Pharmacology Summer CCC - EXAM 4 (Final) - Book Questions

Occasionally, a bismuth preparation is added to the treatment regimen for duodenal ulcers. What are bismuth's effects against H. pylori bacteria? A) Inhibits pepsin activity B) Antibacterial effects C) Accumulates in ulcer craters D) All of these

*ALL OF THESE* A) Inhibits pepsin activity B) Antibacterial effects C) Accumulates in ulcer craters A bismuth preparation is added to some regimens. Bismuth exerts antibacterial effects against H. pylori. It also increases secretion of mucus and bicarbonate, inhibits pepsin activity, and accumulates in ulcer craters.

Your patient, a 37-year-old woman, was admitted due to elevated temperature, oliguria, and dehydration. With adequate hydration, the expected normal urine production would be approximately A) 2 L/d. B) 1 L/d. C) 0.5 L/d. D) 3 L/d.

A) 2 L/d. The glomerular filtration rate (GFR) is about 180 L/d, or 125 mL/min. The end product is about 2 L of urine daily.

**** CHAPTER 32 **** An intravenous dose of 20 mg Lasix has been ordered between a patient's two ordered units of packed bed blood cells. The nurse should be aware that diuresis will peak how long after the Lasix is administered? A) 30 minutes B) 5 to 10 minutes C) 60 to 75 minutes D) 15 minutes

A) 30 minutes

A patient with a history of angina has been ordered IV atenolol. When monitoring this patient's health status, the nurse should recognize that there is a need to titrate the patient's dose of atenolol with the goal of achieving what outcome? A) A heart rate of 50 to 60 beats per minute B) A resting blood pressure of <110/65 mmHg C) Relief of acute chest pain D) Restoration of normal sinus rhythm

A) A heart rate of 50 to 60 beats per minute It is necessary to titrate the dose of the BETA-ADRENERGIC BLOCKER.

An obese, 68-year-old male patient as a history of hypertension and type 2 diabetes and he experienced an MI earlier in the year. His primary care provider has recognized that the patient is at a high risk of heart failure and has deemed pharmacologic therapy appropriate. This patient is most likely to be prescribed a medication from what drug class? A) ACE inhibitor B) Loop diuretic C) Thiazide diuretic D) NSAID

A) ACE inhibitor

Primary hypertension comprises 90% to 95% of hypertensive cases. Which drug groups are used in the management of primary hypertension? Select all that apply. A) Angiotensin II receptor blockers B) Antiadrenergics C) ACE inhibitors D) Direct vasoconstrictors

A) Angiotensin II receptor blockers B) Antiadrenergics C) ACE inhibitors

Adrenergic drugs may be used to treat which of the following? Select all that apply. A) Sinus congestion B) Hypertension C) Seizures D) Shock E) Asthma

A) Sinus congestion D) Shock E) Asthma

Ondansetron (Zoran) has been prescribed for a patient who is experiencing significant postoperative nausea. The nurse who is administering this drug should be aware that it achieves a therapeutic effect by which of the following means? A) Antagonizing serotonin receptors B) Blocking the activity of substance P at NK1 receptors C) Blocking dopamine from receptor sites in the brain D) Blocking the action of acetylcholine in the brain

A) Antagonizing serotonin receptors Ondansetron and the other 5-HT3 receptor antagonists antagonize serotonin receptors, preventing their activation by the effects of emetogenic drugs and toxins. These drugs do not block substance P, dopamine, or acetylcholine.

**** CHAPTER 8 **** A male patient has returned from his annual physical with the news that he has metabolic syndrome and is quite shaken with the news. Knowing the elements of metabolic syndrome, the nurse begins to encourage him with nonpharmacologic measures he could implement to address his risk factors. What do those nonpharmacologic measures include? Select all that apply? A) Begin a regular walking program. B) Begin a low-fat diet. C) Conserve energy by limiting physical activity. D) Begin to increase intake of plant-sourced protein E) Ensure he gets adequate sleep on a regular basis.

A) Begin a regular walking program. B) Begin a low-fat diet.

Auto regulation of blood flow is directly connected to raising or lowering blood pressure via vasoactive substances. Which of the following are vasodilative substances? Select all that apply. A) Bradykinin B) Angiotensin II C) Nitric oxide D) Serotonin

A) Bradykinin C) Nitric oxide

Your newest admission, a 59-year-old homeless man with a history of alcohol abuse, is admitted with dehydration and diarrhea. Your admission interview indicates he collects his meals from dumpsters behind restaurants. What could be causing his diarrhea? Select all that apply. A) Campylobacter bacteria B) Salmonella C) Intestinal infections D) Allergies

A) Campylobacter bacteria B) Salmonella C) Intestinal infections

A 76-year-old woman who resides in a long-term care facility is your newest admission, presenting with dehydration, explosive diarrhea, abdominal pain, elevated temperature, and dementia. She just completed a course of antibiotics for a lower respiratory infection. What do you think is causing her diarrhea? A) Clostridium difficile B) Rotavirus C) Irritable bowel syndrome D) Psychosocial stress

A) Clostridium difficile

You are caring for a 53-year-old man with a 30-year history of alcohol dependance. He presents with ascites, secondary to cirrhosis. Which mechanism is involved in his fluid shift? A) Decreased plasma oncotic pressure B) Increased capillary hydrostatic pressure C) Increased plasma oncotic pressure D) Increased capillary permeability

A) Decreased plasma oncotic pressure Decreased plasma oncotic pressure may occur with decreased synthesis of plasma proteins caused by liver disease.

Recommended treatments for patients with dyslipidemia are made according to their blood levels of total and LDL cholesterol and risk factors for cardiovascular disease. What does the impact of existing cardiovascular disease have on recommendations? A) Decreases target serum LDL level B) Has no effect C) Increases target serum HDL level D) Decreases target serum triglyceride level

A) Decreases target serum LDL level

Upon her visit to your primary care physician's office, your patient presents with 14 pounds of additional weight since her last visit 3 weeks ago. Her lower extremities are quite swollen, and her facial features are puffy. The physician prescribes a diuretic and requests a follow-up visit in 3 days. By what mechanism should the prescribed diuretic decrease the patients onboard fluid? A) Decreasing plasma volume B) Unknown mechanism C) Increasing plasma volume D) Sodium depletion

A) Decreasing plasma volume

A gerontological nurse is aware that furosemide is often an effective treatment for hypertension and edema in older adults. When providing care for older adults who are taking furosemide on a regular basis, the nurse should prioritize assessments that are relevant to what health problem? A) Dehydration B) Dysrhythmias C) Hypernatremia D) Urinary retention

A) Dehydration

A patient has been prescribed catopril by his primary care provider after a series of high blood pressure readings. The nurse at the clinic should describe which of the following adverse effects as being most common? A) Dry cough B) Rash to the trunk and extremities. C) Rhinitis D) Photosensitivity

A) Dry cough A persistent cough develops in a significant number of patients taking captopril, and this problem may lead to discontinuation of the drug.

Auto regulation of blood flow is directly connected to raising or lowering blood pressure via vasoactive substances. Which of the following are vasoconstrictive substances? Select all the apply. A) Endothelin-1 B) Histmine C) Bradykinin D) Angiotensin II

A) Endothelin-1 D) Angiotensin II

Specific drug therapy for diarrhea depends on the cause and may include which of the following? Select all that apply. A) Enzymatic replacement therapy B) Anticholinergics C) Bile-bindingmedications D) None of these

A) Enzymatic replacement therapy C) Bile-bindingmedications

Anaphylaxis kits for patients allergic to bee stings would contain which of the following medications? A) Epinephrine B) Aspirin C) Norepinephrine D) Dopamine

A) Epinephrine

A patient's physician has recommended the use of Metamucil as a first-line treatment for constipation. When describing the possible adverse effects of this medication to the patient, the nurse should explain which of the following? A) Gas and bloating B) Gastroesophageal reflux C) Rectal bleeding D) Opportunistic GI infections

A) Gas and bloating

Your new admit, a 73-year-old woman, reports chronic abdominal pain and dark tarry stools. She has a history of chronic arthritis, for which she takes naproxen daily. What might be the cause of her symptoms? A) Gastric ulcer B) GERD C) Pyloric stenosis D) Duodenal ulcer

A) Gastric ulcer Gastric ulcers associated with stress may occur in any age group. Those associated with NSAID ingestion are more likely to occur in older adults, especially those in the sixth or seventh decades of life, and to be chronic in nature.

Nurses frequently hear references to "good" cholesterol (HDL) and "bad" cholesterol (LDL, VLDL). What determines the "preferred" density of the cholesterol? A) Higher amount of protein in the cholesterol B) Higher amount of plasma in the cholesterol C) Higher amount of lipids in the cholesterol D) None of these

A) Higher amount of protein in the cholesterol

Antacids are alkaline substances primarily used to directly neutralize gastric acid in the stomach to prevent/treat PUD, GERD, and GI bleed. In what other conditions might aluminum-based antacids be used? Select all that apply. A) Hyperphosphatemia B) Chronic renal failure C) Hypophosphatemia D) Hyperkalemia

A) Hyperphosphatemia B) Chronic renal failure Aluminum-based antacids are also given to patients with chronic renal failure to decrease absorption of PHOSPHATES in food.

