NRSG 245 Cumulative Pharmacology Final

____ is a behavior pattern characterized by continued use of a psychoactive substance despite physical, psychologic, or social harm. Physical dependence and ____ are not the same.

Addiction; addiction

________________ is a drug of choice for terminating paroxysmal SVT.

Adenosine

When assessing a patient who is scheduled to receive the second dose of newly prescribed sustained-release nitroglycerin, the patient complains of a headache. What should the nurse do? Administer a prescribed PRN analgesic such as acetaminophen Crush the medication to speed absorption through the oral mucosa Notify the prescriber of the headache STAT Withhold the drug and consult the prescriber

Administer a prescribed PRN analgesic such as acetaminophen

When the medication order says to administer a drug on an empty stomach, what does this mean?

Administer it either 1 hour before or 2 hours after a meal

A patient who is prescribed an ACE inhibitor complains of tongue swelling and is experiencing obvious dyspnea. What is the priority action by the nurse? Administer prescribed PRN epinephrine Assess BP Assess lung sounds Consult the prescriber

Administer prescribed PRN epinephrine

Grapefruit juice can raise levels of verapamil and diltiazem, which can result in toxicity. What is important to tell patients regarding this?

Advise patients that it may be prudent to minimize grapefruit juice consumption.

What is the greatest benefit of combining a statin with a calcium channel blocker? Produces less nausea and vomiting Produces less constipation which prevents having to take a stool softener or laxative Has a greater therapeutic effect Allows the patient to take only one pill which may increase patient adherence to medication regime

Allows the patient to take only one pill which may increase patient adherence to medication regime

_________ __________ are used for hemostasis, nasal decongestion, and elevation of blood pressure, and as adjuncts to local anesthetics.

Alpha1 agonists

A patient who is admitted to the nursing unit from the postanesthesia care unit (PACU) is moaning in pain. The patient is due for another dose of pain medication. What is the nursing priority at this time? Administer prescribed pain-relieving drugs Assess the patient's vital signs, tubes, and surgical site Obtain the patient's pain rating on a scale of 1-10 Review the patient's allergy history

Assess the patient's vital signs, tubes, and surgical site

An alert and oriented patient with a history of penicillin allergy is prescribed cephalexin, a cephalosporin. What is the priority action by the nurse. Administer the cephalexin Administer the cephalexin and carefully assess for allergic reaction Assess the type of reaction the patient has to the penicillin Notify the prescriber of the allergy and ask for a different antibiotic order

Assess the type of reaction the patient has to the penicillin

A 53 year old male was admitted to the ER in the middle of the night for a panic episode. He is highly anxious and short of breath. The doctor continued his home meds of clonazepam prn, lorazepam prn, & the SSRI sertraline(Zoloft). Which med will you offer him first? a.) clonazepam b.) lorazepam c.) sertraline

B (Lorazepam because it has a fast onset)

A patient was started on an SSRI 3 days ago for depression. She was discharged from your nursing unit this morning, but is now calling back to say she is feeling confused, restless, & has a fever of 101 degrees F. Which of the following is the best nursing intervention? a.) Determine if the patient has flulike symptoms. b.) Instruct patient to stop taking the medication. c.) Recommend to take the medication at night. d.) Explain that these are expected side effects.

B, stop taking the SSRI (and get back to hospital). These are signs of serotonin syndrome.

The nurse is reviewing test results for a patient who is prescribed itraconazole (Sporanox). Which result would warrant immediate consultation with the prescriber? a. AST 35 international units/L b. BNP 745 pg/ml c. Echocardiogram-ejection fraction 60% d. potassium 3.8 mEq/L

BNP 745 pg/ml (norm is 100 pg/ml-400 pg/ml)

Instructing a patient on the Valsalva maneuver is asking the patient to do what? Bear down as if having a bowel movement Breathe through pursed lips Pant like a dog Tighten the pelvic floor muscles

Bear down as if having a bowel movement

Instructing a patient on the Valsalva maneuver is asking the patient to do what? Breathe through pursed lips Pant like a dog Bear down as if having a bowel movement Tighten the pelvic floor muscles

Bear down as if having a bowel movement

___________ and thrombolytic drugs (aka fibrinolytic drugs) are used to dissolve existing thrombi (rather than prevent thrombi from forming),

Alteplase (tPA)

What is the priority nursing diagnosis for a patient with a dysrhythmia? Imbalance of fluid and electrolytes Inadequate peripheral tissue perfusion Ineffective breathing pattern Alteration in cardiac output

Alteration in cardiac output

___________ (a class III agent) is highly effective against atrial and ventricular dysrhythmias, but can cause multiple serious adverse effects, including damage to the lungs, eyes, liver, and thyroid.

Amiodarone

Which is the drug of choice for most systemic mycoses? Flucytosine Griseofulin Caspofungin Amphotericin B

Amphotericin B

What are analgesics?

Analgesics are drugs that relieve pain without causing loss of consciousness.

When does anginal pain occur?

Anginal pain occurs when cardiac oxygen supply is insufficient to meet cardiac oxygen demand.

This is a potentially life-threatening reaction to ACE inhibitors. Cough Hyperglycemia Angioedema Dyspepsia

Angioedema

Angioedema is a rare and potentially fatal reaction that can be be an adverse effect of ACE inhibitors, ARBs, and DRI's. What is this reaction characterized by and what should patients do if these symptoms develop?

Angioedema is characterized by giant wheals and edema of the tongue, glottis, and pharynx. Instruct patients to seek immediate medical attention if these symptoms develop.

ACE inhibitors block the formation of a. aldosterone b. Angiotensin II

Angiotensin II

Which has the greatest biologic activity: angiotensin I, angiotension II, or angiotensin III?

Angiotensin II -Angiotensin I is the precursor of angiotensin II and has only weak biologic activity. Angiotensin II has strong biologic activity. Angiotensin III, which is formed by the degradation of angiotensin II, has moderate biologic activity.

____________ __ ___________ _______________ block the actions of angiotensin II in blood vessels, the adrenals, and all other tissues.

Angiotensin II receptor blockers (ARBs)

What is the best protection against influenza? Acetaminophen administration Vigorous handwashing Annual vaccination Wearing a mask throughout the influenza season

Annual vaccination

When a patient with heart failure (HF) is prescribed digoxin and furosemide (Lasix), the nurse should carefully assess the patient for which symptoms of digoxin toxicity? Anorexia and nausea Anxiety and abdominal cramps Bone pain and constipation Muscle spasms and convulsion

Anorexia and nausea

The nurse teaches a patient about benazepril [Lotensin]. Which statement by the patient requires an intervention by the nurse? "I use NoSalt instead of salt to season foods." "I eat sweet potatoes once or twice a week." "I drink 4 ounces of prune juice each morning." "I like asparagus because it's high in vitamin K."

Answer: "I use NoSalt instead of salt to season foods." Rationale: An adverse effect of angiotensin-converting enzyme (ACE) inhibitors (for example, benazepril) is hyperkalemia. Significant potassium accumulation is usually limited to patients taking potassium supplements, salt substitutes (which contain potassium), or a potassium-sparing diuretic. Patients should be instructed to avoid potassium supplements and potassium-containing salt substitutes unless they are prescribed. Sweet potatoes and prune juice are foods high in potassium; asparagus is high in vitamin K. Foods high in vitamin K are restricted for patients who are prescribed warfarin [Coumadin].

A patient's cardiac output is 8 liters per minute. Which hemodynamic effect would the nurse expect? Decreased contractility Increased stroke volume Decreased preload Increased arterial pressure

Answer: increased stroke volume Rationale: The average value for cardiac output is 4.9 liters per minute. An increase in stroke volume will increase cardiac output. Stroke volume is determined by contractility, preload, and afterload. A decrease in contractility or preload will decrease stroke volume and cardiac output. An increase in afterload (or arterial blood pressure) will decrease stroke volume and cardiac output.

Along with an antisecretory agent, what other classification of drugs is recommended for a patient who has a gastric or duodenal ulcer and documented H. pylori infection? Proton Pump Inhibitors (PPIs) Antibiotics Histamine 2 Receptor Antagonists (H2RAs) Mucosal protectants

Antibiotics

Pharmacological management of stable COPD includes all of these drug classifications except: Bronchodilators Glucocorticoids Antibiotics PED4 inhibitors

Antibiotics

Which classification of drugs has as its principal indication to prevent thrombosis in veins? Antiplatelet Anticoagulants Fibrinolytics Thrombolytics

Anticoagulants

Venus thrombi are best prevented with:

Anticoagulatns (heparin or warfarin)

Which classification of drugs is used primarily to prevent arterial thrombosis? Anticoagulants Low-Molecular-Weight Heparins Antiplatelets Thrombolytics

Antiplatelets

Which month of the year is DNA Day celebrated?

April

____________ thrombi begin with formation of a platelet plug, which is then reinforced with fibrin.

Arterial

_________ serve as control valves to regulate local blood flow.

Arterioles

What is the Valsalva maneuver?

Asking the patient to bear down as if having a bowel movement

____ is the prototype of the first-generation NSAIDs.

Aspirin

___________ (an antiplatelet drug) combined with ___________ is recommended for all patients undergoing reperfusion therapy with a fibrinolytic drug.

Aspirin; clopidogrel

Arterial thrombi are best prevent with:

Asprin, an antiplatelet

Mrs. B has recently experienced an increase in stress due to relationship problems at home and financial stressors. She has difficulty falling asleep and wakes every 2-3 hrs throughout the night, with worries of the day racing through her mind. Lately she's been tired at work and feeling less productive. What are some benefits of sleep medication? What are some adverse effects to watch for? What other nonpharmacological therapy might help Mrs. B?

Benefits of sleep medication - improved number of hours slept and improved quality of sleep, improved mood and energy level the next day. Adverse effects - depressed respirations, grogginess the next day, can be additive such as benzodiazpines. Non drug interventions - dim lights, soften noises, relaxation sounds and music, comfortable temperature ( not too cold, not too hot), bedtime snack, good sleep hygiene and self-care before going to sleep.

How do benzodiazepines work?

Benzodiazepiens potentiate or intensify the action of gamma-aminobutyruic acid (GABA). GABA is an inhibitory neurotransmitter meaning that it slows transmission down. It slows down the racing thoughts, muscle tremors, and the rumbling stomach and also allows the mind and body to relax. Benzodiazepines are CNS depressants.

What drug class is used to treat anxiety disorders?

Benzodiazepines (the "-pams")

Beta blockers produce most of their beneficial effects by blocking which receptors in the heart? Beta 1 receptors Beta 2 receptors Alpha 1 receptors Alpha 2 receptors

Beta 1 receptors

What can reflex tachycardia be blunted with?

Beta blocker, calcium channel blocker

_______ __________ prevent pain of stable angina primarily by decreasing heart rate and contractility, which reduces cardiac oxygen demand.

Beta blockers

____________ ___________ intensify cardiosuppression caused by verapamil and diltiazem.

Beta blockers

____________ ______________ can delay awareness of hypoglycemia by masking hypoglycemia-induced signs that are caused by activation of the sympathetic nervous system (eg, tachycardia, palpitations). In addition, _______ ___________ inhibit the breakdown of glycogen into glucose, and can thereby impede glucose replenishment.

Beta blockers; beta blockers

____________ __________ can be used to suppress reflex tachycardia caused by ____________ and other dihydropyridines.

Beta blockers; nifedipine

__________-___________ inhibitors, such as clavulanic acid, are combined with certain penicillins to increase their activity against ______-___________-producing bacteria.

Beta-lactamase; beta-lactamase

This word refers to the amount of active drug that reaches the systemic circulation from its site of administration

Bioavailability

The major complication of fibrinolytic therapy is A ventricular dysrhythmia Bleeding Hypotension Bradycardia

Bleeding

What is the major complication of warfarin therapy?

Bleeding

What does the term "retinopathy" mean?

Blindness

_______________ _____________ are gated pores in the cytoplasmic membrane that regulate calcium entry into cells.

Calcium channels

___________ beta blockers are preferred to _________ beta blockers for patients with asthma or diabetes.

Cardioselective; nonselective

In addition to gastrointestinal side effects, erythromycin, a macrolide antibiotic, can also cause: Headache Neurotoxicity Myalgia Cardiotoxicity

Cardiotoxicity

What is the most serious side effect of tricyclic antidepressants?

Cardiotoxicity and liver failure (nephrotoxicity)

You are administering a vasodilator to your patient. Which assessment would be the most important one to perform? Skin breakdown risk assessment Fall risk assessment Cardiovascular system assessment Neurological assessment

Cardiovascular system assessment

Which bacteriostatic inhibitor of protein synthesis causes a high incidence of potentially fatal clostridium difficile diarrhea? Erythromycin Clindamycin Doxycycline Minocycline

Clindamycin

Vancomycin is an important but potentially toxic drug used primarily for (1) ________________ _____________ infection, (2) __________ infection, and (3) serious infections by susceptible organisms in patients allergic to ________________.

Clostridium dfficile; MRSA; penicillins

Safety alert: Clindamycin can cause potentially fatal _______________ ____________ diarrhea. Patients should promptly report any diarrhea to their healthcare provider.

Clostridium difficile

What 3 signs indicate an opioid overdose?

Coma, respiratory depression, pinpoint pupils

Dietary supplements are the most common form of ____ ____ ____.

Complimentary Alternative Medicine (CAM)

What is the underlying cause of stable angina?

Coronary artery artherosclerosis

What is the underlying cause of variant angina?

Coronary artery spasm

What is the most common reason for discontinuing an ACE inhibitor? Diarrhea Hyperkalemia Cough Hyperglycemia

Cough

_________, secondary to accumulation of bradykinin, is the ost common reason for discontinuing ACE inhibitors.

Cough

Knowing that statins cause myopathy, which marker for muscle injury should be measured prior to starting a patient on a statin? Creatine kinase (CK) Troponin I (TNI) Blood urea nitrogen (BUN) Partial thromboplastin time (PTT)

Creatine kinase (CK)

Which lab values should you monitor with amphitericin B?

Creatine levels

Which measure of renal function should be determined for all patients taking drugs that are eliminated primarily by the kidneys?

Creatinine clearance

A patient prescribed an antidepressant 1 week ago says, "I really don't think this medication is helping me." Which nursing response is most appropriate? a.) "Are you feeling suicidal?" b.) "Are you having side effects?" c.) "You need to schedule a clinic appointment so we can discuss this more." d.) "It takes about 3 weeks for your medication to work."

D

Your patient is taking Echinacea. Which statement best indicates this herb has been effective for him? a.) "It has prevented me from getting diarrhea since I have been taking antibiotic." b.) "I do not get nauseated in the morning any more." c.) "The fungal infection in my feet is getting better." d.) "I have not had a cold all winter."

D - I have not had a cold all winter

Your patient is on Nardil, an MAOI, for depression. Which statement by the patient best indicates that medication education has been effective? a.) "I am eating three well balanced meals a day." b.) "I've been eating lots of avocados." c.) "I ordered cheese pizza instead of pepperoni pizza." d.) "At a family cookout I chose grilled chicken instead of the smoked salmon."

D, grilled chicken. Avoid foods that are aged, smoked, or cured while on an MAOI to prevent a hypertensive crisis.

______-__ inhibitors are oral medications that, on average, lower A1c by about 0.5%. These agents are generally well tolerated and augment the effects of natural _________ hormones.

DPP-4; incretin

____________ is an oral anticoagulant that works by direct inhibition of thrombin.

Dabigatran

Drugs that dilate resistance vessels (arterioles) Increase cardiac afterload Decrease cardiac preload Increase cardiac preload Decrease cardiac afterload

Decrease cardiac afterload

Drugs that dilate capacitance vessels (veins) Decrease cardiac preload Increase cardiac preload Decrease cardiac afterload Increase cardiac afterload

Decrease cardiac preload

Postural (orthostatic hypotension is caused by Decreased venous return Increased cardiac output Vasoconstriction Water retention

Decreased venous return

Postural (orthostatic) hypotension is caused by Decreased venous return Increased cardiac output Vasoconstriction Water retention

Decreased venous return

Furosemide, a loop diuretic, can produce excessive loss of sodium, chloride, and water which can result in the condition below which promotes hypotension, thrombosis, and embolism? Ototoxicity Hyperuricemia Dehydration Hypotension

Dehydration

What is often the first sign of a hypersensitivity reaction to a drug? Difficulty breathing A rash A fever Constipation

Difficulty breathing

_____________ are first-line drugs for all patients with fluid overload. By reducing __________ ___________, these drugs can decrease venous pressure, arterial pressure, pulmonary edema, peripheral edema, and cardiac dilation.

Diuretics; blood volume

An oral potassium supplement is ordered for your patient at 0800. The potassium value from the morning's labs is 6.4 mEq/L. What is your best course of action? Do not administer the medication Give the medication because it is ordered Notify the provider Wait and give the medication at 1200

Do not administer the medication

A patient has been prescribed extended-release nifedipine (Procardia). Teaching regarding administration should include which instruction? Administer 1 hour before or 2 hours after meals Do not crush or chew tablet Take with grapefruit juice to improve absorption Take on an empty stomach

Do not crush or chew tablet

Because hepatic metabolism and GFR increase during pregnancy, what must occur with some drug dosages?

Dosage may need to be increased

______________, a derivative of amiodarone, is somewhat less toxic than amiodarone, but also less effective. In patients with heart failure or permanent atrial fibrillation, ______________ doubles the risk of death.

Dronedarone; dronedarone

Which effect will liver disease have on drug levels in the body? No effect Drug accumulation Rapid metabolism Decreased responsiveness

Drug accumulation

An abnormality in the rhythm of the heart beat is called a Cardiac cycle Dysrhythmia Baroreceptor reflex Bruit

Dysrhythmia

______________ arise from disturbances of impulse formation (automaticity) or impulse conduction.

Dysrhythmias

Which herbal medicine is used as an immune stimulant, antiviral, antibacterial, anti-inflammatory, or used to prevent viral illnesses, such as influenza and the common cold? Its contraindications are patients with autoimmune disorders such as lupus or rheumatoid arthritis

Echinacea

The following information was included in the change of shift report on a patient who is prescribed aspirin for its anticoagulant effects. Which patient symptom, if present, would be a priority for the nurse to report to the attending physician? Abdominal bloating Emesis of dark-brown particles Heartburn when recumbent Two liquid stools in the past 24 hours

Emesis of dark-brown particles

Treating an infection before the laboratory tests confirm the infecting organism is called Prophylactic therapy Empiric therapy Respiratory therapy Aquatic therapy

Empiric therapy

What is important to encourage patients to do when establishing a collaborative relationship with a patient?

Encourage patients to be active partners in setting treatment goals, creating a treatment program, and evaluating progress.

Because it can activate beta 1 receptors, this drug may be used to restore cardiac function in cardiac arrest patients experiencing asystole. Albuterol Epinephrine Dobutamine Ephedrine

Epinephrine

_________ can also be used to control superficial bleeding, restart the heart after cardiac arrest, and delay absorption of local anesthetics.

Epinephrine

__________ is a catecholamine that activates alpha1, alpha2, beta1, and beta2 receptors.

Epinephrine

What are PDE5 inhibitors used for? can you combine this with nitroglycerine?

Erectile dysfunction, do not combine with nitroglycerine due to postural hypotension

Which macrolide is the drug of first choice for individuals infected with Bordetella pertussis? Azithromycin Clarithromycin Tetracycline Erythromycin

Erythromycin

________________, the prototype of the macrolide antibiotics, is a bacteriostatic drugs that inhibits bacterial protein synthesis.

Erythromycin

The primary indication for thiazide diuretics is Essential hypertension Heart failure Pulmonary edema Hyperkalemia

Essential hypertension

If a severe digoxin overdose is responsible for dysrhythmias, digoxin levels can be lowered using _____ antibody fragments [Digibind].

Fab

What is a common cause of variability in the response to a prescribed dose of medication?

Failure to administer the medication as prescribed (poor patient adherence)

You are administering a vasodilator to your patient. Which assessment would be the most important one to perform? Skin breakdown risk assessment Fall risk assessment Cardiovascular system assessment Neurological assessment

Fall risk assessment

A patient may stop their prescribed antibiotic when symptoms clear and they feel well. True False Unsure Consult with the prescriber

False

Drugs that are toxic to the same organ can be combined without caution. True False

False

Lidocaine is used only for ventricular dysrhythmias. T or F

False

Aminoglycides are nephrotoxic and the renal injury is never reversible. True or false?

False Aminoglycosides are nephrotoxic, but RENAL INJURY IS USUALLY REVERSIBLE.

With aminoglycosides, ototoxicity is largely reversible. True or false?

False Ototoxicity is largely irreversible. Accordingly, if permanent injury is to be avoided, aminoglycosides should be withdrawn at the first sign of damage (ie, tinnitus, persistent headache, or both).

First generation NSAIDS inhibit only COX 2. True or False?

False, first-generation NSAIDS inhibit COX-1 and COX-2. Second-generation NSAIDS inhibit only COX-2.

___________ potentials occur in the His-Purkinje system, atrial muscle, and ventricular muscle.

Fast

The New York Heart Association (NYHA) bases their heart failure classification on what criteria? Structural disease Risk factors Functional limitations Amount of cardiac remodeling

Functional limitations

The most common side effect of Metformin is?

GI disturbances

the major adverse effects of Metformin are?

GI disturbances

What are the major adverse effects of biguanides? Hypoglycemic episodes GI symptoms Hypersensitivity reactions Injection site reactions

GI symptoms

What ingredient on a pizza might make you feel a little better about cholesterol levels?

Garlic - decreases LDL, decreases triglycerides, increases HDL

What is the absolute requirement for ulcer formation?

Gastric Acid

______________ ___/____ ____________ (eg, abciximab) are powerful IV antiplatelet drugs that can enhance benefits of primary percutaneous coronary intervention (PCI).

Glycoprotein IIb/IIIa inhibitors

This juice can inhibit the intestinal metabolism of certain drugs; thereby, increasing the drug's absorption which may cause drug toxicity.

Grapefruit Juice

The most common cause of PUD

H. Pylori Infection

Abacavir (NRTI) can cause potentially fatal hypersensitivity reactions, and hence must not be given to patients with this mutation

HLA-B*5701

What are the common initial side effects of SSRIs?

Headache, nausea (take with food instead), drowsiness (take at bedtime), sleeplessness (take in morning), and agitation *These side effects usually go away after the first week

Zollinger-Ellison syndrome is characterized by which underlying cause?

Hypersecretion of gastric acid

Zollinger-Ellison syndrome is characterized by which underlying cause? Inflammation Aspiration of gastric acid Positive test for H. pylori Hypersecretion of gastric acid

Hypersecretion of gastric acid

_________________ is the most common complication of pregnancy.

Hypertension

The main significant adverse effect of the second-generation sulfonylureas, glinides, and glitazones is: Orthostatic hypotension GI symptoms Hypoglycemia Pancreatitis

Hypoglycemia

When administering insulin, the nurse must keep in mind that the most immediate and serious adverse effect of insulin therapy is: Postural hypotension Reflex tachycardia Hypoglycemia Nausea and vomiting

Hypoglycemia

The nurse is caring for several patients who receive beta-agonist inhalation treatments for asthma. After treatments are administered, it is of greatest priority to reassess the patient who also has a history of which condition? Rheumatoid arthritis (RA) Heart failure (HF) Deep vein thrombosis (DVT) Peptic ulcer disease (PUD)

Heart failure (HF)

A patient is prescribed diltiazem (Cardizem), a calcium channel blocker. It would be a priority to withhold the drug and contact the prescriber if which assessment finding is present? BP 150/85 mmHg Constipation Heart rate 50 beats per minute (bpm) Dizziness with position changes

Heart rate 50 beats per minute (bpm)

__________ is a large polymer (molecular weight range, 3000 to 30,000) that carries many negative charges.

Heparin

___________ is recommended for all patients undergoing fibrinolytic therapy or percutaneous coronary intervention (PCI).

Heparin

____ ____ from acetaminophen overdose results from accumulation of a toxic metabolite. Risk is increased by undernourishment, ____ consumption, and preexisting liver disease.

Hepatic necrosis; alcohol

What is most common reason for removing drugs from the market?

Hepatotoxicity

Platelet aggregation depends on activation of platelet glycoprotein (GP) ____/_____ receptors, which bind fibrinogen to form cross-links between platelets.

IIb/IIIa

Loop diuretics are also called

High ceiling diuretics

When would the nurse use a depot preparation?

IM and SUBQ

The first sign of impending cochlear damage with a patient on an aminoglycoside is High-pitched tinnitus Persistent headache Vertigo Unsteadiness

High-pitched tinnitus

The patient is on Warfarin to prevent clots from atrial fibrillation. What test is performed to monitor therapeutic anticoagulation? INR (international normalized ratio) aPTT (activated partial thromboplastin time) B-type natriuretic peptide (BNP) Complete blood count (CBC)

INR (international normalized ratio)

Anticoagulation effects of heparin develop within minutes of ___ administration.

IV

Adenosine has a very short half-life (less than 10 seconds) and must be given by ___ _________.

IV bolus

Heparin is administered ___ or ______. Because of its large size and negative charges, heparin is unable to cross membranes, and hence cannot be administered ___.

IV; subQ; PO

The ____-__________ ____________ conducts impulses rapidly throughout the ventricles, thereby causing all parts of the ventricles to contract in near synchrony.

His-Purkinje system

________________, a beta-lactam antibiotic, has an antimicrobial spectrum that is broader than that of practically all other antimicrobial drugs.

Imipenem

____________-_____________ nifedipine has been associated with increased mortality in patients with myocardial infarction and unstable angina, although a causal relationship has not been established. The National Heart, Lung, and Blood Institute recommends that ___________-_____________ nifedipine, especially in higher doses, be used with great caution, if at all.

Immediate-release; immediate-release

Drugs that activate B1 receptors in the heart can improve cardiac performance by?

Increasing the force of contraction in a patient with heart failure (positive inotropic effect)

What is most important in a a pre-administration Assessment?

Individualize the patient

Suppression of myocardial contractility by beta blockade can cause heart failure. What should the nurse inform the patient regarding this?

Inform patients about early signs of heart failure (shortness of breath, night coughs, swellings of the extremities), and instruct them to notify the prescriber if these occur.

Neutropenia can be caused by ACE inhibitors, mainly with captopril, and poses a high risk of infection. What can the nurse tell patients regarding this?

Inform patients about early signs of infection (fever, sore throat, mouth sores) and instruct them to notify the prescriber if these occur.

Verapamil and diltiazem can cause bradycardia, AV block, and heart failure. What is important to tell patients regarding this?

Inform patients about manifestations of cardiac effects, such as slow heartbeat, shortness of breath, and weight gain, and instruct them to notify the prescriber if these occur.

Amiodarone can injure the liver. What is important to tell patients regarding this?

