Pharm Exam NCLEX Cardiovascular to Maternity

A client taking an angiotensin-converting enzyme (ACE) inhibitor to treat hypertension calls the clinic nurse and reports a dry, nonproductive cough that is very bothersome. The nurse would respond by making which statement?

"The medication may need to be changed."

A client with a history of heart failure who is receiving digoxin daily has a serum potassium level of 3 mEq/L (3 mmol/L) and is complaining of anorexia. The primary health care provider orders a serum digoxin level to be done. The nurse checks the results and would expect to note which level that is outside the therapeutic range?

2.2 ng/mL

A client is scheduled for a dose of ramipril. The nurse would check which measurement before administering the medication?

Blood pressure

A client who has begun taking betaxolol demonstrates an effective response to the medication as indicated by which nursing assessment finding?

Decrease in blood pressure from 142/94 mm Hg to 128/82 mm Hg

Atorvastatin has been prescribed for a client, and the client asks the nurse about the side and adverse effects of the medication. What would the nurse tell the client is a frequent side effect of this medication?

Headache

A client seen in the health care clinic for follow-up care is taking atorvastatin. The nurse would assess the client for which adverse effect of the medication?

Photosensitivity

Lisinopril has been prescribed for a client with hypertension. What would the nurse instruct the client about this medication?

Rise slowly from a reclining to a sitting position.

Atenolol has been prescribed for a client, and the client asks the nurse about the action of the medication. How would the nurse respond regarding the action of this medication?

Slows the heart rate

A client is admitted to the emergency department with a diagnosis of myocardial infarction (MI). The primary health care provider (PHCP) prescribes the administration of alteplase. The registered nurse (RN) preceptor is orienting a new RN in the use of this medication. Which statement by the new RN indicates that teaching has been effective?

"Administer the medication within 4 to 6 hours after onset of chest pain."

The nurse is providing education to a client who is being started on atenolol. Which statement by the client indicates that teaching has been effective?

"I am taking this medication for hypertension."

The nurse has completed giving medication instructions to a client receiving benazepril. Which client statement indicates to the nurse that the client needs further instruction?

"I can use salt substitutes freely and eat foods high in potassium."

A client with angina pectoris has been given a new prescription for nitroglycerin transdermal patches. The client indicates an understanding of how to use this medication administration system by making which statement?

"I need to apply the patch in the morning and leave it in place for 12 to 14 hours as directed."

A hypertensive client has been prescribed clonidine hydrochloride, a transdermal patch. The nurse provides written instructions to the client on the use of the patch. Which statement by the client indicates the need for further instruction?

"I need to change the patch every 24 hours."

The nurse has given a client information about the use of nitroglycerin sublingual tablets. The client has a prescription for PRN (as needed) use if chest pain occurs. Which client statement indicates an understanding of this medication?

"I need to discard unused tablets 6 months after the bottle is opened."

A client is to be discharged from the hospital on quinidine gluconate to control ventricular ectopy. The nurse provides instructions to the client about the medication. Which statement by the client indicates a need for further instruction?

"I need to stop the medication immediately if diarrhea, nausea, or vomiting occurs."

TThe nurse is caring for a child with heart failure (HF). The nurse provides instructions to the parent regarding the procedure for administration of the prescribed digoxin. Which statement by the parent indicates a need for further teaching?

"I will make sure to mix the medication with food."

A client with chronic atrial fibrillation is being started on quinidine sulfate as maintenance therapy for dysrhythmia suppression, and the nurse provides instructions to the client about the medication. Which statement by the client indicates a need for further instruction?

"I will stop taking the prescribed anticoagulant after starting this new medication."

The nurse provides discharge instructions to a client with atrial fibrillation who is taking warfarin sodium. Which statement by the client reflects the need for further teaching?

"I will take coated aspirin for my headaches."

The home health care nurse is visiting a client with coronary artery disease with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL (10 mmol/L). The client is taking cholestyramine, and the nurse teaches the client about the medication. Which statement by the client indicates the need for further teaching?

"I'll continue my nicotinic acid from the health food store."