A patient with recurrent nausea has been prescribed promethazine. The nurse should anticipate what rout of administration? A) Intramuscular injection B) Subcutaneous injection C) Topical D) Intravenous

A) Intramuscular injection The preferred route of promethazine administration is intramuscular, which reduces the risk of surrounding muscle and tissue damage.

Upon her visit to your primary care physician's office, your patient presents with 11 pounds of additional weight since her last visit 3 weeks ago. Her lower extremities are quite swollen, and her facial features are puffy. The physician prescribes a diuretic and requests a follow-up visit in 3 days. Two days later, the patient contacts the office so dyspneic she is hard to understand over the phone. An ambulance is dispatched, and she is admitted to the hospital for rapid diuresis. Which diuretic will most likely be the initial drug of choice? A) Loop diuretic B) Potassium-sparing diuretic C) Osmotic diuretic D) Thiazide

A) Loop diuretic Loop diuretics are the diuretics of choice when RAPID effects are required.

To effectively prevent or manage metabolic syndrome, what should the desired blood lipid profile include? Select all that apply? A) Low triglycerides B) High HDL cholesterol C) High total cholesterol D) Low LDL cholesterol

A) Low triglycerides B) High HDL cholesterol D) Low LDL cholesterol

Mrs. Sykes, a 67-year-old Hispanic woman, is 1 week status post-MI. Her cardiologist is prescribing medication for her myocardial ischemia to preserve cardiac function without decreasing heart rate or blood pressure. What medication would you expect would be prescribed? A) Metabolic modulator B) Organic nitrate C) Calcium channel blocker D) Beta-adrenergic blocker

A) Metabolic modulator A new classification, METABOLIC MODULATORS increase the heart's effectiveness in energy production to preserve cardiac function without decreasing heart rate or blood pressure.

Nausea and vomiting have diverse causes. Which of the following are causes for nausea and/or vomiting? Select all that apply? A) Neurologic disorders B) Urticaria C) Hypertension D) Metabolic disorders E) Progesterone preparations

A) Neurologic disorders D) Metabolic disorders

A patient's care provider is discussing the management of a 68-year old patient's angina, which has been getting gradually more severe over the past several months. The use of a beta-blocker is being considered. Beta-blockers have what advantage over nitrates in the management of angina? A) Patients do not develop tolerance to beta-blockers. B) Beta-blockers do not affect the patient's heart rate or blood pressure. C) Patients can obtain beta-blockers on an over-the-counter basis. D) Beta-blockers can be administered on an outpatient basis.

A) Patients do not develop tolerance to beta-blockers.

When applied topically to the eye, which of the following drugs produces dilation of the pupil without changing accommodation? A) Phenylephrine B) Neostigmine C) Phentolamine D) Atropine

A) Phenylephrine Ophthalmic preparations of adrenergic drugs are used as a vasoconstrictor and mydriatic.

Organic nitrates are widely used to decrease cardiac workload, effectively decreasing angina. Nitrate efficacy in lowering systolic blood pressure contraindicates its use with which of the following? Select all that apply. A) Phosphodiesterase enzyme type 5 inhibitor B) Variant angina C) Cerebral hemorrhage D) Hypervolemia

A) Phosphodiesterase enzyme type 5 inhibitor (Viagra) C) Cerebral hemorrhage

Your patient, a 37-year-old woman, presents with a blood pressure of 128/86 mmHg. She exercises regularly, is weight-appropriate for her height, and indicates no use of tobacco or alcohol. How would the patients blood pressure be classified? A) Prehypertension B) Normal C) Stage 2 hypertension D) Stage 1 hypertension

A) Prehypertension

In using beta-blockers, awareness of metabolism is very important as it relates to drug selection and dosing. Your patient has a history of chronic renal failure and needs additional pharmacological therapy for treatment of his angina. Nitroglycerin does quite well, but he has begun to develop additional episodes of angina not responding to nitroglycerin. In light of the patient's renal status, which of the following beta--blockers would be a logical addition to his angina treatment regimen? A) Propanolol B) Atenolol C) Nadolol D) Metoprolol

A) Propanolol Propranolol would be indicated as it is metabolized exclusively in the liver, without renal involvement. The other choices are excreted by the kidneys, and dosage must be reduced in patients with renal impairment.

Lack of oxygen, accumulation of products of cellular metabolism, and other forms of tissue injury contribute to the regulation of local blood flow. What tissue factors govern vasodilation and vasoconstriction? Select all that apply. A) Prostacyclin B) Cytokinin C) Thromboxane A2 D) Melatonin

A) Prostacyclin C) Thromboxane A2

A patient has a diagnosis of left-sided heart failure. What sign or symptom is this patient most likely to experience? A) Pulmonary edema B) Palpitations C) Venous ulcers D) Chest pain

A) Pulmonary edema

A patient has suffered a cardiac arrest and epinephrine has been administered intravenously. The nurse should be aware that this drug promotes oxygenation of the heart and brain by which of the following means? A) Redirecting blood flow away from the peripheral circulation B) Simultaneously slowing the heart rate and increasing the force of contraction. C) Promoting vasodilation in the myocardium and the brain D) Promoting the binding of oxygen to hemoglobin

A) Redirecting blood flow away from the peripheral circulation

An older patient with early stage Alzheimer's disease has had hydroxyzine prescribed for nausea. When planning this patient's care, the nurse should consequently identify what risk nursing diagnosis? A) Risk for falls related to adverse effects of hydroxyzine B) Risk for impaired skin integrity related to adverse effects of hydroxyzine C) Risk for functional urinary incontinence related to adverse effects of hydroxyzine D) Risk for infection related to adverse effects of hydroxyzine

A) Risk for falls related to adverse effects of hydroxyzine Hydroxyzine creates drowsiness, which may place a patient at risk for experiencing a fall.

A patient with recent abdominal pain has a 40 pack-year smoking history. He reports his smoking has decreased to approximately 1/2 pack/day. The physician, after thorough assessment and evaluation and labs, prescribes a treatment regimen for duodenal ulcer. What important teaching would you include in relation to treatment? A) Smoking's effect of the healing of ulcers B) The importance of taking prescribed medication until he is feeling better C) General health dangers of smoking D) The connection between smoking and chronic pain

A) Smoking's effect of the healing of ulcers Duodenal ulcers are associated with cigarette smoking. The ulcers of smokers heal more slowly and recur more rapidly than do those of nonsmokers.

A hospital patient has been prescribed dipenoxylate with atropine, and the nurse is preparing to administer the first dose. In the hours following administration, the nurse should plan to assess the patient for which of the following problems? A) Tachycardia and dizziness B) Pulmonary edema C) Pruritis and drowsiness D) Urinary frequency and incontinence

A) Tachycardia and dizziness Adverse effects of diphenoxylate with atropine include tachycardia, dizziness, headache, flushing, nausea and vomiting, dry skin and mucous membranes, and urinary retention.

A 73-year-old man has been admitted to the emergency department with severe chest pain. Onset of symptoms is within the last 60 minutes. What medication would you expect the physician to order for his acute disorder? A) Thrombolytic drugs B) Direct thrombin inhibitor drugs C) Anticoagulant drugs D) Antiplatelet drugs

A) Thrombolytic drugs The main use of thrombolytic agents is for management of acute, severe thromboembolic disease, such as myocardial infarction or pulmonary embolism.

**** CHAPTER 37 **** People who work at busy jobs where they are constantly on their feet have difficulty taking needed bathroom breaks. What results from this consistent practice? A) Weakened defection reflex B) Bowel incontinence C) Strengthened gastrocolic reflex D) None of these

A) Weakened defection reflex

**** CHAPTER 38 **** A patient has told the nurse of his intention to buy some Pepto-Bismol to treat his diarrhea. The nurse should inform the patient that there is a potential that the medication will cause A) a dark tongue or dark stool. B) hyperglycemia and a metallic taste. C) yellowing if the sclera. D) photosensitivity and visual "floaters."

A) a dark tongue or dark stool. Bismuth subsalicylate causes a temporary and harmless darkening of the tongue or stool.

A patient has been transferred from a long-term care facility to the emergency department because of care provider's concerns about the resident's recent diarrhea. The character of the patient's diarrhea is reported to be atypical and is described as being "fatty." The etiology of the patients diarrhea may involve A) enzyme deficiency B) malnutrition C) laxative abuse D) gram-negative infection

A) enzyme deficiency Steatorrhea may result when a deficiency of pancreatic enzymes causes malabsorption. Infection and laxative abuse may cause diarrhea, but the resulting stools rarely contains fat.

