nurse notes that the client is experiencing severe hypotension and bradycardia. Which medications can the nurse expect to administer to manage this client's condition? (Select all that apply.) a. Vasopressors b. Glucagon c. Phenothiazines d. Digoxin e. Atropine

a. Vasopressors b. Glucagon e. Atropine -Rationale: The client is experiencing overdose of the medication propranolol. Treatment is targeted to reversing hypotension with vasopressors, and bradycardia with atropine or isoproterenol. Intravenous glucagon reverses the cardiac depression caused by beta blocker overdose by enhancing myocardial contractility, increasing heart rate, and improving AV node conduction. Phenothiazines can add to the hypotensive effects of propranolol. Digoxin can worsen the bradycardia.

The patient is being discharged with nitroglycerin (Nitrostat) for sublingual use. While planning patient education, what instruction will the nurse include? a. "Swallow three tablets immediately for pain and call 911." b. "Put one tablet under your tongue for chest pain. If the pain does not subside, call 911." c. "Call your health care provider when you have chest pain. He will tell you how many tablets to take." d. "Place three tablets under your tongue and call 911."

b. "Put one tablet under your tongue for chest pain. If the pain does not subside, call 911." -Rationale: At the initial onset of chest pain, sublingual nitroglycerin is administered and if the pain persists after the initial dose, the patient should seek emergency medical assistance for more definitive diagnosis and care. Options 1, 3, and 4 are incorrect. Nitro- glycerin sublingual dosing should not be swallowed, and no more than one tablet is administered at a time. Trying to reach the health care provider may cause unnecessary delays in treatment.

Which intravenous fluid solution should the nurse administer to manage a client with a serum sodium level of 130 mEq/L? a. Albumin 5% b. 0.9% NS c. 3% NaCl d. D5W with KCl

b. 0.9% NS -Rationale: Hyponatremia is defined as serum sodium levels < 135 mEq/L. Mild hyponatremia usually is treated with intravenous infusions of normal saline (NS) or lactated Ringer's. A solution of 3% NS is hypertonic and usually reserved for treating severe hyponatremia.

The nurse weighs the patient who is on an infusion of lactated Ringer's postoperatively and finds that there has been a weight gain of 1.5 kg since the previous day. What would be the nurse's next highest priority? a. Check with the patient to determine whether there have been any dietary changes in the last few days b. Assess the patient for signs of edema and blood pressure for possible hypertension c. Contact dietary to change the patients diet to reduced sodium d. Request a diuretic from the patients provider

b. Assess the patient for signs of edema and blood pressure for possible hypertension -Rationale: A weight gain of 1 kg (2 lb) or more may indicate fluid retention. Signs of fluid retention include increased blood pressure, or HTN, and edema. A complete nursing assessment is needed to determine other signs or symptoms that may be present. Options 1, 3, and 4, are incorrect. Checking dietary history may be considered after the nursing assessment is completed. Changing diet or medications is part of the collaborative treatment plan with the health care provider.

The nurse prepares discharge teaching for a client receiving isosorbide dinitrate for treatment of angina. Which information must the nurse include? a. Limit exercise to 30 minutes twice a week. b. Avoid alcohol consumption. c. Monitor intake and output. d. Report skin flushing immediately.

b. Avoid alcohol consumption. -Rationale: Use of alcohol with antihypertensive drugs may cause additive hypotension. Exercise does not need to be limited to twice a week. It is not necessary to monitor intake and output. Flushing is an expected adverse effect that occurs with nitroglycerin.

A nurse is caring for a client with a spinal cord injury and is experiencing neurogenic shock. What would the nurse expect to find during assessment of the client? a. Massive bleeding at injury site b. Bradycardia and hypotension c. Laryngospasm and dyspnea d. Acute respiratory distress

b. Bradycardia and hypotension -Rationale: Neurogenic shock results in bradycardia and hypotension due to sudden loss of sympathetic nerve activity from the spinal cord injury. Obvious trauma or bleeding would suggest hypovolemic shock related to blood loss. Laryngospasm and dyspnea can indicate anaphylactic shock. Septic shock is often a precursor to acute respiratory distress syndrome.

A nurse is providing medication teaching to a client who is prescribed transdermal nitroglycerin patches for management of angina. Which instruction should the nurse include? a. Apply the patch on the same site consistently. b. Cleanse the skin under the previous site gently. c. Use the arm or leg for ease of application. d. Ensure that a patch is worn around the clock.

b. Cleanse the skin under the previous site gently. -Rationale: The nurse should instruct the patient to always remove the old patch, cleanse the skin underneath gently, and rotate sites before applying a new patch. Use hair-free areas of the torso to apply the patch, not on arms or legs. Increased muscle activity of the limbs may increase drug absorption. Removing the patch at night, for 6-12 hours or as directed, helps to prevent or delay the development of tolerance to nitrates

Which assessment finding requires immediate intervention by the nurse caring for a client receiving phenylephrine (Neosynephrine)? a. Decreased heart rate b. Decreased urinary output c. Respiratory rate 24 per minute d. Negative Homans' sign

b. Decreased urinary output -Rationale: Phenylephrine (Neosynephrine) causes vasoconstriction. Urinary output should be monitored, because extreme vasoconstriction could lead to reduced renal perfusion. Because of adverse effects and potential organ damage due to the rapid and intense vasoconstriction, vasopressors are used only after fluid and electrolyte restoration has failed to raise blood pressure.

