Pharm Exam 2 Questions
A nurse administers quinidine sulfate to a patient with atrial fibrillation. The nurse should assess the electrocardiogram (ECG) tracing knowing that quinidine sulfate has what effect on the ECG? A) Prolongation of the QT interval B) Prolongation of the PR interval C) Narrowing of the QRS complex D) Tall, peaked T waves
A
A patient is receiving an intravenous infusion of heparin to treat a pulmonary embolism. What laboratory value will the nurse monitor to evaluate treatment with this medication? A) Activated partial thromboplastin time (aPTT) B) Prothrombin time (PT) C) Platelet count D) Hemoglobin and hematocrit
A
A patient with angina pectoris is prescribed sublingual nitroglycerin. Which statement made by the patient indicates understanding of the medication teaching? A) "I may experience a headache as a side effect." B) "The chest pain should be relieved within 20 minutes." C) "I should swallow the tablet and drink a glass of water." D) "I should take this medication in the morning before breakfast."
A
Cholestyramine has been prescribed for a patient. Which instruction should the nurse include in patient teaching? A) Cholestyramine can impair absorption of fat-soluble vitamins. B) Stop taking the drug if you develop constipation. C) Take cholestyramine with other drugs you are prescribed to enhance absorption. D) Do not take the medication if the formula is cloudy after mixing with water.
A
A patient with stage 2 hypertension has been prescribed a thiazide diuretic and an angiotensin-converting enzyme inhibitor. It is most appropriate for the nurse to do what? A) Contact the health care provider. B) Administer both drugs to the patient. C) Administer the thiazide diuretic at bedtime. D) Hold the medications if the blood pressure is normal
A A combination of drugs is used to treat stage 2 hypertension; each drug has a different mechanism of action. The nurse should administer antihypertensive medications even if the blood pressure is normal. Thiazide diuretics should be given in the morning because of diuresis
The nurse teaches a patient about benazepril [Lotensin]. Which statement by the patient requires an intervention by the nurse? A) "I use NoSalt instead of salt to season foods." B) "I eat sweet potatoes once or twice a week." C) "I drink 4 ounces of prune juice each morning." D) "I like asparagus because it's high in vitamin K."
A 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]
The nurse is caring for a patient who is taking phenytoin [Dilantin]. Which medication, if ordered by the physician, should the nurse question? A) Cimetidine [Tagamet] B) Captopril [Capoten] C) Pantoprazole [Protonix] D) Ondansetron [Zofran]
A Cimetidine will elevate phenytoin levels by reducing the rate at which phenytoin is metabolized. Phenytoin levels may increase to toxic levels. The use of cimetidine should generally be avoided in patients who are treated with phenytoin, because safer alternatives are available.
A patient is receiving prednisone as part of treatment for severe arthritis. He is also receiving furosemide (a loop diuretic), levothyroxine (for hypothyroidism), and a proton pump inhibitor and antacid (for gastroesophageal reflux disease). Which drug does the nurse identify as most likely to be a concern during the therapy with prednisone?A) Furosemide B) Levothyroxine C) Proton pump inhibitor D) Antacid
A Coadministration of a loop diuretic with a corticosteroid may result in hypokalemia because of the potassium loss caused by both drugs
The health care provider prescribes sustained-release verapamil [Calan SR] to an 82-year-old patient who takes digoxin [Lanoxin] daily. Which action is most appropriate for the nurse to take? A) Monitor the patient's cardiac rhythm continuously. B) Assess the patient for tachycardia and hypertension. C) Maintain the patient on bed rest for 8 to 10 hours. D) Reduce dietary fiber to prevent loose, watery diarrhea.