A nurse at a long-term care facility is reviewing a new resident's medication regimen and notes that he takes omaprazole and warfarin. The nurse should be aware that this combination of medication creates a risk of A) hemorrhage B) rebound GERD C) fluid volume excess D) venous thromboembolism

A) hemorrhage Omeprazole increases blood levels of warfarin; this creates a risk for bleeding.

An adrenergic drug has been administered to a patient in distress. Adrenergic drugs produce which of the following effects? A) increased heart rate B) Urinary incontinence C) Decreased blood pH D) Decreased respiratory rate

A) increased heart rate

A nurse is preparing to administer a scheduled dose of niacin to a resident of a long-term care facility. The nurse should be cognizant that this drug is the most effective method of A) increasing the concentration of HDL cholesterol B) mitigating the health consequences of hyperlipidemia C) reducing total cholesterol levels D) decreasing LDL cholesterol levels

A) increasing the concentration of HDL cholesterol

Different medications are used to treat the differing causes of nausea and vomiting. Antihistamines may be effective in the treatment of nausea and vomiting that is attributed to A) motion sickness. B) drugs. C) surgery. D) radiation therapy.

A) motion sickness. Antihistamines are usually effective in preventing or treating nausea and vomiting induced by motion sickness. Not all antihistamines are effective as antiemetic agents.

A nurse is preparing to administer a patient's scheduled dose of atorvastatin (Lipitor). The nurse should be aware that this drug achieves a therapeutic effect on cholesterol levels by A) reducing the amount of cholesterol synthesized by the liver. B) binding with LDL molecules and eliminating their potential for atherosclerosis. C) increasing the rate of renal excretion of LDL. D) inhibiting the absorption of dietary cholesterol in the small intestine.

A) reducing the amount of cholesterol synthesized by the liver.

Antacids are alkaline substances used to directly neutralize gastric acid in the stomach. Of the commonly used compounds, which is rarely used in PUD? A) Magnesium compounds B) Calcium compounds C) Simethicone compounds D) Aluminum compounds

B) Calcium compounds Calcium compounds have rapid onset of action but may cause hypercalcemia and hyper secretion of gastric acid (acid rebound) due to stimulation of gastrin release, if large doses are used. Consequently, calcium compounds are rarely used in PUD.

A post surgical patient possess numerous risk factors for venous thromboembolism, including a previous deep vein thrombosis. What drug would the nurse anticipate administering while this patient recovers in the hospital? A) Vitamin K B Heparin C) Clopidogrel (Plavix) D) Cilostazol (Pletal)

B Heparin Heparin is FREQUENTLY used to prevent post surgical venous thromboembolism.

A 39-year-old nulliparous woman has been taking Lipitor for two years and has now decided that she would like to become pregnant. What health education should the nurse provide to this patient? A) "There's no evidence that Lipitor is either safe or unsafe during pregnancy, so it's best to err on the side of caution." B) "It's important that you stop taking Lipitor before you stop using contraception." C) "Lipitor can be taken safely throughout your pregnancy since it does not cross through the placenta." D) "Lipitor is approved to be taken during pregnancy but you would have to stop taking it if your chose to breastfeed."

B) "It's important that you stop taking Lipitor before you stop using contraception."

A patient has been diagnosed with intermittent claudication and has been prescribed cilostazol for its management. She has been taking her medication as prescribed for 3 weeks and asks when she might expect better symptom control. Your answer to her is to contact her physician if she has not experienced improvement by A) tomorrow. B) 12 weeks. C) 6 weeks. D) 2 months

B) 12 weeks. Symptoms usually improve within 2 to 4 weeks but may take as long as 12 weeks.

A patient took cathartics prior to scheduled sigmoidoscopy. the nurse should inform the patient that she is unlikely to have a bowel movement for how long? A) A week to 10 days B) 2 to 3 days C) 12 to 24 hours D) 5 to 7 days

B) 2 to 3 days After taking a strong laxative or cathartic, it takes 2 to 3 days of normal eating to produce enough feces in the bowel for a bowel movement.

A nurse who works with elderly adults in the community has often recommended the use of bulk-forming laxatives to patients. In which of the following circumstances would the use of a laxative be contraindicated? A) A patient is taking vitamin B supplements. B) A patient is experiencing acute abdominal pain. C) A patient is unable to ambulate to the bathroom without assistance. D) A patient has a history of hemorrhoids.

B) A patient is experiencing acute abdominal pain.

A patient reveals to the nurse that she has been taking OTC bisacodyl on a daily basis for several months. In light of this revelation, the nurse should prioritize what assessment? A) Assessment of apical heart rate B) Assessment of electrolyte levels C) Assessment of deep tendon reflexes D) Assessment of coagulation factors

B) Assessment of electrolyte levels

Your patient is a 48-year-old man who has frequent episodes of angina and experienced an MI in 2011. What is the first drug of choice for treatment of his condition? A) Calcium-channel blockers B) Beta-blockers C) ARBs D) Antiadrenergics

B) Beta-blockers Beta-adrenergic blockers are the drugs of FIRST CHOICE for patients younger than 50 years of age with high-renin hypertension, tachycardia, angina pectoris, myocardial infarction, or left ventricular hypertrophy.

Adrenergic drugs stimulate beta1-receptor activity and can be of great benefit to critically ill patients. However, they carry the potential for which of the following adverse effects? A) Hypoglycemia B) Cardiac dysrhythmias C) Intestinal wall muscle spasm D) Stupor

B) Cardiac dysrhythmias

When teaching a group of recent nursing graduates about the clinical use of promethazine, a nursing educator should emphasize the fact that this drug is absolutely contraindicated with which of the following patient populations? A) Adults who are taking tricyclic antidepressants B) Children under the age of two C) Patients with type 1 diabetes D) Pregnant women

B) Children under the age of two A black box warning alerts nurses that promethazine is contraindicated in children younger that 2 years of age because of the risk of potentially fatal respiratory depression. The drug is not absolutely contraindicated in pregnancy (category C).

A patient has not achieved an appreciable reduction in serum triglyceride levels with her current medication profile. Consequently, her care provider is considering the use of a fibrate. What health problems contraindicate the use of fibrates for the treatment of dyslipidemia? Select all that apply. A) Ischemic heart disease B) Chronic renal failure C) Diabetes mellitus D) Liver disease E) History of venous thromboembolism

B) Chronic renal failure D) Liver disease

**** CHAPTER 7 **** Although venous thrombosis can occur in either arteries or veins, venous thrombosis is usually associated with venous stasis. Venous stasis is a decreased rate of blood flow that concentrates substances that initiate the clotting process. Why would a patient with a history of chronic hepatic failure be at risk for thrombi? A) Increased procoagulant substance removal via Keupffer's cells B) Decreased procoagulant substance removal via Jupiter's cells C) Decreased clotting factor production via venous endothelial cells D) Increased clotting factor production via venous endothelial cells

B) Decreased procoagulant substance removal via Jupiter's cells With a normal rate of blood flow, these substances are rapidly removed from the blood, primarily by Keupffer's cells in the liver.

Your patient has a history of severe renal failure. Recently, he has been placed on digoxin. You anticipate which of the following actions based upon your patient's history? A) Digoxin will need to be changed to another medication, as it is contraindicated in the case. B) Digoxin dose will need to be reduced. C) Digoxin dose will need to be increased and Lasix will need to be added. D) Digoxin dose will need to be reduced and potassium supplements will need to be added.

B) Digoxin dose will need to be reduced. Dosage of digoxin must be reduced in the presence of renal failure because most of the drug is excreted unchanged by the kidneys to prevent drug accumulation and toxicity.

In acute coronary syndrome (unstable angina, MI) platelet aggregation must be inhibited before medical or surgical treatment begins. Which medications exhibits anti platelet effects during infusion that cease when the infusion is stopped? A) Cilostazol B) Eptifibatide C) None of these D) Anagrelide

B) Eptifibatide

A nurse is assessing a newly admitted patient for risk factors that may predispose him to the development of constipation. Which of the following is a noted risk factor for constipation? A) Active infection B) Hypothyroidism C) Use of beta-adrenergic blockers D) Diabetes mellitus

B) Hypothyroidism

When are bile-binding drugs useful in treating diarrhea? Select all that apply. A) Irritable bowel syndrome (IBS) B) Ileectomy C) Chron's disease D) Hemorrhodectomy

B) Ileectomy C) Chron's disease

"Water follows salt" is a maxim that can guide may aspects of nursing practice. To what mechanism within the pathophysiology of edema does this principal apply? A) Decreased plasma oncotic pressure B) Increased capillary hydrostatic pressure C) No application D) Increased capillary permeability

B) Increased capillary hydrostatic pressure Increased capillary hydrostatic pressure results from sodium retention. This is the primary mechanism for edema formation in heart failure, pulmonary edema and renal failure.

Your patient is experiencing acute-onset heart failure (HF). You anticipate all of the following drugs being used EXCEPT A) digoxin. B) Inderal. C) HCTZ D) Lasix

B) Inderal. Beta-blockers are NOT recommend for patients in acute HF because of the potential for an initial decrease in myocardial contractility.