A patient is given a prescription for propranolol (Inderal) 40 mg BID. What is the most important instructions the nurse should give to this patient? a. Take this medication on an empty stomach, as food interferes with its absorption b. Do not stop taking this medication abruptly; the dosage must be decreased gradually if it is discontinued c. If the patient experiences any disturbances in hearing, the patient should notify the provider immediately d. The patient may become very sleepy while taking this medication; do not drive

b. Do not stop taking this medication abruptly; the dosage must be decreased gradually if it is discontinued -Rationale: Beta blockers such as propranolol should never be stopped abruptly because of the possible rebound HTN and increased dysrhythmias that may occur. Options 1, 3, and 4 are incorrect. The nurse may teach the patient to take the medication on an empty stomach and to be cautious with drowsiness while taking beta blockers. However, these are not as significant as the HTN or dysrhythmias that may occur from abrupt cessation and would be considered secondary teaching points. Hearing loss is not a common side effect of beta blockers.

A client receiving metoprolol (Lopressor) as adjunct therapy to treatment of acute exacerbation of heart failure is experiencing severe hypotension. The nurse should prepare to administer which drug? a. Isoproterenol b. Dobutamine c. Atropine d. Digibind

b. Dobutamine -Rationale: Hypotension caused by beta blockers, like metoprolol, may be reversed by a vasopressor such as parenteral dopamine or dobutamine. Atropine or isoproterenol can be used to reverse bradycardia caused by metoprolol overdose. Digoxin immune fab (Digibind) is the reversal agent for digoxin toxicity.

A patient who is experiencing shock is started on norepinephrine (Levophed) by intravenous drip. Why must the nurse conduct frequent inspections of the intravenous insertion site while the patient remains on this drug? a. The patients blood pressure may rise if the site is occluded b. Extravasation and leakage at the intravenous site may cause local tissue damage c. Bleeding may occur from the site due to localized drug effects d. The patients blood pressure may drop precipitously if the intravenous runs too quickly

b. Extravasation and leakage at the intravenous site may cause local tissue damage -Rationale: Norepinephrine (Levophed) is a potent vasoconstrictor. Extravasation or leakage at the insertion site will cause intense vasoconstriction in the local area with loss of tissue perfusion and tissue dam- age. Options 1, 3, and 4 are incorrect. Norepinephrine raises the blood pressure by vasoconstriction, and an occluded IV would not allow the drug to be infused and the blood pressure would drop. Infusing the drug too rapidly would cause a dramatic increase in vasocostriction and blood pressure. The drug constricts blood vessels and bleeding would not be a localized drug effect.

A nurse is caring for a client receiving an intravenous (IV) bolus of 0.9% normal saline (NS) for treatment of hypovolemia due to dehydration. Which assessment finding warrants immediate intervention by the nurse? a. Client report of being thirsty b. Fine crackles at lung bases c. Client need to void frequently d. Lower-than-normal blood pressure

b. Fine crackles at lung bases -Rationale: Fine crackles at lung bases may indicate that the client is experiencing fluid overload, warranting immediate intervention by the nurse. Patients who are dehydrated with low blood pressure should be given normal saline (NS). While the immediate goal in treating a volume deficit disorder is to replace the depleted fluid, replacement of depleted fluids should always be conducted in a controlled, stepwise manner because infusing fluids too rapidly can cause fluid overload, pulmonary edema, and cardiovascular stress.

A nurse is caring for a client started on niacin therapy as adjunct to atorvastatin (Lipitor) regimen. What should the nurse monitor in the client following administration of the medication? a. Confusion and agitation b. Flushing and hot flashes c. Hypotension and tachycardia d. Nausea and constipation

b. Flushing and hot flashes -Rationale: Flushing and hot flashes occur in almost every patient who takes niacin for hypercholesteremia. Taking a dose of aspirin 30 minutes prior to niacin administration can reduce uncomfortable flushing in many patients.

A client receiving hydrochlorothiazide (HCTZ) and digoxin complains of nausea, vomiting, and seeing haloes around lights. The client's serum digoxin level is 2.5 ng/mL. Which is the most appropriate nursing action to take? a. Hold the digoxin, give HCTZ as prescribed. b. Hold both the digoxin and the HCTZ. c. Document assessment and lab findings. d. Administer both drugs as prescribed.

b. Hold both the digoxin and the HCTZ. -Rationale: The client is exhibiting digitalis toxicity; therefore, the nurse should hold both medications and notify the healthcare provider. Thiazide diuretics, such as HCTZ, increase serum digoxin levels by promoting potassium loss, thereby increasing the risk of digoxin toxicity.

Which adverse effect should the nurse emphasize when teaching a client with diabetes about thiazide therapy? a. Hypocalcemia b. Hyperglycemia c. Urinary frequency d. Anemia

b. Hyperglycemia -Rationale: Thiazides may reduce the effectiveness of antidiabetic drugs including insulin; therefore, the nurse should emphasize teaching the client about occurrence of hyperglycemia with use of thiazide therapy. Instruct the patient with diabetes to report a consistent elevation in blood glucose to the healthcare provider.

The nurse is preparing to administer the first dose of enalapril (Vasotec). Identify the potential adverse effects of this medication. (Select all that apply.) a. Reflex hypertension b. Hyperkalemia c. Persistent cough d. Angioedema e. Hypotension

b. Hyperkalemia c. Persistent cough d. Angioedema e. Hypotension -Rationale: Side effects of ACE inhibitors such as enalapril (Vasotec) include persistent cough and postural hypotension. Hyperkalemia may occur and can be a major concern for those patients with renal impairment and in patients who are taking potassium-sparing diuretics. Though rare, the most serious adverse effect of ACE inhibitors is the development of angioedema. Option 1 is incorrect. Hypotension with reflex tachycardia is a possibility depending on how low or how fast the BP decreases.

