pharm test 2

13. The nurse is preparing to administer benztropine (Cogentin) to a patient who has Parkinsons disease. When performing an assessment, which aspect of the patients history would cause the nurse to hold the medication and notify the provider? a. Asthma b. Glaucoma c. Irritable bowel syndrome d. Motion sickness

ANS: B Patients who have glaucoma should not take anticholinergic medications.

The nurse is caring for a patient who is taking a cholinergic (parasympathomimetic) drug. Which assessment will indicate that the medication is having a desired effect? a. Increased gastrointestinal (GI) motility b. Mydriasis c. Urinary retention d. Vasoconstriction

A Cholinergic effects mimic the parasympathetic nervous system (rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing GI motility helps the digestive process.

The nurse monitors a patient prescribed dicyclomine (Bentyl) for which therapeutic effect? a. Decrease in GI motility b. Decrease in urinary frequency c. Increase in heart rate d. Increase in blood pressure

A Dicyclomine (Bentyl) is an antispasmodic cholinergic blocker used to decrease GI motility in patients with functional GI disorders such as irritable bowel syndrome.

14. A patient is ordered to receive a nitrate to relieve stable angina. What side effect(s) will the nurse anticipate in a patient receiving this medication? a. Nausea and vomiting b. Increased blood pressure c. Pruritus and skin rash d. Pounding headache

ANS: D The pounding headache is related to vasodilation of the cerebral vessels. Nitrates decrease blood pressure.

A patient is to receive dopamine 5 mcg/kg/min. The patient weighs 176 pounds. An infusion of dopamine 400 mg in 500 mL of D5W is available. The nurse will infuse this drug at a rate of how many milliliters per hour?

1.3 ml/hr The patient's weight of 176 lb is converted to kg by dividing by 2.2: 176 ÷ 2.2 = 80 kg. 5 mcg/kg × 80 kg = 400 mcg, or 0.4 mg/min. 0.4 mg/min ÷ 400 mg/500 mL = 0.5 mL/min; 0.5 mL/min × 60 min = 30 mL/hr.

A patient with cardiac decompensation is receiving dobutamine as a continuous infusion. The patient's blood pressure has increased from 100/80 mm Hg to 130/90 mm Hg. What is the nurse's priority action? a. Assess hourly blood pressure readings. b. Assess the patient's ECG and slow the infusion. c. Assess the patient's respiratory rate and measure ABGs. d. Assess the patient's I&O and decrease IV fluids.

A The major therapeutic effect of dobutamine is to increase cardiac output. Cardiac output is reflected in the patient's heart rate, blood pressure, and urine output. An increase in blood pressure is the expected therapeutic effect.

Which patient assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker? a. Absence of chest pain b. Decreased swelling in the ankles and feet c. Patient denies dizziness. d. Patient states that she feels stronger.

A The workload in the heart should be decreased with the vasodilation from the calcium channel blocker. With less strain, the patient should have fewer incidences of angina as afterload is decreased.

When a patient has a cholinergic overdose from excessive dosing of bethanechol (Urecholine), the nurse anticipates administration of which drug as the antidote? a. atropine b. tolterodine c. benztropine d. metoclopramide

A

When benztropine (Cogentin) is ordered for a patient, the nurse acknowledges that this drug is an effective treatment for which condition? a. Parkinsonism b. Paralytic ileus c. Motion sickness d. Urinary retention

A

A patient is to be discharged with a transdermal nitroglycerin patch. Which instruction will the nurse include in the patient's teaching plan? a. "Apply the patch to a non-hairy area of the upper torso or arm." b. "Apply the patch to the same site each day." c. "If you have a headache, remove the patch for 4 hours and then reapply." d. "If you have chest pain, apply a second patch next to the first patch."

A A nitroglycerin patch should be applied to a non-hairy area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation. The drug should be continued if headache occurs, as tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.

The nurse is preparing to discharge a patient who is receiving acebutolol HCl (Sectral). Which instruction will the nurse include in the medication teaching plan for this patient? a. "If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions." b. "If you become dizzy, do not take your medication for 2 days and then restart on the third day." c. "This medication may make you fatigued; increasing caffeine in your diet may help alleviate this problem." d. "Increase intake of green leafy vegetables to prevent bleeding problems that can be caused by this medication."

A Acebutolol HCl (Sectral), a beta blocker, has negative chronotropic effects and could cause symptomatic bradycardia and/or heart block. The health care provider should be consulted before acebutolol is administered to a patient with bradycardia (heart rate less than 60 beats/min)

The nurse assesses a patient receiving an adrenergic (sympathomimetic) agent. Which finding will be of greatest concern to the nurse? a. Weak peripheral pulses and decreased heart rate b. Increased peripheral pulses and increased heart rate c. Stable blood pressure and increased cardiac output d. Heart rate of 95 beats per minute and strong peripheral pulses

A Adrenergic agents stimulate the sympathetic nervous system, which increases heart rate (positive chronotropic effect), contractility (positive inotropic effect), and conductivity (positive dromotropic effect). The nurse would be most concerned that the pulses remain weak and heart rate decreased after receiving this drug, as the therapeutic effect is not being achieved.

Which is a priority nursing diagnosis for a patient receiving an anticholinergic (parasympatholytic) medication? a. Impaired gas exchange related to thickened respiratory secretions b. Knowledge deficit related to pharmacologic regimen c. Risk for injury related to excessive CNS stimulation d. Urinary retention related to loss of bladder tone

A Although all of these nursing diagnoses are appropriate, the priority is determined by remembering the ABCs. Anticholinergic drugs decrease respiratory secretions, which could lead to mucous plugs and resultant impaired gas exchange.