A Digoxin and verapamil suppress impulse conduction through the atrioventricular (AV) node. When these drugs are used concurrently, the risk of AV block is increased. The cardiac rhythm of patients receiving both medications should be monitored closely. The patient should be monitored for bradycardia and hypotension. Bed rest is not indicated. Constipation may occur; increased dietary fiber and fluids are indicated to prevent constipation
When providing discharge teaching for a patient who has been prescribed furosemide [Lasix], it is most important for the nurse to include which dietary items to prevent adverse effects of furosemide [Lasix] therapy? A) Oranges, spinach, and potatoes B) Baked fish, chicken, and cauliflower C) Tomato juice, skim milk, and cottage cheese D) Oatmeal, cabbage, and bran flakes
A Furosemide may have the adverse effect of hypokalemia. Hypokalemia can be reduced by consuming foods that are high in potassium, such as nuts, dried fruits, spinach, citrus fruits, potatoes, and bananas
The nurse cares for a patient receiving digoxin [Lanoxin]. What indicates to the nurse that treatment with this medication is effective? A) Improved cardiac output B) Reduced exercise tolerance C) Increased body weight D) Decreased cardiac contractility
A If the dosage of the digoxin (Lanoxin) is effective-the muscle contractility of the myocardium will strengthen and improve cardiac output
The nurse should teach a patient taking an oral corticosteroid to take the medication at what time? A) 8:00 am B) 12 noon C) 5:00 pm D) 8:00 pm
A Oral corticosteroids should be taken in the morning to minimize adrenal suppression
Which of the following should the nurse include when teaching a patient about glucocorticoid therapy? A) Do not abruptly stop taking the drug. B) Take the medication on an empty stomach. C) Avoid use of antiulcer medications when taking glucocorticoids. D) When used long term, alternate-day dosing of glucocorticoids will help minimize thyroid suppression.
A With oral and all other forms of glucocorticoids that are given short or long term, abrupt withdrawal must be avoided. Abrupt withdrawal of adrenal drugs (e.g., prednisone, methylprednisolone) may lead to a sudden decrease in, or no production of, endogenous glucocorticoids, resulting in adrenal insufficiency. It is recommended that oral dosage forms be given with a snack or meal to help minimize GI upset. An order for an H2 receptor antagonist or a proton pump inhibitor may be prescribed to minimize GI upset and to minimize ulcer formation because these drugs are ulcerogenic. In long-term therapy, alternate-day dosing of glucocorticoids, if possible, will help minimize the adrenal suppression
Are there any other steps the nurse should take regarding IV administration of mannitol?
Along with following all the appropriate safety precautions for medication administration, the nurse should use a filter needle to withdraw mannitol from the vial, as well as an in-line filter for IV infusion, to prevent crystals from entering the circulation
A patient diagnosed with systemic lupus erythematosus (SLE) develops a dysrhythmia. Which medication, if ordered by the physician, should the nurse question? A) Lidocaine [Xylocaine] B) Procainamide [Procanbid] C) Disopyramide [Norpace] D) Amiodarone [Cordarone]
B
A patient is prescribed lovastatin [Mevacor]. The nurse will teach the patient to take the medication at which time? A) With any meal B) With the evening meal C) 1 hour before breakfast D) 2 hours after a meal
B
The nurse will teach a patient who is prescribed niacin [Niacor] to prevent flushing of the face by doing what? A) Drinking a full glass of water after taking the medication B) Taking 325 mg of aspirin 30 minutes before each dose C) Ingesting a meal before taking the medication D) Increasing dietary fiber before and after each dose
B
A patient who takes oxybutynin [Ditropan] for an overactive bladder takes an over-the-counter antihistamine for hay fever symptoms. What symptoms should the nurse watch for that would indicate toxicity? A) Cool and moist skin, confusion, and bradycardia B) Dry mouth, increased temperature, and blurred vision C) Hallucinations, increased salivation, and diaphoresis D) Hypothermia, increased respiratory rate, and pupil constriction
B A number of drugs that are not classified as muscarinic antagonists can nonetheless produce significant muscarinic blockade. Among these are antihistamines, phenothiazine antipsychotics, and tricyclic antidepressants. Because of their prominent anticholinergic actions, these drugs can greatly enhance the antimuscarinic effects of atropine and related agents. Accordingly, it is wise to avoid the combined use of atropine with other drugs that can cause muscarinic blockade
A nurse instructs a patient about signs and symptoms of digoxin toxicity. The nurse determines that teaching is successful if the patient makes which statement? A) "If my heart is racing, the dose may be too high." B) "I should report any muscle weakness or nausea." C) "My doctor should be notified if diarrhea occurs." D) "The dose will be reduced if I develop memory loss."