A client with type II diabetes mellitus is prescribed to take propranolol therapy for treatment of cardiac dysrhythmias. For which adverse effect should the nurse monitor in the client? a. Proteinuria b. Hypoglycemia c. Elevated liver enzymes d. Decreased ANA titers

b. Hypoglycemia -Rationale: Propranolol should be used cautiously in patients with diabetes due to its hypoglycemic effects and because it may mask the symptoms of hypoglycemia as the adrenergic "fight-or-flight" response to hypoglycemia is blocked.

A nurse is developing a teaching plan for a client receiving thiazide diuretics. Which information should the nurse provide the client? a. Teaching the client to take an apical pulse b. Including potassium-rich foods in the diet c. Monitoring for rebound hypertension d. Reporting hearing disturbances or difficulties

b. Including potassium-rich foods in the diet -Rationale: Thiazide diuretics are potassium-wasting, and levels should be closely monitored. Encouraging intake of foods rich in potassium could help maintain potassium levels. Taking an apical pulse is indicated before administering cardiac glycosides and beta blockers, but not for thiazide diuretics. Rebound hypertension occurs with use of beta blockers. Loop diuretics, not thiazide diuretics, can cause ototoxicity.

The patient is to begin taking atorvastatin (Lipitor) and the nurse is providing education about the drug. Which symptom related to this drug should be reported to the health care provider? a. Constipation b. Increasing muscle or joint pain c. Hemorrhoids d. Flushing or "hot flash"

b. Increasing muscle or joint pain -Rationale: "Statins" (HMG-CoA reductase inhibitors) such as atorvastatin (Lipitor) may cause rhabdomyolysis, a rare but serious adverse effect. Options 1, 3, and 4 are incorrect. Constipation and hemorrhoids may result from bile acid sequestrants. A feeling of flushing or hot flash-type effects may result from nicotinic acid.

The patient is taking atenolol (Tenormin) and doxazosin (Cardura). What is the rationale for combining two antihypertensive drugs? a. The blood pressure will decrease faster b. Lower doses of both drugs may be given with fewer adverse effects c. There is less daily medication dosing d. Combination therapy will treat the patients other medical conditions

b. Lower doses of both drugs may be given with fewer adverse effects -Rationale: The advantage of using a combination of two drugs such as atenolol (Tenormin; a beta blocker) and doxazosin (Cardura; an alpha-1 antagonist) is that lower doses of each may be used resulting in fewer side effects. Options 1, 3, and 4 are incorrect. With careful dosing, the BP should be gradually lowered to a safe limit. The number of doses per day is dependent on the half-life of the drug not the combination. Other conditions may be treated, but the primary reason to com- bine antihypertensives is not in treatment of additional conditions.

A nurse is caring for a client who is prescribed procainamide for treatment of cardiac dysrhythmias. For which adverse effects should the nurse monitor the client while administering this drug? (Select all that apply.) a. Blurred vision b. Lupus-like syndrome c. Bone marrow depression d. Complete heart block e. Elevated ANA titers f. Photosensitivity

b. Lupus-like syndrome c. Bone marrow depression d. Complete heart block e. Elevated ANA titers -Rationale: Procainamide, a sodium-channel blocker used for treatment of Class IA dysrhythmias, have several Black Box warnings. Prolonged administration may result in an increased titer of antinuclear antibodies (ANAs). A lupus-like syndrome may occur in 30% to 50% of patients who are taking the drug for more than a year. Bone marrow depression has been reported, usually within the first 3 months of therapy. Procainamide is reserved for life-threatening dysrhythmias because it has the ability to produce new dysrhythmias or worsen existing ones. Therefore, the nurse should monitor for complete heart block that can occur with administration of this drug. Potassium channel blockers, like amiodarone, may cause photosensitivity, blurred vision, and skin rashes.

Drug therapy with atorvastatin (Lipitor) is initiated for a client with hyperlipidemia. The nurse develops a nursing care plan to include which appropriate intervention? a. Eliminate cholesterol from the diet. b. Monitor lipid levels and liver function. c. Discontinue drug therapy in 3 months. d. Take the medication on an empty stomach.

b. Monitor lipid levels and liver function. -Rationale: Monitoring lipid levels will help determine effectiveness of therapy. A small percentage of patients experience liver damage; thus, hepatic function is monitored during the first few months of therapy. Cholesterol intake should be reduced, but not totally eliminated. The drop in lipid levels is not permanent, however, so patients need to remain on these drugs during the remainder of their lives or until their hyperlipidemia can be controlled through dietary or lifestyle changes. Atorvastatin should be administered with food to decrease GI discomfort.

Dobutamine (Dobutrex) is used to treat a client experiencing cardiogenic shock. Which nursing action should the nurse include in the client's plan of care? a. Monitoring for fluid overload b. Monitoring for dysrhythmias c. Monitoring respiratory status d. Monitoring for hypotension

b. Monitoring for dysrhythmias -Rationale: Because of its profound effects on the cardiovascular system, patients who are receiving dopamine must be continuously monitored for signs of dysrhythmias and hypertension.