Inform patients about signs and symptoms of liver injury (eg, anorexia, nausea, vomiting, malaise, fatigue, itching, jaundice, dark urine) and instruct them to report them immediately.

Peripheral edema is a possible adverse effect of verapamil and diltiazem, as well as nifedipine and other dihydropridines. What is important to tell the patients regarding this?

Inform patients about signs of edema, like swelling in the ankles or feet, and instruct them to notify the prescriber if these occur.

Amiodarone can cause potentially fatal lung damage. What is important to tell patients regarding this?

Inform patients about signs of lung injury (dyspnea, cough, chest pain) and instruct them to report these immediately.

To minimize adverse effects of antihypertensives, what is important to tell the patients?

Inform patients about the potential side effects of treatment and encourage them to report objectionable responses.

Diarrhea and other GI disturbances can occur as an adverse effect of quinidine. What is important to tell patients regarding these effects?

Inform patients that they can reduce GI effects by taking quinidine with meals.

The _________ ____ _____ ____________ ______________ includes all ___ adrenergic antagonists on its list of high-alert medications. High-alert medications can cause devastating effects to patients in the event of a medication error.

Institute for Safe Medication Practices (ISMP); IV

The ________ ___ ____ ___________ __________ includes all IV adrenergic _________ and adrenergic ____________ among its list of high-alert medications. High-alert medications are those drugs that can cause devastating effects to patients in the event of a medication error.

Institute for Safe Medication Practices (ISMP); agonists; antagonists

ACE inhibitors and aliskiren, a DRI, can cause hyperkalemia. What can the nurse tell patients regarding this?

Instruct patients to avoid potassium supplements and potassium-containing salt substitutes unless they are prescribed by the provider.

To evaluate the therapeutic effects of nitroglycerin, what can the nurse tell patients to do?

Instruct patients to keep a record of the frequency and intensity of anginal attacks, the location of anginal pain, and the factors that precipitate attacks.

First-dose hypotension can occur as an adverse effect of ACE inhibitors. What should the nurse tell patients to do if this occurs?

Instruct patients to lie down if hypotension develops.

___________-_________ hypoglycemia can be treated with a fast-acting oral sugar (eg, glucose tablets, orange juice, sugar cubes), IV glucose, or pareteral glucagon. (Oral sucrose--aka table sugar--acts slowly, and will barely work at all in patients taking __________, a drug that prevents intestinal conversion of sucrose into glucose and fructose).

Insulin-induced; acarbose

Which route of administration is used to administer depot preparations of drugs?

Intramuscular

________________ injections are frequently painful; forewarn the patient.

Intramuscular

A patient is admitted to the medical unit and prescribed IV ampcillin/sulbactam (Unasyn) after a specimen was sent for culture and sensitivity (C&S) from the emergency department. The nurse knows the priority reason for notifying the prescriber of culture results as soon as they are available is that ampicillin/sulbactam Has many more adverse effects than most other antibiotics Is a broad-spectrum antibiotic, and there may be an effective narrow-spectrum antibiotic Is a very expensive antibiotic Is a narrow-spectrum antibiotic and may not be effective for the cultured organism

Is a broad-spectrum antibiotic, and there may be an effective narrow-spectrum antibiotic

__________ is a catecholamine that activates beta1 and beta2 receptors.

Isoproterenol

______________ is important because multidrug-resistant gram-positive pathogens, including vancomycin-resistacnt enterococci (VRE) and methicillin-resistant Staph. aureus (MRSA)

Linzolid

What drugs readily enter breast milk?

Lipid soluble drugs

What is the condition that can occur when patients do not rotate injection sites with the administration of insulin? Lipohypertrophy Hypoglycemia Hyperglycemia Hyperpigmentation

Lipohypertrophy

What levels must be kept low when taking mood stabilizers?

Lithium levels must be kept below 1.5 mEq/L

Statins cause: Kidney damage Liver damage Heart damage Brain damage

Liver damage

________ ___________ are effective even when GFR is low, and are preferred to __________ for most patients.

Loop diuretics; thiazides

What is the prototype drug for ARB drugs in the book?

Losartan

_____-___________-________ heparins are produced by breaking molecules of unfractioned heparin into smaller pieces.

Low-molecular-weight (LMW)

Epinephrine should not be combined with ____ ________, and should be used cautiously in patients taking __________ ____________.

MAO inhibitors; tricyclic antidepressants

Because of its antiplatelet actions, Aspirin can prevent against ____, ____, and other thrombotic events.

MI; stroke

Like all first-generation NSAIDs (except aspirin), coxibs pose a risk of ____ and ____.

MI; stroke

When encouraging patients to self-monitor what is important to teach patients?

Make certain that patients know the treatment goal (usually reduction of blood pressure to less than 140/90 to 150/90 mm Hg) and teach them to monitor and chart their own blood pressure.

What is the first rule of antimicrobial therapy? Ask the patient when their symptoms first appeared Match the drug to the bug Begin empiric therapy as soon as possible Give the antimicrobial intravenously (IV)

Match the drug to the bug

A major cause of morbidity and mortality, costing about $3.5 billion a year in hospitalized patients alone is (are)

Medication Errors

__________ (a biguanide) decreases glucose production by the liver and increases glucose uptake by muscle and adipose tissue.

Metformin

What is the priority reason why the nurse teaches a patient who is prescribed sulfamethoxazole, a sulfonamide, to take this medication with a full glass of water? Decrease the risk of esophageal irritation Minimize crystal formation in the urine Prevent nausea Stimulate frequent voiding

Minimize crystal formation in the urine

______________ causes selective and profound dilation of arterioles.

Minoxidil

____ (____) is the only antidepressant that can be taken PRN.

Mirtazapine (Remeron)

The _________-__________-_________ ___________ helps regulate blood pressure, blood volume, and fluid and electrolyte balance.

Renin-Angiotensin-Aldosterone System (RAAS)

___________ __________, which restores blood flow through blocked coronary arteries, is the most beneficial treatment for STEMI.

Reperfusion therapy

____ ____ is the most serious adverse effect of the opioids.

Respiratory depression

To reduce the risk of lipodystrophy in a diabetic patient, what practice needs to be followed? See the optometrist regularly Rotate injection sites Have renal function tests evaluated regularly Use only a pen injector for insulin administration

Rotate injection sites

In the healthy heart, the ___ _______ is the pacemaker.

SA (sinoatrial) node

What is known as the "pacemaker of the heart"?

SA node

In patients with supraventricular tachydysrhythmias, propanolol helps by slowing discharge of the ____ _________, and decreasing impulse conduction through the ___ _______, which prevents the atria from driving the ventricles at an excessive rate.

SA node; AV node

With high doses of bupropion (Wellbutrin), ____ risk is a concern.

Seizure

What are the adverse effects of SSRIs?

Serotonin syndrome (too much serotonin transmission), withdrawal syndrome, possible birth defects, weight gain, sexual dysfunction, and suicide risk

When caring for a patient who is prescribed minoxidil, it is most important for the nurse to assess for which adverse effect? Excessive hair growth Bradycardia Fluid volume deficit Shortness of breath

Shortness of breath

The nurse would withhold a beta 1 blocker and immediately contact the prescriber if it were discovered that the patient has a history of which condition? First-degree heart block Hyperglycemia Asthma Sick sinus syndrome

Sick sinus syndrome

_______________ _______________ dilates arterioles and veins.

Sodium nitroprusside

What is panic disorder?

Someone with panic disorder experiences recurrent unexpected panic attacks.

Which herbal medicine is used to treat mild to moderate depression? It intensifies serotonin effects and puts the consumer at risk for Serotonin Syndrome.

St. John's Wort

The penicillinase-resistant penicillins (eg, nafcillin) are used primarily against penicillinase-producing strains of __________ _________.

Staph. aureus

The balance between the pulmonary and systemic circulations in a healthy heart is maintained in accordance with: The amount of peripheral resistance present Starling's Law of the Heart The baroreceptor reflex The venous pump

Starling's Law of the Heart

Because cardiac muscle operates under __________ ____, the right and left ventricles always pump exactly the same amount of blood (assuming the heart is healthy). Hence, balance between the pulmonary and systemic circulations is ___________.

Starling's Law; maintained

___________ ____ states that the force of ventricular contraction is proportional to the myocardial fiber length. Because of this relationship, when more blood enters the heart, _____ blood is pumped out. As a result, the heart is able to precisely match ________ with venous return.

Starling's law; more; output

A patient is prescribed clopidogrel (Plavix) to prevent blood clots after exeriencing a myocardial infarction (MI). He self-prescribes omeproazole (Prilosec OTC) for heartburn. Because omeprazole can inhibit the efficacy of clopidogrel, it is a priority for the nurse to teach the patient to report which effect? Dizziness Nausea and vomiting Joint pain Sudden shortness of breath or chest pain

Sudden shortness of breath or chest pain

What is the 3 week window called where someone might have more energy to commit suicide?

Suicide Risk

______________ stimulate release of insulin from the pancreas. They may also increase cellular sensitivity to insulin.

Sulfonylureas

Aspirin and other antiplatelet drugs Suppress thrombus formation in arteries Prevent activation of vitamin K Dissolve existing thrombi Bind to plasma proteins

Suppress thrombus formation in arteries

Your Type 1 diabetic patient is on a beta blocker. Which is the best way to determine if your patient is hypoglycemic? Watch for symptoms of hypoglycemia Monitor capillary blood glucose Check blood glucose once a week Don't worry because the patient is on a beta blocker and will not become hypoglycemic

Monitor capillary blood glucose

____ ____ ____ (____) are still used today for hard to treat depression, but are 2nd and 3rd choice antidepressants because of the dangerous side effects.

Monoamine oxidase inhibitors (MAOIs)

What are the three major classes of opioid receptors?

Mu, kappa, and delta

The nurse should be aware of which disorder when administering ciprofloxacin?

Myasthenia Gravis

Which insulin preparation is a suspension? Glargine Regular NPH Lispro

NPH

One insulin preparation-_____ __________-is a suspension. It looks cloudy and should be agitated before being drawn into a syringe. All other insulins are __________. They look clear and do not require agitation.

NPH insulin; solutions

Live, attenuated influenza vaccine (LAIV) is administered by Intramuscular injection Intradermal injection Oral tablet Nasal spray

Nasal spray

What defends the cardiovascular system from fluid overload? Angiotension II Aldosterone Natriuretic peptides Renin

Natriuretic peptides

What protects the cardiovascular system in the event of volume overload? Angiotensin II Aldosterone Natriuretic peptides Renin

Natriuretic peptides

What is important to teach patients about with regards to adverse noncardiac adverse effects of digoxin?

Nausea, vomiting, anorexia, fatigue, and visual disturbances are adverse effects of digoxin that frequently foreshadow more serious toxicity, such as dysrhythmias. Inform patients about these early indications of toxicity, and instruct them to notify the prescriber if they develop.

______________ and other dihydropyridines can cause reflex tachycardia. Tachycardia is most intense with _____________-_____________ formulations, and much less intense with ____________-_____________ formulations.

Nifedipine; immediate-release; sustained-release

What is the drug of choice for hypertensive emergencies?

Nitroprusside (IV)

What is diabetes characterized by?

Sustained hyperglycemia

What is the most important determinant of venous return?

Systemic filling pressure -Systemic filling pressure can be raised by constricting veins and increasing blood volume.

The __ _____ is caused by repolarization of the ventricles.

T wave

Which classes of antidepressants are considered older classes? (developed in 1950s, more serious side effects)

TCAs and MAO inhibitors

What drugs inhibit the final common step in platelet aggregation, and hence are the most effective antiplatelet drugs available?

The GP IIb/IIIa receptor blockers (eg, abciximab)

What syndrome is associated with sulfonamides? a. Red mans syndrome b. stevens johnsons syndrome c. Reyes syndrome d. sick sinus syndrome

Steves johnson syndrome

An oral potassium supplement is ordered for your patient at 0800. The potassium value from the morning's labs is 6.4 mEq/L. What is your best course of action? Do not administer the medication Give the medication because it is ordered Notify the provider Wait and give the medication at 1200

Notify the provider

You have been assigned a diabetic patient as part of your patient care team. Upon your initial assessment, your patient is complaining of a headache, appears drowsy, and somewhat confused. What is your priority nursing action?

Obtain a finger stick of blood glucose

____-induced sedation and euphoria and can ____ pain relief.

Opioid; complement

What are the most effective analgesics available?

Opioids

What medication is recommended for mild/moderate initial episodes of Clostridium difficile (C. diff) infections? IV metronidazole (Flagyl) IV vancomycin Oral (po) vancomycin Oral (po) metronidazole (Flagyl)

Oral (po) metronidazole (Flagyl)

In general, what is the main reason very young patients are highly sensitive to drugs?

Organ system is immature

The major adverse effects of aminoglycosides are Cardiotoxicity and hepatotoxicity Ototoxicity and cardiotoxicity Ototoxicity and nephrotoxicity Nephrotoxicity and hepatotoxicity

Ototoxicity and nephrotoxicity

What is the drug of choice for all stages of syphilis?

Penicillin G

What is the drug of choice for treating all stages of sychilis? Metronidazole Penicillin G Clindamycin Azithromycin

Penicillin G

__________ weaken the bacterial cell wall, causing lysis and death.

Penicillins

___________ are the safest antibiotics available.

Penicillins

Cardiac afterload is primarily determined by Stroke volume Myocardial contractility Peripheral resistance Systemic filling pressure

Peripheral resistance

The study of how genetic variations can affect individual responses to drugs

Pharmacogenomics

The study of how genetic variations can affect individual responses to drugs is

Pharmacogenomics

___________________, a thiazolidinedione (glitazone) for type 2 diabetes, increase insulin sensitivity of target cells, and thereby increases glucose uptake by muscle and adipose tissue, and decreases glucose production by the liver.

Pioglitazone

___________, the active form of plaminogen, serves to degreade the fibrin meshwork of clots.

Plasmin

All of the following are symptoms of diabetes mellitus except Polycystic Polyuria Polydipsia Polyphagia

Polycystic

What is the three characteristics of Diabetes Mellitus?d

Polyuria, polydipsia, polyphagia

It is a priority to assess for digitalis toxicity if a patient is receiving digoxin (Lanoxin), the digoxin levvel is 1.3 ng/mL, and the patient has which other laboratory result? BNP 1813 picograms/mL INR 1.5 Potassium (K) 3.0 mEq/L Sodium 150 mEq/L

Potassium (K) 3.0 mEq/L

What drugs are used to counteract potassium loss caused by thiazide diuretics and loop diuretics?

Potassium-sparing diuretics

_____________, an amylin mimetic, is injected subQ before meals to enhance the effects of mealtime insulin in patients with type 1 or type 2 diabetes. The drug delays gastric emptying and suppresses glucagon release, and thereby helps reduce _____________ hyperglycemia.

Pramlintide; postprandial

A patient is prescribed a tetracycline antibiotic. Which patient information is a reason for the medication to be withheld by the nurse and the prescriber consulted? Patient has an allergy to penicillin Patient is a 12 year-old child Pregnancy status of patient is unknown Theophylline for asthma is also prescribed

Pregnancy status of patient is unknown

________ is defined as the amount of tension (stretch) applied to a muscle before contraction.

Preload

Which outcome would be of greatest priority for most asthma patients? Preventing airway inflammation Avoiding pollution Stimulating release of eosinophils Increasing exercise tolerance

Preventing airway inflammation

Which drug for PUD is the most effective in inhibiting gastric acid? a. proton pump inhibitors (PPIs) b. Mucosal protectant c. h2 receptor Antagonist d. antacids

Proton Pump Inhibitors (PPIs)

Which drug for PUD is associated with dose-related increase in the risk of infection with C.diff? a. proton pump inhibitors (PPIs) b. Mucosal protectants c. h2 receptor antagonists d. antacids

Proton pump inhibitors(PPIs)

Slowing ventricular conduction widens the _____ ___________.

QRS complex

The ____ _________ is caused by depolarization of the ventricles. Widening of the ____ ___________ indicates slowed conduction through the ventricles.

QRS complex; QRS complex

Quinidine can cause dause dysrhythmias. Widening of the ____ __________ (by 50% or more) and excessive prolongation of the ___ __________ are warning signs.

QRS complex; QT interval

The QT interval represents the time between onset of the ____ ___________ and the completion of the ___ _______. QT prolongation indicates delayed _____________ repolarization.

QRS complex; T wave; ventricular

Roazaline increases the ___ __________ and may pose a risk of __________ __ _______, a serious ventricular dysrhythmia.

QT interval; torsades de pointes

______________ appears to reduce anginal pain by helping the heart generate energy more efficiently.

Ranolazine

______________ dysrhythmias result from a localized, self-sustaining circuit capable of repetitive cardiac stimulation.

Reentrant

Activation of the baroreceptor reflex triggers?

Reflex tachycardia

________ __________ from nitroglycerin can be prevented with a beta blocker, diltiazem, or verapamil.

Reflex tachycardia

What principle is essential to consider when prescribing therapy for the geriatric population?

Therapy must be individualized for the elderly

Describe the neurochemical etiology of depression.

There is a decreased availability of norepinepherine and/or serotonin (dopamine) at transmitter-specific synapses (Monoamine deficiency hypothesis)

It is important for the nurse to discuss adverse effects of the antihypertensive drugs that are prescribed because the nurse knows what about the drugs' adverse effects? They affect adherence They are life-threatening They are necessary if the antihypertensive is an effective dose They reflect the cause of hypertension

They affect adherence

What is the reason tetracyclines cause tooth discoloration? They have a long half-life and adhere to the tooth a long time They are lipid soluble and enter the tooth enamel They bind to calcium in developing teeth They are eliminated by kidneys

They bind to calcium in developing teeth

All antidysrhythmic drugs are also prodysrhythmic. What does this mean?

They can produce dysrhythmias

Calcium channel blockers are useful in treating hypertension and angina pectoris because: They cause bradycardia They are convenient to administer They promote vasodilation They are generally well-tolerated

They promote vasodilation

Beta blockers can be detrimental to diabetic pts because

They suppress glycogenolysis.

What makes penicillins bacteriocidal? They weaken the cell wall They lack a beta-lactam ring They are only effective against gram-negative bacteria They do not cause drug allergies

They weaken the cell wall

What is the preferred drug for uncomplicated hypertension?

Thiazide diuretic

What are the preferred drugs for initial therapy of uncomplicated hypertension?

Thiazide diuretics

What is a first-line drug for hypertension?

Thiazide diuretics

Which drug classification is the first-line drug treatment for hypertension? Loop diuretics Beta blockers Thiazide diuretics Aldosterone antagonists

Thiazide diuretics

_____________ ____________ are ineffective when GFR is low, and cannot be used if cardiac output is greatly reduced.

Thiazide diuretics

Oral candidiasis is also known as Tinea Pedis Thrush Onchomycosis Glaucoma

Thrush

Which symptom suggests an ototoxic reaction to a drug? Tinnitus Dizziness Headache Nausea

Tinnitus

What is the therapeutic goal with the use of dobutamine? To treat anaphylaxis To treat cardiac tachycardia and dysrhythmias To improve the hemodynamic status of patients with heart failure To treat hypertension

To improve the hemodynamic status of patients with heart failure

What is the major use of epinephrine? Treatment of anaphylaxis Control of superficial bleeding Delay of local anesthetic absorption Management of cardiac arrest (asystole)

Treatment of anaphylaxis

Ace inhibitors can cause angioedema, a potentially fatal threatening reaction. if patients report edema of the tongue, lips, or eyes, emergency care should be taught immediately and the patient must never take ACE inhibitors again. True or False

True

Ace inhibitors can cause major fetal malformations and should be avoided during pregnancy. T or F

True

Aldosterone promotes retention of water and sodium and also mediates pathologic changes in cardiovascular effects. T or F

True

All CCBs promote vasodilation and hence are useful in hypertension and angina pectoris. True or false.

True

All antidysrhythmic drugs are prodysrhythmic, meaning these drugs can worsen existing dysrhythmias and generate new ones. True False

True

All first-generation NSAIDs are associated with increased risk of gastrointestinal bleeding that can lead to hospitalization or death. T or F

True

Aminoglycosides are nephrotoxic T or F

True

Because fluoroquinolone can cause tendinitis and tendon rupture, they should be discontinued at the first sign of tendon pain or inflammation. Also, the patient should not exercise until tendinitis has been ruled out. T or F

True

Diuretics are the first line drugs for all patients with fluid overload. T or F

True

Drugs that dilate veins reduce cardiac preload. T or F

True

Epinephrine is the drug of choice for treating anaphylactic shock. T or F

True

Escherichia coli is the most common cause of uncomplicated, community associated UTIs T or F

True

Instruct patients taking penicillins to complete the prescribed course of treatment, even though symptoms may abate before the full course is over. True or false?

True

NSAID induced ulcers are responsible for more than 10000 hospitalizations and 7000 to 10,000 deaths/year. T or F

True

On average, the GFR declines about 10 ml/min every 10 years after the age of 40. T or F

True

Oral Candidiasis is also known as thrush T or F

True

The NYHA classifies HF based on the functional limitations it causes. T or F

True

Therapy with cholesterol-lowering drugs must continue lifelong. True False

True

Therapy with cholesterol-lowering drugs must continue lifelong. True or false

True

Treatment of supraventricular tachydysrhytmias is often directed at blocking impulse conduction through the AV node, rather than at eliminating the dysrhythmia. True or False

True

Trimethoprim is used primarily for UTIs T or F

True

True or false? Environmental or learned behaviors may affect neurotransmitter functions or have independent influence (psychosocial, financial, war, etc.)

True

When using an aminoglycoside for wound irrigation, the medication may be absorbed in amounts sufficient to produce systemic toxicity. True False

True

when using an amino glycoside for wound irrigation, the med may be absorbed in amounts sufficient to produce systemic toxicity? T or F

True

What should be avoided when taking MAOIs?

Tyramine rich foods = hypertensive crisis (aged cheese, smoked meat, overripe, beer, beans)

which conditions are allowed for the prophylactic use of antibiotics?

UTI treatment, prostatic heart valve, surgery, neutropenia

The emergency department (ED) triage nurse answers the call of a patient who as a history of coronary heart disease and chronic obstructive pulmonary disease (COPD). The patient reports chest pain that has not been relieved by three doses of sublingual nitroglycerin. The appropriate diagnosis here is: Unstable angina Stable angina A myocardial infarction A STEMI

Unstable angina

What is a major force for promoting the emergence of antibiotic resistance? Prophylactic antimicrobial treatment Misuse of antibiotics Completing prescribed course of antibiotic treatment Use of antibiotics to promote growth in livestock

Use of antibiotics to promote growth in livestock

____________ reduces resistance to blood flow, __________ increases resistance to flow.

Vasodilation; vasoconstriction

_____ are a reservoir for blood.

Veins

___________ thrombi begin with formation of fibrin, which then enmeshes red blood cells and platelets.

Venous

____________ and ______________ (Class IV antidysrhythmics) block cardiac calcium channels, and thereby reduce automaticity of the SA node, slow conduction through the AV node, and decrease myocardial contractility. These effects are identical to those of beta blockers.

Verapamil; diltiazem

___________ prevents activation of Vitamin K, and thereby blocks the biosynthesis of Vitamin K-depenedent clotting factors.

Warfarin

Amiodarone can cause heart failure and atrial and ventricular dysrhythmias. What is important to tell patients regarding this?

Warn patients about signs of heart failure (eg, shortness of breath, reduced exercise tolerance, fatigue, tachycardia, weight gain) and instruct them to report these immediately.

Which action by the nurse would be of greatest priority when a patient experiences five watery stools in 24 hours when prescribed a proton pump inhibitor (PPI)? Consult the prescriber for an order for stool for ova and parasite Wash hand with soap and water after caring for the patient Encourage oral intake of 2000 mL of fluids in 24 hours Place the patient in isolation

Wash hand with soap and water after caring for the patient

The kidneys provide long-term control of arterial pressure by regulating Angiotensin II Water Potassium Peripheral resistance

Water

A patient who is having a STEMI is prescribed metoprolol tartrate 5 mg IV every 5 minutes times three. It would be a priority to immediately contact the prescriber if which assessment finding was present? Altered taste Insomnia Rhinorrhea Wheezing

Wheezing

What is a side effect of a nonselective beta blocker?