B Alert to complaints from the patient regarding blurred vision, nausea, vomiting or muscle weakness. The physician should be notified and the patient evaluated by checking the drug plasma level for digoxin along with a serum potassium level
The nurse prepares to administer the first dose of an antipsychotic agent to a patient. One hour after administration, it is most important for the nurse to assess what? A) The range of motion of the upper and lower extremities B) The orthostatic blood pressure measurements C) The abdomen for distention and bowel sounds D) The tympanic membrane with an otoscope
B Antipsychotic drugs promote orthostatic hypotension. The blood pressure and pulses should be checked before dosing and 1 hour afterward. Measurements should be taken while the patient is lying down and again after the patient has been sitting or standing for 1 to 2 minutes. Hypotension is more likely with low-potency first-generation antipsychotics than with high-potency first-generation antipsychotics. Tolerance to hypotension develops after 2 to 3 months
A patient is newly prescribed carbamazepine [Tegretol] for seizure control. It is most important for the nurse to teach the patient to avoid which food? A) Tomatoes B) Grapefruit juice C) Spinach D) Kiwi fruit
B Grapefruit juice can inhibit the metabolism of carbamazepine, thereby causing plasma levels to rise. Grapefruit juice may increase the peak and trough levels of carbamazepine by up to 40%
A patient with schizophrenia is prescribed chlorpromazine oral concentrate. Which instruction should the nurse include in the teaching plan? A) Sexual arousal may be enhanced with this medication. B) Avoid direct skin contact with this medication. C) The medication may cause excessive salivation. D) Do not limit salt intake while taking the medication.
B Handling chlorpromazine (or other antipsychotics) can cause contact dermatitis in patients and healthcare personnel. Avoid direct contact with these drugs. Sexual dysfunction may occur, dry mouth may be an adverse effect, and sodium intake is not affected
A patient with heart failure who takes furosemide [Lasix] is diagnosed with bacterial pneumonia. Which medication, if ordered by the physician, should the nurse question? A) Ciprofloxacin [Cipro] B) Gentamicin [Garamycin] C) Amoxicillin [Amoxcil] D) Erythromycin [E-Mycin]
B High-ceiling loop diuretics may cause hearing impairment; furosemide may result in deafness that is transient. Because of the risk of hearing loss, caution is needed when high-ceiling diuretics are used in combination with other ototoxic drugs (for example, aminoglycoside antibiotics). Gentamicin is an aminoglycoside. The other antibiotics are safe to administer with furosemide
A patient is prescribed hydralazine. What is most important for the nurse to teach the patient? A) Precautions for postural hypotension B) Prevention of reflex tachycardia C) High initial dose for slow acetylators D) Recognition of hypertrichosis
B Hydralazine is usually combined with a beta blocker to protect against reflex tachycardia. Hydralazine is an arterial vasodilator; postural hypotension is minimal. Hydralazine is inactivated by acetylation, and the ability to acetylate drugs is genetically determined. To avoid hydralazine accumulation, the dosage should be reduced in slow acetylators. Minoxidil commonly causes hypertrichosis, or increased hair growth
A patient who is hospitalized for an infection takes eplerenone [Inspra] for heart failure. Which medication, if ordered by the physician, should the nurse question? A) Ciprofloxacin [Cipro] B) Itraconazole [Sporanox] C) Tetracycline [Sumycin] D) Ampicillin [Principen]
B Inhibitors of CYP3A4 can increase levels of eplerenone, thereby posing a risk of toxicity. Weak inhibitors (for example, erythromycin, saquinavir, verapamil, fluconazole) can double eplerenone levels. Strong inhibitors (for example, ketoconazole, itraconazole) can increase levels fivefold. If eplerenone is combined with a weak inhibitor, the eplerenone dosage should be reduced. Eplerenone should not be combined with a strong inhibitor
A patient with severe hypertension is prescribed minoxidil. Which medications will the nurse expect to be administered to reduce adverse responses to minoxidil? A) Adenosine [Adenocard] and ticlopidine [Ticlid] B) Furosemide [Lasix] and propranolol [Inderal] C) Digoxin [Lanoxin] and captopril [Capoten] D) Donepezil [Aricept] and clonidine [Catapres]
B Minoxidil may cause adverse responses (for example, reflex tachycardia, expansion of blood volume, pericardial effusion). Minoxidil should be used with a beta blocker (for example, propranolol) plus intensive diuretic therapy (for example, furosemide).