You are caring for a 53-year-old man with a 30-year history of alcohol dependance. He presents with ascites, secondary to chirrosis, with weeping edema of his lower extremities. To decrease his onboard fluid, low-dose combination diuretic therapy is used. When his urine output doesn't meet the physician's expectations, what would your expect the physician to do with the low diuretic dosage? A) Increase the dose. B) Leave the dose the same. C) Discontinue the diuretics. D) Decrease the dose.

B) Leave the dose the same. In liver disease, small doses of all diuretics are usually indicated because diuretic-induced electrolyte imbalances may precipitate or aggravate hepatic coma.

After receiving the results of his echocardiogram, your patient has many questions regarding results and their impact on his lifestyle. He is a 57-year-old Hispanic man with a 10-year history of hypertension. Disturbed by all the dietary changes proposed by the cardiologist, he questions what effect hypertension has on his heart. What is your reply? A) Arterial lumen dilation B) Myocardial hypertrophy C) Increased risk for hepatic damage D) Decreased risk of thrombosis

B) Myocardial hypertrophy

Ingesting prescribed medication can result in allergic reactions and adverse effects. What are the most common adverse effects of drug therapy? A) Elevated temperature and vomiting B) Nausea and vomiting C) Nausea and elevated temperature D) Respiratory depression and rash

B) Nausea and vomiting

Medications are given postoperatively to prevent or treat severe nausea and vomiting associated with the surgery. What serotonin receptor antagonist would you expect the surgeon to order? A) Levodopa B) Ondansetron C) Promethazine D) Metoclopramide

B) Ondansetron

Your patient, a 35-year-old man who works on the stock exchange, is at his follow-up visit for GERD. Antacids have not been effective for his reflux, and the physician is prescribing a proton pump inhibitor. Why might a PPI be preferable to an H2RA? A) PPIs suppress acid more strongly and for a shorter time. B) PPIs suppress acid more strongly and for a longer time C) PPIs strengthen the cardiac sphincter. D) PPIs suppress acid more gently and for a longer time.

B) PPIs suppress acid more strongly and for a longer time. Compared with H2RAs, PPIs suppress gastric acid more strongly and for a longer time. This effect provides faster symptom relief and faster healing in acid-related diseases.

In the defecation process, what is caused by gastrocolic and duodenocolic reflexes? A) Propulsion of chyme into rectum B) Propulsion of feces into the rectum C) Expulsion of fecal mass D) Propulsion of food into the stomach

B) Propulsion of feces into the rectum When the stomach and duodenum are distended with food or fluids, gastrocolic and duodenocolic reflexes cause propulsive movements in the colon, which move feces into the rctum and arouse the urge to defecate.

The anatomical structures involved in the physiologic process of vomiting are activated by various stimuli. Which is the consummating step in the physiologic process of vomiting? A) 5-HT3 receptor activation B) Reverse peristalsis C) CTZ activation D) Diaphragm contraction

B) Reverse peristalsis

Your patient is being prepped for a colonoscopy. He has been receiving hemodialysis three times weekly awaiting his kidney transplant. Which laxative/cathartic is contraindicated due to the potential of developing hypermagnesemia, hyperphosphatemia, or hyperkalemia? A) Aloe cathartics B) Saline cathartics C) Mineral cathartics D) None of these

B) Saline cathartics Saline cathartics containing magnesium, phosphate, or potassium salts are contraindicated in patients with renal failure because hypermagnesemia, hyperphosphatemia, or hyperkalemia may occur.

A patient with a history of diabetes and renal failure has been diagnosed with angina. What effect would the patient's chronic renal failure have upon calcium channel blocker administration and dosing when compared with a person who has full minded function? A) Same route, different drug B) Same route, same dosing C) Same route, increased dosing D) Same route, decreased dosing

B) Same route, same dosing Calcium channel blockers are metabolized in the liver, and dosage should be reduced in patient with severe liver disease. Dosage reductions are not required with renal disease.

A nurse is teaching a group of older adults about strategies for preventing constipation that do not involve the use of medications. The nurse should recommend which of the following? Select all that apply. A) Adequate sleep B) Six to ten glasses of fluid each day C) Increased intake of organic foods D) A high-fiber diet E) Frequent physical exercise.

B) Six to ten glasses of fluid each day D) A high-fiber diet E) Frequent physical exercise.

About 80% water, sodium, potassium, and other substances are reabsorbed during renal processing; the remaining 20% enters the loop of Henle. What substance is reabsorbed in the ascending limb of the loop of Henle? A) Water B) Sodium C) Amino acids D) Glucose

B) Sodium

Your patient had a difficult delivery and is severely lacerated posteriorly. After surgical repair, she received postoperative instructions to increase fluids, medicate for pain as needed, and to medicate to ease defecation. Which laxative or cathartic did her obstetrician likely recommend? A) Lubricant laxatives B) Surfactant laxatives C) Saline laxatives D) Bulk-forming laxatives

B) Surfactant laxatives Surfactant laxative have little is any laxative effect. Their main value is to prevent straining while expelling stool. They usually act within 1 to 3 days and should be taken daily.

A patient with a dysrhythmia has not responded appreciably to treatment with oral propranolol. The patient's cardiologist has opted to eliminate this drug from the patient's regimen. The nurse should prepare to teach the patient how to perform which of the following actions? A) Monitor her cardiac status at home after taking her last dose of propranolol B) Taper down her propranolol dose over a period of 2 weeks. C) Convert to an IM depot form of delivery for 3 months D) Gradually replace the propranolol with metoprolol

B) Taper down her propranolol dose over a period of 2 weeks.

A patient has purchased OTC dimenhydrinate (Dramamine) to treat cause. The nurse should convey which of the following teaching points to this patient? A) The drug has a high potential for abuse. B) The drug takes up to 4 hours to achieve full effect. C) The drug protects against nausea for up to 3 days. D) The drug can cause significant anticholinergic effects.

B) The drug takes up to 4 hours to achieve full effect.

A patient has had spironolactone (Aldactone) added to her medication regimen for treating heart failure. What is a goal of spironolactone therapy that the nurse should identify? A) The patient will resume pre diagnosis levels of stamina. B) The patient will experience a decrease in edema. C) The patient will will not require inotropes of beta-blockers. D) The patient will exhibit increased serum potassium levels.

B) The patient will experience a decrease in edema.

Substance exchange occurs freely through the walls of the renal convoluted tubules. Why? A) The tubules have many holes. B) The tubules have a large surface area. C) The tubules are extensively porous. D) There are many tubules.

B) The tubules have a large surface area.

In traveler's diarrhea, why are antibiotics contraindicated for the treatment of infection? A) They are ineffective. B) They may produce drug-resistant microbes. C) They may increase diarrhea. D) They may cause different infections.

B) They may produce drug-resistant microbes.

Your 92-year-old patient is being seen for follow-up after her latest hospital discharge in her 15-yer history of heart failure (HF). To decrease her cardiac workload, what type of diuretic has she most likely been using in the management of her long-term HF? A) Potassium-sparing diuretic B) Thiazide C) Loop diuretic D) Osmotic diuretic

B) Thiazide Thiazides and related diuretics are frequently prescribed in the long-term management of heart failure and hypertension.

A nurse is reviewing the medical history of a new resident of a care facility. The nurse reads that the patient has a documented allergy to sulfonamides. This allergy would contraindicate the use of what diuretics? A) Osmotic diuretics B) Thiazide diuretics C) Loop diuretics D) Potassium-sparing diuretics

B) Thiazide diuretics

A patient is newly diagnosed with heart failure and will receive her first four doses of digoxin the following day. The patient's husband also takes digoxin and asks the nurse why his wife will receive four doses, rather than one dose, in a 24-hour period. What is the rationale for this dosing schedule? A) To confirm that the patient does not have a hypersensitivity to digoxin B) To rapidly bring the patient's serum digoxin levels up to therapeutic levels C) To more accurately gauge the effect of digoxin on the patients cardiac function. D) To mitigate the potential for adverse effects.

B) To rapidly bring the patient's serum digoxin levels up to therapeutic levels Digitalization is the administration of a loading dose (a dose larger than the regularly prescribed daily dosage) of digoxin to reach therapeutic index rapidly.

A patient with heart failure and coronary artery disease has begun taking metoprolol (Lopressor). The nurse should caution the patient against abrupt cessation of treatment in order to avoid A) ventricular hyperplasia. B) angina or MI. C) a type IV hypersensitivity reaction. D) pulmonary hypertension.

B) angina or MI. The FDA has issued a black box warning for beta-adrenergic blocking agents for patients with coronary artery disease; Withdrawing oral forms of the class may result in exacerbation of angina, increased incidence of ventricular arrhythmias, and the occurrence of MI.