A patient is prescribed metoprolol (Lopressor) to treat hypertension. It is important for the nurse to monitor the patient for which condition? (Select all that apply.) a. Bradycardia b. Hypotension c. Ankle edema d. Decreased respirations e. Increased respirations

A, B

The nurse will monitor the patient taking albuterol (Proventil) for which conditions? (Select all that apply.) a. Palpitations b. Hypertension c. Hypoglycemia d. Bronchospasm e. Uterine contractions

A, B

A nurse is preparing to administer a beta blocker to a patient. The nurse recognizes that beta blockers are used to treat which conditions? (Select all that apply.) a. Angina pectoris b. Cardiogenic shock c. Chronic obstructive pulmonary disease (COPD) d. Congestive heart failure (CHF) e. Hypertension f. Sinus bradycardia

A, D, E Beta blockers are effective in treating hypertension (secondary to negative inotropic effects) and angina pectoris (decreases cardiac workload when decreasing heart rate and contractility). Beta blockade has also been shown to reduce mortality in patients with CHF.

17. The nurse is preparing to administer tolterodine tartrate (Detrol LA) to a patient who has incontinence. Which symptom would be a contraindication for this drug? a. Decreased bowel sounds b. Drooling c. Gastric upset d. Pain

ANS: A A decrease in bowel sounds could signal the beginning of paralytic ileus. Detrol is contraindicated in patients with paralytic ileus.

10. A patient is taking doxazosin mesylate (Cardura) 1 mg per day to treat hypertension. The nurse notes a blood pressure of 110/72 mm Hg and a heart rate of 92 beats per minute. The nurse will contact the provider to discuss which change to the drug regimen? a. Changing to a beta-adrenergic blocker b. Decreasing the drug dose c. Increasing the drug dose d. Adding a diuretic

ANS: A Alpha-adrenergic blockers can cause orthostatic hypotension and reflex tachycardia. Beta blockers do not cause reflex tachycardia. Decreasing or increasing the drug dose is not recommended. Diuretics are added if blood pressure is not well-controlled.

2. A nursing student asks why a direct-acting cholinergic agonist drug that is selective to muscarinic receptors is described as being non-specific. The nurse will explain that this is because a. muscarinic receptors are present in many different tissues. b. the action of cholinesterase alters the bioavailability at different sites. c. these drugs can also affect nicotinic receptors. d. they vary in their reversible and irreversible effects

ANS: A Although drugs classified as direct-acting cholinergic agonists are primarily selective for muscarinic receptors, they are non-specific because muscarinic receptors are located in different sites, causing actions in various organs. They are not affected differently by cholinesterase activity and have negligible actions on nicotinic receptors.

9. A patient who has irritable bowel syndrome would most likely receive which type of drug to treat this condition? a. An anticholinergic b. A cholinergic esterase inhibitor c. A muscarinic agent d. A nicotinic agent

ANS: A Anticholinergic drugs are used to treat peptic ulcers and intestinal spasticity because of their actions to decrease gastric secretions and gastrointestinal spasms.

16. A patient who is intubated develops bradycardia because of vagal stimulation. Which medication will the nurse anticipate administering to treat this symptom? a. Atropine sulfate (Atropine) b. Benztropine (Cogentin) c. Bethanechol chloride (Urecholine) d. Metoclopramide (Reglan)

ANS: A Atropine is used to treat bradycardia caused by vagal stimulation

10. A patient who has stable angina pectoris is given nitroglycerin to use as needed. In addition to pharmacotherapy, the nurse will give the patient which instruction? a. Avoid extremes in weather. b. Begin a rigorous exercise program. c. Drink glass of red wine daily. d. Seek medical care at first sign of pain.

ANS: A Avoiding extreme weather conditions is important to help prevent anginal attacks. Patients should be instructed to avoid strenuous exercise; avoid alcohol, which can enhance hypotensive effects of nitrates; and use nitroglycerin at the first sign of pain.

1. The nurse is caring for a patient who has asthma and administers a selective beta2-adrenergic agonist to treat bronchospasm. The nurse will expect this drug to also cause which side effect? a. Increased blood glucose b. Increased blood pressure c. Increased heart rate d. Increased gastrointestinal (GI) motility

ANS: A Drugs that act on beta2 receptors activate glyconeogenesis in the liver causing increased blood glucose. Selective beta2 drugs act on beta2 receptors only and not on beta1 receptors, so they do not cause increased blood pressure or increased heart rate. Adrenergic agonists cause decreased GI motility.

9. A patient will begin taking albuterol (Proventil) to treat asthma. When teaching the patient about this drug, the nurse will make which recommendation? a. Report rapid or irregular heart rate. b. Drink 8 to 16 extra ounces of fluid each day. c. Monitor serum glucose daily. d. Take a calcium supplement.

ANS: A High dosages of albuterol may affect beta1 receptors, causing an increase in heart rate that could be dangerous. It is not necessary to consume extra fluids or take a calcium supplement while using this drug. Serum glucose may be elevated slightly, but this is not a concern in non-diabetic patients.

4. An adult patient is brought to the emergency department for treatment of an asthma exacerbation. The patient uses inhaled albuterol as needed to control wheezing. The nurse notes expiratory wheezing, tremors, restlessness, and a heart rate of 120 beats per minute. The nurse suspects that the patient has a. over-used the albuterol. b. not been using albuterol. c. taken a beta-adrenergic blocker. d. taken a monoamine oxidase (MAO) inhibitor.

ANS: A High doses of albuterol may affect beta1 receptors, causing an increase in heart rate. Patients having an asthma exacerbation may over-use their albuterol inhalers when seeking relief. Patients may have wheezing and increased heart rate during an untreated asthma exacerbation, but they will not have tremors and restlessness.

6. The nurse is teaching a patient how to use phenylephrine HCl (Neo-Synephrine) nasal spray to treat congestion from a viral upper respiratory infection. What instruction will the nurse give the patient? a. Stop using the medication after 3 days. b. Spray the medication into the nose while lying supine. c. Use frequently since systemic side effects do not occur. d. Use the medication with any other over-the-counter medications.