The nurse instructs a patient about taking nifedipine [Procardia XL]. Which statement made by the patient indicates an understanding of medication teaching? A) "I'll stop taking my beta blocker." B) "The pill should be swallowed whole." C) "The drug will cause constipation." D) "This drug treats heart rhythm problems."
B Patients should swallow sustained-release tablets whole, without crushing or chewing. Nifedipine may cause reflex tachycardia; beta blockers are prescribed to prevent reflex tachycardia. Nifedipine causes very little constipation. Nifedipine cannot be used to treat dysrhythmias
A patient is diagnosed with type 2 diabetes mellitus and schizophrenia. The nurse will closely monitor the blood sugar if the patient receives which medication for the treatment of schizophrenia? A) Loxapine [loxitane] B) Clozapine [clozaril] C) Thiothixene [navane] D) Haloperidol [haldol]
B Second-generation antipsychotics such as clozapine carry a higher risk of serious metabolic effects (for example, diabetes and dyslipidemia) than first-generation antipsychotics (for example, loxapine, thiothixene, and haloperidol). Among the second-generation antipsychotics, the risk of metabolic effects is greatest with clozapine and olanzapine. Clozapine should be used with caution in patients with diabetes
A patient is taking an inhaled corticosteroid for asthma. After the patient takes a dose of the inhaler, the nurse's priority should be to A) listen to the patient's breath sounds. B) have the patient rinse his mouth with warm water. C) instruct the patient to cough and deep breathe. D) take the patient's apical pulse for 1 minute
B The patient should rinse his mouth with water immediately after taking an inhaled corticosteroid to avoid oral fungal infections and other oral irritations
A patient diagnosed with heart failure has stage 1 hypertension. Which medication, if ordered by the health care provider, should the nurse question? A) Angiotensin-converting enzyme inhibitor B) Calcium channel blocker C) Thiazide diuretic D) Beta blocker
B The patient with heart failure should not receive a calcium channel blocker (for example, verapamil, diltiazem); calcium channel blockers may act on the heart to decrease myocardial contractility, thereby further reducing cardiac output
The nurse teaches a patient diagnosed with chronic stable angina about the mechanism of action of nitroglycerin. The nurse should include which instruction? A) "Nitroglycerin reduces vasospasms of the heart's arteries, which improves blood supply." B) "Nitroglycerin opens the arteries to allow more oxygen to be delivered to the heart muscle." C) "Nitroglycerin dilates veins, which decreases the amount of oxygen needed by the heart." D) "Nitroglycerin improves blood flow to the heart muscle by increasing blood pressure."
C
A patient is prescribed a nitroglycerin transdermal patch. The nurse should include which statement when teaching the patient how to use this medication? A) "Apply the patch to the chest over the heart." B) "Change the patch each week." C) "Remove the patch at bedtime." D) "Put on the patch before exercising."
C
During administration of alteplase [Activase], the patient's IV site starts to ooze blood around the catheter. Which action by the nurse is most appropriate? A) Discontinue the infusion of alteplase. B) Assess the patient's vital signs. C) Apply direct pressure over the puncture site. D) Administer aminocaproic acid [Amicar].