A middle-aged patient has achieved adequate blood pressure control through the use of captors and a thiazide diuretic. Captopril contributes to a reduction in this patients blood pressure by A) blocking the blood pressure-raising effects of angiotensin II. B) blocking the conversion of angiotensin I to angiotensin II. C) dilating peripheral arteries and relaxing vascular smooth muscle. D) increasing renal excretion of sodium and water.

B) blocking the conversion of angiotensin I to angiotensin II.

A community health nurse is reviewing the medication administration record of an elderly patient with a complex cardiac history. The nurse notes that the patient's current medications include diltiazem for a dysrhythmia as well as nitroglycerin for coronary artery disease. The nurse who'll recognize the need to closely monitor the patient's A) peripheral pulses. B) blood pressure. C) level of consciousness. D) oxygen saturation levels.

B) blood pressure.

Your patient, a 71-year-old man, is seeking care because of constipation. The patient is eager to know what normal bowel function should consist of. The nurse explains that there is no "normal" number of stools because of differences in A) ethnicity. B) diet. C) cultural expectations. D) gender.

B) diet.

A medical nurse is creating a plan of care that will address a patient's recent diarrhea. The nurse knows that loperamide (Imodium) is generally associated with fewer adverse effects than diphenoxylate because loperamide A) has a slower onset, later peak and longer half-life. B) does not affect the central nervous system. C) is metabolized by the kidneys rather than the liver. D) is organically derived.

B) does not affect the central nervous system. Because loperamide does not penetrate the CNS well, it does not cause the CNS effects associated with opioid use and lacks potential for abuse. Differences between the adverse effects of these two drugs are not attributable to pharmacokinetics or organic origin.

Many overlapping factors contribute to the development and progression of coronary artery disease, one of which is atherosclerosis. A 65-year-old black woman has been prepped for a heart catheterization within your outpatient surgery unit. The proliferation of atherosclerotic plaque has most likely occurred in her coronary arteries in response to A) diabetes mellitus B) elevated blood cholesterol levels C) epigastric pain D) variant angina

B) elevated blood cholesterol levels

Dyslipidemia is associated with atherosclerosis, myocardial ischemia, and stroke. It can have many causes, including the use of A) anticoagulants. B) oral estrogens. C) NSAIDs. D) diuretics.

B) oral estrogens.

A nurse is completing an assessment of a patient who has been administered an adrenergic drug. Adrenergic drugs mimic the effects of stimulating the A) autonomic nervous system. B) sympathetic nervous system. C) parasympathetic nervous system. D) adrenal medulla.

B) sympathetic nervous system.

Long-term oral amiodarone therapy has been identified as a viable treatment option for a patient's dysrhythmia. The nurse has taught the patient about the potential for drug interactions, knowing that such interactions have the potential to result in A) hypertensive crisis or hypertensive emergency. B) the development of new dysrhythmias C) negation of the therapeutic effects of amiodarone. D) seizure activity.

B) the development of new dysrhythmias Drugs that interact with amiodarone include beta-blockers, oral anticoagulants, digoxin, and phenytoin.

Angina can be caused by a thrombus forming in A) the lungs. B) the heart. C) the legs. D) the brain.

B) the heart.

An elderly patient has filled his first prescription for Lipitor. What should the nurse teach this patient about potential adverse effects? A) "The more serious side effects of Lipitor involve a risk of bleeding, but this is quite rare." B) "Most people who get side effects from Lipitor complain of things like stiffness in their joints or calves." C) ""The most common side effects of Lipitor involve some mild gastrointestinal upset." D) "Some patients get some mild chest pain when they are first starting Lipitor, but rest assured that this does not indicate a heart attack."

C) ""The most common side effects of Lipitor involve some mild gastrointestinal upset."

Older adults who are unable or unwilling to eat an adequate diet or who are debilitated may benefit from using bulk-formin laxatives. What is an important teaching regarding intake for anyone using bulk-forming laxatives? A) Assure adequate roughage intake B) Assure adequate fat intake C) Assure adequate fluid intake D) Assure adequate protein intake

C) Assure adequate fluid intake

Which of the following health problems is the most likely indication for the use of adrenergic drugs in a home care setting? A) Chronic heart failure B) Atrial fibrillation C) Asthma D) Pneumonia

C) Asthma

A 72-year-old patient with a history of PUD has been taking a PPI for the past 3 years. In light of the possible adverse effects of long-term PPI use, the nurse practitioner should focus on what assessment? A) Dental health B) Joint mobility C) Bone density D) Integumentary assessment

C) Bone density Long-term use of PPI's is associated with increased risk of hip fractures in people older than 50 years of age; the risk of fractures increases the longer the medications are taken and is greater in people who take higher doeses of PPI's. Bone density assessment may thus be warranted.

Your patient, a 15-year-old girl, is brought to your office by her mother, who reports the patient has chronic diarrhea. The patient reports lack of appetite and is significantly underweight with dry hair and skin. Oral assessment reveals erosion of tooth enamel. When asked, the patient reports occasional laxative use for "constipation." What do you suspect? A) Dehydration and hyperkalemia B) Sodium retention C) Bulimia with laxative abuse D) Anorexia nervosa

C) Bulimia with laxative abuse Enamel erosion is a hallmark of bulimia. The report of "occasional" laxative abuse plus the report of chronic diarrhea raises the strong potential for laxative abuse.

A 62-year-old woman with a history of MI is brought by the squad to your trauma center after an MVA in which she suffered extensive facial and oral trauma. She uses sublingual nitroglycerin in the management of her angina. What effect, if any, would the latest development have in her angina management? A) No effect B) Discontinue nitroglycerine use C) Change nitroglycerin route to transdermal D) Increases nitroglycerin dosage.

C) Change nitroglycerin route to transdermal

Blood lipids are a category of fatty acids, which are used within the body to perform essential functions. Which category of blood lipids is involved in the formation of atherosclerotic plaques? A) Phospholipids B) Triglycerides C) Cholesterol D) None of these

C) Cholesterol

A patient has had cholestyramine added to her treatment plan for dyslipidemia. What effect will this have on the pharmacokinetics of the other medications that the patient currently takes? A) Faster excretion B) Increased metabolism) C) Decreased absorption D) Increased first-pass effect

C) Decreased absorption

**** CHAPTER 26 **** An 83-year-old white man, a resident at a long term care facility in which you work, has taken nitroglycerin regularly for 15 years for his angina. In the past few years, his anger has decreased but increases as his myocardial workload increases with activity. What would explain the decrease in his resting angina? A) Decrease in number of lipid-filled macrophages B) Aut repair of endothelial injury C) Development of collateral circulation D) Decrease in number of plaque lesions

C) Development of collateral circulation

Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. In addition to being synthesized in the liver and intestine, from where are blood lipids derived? A) Exercise B) Medications C) Diet D) Kidneys

C) Diet

Adenosine has been ordered to restore NSR in a patient who has been diagnosed in the emergency department with paroxysmal supra ventricular tachycardia (SVT). The drug has been ordered to be administered as a bolus and the nurse has confirmed this with the cardiologist. What is the rationale for administering adenosine as a bolus? A) Bolus administration lessens the risk of adverse effects. B) It undergoes an unusually high first-pass effect. C) It has an exceptionally short half-life. D) A sudden, high serum level provides a long-lasting effect.

C) It has an exceptionally short half-life. Serum half-life of less than 10 seconds

Your ED patient has presented with a heart rate of approximately 195 beats per minute. Following a diagnostic workup, the team has identified the presence of atrial fibrillation and proceeded with cardioversion. What will be the primary goal of antidysrhythmic drug therapy in this patient's care? A) Increase in blood pressure and tissue perfusion B) Restoration of balance between intracellular potassium and extracellular sodium C) Maintenance of normal sinus rhythm D) Increased cardiac contractility.

C) Maintenance of normal sinus rhythm

Your newest admit to your cardiac-monitored floor is being readied for cardiac catheterization. After you obtain a complete history and complete your nursing assessment, you notify the cardiac surgeon of your patient's contraindication to abciximab administration. What the the contraindications to percutaneous transluminal coronary angioplasty? Select all that apply. A) Diabetes mellitus B) High body mass index C) Major trauma within last month D) Uncontrolled hypertension E) Heparin use

C) Major trauma within last month D) Uncontrolled hypertension

A patient with chronic renal failure secondary to diabetes mellitus has become seriously ill and the care team is considering the administration of epinephrine. Why do patients with impaired renal function require cautious use of epinephrine? A) Epinephrine is fully resorbed in the proximal tubules and can accumulate to toxic levels. B) Epinephrine can cause lysis of Bowman's capsules, further reducing renal function. C) Metabolites may accumulate and increase the risk of adverse effects. D) Epinephrine increases the pH of urine and constitutes a risk for urosepsis.

C) Metabolites may accumulate and increase the risk of adverse effects. The renal system eliminates many adrenergic drugs and their metabolites. In the presence of renal disease, these compounds may accumulate and cause increased adverse effects.