ANS: A Nurses should explain to patients that continuous use of nasal sprays containing adrenergic agonists may result in rebound nasal congestion; these sprays should not be used more than 3 days. To avoid systemic absorption, spray should be administered while the patient is in an upright position. The medication may cause systemic side effects and should not be routinely used with other OTC cold medications.

5. The nurse is teaching a patient who will begin taking bethanechol (Urecholine). Which statement by the patient indicates a need for further teaching? a. Excessive sweating is a normal reaction to this medication. b. Excess salivation is a serious side effect. c. I should get out of bed slowly while taking this drug. d. I will not take the drug if my heart rate is less than 60 beats per minute.

ANS: A Patients taking bethanechol should be instructed to report increased salivation and diaphoresis since they can be early signs of overdosing. They should also be taught to rise slowly to avoid orthostatic hypotension and to hold the drug if their heart rate is low.

14. The nurse is caring for a patient whose provider has just ordered a switch from atenolol (Tenormin) to reserpine. When preparing the patient to take this medication, what will the nurse do? a. Ask about herbal supplements. b. Counsel that NSAIDs are safe to take with reserpine. c. Teach about potential side effects of mood elevation and euphoria. d. Tell the patient to expect immediate therapeutic effects.

ANS: A St. Johns wort may antagonize hypotensive effects of reserpine. Reserpine should not be taken with NSAIDs. Side effects include depression, not mood elevation. Therapeutic effects may take 2 to 3 weeks.

8. The nurse administers a dose of digoxin (Lanoxin) to a patient who has heart failure and returns to the room later to reassess the patient. Which finding indicates that the medication is effective? a. Decreased dyspnea b. Decreased urine output c. Increased blood pressure d. Increased heart rate

ANS: A The patient should show improvement in breathing and oxygenation. Urine output should increase. Blood pressure and heart rate will decrease.

8. The nurse is caring for a postoperative patient and notes that the patient received atropine sulfate preoperatively. Which assessment finding would prompt the nurse to notify the provider? a. Absent bowel sounds b. Drowsiness c. Dry mouth d. Heart rate of 78 beats per minute

ANS: A These are all side effects of atropine. Absent bowel sounds can indicate a paralytic ileus. The other side effects are not harmful.

6. The nurse is caring for a male patient with myasthenia gravis who will begin taking ambenonium chloride (Mytelase). When performing a health history, the nurse will be concerned about a history of which condition in this patient? a. Benign prostatic hypertrophy b. Chronic constipation c. Erectile dysfunction d. Upper respiratory infection

ANS: A This drug is a reversible cholinesterase inhibitor and is given to increase muscle strength. Cholinesterase inhibitors are contraindicated in patients with urinary tract obstruction.

6. A patient who takes digoxin to treat heart failure will begin taking a vasodilator. The patient asks the nurse why this new drug has been ordered. The nurse will explain that the vasodilator is used to a. decrease ventricular stretching. b. improve renal perfusion. c. increase cardiac output. d. promote peripheral fluid loss.

ANS: A Vasodilators are given to decrease venous blood return to the heart, resulting in decreased cardiac filling and decreased ventricular stretching, in turn reducing preload, contractility, and oxygen demand on the heart.

1. The nurse caring for a patient who is taking an adrenergic agent will expect which side effects? (Select all that apply.) a. Dilated pupils b. Increased heart rate c. Increase gastrointestinal motility d. Vasodilation e. Bronchospasm f. Relaxed uterine muscles

ANS: A, B, F Adrenergic agents stimulate the sympathetic nervous system, evoking the fight or flight response. This response increases those functions needed to respond to stress (increased heart rate to perfuse muscles, bronchodilation to increase oxygen exchange). Adrenergic drugs shunt blood away from the reproductive tract and gastrointestinal organs as these functions are not needed during a fight or flight response.

3. The nurse administers subcutaneous epinephrine to a patient who is experiencing an anaphylactic reaction. The nurse should expect to monitor the patient for which symptom? a. Bradycardia b. Decreased urine output c. Hypotension d. Nausea and vomiting

ANS: B Epinephrine can cause renal vasoconstriction and thereby reduce renal perfusion and decrease urinary output. Epinephrine causes tachycardia and elevates blood pressure. Nausea and vomiting are not expected to occur.

2. A patient who has asthma is diagnosed with hypertension. The nurse understands that which drug will be safe to give this patient? a. Pindolol (Visken) b. Metoprolol (Lopressor) c. Nadolol (Corgard) d. Propranolol (Inderal)

ANS: B Metoprolol is a selective adrenergic blocker that has a greater affinity for receptors that decrease heart rate and blood pressure and is less likely to cause bronchospasm. The other adrenergic blockers are not selective and can cause bronchoconstriction.

4. The nurse is preparing to administer digoxin to a patient who has heart failure. The patient reports nausea, vomiting, and a headache. The nurse notes a respiratory rate of 18 breaths per minute, a heart rate of 58 beats per minute, and a blood pressure of 120/78 mm Hg. What will the nurse do next? a. Administer the next dose as ordered since these are mild side effects. b. Hold the dose and notify the provider of possible digoxin toxicity. c. Reassure the patient that these are common, self-limiting side effects. d. Request an order for an antiemetic and an analgesic medication.

ANS: B Nausea, vomiting, and headache are common signs of digoxin toxicity as is a heart rate less than 60 beats per minute. The nurse should hold the dose and notify the provider.