A nurse Is caring for a client diagnosed with Stage I hypertension and no history of other medical conditions. The nurse anticipates that which treatment is most likely to be initiated for managing the client's condition? a. Combination of loop diuretic and beta blocker b. Monotherapy with a thiazide diuretic c. Combination of beta blocker and vasodilator d. Monotherapy with an alpha-adrenergic agonist

b. Monotherapy with a thiazide diuretic -Rationale: First-line drugs for treatment of hypertension include thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs). Beta-adrenergic blockers are no longer considered first-line drugs. Alpha-adrenergic agonists and blockers are second-line drugs used for treatment of hypertension.

Which of the following nursing interventions is most important when caring for a patient receiving dextran 40 (Gentran 40, LMD)? a. Assess the patient for deep venous thrombosis b. Observe for signs of fluid overload c. Encourage fluid intake d. Monitor arterial blood gases

b. Observe for signs of fluid overload -Rationale: Dextran 40 (Gentran 40, LMD) is a colloidal plasma volume expander that causes fluid to move rapidly from the tissues to vascular spaces. This places the patient at risk for fluid overload. Options 1, 3, and 4 are incorrect. Deep vein thrombosis or changes in arterial blood gases are not related to dextran 40. Fluid intake should be monitored during administration but not encouraged due to the shifting of fluids from tissues to vascular spaces that occurs with administration of the drug.

Which nursing intervention is most important when caring for a client receiving dextran 40? a. Assess for deep vein thrombosis. b. Observe for signs of hypersensitivity. c. Encourage oral fluid intake. d. Monitor arterial blood gases.

b. Observe for signs of hypersensitivity. -Rationale: A small percentage of patients are allergic to dextran 40, including the possibility of anaphylaxis. The drug should be discontinued immediately if signs of hypersensitivity are suspected.

Nifedipine (Procardia) has been ordered for a patient with hypertension. In the care plan, the includes the need to monitor for which adverse effect? a. Rash and chills b. Reflex tachycardia c. Increased urinary output d. Weight loss

b. Reflex tachycardia -Rationale: Nifedipine (Procardia) may cause hypotension with reflex tachycardia. Options 1, 3, and 4 are incorrect. Rash, chills, increased urine output, and weight loss are not adverse effects of CCBs.

The nurse is providing teaching to a patient who has been prescribed furosemide (Lasix). Which of the following should the nurse teach the patient? a. Avoid consuming large amounts of kale, cauliflower, or cabbage b. Rise slowly from a lying or sitting position to standing c. Count the pulse for one full minute before taking this medication d. Restrict fluid intake to no more than 1 L per 24-hour period

b. Rise slowly from a lying or sitting position to standing -Rationale: Loop diuretics such as furosemide (Lasix) may dramatically reduce a patient's circulating blood volume from diuresis and may cause orthostatic hypotension. To minimize the chance for syncope and falls, the patient should be taught to rise slowly from a lying or sitting position to standing. Options 1, 3, and 4 are incorrect. Kale, cauliflower, and cabbage contain vitamin K, which does not need to be restricted during diuretic therapy. Monitoring the pulse along with the blood pressure to assess for reflex tachycardia is advised, but the pulse does not need to be taken for one full minute before taking the drug. Fluids should not be restricted during diuretic therapy unless ordered by the provider.

The nurse reviews laboratory studies of a patient receiving digoxin (Lanoxin). Intervention by the nurse is required if the results include which of the following laboratory values? a. Serum digoxin level of 1.2 ng/dL b. Serum potassium level of 3 mEq/L c. Hemoglobin of 14.4 g/dL d. Serum sodium level of 140 mEq/L

b. Serum potassium level of 3 mEq/ L -Rationale: Normal serum potassium level is 3.5 to 5 mEq/L. Hypokalemia may predispose the patient to digitalis toxicity. Options 1, 3, and 4 are incorrect. A digoxin level of 1.2 ng/dL is within therapeutic range. A hemoglobin of 14.4 g/dL and a serum sodium of 140 mEq/L are also within normal range.

The nurse reviews lab studies of a client receiving digoxin (Lanoxin). Which lab finding warrants immediate action by the nurse? a. Serum digoxin level of 1.2 ng/dL b. Serum potassium level of 3.0 mEq/L c. Serum hemoglobin level 14.4 g/dL d. Serum sodium level of 140 mEq/L

b. Serum potassium level of 3.0 mEq/L -Rationale: Normal serum potassium level is 3.5-5.0 mEq/L. Hypokalemia may predispose the client to digitalis toxicity. The other lab values are within normal limits.

A patient with significant hypertension unresponsive to other medications is given a prescription for hydralazine (Apresoline). An additional prescription of propranolol (Inderal) is also given to the patient. The patient inquires why two drugs are needed. What is the nurses best response? a. Giving the two drugs together will lower the blood pressure even more than just one alone b. The hydralazine may cause tachycardia and the propranolol will help keep the heart rate within normal limits c. The propranolol is to prevent lupus erythematosus from developing d. Direct-acting vasodilators such as hydralazine cause fluid retention and the propranolol will prevent excessive fluid build up

b. The hydralazine may cause tachycardia and the propranolol will help keep the heart rate within normal limits -Rationale: Propranolol (Inderal) and other beta-blocking drugs are used to prevent reflex tachycardia that may occur as a result of treatment with direct- acting vasodilators. Giving two antihypertensive drugs together may also lower BP further; however, the beta- blocking drugs also lower the heart rate and are given in this case to reduce the chance for reflex tachycardia. Options 1, 3, and 4 are incorrect. Propranolol has not been demonstrated to have effects in preventing lupus and is not a diuretic, although judicious diuretic therapy may be necessary if excessive fluid gain is an adverse effect of direct-acting vasodilator therapy.