****CHAPTER 36**** Different medications are used to treat the differing causes of nausea and vomiting. Scopolamine, an anticholinergic drug, is particularly effective in which of the following circumstances? A) Anticipatory nausea B) Chemotherapy C) Motion sickness D) Idiopathic nausea

C) Motion sickness

After a cardiac muscle responds to an adequate electrical stimulus, it contracts. What happens chemically to prepare the muscle cells for the next contraction? A) Sodium and calcium ions return to the intracellular space. B) Potassium ions return to the extracellular space. C) Potassium ions return to the intracellular space. D) Muscle constriction occurs.

C) Potassium ions return to the intracellular space.

An adult patient with multiple chronic health problems has been prescribed furosemide in the management of hypertension. When reviewing this patient's current medication administration record, what drug should signal the nurse to a potentially increased risk of hypokalemia? A) Vitamin D B) Calcium carbonate C) Prednisone D) Ibuprofen (Advil)

C) Prednisone Corticosteroids INCREASE the risk of hypokalemia in patients who are taking furosemide.

Your patient has acute onset pulmonary edema. He has not experienced a response to digitalization. You would expect which of the following drugs to be used for this patient? A) Verapamil B) Nitroglycerin C) Primacor D) Lasix

C) Primacy Primacor is the most commonly used cardiotonic-inotropic agent for short-term management of acute, severe HF that is not controlled by digoxin, diuretics, and vasodilators.

Your patient, a 68-year-old man, is being discharged status post atrial flutter cardioversion to NSR. His cardiologist has prescribed propranolol to maintain NSR. What important information should be included in your patient education about potential adverse effects? A) Propanolol may cause restless leg syndrome. B) Propanolol may cause rebound hypertension. C) Propanolol may cause adverse respiratory effects. D) Propanolol may cause agitation.

C) Propanolol may cause adverse respiratory effects. Bronchospasm and laryngospasm are the most serious adverse effects of propranolol.

Several alternate dosage forms have been developed for nitroglycerin administration to relieve acute angina pectoris, prevent exercise-induced angina, and decrease anginal episodes in frequency and severity. Indicate why oral form dosing of nitrates is not the most effective administration route. Select all that apply. A) Large doses reach systemic circulation quickly B) Longer duration of action C) Rapid metabolism by the liver D) Slow onset of action doesn't relieve acute pain.

C) Rapid metabolism by the liver D) Slow onset of action doesn't relieve acute pain.

Your patient, 4 days status post radio frequency cardiac ablation, is heading home, discharge instructions in hand. She questions the lack of medication prescribed to prevent repeating episodes of her dysrhythmias. How do you explain to her the recent changes in approaches to antidysrhythmic therapy? A) Medications are always given to control significant dysrhythmias. B) Pharmacologic management of her dysrhythmia is unlikely to benefit her. C) Recent changes include greater use of nonpharmacologic management of dysrhythmias. D) Additional medications are given as tachydysrhythmias increase in frequency and severity.

C) Recent changes include greater use of nonpharmacologic management of dysrhythmias.

**** CHAPTER 28 **** A patient with a long history of hypertension has just been prescribed an alpha1-adrenergic receptor blocker. In order to reduce this patent's risk of orthostatic hypotension and falls, the nurse should encourage the patient to do which of the following? A) Take the medication with a high-fat meal B) Start with a low dose and increase gradually over 2-3 weeks C) Take the medication at bedtime D) Increase fluid intake for 48 hours before taking the first dose.

C) Take the medication at bedtime

A female patient with a complex medical history has been experiencing frequent nausea and has vomited several times over the past 24 hours. When considering the use of aprepitant, what variable must be accounted for? A) The fact that the drug is still pending FDA approval? B) The fact that the drug is pregnancy category X C) The potential for drug interactions D) The potential for dependance

C) The potential for drug interactions

**** CHAPTER 24 **** Your patient has been admitted with digitalis toxicity. He has been taking the same dose for more than 10 years. His family is asking how common this problem is and how he developed a toxic level while taking the usual dose. What would be your best explanation? A) Toxicity is usually due to incorrect prescription strength. B) The patient probably has developed severe renal impairment. C) Toxicity can occur even on low-dose therapy due to many factors, including advanced age, contributing medical conditions, and declining renal function. D) The patient must have been taking the wrong dose

C) Toxicity can occur even on low-dose therapy due to many factors, including advanced age, contributing medical conditions, and declining renal function.

Your patient has been diagnosed with a duodenal ulcer caused by H. pylori infection. What type of medications might be used to treat his ulcer and eradicate his infection? A) An antibiotic and an antacid B) An antibiotic and sucralfate C) Two antimicrobials and either a PPI or H2RA D) Sucralfate and H2RA

C) Two antimicrobials and either a PPI or H2RA It is common to use two antimicrobials to treat H. pylori bacterium and an antisecretory medication to treat an active ulcer. The antisecretory drug accelerates symptom relief and ulcer healing.

In treating a Helicobacter pylori infection, a physician has prescribed a patient two antimicrobials. What is the rationale for using two antimicrobials? A) One antimicrobial alters the action of the PPI or H2RA. B) More than one microbe is involved in the infection. C) Two are needed to prevent the emergence of drug-resistant H. pylori organisms. D) One antimicrobial isn't strong enough

C) Two are needed to prevent the emergence of drug-resistant H. pylori organisms.

During your patient's cardiac catheterization and concurrent GP IIb/IIIa receptor antagonist administration, he begins to bleed from the arterial access site of the catheterization. In what specific circumstance can the infusion continue? A) When the procedure is within 15 minutes of completion. B) It can't; it must be stopped. C) When bleeding can be controlled by pressure application D) When the patient can tolerate the Trendelenberg's position.

C) When bleeding can be controlled by pressure application

A patient's angina has prompted the care provider to prescribe nitroglycerin transdermal spray. The nurse should teach the patient to administer the spray A) after consulting with the care provider or a nurse. B) after administering oxygen by nasal prongs. C) as soon as chest pain develops. D) if the angina pain is unrelieved by 30 minutes of rest.

C) as soon as chest pain develops.

Your patient's digoxin level is reported to be 2.2 ng/mL. You know that this result indicates A) a sub therapeutic drug level. B) a loading dose has been given. C) digitalis toxicity. D) a therapeutic drug level

C) digitalis toxicity. The normal digoxin level is 0.5-2.0 ng/mL.

**** CHAPTER 27 **** A patient has been administered epinephrine. Subsequent stimulation of beta1-adrenergic receptors in the heart results in A) decreased heart muscle contractions. B) vasoconstriction of the coronary arteries. C) increased heart rate. D) decreased oxygen demand by the myocardium.

C) increased heart rate.

You are interviewing the latest admission to your medical floor. The patient requests a magnesium citrate "cocktail" overnight to "keep regular." Her request is evidence of potential A) normal colon function B) anorexia C) laxative abuse D) constipation.

C) laxative abuse Saline laxatives are generally useful and safe for short-term treatment of constipation, cleansing the bowel prior too endoscopic examinations, and treating fecal inaction. However they are not safe for frequent or prolonged use

A community health nurse notes that a new patient has been taking losartan potassium (Cozaar) for several years for the treatment of heart failure. The nurse should recognize that Cozaar addresses the pathophysiology of heart failure by A) reducing preload. B) increasing the patient's stroke volume. C) lowering the patient's blood pressure. D) increasing the patient's heart rate.

C) lowering the patient's blood pressure. Losartan potassium selectively blocks the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal glands. This, in turn, blocks the vasoconstrictive effect of the renin-angiotensin system and the release of aldosterone, leading to a decrease in the patient's blood pressure.

Any part of the heart's conduction system can spontaneously start an impulse, but the sinoatrial node normally has the fastest automaticity rate, serving as the pacemaker site. Initiation of an electrical impulse depends predominantly on the movement of (select all that apply) A) sodium and calcium ions out of a myocardial cell. B) potassium ions into a myocardial cell. C) potassium ions out of a myocardial cell. D) sodium and calcium ions into a myocardial cell.

C) potassium ions out of a myocardial cell. D) sodium and calcium ions into a myocardial cell.

**** CHAPTER 25 **** Your patient has questions about the new medication prescribed for her cardiac rhythm after having cardioversion performed. You explain how the sodium channel blocker decreases the likelihood of dysrhythmias by A) increasing automaticity of sodium-dependent cardiac tissue. B) increasing formation ad conduction of electrical impulses. C) prolonging the refractory period. D) shortening conduction velocity.

C) prolonging the refractory period.

Your patient, a 37-year-old woman with moderately elevated lipid levels, requests immediate pharmacotherapy for her dyslipidemia. You explain that a period of intensive diet therapy and lifestyle modification will likely be recommended before drug therapy is considered. You explain the rationale for they regimen as A) continued therapeutic lifestyle changes during drug therapy will guarantee success. B) nonpharmacologic interventions are cheaper than using medications. C) therapeutic lifestyle changes are the preferred method for lowering blood lipids. D) therapeutic lifestyle changes work only when used conjunction with medications.

