1 quizlet to rule them all

A nurse teaching a client receiving allopurinol (Zyloprim) should include which information? "Increase your fluid intake to 3 L per day." "This medication may cause your urine to turn orange." "Include salmon and organ meats in your diet on a weekly basis." "Take the medication with an antacid to minimize GI distress."

"Increase your fluid intake to 3 L per day." Clients taking allopurinol should be informed to increase fluid intake to 3 L per day, avoid hazardous activities if dizziness or drowsiness occurs with the medication, and avoid the use of alcohol and caffeine because these drugs will increase uric acid levels and decrease the levels of allopurinol.

The nurse would question the use of milrinone (Primacor) in a patient with which condition? a. Acute renal failure b. Aortic regurgitation c. Systolic heart failure d. Mitral valve prolapse

B

7. The medication order for a 5-year-old patient reads: "Give digoxin elixir, 15 mcg/kg, PO now." The child weighs 20 kg. How many milligrams will this patient receive?

0.3 mg

An elderly patient has had hip surgery and will be receiving heparin, 4000 units subcutaneously every 12 hours. The heparin is available in vials of 5000 units/mL. Calculate how much heparin the nurse will administer for this dose. _______

0.8 mL 5000 units : 1 mL :: 4000 units : x mL

When teaching a patient regarding the administration of digoxin (Lanoxin), the nurse instructs the patient not to take this medication with which food? a. Bananas b. Wheat bran c. French toast d. Scrambled eggs

B

7. The order for enoxaparin (Lovenox) reads: Give 1 mg/kg subcut every 12 hours. The patient weighs 242 lb, and the medication is available in an injection form of 120 mg/0.8 mL. How many milligrams will this patient receive? How many milliliters will the nurse draw up for the injection? (Round to hundredths.)

110 mg- 0.73 mL

A pediatric patient weighing 66 lb is prescribed digoxin (Lanoxin) 12 mcg/kg in 3 evenly divided doses. How much will the nurse administer per dose?

120 mcg per dose

7. A patient is in the emergency department with new-onset rapid-rate atrial fibrillation. The nurse is about to add a continuous infusion of diltiazem (Cardizem) at 5 mg/hr, but must first give a bolus of 0.25 mg/kg over 2 minutes. The patient weighs 220 pounds. The medication comes in a vial of 5 mg/mL. How many milligrams will the patient receive, and how many milliliters will the nurse draw up for this dose?

25 mg- 5 mL

The order reads, "Give metoprolol (Lopressor) 300 mg/day PO in 2 divided doses." The tablets are available in 50-mg strength. How many tablets will the patient receive per dose?

3 tablets per dose (150mg per dose)

The order for a child reads, "Give furosemide (Lasix) 2 mg/kg IV STAT." The child weighs 33 pounds. Identify how many milligrams will the child receive for this dose. _______

30 mg

6. The order reads: Give hydralazine (Apresoline) 0.75 mg/kg/day. The child weighs 16 pounds. How much hydralazine will be given? (Record your answer using two decimal places.)

5.45 mg/kg/day

A patient weighing 44 lb is prescribed a digoxin (Lanoxin) loading dose of 0.03 mg/kg to be administered in three divided doses. How much will the nurse administer in each dose? a. 0.2 mg b. 0.3 mg c. 0.4 mg d. 0.6 mg

A

Before administering a dose of an antidysrhythmic drug to a patient, what is the priority nursing assessment? a. Check apical pulse and blood pressure. b. Measure urine output and specific gravity. c. Obtain temperature and pulse oximetry on room air. d. Evaluate peripheral pulses and level of consciousness.

A

Before administering isosorbide mononitrate (Imdur) sustained-release tablet to a patient, what is the priority nursing intervention? A. Obtain a blood pressure reading. B. Remind the patient to take the tablet before meals. C. Emphasize that the patient should swallow the tablet whole. D. Advise the patient that Tylenol is used to treat headache.

A

Phosphodiesterase inhibitors (PDIs) have an added advantage in treating heart failure. These drugs cause a positive inotropic effect and what other effect? a. Vasodilation b. Bronchodilation c. Vasoconstriction d. Platelet inhibition

A

The patient states to the nurse, "My friend said nitroglycerin relieves angina pain by reducing preload. What is preload?" Which statement by the nurse explains preload to this patient? A. "It is the blood return to the heart." B. "It is the oxygen demand of the heart." C. "It is the pressure against which the heart must pump." D. "It is dilation of arteries and veins throughout the body."