Nitroprusside (Nitropress) is prescribed for a client being treated for a blood pressure of 220/110 mmHg. Which action by a new nurse would require intervention by the charge nurse? a. The nurse cautions the client to get assistance when getting out of bed. b. The nurse uses electronic monitoring of blood pressure every hour. c. The nurse documents the IV rate and status of the site every 15 minutes. d. The nurse inserts a Foley catheter to monitor urine output each shift.

b. The nurse uses electronic monitoring of blood pressure every hour. -Rationale: Nitroprusside decreases blood pressure instantaneously. Vital signs must be monitored very closely, every 5-15 minutes, not every hour.

A patient is receiving 5% dextrose in water (D5W). Which of the following statements is correct? a. The solution may cause hypoglycemia in the patient who has diabetes b. The solution may be used to dilute mixed intravenous drugs c. The solution is considered a colloid solution d. The solution is used to provide adequate calories for metabolic needs

b. The solution may be used to dilute mixed intravenous drugs -Rationale: 5% dextrose in water (D5W) is often used to reconstitute (dilute) powdered forms of drugs that are intended to be given parenterally. Options 1, 3, and 4 are incorrect. The solution may cause hyperglycemia in the patient with diabetes due to the dextrose content. The solution is considered a crystalloid solution and 1 liter of D5W supplies only 170 calories which is not enough to meet the metabolic and nutritional needs of the patient.

Erectile dysfunction drugs such as sildenafil (Viagra) are contraindicated in patients taking nitrates for angina. What is the primary concern with concurrent administration of these drugs? a. They contain nitrates, resulting in an overdose b. They also decrease blood pressure through vasodilation and may result in prolonged and severe hypotension when combined with nitrates c. They will adequately treat the patients angina as well as erectile dysfunction d. They will increase the possibility of nitrate tolerance developing and should be avoided unless other drugs can be used

b. They also decrease blood pressure through vasodilation and may result in prolonged and severe hypotension when combined with nitrates -Rationale: Erectile dysfunction drugs such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) decrease BP. When combined with nitrates, severe and prolonged hypotension may result. Options 1, 3, and 4 are incorrect. Erectile dysfunction drugs do not contain nitrates and do not lead to nitrate tolerance. These drugs are not recognized as useful for the treatment of anginal pain.

The patient has been given a prescription of furosemide (Lasix) as an adjunct to treatment of hypertension and returns for a follow-up check. Which of the following is the most objective data for determining the therapeutic effectiveness of the furosemide? a. Absence of edema in lower extremities b. Weight loss of 13 kg (6 lbs) c. Blood pressure log notes blood pressure 120/70 mmHg to 134/88 since discharge d. Frequency of voiding of at least six times per day

c. Blood pressure log notes blood pressure 120/70 mmHg to 134/88 since discharge -Rationale: Furosemide (Lasix) was prescribed as an adjunct treatment for HTN. Blood pressure decrease toward normal limits indicates that the use of this treatment has been effective. Options 1, 2, and 4 are incorrect. Although absence of edema, weight loss, and frequency of voiding are related to fluid status and are other effects of furosemide, they are not related to the primary reason this drug was given (adjunctive therapy in HTN).

A patient is receiving PlasmaLyte for treatment of hypovolemic shock. When monitoring for therapeutic effects, which of the following will the nurse expect to occur? a. Breath sounds are clear b. Potassium, glucose, and sodium levels remain within normal range c. Blood pressure returns to within normal range and urine output increases d. The pulse rate and ECG return to normal rate and pattern

c. Blood pressure returns to within normal range and urine output increases -Rationale: As fluid volume increases, blood pressure, cardiac output, and renal perfusion all in- crease. Blood pressure should return to normal or near- normal levels, and urine output should increase as renal perfusion increases. Options 1, 2, and 4 are incorrect. When given for hypovolemic shock, PlasmaLyte should increase intravascular volume. Breath sounds; potassium, glucose, and sodium levels; and pulse rate or ECG are not indicators of therapeutic effect.

Which of the following clinical manifestations may indicate that the patient taking metolazone (Zaroxolyn) is experiencing hypokalemia? a. Hypertension b. Polydipsia c. Cardiac dysrhythmias d. Skin rash

c. Cardiac Dysrhythmias -Rationale: Metolazone (Zaroxolyn) is a thiazide diuretic and causes potassium loss. Signs of hypokalemia include cardiac dysrhythmias, hypotension, dizziness, and syncope. Options 1, 2, and 4 are incorrect. Polydipsia is not associated with hypokalemia. HTN is a clinical indication for the use of diuretics. Skin rashes are an adverse effect of metolazone but are not a symptom of hypokalemia.

A nurse is caring for a client following an episode of myocardial infarction (MI). The nurse determines that treatment with a beta-adrenergic blocker has been effective based on which assessment finding? a. Heart rate is 112 bpm at rest. b. Blood pressure is 96/68 mmHg. c. Decreased dysrhythmias occur. d. Increase in urinary output

c. Decreased dysrhythmias occur. -Rationale: Beta blockers have the ability to decrease heart rate, decrease contractility, and decrease blood pressure, leading to decreased oxygen demand. They also slow conduction, which suppresses dysrhythmias. A low blood pressure alone would not indicate effective treatment of the MI. In fact, the nurse should monitor this client closely for hypotension.