A neurologist prescribed ticlopidine to the client with thrombotic stroke. The nurse provides instructions to the client and spouse regarding the medication. Which statement made by the client indicates that education was effective?

"I'll take the medicine with meals."

A client is prescribed nicotinic acid for the treatment of coronary artery disease and hyperlipidemia, and the nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions?

"Ibuprofen IB taken 30 minutes before the nicotinic acid would decrease the flushing."

The nurse provides instructions to the client about nicotinic acid prescribed for hyperlipidemia. Which statement by the client indicates understanding of the instructions?

"Ibuprofen taken 30 minutes before the nicotinic acid may decrease the flushing."

Atenolol has been prescribed for a client, and the nurse provides instructions to the client about the medication. Which statement by the client indicates the need for further teaching?

"If I feel that my heart rate is too low, I need to stop the medication."

A client is being discharged on warfarin sodium, and the nurse provides instructions to the client regarding the medication. Which statement, if made by the client, indicates to the nurse that the client understands the teaching provided?

"If I notice blood-tinged urine, I will call my doctor."

Daily administration of dipyridamole has been prescribed for the client, and the nurse teaches the client about the medication. Which client statement indicates an understanding of the instructions?

"If I take this medicine with my warfarin, it will protect my artificial heart valve."

Atorvastatin has been prescribed for a client, and the client asks the nurse about the action of the medication. How would the nurse respond?

"It decreases low-density lipoproteins (LDLs)."

A registered nurse (RN) is orienting a new RN on the use of atorvastatin. Which statement by the new RN indicates that the teaching has been effective?

"It is given to clients with hypercholesterolemia."

A client is being treated for moderate hypertension and has been taking diltiazem for several months. The client schedules an appointment with the primary health care provider because of episodes of chest pain, and Prinzmetal's angina is diagnosed. The client asks the nurse which therapeutic effects the medication will provide, and the nurse provides education. Which statement by the client indicates that the teaching has been effective?

"It prevents an influx of calcium ions in the smooth muscle."

Minoxidil is prescribed for a client to treat hair loss. The client asks the nurse if the hair will continue to grow when the medication is stopped. What is the appropriate nursing response?

"Newly gained hair is lost in 3 to 4 months."

A client receives education regarding self-administration of enoxaparin on discharge to home. The client complains, "I feel as if the primary health care provider is discharging me too soon if I still have to take injections at home." Which response would the nurse make?

"Research shows that it is best for clients to administer this medication at home rather than stay in the hospital."

A primary health care provider (PHCP) prescribes warfarin sodium for a client. The home care nurse visits the client at home and teaches the client about the medication and its administration. Which statement by the client indicates a need for further teaching?

"The urine normally changes to orange."

The nurse has given the client with atrial fibrillation instructions to take 1 aspirin daily. The client says to the nurse, "Why do I need to take this? I don't get any pain with my heart rhythm. "Which response by the nurse is the most appropriate?

"This will help prevent clot formation in your heart as a result of your heart's rhythm."

A client scheduled to take a subcutaneous anticoagulant at home says to the nurse, "I'm not sure I will be able to take this medication at home." Which statement by the nurse is appropriate?

"What are your concerns about taking this medication at home?"

A client is experiencing impotence after taking guanfacine. The client states, "I would sooner have a stroke than keep living with the effects of this medication." What is the most appropriate response by the nurse?

"You are concerned about the effects of your medication."

The nurse is providing discharge instructions to a client taking warfarin sodium. Which statement, based on primary health care provider (PHCP) permission, is appropriate to include in client teaching for this medication?

"You need to check with your doctor about what can be taken for headaches."

The nurse is monitoring a client with heart failure who is taking digoxin. Which findings are characteristic of digoxin toxicity? Select all that apply.

- Diarrhea - Blurred vision - Nausea and vomiting

The nurse is monitoring for adverse effects in a client who is taking digoxin. Which findings are characteristic of digoxin toxicity? Select all that apply.

- Diarrhea - Blurred vision - Nausea and vomiting

A postpartum client with deep vein thrombosis is being treated with anticoagulant therapy. The nurse teaches the client that the primary health care provider (PHCP) would be contacted for which noted side and adverse effects? Select all that apply.

