Pharm 2 exam 2

A nurse is collecting data from a client who is experiencing chest pain. Which of the following medications should the nurse expect to administer to suppress the aggregation of platelets? A. Nitroglycerin B. Aspirin C. Morphine D. Metoprolol

B. Aspirin Aspirin suppresses platelet aggregation, producing an immediate antithrombotic effect. The client should chew the first dose of aspirin to allow rapid absorption.

nurse is reviewing the medical record of a client who is requesting a prescription for sildenafil citrate. Which of the following findings in the client's record should the nurse identify as a contraindication for the use of this medication? A. Diabetes mellitus B. Current use of nitroglycerine to treat heart failure C. Eyeglasses for presbyopia D. Osteoarthritis

B. Current use of nitroglycerine to treat heart failure Taking any nitrates such as nitroglycerin is a contraindication for sildenafil, a medication that treats erectile dysfunction. Taking it concurrently with nitrates can cause life-threatening hypotension.

A nurse is collecting data from a client who uses an albuterol inhaler to treat asthma. For which of the following findings should the nurse withhold the medication and notify the provider? A. Tremors B. Wheezing C. Restlessness D. Palpitations

B. Wheezing The nurse should identify that wheezing can indicate a paradoxical bronchospasm. If this condition worsens, the nurse should withhold the medication and notify the provider immediately.

A nurse is assisting with the care of a client who reports crushing chest pain. The nurse reviews the client's ECG results and notes ST changes. Which of the following medications should the nurse administer? A. Simvastatin B. Furosemide C. Nitroglycerin D. Sildenafil

C. Nitroglycerin The nurse should identify the need to administer nitroglycerin, which is used to treat angina. Nitroglycerin acts directly on vascular smooth muscle to promote vasodilation.

A nurse is reinforcing teaching with a client who has a new prescription for nitroglycerin sublingual tablets. Which of the following client statements indicates an understanding of the teaching? A. "I will not eat or drink anything for 1 hour after taking the medication." B. "I will keep the pills in my plastic pill box when traveling." C. "I will contact my doctor if the medication gives me a headache." D. "I will sit down when I take this medication."

D. "I will sit down when I take this medication." The nurse should reinforce with the client the need to sit down when taking this medication to prevent orthostatic hypotension. The client should change positions slowly after taking this medication.

A nurse is caring for a client who is experiencing an acute asthma exacerbation. Which of the following medications should the nurse identify as being contraindicated for this client? A. Dextromethorphan B. Montelukast C. Ciprofloxacin D. Propranolol

D. Propranolol The nurse should identify that a client who is experiencing an acute asthma exacerbation requires the use of a beta2-agonist to alleviate bronchospasm and relax the client's airway. Therefore, propranolol is contraindicated for this client. Propranolol is a beta-blocker that is used to treat cardiac conditions, including hypertension. Blocking the beta receptors prevents the action of beta2-agonists such as albuterol

Which statement by the patient reflects the need for addi-tional patient education about the calcium channel blocker diltiazem (Cardizem)? a. "I can take this drug to stop an attack of angina." b. "I understand that food and antacids alter the absorption of this oral drug." c. "When the long-acting forms are taken, the drug cannot be crushed." d. "This drug may cause my blood pressure to drop, so I need to be careful when getting up."

a. "I can take this drug to stop an attack of angina."

When teaching the patient about the signs and symptoms of cardiac glycoside toxicity, the nurse should alert the patient to watch for which of these? (Select all that apply.) a. Dizziness b. Visual changes such as halos around lights c. Headaches d. Increased urine output e. Dark stools

a. Dizziness b. Visual changes such as halos around lights c. Headaches

When monitoring a patient who is receiving an intravenous infusion of nesiritide (Natrecor), the nurse will look for which adverse effect? a. Dysrhythmia b. Proteinuria c. Hyperglycemia d. Hypertension

a. Dysrhythmia

A patient is taking a beta blocker as part of the treatment plan for heart failure. The nurse knows that the purpose of the beta blocker for this patient is to a. increase urine output. b. prevent stimulation of the heart by catecholamines. c. increase the contractility of the heart muscle. d. cause peripheral vasodilation.

b. prevent stimulation of the heart by catecholamines.