C
The nurse administers an intravenous infusion of amiodarone [Coredarone] to a patient to prevent recurrent episodes of ventricular fibrillation. It is most important for the nurse to assess the patient for which condition? A) Urinary retention B) Hypercalcemia C) Hypotension D) Metallic taste
C
What is the antidote for heparin? A) Ferrous sulfate B) Atropine sulfate C) Protamine sulfate D) Magnesium sulfate
C
Which patient does the nurse identify as most likely needing an increased dose of warfarin [Coumadin] to have the same anticoagulant effect? A) Patient taking acetaminophen [Tylenol] for back pain B) Patient taking cimetidine [Tagamet] to prevent gastric ulcers C) Patient taking oral contraceptives to prevent pregnancy D) Patient taking prednisone [Deltasone] for rheumatoid arthritis
C
When administering aminoglutethimide (Cytadren) to a patient, it is most important for the nurse to monitor A) serum electrolytes. B) cardiac enzymes. C) liver enzymes. D) arterial blood gases
C Aminoglutethimide therapy may cause hepatotoxicity, so it is important to monitor liver enzymes
A patient is prescribed isocarboxazid [Marplan] for the treatment of depression. Which foods should the patient be taught to avoid? A) Broccoli, shrimp, and yogurt B) Tomatoes, chicken, and milk C) Bananas, smoked fish, and cheese D) Apples, steak, and cottage cheese
C Foods that are high in tyramine should be avoided if a patient is taking a monoamine oxidase inhibitor such as isocarboxazid. Dietary tyramine promotes the release of accumulated norepinephrine to cause massive vasoconstriction and the excessive stimulation of the heart. A hypertensive crisis may occur. Foods to avoid include yeast extracts, most cheeses, fermented sausages, and aged fish or meat
A patient is prescribed digoxin [Lanoxin] and furosemide [Lasix]. It is most important for the nurse to assess which value before administering these medications? A) Serum sodium B) Blood urea nitrogen C) Serum potassium D) Plasma B-natriuretic peptide
C Lasix can cause loss of potassium and sodium in the secreted water/increased urine output. But is the potassium that we are concerned about with digoxin as hypokalemia increases the risk for digoxin toxicity.
A patient is prescribed spironolactone [Aldactone] for treatment of hypertension. Which foods should the nurse teach the patient to avoid? A) Baked fish B) Low-fat milk C) Salt substitutes D) Green beans
C Spironolactone is a potassium-sparing diuretic. Medications that are potassium sparing, potassium supplements, and salt substitutes should be avoided. High-potassium foods should also be avoided
Which manifestations does the nurse associate with tardive dyskinesia? A) Pacing and squirming, with an uncontrollable need for motion B) Mask-like face with drooling, tremors, rigidity, and shuffling gait C) Twisting, worm-like movements of the tongue and face D) Sudden high fever, sweating, and blood pressure fluctuations
C Tardive dyskinesia is characterized by involuntary twisting, writhing, worm-like movements of the tongue and face. Parkinsonism is characterized by a mask-like face with drooling, tremors, rigidity, and shuffling gait. Akathisia is characterized by pacing and squirming, with an uncontrollable need for motion. Neuroleptic malignant syndrome is characterized by sudden high fever, sweating, and fluctuations in blood pressure
A patient is prescribed verapamil [Calan]. The nurse should assess the patient for which common adverse effects? A) Atrial fibrillation, photosensitivity, and blurred vision B) Tachycardia, stomatitis, and inflammation of the joints C) Constipation, headache, and edema of the ankles and feet D) Dry mouth, lymphadenopathy, and decreased appetite
C The adverse effects of verapamil occur secondary to vasodilation. Common adverse effects include constipation, dizziness, facial flushing, headache, and edema of the ankles and feet
A patient with depression has been prescribed fluoxetine [Prozac]. Which statement made by the patient indicates an understanding of the medication teaching? A) "Disorientation and hallucinations are common." B) "The drug may enhance my interest in sex." C) "It may take 3 to 4 weeks before my mood is elevated." D) "I can stop this medication when I feel less depressed."
C The half-life of this drug is prolonged; therefore, approximately 4 weeks of treatment are required to produce steady-state plasma drug levels. Antidepressants do not relieve symptoms immediately. Initial responses develop after 1 to 3 weeks. Maximal responses develop in 1 to 2 months. Adverse effects of fluoxetine include sexual dysfunction (for example, impotence, delayed or absent orgasm, delayed or absent ejaculation, and decreased sexual interest), weight gain, serotonin syndrome, and withdrawal syndrome. Serotonin syndrome (disorientation and hallucinations) is uncommon unless the patient is taking a monoamine oxidase inhibitor or ritonavir. The abrupt discontinuation of fluoxetine can cause withdrawal syndrome (for example, dizziness, headache, nausea, tremor, anxiety, and dysphoria).