A

The patient improved within the first three months of treatment with methotrexate. Six months later, the patient experienced worsening of symptoms. The prescriber will most likely order which monoclonial antibody for the treatment of rheumatoid arthritis? A. adalimumab (Humira) B. trastuzumab (Herceptin) C. rituximab (Rituxan) D. cetuximab (Erbitux)

A (Adalimumab (Humira) is indicated for the treatment of severe, progressive RA for which other RA therapies have failed. Trastuzumab (Herceptin) is indicated for the treatment of breast cancer. Rituximab (Rituxan) is used for the treatment of non-Hodgkin's lymphoma, and cetuximab (Erbitux) is indicated for the treatment of metastatic colorectal cancer)

A 40-year-old female patient is seen in the clinic. She has been newly diagnosed with rheumatoid arthritis. Which medication does the nurse anticipate being ordered for the patient? A. methotrexate B. adalimumab C. infliximab D. etanercept

A (For the treatment of rheumatoid arthritis, the recommend therapy with nonbiologic DMARDs usually begins with methotrexate or leflunomide for most patients. Biologic DMARDs are generally reserved for those patients whose disease does not respond to methotrexate or leflunomide. The biologic DMARDs include etanercept, infliximab, adalimumab, abatacept, and rituximab)

The nurse should question a prescription to administer acetylsalicylic acid (aspirin) to which client? A 62-year-old patient with a history of stroke A 45-year-old patient with a history of heart attack A 28-year-old patient with a history of sports injury A 14-year-old patient with a history of flulike symptoms

A 14-year-old patient with a history of flulike symptoms Aspirin should never be administered to children with flulike symptoms. The use of aspirin in children with flulike symptoms has been associated with Reye's syndrome.

ANS: A Diazepam (Valium) is considered by many to be the drug of choice for status epilepticus. Other drugs that are used are listed in Table 14-3 and do not include the drugs listed in the other options.

A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition? a.diazepam (Valium) b.midazolam (Versed) c.valproic acid (Depakote) d.carbamazepine (Tegretol)

Which dosage form of nitroglycerin has the longest duration of action? A. Sublingual tablet B. Transdermal patch C. Intravenous (IV) infusion D. Immediate-release tablet

B

For a patient receiving a positive inotropic drug, which nursing assessments should be performed? (Select all that apply.) a. Check apical pulse. b. Obtain daily weights. c. Auscultate lung sounds. d. Monitor serum electrolytes. e. Review red blood cell count.

A,B,C,D

The nurse understands that a patient receiving nitroglycerin should be monitored for which common adverse effects associated with this medication? (Select all that apply.) A. Flushing B. Headache C. Dizziness D. Hypotension E. Blurred vision

A,B,C,D

A patient will be starting therapy with etanercept (Enbrel) as part of treatment for severe rheumatoid arthritis. which conditions, if present, may be contraindictation for this drug? (SELECT ALL THAT APPLY) A. Latex allergy B. Active bacterial infection C. Diabetes mellitus D. Latent tuberculosis E. Acute hepatits B F. Peanut allergy

A,B,D,E (Latex allergy, Active bacterial infection, Latent tuberculosis, Acute hepatits B)

For a patient receiving IV nitroglycerin (Tridil), what are the priority nursing interventions? (Select all that apply.) A. Check the heart rate. B. Monitor blood pressure. C. Auscultate lung sounds. D. Measure intake and output. E. Assess for worsening chest pain.

A,B,E

The nurse is reviewing the medical history of a patient who is about to receive therapy with etanercept (Enbrel). which conditions, if present, would be contraindicated or caution for therapy with this drug? (SELECT ALL THAT APPLY) A. Urinary tract infection B. Psoriasis C. Heart failure D. Glaucoma E. Latex allergy

A,C,E (Urinary tract infection, Heart failure, Latex allergy)

Which drug class is used to treat both hypertension and antidysrhythmias? a. Sodium channel blockers b. Calcium channel blockers c. Direct-acting vasodilators d. Alpha-adrenergic-blocking

B

A patient has received an overdose of enoxaparin (Lovenox). The order was for 30 mg, but the patient received 90 mg. The nurse notes that the patient is showing signs of bleeding (oozing blood from the intravenous sites, increased bruising) and notifies the physician, who prescribes protamine sulfate to cover the excess amount of enoxaparin that the patient received. Calculate how much protamine sulfate the patient will receive. _______