Wheezing

Patients taking opioids should avoid ____ and other CNS depressants- because these drugs can ____ opioid-induced sedation and respiratory depression.

alcohol; intensify

In patients with heart failure, ______________ _____________ (eg, spironolocatone, eplerenone) reduce symptoms and prolong life. Benefits derive from blocking ____________ receptors in the heart and blood vessels.

aldosterone antagonists; aldosterone

By suppressing ___________ release, ACE inhibitors can cause hyperkalemia. Exercise caution in patients taking _____________ supplements, salt substitutes, or potassium-sparing diuretics.

aldosterone; potassium

Instruct outpatients to report any signs of an ___________ response (eg, skin rash, itching, hives).

allergic

The principal adverse effect of penicillins is ___________ ___________, which can range from rash to life-threatening anaphylaxis.

allergic reaction

What are the most common adverse effects of cephalosporins?

allergic reactions

Instruct the patients taking cephalosporins to report any signs of ____________ (eg, skin rash, itching, hives).

allergy

Which assessment is of greatestt priority for the nurse to complete before administering a penicillin antibiotic? a. allergy history b. BUN c. Temperature d. wound drainage

allergy history

Safety alert: Penicillins are the most common cause of drug ___________. Between 0.4% and 7% of patients who receive penicillins experience an ___________ reaction. Severity can range from a minor rash to life-threatening anaphylaxis.

allergy; allergic

Most beneficial responses to alpha blockers, including reduction of blood pressure in patients with hypertension, result from blockade of ________ receptors on blood vessels.

alpha1

The alpha blockers used most frequently-prazoxin, doxazosin, and terazosin-produce selective blockade of _______ receptors.

alpha1

Penicillins should not be combined with ___________ (eg, gentamycin) in the same IV solution.

aminoglycosides

In contrast to penicillin G, the broad-spectrum penicillins, such as ___________ and ____________, have useful activity against __________-________ bacilli.

ampicillin; amoxicillin; gram negative

Insulin is an __________ hormone. That is, it promotes conservation of energy and buildup of energy stores.

anabolic

Epinephrine is drug of choice for treating ____________ ______: By activating alpha1, beta1, and beta2 receptors, epinephrine can elevate blood pressure, suppress glottal edema, and counteract bronchoconstriction.

anaphylactic shock

With nitroglycerin, advise patients to avoid activities that are likely to elicit an __________ ________ (eg, overexertion, heavy meals, emotional stress, cold exposure).

anginal attack

ACE inhibitors can cause ___________, a potentially life-threatening reaction. If patients report _________ of the tongue, lips, or eyes, emergency care should be sought immediately, and the patient must never take ACE inhibitors again.

angioedema; edema

ACE inhibitors block formation of ____________ __, promote accumulation of __________, and reduce ____________ release. As a result, these drugs cause __________ of veins and arterioles, promote renal excretion of ___________, and favorably alter cardiac remodeling.

angiotensin II; kinins; aldosterone; dilation; water

By inhibiting ACE, ACE inhibitors decrease production of _______________ __. The result is ______________, decreased _________ ____________, and prevention or reversal of pathologic changes in the ______________ and blood vessels mediated by angiotensin II and aldosterone.

angiotensin II; vasodilation; blood volume; heart

Pure opioid ____ are used primarily to treat opioid overdose. One agent - methylnaltrexone - is used for opioid-induced constipation, and another - alvimopan - for opioid-induced ileus.

antagonists

The principal differences among the penicillins relate to ____________ ____________, stability in _________ _________, and duration of __________.

antibacterial spectrum; stomach acid; action

All patients with gastric or duodenal ulcers and confirmed infection with H. Pylori should be treated with which combination of drugs?

antibiotics and an antisecretory agent

Patients taking opioids should avoid ____ drugs (eg, antihistamines, tricyclic antidepressants, atropine-like drugs)- because these drugs can exacerbate opioid-induced ____ and ____ retention.

anticholinergic; constipation; urinary

Patients taking opioids should avoid which drugs due to exacerbation of opioid-induced constipation and urinary retention?

antihistamines, tricyclic antidepressant,s, atropine -like drugs

Because platelets are unable to synthesize new COX, the ____ effects of a single dose of aspirin persist for the life of the platelet (about 8 days).

antiplatelet

Arterial thrombi are best prevented with ____________ drugs (eg, aspirin, clopidogrel), whereas venous thrombi are are best prevented with __________ (eg, heparin, warfarin, dabigatran).

antiplatelet; anticoagulants

The major adverse effects of metformin are GI disturbances: decreased __________, ___________ and ___________. Metformin does NOT cause ______________ when used alone.

appetite; nausea; diarrhea; hypoglycemia

For the heart, afterload is the _________ ___________ that the left ventricle must overcome to eject blood.

arterial pressure (AP)

Aspirin and other antiplatelet drugs suppress thrombus formatio in __________.

arteries

Calcium channel blockers (eg, diltiazem, nefedipine) reduce blood pressure by promoting dilation of ____________.

arterioles

Hydrazaline causes selective dilation of ___________.

arterioles

Some vasodilators are selective for ____________, some are selective for __________, and some dilate both types of vessel.

arterioles; veins

Instruct patients taking clopidogrel being treated for acute coronary syndrome (ACS) to take _________ (75 to 325 mg) once daily.

aspirin

which nursing action would best meet the therapeutic objective of drug therapy?

assessing the patient for adverse effects

Albuterol is used to treat ______.

asthma

Drugs that activate beta2 receptors are used primarily for _______.

asthma

When is the preferred time to administer a Statin?

at nighttime

Dabigatran is an alternative to warfarin for chronic anticoagulation in patients with _________ ___________.

atrial fibrillation

Verapamil and diltiazem are used to slow ventricular rate in patients with ______ ____________ or _________ ____________ and to terminate supreventricular tachydysrhythmias (SVT) caused AV nodal reentrant circuit. In both cases, benefits derive from suppressing ___ _______ conduction.

atrial fibrillation; atrial flutter; AV nodal

Bupropion (Wellbutrin) is an _____ antidepressant that possibly acts by blocking ____ and/or ____.

atypical; dopamine; neuroepinephrine

Spontaneous phase 4 depolarization- of fast or slow potentials-gives cells ______________.

automaticity (the ability to initiate an action potential through self-excitation)

The nurse would be concerned about administering live flu vaccine to which patient? a. 7 - yr old boy with a seizure disorder b. 12-yr old girl receiving aspirin for its cardioprotective effects c. 28 yr old man with type 1 diabetes d. 38 yr old woman with multiple sclerosis

b. 12 yr old girl receiving aspirin for its cardioprotective effects

Which diastolic blood pressure indicates a hypertensive emergency? a. 100 mm hg b. 120 mm hg c. 165 mm hg d. 90 mm hg

b. 120 mm hg

Which has greater biologic activity? a. Angiotensin 1 b. Angiotensin II

b. Angiotensin II

A patent who is admitted to the nursing unit from the post anesthesia care unit (PACU) is moaning in pain. The patient is due for another dose of pain medication. What is the nursing priority at this time? a. Administer prescribed pain-relieving drugs b. Assess the patients vital signs, tubes, and surgical site c. obtain the patient's pain rating on a scale of 1-10 d. Review the patient's allergy history

b. Assess the patients vital signs, tubes, and surgical site

Knowing that statins cause myopathy, which marker for muscle injury should be measured prior to starting a patient on a statin? a. INR b. CK c. BUN d. aPTT

b. CK (creatinine clearance)

Postural (orthostatic) hypotension is caused by? a. Increased venous return b. Decreased venous return

b. Decreased venous return

The following information was included in the change of shift report on a patient who is prescribed aspirin for its anticoagulant effects. which patient symptom, if present, would be a priority for the nurse to report to the attending physician? a. Abnormal bloating b. Emesis of dark-brown particles c. heartburn when recumbent d. two liquid stools in the past 24 hours

b. Emesis of dark-brown particles

The nurse is administering an IV dopamine infusion. the nurse assesses the large antecubital vein and notes that the site is swollen, cold, and extremely pale. What is the basis of the nurse's next action? a. A clot has formed and can break off and become an embolus b. Extravasation of dopamine may have caused tissue necrosis c. the nurse should infuse dopamine only through a central vein d. the EV infusion must continue at this site until another IV is successfully started.

b. Extravasation of dopamine may have caused tissue necrosis

the nurse is administering an IV dopaine infusion. the nurse assesses the large antecubital oven and notes that the site is swollen, cold, and extremely pale. What is the basis of the nurse's next action? a. a clot has formed and can break off and become an embolus b. Extravasation of dopamine may have caused tissue necrosis c. the nurse should infuse dopamine only through a central vein d. The IV infusion must continue at this site until another IV is successfully started

b. Extravasation of dopamine may have caused tissue necrosis

the nurse assesses a 6-yr-old child who is receiving ciprofloxacin (cipro) for complicated UTI. what is the priority nursing concern? a. Abdominal pain b. Fluid and electrolyte balance c. nutrition d. skin integrity

b. Fluid and electrolyte balance

Which lab value should be monitored when a patient is taking acetaminophen? a. aPTT b. INR c. BUN d. CK

b. INR

when a patint with heart failure is prescribed digoxin and Furosemide (lasix), the nurse should carefully assess the patient for which symptoms of digoxin toxicity? a. bleeding b. nausea and anorexia c. headache d. orthostatic hypotension

b. Nausea and anorexia

A patient who is having a STEMI is prescribed metoprolol tartrate 5 mg IV every 5 min times three. It would be a priority to immediately contact the prescriber if which assessment finding was present? a. Falling b. wheezing c. sweating d. shaking

b. Wheezing

Which assessment finding would be a priority for the nurse to report if a patient was receiving celecoxib celebrex)? a. bruising of arms and shins b. a weight gain of 1 lb each day for 3 days. c. heartburn at night d. inadequate joint pain relief after taking for 1 week

b. a weight gain of 1 lb each day for 3 days

A patient admitted with chest pain has IV heparin infusing. What lab test will the nurse use to titrate the heparin infusion for therapeutic anticoagulation? a. INR b. aPTT c. CK d. BUN

b. aPTT

Acetaminophen overdose is treated with a. epinephrine b. acetylcysteine c. vancomycin d. Desloratadine

b. acetylcystene. used PO or IV (substitutes for depleted glutathione associated with clearing toxicity)

Which classification of drugs has its principal indication to prevent thrombosis in veins? a. antiplatelets b. anticoagulants c. thrombolytic drugs d. lovastatin

b. anticoagulants

A patient who is prescribed highly active antiretroviral therapy (HAART) including rilpivirine reports loss of interest in usual activities. Which nursing action is of greatest priority? a. asking about difficulties complying with therapy b. assessing for thoughts of harming self c. identifying reasons for loss of interest d. proving a safe environment

b. assessing for thoughts of harming self

What is a priority assessment when a patient is switched from a TCA antidepressant to an MAO inhibitor? a. blood glucose b. blood pressure c. skin color d. skin hydration

b. blood pressure

In additoin to gastrointestinal side effects, erythromycin, a macrolide antibiotic, can also cause? a. hypotension b. cardiotoxicity c. hepatotoxicity d. renal failure

b. cardiotoxicity

Based on german studies, it is important for the nurse to teach women prescribed antihypertensives and taking black cohosh for hot flashes and insomnia to: a. avoid prolonged exposure to the sun b. change positions slowly c. drink adequate amounts of fluids d. stop taking the herb if headache occurs

b. change positions slowly

which assessment finding suggests hypokalemia and should be reported to the prescriber of moxifloxacin? a. confusion and irritability b. constipation and weakness c. diarrhea and vomiting d. tremor and numbness

b. constipation and weakness (low potassium)

The nurse is caring for a pt who is receiving gentamicin 2x/day. peak and trough levels were drawn after the fourth dose. Results were peak 3mcg/ml and trough 0.6 mcg/ml. What should the nurse do? a. administer additional dose. .b. continue nurse care c. consult prescriber d. withhold future doses until prescribe can be consulted

b. continue nursing care. Trough levels are close to 0

Cardiac afterload is determined by: a. systemic filling pressure b. degree of constriction of arterioles c. vessel diameter d. myocardial fiber length

b. degree of constriction of arterioles

Which of these assessment findings, if identified in a patent who is receiving nitrofurantoin, should the nurse report to the prescriber immediately?? a. Brown-colored urine b. dyspnea c. nausea d. headache

b. dyspnea (pulmonary reactions)

Which aspirin preparation is the least irritating to the stomach? a. buffered aspirin solution b. enteric-coated aspirin c. four chewable children aspirin d. timed-release aspirin

b. enteric-coated apirin

it would be a priority to report which symptoms in a patient who is prescribed the -azole anti fungal drug flucoconazole a. Abdominal pain and diarrhea b. fever and blisters in the mouth c. headache and photophobia d. nausea and vomiting

b. fever and blisters in the mouth

It would be a priority to report which symptoms in a patient who is prescribed the -azole anti fungal drug fluconazole (diflucan)? a. abdominal pain and diarrhea b. fever and blisters in the mouth c. headache and photophobia d. nausea and vomiting

b. fever and blisters in the mouth (SJS)

it would be a priority to report which lab result if the patient is prescribed tetracycline? a. G6PD 8.2 U/g of hemoglobin b. hCG 5325 mIU/ml c. INR 1.1 d. sodium 132 mEq/L

b. hCG 5325 mIU/ml (pregnancy)

An accident victim is prescribed heparin after ORIF of multiple fractures. Which symptoms would be of greatest concern to the nurse after beginning subQ heparin therapy? a. Bruising at the injection site b. headache and faintness c. pain and temp of 100 degrees F d. pink saliva after brushing teeth

b. headache and faintness (increased bleeding is an serious adverse effect of anticoagulant drugs)

What is the principal adverse effect of potassium-sparing diuretics? a. hypoglycemia b. hyperkalemia c. hypokalemia d. hypertension

b. hyperkalemia

The patient was taking metoprolol for hypertension. The BP became elevated. this indicates what type of reaction? a. anaphylaxis b. idiosyncratic response c. a hypersensitivity reaction d. normal side effect

b. idiosyncratic response

A patient is admitted to a medical unit and prescribed IV ampicillin/sulbactam after a specimen was sent for culture and sensitivity from the emergency department. The nurse knows the priority reason for notifying the prescriber of culture results as soon as they are available is that ampicillin/sulbactam a. has many more adverse effects than most other antibiotics b. is a broad-spectrum antibiotic, and there may be an effective narrow-spectrum antibiotic c. is a very expensive antibiotic d. is a narrow-spectrum antibiotic and may not be effective for the cultured organism

b. is a broad-spectrum antibiotic, and there may be an effective narrow-spectrum antibiotic

What is the priority reason why the nurse teaches a patient who is prescribed sulfamethoxazole to take this education with a full glass of water? a. decrease the risk of esophageal irritation b. minimize crystal formation in the urine c. prevent nausea d. stimulate frequent voiding

b. minimize crystal formation in the urine

The nurse is caring for a patient who admits to using mail order ma huang (ephedra) for weight loss. It is a priority for the nurse to do what? a. assess mental status b. monitor vital signs c. not administer any other sedatives d. weigh the patient daily

b. monitor vital signs (elevation of BP)

Cardiac afterload is determined primarily by? a. the amount of tension applied to a muscle before contraction b. myocardial contractility c. vasodilation b. peripheral resistance

b. peripheral resistance (which is determined by the degree of constriction of the arterioles)

it is a priority to assess for digitalis toxicity if a patient is receiving digoxin, the digoxin level is 1.3 ng/ml, and the patient has which lab result? a. Sodium 135 mEq/L b. potassium 3.0 mEq/l c. chloride 100 mEq/l d. Mg 1.9 MEq/l

b. potassium 3.0 mEq/l

What is the most serious side effect of opioids? a. pinpoint pupils b. respiratory depression c. constipation d. urinary retention

b. respiratory depressoin

A pt who has overdosed on OxyContin is brought to the ED unresponsive with severely depressed respirations. the pt receives IV narcan with an improvement in level of consciousness and respiratory rate and effort within minutes. the nurse is scheduled to go to lunch in 15 min. what is nursing priority that must be communicated before nurse leaves for lunch? a. prevention of abstinence syndrome b. the short half-life of naloxone c. the short half-life of oxycodone d. history of substance abuse

b. the short half-life of naloxone

Because of the risk of hyperkalemia when preparing trimethorpim, it is a priority fr the nurse to teach the pt to report what symptom? a. bruising b. weakness c. pallor d. sore throat

b. weakness

What is atropine used for? a. Tachycardia b. Bradycardia c. hypertension d. AV heart block

b.Bradycardia, Beta adrenergic agonist

Diabetes is primarily a disorder of? a. Lipids b. Carbohydrates c. Protein d. Sodium

b.Carbohydrates

What does the term idiosyncratic mean? a. is a disease that occurs as the result of medical care or treatment b. an adverse drug reaction based on genetic predisposition (uncommon) c. effect is the opposite of the intended drug effect d. effect is a drug-induced birth defect

b.an adverse drug reaction based on a genetic predisposition (uncommon)

Percutaneous coronary intervention (PCI) consists of _________ _________ couples with placement of a drug-eluting _______.

ballon angioplasty; stent Balloon: A catheter with a small balloon tip is guided to the narrowing in your artery. Once in place, the balloon is inflated to push the plaque and stretch the artery open to boost blood flow to the heart. Stent: This is a small tube that acts as a scaffold to support the inside your coronary artery.

The _________ ________ is useful only for short-term control of AP. When pressure remains elevated or lowered, the system resets to the new pressure within 1 to 2 days, and hence ceases to respond.

baroreceptor reflex

Alpha blockers reduce symptoms of _______ ___________ __________ by blocking _________ receptors in the bladder neck and prostatic capsule, which causes smooth muscle at those sites to relax.

benign prostatic hyperplasia (BPH); alpha1

Reflex tachycardia can be blunted with a _______ ___________.

beta blocker

what drug can be used to prevent reflex tachycardia?

beta blocker

To lower the risk of a second myocardial infarction (MI), all patients should decrease cardiovascular risk factors (eg, smoking, hypercholesterolemia, hypertension, diabetes); exercise for 30 minutes at least 3 or 4 days a week; and undergo long-term therapy with four drugs: a _________ __________, an ____ __________ or ____; an ___________ drug or warfarin; and a _______.

beta blocker; ACE inhibitor; ARB; antiplatelet; statin

Ranolazine should not be used alone. Rather, it should combined with a nitrate, a ________ ________, or the CCB _____________.

beta blocker; amlodipine

In patients undergoing acute STEMI, ______ ________ reduce cardiac pain, infarct size, short-term mortality, recurrent ischema, and reinfarction. Continued use increases long-term survival. All patients should receive a ______ _________ in the absence of specific contraindications.

beta blockers; beta blocker

Cephalosporins are __________-_________ antibiotics that weaken the bacterial cell wall, causing lysis and death.

beta-lactam

By blocking cardiac _________ receptors, propanolol attenuates (weakens) sympathetic stimulation of the heart, and thereby decreases SA nodal automaticity, AV conduction velocity, and myocardial contractility.

beta1

Propanolol and other class II drugs block cardiac __________ receptors.

beta1

Drugs that activate ______ ________ can be used to treat heart failure, AV block, and cardiac arrest caused by asystole.

beta1 receptors

In the heart, calcium channels are coupled to __________ receptors, activation of which enhances calcium entry. As a result, calcium channel blockade and ________ blockade have identical effects on cardiac function.

beta1; beta

Beta blockers produce most of their beneficial effects by blocking ______ receptors in the heart, thereby reducing ______ ______, force of _______, and AV ________.

beta1; heart rate; contraction; conduction

Albuterol is a noncatecholamine that produces selective activation of ______ receptors.

beta2

Because albuterol is "selective" for _______ receptors, it produces much _____ stimulation of the heart than does isoproterenol. Accordingly, albuterol and related drugs have replaces isopterenol for therapy of asthma.

beta2; less

Which herbal medicine is used for relief of menopausal symptoms and cannot be mixed with blue cohosh because it had many opposite effects?

black cohosh

Safety alert: All anticoagulant, antiplatelet, and throbolytic drugs increase the risk of _________. Careful assessment of mental status, blood pressure, hear rate, and mucous membranes should be completed to assess for internal bleeding.

bleeding

What is the major adverse effect of clopidogrel?

bleeding

What is the major adverse effect of heparin?

bleeding

What does the term "coagulopathy" mean?

bleeding disorder. the body is unable to form clots. Do not give antiplatelet drugs (aspirin)

The major complication of fibrinolytic therapy is _____________. __________ ___________ is the greatest concern.

bleeding; Intracranial hemorrhage

Thrombolytic drugs carry a significant risk of _________. ______________ __________ is the greatest concern.

bleeding; Intracranial hemorrhage

Safety alert: all of the anticoagulant and antiplatelet drugs increase the risk for __________. The nurse must be diligent in assessing for and reporting any signs and symptoms of bleeding, including decreased level of __________, painful or swollen _______, ooozing gums, hematuria, or decrease in platelet or hemoglobin values.

bleeding; consciousness; joints

Beta blockers produce most of their beneficial effects by?

blocking b1 receptors in the heart

Cardiac oxygen supply is determined by myocardial ________ _______. Drugs that increase oxygen supply will reduce anginal pain.

blood flow

Because the ____-____ ____ is poorly developed in infants, these patients need smaller doses of opioids (adjusted for body weight) than do older children and adults.

blood-brain barrier

The ____-____ ____ can protect the CNS from toxic substances, but can also block entry of medicines into the ___.

blood-brain barrier; CNS

Warfarin enters breast milk and may harm the nursing infant. Warn patients against _______-__________.

breast-feeding

Because they are ___________-____________ antibiotics, tetracyclines can cause superinfections, especially ___ ______________-associated diarrhea and overgrowth of the mouth, pharynx, vagina, or bowel with ____________ ___________.

broad-spectrum; C. difficile(-associated diarrhea; CDAD); Candida albicans

How often should HgAIC be measured to assess long-term glycemic control? a. 3-6 weeks b. 4-8 weeks c. 3-6 months d. every 12 months

c. 3-6 months

When can drugs produce the most teratogenic harm? a. 4-5 weeks b. 6-9 weeks c. 3-8 weeks d. 2-6 weeks

c. 3-8 weeks (Organogenesis)

The nurse has done an initial assessment on assigned patients and is preparing to administer prescribed insulin. All patients are alert and oriented. it is 8:07 AM, and breakfast trays are scheduled to arrive at 8:45 AM. The nurse should administer the insulin first to the patient who has a. 8:00 AM SMGBG 100mg/dl; prescribed insulinl aspart (NovoLog) 5 units b. 8:00 AM SMBG 110mg/dl; prescribed insulin glulisine (Aprida) 7 units c. 8:00 AM SMBG 80mg/dl; prescribed NPH insulin (Novolin N) 34 units d. 8:00 AM SMBG 90 mg/dl; prescribed regular insulin (Humulin R) 5 units

c. 8:00 AM SMG 80mg/dl; prescribed NPH insulin (Novolin N) 34 units

Which cyclooxyrgenase inhibitor should be used in the elderly n and why? a. Ibuprofen b. Aspirin c. Acetaminophen d. Celecoxib

c. Acetaminophen due to the decreased risk of renal failure

Water retention is mediated in part by? a. Angiotensin II b. Natriuretic peptides c. Aldosterone d. Dopamine

c. Aldosterone

Drugs that activate beta2 receptors are used primarily for? a. hypertension b. first degree heart block c. asthma d. DVT

c. Asthma

What baseline data should be collected before giving an alpha1-adrenergic antagonist? a. temperature b. o2 stat c. Blood pressure and heart rate d. height and weight

c. Blood pressure and heart rate

Which drug would you not want to combine with a beta blocker due to excessive cardiosupression? a. Ace inhibitors b. ARBS c. Calcium Channel Blockers d. Diuretics

c. Calcium Channel Blockers

A patient with L sided HF, has been prescribed a high-cling diuretic. Which assessment most accurately reflects a therapeutic effect of this drug? a. Drop in systolic blood pressure of 10 mm Hg b. Normal heart sounds c. Clear lung sounds d. pulse 80 and regular

c. Clear lung sounds

Which bacteriostatic inhibitor of protein synthesis causes a high incidence of potentially fatal C-diff diarrhea? a. erythromycin b. vancomycin c. clindamycin d. penicillin

c. Clindamycin

Which is the safest drug for asthma? a. Glucocorticoids b. Beta2-Adrenergic agonists c. Cromolyn d. Theophylline

c. Cromolyn

Because it can activate B1 receptors, this drug may be used to restore cardiac function in cardiac arrest patients experiencing asystole a. Dopamine b. Epinephrine c. Dobutamine

c. Dobutamine

which herbal supplement can a patient use to treat vertigo? a. echinacea b. Garlic c. Ginger root d. Ginsing

c. Ginger root

Which lab test would be a priority for the nurse to monitor if ta patient with heart failure was prescribed warfarin and self-prescribes a series of supplements? a. ALT b. CBC c. INR d. NA

c. INR

It is a priority to assess for digitalis toxicity if a patient is receiving digoxin. The digoxin level is 1.3 ng/ml, and the patient has which other lab result? a. BNP 1813 pg/ml b. INR 1.5 c. Potassium 3.0 mEq/L d. Sodium 150 mEq/L

c. K 3.0 mEq/L

the nurse is aware that which herbal supplement has been associated with liver failure? a. black cohosh b. ginger c. kava d. valerian

c. Kava

Statins cause: a. kidney failure b. tinnitus c. Liver damage d. tingling and numbing of the extremities

c. Liver damage

A patient is prescribed a tetracycline antibiotic. Which patient information is a reason for the medication to be withheld by the nurse and the prescriber consulted? a. patient has an allergy to penicillin b. patient is a 12 year old child c. Pregnancy status of the patient is unknown d. Theophylline for asthma is also prescribed

c. Pregnancy status of the patient is unknown

The use of Aspirin in children younger than 18 years is associated with? a. Red mans syndrome b. Stevens Johnsons Syndrome c. Reye's syndrome d. Sick sinus syndrome

c. Reyes Syndrome (rare, but serious in children. Encephalopathy and fatty liver degeneration)

Which assessment finding would be a priority to report to the prescriber if it occurred after administration of a large IV dose of penicillin? a. discomfort at IV site b. Fever higher than 100.4 c. Wheezing d. Shivering

c. Wheezing

What inhibits formation of angiotensin II: a. calcium channel blocker b. beta blocker c. ace inhibitor

c. ace inhibitor

What is the greatest benefit of combining a statin with a calcium channel blocker? a. Greater therapeutic effect b. produces less nausea and vomiting c. Less constipation d. Allows the patient to take one pill

c. allows the patient to take one pill

What is a common adverse effect of Digoxin? a. reflex tachycardia b. orthostatic hypotension c. Anorexia and nausea/vomiting d. black, tarry stools

c. anorexia and nausea/vomiting

An alert and oriented patient with a history of penicillin allergy is prescribed cephalosporin, what is the priority by the nurse? a. administer the drug b. administer drug and carefully assess for allergic reaction c. assess the type of reaction patient had to penicillin d. notify the prescriber of the allergy and ask for a different antibiotic

c. assess the type of reaction

An alert and oriented patient with a history of penicillin allergy is prescribed cephalexin, a cephalosporin. What is the priority action by the nurse? a. contact the prescriber b. continue to administer the caphalexin c. assess the type of reaction to penicillin d. call 911

c. assess the type of reaction to penicillin

What is reflex tachycardia blunted by? a. calcium channel blocker b. diuretic c. beta blocker d. statins

c. beta blocker

Dosage adjustments made to account for size are often based on: a. body weight b. body height c. body surface area d. body mass

c. body surface area

First-generation NSAIDS inhibit: a. Cox-1 b. cox-2 c. Both cox-1 and cox-1 d. none of the above

c. both

Which drug is used to treat variant (vasospastic) angina? a. Ace inhibitors b. Beta blockers c. Calcium channel blockers d. vasodilators

c. calcium channel blockers

A pt received a nuromuscular blocking agent during surgery. In the post anesthesia care unit, the prescriber orders gentamicin 40mg IV STAT. what is the most appropriate nursing action? a. administer drug as quickly as possible b. assess patients vital signs c. clarify order d. refuse to administer drug

c. clarify order

A consulting urologist orders ciprofloxacin 250 mg 2x/day for a 72-yr-old woman with a UTI. The pt is also receiving ferrous sulfate 300mg for anemia and calcium carbonate 400 mg 4 times a day for osteopenia. What should the nurse do? a. administer cipro 1 hour before the other meds b. administer cipro 2 hours after the others c. consult the prescriber for directions d. hold the ferrous sulfate and calcium during cipro therapy

c. consult prescriber for direction (timing of other meds)

The nurse inadvertently administers heparin 100 units/mL subQ, which is available on the nursing unit as part of an IV flush protocol, instead of the heparin 5000 units/mL that was prescribed to prevent postoperative DVT. What is the priority nursing concern? a. assessing the patient for a DVT b. consulting the prescriber for direction c. filling out an incident report d. preventing excessive bleeding

c. consulting the prescriber for direction

The nurse is administering medications on a medsurg unit. the medication administration record states that the pt should receive Cardizem LA 120mg once a day. The patient's drug supply includes Cardizem SR. What should the nurse do? a. administer the meds b. Adminster the med and notify the prescriber of the change c. contact the pharmacy d. hold the ed and contact prescriber

c. contact the pharmacy

it is of greatest priority to report which change when a 65 year old female e patient is prescribed celecoxib a. belching b. bruise on left arm dc. difficulty speaking d. headache e. nausea

c. difficulty speaking

A patient has been prescribed extended-release nifedipine. Teaching regarding administration should include which instruction? a. Drink with a full glass of water b. Take on a full stomach c. do not crush or chew tablet.