A nurse is assigned to care for several clients who are postoperative. The nurse should identify that the client taking which of the following medications is at risk for delayed wound healing? A. Nifedipine to treat hypertension B. Prednisone to treat persistent arthritis exacerbatio C. Albuterol to treat asthma D. Chlorpromazine to treat schizophrenia

B. Prednisone to treat persistent arthritis exacerbations Prednisone is a corticosteroid that is associated with delayed wound healing. Clients who have arthritis often require high doses of prednisone to help resolve exacerbations.

A nurse is reinforcing teaching with a client who has systemic lupus erythematosus and a new prescription for oral glucocorticoid therapy. Which of the following client statements indicates an understanding of the teaching? A. "I should take a calcium supplement while on this medication." B. "I have to complete regular liver function studies while I am taking this medication." C. "I can take NSAIDs to treat mild pain while using this medication." D. "I will be sure to eat 6 small meals a day to prevent hypoglycemia from this medication."

A. "I should take a calcium supplement while on this medication." An adverse effect of systemic glucocorticoid therapy is osteoporosis. Increasing calcium-rich foods in the client's diet and adding calcium and vitamin D supplements should be encouraged to prevent osteoporosis and decrease the risk of fractures.

A nurse is caring for a client who is undergoing treatment for hypertension. Which of the following statements should the nurse identify as an indication that the client is adhering to the treatment plan? A. "I would never have believed I could get used to enjoying my food without salt." B. "My blood pressure device at home usually shows about 156 over 98 or so." C. "I make sure I take my blood pressure medicine when I have headaches." D. "My blood pressure pills are very expensive. Could I take a cheaper medication?"

A. "I would never have believed I could get used to enjoying my food without salt." This statement implies that the client has most likely stopped adding salt to food. Sodium restriction is an aspect of the treatment plan and indicates dietary adherence by the client.

A nurse is preparing to administer a sublingual nitroglycerin tablet to a client who is reporting chest pain. For which of the following adverse effects should the nurse monitor after giving this medication? A. Hypotension B. Myalgia C. Diarrhea D. Ototoxicity

A. Hypotension Nitroglycerin is a coronary vasodilator and antianginal agent. A major adverse effect of this medication is hypotension; therefore, blood pressure and pulse must be monitored before and after administration.

A nurse is reinforcing teaching with a female client who has a new prescription for pravastatin to treat hyperlipidemia. Which of the following pieces of information should the nurse include in the teaching? A. Pravastatin can be taken with grapefruit juice. B. Pravastatin can be continued during pregnancy. C. Pravastatin should be taken with the morning meal. D. Laboratory testing to monitor WBC count is required.

A. Pravastatin can be taken with grapefruit juice. Pravastatin, unlike other statins, such as lovastatin, simvastatin, and atorvastatin, is not affected by CYP3A4 inhibitors. It is safe for the client to consume grapefruit juice if desired.

A nurse is reinforcing teaching with a client who has a new prescription for lisinopril. Which of the following should the nurse include in the teaching as an adverse effect of lisinopril? A. Tongue swelling B. Low potassium level C. Runny nose D. Bruising

A. Tongue swelling Angioedema is a fatal response that occurs in about 1% of clients who use ACE inhibitors such as lisinopril. Manifestations of angioedema include swelling of the tongue, lips, or pharynx.

nurse is reinforcing teaching about preventing systemic toxicity with a client who is using topical lidocaine. Which of the following pieces of information should the nurse include about the application of topical lidocaine? A. Apply a dressing after covering the affected areas with topical lidocaine B. Apply topical lidocaine to affected areas that are intact C. Apply topical lidocaine in a thick layer to affected areas D. Apply topical lidocaine frequently to large affected areas

B. Apply topical lidocaine to affected areas that are intact The nurse should tell the client to apply topical lidocaine to skin that is intact rather than blistered, broken, or irritated to prevent a large amount of medication from being absorbed and to decrease the risk of systemic toxicity.