15. A patient asks the nurse why nitroglycerin is given sublingually. The nurse will explain that nitroglycerin is administered by this route for which reason? a. To avoid hypotension b. To increase absorption c. To minimize gastrointestinal upset d. To prevent hepatotoxicity

ANS: B Nitroglycerin is given sublingually to avoid first-pass metabolism by the liver, which would occur if the drug is swallowed. It does not prevent hypotension. Gastrointestinal upset and hepatotoxicity usually do not occur.

16. The nurse is performing an admission assessment on a patient who has recently begun taking reserpine. The patient reports using St. Johns wort. The nurse anticipates that the patient will have a. hypotension. b. hypertension. c. bradycardia. d. tachycardia.

ANS: B St. Johns wort antagonizes the hypotensive effects of reserpine, causing hypertension.

3. A patient with chronic obstructive pulmonary disease (COPD) has increasing dyspnea and is being evaluated for heart failure (HF). Which test will be ordered to help differentiate between dyspnea due to lung dysfunction and dyspnea due to HF? a. Atrial natriuretic hormone (ANH) level b. Brain natriuretic peptide (BNP) level c. Cardiac enzymes d. Electrocardiogram (ECG)

ANS: B The BNP is used to differentiate that dyspnea is due to HF and not lung dysfunction. The other tests will all be a part of the diagnostic workup but do not help with this distinction.

4. The nurse administers bethanechol (Urecholine) to a patient to treat urinary retention. After 30 minutes, the patient voids 800 mL of urine and reports having a loose stool but no cramping or gastrointestinal pain. The patients blood pressure is 110/70 mm Hg. The nurse will perform which action? a. Notify the provider of bethanechol adverse effects. b. Record the urine output and the blood pressure and continue to monitor. c. Request an order for intravenous atropine sulfate. d. Suggest another dose of bethanechol to the provider.

ANS: B The patient is exhibiting desired effects and mild side effects of bethanechol, so the nurse should record information and continue to monitor the patient. There is no need to notify the provider, give an antidote, or repeat the dose.

1. A patient who has atrial fibrillation is taking digoxin. The nurse expects which medication to be given concurrently to treat this condition? a. Hydrochlorothiazide (HydroDIURIL) b. Inamrinone (Inocor) c. Milrinone (Primacore) d. Warfarin (Coumadin)

ANS: D Digoxin is given for atrial fibrillation to restore a normal heart rhythm. To prevent thromboemboli, warfarin is given concurrently. Hydrochlorothiazide is a diuretic medication. Inamrinone and milrinone are inotropic agents that would be used instead of digoxin.

7. The nurse is caring for a patient who will begin taking atenolol (Tenormin). What information will the nurse include when teaching the patient about taking this medication? a. The drug must be taken twice daily. b. The patient must rise slowly from a chair or bed. c. The medication is safe to take during pregnancy. d. Use NSAIDs as needed for mild to moderate pain.

ANS: B The side effects commonly associated with beta blockers include bradycardia, hypotension, and dizziness. Patients should be instructed to use caution when rising from a sitting or lying position to avoid orthostatic hypotension. Atenolol may be taken once daily. Atenolol is contraindicated in the pregnant patient. NSAIDs decrease the effects of beta blockers and should be avoided.

18. The nurse is preparing to administer digoxin to a patient who has a serum digoxin level of 2.5 ng/mL. The patient takes 0.25 mg of digoxin per day. What action will the nurse take? a. Administer the next dose as ordered. b. Notify the provider of digoxin toxicity. c. Request an order to decrease the digoxin dose. d. Suggest that the patient may need an increased digoxin dose.

ANS: B The therapeutic range of digoxin is between 0.5 and 2 mg/mL. This patients level is high, indicating toxicity. The nurse should not give the next dose or request a change in dose.

1. Cholinergic drugs have specific effects on the body. What are the actions of cholinergic medications? (Select all that apply.) a. Dilate pupils b. Decrease heart rate c. Stimulate gastric muscle d. Dilate blood vessels e. Dilate bronchioles f. Increase salivation g. Constrict pupils

ANS: B, C, D, F, G Decreasing heart rate, stimulating gastric muscles, dilating blood vessels, increasing salivation, and constricting pupils are actions of the cholinergic drugs.

1. A patient has congestive heart failure and has been taking digoxin (Lanoxin) for 9 years. The patient is admitted with signs and symptoms of digoxin toxicity. Which signs and symptoms are associated with digoxin toxicity? (Select all that apply.) a. Dysuria b. Vomiting c. Tachycardia d. Yellow haloes in the visual field e. Diarrhea f. Insomnia

ANS: B, D, E Vomiting, yellow haloes in the visual field, and diarrhea are classic signs of digoxin toxicity. Bradycardia, not tachycardia, will likely be noted.

1. The nurse is preparing to administer a drug and learns that it is an indirect-acting cholinergic agonist. The nurse understands that this drug a. acts on muscarinic receptors. b. acts on nicotinic receptors. c. inhibits cholinesterase. d. inhibits cholinergic receptors.

ANS: C Agents that inhibit cholinesterase, which is the enzyme that destroys acetylcholine, indirectly enhance the actions of acetylcholine.

14. The nurse is caring for a patient in the post-anesthesia recovery unit. The nurse notes that the patient received atropine sulfate 2 mg 30 minutes prior to anesthesia induction. The patient has received 1,000 mL of intravenous fluids and has 700 mL of urine in the urinary catheter bag. The patient reports having a dry mouth. The nurse notes a heart rate of 82 beats per minute. What action will the nurse perform? a. Administer a fluid bolus. b. Give the patient ice chips. c. Palpate the patients bladder. d. Reassess the patient in 15 minutes

ANS: C Atropine can cause urinary retention. The patients urine output is less than the fluid intake, so the nurse should palpate the bladder to assess for distension. Dry mouth is an expected side effect and does not indicate dehydration.