c. do not crush or chew tablet

The nurse is preparing to administer IV acyclovir. It would be a priority for the nurse to provide nursing interventions for which assessment finding? a. BP 150/85 mm Hg b. creatinine 0.9 mg/dl c. dry, sticky oral mucous membrane d. Eight-hour urine output 750 ml

c. dry, sticky oral mucous membranes (normal creatinine= 0.6-1.2 mg/dl)

Which lab result is greatest priority to review before the nurse administers nitrofurantoin (Furadantin)? a. ALT b. Bilirubin c. eGFR d. Sodium

c. eGFR (nitrofurantonin is used for uncomplicated cystitis)

What does the term paradoxical mean? a. an adverse drug reaction based on genetic predisositin b. a disease that occurs as the result of medical care or treatment c. effect is the opposite of intended drug effect d. effect is a drug-induced birth defect

c. effect is the opposite of intended drug effect

The throat culture of a 6-year old boy is positive for neisseria gonorrheoeae. What is the nursing priority in this situation? a. Assessing for eye exudate b. calculating the dose of ceftriaxone to be administered c. ensuring the safety of the child d. removing the child rom his home

c. ensuring the safety of the child

What would be of greatest priority to report which new condition to the prescriber of bupropion (Wellbutrin)? a. anemia b. diabetes mellitus c. epilepsy d. glaucoma

c. epilepsy

A neonate is born to a known heroine addict. the infant is exhibiting symptoms of opioid withdrawal. Which of these nursing issues is of the highest priority as the nurse cares for the neonate in the nursery? a. altered nutrition b. disturbed sleep c. fluid deficit d. parenting

c. fluid deficit

A patient is admitted to the ED after a traumatic injury and is in severe pain from compound fractures. Which chronic condition would be of greatest concern when administering an opioid? a. Asthma b. Diabetes c. head injury d. hypertension

c. head injury

What is the priority nursing concern for a patient with angina pectoris? a. decreased cardiac output b. impaired gas exchange c. Ineffective tissue perfusion: cardiopulmonary d. ineffective breathing pattern

c. ineffective tissue perfusion: cardiopulmonary

A patient has nail fungus. Which anti fungal drug would you administer? a.Amphotericin B b. flucoconazole c. itraconazole d. riseofulvin

c. itraconazole

Th e nurse is assessing for adverse effects of IV tobramycin. Which change would be a priority to report to the prescriber? a. dilute urine b. headache c. limp, weak muscles d. ringing in the ears

c. limp, weak muscles. (flacid paralysis with tobramycin)

Which diuretic produces the greatest diuresis? a. thiazide diuretic b. potassium sparing diuretics c. loop diuretics

c. loop diuretics

the nurse should assess for adv effects of lightheadedness and dizziness when a patient is receiving which medication? a. demeclocycline b. doxycycline c. minocycline. d. oxytetracycline

c. minocycline

What is the best way to determine if your patient is hypoglycemic? a. ask them to stand up fast b. monitor input and output levels c. monitor capillary blood glucose

c. monitor capillary blood glucose

A patient has been prescribed furosemide (lassie). Which symptom is a priority for the nurse to monitor that suggests possible excessive loss of potassium? a. Hunger and fatigue b. 4+ deep tendon reflexes c. Muscle weakness and cramping d. Tall, tented T waves on ECG

c. muscle weakness and cramping

when a patient who is receiving an antidepressant verbalizes suicidal ideation, what is the priority nursing action? a. Administer the antidepressant b. ask the patient why he or she feels this way c. notify the prescriber d. provide a safe environment

c. notify the prescriber

When are trough levels drawn? a. 1 hour after the next dose b. 30 minutes before the next dose c. one hour before giving the next dose d. 30 minutes after the next dose

c. one hour before giving the next dose (twice daily = 30 min before)

A nurse is administering trimethoprim to a patient who has a history of alcohol use disorder. Because folate deficiency i associated with alcohol disorder, the nurse should assess for symptoms of possible adverse effects of trimethoprim, which include a. nausea and vomiting b. rash and malaise c. pallor and sore throat d. photosensitivity and drug fever

c. pallor and sore throat

which outcome would be of greatest priority for most asthma patients? a. Avoiding pollution b. increasing exercise tolerance c. prevent airway inflammation d. stimulating release of eosinophils

c. prevent airway inflammation

It would be a priority for the nurse to respond to which symptoms if exhibited by a patient who is receiving insulin therapy for diabetes? a. fatigue and blurred vision b. perineal itching and copious urine c. Profuse sweating and difficult to arouse d. thirst and constant hunger

c. profuse sweating and difficult to arouse

it would be a priority for the nurse to respond to which symptoms if exhibited by a patient who is receiving insulin therapy for diabetes? a. Fatigue and blurred vision b. perineal itching and copious urine c. profuse sweating and difficult to arouse d. thirst and constant hunger

c. profuse sweating and difficult to arouse

Which symptom suggests that blood levels of a salicylate such as aspirin are too high? a. fatigue b. heartburn after meals c. ringing in the ears d. vomiting

c. ringing in the ears

What is valerian used for? a. common colds b. UTIs c. sleep d. constipation

c. sleep

A patient who has received morhphine becomes slightly disoriented. if this adverse effect is due to the morphine, which inteverion by the nurse might aid in reversing it? a. assist the pt to ambulate b. instruct the patient to change positions slowly c. instruct the pt to take slow, deep breaths d. keep room well-lit

c. slow, deep breaths

it is of greatest priority for the nurse to communicate self-prescribed aspirin use to the primary care provider if the patient has which history? a. Genetic hyper coagulability disorder b. sexually active woman not using any form of birth control c. Smoking two packs of cigs per day d. type 2 diabetes mellitus

c. smoking 2 packs of cigs per day

A patient is prescribed clopidogrel to prevent blood clots after experiencing a MI. He self prescribes omeprazole for heart burn. Because omeprazole can inhibit the efficacy of clopidogrel, it is a priority for the nurse to teach the patient to report which effect? a. heart rate 50 beats per minute b. respiration rate 12 breaths per minute c. sudden shortness of breath or chest pain d. nausea or vomiting

c. sudden shortness of breath or chest pain

The nurse is administering ciprofloxacin to a pt who receives theophylline for asthma. Because of potential drug interactions, the nurse should monitor theophylline levels and assess for a. constipation b. drowsiness c. tachycardia d. weakness

c. tachycardia. (theophylline increases heart rates, broncodilaor, narrow therapeutic range-)

Because of the risk of prolonged QT interval and tornadoes de pointes, the nurse would consult the prescriber beofre administering erythromycin to a patient who has experienced a. frequent headaches b. nausea c. unexplained fainting d. wheezing

c. unexplained fainting

The priority teaching when a patient chooses to use a dietary supplement is that it is best to: a. always buy the more expensive brand b. take the herb with at least 8 ounces of water c. use products that have the seal of approval from the USP d. use the lowest dose possible

c. use products that have the seal of approval from the USP: usphaimacopieia

Which would be a priority to report to the prescriber if it occurred after administration of large IV dose of penicillin? a. discomfort at IV site b. fever higher than 104 c. wheezing d. shivering

c. wheezing

What is the drug of choice for hypertensive emergencies? a. Hydralazine b. minoxidil c. sodium nitroprusside d. verapamil

c.Sodium Nitroprusside

Erythromycin is the first drug of choice for those infected with a. rubella b. syphillis c. bordtella pertussis d. chlamydia trachomatis

c.bordtella pertussis

During phase 2 of fast potentials, _____________ enters myocardial cells, thereby promoting contraction.

calcium

Phase 0 of slow potentials (depolarization) is caused by slow influx of ______________. Because depolarization is slow, these potentials conduct slowly.

calcium

Combining a beta blocker with a _______ __________ blocker can produce excessive cardiosuppression.

calcium channel

What is variant angina fixed with?

calcium channel blocker

The effects of propanolol on the heart result (ultimately) from suppressing ___________ entry. Therefore, the cardiac effects of propanolol and the effects of ___________ ____________ _____________ are nearly identical.

calcium; calcium channel blockers

Tetracyclines form insoluble cheleates with calcium, iron, magnesium, aluminum, zinc. Accordinly, they must not be administered with ___________ supplements, ____________ products, ___________ supplements, ______________-___________ laxatives, and most __________.

calcium; milk; iron; magnesium-containing; antacids

Most cases of vulvovaginal candidiasis are caused by which organism?

candida albicans

Acarbose, an alpha-glucosidase inhibitor for type 2 diabetes, inhibits digestion and absorption of ____________, and thereby reduces the postprandial rise in blood ___________.

carbohydrates; glucose

Drugs that dilate arterioles reduce ___________ _____________, and can thereby reduce cardiac work while increasing cardiac output and tissue perfusion.

cardiac afterload

Drugs that dilate veins reduce ____________ ______________, and can thereby reduce cardiac work, cardiac output and tissue perfusion.

cardiac preload

The initial phase of heart failure consists of __________ _____________- a process in which the ventricles dilate (grow larger), hypertrophy (increase in wall thickness), and become more spherical-coupled with __________ __________ and _________ __________. As a result of these changes, cardiac output is _______________.

cardiac remodeling; cardiac fibrosis; myocyte death; reduced

In toxic doses, nifedipine and other dihydropyridines can cause _________________, just like verapamil and diltiazem.

cardiosuppression

To avoid excessive _______________, beta blocker dosage must be very low initially and then gradually increased.

cardiosuppression

Insulin deficiency puts the body into a ____________ mode. As a result, glycogen is converted to __________, proteins are degraded to ________ _______, and fats are converted to glycerol (glycerin) and free fatty acids.

catabolic; glucose; amino acids

What are the two chemical classes that adrenergic agonists fall into?

catecholamines and noncatecholamines

When do you start antiretroviral treatment? When is a patient at a critical level?

cd-4 T cell count at 500 below 200 = critical level. risk of developing opportunistic infections

Two cephalosporins--_____________ and _______________--can cause bleeding tendencies.

cefotetan; ceftriaxone

Currently, ____ (Celebrex) is the only coxib on the market.

celecoxib

Early in the disease process, symptoms of type 2 diabetes result mainly from _____________ ____________ to insulin's actions, not from insulin deficiency. However, later in the disease process, insulin ___________ develops.

cellular resistance; deficiency

Except for _________________, all cephalosporins are eliminated by the kidneys, and therefore must be given in reduced dosage to patients with renal impairment.

cetriaxone

Although routine monitoring of digoxin levels is generally unnecessary, monitoring can be helpful when dosage is ____________, symptoms of heart failure __________, kidney function ______________, signs of ___________ appear, or drugs that affect digoxin levels are added to or deleted from the regimen.

changed; intensify; declines; toxicity

ST-elevation myocardial infarction (STEMI) is diagnosed by the presence of ______ ________, characteristic ____ changes, and elevated serum levels of cardiac _________.

chest pain; ECG; troponins

Although rarely fatal in adults, aspirin poisoning may prove lethal in ____.

children

What is the most common bacterial STI?

chlamydia

what is the most frequently reported bacterial sexually transmitted disease?

chlamydia

With patients taking quinidine, it is important to inform patients about symptoms of ___________ (tinnitus, headache, nausea, vertigo, disturbed vision), and instruct them to notify the prescriber if these develop.

cinchonism

Instruct patients to take oral ___________ with a full glass of water.

clindamycin

Despite their similarities, aliskiren, ARBs, and ACE inhibitors are not ___________ _____________.

clinically interchangeable

Heparin suppresses ____________ by helping antithrombin inactivate thrombin and factor ___.

coagulation; Xa

Like morphine, ____ and other moderate to strong opioid agonists produce analgesia, sedation, euphoria, respiratory depression, constipation, urinary retention, cough suppression, and miosis. These drugs differ from morphine in that they produce ____ analgesia and respiratory depression and have a ____ potential for abuse.

codeine; less; lower

The combination of ____ with a ____ ____ (eg, aspirin, acetaminophen) produces greater pain relief than can be achieved with either agent alone.

codeine; nonopioid analgesic

Which herbal medicine is used to reduce the effects of heart failure or muscle injury caused by statins (anticholesterol drugs)?

coenzyme Q10

Instruct patients taking cephalosporins and vancomycin to _____________ the prescribed course of therapy even though symptoms may abate before the full course is over.

complete

With tetracyclines, erythromycin, and clindamycin, instruct patients to ____________ the prescribed course of treatment, even though symptoms may abate before the full course is over.

complete

Flaxseed used for?

constipation

Other important adverse effects are ____, ____ retention, ____ ____, emesis, miosis, ____ defects, and elevation of ICP.

constipation; urinary; orthostatic hypotension; birth

The RAAS supports AP by causing (1) __________ of arterioles and veins and (2) retention of water by the ________. Vasoconstriction is mediated by _____________ __; water retention is mediated in part by __________.

constriction; kidneys; angiotensin II; aldosterone

Fibrin is produced by two pathways-the _________ _________ pathway (aka intrinsic pathway) and the ____________ __________ pathway (aka extrinsic pathway)-that converge at clotting factor ___, which catalyzes formation of thrombin, which in turn catalyzes formation of fibrin.

contact activation; tissue factor; Xa

Digoxin increases ___________ by inhibiting myocardial Na+,K+-ATPase, thereby (indirectly) increasing intracellular _____________, which in turn facilitates the interaction of _________ and __________

contractility; calcium; actin; myosin

What is the goal of hyperlipidemia?

control LDL

What is the most common reason for discontinuing ACE inhibitors?

cough

Which herbal medicine is used to prevent UTIs or decrease urine odor?

cranberry

Patients allergic to one penicillin should be considered _______-_________ to all other penicillins. In addition, they have about a 1% chance of cross-allergy to ____________.

cross-allergy; cephalosporins

All of the drugs described in chapter 71 (NSAIDs and Acetaminophen) inhibit ____ (___), an enzyme that converts arachidonic acid into prostanoids (prostaglandins and related compounds)

cyclooxygenase (COX)

Aspirin inhibits platelet aggregation by causing irreversible inhibition of ____________. Since platelets are unable to synthesize new _______________, inhibition persists for the life of the platelet (7 to 10 days).

cyclooxygenase; cyclooxygenase

A patient is admitted in a state of diabetic ketoacidosis. The resident orders insulin detemir 0.1 mg/kg/hr to be administered by IV drip. What should the nurse do? a. calculate the insulin dose and mix it with 100ml of normal saline b. calculate the insulin dos e and mix it with 100 ml of DW c. calculate the insulin dose and infuse the solution prepared by the pharmacy d. Consult the prescriber STAT

d. Consult the prescriber STAT

What is a major adverse effect of an ACE inhibitor? a. lightheadedness b. constipation c. hypokalemia d. cough

d. Cough. (you can give an ARB)

Which drug is most effective in lowering trygliceride levels? a. nitroglycerine b. Statins c. Warfarin d. fibrates

d. Fibrates

What defends the cardiovascular system from volume overload: a. Kidneys b. Angiotensin II c. aldosterone d. Natriuretic peptides

d. Natriuretic peptides

A patient who is prescribed an A1-adrenergic antagonist for HBP is brought into the ED after taking viagra supplied by a friend. the priority for the nurse is to assess for and follow orders to prevent what effects? a. Afib and palpitations b. migraine headache and photophobia c. prolonged erection and discomfort d. severe hypotension and vascular collapse

d. Severe hypotension and vascular collapse

The nurse would withhold a beta1 blocker and immediately contact the prescriber if it was discovered that the patient has a history of which condition? a. Asthma b. First-degree heart block c. Hyperglycemia d. Sick sinus syndrome

d. Sick sinus syndrome

the nurse is reviewing the lab values for a patient who has been prescribed lithium carbonate for bipolar disorder and furosemide for heart failure (HF). Which result would be a reason for concern? a. Chloride 100 mEq/ b. Magnesium 1.8 mEq/L c. Potassium 4.1 mEq/L d. Sodium 128 mEq/L

d. Sodium 128 mEq/L (normal sodium levels 135 mEq/L and 145 mEq/L).

the nurse is administering an IV push dose of an opiate analgesic (morphine sulphate). After administering half of the dose, the nurse notes that patient's respirations have decreased from 15/min to 11/min. What is the priority nursing action at this time? a. assess the patient's current pain b. Call the prescriber c. Stimulate the patient d. Stop administration of the rest of the drug

d. Stop administration of the rest of the drug

Which of these ECG findings would suggest hyperkalemia in a patient who is prescribed an ACE inhibitor and who was using a salt substitute? a. Flat T waves b. Prolonged QT interval c. Shortened QT interval d. Tall, peaked T waves

d. Tall, peaked T waves (potassium)

the nurse would consult with the prescriber if an anticholinergic drug was prescribed for a patient with which health issue? a.diarrhea b. GERD c. hypotension d. urinary retention

d. Urinary Retention

A patient is prescribed tetracycline for chylamydia trachomatis. Which change in assessment findings would be a priority to report to the prescriber? a. burning on urination b. perineal itching c. vaginal discharge d. Watery stool

d. Watery stool

The nurse should withhold a drug and contact the prescriber if the patient reported an allergy to the drug with which symptom occurring shortly after the last time the drug was taken? a. constipation b. dry mouth c. Vesicular rash d. Wheezing

d. Wheezing

which would not be an appropriate reason for the nurse to administer an as-needed dose for 650 mg of aspirin? a. hand pain and stiffness when arising b. knee pain with ambulation c. right temporal headache associated with a tense neck d. abdominal pain with distention

d. abdominal pain with distension

What is the priority nursing action before administering an amino glycoside to a patient with an eGFR of 50ml/min? a. ask the pt if he or she has a had a headache. b. assess peak levels of the drug c. assess liver function tests d. compare prescribed dose to recommended dose.

d. compare prescribed dose to recommended dose.

Which lab result would you monitor when administering Amphotericin B to a patient? a. ALT levels b. AST levels c. INR levels d. creatinine levels

d. creatinine levels (nephrotoxicity) infuse with 1 L of saline if high

what is the difference between NSAIDs and Acetaminophen? a. produces reduction in pain b. produces reduction in fever d. does not cause gastric ulceration and does not decrease renal blood flow or cause renal impairment

d. does not cause gastric ulceration and does not decrease renal blood flow or cause renal impairment

Which condition would be of greatest concern when a patient reports reg use of sodium silicate for joint pain? a. COPDD d. heart failure c. diabetes mellitus d. excessive bleeding with dental procedures

d. heart failures

the nurse is caring for a neonate whose mother has an active infection of Neisseria gonorrhoeae. A priority nursing outcome for the neonate relating to possible infection during vaginal delivery is that the neonate will? a. blink in response to direct light shone in the eyes b. breast-feed for 10-15 minutes at least every 3 hours without becoming dysgenic c. have clear breath sounds d. not experience conjunctival discharge

d. not experience conjunctival discharge

A prescribers orders for a new admission include urine culture and sensitivity and ciprofloxacin 400mg IV every 12 hrs. what is a priority nursing responsibility? a. calculate the drip rate for the IV infusion b. flush the IV cap c. Mix the antibiotic in the correct IV solution d. obtain the urine culture specimen before administering the antibiotic

d. obtain a urine culture specimen before administering the antibiotic

A neonate was delivered vaginally to a mother with an active Chlaymida trichromatis infection. What is the priority system when caring for the neonate? a. gastrointestinal b. ophthalmic c. renal d. respiratory

d. respiratory

What is the most common nursing concern when a patient is receiving intrathecal ziconotide (print)? a. breathing b. circulation c. elimination d. safety

d. safety

It is a priority to inform patients with which disorder that ginkgo bloba can aggravate their condition? a. diabetes mellitus b. hay fever c. hypertension d. Seizures

d. seizures

When caring for a patient who is prescribed minoxidil, it is most important for the nurse to assess for what? a. Abnormal hair growth b. Bradycardia c. Fluid volume deficit d. Shortness of breath

d. shortness of breath (water retention in the lungs)

Which type of rash would likely indicate the start of Stevens-Johnson Syndrome when a patient is receiving sulfonamides? a. Amber-colored, crusty rash on the cheeks b. papular rash on the shoulders c. pruritic rash on lower arms d.vesicular rash in the mouth

d. vesicular rash in the mouth

The nurse is taking a history from the spouse of a patient who was admitted in a septic state and prescribed an amino glycoside antibiotic. Which question is most important to ask the patients spouse about the patients history? a." has your spouse ever had any surgery performed?' b. "has your spouse been told to follow any specific diet" c. has your suppose received flu vaccine this year? d. What meds is your spouse currently taking

d. what meds is your spouse currently taking?

A patient who is undergoing an acute STEMI is prescribed metoprolol 50mg by mouth every 6 hours. It would be a priority to immediately contact the prescriber if which assessment finding was present? a. Altered taste b. insomnia c. rhinorrhea d. wheezing

d. wheezing (use in caution with those who have asthma)

The nurse is assessing a patient who is scheduled to receive a dose ofgentamicin. in the last 12 hours, fluid intake has been 900 ml, urine output has been 300 ml, and the patients bladder is not distended. What should the nurse do? a. administer the drug b. administer the drug and notify the prescriber of the output c. instruct the patient to drink a full glass of water eau time the med is administered d. withhold the drug and notify the prescriber of the output

d. withhold the drug and notify the prescriber of the output

A medical resident has prescribed ketorolac 15 mg IM for a woman who is requesting pain relief during labor. Which nursing action is most appropriate? a. administer drug and monitor neonates respirations for depression after delivery. b. assess the pats stage of labor and question the order if the patient is in transition c. question administered IM injection for a woman in labor d. withhold the drug and question the prescriber.

d. withhold the drug and question the prescriber

A pt who was admitted with severe abdominal pain has been diagnosed with H. pylori associated peptic ulcer. Tetracycline 500 mg, metronidazole 250 mg, and bismuth ubsalicylate 525 mg have been prescribed 4x/day. The nurse notes that the patients 24-hour intake has been approximately 2500ml and urine output has been 600-800 ml for each of the past 2 days. What should the nurse do? a. administer the meds and continue care b. administer the med and report change c. withhold med and continue care d. withhold med and notify prescriber of changes

d. withhold the med and notify the prescriber of changes

In contrast to the withdrawal syndrome associated with general CNS depressants, the withdrawal syndrome associated with opioids, although unpleasant, is not ____.

dangerous

What are the principal adverse effects of Benzodiazepines?

daytime sedation, CNS depression, and anterograde amnesia (impaired recall)

Drugs relieve pain of stable angina by __________ cardiac oxygen demand. They do not _________ oxygen supply.

decreasing; increase

Loop diuretics can cause

dehydration and hypotension

Calcium channel blockers (CCBs) relieve pain of stable angina by reducing cardiac oxygen __________. First, all CCBs relax peripheral arterioles and decrease afterload. Second, ___________ and ___________ reduce heart rate and contractility (in addition to decreasing afterload.

demand; verapamil; diltiazem

Trycyclic antidepressants (TCAs) can be used to treat ____, ___, and chronic neuropatic ____, but have serious adverse effects.

depression; OCD; pain

Preliminary data indicate that ACE inhibitors (and ARBs) can reduce the risk of ___________ diabetic retinopathy, although they can't slow the progression of ____________ retinopathy.

developing; established

Quinidine causes ___________ and other GI symptoms in 33% of patients. These effects frequently force drug withdrawal.

diarrhea

Potassium competes with ___________ for binding to Na+, K+-ATPase. Therefore, if potassium levels are _____, excessive inhibition of Na+,K+-ATPase can occur, resulting in toxicity. Conversely, if potassium levels are ______, insufficient inhibition can occur, resulting in therapeutic failure.

digoxin; low; high

When a CCB is combined with a beta blocker, a _____________ (eg, nifedipine) is preferred to verapamil or diltiazem. Verapamil and diltiazem will intensify ______________ caused by the beta blocker, whereas a dihydropiridine will not.

dihydropyridine; cardiosuppression

Drugs that _______ veins intensify and prolong postural hypotension. As with other drugs that reduce AP, venodilators can trigger the _________ _______, and can thereby cause reflex __________.

dilate; baroreceptor reflex; tachycardia

Headache is a possible adverse effect of nitroglycerin. Inform patients that headache will _________ with continued drug use. Advise patients that headache can be relieved with _________, acetaminophen, or some other mild analgesic.

diminish; aspirin

Arteries are not very ________. As a result, large increases in arterial pressure (AP) cause only small changes in arterial

distensible

Drugs that dilate arterioles or veins can cause fluid retention, which can be blunted with a __________.

diuretic

What can be used to reduce fluid retention caused by dilation of arterioles and veins?

diuretic

What is the most common reason for digoxin-related dysrhythmias?

diuretic-induced hypokalemia

Because they cause vasodilation, all calcium channel blockers can cause ____________, ____________, and _____________ _________.

dizziness; headache; peripheral edema

Coxibs do not inhibit platelet aggregation, and hence ____ pose a risk of bleeding.

don't

Activation of ________ receptors dilates renal blood vessels, which helps maintain renal perfusion in _____.

dopamine; shock

Acyclovir, the drug of choice for most infections caused by herpes simplex viruses, is eliminated unchanged by the kidneys. Because of this fact, what must be concluded about the dosage if the patient has renal impairment?

dosage must be reduced

Dopamine is a catecholamine whose receptor receptor specificity is highly _____ __________. At low therapeutic doses, dopamine acts on _________ receptors only; at moderate doses, dopamine activates ______ receptors in addition to dopamine receptors; and at high doses, dopamine activates ______ receptors along with beta1 receptors and dopamine receptors.

dose dependent; dopamine; beta1; alpha1

The risk of nephrotoxicity with aminoglycosides is related to the total cumulative _______ and elevated _________ levels.

dose; trough

Cefazolin and cefotetan can cause alcohol intolerance. Advise patients about alcohol intolerance and warn them not to ________ alcoholic beverages.

drink

Inform patients that warfarin is subject to a large number of potentially dangerous ________ interactions. Instruct them to avoid all drugs-prescription and nonprescription-that have not been specifically approved by the __________.

drug; prescriber

Safety alert: All antidysrhythmic drugs can worsen existing ____________ and generate new ones. Regardless of the particular circumstances of drug use, all patients must be followed closely.

dysrhythmias

In addition to ______________, digoxin can cause GI effects (anorexia, nausea, vomiting) and CNS effects (fatigue, visual disturbances). Gastrointestinal and CNS effects often _________ dysrhythmias, and therefore can provide advance warning of serious toxicity.