A nurse is caring for a client who has been taking taken metformin for 6 months. Which of the following findings should the nurse identify as an expected therapeutic effect of the medication? A. Decreased vitamin B12 levels B. Decreased blood glucose level C. Abdominal bloating and diarrhea D. Decreased LDL level

B. Decreased blood glucose level A client who has taken metformin for 6 months should experience the expected therapeutic effect of a decrease in blood glucose levels. Metformin is a non-insulin medication for clients who have type 2 diabetes mellitus.

A nurse is monitoring a client who has asthma, takes albuterol, and recently started taking propranolol to treat a cardiovascular disorder. The client reports that the albuterol has been less effective. Which of the following factors should the nurse identify as a possible explanation for this change? A. Potentiative interaction B. Detrimental inhibitory interaction C. Increased adverse reaction D. Toxicity-reducing inhibitory interaction

B. Detrimental inhibitory interaction AT detrimental inhibitory interaction can occur with the concurrent use of propranolol and albuterol. When a client takes propranolol and albuterol together, propranolol can interfere with albuterol therapeutic effects.

A nurse is assisting with the care of a client who has atrial fibrillation and is scheduled for cardioversion. The nurse should anticipate a prescription from the provider for which of the following medications for this procedure? A. Amlodipine B. Diltiazem C. Nifedipine D. Lidocaine

B. Diltiazem The nurse should anticipate a prescription for diltiazem, which blocks calcium channels in the heart and blood vessels, thereby lowering blood pressure. Also, it is an antiarrhythmic medication that is used during cardioversion to treat atrial fibrillation.

nurse is reinforcing teaching with a client who has atrial fibrillation and a new prescription for amiodarone. Which of the following items should the nurse instruct the client to avoid while taking this medication? A. Green leafy vegetables B. Grapefruit juice C. Garlic D. Salt substitutes

B. Grapefruit juice

A nurse is reviewing the medication administration record of a client who has impaired swallowing. The nurse should crush the medication when administering which of the following prescriptions? A. Aspirin EC 80 mg PO daily B. Levothyroxine 75 mcg PO q AM before breakfast C. Metformin XR 500 mg PO daily D. Nitroglycerin 0.3 mg SL PRN chest pain, can repeat q 5 min for 2 additional doses

B. Levothyroxine 75 mcg PO q AM before breakfast Levothyroxine can be crushed because it is not extended-release, sublingual, or enteric-coated. If crushed, the medication should be mixed with 5 to 10 mL of water.

A nurse is caring for a client who has been receiving medication through a transdermal patch. The client is experiencing therapeutic benefits from the medication even though the medication in the patch is no longer active. The nurse should recognize that this is an example of which of the following? A. Pharmacodynamic tolerance B. Placebo effect C. Metabolic tolerance D. Tachyphylaxis

B. Placebo effect The nurse should identify that the client is experiencing a placebo effect from the medication in the transdermal patch. This occurs when a medication response is caused by psychological factors and not by the biochemical or physiological properties of the medication.

A nurse is preparing to administer warfarin to a client who has a new onset of atrial fibrillation. The client states, "I forget what the other nurse told me this medication does." Which of the following pieces of information should the nurse reinforce with the client? A. "It helps your heart return to a normal rhythm." B. "It dissolves blood clots." C. "It can reduce your risk of having a stroke." D. "It helps prevent bleeding in atrial fibrillation."

C. "It can reduce your risk of having a stroke." The nurse should identify that atrial fibrillation increases the client's risk of having a stroke due to clot formation in the atrium. Warfarin can prevent clot formation when used long-term, which will reduce the client's risk of having a stroke.

The nurse is reviewing drug interactions with a male patient who has a prescription for isosorbide dinitrate (Isordil) as treatment for angina symptoms. Which substances listed below could potentially result in a drug interaction? (Select all that apply.) a. A glass of wine b. Thyroid replacement hormone c. Tadalafil (Cialis), an erectile dysfunction drug d. Metformin (Glucophage), an antidiabetic drug e. Carvedilol (Coreg), a beta blocker

a. A glass of wine c. Tadalafil (Cialis), an erectile dysfunction drug e. Carvedilol (Coreg), a beta blocker