13. A patient will be discharged on beta blockers. Which skill is essential for the nurse to teach the patients family? a. How to prepare a low-sodium diet b. Assessments to detect fluid retention c. How to monitor heart rate and blood pressure d. Early signs of changing level of consciousness

ANS: C Because of the action and side effects of beta blockers, heart rate and blood pressure should be monitored frequently.

8. The nurse is caring for a patient who has recently begun taking atenolol (Tenormin) to treat hypertension. The patient reports dizziness, nausea, vomiting, and decreased libido since beginning the medication. What will the nurse do? a. Hold the next dose until the provider can be notified of these side effects. b. Reassure the patient that these symptoms are common and not worrisome. c. Recommend that the patient discuss these effects with the provider. d. Suggest that the patient request a different beta-adrenergic blocker.

ANS: C Beta-adrenergic blockers can cause these side effects, which are often dose-related. Patients experiencing these side effects should be encouraged to discuss them with their providers. Beta blockers should not be discontinued abruptly, or rebound symptoms may occur. Since symptoms may be dose-related, reassuring the patient is not correct. All beta blockers have similar side effects.

11. Which cholinesterase inhibitor would be prescribed for a patient who has Alzheimers disease? a. Ambenonium chloride (Myletase) b. Benztropine (Cogentin) c. Donepezil HCl (Aricept) d. Neostigmine methylsulfate (Prostigmin)

ANS: C Donepezil is used to treat Alzheimers disease. Ambenonium and neostigmine are used to treat myasthenia gravis. Benztropine is used to treat Parkinsons disease.

11. The nurse is teaching a patient about the use of a transdermal nitroglycerin patch. Which statement by the patient indicates understanding of the teaching? a. I will apply the patch as needed when I experience anginal pain. b. I will remove the old patch and replace it with a new one at bedtime each day. c. I should rotate sites when changing the patch to prevent skin irritation. d. When I am symptom-free, I may stop using the patch on a regular basis.

ANS: C Patients should be taught to rotate application sites when using the transdermal nitroglycerin. Transdermal nitroglycerin is not used as needed. Patients should remove the patch at bedtime to provide an 8- to 12-hour nitrate-free interval. Patients should use the patch even when symptom-free unless otherwise instructed by the provider.

The nurse is administering atenolol (Tenormin) to a patient. Which concurrent drugs does the nurse expect to most likely cause an interaction? (Select all that apply.) a. ginseng supplement b. An NSAID, such as aspirin c. atropine, an anticholinergic d. haloperidol (Haldol) e. methyldopa (Aldomet)

B, C

5. The nurse is caring for a patient who is taking digoxin to treat heart failure. The patients electrocardiogram shows a ventricular dysrhythmia. The nurse will notify the provider and will anticipate an order for which medication? a. Digoxin immune Fab (Digibind) b. Furosemide (Lasix) c. Phenytoin (Dilantin) d. Potassium

ANS: C The antidysrhythmics phenytoin and lidocaine are effective in treating digoxin-induced ventricular dysrhythmias. Digoxin immune Fab is used to treat severe digitalis toxicity, characterized by bradycardia, nausea, and vomiting. Unless a potassium deficit is present, giving potassium could worsen the dysrhythmia.

12. A nurse is teaching a patient how to use phenylephrine (Neo-Synephrine) nasal spray. To avoid systemic absorption, the nurse teaches the patient to perform which action? a. Apply pressure to the nose after spraying. b. Administer the spray while in the supine position. c. Insert the spray while sitting up. d. Exhale deeply while injecting the nasal spray.

ANS: C The patient should insert the spray while sitting up to avoid it being absorbed systemically.

12. The nurse is teaching a patient who is going on a cruise about the use of transdermal scopolamine . What information will the nurse include when teaching this patient? a. Apply the patch as needed for nausea and vomiting. b. Apply the patch to your upper arm. c. Change the patch every 3 days. d. Restrict fluids while using this patch.

ANS: C The transdermal scopolamine patch is designed to last for 72 hours. The patient should be taught to change it every 3 days. It works best when worn at all times and not just for symptomatic relief. The patch should be applied behind the ear. Patients should not restrict fluids.

19. A patient who has Wolff-Parkinson-White syndrome is given intravenous adenosine (Adenocard). The nurse will explain that the medication is effective because it a. controls atrial flutter. b. deepens myocardial excitability. c. prevents multifocal ventricular contractions. d. prolongs repolarization.

ANS: D Adenosine is a class III drug that prolongs repolarization by increasing the refractory period and prolonging the action potential to slow heart rate. It does not control atrial flutter, deepen myocardial excitability, or prevent multifocal contractions.

2. A patient is diagnosed with heart failure, and the prescriber has ordered digoxin. The patient asks what lifestyle changes will help in the management of this condition. The nurse will recommend which changes? a. Aerobic exercise and weight lifting 2 or 3 times weekly b. Changing from cigarette smoking to pipe smoking c. Consuming 2 teaspoons or less of salt every day d. Having no more than one alcoholic beverage per day

ANS: D Alcohol should either be completely avoided or restricted to no more than one per day. Mild exercise, such as walking, is recommended. All nicotine deprives the heart of oxygen. Salt should be limited to no more than one teaspoon per day

11. A patient who has Raynauds disease will begin taking an alpha-adrenergic blocker. The patient asks the nurse how the drug works to treat symptoms. The nurse explains that alpha-adrenergic blockers treat Raynauds disease by causing a. decreased peripheral vascular resistance. b. orthostatic hypotension. c. reflex tachycardia. d. vasodilation.

ANS: D Alpha-adrenergic blockers can be used to treat peripheral vascular disease because they cause vasodilation.