dysrhythmias; precede

Digoxin causes ____________ by altering the electrical properties of the heart (secondary to inhibition of Na+,K+-ATPase).

dysrhytmias

Safety alert: Like erythromycin, azithromycin has the potential to cause fatal heart ______________ secondary to prolonging the QT interval. Patients at high risk include those with existing QT interval prolongation, low blood levels of ____________ or ___________, or a slower-than-normal heart rate, or those who use drugs to treat abnormal heart rhythms.

dysrthymias

Thrombolytic therapy is most effective when started _______ (eg, for acute MI, within 4 to 6 hours of onset, and preferably sooner).

early

Typically all fibrinolytic drugs are equally ___________. However, when treatment is initiated within 4 to 6 hours of pain onset, ___________ is the most effective.

effective; alteplase

The _____ population have the highest risk of suicide.

elderly

Dysrhythmias result from alteration of the ___________ ____________ that regulate cardiac rhythm. _________________ drugs control rhythm by correcting or compensating for these rhythms.

electrical impulses; Antidysrhytmic

Most patient-controlled analgesia (PCA) devices are ____ ____ pumps that can be activated by the patient to deliver a preset dose of opioid through an indwelling catheter. Some PCA devices also deliver a basal opioid infusion.

electronically controlled

Advise to take most oral tetracyclines on an ___________ stomach (1 hour before meals or 2 hours after) and with a full glass of water. ____________ may be taken with food.

empty; Minocycline

Beta blockers can be hazardous to patients with severe allergies, because they can block beneficial actions of ________, the drug of choice for treating anaphylactic shock.

epinephrine

What is the primary indication for thiazide diuretics?

essential hypertension

Sustained-release formulations of verapamil and diltiazem are reserved for _________ __________. It is important to instruct patients to swallow sustained-release formulations _________, without crushing or chewing.

essential hypertension; whole

Inform patients using erythromycin ___________ and ___________-_____________ formulations of erythromycin base that they may take these drugs without regard to meals.

ethylsuccinate; enteric-coated

For patients with type 1 or type 2 diabetes, how often should hemoglobin A1c be measured to assess long-term glycemic control.

every 3 to 6 months

What is hypertrichosis?

excessive hair production

Rivaroxaban and apixaban are oral anticoagulants that work by direct inhibition of _________ ___.

factor Xa

Vasodilators place patients at increased risk of _______. Patients receiving vasodilators should be informed about symptoms of hypotension (lightheadedness, dizziness) and advised to sit or lie down. Failure to follow this advice may result in ___________. Patients should also be taught that they can minimize hypotension by avoiding abrupt _________ from a supine or seated position to an upright position.

falls; fainting; transitions

Which herbal medicine is used to prevent migraine headaches?

feverfew

The first dose of an alpha blocker can cause fainting from profound orthostatic hypotension. This is known as the ______-_____ ______.

first-dose effect

ACE inhibitors can produce significant _______-_______ ______________ by causing a sharp drop in circulating angiotensin II.

first-dose hypotension

Beta blockers can prolong survival in patients with heart failure, and are considered _________-_______ therapy.

first-line

Because of ____-____ metabolism, ___ doses of morphine must be larger than ____ doses to produce equivalent analgesic effects.

first-pass; oral; parenteral

Because plasma levels of LMW heparins are predictable, these drugs can be administered using a _______ dosage, with no need for routine laboratory monitoring. As a result LMW heparins can be used at home.

fixed

As a rule, opioids should be administered on a ____ ____ (with supplemental doses for breakthrough pain) rather than PRN.

fixed schedule

Beta blockers are administered on a _________ schedule, not ____.

fixed; PRN

The major adverse effects of acarbose are GI disturbances:___________, _________ and __________ _____________.

flatulence, cramps, adominal distension

Which herbal medicine helps relieve or prevent constipation and can lower bad cholesterol? It also can affect absorption of other medications (should be taken one hour before or 2 hours after medications).

flaxseed

Drugs that dilate arterioles or veins can cause

fluid retention

Advise patients to take oral cephalosporins with ________ if gastric upset occurs. Instruct patients to _____________ oral suspensions.

food; refrigerate

ACE inhibitors work by blocking the _____________ of angiotensin II, whereas ARBs block the ___________ of angiotensin II. DRIs prevent formation of _____________ __, and thereby shut down the entire RAAS.

formation; actions; angiotensin I

With tetracyclines, inform patients about symptoms of ___________ infection (vaginal or anal itching; inflammatory lesions of the anogenital region; black, furry appearance of the tongue), and advise them to notify the prescriber if these occur.

fungal

Which herbal medicine lowers LDL and triglyceride levels while raising HDLs?

garlic

Because aspirin inhibits COX-1 as well as COX-2, it cannot cause beneficial effects without posing a risk of ____ ____, ____, and ____ impairment.

gastric ulceration; bleeding; renal

The risk of aspirin-induced ____ ____ can be reduced by (1) testing for and eliminating ____ before starting therapy and by (2) giving a proton pump inhibitor or histamine2 receptor antagonist.

gastric ulcers; H. pylori

Cross-tolerance exists among the various opioid agonists, but not between the opioid agonists and ____ ___ ____.

general CNS depressants

Which herbal medicine is used to treat vertigo and suppress nausea and vomiting associated with motion sickness, morning sickness? It also has some anti-inflammatory and analgesic properties.

ginger

Which herbal medicine is used to increase pain free walking with peripheral artery disease (PAD) and improve memory?

ginkgo

Which herbal medicine is used as a CNS stimulant, to boost immune response, to improve exercise performance, and for impotence?

ginseng

Which herbal medicine is used to decrease joint pain and inflammation in osteoarthritis and improve joint mobility?

glucosamine

Initial metabolic changes of diabetes involve _________ and other carbohydrates. If the disease progresses, metabolism of _____ and _________ changes as well.

glucose; fats; proteins

Insulin deficiency promotes hyperglycemia by increasing _____________ and _______________ and by ____________ glucose utilization.

glycogenolyis; gluconeogenesis; decreasing

Beta blockers can be detrimental to diabetic patients because they suppress ___________ (an important mechanism for correcting insulin-induced hypoglycemia), and they suppress ________, ________, and ___________, which normally serve as an early warning signal that glucose levels are too low.

glycogenolysis; tachycardia; tremors; perspiration

Cephalosporins can be grouped into five "generations". In general, as we progress from first- to fifth- generation drugs, there is (1) increasing activity against ________-_____________ bacteria, (2) increasing resistance to destruction by _____________-_______________, and (3) increasing ability to reach the _________________ __________.

gram-negative; beta-lactamases; cerebrospinal fluid (CSF)

Clindamycin is used primarily as an alternative to penicillin for serious ____________-___________ ____________ infections.

gram-positive anaerobic

Which herbal medication is used for weight loss, mental clarity, and treating cancers of the stomach, skin, bladder, and breast?

green tea

Dietary supplements are presumed safe until proven ____ (opposite logic and regulations for FDA controlled drugs)

hazardous

All of the clinically relevant responses to activation of beta1 receptors result from activating beta1 receptors in the _______.

heart

Untreated hypertension can lead to

heart disease, kidney disease, and stroke

Co enzyme Q10 is used to treat?

heart failure and muscle injury

By increasing cardiac output, digoxin can reverse all overt manifestations of __________ ____________: cardiac output improve, heart rate decreases, heart size declines, constriction of arterioles and veins decreases, water retention reverses, blood volume declines, peripheral and pulmonary edema decrease, water weight is lost, and exercise tolerance improves. Unfortunately, although digoxin can improve ____________, it does not __________ life.

heart failure; symptoms; prolong

Spontaneous phase 4 depolarization of cells in the SA node normally determines _______ _______.

heart rate

St. Johns wort used for?

helps with depression. interferes with SSRIs

ARBs share the beneficial ______________ effects of ACE inhibitors, but not the beneficial effects of ____________ _______________.

hemodynamic; cardiac remodeling

What is the major adverse effect in antiplatelet, anticoagulant and thrombolytic drugs?

hemorrhage

What is the most common reason for removing drugs from the market?

hepatotoxicity

Because of its antiplatelet actions, ____-____ aspirin should be ____ 1 week before elective surgery or parturition. In most cases, ____-____ aspirin taken to protect against thrombosis can be continued.

high-dose; discontinued; low-dose

Safety alert: patients on aminoglycoside therapy should be monitored for ototoxicity. What is the first sign of impending cochlear damage?

high-pitched tinnitus

Antiinflammatory doses of aspirin are much ____ than analgesic or antipyretic doses.

higher

Instruct patients to administer captopril and moexipril at least 1 _______ __________ meals.

hour before

BiDil, a fixed-dose combination of ____________ and ____________ __________, is approved specifically for treating heart failure in ________.

hydrazaline; isobordide dinitrate; blacks

ARBs differ from ACE inhibitors in that they have a much lower incidence of ____________ or _______.

hyperkalemia; cough

Potassium-sparing diuretics can cause ______________. By doing so, they can increase the risk of _____________ in patients taking ACE inhibitors or ARBs.

hyperkalemia; hyperkalemia

Aspirin can cause ____ reactions, especially in adults with asthma, rhinitis, and nasal polyps. Severe reactions (anaphylaxis) can be treated with ____.

hypersensitivity; epinephrine

ACE inhibitors (and ARBs) are used to treat patients with ______________, ___________ ___________, _______________ ___________, and _________________ diabetic nephropathy. In addition, they are used to prevent MI, stroke and death from cardiovascular causes in patients at high risk for a cardiovascular event. Of note, ACE inhibitors (and ARBS) are not effective for _________________ prevention of diabetic nephropathy.

hypertension; heart failure; myocardial infarction (MI); established; primary

Minoxidil can cause ___________.

hypertrichosis

The combination of pramlintide plus insulin poses a risk of severe ___________. Nausea is common

hypoglycemia

The major adverse effect of sulfonylureas is

hypoglycemia

What is the major adverse effect of sulfonylureas?

hypoglycemia

The most important and common adverse effect of insulin therapy is _____________ (blood glucose below 70 mg/dL), which occurs whenever insulin levels __________ insulin needs.

hypoglycemia; exceed

Tight glycemic control increases the risk of severe ____________ and ________ ________, and possibly the risk of ______.

hypoglycemia; weight gain; death

Thiazide diuretics and loop diuretics can cause ___________, and can increase the risk of __________-induced dysrhythmias.

hypokalemia; digoxin

Drugs that dilate veins can cause orthostatic _____________.

hypotension

Postural (orthostatic) _________ is caused by decreased venous return secondary to pooling of blood in veins, which can occur when we assume an erect posture.

hypotension

Major side effects of ace inhibitors?

hypotension, cough

Advise patients with penicillin allergy to wear some form of __________ (eg, Medic Alert bracelet) to alert emergency healthcare personnel.

identificaton

With patients taking warfarin, advise the patients to avoid prolonged ________, elevate the legs when sitting, avoid garments that can restrict _______ ________ in the legs, particpate in __________ activities, and wear support hose.

immobility; blood flow; exercise

the therapeutic goal of dobutamine is to

improve the hemodynamic status of patient with heart failure

By dilating arterioles, ACE inhibitors ____________ regional blood flow in the kidneys and other tissues and reduce cardiac ___________, which causes stroke volume and cardiac output to ______.

improve; afterload; rise

Dietary supplements do not address ____, ___, or ____.

impurities; adulterants (adding other substances to make more of it so it is not as pure); variability

When would it be necessary to use a loading dose to achieve plateau quickly?

in a drug with a long half-life

Warfarin is subject to a large number of clinically significant drug interactions. Drugs can _____________ anticoagulant effects by displacing warfarin from plasma albumin, by inhibiting hepatic enzymes that degrade warfarin, and by decreasing synthesis of clotting factors. Drugs can __________ anticoagulant effects by inducing hepatic drug-metabolizing enzymes, increasing synthesis of clotting factors, and inhibiting warfarin absroption. Drugs that promote bleeding, such as aspirin and ________, will obviously increase the risk of bleeding in patients taking warfarin. Instruct patients to avoid all drugs-prescription and nonprescription- that have not been specifically approved by the prescriber.

increase; decrease; heparin

What are the adverse effects associated with stimulant medications?

increased HR and BP, weight loss, sleep disturbance, physical dependence with long term use

First-generation NSAIDS are associated with:

increased gastrointestinal bleeding that can lead to hospitalization and death

In the heart, calcium entry ___________ heart rate, AV conduction, and myocardial contractility, so calcium channel _________ has the opposite effects.

increases; blockade

Drugs relieve pain of variant angina ____________ cardiac oxygen supply. They do not __________ oxygen demand.

increasing; decrease

Exenatide, an ___________ mimetic for type 2 diabetes, is injected subQ before meals. The drug delays gastric __________, suppresses __________ release and stimulates glucose-dependent release of _________. Exenatide is available as short-acting [Byetta] and longer-acting [Bydureon] formulation.

incretin; emptying; glucagon;insulin

Opioid dosage must be ____. Patients with a low tolerance to pain or with extremely painful conditions need ____ doses. Patients with sharp, stabbing pain need ____ doses than patients with dull pain. Older adults generally require ____ doses than younger adults. Neonates require relatively ____ doses.

individualized; high; higher; lower; low

Procainamide can cause agranulocytosis, thrombocytopenia, and neutropenia. Instruct patients to inform the prescriber at the first sign of_________(fever, chills, sore throat), ___________, or _____________.

infection; bruising; bleeding

Acetaminophen reduces pain and fever, but not ____.

inflammation

Prolonged therapy of procainamide can produce a syndrome resembling Systemic lupus erythematosus (SLE). What is important to tell patients regarding this?

inform patients about manifestations of SLE (joint pain and inflammation; hepatomegaly; unexplained fever; soreness of the mouth, throat, or gums), and instruct them to notify the prescriber if these develop.

Aminoglycosides can cause irreversible injury to sensory cells of the _________ ________, resulting in __________ loss and disturbed ___________.

inner ears; hearing; balance

What is sleep hypnosis used to treat?

insomnia

Type 1 diabetes is treated primarily with ________ ___________.

insulin replacement

NPH insulin has an ____________ duration of action.

intermediate

Aspirin causes ____ inhibition of COX. As a result, the effects of aspirin persist until cells can make more COX.

irreversible

Most agonist-antagonist opioids act as agonists at ____ receptors and antagonists at ____ receptors.

kappa; mu

What are the three dietary supplements that are risky to take?(check all that apply) a. kava b. ginsing c.. comfrey d. Echineacea e. black cohosh f. Ma Haung (Effedra)

kava, comfrey, Ma Haung (effedra)

The ________ provide long-term control of blood pressure by regulating blood volume.

kidneys

Penicillins are normally eliminated rapidly by the __________, but can accumulate to harmful levels if _________ function is severely impaired.

kidneys; renal

By increasing levels of _____________ (and partly by decreasing levels of angiotensin II), ACE inhibitors can favorably alter cardiac remodeling.

kinin

Very rarely, metformin causes __________ ___________, whcih can be fatal. The risk of this is increased by ____________ ___________, which decreases metformin excretion and thereby causes levels to rise rapidly.

lactic acidosis; renal impairment

Because of excessive and inappropriate fears about addiction and abuse, physicians frequently prescribe ____ pain medication than patients need, and nurses frequently administer ____ medication than was prescribed.

less; less

Pentazocine and other agonist-antagonist opioids produce ____ analgesia than morphine and have a ____ potential for abuse.

less; lower

Nitroglycerin is highly ______ ________, and therefore is readily absorbed through the skin and oral mucosa.

lipid soluble

Lidocaine undergoes rapid inactivation by the _________. As a result, it must be administered by continuous IV infusion.

liver

Nitroglycerin undergoes very rapid inactivation in the ________. Hence, when the drug is administered _______, most of each dose is destroyed before reaching the systemic circulation.

liver; orally

High doses of tetracyclines can cause severe ___________ damage, especially in pregnant and postpartum women who have ___________ impairment.

liver; renal

When nitroglycerin is administered sublingually, it is absorbed directly into systemic circulation, and therefore temporarily bypasses the ______. Hence, to produce equivalent effects, sublingual doses can be much ________ than oral doses.

liver; smaller

With nitroglycerin, warn patients against abrupt withdrawal of _______-____________ preparations (transdermal systems, topical ointment, sustained-release tablets and capsules).

long-acting

In type 1 diabetes, tight glycemic control can markedly reduce _______-________ ___________, as demonstrated in the Diabetes Control and Complications Trial (DCCT).

long-term complications

Nitroglycerin preparations that have a _____ duration (eg, patches, sustained-release oral capsules) are used for extended protection against anginal attacks. Administration is on a ________ schedule (but one that allows at least 8 drug-free hours a day).

long; fixed

In contrast to unfractioned heparin, ____-____________-__________ heaprins do not bind nonspecifically to plasma proteins and tissues. As a result, their bioavailability is ______, making their plasma levels predictable.

low-molecular-weight (LMW); high

The baroreceptor reflex, the kidneys, and the Renin-Angiotensin-Aldosterone System (RAAS) can oppose our attempts to _________ blood pressure with drugs. We can counteract the baroreceptor reflex with a __________ ___________, the kidneys with a __________, and the RAAS with an _____ ____________, ____, ____, or ______________ ______________.

lower; beta blocker; diuretic; ACE inhibitor; ARB; DRI; aldosterone antagonist

Drugs that ______ AP trigger the baroreceptor reflex, and thereby cause reflex _________. Hence, the baroreceptor reflex can temporarily _______ efforts to lower AP with drugs.

lower; tachycardia; negate

What does red yeast rice extract do?

lowers cholesterol

To prevent tolerance, nitroglycerin should be used in the __________ effective dose, and _____-_________ formulations should be used on an intermittent schedule that allows at least 8 drug-free hours every day, usually during the night.

lowest; long-acting

Gastrointestinal disturbances (epigastric pain, nausea, vomiting, diarrhea) can be reduced by administering erythromycin with __________. Advise patients to notify the prescriber if GI reactions are severe or persistent.

meals

When administering quinidine, advise patients to take quinidine with _______. Warn them not to crush or chew sustained-release formations.

meals

Black Cohosh treats symptoms of?

menopause

Use of ____ should not exceed 48 hours- so as to avoid accumulation of ____, a toxic metabolite.

meperidine; normeperidine

In type 2 diabetes, tight glycemic control can decrease ____________ complications, but not ____________ complications or mortality, as shown in the ACCORD, ADVANC, and VADT trials.

microvascular; macrovascular

NSAIDs (eg, aspirin, ibuprofen) can interfere with the antihypertensive effects of ACE inhibitors. Advise patients to ___________ NSAID use.

minimize

To ____ symptoms of abstinence, opioids should be withdrawn ____.

minimize; gradually

The sleepy atypical antidepressants include ____ (____) and ____ (____).

mirtazapine (Remeron); trazodone (Desyrel)

When advising patients on digoxin administration, warn patients not to "double up" on doses in attempts to compensate for _________ ________.

missed doses

Regular (native) insulin, when used subQ, has a ___________ ________ onset and ______ duration.

moderately rapid; short

The goal of antihypertensive therapy is to decrease ____________ and __________ without decreasing ____________ ____ ______. For most patients, this goal is achieved by maintaining blood pressure below ____/___ to ____/___ mm Hg.

morbidity; mortality; quality of life; 140/90; to 150/90

All strong opioid agonists are essentially equal to ____ with regard to analgesia, abuse liability, and respiratory depression.

morphine

Pure opioid antagonists act as antagonists at ____ receptors and ____ receptors.

mu; kappa

Stroke volume is determined by?

myocardial contractility, cardiac preload, cardiac after load

Digoxin and other inotropic agents increase the force of ___________ __________, and thereby increase cardiac __________.

myocardial contraction; output

Immediate-release nifedipine has been associated with increased mortality in patients with ____________ __________ and unstable _____________. Other immediate-release CCBs have been associated with an increased risk of myocardial infartion in patients with hypertension. however, in both cases, a casual relationship has not been established. Nonetheless, the National Heart, Lung, and Blood Institute has recommended that immediate-release nifedipine, especially in higher doses, be used with great caution, if at all. It is important to note that these adverse effects have not been associated with ________________-____________ nifedipine or with any other long-acting calcium channel blocker.

myocardial infarction; angina; sustained-release

In its role as an antiplatelet drug, aspirin is given for multiple purposes, including primary prevention of ___________ _____________, acute management of MI, and reduction of cardiovascular events in patients with ________ angina, ___________ __________ angina, ischemic stroke, or a history of _____________ __________ __________.

myocardial infarction; unstable; chronic stable; transient ischemic attacks (TIAs)

Digoxin has a ______________ therapeutic range.

narrow

Aminoglycosides are ________-__________ antibiotics, used primarily against _________ _________-_________ bacilli.

narrow-spectrum; aerobic gram-negative

Penicillin G has a ___________ antibacterial spectrum and is __________ in stomach acid.

narrow; unstable

Myocardial infarction (MI) is the _________ of the myocardium secondary to acute occlusion of a coronary artery. The usual cause is ________ ________ and ___________ formation at the site of a ruptured artherosclerotic plaque.

necrosis; platelet plugging; thrombus

In patients with heart failure, benefits of digoxin are not due solely to improved cardiac output; ______________ effects are important too.

neurohormonal

Safety alert: Aminoglycosides can inhibit _____________ ___________, causing ______________ _____________ and potentially fatal ____________ depression. Most episodes of neuromuscular blockade have occurred following intraperitoneal or intrapleural installation of aminoglycosides. However, neuromuscular blockade has also occurred with IV, IM, and oral dosing.

neuromuscular transmission; flaccid paralysis; repsiratory

In the CNS, at least 21 compounds appear to act as ____.

neurotransmitters

At therapeutic doses, ____________ and the other dihydropyridines act primarily on vascular smooth muscle (VSM). In contrast, _____________ and ____________ act on vascular smooth muscle (VSM) and on the __________.

nifedipine; verapamil; diltiazem; heart

To cause vasodilation, nitroglycerin must first be converted to ________ _______, its active form. This reaction requires a ____________ source.

nitric oxide; sulfhydryl

Anginal pain is prevented with one or more long-acting antiaginal drugs (beta blocker, CCB, long-acting nitrate) supplemented with sublingual _____________ when breakthrough pain occurs.

nitroglycerin

Prolonged infussion of _____________ can result in toxic accumulation of cyanide and thiocyanate.

nitroprusside

Which can cross the blood-brain barrier? a. Catecholamine b. Noncatecholamine

noncatecholamine

The COX inhibitors fall into two major groups: ____ ____ ____ (____) and ____ (in a group by itself).

nonsteroidal antiinflammatory drugs (NSAIDs); acetaminophen

Mirtazapine (Remeron), a sleepy atypical antidepressant, increases the release of ____ and ____ (presynaptic alpha blocker).

norepinepherine; seratonin

Instruct patients to take clopidogrel ______ a day, with or without food.

once

Aspirin is a very effective analgesic. It can e as effective as ____ for some types of postoperative pain.

opioids

Warfarin is our oldest _______ anticoagulant.

oral

Type 2 diabetes is treated with ________ ______________ drugs or, if needed, with _________ or non-insulin injectable drugs-- but always in conjuction with diet modification and exercise.

oral antidiabetic; insulin

Agents in the catecholamine family cannot be taken _______ (because of destruction by MAO and COMT), have a ______ duration of action (because of destruction by MAO and COMT), and cannot cross the _____-______ _________ (because they are polar molecules).

orally; brief; blood-brain barrier

Of the available inotropic agents, digoxin is the only one that is both effective and safe when used ________, and the one suitable for _______-________ use.

orally; long-term

Adrenergic agonists that are noncatecholamines can be taken ______ have a ________ duration than the catecholamines, and can cross the _______-______ ________.

orally; longer; blood-brain barrier

Drugs that dilate veins can cause

orthostatic hypotension

Glucosamine used for?

osteoarthritis in knees and foot: comes from crab and shrimp crustaceans

Aminoglycosides can damage the inner ears, causing irreversible impairment of hearing and balance. Instruct patients to report symptoms of ___________ (tinnitus, high-frequency hearing loss, persistent headache, nausea, unsteadiness, dizziness, vertigo).

ototoxicity

Dietary supplements in the United States are sold ____ ____ ____.

over the counter (OTC)

SSRIs are first line drugs for

panic disorder, OCD, social phobias

Use of ____ opioids during delivery can suppress ____ ____ and cause respiratory depression in the neonate.

parenteral; uterine contractions

what is the number 1 drug for syphyllis?

penicillin

Eythromycin has an antimocrobial spectrum similar to that of ____________ __, and hence can be used in place of ____________ __ in patients with penicillin allergy.

penicillin G; penicillin G

Some bacteria resist penicillins by producing ______________, enzymes that inactivate penicillins.

penicillinases (beta-lactamases)

Patients allergic to ______________ have about a 1% risk of cross-reactivity with cephalosporins.

penicillins

Reperfusion can be accomplished with __________ ____________ ___________ or with _________ drugs. Both approaches are highly effective, but _________ __________ ___________ is now generally preferred.

percutaneous coronary intervention (PCI); fibrinolytic; percutaneous coronary intervention (PCI)

Cardiac afterload is determined primarily by _________ ____________, which in turn is determined by the degree of constriction in arterioles.

peripheral resistance

Activation of alpha2 receptors in the ________ is of minimal clinical significance. In contrast, drugs that activate alpha2 receptors in the _______ _________ _______ produce useful effects.

periphery; central nervous system (CNS)

If administered in excessive dosage to an individual who is ____ ____ on opioid agonists, ____ will precipitate an immediate withdrawal reaction.

physically dependent; noloxone

Fibrinolytic drugs dissolve clots by converting ___________ into ___________, an enzyme that digests the fibrin meshwork that holds clots together.

plasminogen; plasmin

Thrombolytic drugs work by converting ______________ to __________, an enzyme that degrades the fibrin matrix of thrombi.

plasminogen; plasmin

Aspirin suppresses ___________ aggregation, decreasing mortality, reinfarction, and stroke. All patients should chew a 162- to 325-mg dose on hospital admission and should take 81 to 162 mg/day indefinitely after discharge.

platelet

When used to suppress _________ __________, aspirin is administered in low doses- typically 80 to 325 mg/day.

platelet aggregation

Hemostasis occurs in two stages: formation of a _______ _____, followed by ___________ (ie, production of fibrin, a protein that reinforces platelet plug).

platelet plug; coagulation

What is the most opportunistic infection with those who have HIV-AIDS?

pneumocystis pneumonia

Aminoglycosides are highly ___________ polycations. As a result, they are not absorbed from the ___ _______, do not cross the __________-__________ ___________, and are excreted __________ by the kidneys.

polar; GI tract; blood-brain barrier; rapidly

Phase 3 of fast potentials (repolarization) is generated by rapid extrusion (discharge/ejection) of _______________.