The nurse cares for a patient with a digoxin level of 1.9 ng/mL. Which action would be most appropriate for the nurse to take initially? A) Start continuous heart monitoring. B) Check the patient's serum creatinine. C) Administer digoxin as prescribed. D) Give Fab antibody fragments [Digibind].
C The therapeutic ranges for digoxin measured in the plasma are 0.6-2.0
A patient has hypertension, type 2 diabetes, and chronic kidney disease. Which blood pressure goal would be most beneficial for this patient? A) Blood pressure less than 140/90 mm Hg B) Diastolic blood pressure less than 100 mm Hg C) Blood pressure less than 130/80 mm Hg D) Systolic blood pressure less than 160 mm Hg
C The treatment goal for a person with hypertension and diabetes or chronic kidney disease is less than 130/80 mm Hg
A patient is brought to the emergency department with hallucinations related to a tricyclic antidepressant overdose. The patient has hot, flushed skin and an oral temperature of 103.8º F (39.9º C). Which medication should the nurse prepare to administer as an antidote? A) Pyridostigmine [Mestinon] B) Epinephrine [EpiPen] C) Physostigmine [Antilirium] D) Atropine [AtroPen]
C Tricyclic antidepressants are antimuscarinic drugs with pronounced antimuscarinic properties. The most effective antidote to antimuscarinic poisoning is physostigmine, which is an inhibitor of acetylcholinesterase
A patient who is taking spironolactone [Aldactone] is prescribed losartan [Cozaar]. The nurse should take which action? A) Assess for symptoms of hyperkalemia. B) Observe for a hypertensive crisis. C) Administer the medications as scheduled. D) Evaluate for first-dose hypotension.
C??? These medications may be administered together without serious drug interactions. Spironolactone is a potassium-sparing diuretic, and losartan is an angiotensin II receptor blocker (ARB). The hypotensive effects of ARBs are additive with those of other antihypertensive drugs. When an ARB is added to an antihypertensive regimen, dosages of the other drugs may require reduction. The patient would be observed for hypotension (not first-dose hypotension)
A patient is prescribed sustained-release oral nitroglycerin capsules for chronic stable angina. The nurse should include which instruction? A) "Avoid exercising to help prevent chest pain." B) "Place the capsule under the tongue if chest pain occurs." C) "Take the capsule as needed before exercise or exertion." D) "Sit or lie down if dizziness or lightheadedness occurs."
D
The nurse is preparing to administer adenosine [Adenocard] to a patient to treat paroxysmal supraventricular tachycardia (SVT). Which action by the nurse is most appropriate? A) Inject the medication into the peripheral intravenous (IV) line. B) Infuse the dose by diluting the drug in 100 mL of saline. C) Administer a small test dose to determine hypersensitivity. D) Give the medication through the central line catheter.
D
The nurse teaches a patient about bupropion [Wellbutrin]. Which statement by the patient indicates that more teaching is indicated? A) "I can take the drug with food to reduce nausea." B) "This drug will increase my interest in sex." C) "I may experience decreased appetite and weight loss." D) "I had a serious head injury 3 years ago."
D Bupropion is generally well tolerated, but it can cause seizures. Therefore, bupropion should be avoided in patients with prior head trauma, because their risk for seizures is increased. Bupropion does not cause weight gain or sexual dysfunction, and it appears to increase sexual desire and pleasure. Bupropion is administered orally and may be taken with food to decrease gastrointestinal upset
A patient is to receive a scheduled dose of diltiazem [Cardizem]. The nurse should hold the medication and contact the prescriber if which of the following is noted? A) The patient's blood pressure is 112/64 mm Hg. B) The patient's cardiac rhythm is atrial fibrillation. C) The patient is complaining of chest pain. D) The patient is in second-degree heart block.