C) therapeutic lifestyle changes are the preferred method for lowering blood lipids.

Your mother has retired from a cardiology follow-up in which the physician indicated there was no treatment needed for her non symptomatic dysrhythmia. Your mother is understandably concerned, but you assure her no medication is needed because A) there's no treatment needed for bradycardia. B) there's no treatment needed for cardiac function interference. C) there's no treatment needed for adequate perfusion. D) there's no treatment needed for tachycardia.

C) there's no treatment needed for adequate perfusion.

You are educating your patient about a new prescription for propranolol hydrochloride (Inderal) to be used for the patient's heart failure. Which of the following statements indicates effective teaching about beta-blocker therapy? A) "I will take my Inderal whenever I develop chest pain." B) " I know that this drug will tend to make me urinate more often." C) "I'll supplement this drug with my usual regimen of herbs." D) "Ill make sure not to stop taking my Inderal suddenly."

D) "Ill make sure not to stop taking my Inderal suddenly."

Digoxin has been prescribed for an outpatient with symptomatic heart failure. What is the priority teaching point to convey to this patient? A) "Plan to take your digoxin on an empty stomach to make sure it's fully absorbed." B) "Try to limit the number of high-potassium foods in your diet." C) If the swelling in your feet gets worse, you can take up twice your normal dose for 1 day." D) "Make sure to take your pulse for a minute before taking your digoxin."

D) "Make sure to take your pulse for a minute before taking your digoxin."

A patient's angina pectoris is being treated on an outpatient basis with sublingual nitroglycerin. The patient states that she experiences relief of chest pain when she takes this nitrate but that she often gets a severe headache after taking the drug. What teaching point should the nurse convey to the patient? A) "If you can take your nitroglycerin of a full stomach, it might reduce the frequency and severity of your headaches." B) "I'll contact your care provider. This may mean that nitroglycerin is not the right drug for you." C) "This is actually a result of your angina, not the nitroglycerin." D) "This is a common adverse effect of nitroglycerin; try taking Tylenol to treat your headache."

D) "This is a common adverse effect of nitroglycerin; try taking Tylenol to treat your headache."

A patient with a long-standing diagnosis of heart failure has been taking HCTZ for several weeks. The patient states that she has been experiencing moderate diuresis but she and her are provider agree that increased diuresis would be of benefit. However, the care provider has explained that the patient is likely near the ceiling threshold of this drug. What is the main implication of this fact? A) Increased use of HCTZ will have a paradoxical effect of reducing diuresis. B) A higher dose of HCTZ will reduce the patient's ability to produce concentrated urine. C) Increased use of HCTZ will exacerbate, rather that alleviate, her heart failure. D) A higher dose of HCTZ will not result in increased diuresis.

D) A higher dose of HCTZ will not result in increased diuresis.

A 33-year-old woman has been controlling her blood pressure successfully with an ACE inhibitor for several years. She has announced to the nurse her intention to get pregnant and asked if she will nee to change her drug regimen. What statement should underlie the nurses response? A) ACE inhibitors will exacerbate the fluid overload that commonly accompanies pregnancy. B) The woman can safely take her ACE inhibitor during pregnancy. C) The woman will have to reduce the dosage of her ACE inhibitor because it can cross the placenta. D) ACE inhibitors are contraindicated during pregnancy because they are teratogenic.

D) ACE inhibitors are contraindicated during pregnancy because they are teratogenic.

Diarrhea can be caused by innumerable factors, including drugs. Which of the following medications can cause diarrhea? A) Misoprostol B) Tacrolimus C) SSRIs D) All of these

D) All of these

Your patient, a 37-yer-old woman, presents with a blood pressure of 118/86 mmHg. She exercises regularly, is weight-appropriate for her height, and indicates no use of tobacco or alcohol. What advice should the nurse provide to this patient? A) Try to increase your intake of potassium-rich foods. B) Ensure adequate sleep. C) Explore the possible use of a calcium channel blocker with your care provider. D) Be aware of your salt intake and limit hidden salt

D) Be aware of your salt intake and limit hidden salt

Your patient, a 36-year-old pregnant woman, is visiting your OBN office for her monthly prenatal visit. She is at 36 weeks' gestation. She reports continual constipation, which is causing major discomfort due to hemorrhoids. Which substance would you expect the obstetrician to recommend to relieve her constipation? A) Lubricant laxative plus increased water intake B) Saline laxative plus increased water intake C) Stimulant cathartic plus increased water intake D) Bulk-forming laxative plus increased water intake

D) Bulk-forming laxative plus increased water intake Bulk-forming laxatives are the most physiologic laxatives because their effect is similar to that of increased intake of dietary fiber. They usually act within 12-24 hours but may take as long as 2 to 3 days to exert their full effects.

A patient who is undergoing cancer treatment is being discharged home with a prescription for ondansetron (Zoran). When providing health education, the nurse should describe actions that the patient can take to address what common adverse effect? A) Shortness of breath B) Anorexia C) Dry cough D) Diarrhea

D) Diarrhea

Dyslipidemia treatment guidelines offer many options for blood lipid reduction, including eating a healthier diet. A step II diet includes parameters for dietary intake and is recommended for initial use for patients with severe dyslipidemia, cardiovascular disease, or diabetes mellitus. Why are't more stringent fat restrictions recommended? A) Diets with more stringent fat restrictions produce significant reduction in LDL cholesterol. B) Diets with more stringent fat restrictions increase HDL cholesterol concentrations. C) All of these D) Diets with more stringent fat restrictions raise serum triglyceride levels.

D) Diets with more stringent fat restrictions raise serum triglyceride levels.

Your patient is being treated for hypokalemia. His current medications include Inderal, digoxin, and Coumadin. He is complaining about nausea, abdominal discomfort, and visual changes. Which of the following problems would you suspect? A) Myocardial infarction B) Heart failure C) Acute renal failure D) Digitalis toxicity

D) Digitalis toxicity

A 48-year-old black man with an extensive history of hypertension and obesity returns to your office for a 6-month check on his attempt to decrease risk factors for his CAD progression. What the risk factors are included in metabolic syndrome? A) Increased HDL B) Decreased triglycerides C) Increased LDL D) Elevated fasting glucose

D) Elevated fasting glucose

A hospital patient has been prescribed ramiril (Alsace) 5 mg PO daily and the scheduled dose is due at 0800. The nurse first reviews the patient's most recent blood work and should consider withholding the dose in light of what laboratory finding? A) Elevated neutrophil levels B) Low hemoglobin levels C) Low sodium levels. D) Elevated potassium levels.

D) Elevated potassium levels. ACE inhibitors carry a risk of hyperkalemia.

Your current patient, an overweight, 61-year-old man with a history of diabetes mellitus, is status post-MI 1 month and has returned for his cardiology follow-up. Included with his dietary changes, the cardiologist recommended which of the following non pharmacological lifestyle changes to reduce microvascular changes? A) Increased cholesterol consumption B) Increased nicotine use C) Maintaining weight D) Glucose control

D) Glucose control

Histamine2 receptor antagonists are used in the treatment of upper GI disorders. Why are histamine1 receptor antagonists ineffective? A) Histamine 1 receptor antagonists are ineffective in the presence of antacids B) Histamine 1 receptor antagonists are too costly. C) Histamine1 receptor antagonists are outdated medications for these conditions. D) Histamine1 receptor antagonists do not block histamine effects of gastric acid production.

D) Histamine1 receptor antagonists do not block histamine effects of gastric acid production. Traditional antihistamines or histamine1 receptor antagonists prevent or reduce other effects of histamine but do not block histamine effect on gastric acid production.

Lepirudin (Refludan) has been added to a patients medication regimen in order to treat a new onset of acute coronary syndrome. The nurse should anticipate administration by what route? A) Intramuscular B) Subcutaneous C) Oral D) Intravenous

D) Intravenous IV is the ONLY route of administration of lepirudin.

Your patent, an 80-year-old retired teacher, usually has blood pressure readings of approximately 145/80 mmHg. How would this patient's blood pressure be classified? A) Normal B) Stage 2 hypertension C) Stage 1 hypertension D) Isolated systolic hypertension

D) Isolated systolic hypertension A systolic pressure of 140 or above, with a diastolic pressure below 90, is called Isolated systolic hypertension, and is more common in the elderly.

A 2-year-old girl from Nigeria is reported to have excellent health, except for the diarrhea she has demonstrated. Her diarrhea started within days of their arrival in the United States 3 weeks ago. History reveals nothing remarkable, but her mother comments on her love of (and continual consumption of) ice cream, something new to her since coming to this country. What could be causing her diarrhea? A) Clostridium difficile B) Irritable bowel syndrome C) Inflammatory bowel disorder D) Lactase deficiency

D) Lactase deficiency

An adult patient has developed increasingly severe diarrhea over the past 24 hours and the care team has deemed the use of polycarbophil (FiberCon) necessary. When educating the patent about the likely outcomes of this treatment, the nurse should teach the patient to expect which of the following? A) A cessation of diarrhea and no bowel movements for 2 to 3 days. B) A transition to rectal oozing over the next 12 to 24 hours. C) Firm, formed stools. D) Large stools of a gelatin-like consistency.