potassium

Class III antidysrhythmics block ____________ channels, and therepy delay repolarization of _____ potentials. As a result, they prolong the action potential duration and the effective refractory period. By delaying ventricular repolarization, they prolong the ____ ____________.

potassium; fast; QT interval

Warfarin must not be used during __________. The drug can cause fetal malformation, CNS defects, and optic atrophy.

pregnancy

Amiodarone can harm the developing fetus and breast-feeding infant. Warn patients to avoid ____________ and _________-____________ while using amiodarone and for several months after stopping.

pregnancy; breast-feeding

Precautions to opioid use inculde ____, labor and delivery, ____ injury, and decreased ____ ____.

pregnancy; head; respiratory reserve

ACE inhibitors can cause major fetal malformations, and should be avoided during ___________. Until recently, we thought that risk was limited to exposure during the __________ and __________ trimesters. However, new data indicate that exposure during the _______ trimester may be dangerous.

pregnancy; second; third; first

Warfarin can cross the placenta, causing fatal hemorrhage and malformation. Inform those of child-bearing age about potential risks to the fetus, and warn them against becoming __________.

pregnant

When taken for ____ prevention, the benefits of aspirin must be weighed against the potential for harm. Ibuprofen, naproxen, and other nonaspirin NSAIDs can antagonize the antiplatelet actions of aspirin, and can thereby ____ protection against MI and stroke. To minimize this interaction, patients should take aspirin about __ hours before other NSAIDs.

primary; decrease; 2

Which herbal medication is used to prevent suprainfection with antibiotics, such as C. diff and to relieve symptoms of irritable bowel syndrome (IBS)?

probiotics

Instruct patients to administer ____________ at evenly spaced intervals around the clock. Warn patients not to crush or chew sustained-release formulations.

procainamide

Clopidogrel is a ________ that undergoes conversion to its active form by hepatic CYP2C19.

prodrug

All antidysrhthmic drugs are also _________________. That is, they all can worsen existing dysrhythmias and generate new ones.

prodysrhythmic (proarrhythmic)

With ____ opioid use, physical dependence develops. An ____ syndrome will occur if the opioid is abruptly withdrawn.

prolonged; abstinence

With ____ opioid use, tolerance develops to analgesia, euphoria, sedation, and respiratory depression, but not to ____ and ____.

prolonged; constipation; miosis

Insulin glargine and insulin detemir have a ___________ duration, with no definite "________" in either blood levels or hypoglycemic effects.

prolonged; peak

what is feverfew used for ?

prophylaxis of migraines

Acetaminophen inhibits ____ synthesis in the CNS, but not in the periphery. As a result, acetaminophen differs from the NSAIDs in four ways: it (1) lacks ____ actions, (2) does not cause ____ ____, (3) does not suppress platelet ____, and (4) does not impair ____ function.

prostaglandin; antiinflammatory; gastric ulceration; aggregation; renal

Severe heparin-induced bleeding can be treated with ___________ _________, a drug that binds heparin and therapy stops it from working.

protamine sulfate

Aminoglycosides disrupt ___________ synthesis and cause rapid bacterial _________.

protein; death

Warfarin therapy is monitored by measuring ________________ ________. Results are expressed as an international normalized ratio (INR). An INR of __ to __ is the target for most patients.

prothrombin time (PT); 2 to 3

When appropriate, to monitor treatment for patients using warfarin, teach patients to monitor their _________ _________ and ____________ ___________ __________ at home.

prothrombin time (PT); international normalized ratio (INR)

Nitroglycerin preparations that have a _______ onset (eg, sublingual nitroglycerin) are used to abort an ongoing anginal attack and to provide acute prophylaxis when exertion is expected. Administration is ____.

rapid; PRN

Insulin lispro, insulin aspart, and insuin glulisine have a very ________ onset and _____ duration.

rapid; short

All insulins used in the United States are produced by _______________ ______ _______________. Insulin extracted from ______ or _______ pancreas is no longer available.

recombinant DNA technology; beef; pork

Rapid infusion of vancomycin can cause a constellation of distrubing effects--flushing, rash, pruritus, uticaria, tachycardia, and hypotension--known collectively as _______ ____ __________.

red man syndrome

By dilating veins, ACE inhibitors ___________ venous pressure, which in turn ___________ pulmonary congestion, peripheral edema, preload, and cardiac dilation.

reduce; reduces

Quinidine can raise digoxin levels. If the drugs are used together, digoxin dosage must be ___________.

reduced

Garlic used for?

reduces LDL cholesterol, raises HDL.

Drugs that dilate arterioles or veins can cause ___________ _____________, which increases cardiac work and elevates blood pressure.

reflex tachycardia

Drugs that dilate both arterioles or veins can cause

reflex tachycardia

Digoxin is eliminated by_________ excretion.

renal

Tetracycline and demeclocline should not be given in patients with ___________ ____________.

renal failure

What is the principal toxicity of vancomycin?

renal failure

Class IB agents differ from IA agents in two ways: they accelerate ______________ and have little or no effect on the ______________.

repolarization; ECG

Beta blockers (eg, metoprolol) appear to lower blood pressure primarily by reducing peripheral vascular _____________. The mechanism is unknown. They may also lower blood pressure by decreasing myocardial _____________ and suppressing ____________ _______________ (through beta1 blockade in the heart), and be decreasing _____________ release (through beta1 blockade in the kidney).

resistance; contractility; reflex tachycardia; renin

With agonist-antagonist opioids, there is a ceiling to ____ ____.

respiratory depression

The virus that causes aids is a

retrovirus

Naloxone and other pure opioid antagonists can ____ respiratory depression, coma, analgesia, and most other effects of pure opioid agonists. The only exception is methylnaltrexone, which ____ cross the blood-brain barrier.

reverse; doesn't

The nonaspirin NSAIDs differ from aspirin in three important ways. First, nonaspirin NSAIDs cause ____ inhibition of COX, and hence their effects decline as soon as their blood levels decline. Second, although they can suppress platelet aggregation, these drugs are not used to prevent ____ and ____. Third, these drugs actually ____ the risk of ____ and ____, and hence should be used in the lowest effective dosage for the shortest possible time.

reversible; MI; stroke; increase; MI; stroke

Aspirin is a useful drug for ____ ____ and other chronic inflammatory conditions.

rheumatoid arthritis

Like dabigatran, ___________ and __________ are safer than warfarin and easier to use.

rivaroxaban; apixaban

Dietary supplements are not regulated for ____ or ____.

safety; efficacy

With aliskiren, a direct renin inhibitor, advise patients to take each daily dose at the ___________ __________ with respect to meals (eg, 1 hour before dinner).

same time

Which herbal medicine is used to relieve symptoms of benign prostatic hypertrophy (BPH) such as urinary frequency, urgency, straining in med, and does not decrease prostate size? It is also a pregnancy risk category X.

saw palmetto

What are antipsychotics used to treat?

schizophrenia and schizophrenia-like symptoms, such as hallucinations, delusions, agitation

Warn women of child-bearing age that taking ACE inhibitors, ARBs, or DRI's during the __________ and __________ trimesters of pregnancy can cause major fetal injury (hypotension, hypertension, skull hypoplasia, anuria, reversible and irreversible renal failure, death), and that taking these drugs earlier in pregnancy may pose a risk as well.

second; third

What are the adverse effects of mood stabilizers?

sedation, slight tremor, weight gain, metallic taste

For patients with type 1 diabetes, and for patients with type 2 diabetes who use insulin, ________-_____________ ___ ___________ ___________ is the standard method for day-to-day monitoring of therapy. The premeal target is ___ to ____ mg/dL, and the peak postmeal target is _____ mg/dL or lower for many patients.

self-monitoring of blood glucose (SMBG); 70 to 130 mg/dL; 180 mg/dL

Trazodone (Desyrel), a sleepy atypical antidepressant, inhibits reuptake of ____ and antagonize ____ receptor subtype.

seratonin; seratonin

TCAs block uptake of ____ and ____.

serotonin; norepinephrine

SSRIs act by (1) producing selective inhibition of ______ reuptake, (2) potentiating and enhancing the effects of ______, an excitatory neurotransmitter, and (3) producing ___ excitation

serotonin; serotonin; CNS

Because the same aminoglycoside dose can produce very different plasma levels in different patients, monitoring _______ levels is common. ___________ levels must be high enough to cause bacterial kill; _____________ levels must be low enough to minimize toxicity to the inner ears and kidneys.

serum; Peak; trough

Monitoring _________ drug levels provides the best basis for adjusting aminoglycoside dosage. To produce bacterial kill, _________ levels must be sufficiently high. To minimize otoxicity and nephrotoxicity, ________ levels must be sufficiently low.

serum; peak; trough

What are the most common side effects of SNRIs?

sexual dysfunction, insomnia , serotonin syndrome , nausea

Nitroglycerin should be used cautiously with most vasodilators, and must not be used at all with ____________ and other ________ inhibitors.

sildenafil [Viagra]; PDE5

Anticoagulant responses to warfarin develop ______ and persist for several days after warfarin is __________.

slowly; discontinued

Benzathine penicillin G is released very ________ following IM injection, and thereby produced __________ antibacterial effects.

slowly; prolonged

Class I antidysrhythmics block cardiac _________ channels, and thereby slow impulse conduction through the atria, ventricles,and His-Purkinje system.

sodium

Phase 0 pf fast potentials (depolarization) is generated by rapid influx of ____________. Because depolarization is fast, these potentials conduct rapidly.

sodium

Quinidine ( a class IA drug) blocks ____________ channels and delays ventricular repolarization. Delaying ventricular repolarization prolongs the ___ ___________.

sodium; QT interval

Aldosterone antagonists lower blood pressure by preventing aldosterone-mediated retention of _______________ and ____________ in the kidney.

sodium; water

Aldosterone acts on the kidneys to promote retention of _________ and _________. In addition, aldosterone can also mediate pathologic change in ________________ function.

sodium; water; cardiovascular

By blocking aldosterone receptors, aldosterone antagonists can (1) promote renal excretion of ___________ and __________ (and can thereby reduce blood volume and blood pressure) and (2) prevent or reverse pathologic effects of aldosterone on _______________ structure and function.

sodium; water; cardiovascular

By impairing renal function, aspirin can cause ____ and ____ retention, ____ , and ____ of blood pressure. However, adverse outcomes are likely only in patients with additional risk factors: advanced age, preexisting renal dysfunction, hypovolemia, hypertension, hepatic cirrhosis, or heart failure. Long-term aspirin use may lead to ____ papillary necrosis and other forms of ____ injury.

sodium; water; edema; elevation; renal; renal

By suppressing aldosterone release, ACE inhibitors increase excretion of __________ and _________, and decrease excretion of _____________.

sodium; water; potassium

Nitroglycerin relieves pain of _________ __________ by dilating veins, which decreases venous return, which decrease preload, which decreases oxygen ___________.

stable angina; demand

What does the term "empiric therapy" refer to?

starting an antibiotic without knowing the cause

PCA devices provide ____ plasma drug levels, thereby maintaining ____ pain control while avoiding unnecessary sedation and respiratory depression.

steady; continuous

ACE inhibitors can cause a precipitous drop in blood pressure in patients with bilateral renal artery ___________ (or ________ in the artery to a single remaining kidney).

stenosis; stenosis

what is an adverse effect of sulfonamides?

stevens johnsons syndrome

All insulins can be administered ________, and four preparations-regular, aspart,lispro, and glusiline insulin-can be administered ___ as well.

subQ; IV

Exenatide poses a risk of hypoglycemia in patients taking a _____________, but not in those taking ___________. Nausea is common.

sulfonylurea; metformin

Photosensitivity reactions are common with amiodarone. Advise patients to avoid _________ and to wear __________ and protective clothing when outdoors.

sunlamps; sunscreen

Tetracyclines and clindamycin can promote bacterial ____________ of the bowel, resulting in severe diarrhea. Instruct patients to notify the prescriber if significant diarrhea develops.

superinfection

Use of aspirin during labor and delivery can ____ spontaneous uterine contractions, induce premature closure of the ductus arteriosus, and ____ uterine bleeding.

suppress; intensify

Tachydysrhythmias can be divided into two major groups: _______________ tachydysrhythmias or ______________ tachydysrhythmias. In general, _____________ tachydysrhythmias disrupt cardiac pumping more than do ______________ tachydysrhythmias.

supraventricular; ventricular; ventricular; supraventricular

Propanolol is especially useful for treating dysrhythmias caused by excessive _____________ stimulation of the heart.

sympathetic

Reduced cardiac output leads to compensatory responses: activation of the ____________ _______________ __________, activation of the ____________-_______________-___________ ____________, and retention of water and expansion of ___________ ____________. As a result of volume expansion, cardiac dilation _____________.

sympathetic nervous system (SNS); renin-angiotensin-aldosterone system (RAAS); blood volume; increases

Heart rate is increased by _________ nerve impulses and decreased by ____________ impulses.

sympathetic; parasympathetic

Adrenergic agonists are also known as ______________ because their effects mimic those caused by the sympathetic nervous system.

sympathomimetics

What are stimulant medications used to treat?

symptoms of ADD or ADHD

What are mood stabilizers used to treat?

symptoms of Bipolar disorder

Maintenance doses of digoxin are based primarily on observation of the patient: Doses should be large enough to minimize ___________ of heart failure but not so large as to cause _____________ ___________.

symptoms; adverse effects

Although diuretics can reduce _____________ of heart failure, they do not _________ survival.

symptoms; prolong

Hydrazaline can cause a syndrome that resembles _____________ ______________ _______________.

systemic lupus erythematosus (SLE)

In patients older than 50, elevated __________ blood pressure represents a greater cardiovascular risk than elevated ______________ blood pressure.

systolic; diastolic

In addition to the traditional RAAS, in which angiotensin II is produced in the blood and then carried to __________ tissues, angiotensin II can be produced _________ by individual tissues.

target; locally

Three oral tetracyclines--______________, ________________, and ________________-- should be administered on an empty stomach. ________________ can be administered with meals.

tetracycline; demeclocycline; doxycline; Minocycline

Advise patients taking ______________ to avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin.

tetracyclines

Instruct patients that GI distress (epigastric buringing, cramps, nausea, vomiting, diarrhea) can be reduced by taking _____________ with meals, although absorption may be reduced.

tetracyclines

Safety alert: Because they can cause permanent tooth discoloration, ________________ should not be given to pregnant women and breastfeeding women or children younger than 8 years.

tetracyclines

Starlings law states that

the left and right ventricles always pump exactly the same amount of blood

Why should aspirin be avoided by children with influenza or chickenpox?

the risk of Reye's syndrome

Inhaled long acting beta 2 agnonsits can increase the risk of asthma-related death primarily when used alone. To reduce risk, LABA should be used only by patients taking an inhaled glucocorticoid for long-term control, and only if the glucocorticoid has been inadequate by itself. For combined glucocorticoid/LABA therapy, the FDA recommends using a product that contains both drugs in

the same inhaler

A __________ is a blood clot formed within a blood vessel or the atria of the heart.

thrombin

Heparin-induced ________________ is a potentially fatal condition caused by development of antibodies against heparin-platelet protein complexes.

thrombocytopenia

Heparin is contraindicated for patients with ____________ or uncontrolled _____________, and must be used with extreme __________ in all patients for whom there is a high likelihood of bleeding.

thrombocytopenia; bleeding; caution

Warfarin is used to prevent ____________, and to prevent stroke and systemic embolism in patients with _________ ____________.

thromboembolism (VTE); atrial fibrillation

What is the priority reason why the nurse teaches a patient who is prescribed a sulfamethaxozole, to take this med with a full glass of water?

to minimize crystal formation in the urine

Continuous use of nitroglycerin can cause ________ within 24 hours. The mechanism may be depletion of sulfhydryl groups.

tolerance

To promote adherence, it is important to inform patients that failure to take digoxin exactly as prescribed may lead to __________ or _____________ ___________.

toxicity; therapeutic failure

What is Empiric Therapy?

treating an infection before the tests confirm the infecting organism

To promote adherence of warfarin, provide the patient with detailed written and verbal instructions regarding the purpose of __________, dosage size and _________, and the importance of careful adherence to the dosing schedule. Also, provide the patient with a ________ on which to keep an ongoing record of warfarin use.

treatment; timing; chart

Sampling for ________ levels depends on the dosing schedule.

trough

The risk of ototoxicity with aminoglycosides is related primarily to persisitently elevated __________ drug levels, rather than to excessive __________ levels.

trough; peak

When once-daily dosing of aminoglycosides is employed, we only need to measure _______ levels. As a rule, there is no need to measure __________ levels because, when the entire daily dose is given at once, high peak levels are guaranteed. In contrast, when _________ doses are employed, we need to measure both the peak and the trough.

trough; peak; divided

Insulin is used to treat all patients with _________ __ diabetes and many patients with _______ __ diabetes.

type 1; type 2

In contract to ____________ heparin, which inactivates factor Xa and thrombin equally, _____ ___________ ______ heparins preferentially inactivate factor Xa.

unfractioned; low-molecular-weight (LMW)

Saw Palmetto used for?

urinary symptoms with BPH careful with pregnancy!! ("saw your pregnancy out" haha)

Sodium-glucose co-transporter 2 (SGLT-2) inhibitors lower blood sugar by increasing excretion of glucose via the _________. SGLT-2 inhibitors can increase the risk of ________________ ______________.

urine; genitourinary infections

What is the best way to prevent influenza

vaccination

Which herbal medicine is used for insomnia and anxiety? It can also potentiate action of other drugs that depress the CNS.

valerian

What is the drug of choice for MRSA

vancomycin

Beta blockers are not used for ________ angina.

variant

Nitroglycerin relieves pain of __________ _________ by relaxing coronary vasospasm, which increases oxygen ____________.

variant angina; supply

Angiotensin II causes ______________ (primarily in the arterioles) and release of ____________. In addition, angiotensin II can promote pathologic changes in the ________ and blood vessels.

vasoconstriction; aldosterone; heart

The RAAS raises blood pressure by causing _____________ and by increasing _________ ____________ (secondary to aldosterone-mediated retention of sodium and water.

vasoconstriction; blood volume

In blood vessels, calcium entry causes ___________, and hence calcium channel blockade causes _______________.

vasoconstriction; vasodilation

ACE inhibitors, ARBs and DRIs lower blood pressure by preventing angiotensin II-mediated __________________ and aldosterone-mediated ______________ expansion.

vasoconstriction; volume

All calcium channel blockers (CCBs) promote ____________, and hence are useful in hypertension and angina pectoris.

vasodilation

ARBs are similar to ACE inhibitors in that they cause __________.____, suppress ____________ release, promote excretion of ___________ and water, reduce ________ __________; and cause birth defects and _____________.

vasodilation; aldosterone; sodium; blood pressure; angioedema

Like the ACE inhibitors and ARBs, aliskiren causes ____________, suppresses ______________ release, promotes excretion of ______________ and water, reduces ________ __________; and causes birth defects and __________

vasodilation; aldosterone; sodium; blood pressure; angioedema

Nitroglycerin and other ogranic nitrates are _____________.

vasodilators

Isosorbide dinitrate (which dilates _______) plus hydrazaline (which dilates ____________) can be used in place of an ACE inhibitor (or ARB) if an ACE inhibitor (or ARB) cannot be used.

veins; arterioles

In the heart, preload is determined by the force of _______ ________.

venous return

Lidocaine (a class IB agent) is used only for _____________ dysrhythmias. The drug is not active against _______________ dysrhythmias.

ventricular; supraventricular

Because of their cardiosuppressant effects, ____________ and ______________ can cause bradycardia, partial or complete AV block, and exacerbation of heart failure.

verapamil; diltiazem

Because they suppress AV conduction, ___________ and ___________ are useful for treating cardiac dysrhythmias (in addition to hypertension and angina pectoris).

verapamil; diltiazem

Ginger root

vertigo

What is the most important determinant of resistance?

vessel diameter

The first sign of _____________ damage is headache, which may last for 1 or 2 days. After that, nausea, unsteadiness, dizziness, and vertigo begin to appear.

vestibular

What is the plasma HIV RNA?

viral load

Amiodarone has been associated with optic neuropathy and optic neuritus, sometimes progressing to blindness. Advise patients to report reductions in ________ acuity or _________ vision.

visual; peripheral

Four factors in the coagulation pathways require an activated form of ___________ ___ for their synthesis.

vitamin K

Moderate warfarin overdose is treated with _________ __.

vitamin K

Natriuretic peptides defend the cardiovascular system from ________ _________- primarily by ________ blood volume and promoting _________.

volume overload; reducing; vasodilation

What is an adverse effect of flagl?

vomiting

What is an adverse effect of metronidazole (flagyl)?

vomiting

Because of its antiplatelet actions, aspirin can increase the risk of bleeding in patients taking ____, ____, and other anticoagulants.

warfarin; heparin

Pioglitazone promotes ___________ retention, and can thereby increase the risk of heart failure. In addition, pioglitazone can cause _______ damage, bladder _________, and _________, and can cause ovulation in anovulator premenopaual women, thereby posing a risk of unintended pregnancy.

water; liver; cancer; fractures

What are the most common side effects of SSRIs?

weight gain, insomnia, agitation, sexual dysfunction, serotonin syndrome with MAOIs

What is Ephedra used for?

weight loss

Green tea used for?

weight loss, improvement of mental clarity, cancers of the stomach

Inform patients that ARBs may taken _______ or _________ food.

with; without

If given to a patient who is physically dependent on pure opioid agonists, an agonist-antagonist will precipitate ____.

withdrawal

Is depression more common in men or women?

Women

For patients receiving once-daily doses, when should trough samples be taken?

a single sample can be drawn 1 hour before the next dose Side note: the trough level value should be very low when taken, preferably close to zero.

A patient who is prescribed an ACE inhibitor complains of tongue swelling and is experiencing obvious dyspnea. What is the priority action by the nurse? a. administer PRN epinephrine b. contact the prescriber c. do nothing

a. Administer PRN epinephrine

When assessing a patient who is scheduled to receive the second dose of newly prescribed sustained-release nitroglycerin, the patient complains of a headache. What should the nurse do? a. Administer the prescribed PRN analgesic such as acetaminophen b. crush the medication to speed absorption through the oral mucosa c. notify the prescriber of the headache STAT d. withhold the drug and consult the prescriber

a. Administer a prescribed PRN analgesic such as acetaminophen

When a patient with HF is prescribed digoxin and furosemide, the nurse should carefully assess the patient for which symptom of digoxin toxicity? a. anorexia and nausea b. anxiety and abdominal cramps c. bone pain and constipation d. muscle spasms and convulsions

a. Anorexia and nausea

The nurse would be especially cautious when administering a nonselective blocker of alpha1, beta1, and b2 receptors to patients with which chronic disorder(s)? (select all that apply.) a. Asthma b. Benign prostatic hyperplasia c. Diabetes Mellitus d. HIV infection e. Rheumatoid arthritis

a. Asthma b. Benign prostatic hyperplasia c. Diabetes Mellitus

The nurse is researching a drug. The handbook states that it decreases after load. Before the nurse administers this medication to a patient, which assessment would be most critical? a. BP for hypotension b. Pulse for tachycardia c. Respirations for tachycardia d. Temp for fever

a. BP for hypotension

The nurse is preparing to administer IV cipro to a patient with septic arthritis after arthroscopic surgery. it would be a priority to review which ordered diagnostic test result as soon as it is available? a. culture and sensitivity (C&S) b. MRI c. Urinalysis d. X-ray

a. Culture and sensitivity

Which laboratory result would be a reason for the nurse to consult the prescriber regarding administration of rbeprazole (AcipHex)? a. Digoin 2.5 ng/mL b. INR 1 c. LDL 138 mg/dL d. WBC 10,000/mm3

a. Digoxin 2.5 ng/ml (normal levels are 0.5-0.8)

What is the most important property of an ideal drug? a. Effectiveness b.Safety c. Selectivity

a. Effectiveness - most important property so that the drug does what you want it to do.