- Epistaxis - Hematuria - Ecchymosis

A client with hypertension has a new prescription for a medication called moexipril. The nurse plans to provide written directions that tell the client to take the medication at which time?

1 hour before meals

A client who is receiving digoxin daily has a serum potassium level of 3 mEq/L (3 mmol/L) and reports anorexia. The cardiologist prescribes a serum digoxin level to be done. Which level would the nurse recognize as being outside of the therapeutic range?

2.2 ng/mL (2.8 nmol/L)

The nurse is reviewing the laboratory results for a client who arrives at the health care clinic for follow-up assessment after being diagnosed with atrial fibrillation. The international normalized ratio (INR) is analyzed because the client has been taking warfarin sodium since discharge from the hospital. The nurse determines that the INR range is at an appropriate level if what value is noted on the laboratory report?

2.3

The nurse is monitoring the laboratory test results for a client who is taking warfarin sodium after mechanical heart valve replacement. The nurse would expect the international normalized ratio (INR) for this client to be at what value in order to be therapeutic?

3.0

Levothyroxine is prescribed for a client diagnosed with hypothyroidism. The nurse reviews the client's record and notes that the client is presently taking warfarin. The nurse contacts the primary health care provider (PHCP), anticipating that the PHCP will prescribe which medication?

A decreased dosage of warfarin

A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hour. The nurse determines that the client is receiving the therapeutic effect based on which results?

Activated partial thromboplastin time of 60 seconds

A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hr. Which result would indicate to the nurse that the client is receiving a therapeutic dose?

Activated partial thromboplastin time of 60 seconds

The nurse has completed medication administration that included a nitroglycerin. Within minutes, the client is complaining of a headache. Which is the priority nursing action at this time?

Administer the prescribed analgesic.

A client with a subarachnoid hemorrhage needs to have surgery delayed until a stable clinical condition is achieved. The nurse prepares to administer which medication as prescribed to prevent clot breakdown and dissolution?

Aminocaproic acid

The nurse notes a persistent dry cough in an adult client being seen in the ambulatory clinic. When questioned, the client states that the cough began approximately 2 months ago. On further assessment, the nurse learns that the client began taking quinapril shortly before the time that the cough began. How would the nurse interpret the development of the cough?

An expected although bothersome side effect of therapy

Atenolol has been prescribed for a hospitalized client. The nurse would check which item before administering this medication?

Apical heart rate

The primary health care provider (PHCP) writes a prescription for atenolol for a client who was admitted to the hospital. The nurse contacts the PHCP to verify the prescription if which finding is noted in the assessment data?

Apical heart rate is 48 beats/min.

A client who had surgery 3 days earlier is receiving heparin sulfate by subcutaneous injection every 12 hours. In planning for the client's morning care, the priority nursing intervention is which action?

Assist the client to shave using an electric razor.

A client has recently begun medication therapy with propranolol. The long-term care nurse would plan to notify the primary health care provider (PHCP) if which assessment finding is noted?

Audible expiratory wheezes

A client is being treated with procainamide for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. Which intervention would the nurse implement first?

Auscultate the client's apical pulse and blood pressure.

A client is scheduled to have heparin sodium 5000 units subcutaneously. What is the most appropriate nursing intervention?

Avoid aspirating prior to injecting the medication.

A client in the postpartum care unit who is recovering from disseminated intravascular coagulopathy is to be discharged on low dosages of an anticoagulant medication. In developing home care instructions for this client, the nurse would include which priority safety instruction regarding this medication?

Avoid taking acetylsalicylic acid (aspirin).

The nurse has given a client the prescribed dose of intravenous hydralazine. The nurse evaluates the effectiveness of the medication by monitoring which client parameter?

Blood pressure

The nurse is administering a dose of clonidine to a client. The nurse would ensure that which item is in place before administering the medication?

Blood pressure cuff

The nurse would report which assessment finding to the primary health care provider (PHCP) before initiating thrombolytic therapy in a client with pulmonary embolism?