The nurse weighs the client receiving dobutamine (Dobutrex) therapy daily. Which nursing action is most appropriate for using this assessment data? a. Evaluate nutritional status. b. Evaluate fluid output. c. Determine drug dosage. d. Determine renal status.

c. Determine drug dosage. -Rationale: Dobutamine dosing is weight-based and is infused at a rate of 2.5-40 mcg/kg/min for a maximum of 72 hours. Therefore, the patient's weight must be taken daily, and drug doses recalculated based on any changes in weight noted.

A nurse is caring for a client brought to the emergency department for severe burns. Which intravenous solution should the nurse anticipate administering to correct hypovolemic shock associated with the client's condition? a. Lactated Ringer's b. Albumin 5% c. Dextran 40 d. Plasma-Lyte 56

c. Dextran 40 -Rationale: Indications for use of Dextran 40 include fluid replacement for patients experiencing hypovolemic shock due to hemorrhage, surgery, or severe burns. When given for acute shock, it is infused as rapidly as possible until blood volume is restored.

A nurse is providing education to a client receiving plasma protein fraction (Plasmanate). The nurse should instruct the client to immediately report which adverse effect of the drug? a. Unusual bleeding b. Urinary urgency c. Difficulty breathing d. Visual disturbance

c. Difficulty breathing -Rationale: Plasma protein fraction (Plasmanate) is an albumin product that contains 83% albumin and 17% plasma globulins. Because albumin is a natural blood product, the patient may have antibodies to the donor albumin and allergic reactions are possible. If the patient is able to verbalize, the nurse should instruct the client to immediately report symptoms of an allergic reaction to the drug as evidenced by: dyspnea, itching, feelings of throat tightness, palpitations, chest pain or tightening, or headache.

The client's serum digoxin level is 2.2 ng/dL and the heart rate is 120 and irregular. The nurse anticipates administering which drug? a. Potassium 40 mEq added to I.V. fluids b. Digoxin (Lanoxin) 0.5 mg bolus I.V. c. Digoxin immune fab (Digibind) I.V. d. Furosemide (Lasix) 60 mg I.V.

c. Digoxin immune fab (Digibind) I.V. -Rationale: A serum level of 2.2 ng/dL is elevated, and the client is exhibiting signs of digoxin toxicity. Digoxin overdose can be fatal. Specific therapy involves IV infusion of digoxin immune fab (Digibind), which contains antibodies specific for digoxin. The question does not indicate that the potassium level is low. Giving additional digoxin would exacerbate the toxicity. Giving furosemide may reduce potassium levels and contribute to increased toxicity.

The patient who has not responded well to other therapies has been prescribed milrinone (Primacor) for treatment of his heart failure. What essential assessment must the nurse make before starting this drug? a. Weight and presence of edema b. Dietary intake of sodium c. Electrolytes, especially potassium d. History of sleep patterns and presence of sleep apnea

c. Electrolytes, especially potassium -Rationale: Electrolytes, especially potassium for the presence of hypokalemia, should be assessed before beginning milrinone (Primacor) or any phosphodiesterase inhibitory. Hypokalemia should be corrected before administering phosphodiesterase inhibitors because this can increase the likelihood of dysrhythmias. Options 1, 2, and 4 are incorrect. Weight, presence of edema, and dietary intake of sodium will be monitored because of their relationship to HF and for therapeutic improvement, but they are not crucial to assess before beginning therapy. The patient's sleep patterns or presence of sleep apnea have no direct relationship to the drug; however, monitoring may be ordered for other reasons.

Nitroglycerin patches have been ordered for a patient with a history of angina. What teaching will the nurse give to this patient? a. Keep the patches in the refridgerator b. Use the patches only if the chest pain is severe c. Remove the old patch and wait 6-12 hours before applying a new one d. Apply the patch only to the upper arm or thigh areas

c. Remove the old patch and wait 6-12 hours before applying a new one -Rationale: To prevent the development of nitrate tolerance, nitroglycerin patches are often removed at night for 6 to 12 hours. Options 1, 2, and 4 are incorrect. The patches should not be kept in the refrigerator unless excessive room temperatures are anticipated and then only under the direction of the pharmacist or health care provider. Nitroglycerin patches provide long-term control of angina; they should be used regularly and not only in cases of severe chest pain. They should be applied to hair-free areas of the torso and not on the arms or legs. Muscle activity in these areas may increase drug absorption.

A patient will be sent home on diuretic therapy and has a prescription for liquid potassium chloride (KCl). What teaching will the nurse provide before the patient goes home? a. Do not dilute the solution with water or juice; drink the solution straight b. Increase the use of salt substitutes; they also contain potassium c. Report any weakness, fatigue, or lethargy immediately d. Take the medication immediately before bed to prevent heartburn

c. Report any weakness, fatigue, or lethargy immediately -Rationale: Weakness, fatigue, lethargy, and anorexia are symptoms of hypokalemia. Because this patient is taking potassium supplements to replace potassium lost during diuresis, the dosage may need to be adjusted to ensure adequate replacement. Options 1, 2, and 4 are incorrect. Liquid potassium supplements are highly irritating to the gastric mucosa and should be diluted with water, juice, or other liquids before taking or before administration via nasogastric tube. The patient should remain upright to avoid gastric irritation. Salt substitutes should not be used without approval from the health care provider because they often contain potassium chloride.