What is the most effective anti-inflammatiory drugs for asthma management? a. Glucocorticoids b. Beta2-Adrenergic Agonists c. Cromolyn d. Theophylline

a. Glucocorticoids

The nurse is caring for several patients who receive beta-agonit inhalation treatments for asthma. After treatments are administered, it is of greatest priority to reassess the patient who also has a history of which condition? a. Heart failure (HF) b. DVT c. GERD d. Rheumatoid arthritis (RA)

a. Heart Failure (excessive dosage of b1 receptors can be activated and cause angina)

The nurse has administered epinephrine IM to a patient with a history of asthma and T1DM. It is a priority to assess for which possible effect of this drug? a. Hot, dry, flushed skin b. Dizziness with position changes c. sensitivity to light d. Tremor

a. Hot, dry, flushed skin

A patient is on warfarin to prevent clots from atrial fibrillation. What test i performed to monitor therapeutic anticoagulation? a. INR b. aPTT c. CK d. BUN

a. INR

the nurse assesses for which symptom of the electrolyte imbalance that is most likely when a patient is receiving large doses of insulin? a. Muscle weakness and constipation b. restlessness and irritability c. Spasm of the wrist and fingers when circulation of the upper arm is constricted for several minutes d. twitching of the facial nerve when the face is tapped over the nerve

a. Muscle weakness and constipation

The principal toxicity of vancomycin is a. Renal failure b. Liver failure c. hypertension d. tinnitus

a. Renal failure

Acetaminophen is associated with? a. stevens johnsons syndrome (SJS) b. reyes syndrome c. red mans syndrome d. none of the above

a. SJS

The ED triage nurse answers the call of a patient who has a history of coronary heart disease and COPD. The patient reports chest pain that has not been relieved by three doses of sublingual nitroglycerin. The appropriate diagnosis is: a. unstable angina b. stable angina c. NSTEMI d. STEMI

a. Unstable angina

what does the term iatrogenic mean? a. a disease that occurs as the result of medical care or treatment b. an adverse drug reaction based on genetic predisposition c. effect is the opposite of the intended drug effect d. effect is a drug-induced birth defect

a. a disease that occurs as the result of medical care or treatment

What is the priority nursing diagnosis for a patient with a dysrhythmia? a. Alteration in cardiac output b. imbalance in fluid and electrolytes c. inadequate peripheral tissue perfusion d. ineffective breathing pattern

a. alteration in cardiac output

What is a drug of choice for myst systemic mycoses? a. Amphotericin B b. Itraconazole c. cephalosporins d. Fluoroquinolones

a. amphotericin B

Drugs that act on the receptor in the body to stop a reaction are referred to as? a. antagonist b. agonists c. partial agonist d. anti-receptors

a. antagonist

What is a priority nursing action when a nurse discovers that a patient self-presceibes herbal products? a. assess for drug interactions and adverse effects of the product b. be an advocate or the patients right to make choices c. convince the patient to stop taking the products d. teach the patient the importance of informing all health care providers of all products being used

a. assess for drug interactions and adverse effects of the product

While infusing acetylcystine for acetaminophine overdose, the nurse notes that the patient is scratching her arms. Which action is of greatest priority at this time? a. assess respirations, breath sounds, and vital signs b. snout the prescriber regarding changing to an oral formula c. report the itching to the prescriber d. stop the infusion and contact the prescriber STAT

a. assess respirations, breath sounds, and vital signs

Which action by the nurse would be a priority for preventing the most common complications of IV acyclovir therapy? a. assess the IV site before infusing b. ensuring a fluid intake of 2500 to 3000 mg/24hr c. report vomiting to prescriber d. teach perineal hygiene

a. assess the IV site before infusing

What is used for short term control of AP? a. baroreceptor reflex b. systemic filling pressure c. naturetic peptides d. kidneys

a. baroreceptor reflex

a patieint brought into the ED after taking aspirin for a headache exhibits the following symptoms. which symptom would be of greatest priority for the nurse to address? a. bronchospasm b. profuse, watery nasal discharge c. tachycardia d. urticaria

a. bronchospasm

The nurse answers a call to the ED form a woman who is prescribed fentanyl loenge on a stick. She stats she found her 2 year old grandson with the med in his mouth. she took it away from him, and he is standing next to her crying. Which action would be greater priority? a. Call 911 b. assess how much drug was consumed c. contact the poison hotline d. rinse out the childs mouth

a. call 911

a cancer patient has been taking increasing doses of OxyContin for pain relief. Which teaching can prevent the adverse effect that is most likely to persist with long-term use of this drug/ a. consume adequate fluids and fiber b. change positions slowly c. do not operate dangerous machinery d. take deep breaths every hour

a. consume adequate fluids and fiber

the nurse is assessing a new admission. The patient lists echinacea, garlic, and kava among produts that she uses regularly. on first observation, the nurse notes that the patients skin has a yellowish color. What is the most appropriate action for the nurse to take next? a. continue to assess the patient b. document jaundice in the nurses notes c. notify the health care provider of the findings STAT d. tell the patient to stop taking the herbal products

a. continue to assess the patient

The nurse is assessing a patient who is receiving meds for acute HF. Which assessment would be priority to report to prescriber? a. cough with frothy sputum b. Expiratory wheezes of bronchi and bronchioles c. pulse 100 bpm d. respirations 25/min

a. cough with frothy sputum

what lab test would be a priority for the nurse when a pt is receiving an amino glycoside? a. creatinine b. fasting blood glucose c. hemoglobin and hematocrit d. INR

a. creatinine

The nurse is reviewing lab tests before preparing to administer a dose of amphotericin B. Before administering the drug, it is a priority to review which lab result? a. creatinine levels b. ECG c. Liver function tests d. WBC count

a. creatinine levels

The nurse is reviewing lab tests before preparing to administer a dose of amphotericin B. Before administering the drug, it is a priority to review which lab result? a. Creatinine levels b. ECG c. Liver function tests d. WBC count

a. creatinine leves, kidney damage can be minimized by administering 1L of saline

What is the most common reason for digoxin induced dysrhythmias?

a. diuretic induced hypokalemia

What is a priority concern for the nurse when a patient with multiple medical disorders self-prescribes St. John's wort? a. effect on other prescribed drugs. b. constipation c. photosensitivity d. potency of the preparation

a. effect on other drugs

What is a priority concern for the nurse when a patient with multiple medical disorders self-prescribes st. johns wort? a. effect on other prescribed drugs b. constipation c. photosensitivity d. potency of preparation

a. effect on other prescribed drugs

Apatient is prescribed diltiazem, a CCB. It would be a priroity to withhold the drug and contact the prescriber if which assessment finding is present? a. heart rate 50 beats per minute b. nausea and vomiting c. profuse sweating

a. heart rate 50 beats per minute

the nurse is preparing to administer 8 am meds to a patient who is receiving an IV infusion.. the pt is going off to a diagnostic test. the patient is to be off the floor in 30 min. What should the nurse do? a. hold the drug infusion until the pt returns from the test b. infuse the drug in 30 min before placing the patient on the cart c. infuse the drug in 45 min while loading the pt on the cart d. set the infusion to run over 90 min

a. hold the drug infusion until the pt returns from the test

Sodium nitroprusside is the drug of choice for? A. hypertensive emergencies b. hyperglycemia c. hypotensive emergencies

a. hypertensive emergencies

What is greatest benefit of combining acetaminophen and an opioid? a. increased therapeutic effects b. allows the patient to take only one pill c. it has a narrow therapeutic range d. causes euphoria

a. increased therapeutic effects

A patient is prescribed drug therapy including bismuth subsalicylate, metronidazole, and tetracycline. the patient reveals to the nurse that she doe not like taking medications all at once. the nurse should explain that it is important for the patient to take the therapy as prescribed, because taking the drugs alone may cause what to occur? a. increasing the risk of developing resistance b. increasing the incident of adverse effects. c. need for increased dose of the individual drugs. d. experience of nausea and diarrhea

a. increasing the risk of developing resistance

the nurse is caring for a patient who admits to using mal order ma huang for weight loss. it is a priority for the nurse to do what? a. assess mental status b. monitor vital signs c. not administer any other sedatives d. weight the patient daily

a. monitor vital signs

To reduce the emergence of resistance to antiviral drugs, what should be priority? a. never use the drug alone b. use only one antiviral drug in treatment c. administer vancomycin d. administer epinephrine along with antiviral treatment

a. never use the drug alone

When administering coprofloxacin (a flurosquinolone), the nurse should monitor for which adverse effect? a. photosensitivity and tendonitis b. nausea and vomiting c. profuse sweating and fainting d. shortness of breath and wheezing

a. photosensitivity and tendonitis

Drugs that dilate arterioles a. reduce cardiac afterload b. reduce cardiac preload

a. reduce cardiac Afterload (Arterioles; Afterload)

Which drug is the most effective for lowering LDL cholesterol? a. statins b. nitroglycerine c. sodium nitroprusside d. fibrates

a. statins

tetracycline can cause esophageal ulceration. What can the nurse teach to minimize ther risk of this adverse effect? a. stay upright for at least 30 min after taking the med b. take the med at bedtime c. take the med with antacid. d. take med with milk

a. stay upright at least 30 min after taking the med

According to pharmacology, the most important factor that determines venous return is: a. systemic filling pressure b. cardiac output c. vessel diameter d. blood viscosity

a. systemic filling pressure

What is the potential cause of a patient experiencing agitation, rhinorrhea, and yawning after administration of pentazocine, nalbuphine, butorphanol, or buprenorphine? a. the patient has an opioid agonist in her system. b. the patient is allergic to the drug. c. the patient is experiencing a common adverse effect of the drug d. the patient is unable to excrete the drug

a. the patient has an opioid agonist in her system

It is important for the nurse to discuss adverse effects of the antihypertensive drugs that are prescribed because the nurse knows what about the drugs adverse effects? a. they affect adherence b. they are life-threatening c. they are necessary if the antihypertensive is at a dose that is effective d. they reflect the cause of hypertension

a. they affect adhereane

A patient admitted with chest pain has IV heparin infusing. What lab test will the nurse use to titrate the heparin infusion for therapeutic anticoagulation? CBC (complete blood count) aPTT (activated partial thromboplastin time) INR (international normalized ratio) BMP (basic metabolic panel)

aPTT (activated partial thromboplastin time)

Because opioids produce euphoria and other desirable subjective effects, they have a high liability for ____.

abuse

Dispel your concerns about ____ and ____ and give your patients the medication they need to relieve suffering. That's what opioids are for, after all.

abuse; addiction

To be effective, ____________ must be taken with every meal.

acarbose

Acetaminophen overdose is treated with PO or IV ____, a drug that substitutes for depleted glutathione in the reaction that clears the toxic metabolite of ____.

acetylcysteine; acetaminophen

When a combination of drugs is used for hypertension, each drugs should have a different mechanism of __________.

action

Heparin therapy is monitored by measuring the ______________ ___________ _____________ ________.

activated partial thromboplastin time (aPTT)

In patients with __________ ___________ __________, ACE inhibitors decrease mortality, severe heart failure, and recurrent MI. All patients should receive an ACE inhibitor in the absence of specific contraindications. For patients who cannot tolerate ACE inhibitors, an ___________ ____________ _________ should be used.

acute myocardial infarction (MI); angiotensin II receptor blocker (ARB)

Dosages of antihypertensive drugs should be low initially and then gradually increased. This approach minimizes ____________ ___________ and permits _____________ to reset to a lower pressure.

adverse effects; baroreceptors

In the past, drugs for type 2 diabetes were started only _________ a program of diet modification and exercise had failed to yield glycemic control. Today, drugs (usually metformin) are started _____________ after diagnosis, but always in conjunction with diet modification and exercise.

after; immediately

Which statement made by your patient informs you that the patient has done their homework on herbal medications? "I know drinking this cranberry juice because I know it will keep me from getting a UTI" "I would like to take Ma Huang (Ephedra) to lose weight but am hypertensive so decided it was a bad idea to do so" "I'm going to take St. John's Wort for my prenatal nausea" "I'm taking garlic to treat my colon cancer"

"I would like to take Ma Huang (Ephedra) to lose weight but am hypertensive so decided it was a bad idea to do so"

What are the two basic effects of insulin?

(1) stimulates cellular uptake of glucose, amino acids, and potassium (2) promotes synthesis of complex organic molecules (glycogen, proteins, triglycerides)

Principal indications for beta-adrenergic antagonists are hypertension, angina pectoris, heart failure, and cardiac dysrhythmias. To evaluate therapeutic effects, what should the nurse advise patients to do?

-Advise outpatients to monitor blood pressure and heart rate daily. -Advise patients to record the incidence, circumstances, and severity of anginal attacks.

What are some undesirable effects for herbal therapies?

-Allergic reactions -Adverse /toxic reaction - renal, hepatic, GI, neurological, CV -Adversely effect therapeutic levels of prescribed meds or lab tests (St. John's Wort, Ginkgo, Ginseng, etc) -May self-treat an illness with an unfavorable outcome; may have been treated successfully with traditional medical care -Cost = out-of-pocket expense -Commercial harvesting of herbs may pose a threat to biodiversity & possible extinction of some plants

What are important nursing considerations about herbal supplements?

-Always ask about herbal meds, nutritional supplements, homeopathy, OTC meds, treatment from healers, other CAM therapies and document on health record -Encourage them to discuss herbal use with their provider -Instruct on length of time that herbal meds and other OTC supplements should be discontinued before invasive/surgical procedures -Provide info on how to identify reputable resources for herbal info

The Renin-Angiotensin Aldosterone System (RAAS) acts through production of which two hormones?

-Angiotensin II -Aldosterone

Beneficial effects of ACE inhibitors result largely from inhibition of _____________ _______________ ____________ and partly from inhibition of ___________ __ (the name for ACE when the substrate is bradykinin).

-Angiotensin-Converting Enzyme (ACE) -kinase II

What is arterial pressure regulated by?

-Autonomic nervous system (ANS) -Renin-Angiotensin-Aldosterone System (RAAS) -The kidneys -Natriuretic peptides (ANP, BNP, CNP)

Tetracyclines are first-choice drugs for just a few infections. Name some of these infections:

-Chlamydia trachomatis -rickettsia (eg, Rocky Mountain spotted fever) -H. pylori (ie, peptic ulcer disease) -B. anthracis (anthrax) -Borrelia burgdorferi (Lyme disease) -M. pneuomoniae

What are the three forms of angina pectoris?

-Chronic stable angina -Variant (vasospastic) angina -Unstable angina

What are some important things for consumers to keep in mind?

-Don't assume that "natural is safe" or "more is better" -Stop herb immediately if unpleasant effects occur -Children and elderly are at greater risk and may need smaller doses -Report adverse reactions to the CDC, FDA, or Poison Control Centers.

What are the two kinds to treatment that may be used to reduce blood pressure?

-Drug therapy -Lifestyle modification (smoking cessation, reduction of salt and alcohol intake, following the DASH diet, and increasing aerobic exercise.

When providing patient education about hypertension and adherence, what is important to tell them?

-Educate patients about the long-term consequences of hypertension and the ability of lifestyle changes and drug therapy to decrease morbidity and prolong life. -Inform patients that drugs do not cure hypertension, and therefore must usually be taken lifelong.

Why use dietary supplements?

-Empowerment of self diagnosis -Wanting to be "natural" -Provides new choices -Personal control -Lower cost -Easy availability -Frustration, inadequate response, or distrust with traditional medicine -Persuasive marketing

What are five principal indications for vasodilators?

-Essential hypertension -Hypertensive crisis -Angina pectoris -Heart failure -Myocardial infarction

The first-dose effect, which may cause fainting from severe orthostatic hypotension, is a possible adverse effect from alpha1 adrenergic antagonists. What should the nurse tell the patient to minimize the first-dose effect?

-Forewarn patients about first-dose hypotension and advise them to avoid driving and other hazardous activities for 12 to 24 hours after the initial dose. -To minimize risk, advise patients to take the first dose at bedtime.

What three things can untreated hypertension lead to?

-Heart disease -Kidney disease -Stroke

What is cardiac oxygen demand determined by?

-Heart rate -Contractility -Preload -Afterload Note: Drugs that reduce these factors can help relieve anginal pain.

Type 1 diabetes and type 2 diabetes share the same long-term complications. Name several of these complications.

-Hypertension -Heart disease -stroke -blindness -renal failure -neuropathy -lower limb amputations -erectile dysfunction -gastroparesis -others

What are three reasons why adherence to hypertensive treatment is difficult to achieve?

-Hypertension has no symptoms (so drug benefits aren't obvious). -Hypertension progresses slowly (so patients think they can postpone treatment) -Treatment is complex and expensive, continues lifelong, and can cause adverse effects.

What two things are important to teach patients about with regards to adverse cardiotoxic effects of digoxin?

-Inform outpatients about the danger of dysrhythmias. Teach them to monitor their pulses for rate and rhythm, and instruct them to notify the prescriber if significant changes occur. -Teach patients to recognize early symptoms of hypokalemia, such as muscle weakness, and instruct them to notify the prescriber if these develop.

Orthostatic hypotension is a possible adverse effect of nitroglycerin, secondary to vasodilation. What can nurses tell patients regarding this?

-Inform patients about symptoms of hypotension (eg, dizziness, lightheadedness), and advise them to sit or lie down if these occur. -Inform patients that hypotension can be minimized by moving slowly when changing from a sitting or supine position to an upright posture.

Postural (orthostatic) hypotension can be caused by alpha1 blockade and by beta-adrenergic antagonists that also block alpha-adrenergic receptors, like carvedilol and labetalol. What should the nurse tell the patient to minimize postural (orthostatic) hypotension?

-Inform patients about the symptoms of orthostatic hypotension (dizziness or lightheadedness on standing) and advise them to sit or lie down if these occur. -Advise patients to move slowly when changing from a supine or sitting position to an upright posture.

What should nurses consider when administering a benzodiazepine?

-Know how to recognize benzo withdrawal (anxiety, insomnia, tremors, dizzienss) -Know that benzos are dangerous when taken with other CNS depressant drugs such as opioids or alcohol (watch for low, shallow respirations) -Benzos are VERY dangerous with pregnancy (Class D) -Very dangerous with breastfeeding

What are two drugs of choice for treating chronic hypertension of pregnancy?

-Methyldopa -Labetalol

What are three examples of monoamine oxidase inhibitors (MAOIs)?

-Nardil -Parnate -Marplan "No Popular Meds"

What three side effects do nitroglycerin cause and what do they occur secondary to?

-Nitroglycerin causes three characteristic side effects: headache, orthostatic hypotension, and reflex tachycardia. -All three occur secondary to vasodilation.

What patients should loop diuretics be reserved for?

-Patients who need greater diuresis than can be achieved with thiazides -Patients with a low glomerular filtration rate (GFR) (because thiazides don't work when GFR is low)

What two enzymes play very important roles in forming angiotensin II?

-Renin (catalyzes the formation of angiotensin I from angiotensinogen) -Angiotensin-Converting Enzyme (ACE; catalyzes the conversion of angiotensin I into angiotensin II)

How do SNRIs work differently than SSRIs and how do their side effects and adverse effects differ?

-SNRIs work very similar to SSRIs, but they inhibit the reuptake of both serotonin and norepinephrine -common side effects and adverse effects are the same as SSRIs

What do the symptoms of type 1 diabetes result from? What is the underlying cause of type 1 diabetes?

-Symptoms of type 1 diabetes result from a complete absence of insulin. -The underlying cause is autoimmune destruction of pancreatic beta cells.

Verapamil and diltiazem are indicated for angina pectoris. What is it important for the nurse to teach patients regarding this?

-Teach patients to chart the time, intensity, and circumstances of their attacks, and to notify the prescriber if attacks increase.

In what two ways do thiazide diuretics (eg, hydrochlorothiazide, chlorthalidone) and loop diuretics (eg, furosemide) reduce blood pressure?

-They reduce blood volume (by promoting diuresis) -They reduce arterial resistance (by an unknown mechanism)

What three drugs are safe and effective alternatives to penicillins for patients with penicillin allergy?

-Vancomycin -Erythromycin -Clindamycin

What is heart failure with left ventricular (LV) systolic dysfunction, referred to simply as heart failure (HF) in this chapter, characterized by?

-Ventricular dysfunction -Reduced cardiac output -Signs of inadequate tissue perfusion (fatigue, shortness of breath, exercise intolerance) -Signs of fluid overload (venous distension, peripheral edema, pulmonary edema)

Constipation is an adverse effect that occurs primarily with ____________. What is important to tell patients regarding constipation?

-Verapamil; Advise patients that constipation can be minimized by increasing dietary fluid and fiber.

Hemmorhage is the major complication of warfarin therapy, as well as clopidogrel therapy. What can nurses tell patients regarding this?

-Warn patients about the danger of hemmorhage, and inform them about signs of bleeding. These include reduced blood pressure, elevated heart rate, discolored urine or stools, bruises, petechiae, hematomas, persistent headache or faintness (suggestive of cerebral hemorrhage), pelvic pain (suggestive of ovarian hemorrhage), and lumbar pain (suggestive of adrenal hemmorhage) -Instruct the patient to withhold warfarin and notify the prescriber if signs of bleeding are noted. Advise the patient to wear some form of identification (eg, Medic Alert bracelet) to alert emergency personnel of warfarin use. -To reduce the incidence of bleeding, advise the patient to avoid excessive consumption of alcohol. Suggest use of a soft toothbrush to prevent bleeding from the gums. Advise patients to shave with an electric razor. -Warfarin intensifies bleeding during surgical procedures. Instruct the patient to make certain the surgeon is aware of warfarin use.

A persistent cough can occur as an adverse effect of ACE inhibitors. What should the nurse tell patients regarding this?

-Warn patients about the possibility of persistent, dry, irritating, nonproductive cough. -Instruct them to consult the prescriber if cough is bothersome.

Abrupt withdrawal of beta blockers can cause tachycardia and ventricular dysrhythmias, known as rebound cardiac excitation. What is important for the nurse to tell the patient regarding this?

-Warn patients against abrupt discontinuation of drug use. -Also, advise patients, when traveling, to carry an adequate supply of medication plus a copy of their prescription.

Beta1 blockade can mask early signs and symptoms of hypoglycemia by preventing common tachycardia, tremors, and perspiration. What is important to tell patients who are on beta blockers and are diabetic?

-Warn patients that tachycardia, tremors, and perspiration cannot be relied on as an indicator of impending hypoglycemia, and teach them to recognize other indicators, like hunger, fatigue, and poor concentration, that blood glucose if falling dangerously low.

What lifestyle modifications should nurses recommend to patients and what advise could they give them to help?

-Weight reduction: Help patient develop an exercise and weight management program if needed. -Sodium restriction: Encourage patients to consume no more than 2300 mg of salt daily and provide them with information on the salt contents of foods. -DASH diet: Encourage patients to adopt a diet rich in fruits, vegetables, and low-fat dairy products, and low in total fat, unsaturated fat, and cholesterol. -Alcohol restriction: Encourage patients to limit alcohol consumption to 1 ounce/day (for most men) and 0.5 ounce/day (for women and lighter weight men). -Exercise: Encourage patients with a sedentary lifestyle to perform 30 to 45 minutes of aerobic exercise (eg, walking, swimming, bicycling) most days of the week. -Smoking cessation: Strongly encourage patients to quit smoking. Teach patients about aids for smoking cessation (eg, nicotine patch,bupropion, varenicline).

For routine therapy what three drugs is stage C heart failure treated with?

-a diuretic -an ACE inhibitor or an ARB -a beta blocker

With treating chronic stable angina, what two types of drugs can be used to decrease the risk of MI and death?

-antiplatelet agents (aspirin, clopidogrel) -cholesterol-lowering drugs

What are four potential adverse effects from beta1 blockade?

-bradycardia -reduced cardiac output -AV block -precipitation of heart failure (although some beta blockers are used to treat heart failure)

What are two potential adverse effects from beta2 blockade?

-bronchoconstriction (a concern for people with asthma) -glycogenolysis (a concern for people with diabetes)

What are some of the clinical features of major depression needed for diagnosis?

-depressed mood -loss of pleasure or interest (anhedonia) -weight loss or gain (5%) or change in appetite -insomnia or hypersomnia -psychomotor agitation or retardation -fatigue/loss of energy -feelings of worthlessness or guilt -inability to concentrate or make decisions -recurrent thoughts of death or suicide (need at least 5 of these to be diagnosed)

What are the three major groups of drugs for heart failure?

-diuretics -ACE inhibitors or ARBs -beta blockers -Digoxin, which had been used widely in the past, may be added as indicated.

What are some adverse effects of MAOIs?

-excessive CNS stimulation -orthostatic hypotension -hypertensive crisis from dietary tyramine

What are the two kinds of action potentials that the heart employs?

-fast potentials -slow potentials

What does anxiety look like?

-feeling nervous -racing thoughts, can't concentrate -talking louder than usual, pressured voice -disturbed sleeping pattern -chest discomfort, heart palpitation, shortness of breath -dizziness, shakiness, noxious, faint -fearful, decreased eye contact -social isolation

Which two groups are NSAIDs subdivided into?

-first-generation NSAIDs, which inhibit COX-1 and COX-2 -second-generation NSAIDs, which selectively inhibit COX-2

What are the three groups beta blockers can be divided into?

-first-generation agents (non-selective beta blockers, such as propanolol, which block beta1 and beta2 receptors) -second-generation agents (cardioselective beta blockers, such as metoprolol, which block beta1 receptors only at usual doses) -third-generation agents (vasodilating beta blockers, which may be cardioselective or nonselective)

What are two principal adverse effects from beta2 activation?

-hyperglycemia (mainly in diabetic patients) -tremor

What are the four principal cardiovascular indications for beta blockers?

-hypertension -angina pectoris -heart failure -supraventricular tachydysrhythmias

What are two major adverse effects that can result from alpha1 activation.

-hypertension -local necrosis (if extravasation occurs)

What are 5 major side effects of ACE inhibitors?

-hypotension -hyperkalemia -cough -angioedema -birth defects

The generic names of beta1 and beta2 receptor antagonists share what common suffix?

-lol

What are some presentations for depression?

-multiple unexplained symptoms and possibly multiple medical visits -work or relationship relationships -dampened affect (how a person presents themselves) -poor behavioral follow-through with ADLs or prior treatment recommendations -weight gain or loss -sleep disturbances -fatigue -dementia -GI distress -volunteered complains of stress or mood disturbances

What three factors determine the value of stroke volume?

-myocardial contractility -cardiac preload -cardiac afterload

Compared with warfarin, dabigatran has three disadvantages:

-no antidote -limited clinical experience -more GI disturbances (dyspepsia, ulceration, gastritis, etc.)

What are some nursing considerations for psychotherapeutic drugs?

-ongoing patient education is key -obtaining informed consent -most psychotropic drugs are dangerous during pregnancy -keep provider updated on negative side effects -observing and documenting changes in mood, behaviors, and sleep throughout treatment course -carefully watch patient swallow medication -in WI, sometimes psychotherapeutic drugs are court ordered by a judge

What are the adverse effects of TCAs?

-orthostatic hypotension -photophobia -diaphoresis -sedation -hypomania -yawngasm -cardiac toxicity ** TCAs have long half-lives and are very dangerous in overdose

What are four major adverse effects of alpha blockers?

-orthostatic hypotension (caused by blocking alpha1 receptors on veins) -reflex tachycardia (caused by blocking alpha1 receptors on arterioles) -nasal congestion (caused by blocking alpha1 receptors in blood vessels of the nasal mucosa) -inhibition of ejaculation (caused by blocking alpha1 receptors in male sex organs)

The generic names of alpha1 receptor antagonists share what common suffix?

-osin

What are the two objectives for treatment in patients with chronic stable agina?

-prevention of MI and death -prevention of anginal pain

The nurse recognizes that the generic names of ACE inhibitors end in which suffix?

-pril

Most adrenergic agonists act by direct activation of adrenergic receptors. What are the indirect mechanisms by which adrenergic agonists act?

-promotion of norepinehprine (NE) release -blockade of NE uptake -inhibition of NE breakdown

Compared with warfarin, dabigatran has five advantages:

-rapid onset -fixed dosage -no need for coagulation testing -few food-drug interactions -lower risk of hemorrhage stroke and other major bleeds

What are some risk factors for depression?

-recent stressful life or traumatic events -lack of close interpersonal relationships -alcohol or substance abuse (they interfere with thinking process in the brain) -domestic abuse/violence -postpartum period (there are many changes in hormones and neurotransmitters after pregnancy) -chronic mental or medical illness (80% of patients with depression have a comorbidity like bipolar or schizophrenia)

What is the goal of treatment with both type 1 and type 2 diabetes?

-reduce long-term complications, including death

What are some nonpharmacologic ways to help a depressed person?

-refer to community resources, hot lines, support groups -collaborative care model -educate and engage the patient -establish a follow up plan -cognitive-behavioral therapy -psychotherapy -refer for suicidal ideation, prior attempt, plan, or behavior (electroconvulsive therapy which induces controlled seizures)

What are the seven types of insulin that are used in the Unites States?

-regular insulin (human insulin) -NPH insulin -five human insulin analogs: insulin lispro, insulin aspart, insulin glulisine, insulin detemir, and insulin glargine

What are the four major goals for therapy of stage C heart failure?

-relief of pulmonary and peripheral congestion -improvement of functional status and quality of life -delay of progression of cardiac remodeling and left ventricular dysfunction -prolongation of life

Name symptoms that could lead to a diagnosis of generalized anxiety, according to the DSM?