10. The nurse is teaching a patient about the use of an anticholinergic medication. What information will the nurse include when teaching this patient about this medication? a. Check your heart rate frequently to monitor for bradycardia. b. Drink extra fluids while you are taking this medication. c. Rise from a chair slowly to avoid dizziness when taking this drug. d. Use gum or lozenges to decrease dry mouth caused by this drug

ANS: D Anticholinergic medications cause dry mouth, so patients should be advised to use gum or lozenges to counter this side effect. Anticholinergics cause increased heart rate and increased blood pressure. Anticholinergics can cause urinary retention so patients should not increase fluid intake.

7. The nurse is preparing to administer the anticholinergic medication benztropine (Cogentin) to a patient who has Parkinsons disease. The nurse understands that this drug is used primarily for which purpose? a. To decrease drooling and excessive salivation b. To improve mobility and muscle strength c. To prevent urinary retention d. To suppress tremors and muscle rigidity

ANS: D Antiparkinson-anticholinergic drugs are used mainly to reduce tremors and muscle rigidity.

12. The nurse is teaching a patient about sublingual nitroglycerin administration. What information will the nurse include when teaching this patient? a. Call 911 if pain does not improve after three doses. b. If pain persists after one dose, administer a second dose. c. Swallow the tablet with small sips of water. d. Take the first tablet while sitting or lying down.

ANS: D Because nitroglycerin can cause hypotension, patients should be cautioned to take them while sitting or lying down. If pain is not better or has worsened 5 minutes after the first dose, patients should call 911. The tablets must dissolve under the tongue and should not be swallowed.

5. The nurse is caring for a patient who is receiving intravenous dopamine (Intropin). The nurse notes erythema and swelling at the IV insertion site. What is the nurses initial action? a. Apply warm soaks to the area. b. Monitor the patient closely for hypertension. c. Obtain an order for an electrocardiogram. d. Notify the provider of a need for phentolamine mesylate (Regitine).

ANS: D Extravasation of dopamine causes tissue necrosis; if extravasation occurs, the antidote phentolamine mesylate should be infiltrated into the area.

13. A patient who uses transdermal nitroglycerin reports having headaches. The nurse will counsel the patient to perform which action? a. Call 911 when this occurs. b. Notify the provider. c. Reapply the patch three times daily. d. Take acetaminophen as needed.

ANS: D Headaches are one of the most common side effects of nitroglycerin, but they may become less frequent; acetaminophen is generally recommended for pain. The headaches are not an emergency, and the patient does not need to call 911 or notify the provider. The patch is applied once daily.

17. A patient who has begun taking nifedipine (Procardia) to treat variant angina has had a recurrent blood pressure of 90/60 mm Hg or less. The nurse will anticipate that the provider will a. add digoxin to the drug regimen. b. change to a beta blocker. c. order serum liver enzymes. d. switch to diltiazem (Cardizem).

ANS: D Hypotension is a common effect of calcium channel blockers and is more common with nifedipine. It is less common with diltiazem, so the provider may order that drug. Adding digoxin, changing to a beta blocker, or ordering serum liver enzymes are not indicated.

7. The nurse performs a medication history and learns that the patient takes a thiazide diuretic and digoxin (Lanoxin). The nurse will question the patient to ensure that the patient is also taking which medication? a. Cortisone b. Lidocaine c. Nitroglycerin d. Potassium

ANS: D If a patient is taking digoxin and a potassium-wasting diuretic such as thiazide, the patient should also take a potassium supplement to prevent hypokalemia that could result in digoxin toxicity. It is not necessary to take cortisone, lidocaine, or nitroglycerin unless the patient has symptoms that warrant these drugs.

20. The nurse provides teaching for a patient who has a ventricular dysrhythmia who is prescribed acebutolol (Spectral) 200 mg twice daily. Which statement by the patient indicates understanding of the teaching? a. Diuretics may decrease the effectiveness of this drug. b. Dizziness, nausea, and vomiting indicate a severe reaction. c. I should eat fruits and vegetables to increase potassium intake. d. I should not stop taking this drug abruptly to avoid palpitations.

ANS: D Patients who stop taking this drug abruptly can experience palpitations. Diuretics do not decrease drug effectiveness. Dizziness and nausea and vomiting are common side effects.

3. The nurse is preparing to administer bethanechol (Urecholine) to a patient who is experiencing urinary retention. The nurse notes that the patient has a blood pressure of 90/60 mm Hg and a heart rate of 98 beats per minute. The nurse will perform which action? a. Administer the drug and monitor urine output. b. Administer the medication and monitor vital signs frequently. c. Give the medication and notify the provider of the increased heart rate. d. Hold the medication and notify the provider of the decreased blood pressure.

ANS: D Side effects of this medication are a decrease in the pulse rate and vasodilation, which can exacerbate bradycardia and hypotension. The nurse should hold the drug and notify the provider.

9. A patient who has heart failure receives digoxin (Lanoxin) and an angiotension-converting enzyme (ACE) inhibitor. The patient will begin taking spironolactone (Aldactone). The patient asks why the new drug is necessary. The nurse will tell the patient that spironolactone will be given for which reason? a. To enhance potassium excretion b. To increase cardiac contractility c. To minimize fluid losses d. To provide cardioprotective effects

ANS: D Spironolactone is a potassium-sparing diuretic that blocks production of aldosterone, causing improved heart rate variability and decreased myocardial fibrosis. It is given in congestive heart failure for its cardioprotective effects. Spironolactone does not directly alter cardiac contractility but may slightly decrease contractility if fluid volume is decreased. It is a mild diuretic but is not given in this instance to minimize fluid losses.

17. The patient has been ordered to receive Sudafed to treat nasal congestion. The nurse performing an admission assessment learns that the patient has diabetes mellitus. What action is appropriate for the nurse to take? a. Administer the medication as ordered. b. Contact the provider to discuss a lower dose. c. Give the medication and monitor serum glucose closely. d. Hold the medication and contact the provider.

ANS: D Sympathetic drugs should not be taken by patients with diabetes. The medication should not be given.