While planning for a patients discharge from the hospital, which of the following teaching points would be included for a patient going home with a prescription for chlorothiazide (Diuril)? a. Increased fluid and salt intake to make up for the losses caused by the drug b. Increase intake of vitamin-C rich foods such as grapefruit and oranges c. Report muscle cramping or weakness to the healthcare provider d. Take the drug at night because it may cause drowsiness

c. Report muscle cramping or weakness to the healthcare provider -Rationale: Muscle cramping or weakness may indicate hypokalemia and should be reported to the health care provider. Options 1, 2, and 4 are incorrect. Patients on diuretic therapy are taught to monitor sodium (salt) and water intake to maintain adequate, but not excessive, amounts. Vitamin C-rich foods do not need to be increased while a patient is taking chlorothiazide. The drug should be taken early in the day to avoid nocturia. It does not cause drowsiness.

The nurse should consider which pharmacotherapeutic goals as priority in caring for a client experiencing shock? (Select all that apply.) a. Intubate for respiratory support. b. Rapid identification of cause c. Restore normal fluid volume. d. Maintain adequate blood pressure. e. Stop inflammatory response.

c. Restore normal fluid volume d. Maintain adequate blood pressure e. Stop inflammatory response. -Rationale: The two primary pharmacotherapeutic goals are to restore normal fluid volume and composition and to maintain adequate blood pressure. For anaphylaxis, an additional goal is to prevent or stop the hypersensitive inflammatory response. The need for client intubation for respiratory support does rely on pharmacotherapy. Identification of the cause of shock should precede implementation of pharmacotherapy.

A patient is receiving intravenous sodium bicarbonate for treatment of metabolic acidosis. During this infusion, how will the nurse monitor for therapeutic effect? a. Blood urea nitrogen (BUN) b. White blood cell counts c. Serum pH d. Renal function laboratory values

c. Serum pH -Rationale: Sodium bicarbonate may be given in conditions of metabolic acidosis to correct the pH levels to a normal range. Options 1, 2, and 4 are incorrect. BUN, WBC counts, or renal function laboratory values will not monitor the effect of sodium bicarbonate, an alkaline solution, on the pH of the blood in acidosis.

The client's arterial blood gases (ABG) reveal metabolic acidosis. Which medication should the nurse anticipate administering? a. Sodium chloride b. Disodium phosphate c. Sodium bicarbonate d. Potassium sulfate

c. Sodium Bicarbonate -Rationale: The preferred treatment for acute acidosis is to administer infusions of sodium bicarbonate. Bicarbonate ion acts as a base to quickly neutralize acids in the blood and other body fluids. Sodium citrate, sodium lactate, and sodium acetate are alternative alkaline agents sometimes used in place of bicarbonate.

A nurse is providing medication teaching to a client regarding the use of epinephrine (Epipen) for emergency treatment of anaphylaxis. Which client statement indicates further teaching is required? a. "I can administer several doses of the drug up to three times at 10-15 minutes apart." b. "I can expect a burning/stinging sensation at the injection site following administration." c. "I will carry an EpiPen to administer in case I experience an allergic reaction to peanuts." d. "I can experience hypotension and palpitations with administration of this medication."

d. "I can experience hypotension and palpitations with administration of this medication." Rationale: When administered parenterally, hypertension and dysrhythmias may occur rapidly; therefore, the patient should be monitored carefully following injection. If necessary, the dose may be repeated up to three times at 10-to-15-minute intervals. The client may experience stinging/burning at the site of application. Patients with serious allergies may be advised to carry a portable form of epinephrine, such as an EpiPen, for self-administration in case of an emergency anaphylactic reaction.

The community health nurse is working with a patient taking simvastatin (Zocor). Which patient statement may indicate the need for further teaching about this drug? a. "I'm trying to reach my ideal body weight by increasing my exercise." b. "I didn't have any symptoms even though I had high lipid levels. I hear that is common." c. "I've been taking my pill before dinner." d. "I take my pill with grapefruit juice. I've always taken my medications that way."

d. "I take my pill with grapefruit juice. I've always taken my medications that way." -Rationale: Grapefruit juice inhibits the metabolism of statins such as simvastatin (Zocor) allowing them to reach higher serum levels and increasing the risk of adverse effects. Options 1, 2, and 3 are incorrect. Most patients with lipid disorders are asymptomatic and maintaining ideal body weight and increasing exercise are important components of a holistic plan of care. Because cholesterol biosynthesis is higher at night, taking the drug in the evening may ensure that peak levels are reached during the nighttime hours.

A patient with a history of heart failure will be started on spironolactone (Aldactone). Which of the following drug groups should not be used, or used with extreme caution in patients taking potassium-sparing diuretics? a. Nonsteroidal anti-inflammtory drugs b. Corticosteroids c. Loop diuretics d. Angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers

d. Angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers -Rationale: ACE inhibitors and ARBs taken concurrently with potassium-sparing diuretics increase the risk of hyperkalemia. Options 1, 2, and 3 are in- correct. NSAIDs are used cautiously with all diuretics because they are excreted through the kidney. Corticosteroids and loop diuretics may cause hypokalemia and may be paired with a potassium-sparing diuretic to reduce the risk of hypokalemia developing if a diuretic is needed.

A nurse is caring for a client receiving cholestyramine (Questran) for management of hypercholesteremia. Which nursing action is most appropriate to include in the client's plan of care? a. Monitoring for cardiac dysrhythmias b. Monitoring of intake and output c. Assessment of vital signs d. Assessment of bowel sounds

d. Assessment of bowel sounds -Rationale: Cholestyramine is a bile acid sequestrant which exerts its action in the GI tract. Because they are not absorbed into the systemic circulation, adverse effects are limited to the GI tract and include bloating and constipation.