-restlessness or feeling keyed up or on the edge -being easily fatigued -difficulty concentrating or mind going blank -irritability -muscle tension -sleep disturbance **3 or more need to be present for a diagnosis

The nurse recognizes that the generic names of ARB drugs end in which suffix?

-sartan

What are the four major beneficial actions of aspirin?

-suppression of inflammation -relief of mild to moderate pain -reduction of fever -prevention of MI and stroke (secondary to suppressing platelet aggregation *All of these benefits result from inhibiting COX-2, except for prevention of MI and stroke, which results from inhibiting COX-1 (in platelets)

What factors are important to consider when an antidepressant is selected for a patient?

-symptoms -side effects -patient history -comorbid conditions -safety in overdose -availability and costs -drug-drug interactions -clinicians familiarity

What are some important things to remind patients that are taking antidepressants?

-symptoms resolve slowly -doses are started low -initial response happens in 1 to 3 weeks -maximal response happens in 12 weeks

What are three potential adverse effects from beta1 activation?

-tachycardia -dysrhythmias -angina

What are some symptoms of hypoglycemia?

-tachycardia -palpitations -sweating -headache -confusion -drowsiness -fatifue If hypoglycemia is severe, convulsions, coma, and death may follow.

What are the adverse effects of benzodiazepines?

-too much CNS depression (resulting in confusion and poor muscle control) -anterograde amnesia -sleep driving and sleep walking -paradoxical effects (rebound anxiety)

What drug classes are usually prescribed for depression?

-tricyclic antidepressants -selective serotonin reuptake inhibitors (SSRI) -serotonin/norepinephrine reuptake inhibitors (SNRI) -monoamine oxidase inhibitors -atypical antidepressants (buproprion [Wellbutrin], mirtazapine [Remeron], trazadone)

What are the two major forms of diabetes?

-type 1 diabetes -type 2 diabetes

What should nurses do when caring for an anxious patient?

-use a calm voice -clear simple phrases -change environment to eliminate stressors -spend time listening if patient needs to vent -encourage deep breaths -finding a distracting activity can help -know anxiety meds and how to use them

What is the normal Digoxin range?

0.5-0.8 ng/ml

The nurse has done an initial assessment on assigned patients and is preparing to administer prescribed, scheduled insulin. All patients are alert and oriented x4. It is 0807 and breakfast trays are scheduled to arrive at 0845. It would be most appropriate for the nurse to administer the insulin first to the patient who has: 0730 chemstrip of 100mg/dL; prescribed insulin aspart (NovoLog) 5 units 0730 chemstrip of 110 mg/dL; prescribed insulin glulisine (Apidra) 7 units 0730 chemstrip of 80 mg/dL; prescribed NPH insulin (Novolin) N 34 units 0730 cehmstrip of 90 mg/dL; prescribed regular insulin (Humulin R) 5 units

0730 chemstrip of 80 mg/dL; prescribed NPH insulin (Novolin) N 34 units

What yields the best patient outcomes with antidepressants?

A combination of antidepressants and talk therapy

What two things need to happen for a severe hypertensive emergency to exist?

A severe hypertensive emergency exists when: -diastolic blood pressure exceeds 120 mm Hg -ongoing end-organ damage is present

A patient is prescribed diltiazem (Cardizem). It would be a priority to withhold the drug and contact the prescriber if which assessment finding is present? a. BP 150/85 mm Hg b. constipation c. Dizziness with position changes d. Pulse 50 bpm

A. BP 150/85 mm Hg

A patient who is prescribed tobramycin complains of a headache a. Assess the onset, characteristics, and associated symptoms of the headache b. medicate with acetaminophen and reassess in 1 hour c. withhold the tobramycin and notify the prescriber when making rounds d. withhold the tobramycin and notify the prescriber STAT

A. assess the onset, characteristics, and associated symptoms of the headache (assessing for tinnitus)

In patients with heart failure, _______ _____________ improve functional status and reduce mortality. In the absence of specific contraindications, all patients should get one.

ACE inhibitors

The ____ regulates arterial pressure (AP) through (1) tonic control of heart rate and peripheral resistance and (2) through the ________ _______.

ANS; baroreceptor reflex

In patients with heart failure, ______ should be reserved for patients to intolerant of ACE inhibitors (usually owing to ______).

ARBs; cough

Impulses originating in the SA node must travel through the ____ ______ to reach the ventricles. Impulses arriving at the AV node are delayed before going on to excite the ____________.

AV (atrioventricular) node; ventricles

Treatment of supraventricular tachydysrhythmias is often directed at blocking impulse conduction through the ___ ________, rather than at eliminating the dysrhythmia.

AV node

Ginkgo used for?

Painless walking. seizure risk

What is the most frequently reported bacterial sexually transmitted infection? Syphilis Trichomoniasis Chlamydia Gonorrhea

Chlamydia

Dietary supplements are minimally regulated by the ___ ___ ____ ____.

Food and Drug Administration (FDA)

For patients with chronic asymptomatic HIV disease, therapy is now recommended with the CD4 count drops below?

500 cell mm3

It would be a priority for the nurse to respond to which symptoms if exhibited by a patient who is receiving insulin therapy for diabetes mellitus (DM)? Fatigue and blurred vision Perineal itching and copious urine Profuse sweating and difficult to arouse Thirst and constant hunger

Profuse sweating and difficult to arouse

Name a berry good effect that cranberries have?

Promote urinary tract health

For patients with chronic asymptomatic HIV disease, therapy is now recommended when the CD4 count drops below 350 cells/mm to the third 100 cells/mm to the third 500 cells/mm to the third 200 cells/mm to the third

500 cells/mm to the third

The adult circulatory system contains __ L of blood, 64% of which is in _________ veins.

5; systemic

What A1C value is considered diagnostic of diabetes mellitus? 6.5% 7% 5.5% 6%

6.5

Diabetes is diagnosed if (1) hemoglobin A1c is ____ or higher; (2) fasting plasma glucose is __________ mg/dL or higher; or (3) the casual blood glucose is ______ mg/dL or higher, and the patient has the classic signs and symptoms of diabetes: ___________, ___________, and sudden ___________ _________ that cannot be attributed to other common causes.

6.5%; 126; 200; polyuria; polydipsia; weight loss

What is the target activated partial thromboplastin time (aPTT)?

60 to 80 seconds (ie, 1.5 to 2 times the normal value of 40 seconds).

What is the target HA1C level that generally indicates a diabetic has good glycemic control? 6.5% 8% 7% 7.5%

7%

Hypoglycemia is defined as a blood glucose level below: 90 mg/dL 70 mg/dL 60 mg/dL 50 mg/dL

70 mg/dL

A patient you are caring for weighs 186 pounds. How many kilograms does your patient weigh?

84.5 kg

The emergency department (ED) triage nurse answers the call of a patient who as a history of coronary heart disease and chronic obstructive pulmonary disease (COPD). The patient reports chest pain that has not been relieved by three doses of sublingual nitroglycerin. The appropriate diagnosis here is: Unstable angina Stable angina A myocardial infarction A STEMI

A STEMI

In retrospective, observational studies, omeprazole and other PPIs have been associated with a dose-related increase in the risk of which infection? E. Coli C. Difficile H. pylori Klebsiella

C. Difficile

What can result from rapid infusion of IV vancomycin? a. Thrush b. Candida Albicans c. Red Mans syndrome d. Stevens Johnsons Syndrome

C. Red Mans Syndrome

Clindamycin causes a high incidence of ____-____________ ____________ ____________.

C. dfficile-associated diarrhea (CDAD)

Omerazole and other PPIs have been associated with a dose-related increase in risk for which adverse effect?

C.diff

Patients with an inherited deficiency in _________ may an unreliable response to clopidogrel.

CYP2C19

Erythromycin is generally safe. However, combined use of erythromycin with inhibitors of _____________ increases the risk of QT prlongation and sudden cardiac death.

CYP3A4

For patients receiving divided doses, when should trough samples be taken?

Just before the next dose

_______________ can stain developing teeth, and therefore should not be given to pregnant women and breast-feeding women or children under __ years old.

Tetracyclines; 8

We do not understand with precision how ____ drugs produce their effects.

CNS

When aminoglycosides are prescribed IV as a once-daily dose, it is important to monitor trough levels 30 minutes before the next dose 1 hour after completing the dose 1 hour before the next dose 30 minutes after completing the infusion

1 hour before the next dose

In addition to the small pressure head in venules, what three mechanisms help ensure venous return to the heart?

1) Negative pressure in the right atrium sucks blood toward the heart. 2) Constriction of veins increase venous pressure, and thereby drives blood toward the heart. 3) Contraction of skeletal muscles, in conjunction with one-way venous valves, pumps blood toward the heart.

Hypertension is defined as systolic blood pressure (SBP) greater than ____ mm Hg or diastolic blood pressure (DPG) greater than ___ mm Hg in patients 18 to 59 years of age.

140; 90

To enhance therapeutic effects of digoxin: -Advise patients to limit sodium to ______ mg/day, and to avoid excessive fluids. -Advise patients who drink alcohol to consume no more than _____ drink each day. -Help patients establish an appropriate program of regular, mild ___________ (eg, walking, cycling)

1500; one; exercise

instruct patients to take oral penecillins with a full glass of water __ hour before meals or __ hours after.

1; 2

With patients taking erythromycin to take oral preparations on an empty stomach (___ hour before meals or __ hours after) and with a full glass of water. However, if ____ __________ occurs, administration may be done with meals.

1; 2; GI upset

Instruct patients to allow at least ___ hours between ingestion of tetracyclines and these chelators: __________ products, ___________ supplements, ________ supplements, ___________-containing laxatives, and most __________.

2; milk; calcium; iron; magnesium; antacids

Patients are often instructed to stop taking herbal supplements _ ____ before surgery.

2 weeks

What does activation of alpha1 receptors cause?

Activation of alpha1 receptors causes vasoconstricion and mydriasis (dilation of the pupil).

You are administering 2 grams of an antibiotic to a patient with an infection. How many milligrams will you administer?

2000 mg

To prevent digoxin toxicity or therapeutic failure in digoxin, it is important to keep potassium levels in the normal physiologic range, as potassium competes with digoxin for binding to Na+, K+-ATPase. What is the normal physiologic range for potassium?

3.5 to 5 mEq/L

What is the normal potassium range?

3.5-5 mEq/L

Samples for peak levels should be taken ___ __________ __________ giving an IM injection or after completing a 30-minute IV infusion.

30 minutes after

The mean age of onset for depression is ___ years.

40

How do you calculate the Therapeutic index (TI)?

A measure of a drugs safety lethal dose over the effective dose. if the number is low, that indicates that the drug has a very narrow therapeutic index. TI=LD50/ED50

What effect does the activation of cardiac beta1 receptors have, and what does this mean/do?

Activation of cardiac beta1 receptors has a positive inotropic effect. This increases heart rate, force of contraction, and conduction through the AV node.

What is a panic attack?

A panic attack is a discrete period of intense fear or discomfort. Symptoms develop abruptly and reach a peak within 10 minutes. Some symptoms may include palpitations, pounding heart, accelerated HR, sweating, strembling or shaking, sensations of SOB, feeling of choking, chest pain or discomfort, nausea or abdominal distress, dizzy, unsteady, lightheaded, fear of losing control or going crazy, fear of dying, numbness or tingling, chills or hot flashes, etc.

Drugs that activate beta 1 receptors in the heart can improve cardiac performance by increasing the force of a contraction in a patient with heart failure. This increase in the force of contraction is known as: A dysrhythmia An arrhythmia A positive inotropic effect A positive chronotropic effect

A positive inotropic effect

What is the order of pharmacokinetics?

Absorption Distribution Metabolism Excretion (ADME)

____ is defined as drug use that is inconsistent with medical or social norms.

Abuse

____ may increase the risk of warfarin-induced bleeding by inhibiting the metabolism of warfarin.

Acetaminophen

____ is associated with SJS, AGEP, and TEN. If rash appears, this may be a ____ ____.

Acetaminophen; medical emergency

_________ is defined as the load against which a muscle exerts its force.

Afterload

______________ ____________ (spironolactone, eplerenone) block receptors for aldosterone.

Aldosterone antagonists

___________, a direct renin inhibitor (DRI) binds tightly with renin and thereby inhibits cleavage of __________________________ into angiotensin I.

Aliskiren; angiotensinogen

Untreated hypertension can lead to Heart disease Kidney disease Stroke All of the above

All of the above

Which lifestyle modifications are strongly encouraged in patients with primary hypertension? Sodium restriction and the DASH eating plan Smoking cessation and alcohol restriction Aerobic exercise and weight loss All of the above

All of the above

The aging process can affect all phases of the pharmacokinetic process. Physiologic changes that can affect excretion are

All of the above - decrease renal blood flow and GFR; decreased renal tubular secretion; decreased number of nephrons

What is the principal adverse effect of penicillins? Nausea Vomiting Allergic reaction Diarrhea

Allergic reactio

Which nursing action would best meet the therapeutic objective of drug therapy? Assessing the patient for adverse effects Prescribing a drug with the fewest adverse effects Prescribing a drug with the fewest serious adverse effects Recommending that a patient avoid taking drugs because there are possible adverse effects

Assessing the patient for adverse effects

Beta-adrenergic antagonists should be used with caution in patients who have: Asthma Peptic ulcer disease BPH Hepatitis

Asthma

By inhibiting ____, the second-generation NNSAIDs (coxibs) can suppress ____, ____, and ____.

COX-2; inflammation; pain; fever

What are the adverse effects of sleep hypnosis?

CNS depression (daytime drowsiness, dizziness, impaired motor coordination, amnesia)

This antidepressant is often used for smoking cessation: Fluoxetine Amitriptyline Bupropion Selegiline

Bupropion

this antidepressant is often used for smoking cessation: a. Bupropion b. Ziopidem c. zaleplon d. eszopicone

Bupropion

Which drug can help with seasonal affective disorder (SAD)?

Bupropion (Wellbutrin)

____ (____) is prescribed for smoking cessation.

Bupropion (Wellbutrin), also known as Zyban

Which classification of drugs are first-line medications for patients with fluid overload? ACE inhibitors Diuretics ARBs Beta blockers

Diuretics

A patient has been taking citalopram (Celexa), an SSRI, for the past 6 months and is complaining of sexual problems. The doctor prescribes another antidepressant to take with the citalopram. Which antidepressant would this be? a.) Trazodone b.) Venlafaxine (Effexor) c.) Wellbutrin d.) Fluoxetine (Prozac)

C (buproprion (Wellbutrin) goes well with SSRIs.

The ___ often undergoes adaptive changes during prolonged drug exposure. The result can be ____ therapeutic effects, ____ side effects, tolerance, and physical dependence.

CNS; increased; decreased

Inhibition of ____ can cause gastric ulceration, renal impairment, and bleeding.

COX-1

Cyclooxygenase (COX) has two forms: ____ and ____.

COX-1 and COX-2

All of the nonaspirin first-generation NSAIDs are much like aspirin itself. All of these drugs inhibit ____ and ____; they all can suppress inflammation, pain, and fever; and they all can cause ____ ____, ____ impairment, and ____.

COX-1; COX-2; gastric ulceration; renal; bleeding

A patient taking the MAOI, nardil, tells the nurse that she also started taking St. John's Wort for her depression. What information should the nurse discuss with the patient next? a.) Discuss the need to avoid tyramine-rich foods b.) Tell the patient to wear sunscreen when outdoors c.) Tell the patient to stop taking the herbal supplement.

C - tell patient to stop taking the herbal supplement, St John's wort, because it interferes with antidepressants

By sparing ____, the coxibs may cause ____ gastric ulceration than the first-generation NSAIDs.

COX-1; less

Inhibition of ____ suppresses inflammation, pain, and fever, but can also cause renal impairment.

COX-2

what are the major drugs for heart failure?

Diuretics, Ace inhibitors, ARBs, Beta blockers

When treating infection, what is (are) the therapeutic objective(s) of the treatment? To promote maximal antimicrobial effects To cause minimal harm to the host To always kill the bacteria Both a and b

Both a and b

Which antibiotics promote the emergence of drug resistance? Narrow-spectrum antibiotics Antibiotics used prophylactically Broad-spectrum antibiotics Antibiotic combinations

Broad-spectrum antibiotics

Superinfections occur more often with which category of antibiotics? Narrow-spectrum drugs Antiviral drugs Antifungal drugs Broad-spectrum drugs

Broad-spectrum drugs

Which patient would most likely have an infection that is resistant to antibiotic therapy? a. A child with asthma who develops pneumonia b. An adult construction woker who drinks from a worksite water supply and develops giardiasis c. An adult who developed a wound infection while in the hospital after surgery d. An older adult who got an infected paper cut

C. An adult who developed a wound infection while in the hospital after surgery

What baseline data should be collected before given an alpha1-adrenergic antagonist? Blood pressure and heart rate Liver function studies Kidney function studies Fasting lipid panel

Blood pressure and heart rate

What will happen if compensatory responses to reduced cardiac output are not sufficient to maintain adequate production of urine?

Body water will continue to accumulate, eventually causing death (from complete cardiac failure secondary to excessive cardiac dilation and cardiac edema).

Most cases of vulvovaginal candidiasis are caused by which organism? Candida glabrata Candida neoformans Candida albicans Candida immitis

Candida albicans

What is the prototype drug for ACE inhibitors in the book?

Captopril

____ alcohol consumption ____ the risk of liver damage from acetaminophen overdose, but probably not from therapeutic doses. Two major mechanisms are involved: induction of cytochrome P450 (which increases production of the toxic metabolite of acetaminophen) and depletion of glutathione stores (which reduces detoxification of the metabolite).

Chronic; increases

A patient with systolic heart failure (HF) who is admitted with fluid overload has been prescribed a high-ceiling diuretic. Which assessment most accurately reflects a therapeutic effect of a drug? Drop in systolic BP of 10 mmHg Clear lung sounds Normal heart sounds Pulse of 80 and regular

Clear lung sounds

The nurse inadvertently administers heparin 100 units/mL subcutaneously (which is available on the nursing unit as part of an IV flush protocol) instead of the heparin 5000 units/mL that was prescribed to prevent postoperative deep vein thrombosis (DVT). What is the priority nursing concern? Assessing the patient for DVT Consulting the prescriber for direction Filling out an incident report Preventing excessive bleeding

Consulting the prescriber for direction

The nurse is administering medications on a medical-surgical unit in a hospital. The medication administration record states the patient should receive Cardizem LA 12- mg once a day. The patient's drug supply includes Cardizem SR. What should the nurse do? Administer the medication Administer the medication and notify the prescriber of the change Contact the pharmacy Hold the medication and contact the prescriber

Contact the pharmacy

Natriuretic peptides defend the cardiovascular system from?

Fluid overload- primarily by reducing blood volume and promoting vasodilation

What is the number one side effect of niacin?

Flushing

Why do they always seem to have this herbal supplement containing beverage on airplanes?

Ginger - such as ginger ale Ginger treats vertigo and suppresses nausea and vomiting associated with motion sickness

Which herbal supplement can a person use to treat vertigo? Ginger root Comfrey Black cohosh Echinacea

Ginger root

You have been assigned a diabetic patient as part of your patient care team. Upon your initial assessment, your patient is complaining of a headache, appears drowsy and somewhat confused. What is you priority action? Give the patient 4 ounces of cranberry juice Obtain a fingerstick blood glucose Give the patient parenteral glucagon Immediately call the provider

Give the patient parenteral glucagon

Which drug classification is the most effective for treating asthma? Aminoglycoserides Sulfonamides Glucocorticoids Fluoroquinolones

Glucocorticoids

How can ma huang (ephedra) be a harmful substance?

It dangerously elevates BP, stimulates HR, and CNS. It is associated with stroke, MI, and death. In the U.S., amounts greater than 10 mg are banned with exception of traditional Asian medicine. It is used for weight loss, allergies, asthma, bronchitis, fever, and headache.

How can kava be a harmful substance?

It is used to relieve anxiety, insomnia, and to relax muscles, but can cause severe liver damage.

How can comfrey be a harmful substance?

It is used to treat skin inflammation, but can cause liver disease or cancer if taken orally. Topically is still okay.

When monitoring serum drug levels in patients receiving divided doses of a drug, when are "trough levels" drawn? 30 minutes after completing a 30-minute IV infusion 30 minutes before giving an IM injection 1 hour before giving the next dose Just before administering the next dose

Just before administering the next dose

The principal toxicity of vancomycin is Liver failure (hepatotoxicity) Kidney failure (nephrotoxicity) Hearing impairment (ototoxicity) Heart damage (cardiotoxicity)

Kidney failure (nephrotoxicity)

Bactericidal antibiotics: Kill bacteria Suppress growth of bacteria Cause drug resistance Are used prophylactically

Kill bacteria

What is the major cause of treatment failure in antihypertensive therapy?

Lack of patient adherence

What is MONA?

Morphine Oxygen Nitroglycerine Asprin

____ and other pure opioid agonists relieve pain by mimicking the actions of endogenous opioid peptides- primarily at ___ receptors, and partly at ____ receptors.

Morphine; mu; kappa

____________, ____________, ____________ are considered routine therapy for suspected STEMI. They should be started, as appropriate, soon after symptom onset.

Oxygen; morphine; nitroglycerin

The __ _____ of an ECG (electrocardiogram) is caused by depolarization of the atria.

P wave

The PR interval represents the time between onset of the ___ _______ and onset of the ____ __________. PR prolongation indicated delayed ___ conduction.

P wave; QRS complex; AV

Extended-spectrum penicillins-piperacillin and ticarcillin- are useful against __ _____________.

P. aeruginosa

Clopidogrel suppresses platelet aggregation by causing irreversible blockade of ____ ____ receptors on the platelet surface.

P2Y12 ADP (Adenosine Diphosphate)

Most drug metabolism takes place in the liver and is catalyzed by which system of enzymes?

P450 hepatic enzymes

Warn patients to combine not to combine nitroglycerin with a ______ inhibitor (eg, sildenafil [Viagra]), because life-threatening hypotension can result. Also advise patients using nitroglycerin to avoid _________.

PDE5; alcohol

Which drugs are the most effective inhibitors of gastric acid secretion?

PPIs

By decreasing conduction velocity, propanolol prolongs the ___ _____________.

PR interval

by suppressing AV conduction, verapamil and diltiazem prolong the ___ _________.

PR interval

______________ hypertension (_____________ hypertension), defined as hypertension with no identifiable cause, is the most common form of hypertension.

Primary; essential

What is the first sign of hypersensitivity reaction to a drug?

Rash

What syndrome is caused by the rapid infusion of intravenous (IV) vancomycin? Stevens Johnson syndrome Red Man syndrome Acute Coronary syndrome Toxic shock syndrome

Red Man syndrome

Diabetes is the major cause of blindness among American adults. What is the term for this visual loss? Nephropathy Neuropathy Encephalopathy Retinopathy

Retinopathy

The virus that causes AIDS is a Retrovirus Herpesvirus Zoster virus Varicella virus

Retrovirus

As a rule, when is revasucularization with Coronary artery bypass grafting (CABG) surgery or purcutaneous coronary intervention (PCI) indicated?

Revascularization is indicated only after treatment with two or three antianginal drugs has failed.

_______ ___________ ___ ___________ ___________ is an essential component of intensive insulin therapy.

Self-monitoring of blood glucose (SMBG)

____________ potentials occur in the SA node and AV node.

Slow

What is the most common dysrhythmia?

Tachydysrhythmia

What instruction can patients be given when taking diuretics to prevent nocturia? Take medication with meals Take medication early in the day Take medication after meals Take medication with applesauce

Take medication early in the day

Which of these ECG findings would suggest hyperkalemia in a patient who is prescribed an ACE inhibitor and was using a potassium substitute? Flat T waves Prolonged QT interval Shortened QT interval Tall, peaked T waves

Tall, peaked T waves

Verapamil and diltiazem, as well as nifedipine and other dihydropyridines, are indicated for essential hypertension. What is important to teach patients regarding evaluating for these effects?

Teach patients to self-monitor their blood pressure and to maintain a blood pressure record.

When evaluating treatment of hypertension, what is important to teach patients?

Teach patients to self-monitor their blood pressure and to maintain a blood pressure record.

Your heart failure patient has been started on digoxin. What is the most important patient teaching consideration regarding the medication? Teach the patient the signs and symptoms of digoxin toxicity Teach the patient to take the medication at the same time every day Teach the patient to take their blood pressure before each dose Teach the patient to keep their scheduled appointments with their health care provider

Teach the patient the signs and symptoms of digoxin toxicity

______________ are broad-spectrum, bacteriostatic antibiotics that inhibit bacterial protein synthesis.

Tetracyclines

What must occur when a patient becomes tolerant to a drug to maintain beneficial effects?

The dosage must be increased

Acyclovir, the drug of choice for most infections caused by herpes simplex viruses, is eliminated unchanged by the kidneys. Because of this fact, what must be concluded about the dosage if the patient has renal impairment? The dosage must be increased The dosage must be calculated per kilogram The dosage must be reduced Infuse the dosage rapidly when giving the drug intravenously (IV)

The dosage must be reduced

Why must aminoglycosides be given parenterally? The gastric acid in the stomach destroys the drugs The GI symptoms caused by the drugs are too severe The drugs cross membranes poorly The drugs are eliminated by the liver

The drugs cross membranes poorly

Which is the best way to assess long-term glycemic control? The blood glucose should be measured every day The hemoglobin A1c should be measured every year The blood glucose should be measured every 2-3 months The hgbA1c should be measured every 3-4 months

The hgbA1c should be measured every 3-4 months

While assessing a 76 year-old male patient, the nurse determines the patient is experiencing polypharmacy which means

The patient takes multiple medications for one of more diagnoses

When treating a patient with bacteriostatic antimicrobial, which of the following is critical in attempts to cure an infection? The patient's history of allergic reactions The patient's genotype The patient's host defenses The patient's place of employment

The patient's host defenses

Your patient with peripheral edema, weight gain, shortness of breath, and crackles in their bilateral lung bases is given an IV dose of a loop diuretic. What would you observe that indicated the medication was effective? The patient's weight would increase The patient would become more short of breath The patients lung fields would clear The patient would complain of chest pain

The patients lung fields would clear

What is the most reliable way to test the efficacy and safety of a drug?

The use of a randomized control trial

Which is the preferred drug of choice for healthcare-associated methicillin-resistant staphlococcus aureus (HCA-MRSA)? Doxycycline Vancomycin Nafcillin Oxacillin

Vancomycin

What is the major disadvantage of administering medications orally (po= per os)?

Variability of absorption

Genetic testing for variant genes that code for ___________ and __________ can identify people with increased sensitivity to warfarin, and who therefore may need a dosage reduction.

VKORC1; CYP2C9

What is the drug of choice for MRSA? Dictoxacillin Nafcillin Oxacillin Vancomycin

Vancomycin

What is the drug of choice for SEVERE c.Diff?

Vancomycin