15. A patient who has Parkinsons disease will begin treatment with benztropine (Cogentin). Which symptom of Parkinsons disease would be a contraindication for this drug? a. Drooling b. Muscle rigidity c. Muscle weakness d. Tardive dyskinesia

ANS: D Tardive dyskinesia is a contraindication for this drug.

16. A patient who has been taking nitroglycerin for angina has developed variant angina, and the provider has added verapamil (Calan) to the patients regimen. The nurse will explain that verapamil is given for which purpose? a. To facilitate oxygen use by the heart b. To improve renal perfusion c. To increase cardiac contractility d. To relax coronary arteries

ANS: D Verapamil is a calcium channel blocker and is used to relax coronary artery spasm in patients with variant angina. It does not facilitate coronary muscle oxygen use, improve renal function, or increase cardiac contractility.

15. The patient has been started on a treatment regimen that includes atenolol (Tenormin) and complains to the nurse of feeling weak. Which is the best response from the nurse? a. I will hold your next dose of the medication. b. You may need an increase in your next dose of the medication. c. This is an adverse reaction to the medication. I will stop the drug. d. This is a side effect of the medication. I will notify your physician.

ANS: D Weakness can be a side effect of atenolol. Beta blockers should not be stopped abruptly.

A patient is receiving bethanechol (Urecholine). The nurse realizes that the action of this drug is to treat which condition? a. Glaucoma b. Urinary retention c. Delayed gastric emptying d. Gastroesophageal reflux disease

B

The nurse realizes that cholinergic agonists mimic which parasympathetic neurotransmitter? a. dopamine b. acetylcholine c. cholinesterase d. monoamine oxidase

B

The patient asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response? a. "You can protect it from heat by placing the bottle in an ice chest." b. "It's best to keep it in its original container away from heat and light." c. "You can put a few tablets in a resealable bag and carry in your pocket." d. "It's best to lock them in the glove compartment to keep them away from heat and light."

B Although nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest where it could freeze. It should also not be locked up and must be kept away from light, not in a clear plastic bag.

The nurse is caring for a patient who has been recently diagnosed with hypertension and is to receive an initial dose of atenolol (Tenormin). What is the nurse's primary intervention? a. Assess the patient's lungs. b. Teach the patient about beta blockers. c. Call the health care provider. d. Ask the patient if he has a history of any respiratory disease

B At therapeutic dosages, atenolol selectively blocks only the beta1 receptors in the heart, not the beta2 receptors located in the lungs. It is not necessary to determine specifically the history of respiratory disease. Although the nurse should assess the patient overall on a regular basis, the assessment should include all body systems, not only the lungs. It is not necessary to notify the health care provider prior to administration of the first dose of the medication.

The nurse administered donepezil (Aricept) to a patient. Which finding indicates that the medication is therapeutic? a. The patient is relaxed. b. The patient has increased cognition. c. The patient is awake. d. The patient has urinated.

B Donepezil (Aricept) is used to treat Alzheimer's disease, a disorder of decreased acetylcholine levels in the brain. It can increase cognition.

Which is the highest priority intervention for a patient admitted with glaucoma? a. Teach the patient to wear glasses at all times. b. Administer pilocarpine. c. Keep lights very low. d. Teach the patient to stay out of sunlight.

B Pilocarpine is a direct-acting cholinergic drug that constricts the pupils of the eyes, thus opening the canal of Schlemm to promote drainage of aqueous humor (fluid). This drug is used to treat glaucoma by relieving fluid (intraocular) pressure in the eye.

A patient comes to the emergency department with symptomatic bradycardia. The nurse prepares to administer which dose of atropine intravenously? a. 0.3 mg b. 0.5 mg c. 1.25 mg d. 2 mg

B The recommended dose of atropine to treat symptomatic bradycardia is 0.5 to 1 mg.

A patient who is taking epinephrine is also taking several other medications. The nurse should realize that there is a possible drug interaction with which drugs? (Select all that apply.) a. albuterol (Proventil) b. metoprolol (Lopressor) c. propranolol (Inderal) d. digoxin (Lanoxin) e. methyldopa (Aldomet)

B, C, D

Nadolol (Corgard) is prescribed for a patient. The nurse realizes that this drug is a beta-adrenergic blocker and that this drug classification is contraindicated for patients with which condition? a. Hypothyroidism b. Angina pectoris c. Bronchial asthma d. Liver dysfunction

C

The nurse realizes that beta1 receptor stimulation is differentiated from beta2 stimulation in that stimulation of beta1 receptors leads to which condition? a. Increased bronchodilation b. Decreased uterine contractility c. Increased myocardial contractility d. Decreased blood flow to skeletal muscles

C

The nurse teaches the patient receiving atropine (Atreza) to expect which side effect? a. Diarrhea b. Bradycardia c. Blurred vision d. Frequent urination

C

A patient has been taking metoprolol (Lopressor) and tells the home care nurse, "I can't afford this medication any more, and I stopped it yesterday." What is the nurse's priority action? a. Refer the patient to the social worker. b. Call the drug company to ask for assistance. c. Assess the patient's blood pressure. d. Teach the patient that abrupt medication withdrawal may lead to a rebound hypertensive crisis.

C Abrupt withdrawal of a beta blocker can cause rebound hypertension. The nurse should immediately check the patient's blood pressure and then proceed with teaching and calling the health care provider.

Which adverse reaction will the nurse monitor for in a patient taking bethanechol (Urecholine) for treatment of urinary retention? a. Constipation b. Hypertension c. Muscle weakness d. Tachycardia

C Adverse reactions to bethanechol (Urecholine) include abdominal cramps, diarrhea, orthostatic hypotension, bradycardia, and muscle weakness.