Blood pressure of 198/110 mm Hg

The nurse prepares to teach a client with subarachnoid hemorrhage about the effects of nimodipine. The nurse plans to explain which information about the type and action of this medication?

Calcium channel blocker that will decrease spasm in cerebral blood vessels

A client who is scheduled to have warfarin sodium therapy has a prothrombin time (PT) of 28 seconds (28 seconds). What is the most appropriate nursing intervention at this time?

Call the primary health care provider (PHCP).

A client with a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium 7.5 mg at 5:00 p.m. daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. The nurse would take which action based on the client's laboratory results?

Collaborate with the PHCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed.

A client with valvular heart disease who has a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hr and warfarin sodium 7.5 mg at 1600 daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. Which action would the nurse take based on the client's laboratory results?

Collaborate with the PHCP to obtain a prescription to increase the heparin infusion and continue the warfarin sodium as prescribed.

A client taking verapamil has been given information about side effects of this medication. The nurse determines that the client understands the information if the client states to watch for which most common side effect of this medication?

Constipation

A client who began medication therapy with prazosin hydrochloride 1 week earlier arrives at the health care clinic for follow-up evaluation and care. The nurse interprets that the client is experiencing the expected benefit of therapy if which is noted?

Decreased blood pressure

A client is receiving scheduled doses of lovastatin. The nurse determines that the medication is having the intended effect if which is noted?

Decreased cholesterol level

Atenolol has been prescribed for a client with hypertension, and the client asks the nurse about the side effects of the medication. What would the nurse tell the client is an occasional side effect of this medication?

Decreased libido

The nurse is monitoring a client with hypertension who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this medication?

Development of expiratory wheezes

A client is admitted to the hospital with a diagnosis of myocardial infarction (MI). The client is started on alteplase therapy. The nurse determines that teaching has been effective when the client's significant other states that the purpose of the medication is to perform which action?

Dissolve any clots in the coronary arteries.

The nurse has a prescription to give a client a scheduled dose of digoxin. Prior to administering the medication, the nurse would assess for which manifestations that could indicate digoxin toxicity?

Double vision, loss of appetite, and nausea

A client is receiving heparin sodium by continuous intravenous (IV) infusion. The nurse would notify the primary health care provider if ongoing nursing assessment reveals which finding?

Ecchymosis

Gemfibrozil is prescribed for a client. Which laboratory finding would alert the nurse to the need to withhold the medication and contact the primary health care provider?

Elevated liver function tests

The primary health care provider (PHCP) writes a prescription for lisinopril for a hospitalized client with hypertension. The nurse caring for the client determines that the medication has been prescribed to treat which disorder?

Hypertension

A client admitted to the hospital is taking atenolol. The nurse monitors the client for which sign or symptom of an adverse effect of the medication?

Hypotension

A client has been prescribed pindolol for hypertension. The nurse provides anticipatory guidance, knowing that which common side effect of this medication may decrease client compliance?

Impotence

Atorvastatin has been prescribed for a client. The nurse tells the client that which blood test will be done periodically while the client is taking this medication?

Liver function studies

The nurse has conducted medication instructions with a client receiving lovastatin. Which periodic blood study will be necessary and included in the client's instructions?

Liver function studies

A client with chronic kidney disease (CKD) who is receiving an antihypertensive medication is experiencing frequent hypotensive episodes. The nurse reviews the client's medication record, knowing that which medication would have the greatest tendency to cause hypotension?

Methyldopa

A client is diagnosed with an ST segment elevation myocardial infarction (STEMI) and is receiving a tissue plasminogen activator, alteplase. Which action is a priority nursing intervention?

Monitor for signs of bleeding.

The nurse would educate the client receiving pravastatin to immediately report which finding?

Muscle pain

A client with cardiac disease has begun taking propranolol, and the nurse provides information to the client about the medication. The nurse would tell the client to contact the primary health care provider (PHCP) if which symptoms develop?

Night cough and dyspnea

The nurse has been given a medication prescription to administer intravenous (IV) hydralazine. The nurse obtains which priority piece of equipment needed for use during administration of this medication?