During a follow-up visit, a client who has been prescribed verapamil (Calan) for treatment of dysrhythmia reports muscle aches and weakness. The nurse should review the client's medical history for which drug? a. Diltiazem (Cardizem) b. Atenolol (Tenormin) c. Digoxin (Lanoxin) d. Atorvastatin (Lipitor)

d. Atorvastatin (Lipitor) -Rationale: Verapamil should not be administered with statins because the risk of myopathy increases significantly. Diltiazem, atenolol, and digoxin—when used in conjunction with verapamil—can cause bradycardia and/or hypotension.

A client is prescribed isosorbide mononitrate (Imdur) 20 mg by mouth twice daily. The nurse providing client teaching explains that this drug relieves chest pain by which action? a. Dilating specifically the coronary arteries b. Decreasing the blood pressure c. Increasing contractility of the heart d. Dilating arteries and veins systemically

d. Dilating arteries and veins systemically -Rationale: Isosorbide mononitrate (Imdur) is a long-acting organic nitrate. The primary therapeutic action of the organic nitrates is their ability to relax both arterial and venous smooth muscle. Dilation of veins reduces the amount of blood returning to the heart (preload). With less blood for the ventricles to pump, cardiac output is reduced and the workload on the heart is decreased, thereby lowering myocardial oxygen demand. The therapeutic outcome is that chest pain is alleviated and episodes of angina become less frequent. In treating vasospastic angina, the organic nitrates can relax the spasms, allowing more oxygen to reach the myocardium, thereby terminating the pain.

A client is prescribed to take nifedipine (Procardia) and atenolol (Tenormin) for management of long-standing hypertension. The nurse providing medication teaching should instruct the client to immediately report which adverse effect(s) of the drugs? a. Dizziness when changing positions b. Impotence or sexual dysfunction c. Generalized fatigue and insomnia d. Increased shortness of breath and orthopnea

d. Increased shortness of breath and orthopnea -Rationale: Concurrent use of nifedipine with a beta blocker increases the client's risk of heart failure, which is evidenced by increased shortness of breath and orthopnea. Dizziness, fatigue, insomnia, and sexual dysfunction are expected side effects of both medications that need to be managed but do not require immediate interventions.

The nurse is caring for a patient with chronic stable angina who is receiving isosorbide dinitrate (Isordil). Which of the following are common adverse effects of isosorbide? a. Flushing and headache b. Tremors and anxiety c. Sleepiness and lethargy d. Light-headedness and dizziness

d. Light-headedness and dizziness -Rationale: Lightheadedness and dizziness may occur secondary to the hypotensive effects of the isosorbide (Isordil). Options 1, 2, and 3 are incorrect. The oral form of isosorbide has a slower onset than the sub- lingual form and flushing and headache are not usually experienced. Tremors, anxiety, sleepiness, or lethargy are not associated effects from the drug and if they occur, other causes should be investigated.

A patient with type 1 diabetes on insulin therapy reports that he takes propranolol (Inderal) for hypertension. The nurse will teach the patient to check glucose levels more frequently because of what concern? a. The propranolol can produce insulin resistence b. The two drugs used together will increase the risk of ketoacidosis c. Propranolol will increase insulin requirements by antagonizing the effects at the receptors d. The propranolol may mask symptoms of hypoglycemia

d. The propranolol may mask symptoms of hypoglycemia -Rationale: Beta blockers such as propranolol decrease the body's adrenergic "fight-or-flight" responses and may diminish or mask the symptoms and signals of hypoglycemia that a patient with diabetes normally perceives as blood glucose drops. Options 1, 2, and 3 are incorrect. Beta blockers may inhibit glycogenolysis, resulting in hypoglycemia, and have no effect on the development of insulin resistance.

A client receiving intravenous dopamine experiences extravasation at the IV site. Which nursing action is most appropriate to take? a. Administer phenytoin by mouth. b. Flush the IV line with normal saline. c. Assess for pheochromocytoma. d. Treat the site with phentolamine.

d. Treat with phentolamine. -Rationale: Following extravasation of dopamine, the affected area should be infiltrated immediately with 5-10 mg of phentolamine, an adrenergic blocker. Dopamine is a vesicant drug that can cause severe, irreversible skin and soft tissue damage if the drug infiltrates.

A patient was admitted from the emergency department after receiving treatment for dysrhythmias. He will be started on amiodarone (Cordarone, Pacerone) due to the lack of therapeutic effects from his other antidysrhythmic therapy. When the nurse checks with him in the afternoon, he complains of feeling light-headed and dizzy. What will the nurse assess first? a. Whether there is the possibility of sleep deprivation from the stress of admission to the hospital b. Whether an allergic reaction is occurring with anticholinergic- like symptoms c. Whether the amiodarone level is not yet therapeutic enough to threat the dysrhythmias d. Whether the patients pulse and blood pressure are within normal limits

d. Whether the patients pulse and blood pressure are within normal limits -Rationale: Potassium channel blockers such as amiodarone, like other antidysrhythmics, may cause significant bradycardia and hypotension. The lightheadedness and dizziness may be associated with a drop in cardiac output due to bradycardia and hypotension. Options 1, 2, and 3 are incorrect. The significant finding of dizziness would first be assessed in relation to the known adverse effects of the drug. If pulse and blood pressure are within normal limits, the nurse could then consider sleep deprivation, allergies, and drug level as causes of these symptoms.