Week 5

A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] and digoxin. The prescriber has ordered spironolactone [Aldactone] to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching?

"I need to stop taking potassium supplements."

Lovastatin [Mevacor] is prescribed for a patient for the first time. The nurse should provide the patient with which instruction?

"Take lovastatin with your evening meal."

A patient with a history of elevated triglycerides and LDL cholesterol begins taking nicotinic acid [Niacin]. The patient reports uncomfortable flushing of the face, neck, and ears when taking the drug. What will the nurse advise the patient?

"You should take 325 mg of aspirin a half hour before each dose of Niacin to prevent this effect."

Which of the following anti-platelet drugs act by blocking the P2Y12 receptor?

Clopidogrel

A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed spironolactone [Aldactone]. The nurse assesses the patient and notes dyspnea, bilateral crackles, and pitting edema in both feet. Which intervention is appropriate?

Contact provider to discuss an order for furosemide [Lasix].

Which plasma lipoprotein level is most concerning when considering the risk of coronary atherosclerosis?

Elevated low-density lipoprotein

A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to administer which drug?

Furosemide [Lasix]

A patient with hypertension will begin taking an alpha1 blocker. What will the nurse teach this patient?

Move slowly from sitting to standing when taking this drug.

A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide [Lasix]. The nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern?

Potassium level of 3.5 mEq/L (low)

A patient on heparin is experiencing uncontrolled bleeding. Which of the following do you expect to be administered?

Protamine Sulphate

A patient is admitted with severe hypertensive crisis. The nurse will anticipate administering which medication?

Sodium nitroprusside [Nitropress] IV

A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L (elevated). Which diuretic agent ordered by the prescriber should the nurse question?

Spironolactone [Aldactone]

Which drug is the most effective for lowering LDL cholesterol? a. Atorvastatin [Lipitor] b. Cholestyramine [Questran] c. Gemfibrozil [Lopid] d. Ezetimibe [Zetia]

a. Atorvastatin [Lipitor] The statin drugs (such as atorvastatin) are most effective for reducing cholesterol

Which are beneficial effects that can be derived from simvastatin [Zocor] and other drugs in this class? (Select all that apply.) a. Reduction of LDLs b. Elevation of HDLs c. Stabilization of the plaque in coronary arteries d. Reduction of risk of cardiovascular events e. Improvement of liver function

a. Reduction of LDLs b. Elevation of HDLs c. Stabilization of the plaque in coronary arteries d. Reduction of risk of cardiovascular events The benefits of statin drugs include all but answer choice (e). Statins can actually be hepatotoxic in some people.

The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? a. "I can take this medication in the morning to reduce nighttime urination." b. "I will rise slowly when changing from a sitting to a standing position." c. My heart rate may slow down with this drug. I will call if my pulse is below 60." a. "I need to increase my intake of fluids and foods that are high in fiber."

b. "I will rise slowly when changing from a sitting to a standing position." Vasodilators can cause orthostatic hypotension so (b) best describes effective understanding of this side effect.

The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? a. Very-low-density lipoprotein (VLDL) b. polipoprotein B-100 c. Low-density lipoprotein (LDL) d. High-density lipoprotein (HDL)

c. Low-density lipoprotein (LDL) LDLs carry cholesterol through the bloodstream. High LDL concentration is the leading risk factor for coronary heart disease.

Which laboratory result may be a consequence of therapy with a thiazide diuretic? a. Serum glucose level of 58 mg/dL b. Serum potassium level of 5.3 mEq/L c. Serum sodium level of 135 mEq/L d. Serum uric acid level of 10.4 mg/dL

d. Serum uric acid level of 10.4 mg/dL Thiazide diuretics will not cause hypoglycemia as seen in (a), (b) & (c) represent normal potassium and sodium levels so they don't qualify as "consequences" of drug therapy. The uric acid levels in (d) are higher than normal which is a possible adverse effect of many diuretic drugs including thiazides.

The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? a. To reduce the risk of headache b. To improve hypotensive effects c. To prevent heart failure d. To protect against reflex tachycardia

d. To protect against reflex tachycardia Hydralazine is a vasodilator and will cause a decline in BP. Drops in blood pressure can cause reflex tachycardia. Beta blockers such as propranolol taken along with a vasodilator will block reflex tachycardia.

Which of the following is a thrombolytic drug that carries the greatest risk for hemorrhage?

enoxaparin

A patient who is taking simvastatin [Zocor] develops an infection and the provider orders azithromycin [Zithromax] to treat the infection. The nurse should be concerned if the patient complains of:

muscle pain

A patient who was in a motor vehicle accident sustained a severe head injury and is brought into the emergency department. The provider orders intravenous mannitol [Osmitrol]. The nurse knows that this is given to:

reduce intracranial pressure.