ANS: 60 mg Protamine sulfate is used to reverse the effects of low-molecular-weight heparins (LMWHs). A 1-mg dose of protamine is administered for each milligram of the LMWH. This patient received 60 mg of enoxaparin more than the ordered dose of 30 mg; therefore, 60 mg of protamine sulfate will be used as an antidote. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 416 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient who has been anticoagulated with warfarin (Coumadin) has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the patient may have taken too much warfarin. The nurse anticipates that the patient will receive which antidote? a. Vitamin E b. Vitamin K c. Protamine sulfate d. Potassium chloride

ANS: B Vitamin K is given to reverse the anticoagulation effects of warfarin toxicity. Protamine sulfate is the antidote for heparin overdose. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 416 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient's blood pressure elevates to 270/150 mm Hg, and a hypertensive emergency is obvious. He is transferred to the intensive care unit and started on a sodium nitroprusside (Nipride) drip to be titrated per his response. With this medication, the nurse knows that the maximum dose of this drug should be infused for how long? a. 10 minutes b. 30 minutes c. 1 hour d. 24 hours

ANS: A Sodium nitroprusside is a potent vasodilator and may lead to extreme decreases in the patient's blood pressure. For this reason, it is never infused at the maximum dose for more than 10 minutes. If this drug does not control a patient's blood pressure after 10 minutes, it will most likely be ordered to be discontinued. The other times listed are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 357 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A patient with gout has been treated with allopurinol (Zyloprim) for 2 months. The nurse will monitor laboratory results for which therapeutic effect? a. Decreased uric acid levels b. Decreased prothrombin time c. Decreased white blood cell count d. Increased hemoglobin and hematocrit levels

ANS: A Treatment of gout with allopurinol should result in decreased uric acid levels. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 704 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

1. The nurse is presenting information to a class of students about adrenergic drugs. Which are effects of drugs that stimulate the sympathetic nervous system? (Select all that apply.) a. Dilation of bronchioles b. Constriction of bronchioles c. Decreased heart rate d. Increased heart rate e. Dilated pupils f. Constricted pupils g. Glycogenolysis

ANS: A, D, E, G Stimulation of the sympathetic nervous system causes bronchodilation, increased heart rate, pupil dilation, and glycogenolysis as well as many other effects (see Table 18-1). The other responses are effects that occur as a result of the stimulation of the parasympathetic nervous system.

When monitoring a patient who is taking hydrochlorothiazide (HydroDIURIL), the nurse notes that which drug is most likely to cause a severe interaction with the diuretic? a. Digitalis b. Penicillin c. Potassium supplements d. Aspirin

ANS: A. Digitalis There is an increased risk for digitalis toxicity in the presence of hypokalemia, which may develop with hydrochlorothiazide therapy. Potassium supplements are often prescribed with hydrochlorothiazide therapy to prevent hypokalemia. The other options do not have interactions with hydrochlorothiazide.

Mannitol (Osmitrol) has been ordered for a patient with acute renal failure. The nurse will administer this drug using which procedure? a. Intravenously, through a filter b. By rapid intravenous bolus c. By mouth in a single morning dose d. Through a gravity intravenous drip with standard tubing

ANS: A. Intravenously, through a filter Mannitol is administered via intravenous infusion through a filter because of possible crystallization. It is not available in oral form. The other options are incorrect.

A patient has had recent mechanical heart valve surgery and is receiving anticoagulant therapy. While monitoring the patient's laboratory work, the nurse interprets that the patient's international normalized ratio (INR) level of 3 indicates that: a. the patient is not receiving enough warfarin to have a therapeutic effect. b. the patient's warfarin dose is at therapeutic levels. c. the patient's intravenous heparin dose is dangerously high. d. the patient's intravenous heparin dose is at therapeutic levels.

ANS: B A normal INR (without warfarin) is 1.0. A therapeutic INR for patients who have had mechanical heart valve surgery ranges from 2.5 to 3.5, with a middle value of 3. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 419 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. The nurse notes in a patient's medication history that the patient is taking allopurinol (Zyloprim). Based on this finding, the nurse interprets that the patient has which disorder? a. Rheumatoid arthritis b. Gout c. Osteoarthritis d. Systemic lupus erythematosus

ANS: B Allopurinol is indicated for the treatment of gout but is not indicated for the other disorders listed. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 699 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient is receiving a moderate-level dose of dobutamine for shock and is complaining of feeling more "skipping beats" than yesterday. What is the nurse's next action? a. Assess the patient's vital signs and cardiac rhythm. b. Discontinue the dobutamine immediately. c. Titrate the rate to a higher dose to reduce the palpitations. d. Monitor for other signs of a therapeutic response to the drug.