D) Large stools of a gelatin-like consistency. Polycarbophil absorbs large amounts of water and produces stools of gelatin-like consistency.

The squad brought a 48-year-old man to your ED in the midst of a hypertensive emergency. Blood pressure is 198/112 mmHg, and the patient reports severe headache and drowsiness. He becomes disoriented and vomits. What is your primary goal in the hypertensive emergency? A) Lower blood pressure gradually B) Obtain complete medical history C) Observe for signs and symptoms of the cause of this hypertension before proceeding D) Lower blood pressure as quickly as possible.

D) Lower blood pressure as quickly as possible.

A popular pharmacotherapy for decreasing risks for MI and thrombus formation includes daily NSAID use because of the drug's anti platelet effects. You patient takes naproxen on a daily basis for his arthritis. Is there another medication that should also be prescribed? A) Yes. Naproxen's anti platelet effect is irreversible. B) Yes. Naproxen has no anti platelet effects. C) Yes. Aspirin should be added to his medication regimen. D) No. The antiplatelet effects of naproxen are effective.

D) No. The antiplatelet effects of naproxen are effective.

Regular use of anti platelet medications can contribute to increased risk of bleeding. Your patient, a 79-year-old woman, is admitted to the hospital with black, tarry stools and several large, scattered ecchymoses. She has a history of TIAs and has taken clopidogrel for several years. What would you expect the physician to prescribe to control her bleeding? A) Vitamin K B) Protamine sulfate C) Both of these D) None of these

D) None of these Clopidogrel irreversibly blocks the (ADP) receptor on platelet cell membranes. This effectively prevents platelet aggregation for the life span of the platelet. Platelet transfusion should be considered in patients who take these drugs and develop bleeding complications.

Some medications are more likely to cause the adverse effects of nausea and vomiting than others. With which medications are nausea and vomiting especially associated? A) Loop diuretics B) Selective serotonin reuptake inhibitors.(SSRIs) C) Beta-adrenergic blockers D) Opioid analgesics

D) Opioid analgesics Nausea and vomiting are especially associated with alcohol, aspirin, digoxin, anticancer drugs, antimicrobials, estrogen preparations, and opioid analgesics.

A nurse is explaining the varied therapeutic uses of epinephrine to a new nursing graduate. Epinephrine may be administered by all by which of the following routes? A) Topical B) Intravenous C) Subcutaneous D) Oral

D) Oral

A patient with a prosthetic heart valve has been taking warfarin (Coumadin) for several years. The nurse should know that this drug achieves the desired anticoagulant effects by which one of the following means? A) Preventing plasminogen from binding with fibrin B) Preventing platelets from aggregating on vessel walls C) Dissolving microclots that develop in the atria and ventricles D) Preventing synthesis of clotting factors in the liver.

D) Preventing synthesis of clotting factors in the liver. Warfarin acts in the liver to prevent synthesis of Vitamin K-dependant clotting factors (factors II, VII, IX, X)

An adult patient with hemorrhoids states that he experiences intense pain when straining to pass stools. What type of laxative would be the first choice? A) Stimulant cathartic B) Saline cathartic C) Bulk-forming laxative D) Stool softener

D) Stool softener For patients in whom straining is potentially harmful or painful, stool softeners (e.g., docusate sodium) are the agents of choice.

A resident of a long-term care facility who has chronic heart failure has begun taking enalapril maleate (Vaster). What change in this resident's immediate health status would necessitate withholding a scheduled dose? A) The patient's level of consciousness is less that normal baselines. B) The patient has recently taken an antacid containing magnesium. C) The patient has an infected pressure ulcer that is being treated with a macrolide antibiotic. D) The patient is volume-depleted following a bout of diarrhea.

D) The patient is volume-depleted following a bout of diarrhea.

An acutely ill patient requires the administration of epinephrine. How does the fact that the patient also takes propranolol affect dosing? A) The use of propranolol does not influence the use of epinephrine. B) The use of epinephrine is contraindicated. C) The patient should be given a smaller-than-normal does of epinephrine. D) The patient may require a higher dose of epinephrine.

D) The patient may require a higher dose of epinephrine. Victims of anaphylaxis who have been taking beta-adrenergic blocking drugs (e.g. propranolol [Inderal]) do not respond as readily to epinephrine as those not taking beta-blockers. Larger doses of epinephrine and large amounts of IV fluids may be required.

A patient has been admitted to the hospital with dehydration and hypokalemia secondary to severe diarrhea. Why might the care team be reluctant to aggressively treat the patient's diarrhea and slow the patient's peristalsis? A) A rapid cessation of diarrhea can exacerbate electrolyte imbalances B) The patient may become fluid overloaded. C) Rebound bowel obstruction is likely to occur. D) The patient's body may be ridding itself of toxins.

D) The patient's body may be ridding itself of toxins.

A woman with irritable bowel syndrome has had alosetron (Lotronex) prescribed by her gastroenterologist. Before administering this drug, the nurse should ensure that the patient has been made aware of what potentially severe adverse effect? A) The risk of anal fissures B) The risk of blood dycrasias C) The risk of diverticulosis D) The risk of bowel obstruction

D) The risk of bowel obstruction

Your patient is a 36-year-old man who undergoes dialysis three times weekly while waiting for renal transplant. A diuretic has been added to his current medications to combat developing edema. Why would potassium-sparing diuretics be contraindicated? A) They promote excretion of potassium. B) They are strong diuretics. C) They may cause rebound edema. D) They may cause hyperkalemia.

D) They may cause hyperkalemia.

The nurse is providing care for an adult patient whose nausea is being treated with promethazine. The nurse should consequently assess for what adverse effect? A) Pruritis B) Peripheral edema C) Nausea D) Urinary retention

D) Urinary retention The nurse assesses the patient who is taking promethazine for associated adverse ANTICHOLINERGIC effects including dry mouth, blurred vision, urinary retention, constipation, acute confusion, dizziness, and tachycardia.

A patient with a pulmonary embolism is receiving an IV heparin infusion. What laboratory blue will the nurse prioritize when providing this patient's care? A) Factor XIII levels B) D-dimer C) Platelet level D) aPTT

D) aPTT

A nurse is aware that clopidogrel irreversibly blocks the ADP receptor on platelet cell membranes and reduces the patient's risks of subsequent coronary events. In order to compensate for the drug's slow onset of action, however, the nurse should anticipate. A) temporarily supplementing the patient's medication regimen with low molecular weight heparin. B) administering the first two to three doses of clopidogrel intravenously. C) giving the patient warfarin (Coumadin) simultaneously with clopidogrel. D) administering a one-time loading dose that is higher than the maintenance dose.

D) administering a one-time loading dose that is higher than the maintenance dose.

A medical nurse is aware that any part of the heart's conduction system is able to generate an electrical impulse. This ability is known as A) spontaneous stimulation. B) perpetuity. C) initiation. D) automaticity.

D) automaticity.

Epinephrine typically causes an increase in the tone of many muscles. However it has the potential to promote relaxation of A) smooth muscles in the intestinal wall. B) superficial blood vessels. C) sphincter muscles D) bronchioles

D) bronchioles

A patient has achieved adequate control of her angina by taking nifedipine 20 mg PO t.i.d. The nurse is aware that this drug achieves a therapeutic effect by A) potentiating the effect of b-type natriuretic peptide. B) preventing the outflow of intracellular potassium. C) binding extracellular sodium ions with chloride ions. D) inhibiting the influx of calcium through slow channels.

D) inhibiting the influx of calcium through slow channels. Nifedipine inhibits the influx of calcium entering through slow channels, producing vasodilation of the peripheral blood vessels and coronary arteries.

A patient with seasonal allergies has begun using phenylephrine to relieve nasal congestion. The nurse should caution the patient against using this drug for a prolonged period due to the risk of A) sympathomimetic effects. B) epistaxis. C) glaucoma. D) rebound congestion.

D) rebound congestion.

Atherosclerosis can affect any organ or tissue but often involved specific locations in the body. Plaque site contribute to the formation of a thrombus, which can partially or completely occlude the blood vessel. Additionally, portions of thrombi may travel through the bloodstream and cause occlusion. Intermittent claudication can be caused by a thrombus lodging in A) the lungs B) the heart. C) the brain. D) the legs.

D) the legs. In peripheral arteries, a thrombus in peripheral circulation may cause intermittent claudication (pain in the legs with exercise) or acute occlusion.

A patient has been prescribed a metered dose inhaler of epinephrine. The nurse has emphasized the importance of not exceeding the recommended frequency of administration because using the drug too often can result in A) rebound bronchoconstriction. B) upper respiratory infections. C) heart block. D) tolerance to the drug.

D) tolerance to the drug.