A nurse is monitoring a patient receiving atropine. Which finding requires nursing action? a. Heart rate of 60 beats/min b. Nasal congestion c. Blood pressure of 90/40 mm Hg d. Dilated pupils

C Atropine is an anticholinergic agent that blocks the effects of the parasympathetic nervous system, producing sympathetic nervous system effects. Adverse reactions include nasal congestion, tachycardia, hypotension, pupillary dilation, abdominal distention, and palpitations. This blood pressure is low enough that action is required.

Before the nurse administers isosorbide mononitrate (Imdur), what is a priority nursing assessment? a. Assess serum electrolytes. b. Measure blood urea nitrogen and creatinine. c. Assess blood pressure. d. Monitor level of consciousness.

C Isosorbide mononitrate (Imdur) is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.

Which assessment most assists the nurse in determining if bethanechol has had a therapeutic effect? a. Neurologic assessment b. Muscular assessment c. Urinary assessment d. Gastric assessment

C This medication increases the tone of the detrusor muscle and causes the patient to void.

A patient is given epinephrine (Adrenalin), an adrenergic agonist (sympathomimetic). The nurse should monitor the patient for which condition? a. Decreased pulse b. Pupil constriction c. Bronchial constriction d. Increased blood pressure

D

Dicyclomine (Bentyl) is an anticholinergic, which the nurse realizes is given to treat which condition? a. Mydriasis b. Constipation c. Urinary retention d. Irritable bowel syndrome

D

The nurse is administering bethanechol (Urecholine), a cholinergic agonist, and should know that the expected cholinergic effects include which of the following? a. Increased heart rate b. Decreased peristalsis c. Decreased salivation d. Increased pupil constriction

D

A patient is admitted to the emergency department with an expected cholinesterase inhibitor overdose. What is the nurse's primary action? a. Monitor urinary output. b. Insert a large-bore IV catheter. c. Attach patient to telemetry monitor. d. Administer ordered anticholinergic medication.

D An anticholinergic can act as an antidote to the toxicity caused by cholinesterase inhibitors and organophosphate ingestion.

Which is the highest priority potential nursing diagnosis for a patient who is starting on metoprolol (Lopressor)? a. Decreased cardiac output related to effects of medication b. Fatigue related to side effects of medication c. Knowledge deficit regarding pharmacologic therapy d. Risk for injury related to side effects of medication

D Decreased cardiac output puts the patient at highest risk. Although the other nursing diagnoses are pertinent, they are not the priority.

Which statement indicates to the nurse that the patient understands sublingual nitroglycerin medication instructions? a. "I will take up to five doses every 3 minutes for chest pain." b. "I can chew the tablet for the quickest effect." c. "I will keep the tablets locked in a safe place until I need them." d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."

D Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. Three doses can be taken 5 minutes apart. The tablet should be placed under the tongue to dissolve. The medication should be kept in a readily accessible location for immediate use should chest pain occur.

The nurse is caring for a patient diagnosed with heart failure and chronic obstructive pulmonary disease (COPD). The patient is ordered a nonselective beta blocker. What is the nurse's primary intervention? a. Assess the heart rate before administration. b. Maintain the patient on intake and output. c. Make sure the patient is on telemetry monitoring. d. Call the health care provider to request a different medication.

D Nonselective beta blockers are used to treat supraventricular dysrhythmias secondary to their negative chronotropic effects (decreasing heart rate). They may exacerbate heart failure and COPD. The patient could receive a selective beta blocker instead. The nurse should make the health care provider aware of the patient's history of respiratory disease.

Which statement made by the patient demonstrates a need for further instruction regarding the use of nitroglycerin? a. "If I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief." b. "I should keep my nitroglycerin in a cool, dry place." c. "I should change positions slowly to avoid getting dizzy." d. "I can take up to five tablets at 3-minute intervals for chest pain if necessary."

D Patients are taught to take up to three tablets every 5 minutes. If no relief from chest pain is obtained after one tablet, they should seek medical assistance and take up to two more tablets. All other responses demonstrate a good understanding by the patient.

The nurse is caring for a patient who is prescribed propranolol (Inderal). Which assessment finding will reveal if the medication is having a therapeutic effect? a. The patient's lung sounds are clear. b. The patient is in sinus rhythm. c. The patient has strong peripheral pulses. d. The patient's blood pressure is 130/75 mm Hg

D Propranolol (Inderal) is nonselective—it blocks both beta1 and beta2 receptors at therapeutic doses. The medication is administered to treat hypertension. The patient's blood pressure is within normal limits, which indicates therapeutic effect.

The nurse assesses the peripheral intravenous infusion site of a patient receiving intravenous dopamine and suspects extravasation. What is the nurse's primary action? a. Apply a cold pad to the site. b. Pull the IV immediately. c. Elevate the patient's extremity. d. Stop the infusion

D The nurse's first action is to stop the infusion, followed by infusing phentolamine (Regitine) into the area to counteract vasoconstrictive effects of the dopamine.

The nurse is monitoring a patient during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action? a. Blood pressure 110/90 mm Hg b. Flushing c. Headache d. Chest pain

D The patient should not continue to have chest pain while on IV nitroglycerin. This would prompt the nurse to intervene. Blood pressure of 110/90 mm Hg is not cause for concern and is expected with nitroglycerin. Headache and flushing are common side effects of nitroglycerin.

A nurse is monitoring a patient with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective? a. Blood pressure of 120/80 mm Hg b. Heart rate of 70 beats per minute c. ECG without evidence of ST changes d. Patient stating that pain is 0 out of 10

D The patient taking nitroglycerin should expect the therapeutic effect of absence of chest pain. It is unrealistic to expect that the patient's blood pressure, heart rate, and ECG will all be in completely normal range since variations in blood pressure and heart rate will occur as part of daily life and the patient may have some underlying cardiac disease that is producing the angina.