D Diltiazem is contraindicated in patients with second-degree or third-degree heart block; diltiazem can exacerbate cardiac dysfunction
A patient is prescribed doxepin [Sinequan] for the treatment of depression. Which over-the-counter medication should the nurse teach the patient to avoid? A) Glucosamine sulfate B) Omeprazole [Prilosec] C) Fish oil (omega-3 fatty acids) D) Diphenhydramine [Benadryl]
D Drugs that are capable of blocking muscarinic receptors will enhance the anticholinergic effects of doxepin and other tricyclic antidepressants. The nurse should warn patients against the concurrent use of other anticholinergic drugs such as scopolamine, antihistamines, and phenothiazines. Diphenhydramine is an antihistamine
Which patient would most likely be prescribed sodium nitroprusside [Nitropress]? A) A patient with a recent diagnosis of essential hypertension B) A patient with heart failure who receives weekly home visits C) A patient who is hypotensive after a myocardial infarction D) A patient with a hypertensive crisis in the intensive care unit
D Sodium nitroprusside is used to treat hypertensive emergencies. The medication is administered intravenously, with continuous monitoring of blood pressure
Which patient is the most appropriate candidate for both lifestyle changes and drug therapy with an antihypertensive medication? A) A 47-year-old patient with blood pressure of 110/78 mm Hg and with type 2 diabetes mellitus B) A 76-year-old patient with blood pressure of 128/88 mm Hg and a history of dyslipidemia C) A 52-year-old patient with blood pressure of 136/89 mm Hg who smokes 1 pack of cigarettes per day D) A 32-year-old patient with blood pressure of 142/94 mm Hg who is sedentary
D Stages 1 and 2 hypertension should be treated with both lifestyle changes and drug therapy to control blood pressure
A patient is prescribed phenytoin [Dilantin] for epileptic seizures. Which of the following is the priority for patient teaching? A) Teach the patient to adjust the dose according to the presence of symptoms. B) Tell the patient to take the medication with meals. C) Inform the patient about the prevention of gingival hyperplasia. D) Teach the patient to avoid the abrupt cessation of treatment.
D The most important concept is to teach the patient to avoid the abrupt cessation of treatment. This could lead to a life-threatening seizure or to status epilepticus. The patient should not adjust the dose without consulting the prescriber. Although teaching the patient to take the medication with meals and teaching the patient how to avoid gingival hyperplasia are indicated, they are not the priority
The nurse cares for a patient who is prescribed oral bumetanide twice daily. It is most important for the nurse to take which action? A) Monitor the patient for signs and symptoms of hyperkalemia. B) Insert a urinary catheter and assess the hourly urine output. C) Weigh the patient before administering each dose. D) Schedule the medication to be given at 0800 and 1400
D The nurse should administer oral bumetanide with twice-a-day dosing at 0800 and 1400 to minimize nocturia. Daily weights should be obtained in the morning before eating. Patients receiving IV bumetanide are more likely to need hourly monitoring of urine output with a urinary catheter. Bumetanide may cause hypokalemia; signs and symptoms of hypokalemia include irregular heartbeat, muscle weakness, cramping, flaccid paralysis, leg discomfort, extreme thirst, and confusion
Mannitol IV has been ordered for the patient. When the IV solution of mannitol arrives from the pharmacy, the nurse notes crystals in the fluid. What is the most appropriate action by the nurse?
Mannitol may crystallize out of solution if exposed to a low temperature. Accordingly, preparations should be observed for crystals before use. Preparations that contain crystals should be warmed (to redissolve the mannitol) and then cooled to body temperature for administration
A patient who sustained a head injury is admitted to the critical care unit with increased intracranial pressure (ICP). The healthcare provider says that a diuretic will be used to lower the patient's ICP. The nurse anticipates that which diuretic will be ordered, and why?
The nurse anticipates that mannitol, an osmotic diuretic, will be ordered. Intracranial pressure (ICP) that has been elevated by cerebral edema can be reduced with mannitol. The drug lowers ICP because its presence in the blood vessels of the brain creates an osmotic force that draws edematous fluid from the brain into the blood. There is no risk of increasing cerebral edema because mannitol cannot exit the capillary beds of the brain