While assessing a patient with angina who is to start beta blocker therapy, the nurse is aware that the presence of which condition may be a problem if these drugs are used? (Select all that apply.) a. Diabetes mellitus b. Essential tremors c. Exertional angina d. Asthma e. Hypertension

a. Diabetes mellitus d. Asthma

6. The nurse is administering an intravenous infusion of a phosphodiesterase inhibitor to a patient who has heart failure. The nurse will evaluate the patient for which therapeutic effects? (Select all that apply.) a. Positive inotropic effects b. Vasodilation c. Decreased heart rate d. Increased blood pressure e. Positive chronotropic effects

a. Positive inotropic effects b. Vasodilation e. Positive chronotropic effects

5. A 68-year-old male patient has been taking the nitrate isosor-bide dinitrate (Isordil) for 2 years for angina. He recently has been experiencing erectile dysfunction and wants a prescription for sildenafil (Viagra). Which response would the nurse most likely hear from the prescriber? a. "He will have to be switched to isosorbide mononitrate if he wants to take sildenafil." b. "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists." c. "I'll write a prescription, but if he uses it, he needs to stop taking the isosorbide for one dose." d. "These drugs are compatible with each other, and so I'll write a prescription."

b. "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists."

A patient with a rapid, irregular heart rhythm is being treated in the emergency department with adenosine. During admin-stration of this drug, the nurse will be prepared to monitor the patient for which effect? a. Nausea and vomiting b. A brief period of systole c. Muscle tetany d. Hypertension

b. A brief period of systole

A patient is in the clinic for a follow-up visit. He has been taking amiodarone (Cordarone) for almost 1 year, and today he tells the nurse, "I am noticing some blue color around my face, neck, and upper arms. Is that normal?" Which is the nurse's correct response? a. "This is an expected side effect and should go away soon." b. "This is a harmless effect. As long as the medication is working, we'll just monitor your skin." c. "This can happen with amiodarone. I will let your doctor know about it right away." d. "How much sun exposure have you had recently?"

c. "This can happen with amiodarone. I will let your doctor know about it right away."

A patient with heart failure will be starting the beta blocker metoprolol (Lopressor). The nurse will monitor for which expected cardiovascular effects? (Select all that apply.) a. Increased heart rate b. Increased myocardial contractility c. Delayed AV node conduction d. Reduced heart rate e. Decreased myocardial automaticity

c. Delayed AV node conduction d. Reduced heart rate e. Decreased myocardial automaticity

A nurse with adequate knowledge about the administration of intravenous nitroglycerin will recognize that which statement is correct? a. The intravenous form is given by IV push injection. b. Because the intravenous forms are short-lived, the dosing must be every 2 hours. c. Intravenous nitroglycerin must be protected from exposure to light through use of special tubing. d. Intravenous nitroglycerin can be given via gravity drip infusions.

c. Intravenous nitroglycerin must be protected from exposure to light through use of special tubing.

In assessing a patient who has been taking amiodarone for 6 months, the nurse monitors for which potential adverse effect? a. Hyperglycemia b. Dysphagia c. Photophobia d. Urticaria

c. Photophobia

During assessment of a patient who is receiving digoxin, the nurse monitors for findings that would indicate an increased possibility of toxicity, such as a. apical pulse rate of 62 beats/min. b. digoxin level of 1.5 ng/mL. c. serum potassium level of 2.0 mEq/L. d. serum calcium level of 9.9 mEq/L.

c. serum potassium level of 2.0 mEq/L.

1. A patient has a new prescription for transdermal nitroglycerin patches. The nurse teaches the patient that these patches are most appropriately used for which reason? a. To relieve exertional angina b. To prevent palpitations c. To prevent the occurrence of angina d. To stop an episode of angina

d. To stop an episode of angina

8. A patient with angina has been given a prescription for a calcium channel blocker. The nurse knows that this class of drugs is used to treat which type of angina? a. Effort b. Unstable c. Crescendo d. Vasospastic

d. Vasospastic

The nurse is assessing a patient who is receiving a milrinone infusion and checks the patient's cardiac rhythm on the heart monitor. What adverse cardiac effect is most likely to occur in a patient who is receiving intravenous milrinone? a. Tachycardia b. Bradycardia c. Atrial fibrillation d. Ventricular dysrhythmia

d. Ventricular dysrhythmia