Noninvasive blood pressure cuff

The nurse is caring for a client who suddenly starts to complain of palpitations, restlessness, and anxiety. The nurse obtains a stat electrocardiogram (ECG), which shows this rhythm. Refer to figure. The nurse would perform which actions in anticipation of appropriate medication therapy with amiodarone?

Obtain an infusion pump and prepare to administer 150 mg over 10 minutes followed by a maintenance dose.

The nurse is providing medication information to a client who is beginning medication therapy with enalapril. The nurse would tell the client that which is an anticipated, although unpleasant, side effect of this medication?

Persistent dry cough

The nurse is caring for a client who is taking warfarin. The nurse notes the presence of gross hematuria and large areas of bruising on the client's body. The nurse notifies the primary health care provider (PHCP) and ensures that which prescribed medication is available?

Phytonadione (vitamin K)

The nurse is caring for a client who is receiving heparin sodium intravenously as a continuous infusion. Which laboratory finding requires immediate nursing intervention?

Platelet count of 98,000 mm3 (98 × 109/L)

A client is admitted to a hospital with acute myocardial infarction and is started on tissue plasminogen activator (tPA) by infusion. Which parameter would the nurse determine requires the least frequent assessment to detect complications of therapy with tPA?

Presence of bowel sounds

A client receiving heparin sodium by continuous intravenous (IV) infusion removes the tubing from the pump to change his hospital gown. The nurse is concerned that the client received a bolus of medication. After requesting a prescription for a stat partial thromboplastin time (PTT), the nurse would check for the availability of which medication in the medication cart?

Protamine sulfate

Intravenous heparin therapy is prescribed for a client with atrial fibrillation. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit?

Protamine sulfate

A client is being discharged to home with enoxaparin for short-term therapy. What would the nurse explain to the family about the medication action?

Reduces the risk of deep vein thrombosis

A client is scheduled to take ticlopidine. The nurse plans to take which action before implementing this medication therapy?

Review the results of the complete blood cell (CBC) count.

Prior to administering a client's daily dose of digoxin to treat heart failure, the nurse reviews the client's laboratory data and notes the following results: serum calcium, 9.8 mg/dL (2.45 mmol/L); serum magnesium, 1.0 mEq/L (0.4 mmol/L); serum potassium, 4.1 mEq/L (4.1 mmol/L); serum creatinine, 0.9 mg/dL (79.5 mcmol/L). Which result would alert the nurse that the client is at risk for digoxin toxicity?

Serum magnesium level

A client has a prescription to receive enoxaparin. The nurse would plan to administer this medication by which route?

Subcutaneous

The nurse is monitoring a client who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this medication?

The development of audible expiratory wheezes

A thrombolytic is administered in the hospital emergency department to a client who has had a myocardial infarction. The client's spouse asks the nurse about the purpose of the medication. The nurse bases the response on which fact regarding this medication?

Thrombolytics act to dissolve thrombi that have already formed.

The nurse has completed client teaching on the use of thrombolytic medications in acute ischemic stroke. The nurse determines that the educational session was effective if the client states that thrombolytics are used for what purpose?

To dissolve clots

The nurse is preparing to administer heparin sodium subcutaneously. Which nursing action is the most appropriate?

Use a 25- to 27-gauge, ½-inch (1.3 cm) needle.

The nurse is providing instructions to a client with chronic atrial fibrillation who is being started on quinidine sulfate. The nurse would plan to provide which instruction to the client?

Wear a MedicAlert bracelet.

A 56-year-old adult client with heart failure is receiving digoxin. The nurse is auscultating the apical heart rate before giving digoxin and notes that the heart rate is 48 beats/minute. Which action would the nurse take?

Withhold the digoxin, and assess for signs of decreased cardiac output and digoxin toxicity.

A primary health care provider (PHCP) writes a prescription for digoxin, 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is most important to be sure to implement which measure?

Withhold the medication and call the PHCP if the pulse is slower than 60 beats/min.

A man has developed atrial fibrillation and has been placed on warfarin. The nurse is doing discharge dietary teaching with the client and determines that the client needs additional education if he states that he would choose which food while taking this medication?

broccoli