ANS: B During the administration of adrenergic drugs, adverse effects such as cardiac irregularities, hypertension, and tachycardia may occur. Stopping the drug should cause the toxic symptoms to subside quickly because of the drug's short half-life.

The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew? a. Muscle aches b. Migraine headaches c. Leg cramps d. Incision pain after surgery

ANS: B Feverfew is commonly used for migraine headaches, menstrual problems, arthritis, and fever. Possible adverse effects include muscle stiffness and muscle and joint pain. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 162 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient? a. His pulse rate b. His respiratory rate c. The appearance of the incision d. The date of his last bowel movement

ANS: B One of the most serious adverse effects of opioids is respiratory depression. The nurse must assess the patient's respiratory rate before administering an opioid. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 153 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A patient has received an overdose of intravenous heparin, and is showing signs of excessive bleeding. Which substance is the antidote for heparin overdose? a. Vitamin E b. Vitamin K c. Protamine sulfate d. Potassium chloride

ANS: C Protamine sulfate is a specific heparin antidote and forms a complex with heparin, completely reversing its anticoagulant properties. Vitamin K is the antidote for warfarin (Coumadin) overdose. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 416 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is reviewing drug therapy for hypertension. According to the JNC-8 guidelines, antihypertensive drug therapy for a newly diagnosed hypertensive African-American patient would most likely include which drug or drug classes? a. Vasodilators alone b. ACE inhibitors alone c. Calcium channel blockers with thiazide diuretics d. Beta blockers with thiazide diuretics

ANS: C According to the JNC-8 guidelines, calcium channel blockers and diuretics are recommended as first-line therapy for management of hypertension in African-American patients. The other drugs are not recommended as first-line drugs for this group. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 355 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient is to receive acetylcysteine (Mucomyst) as part of the treatment for an acetaminophen (Tylenol) overdose. Which action by the nurse is appropriate when giving this medication? a. Giving the medication undiluted for full effect b. Avoiding the use of a straw when giving this medication c. Disguising the flavor with soda or flavored water d. Preparing to give this medication via a nebulizer

ANS: C Acetylcysteine has the flavor of rotten eggs and so is better tolerated if it is diluted and disguised by mixing with a drink such as cola or flavored water to help increase its palatability. The use of a straw helps to minimize contact with the mucous membranes of the mouth and is recommended. The nebulizer form of this medication is used for certain types of pneumonia, not for acetaminophen overdose. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 162 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A 6-year-old child who has chickenpox also has a fever of 102.9° F (39.4° C). The child's mother asks the nurse if she should use aspirin to reduce the fever. What is the best response by the nurse? a. "It's best to wait to see if the fever gets worse." b. "You can use the aspirin, but watch for worsening symptoms." c. "Acetaminophen (Tylenol) should be used to reduce his fever, not aspirin." d. "You can use aspirin, but be sure to follow the instructions on the bottle."

ANS: C Aspirin is contraindicated in children with flu-like symptoms because the use of this drug has been strongly associated with Reye's syndrome. This is an acute and potentially life-threatening condition involving progressive neurologic deficits that can lead to coma and may also involve liver damage. Acetaminophen is appropriate for this patient. The other responses are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 698 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Health Promotion and Maintenance

A patient is on a low-dose dobutamine drip for heart failure. She had been feeling better but now has a sense of tightness in her chest, palpitations, and a bit of anxiety. Her heart rate is up to 110 per minute, and her blood pressure is 150/98 mm Hg (increased from previous readings of 86 per minute and 120/80 mm Hg). What is the nurse's immediate concern for this patient? a. She is experiencing normal adverse effects of dobutamine therapy. b. She may be experiencing an allergic reaction to the dobutamine. c. The medication may be causing a worsening of a preexisting cardiac disorder. d. The dosage of the dobutamine needs to be increased to control the symptoms better.

ANS: C Because dobutamine is a vasoactive adrenergic, it works by increasing the cardiac output in heart failure patients by increasing myocardial contractility and stroke volume. However, adrenergic drugs may worsen a preexisting cardiac disorder, such as causing a myocardial infarction in a patient with coronary artery disease. The other options are incorrect.

A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition? a. Tachycardia b. Central nervous system depression c. Hepatic necrosis d. Nephropathy

ANS: C Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 158 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

The nurse is assessing a patient for contraindications to drug therapy with acetaminophen (Tylenol). Which patient should not receive acetaminophen? a. A patient with a fever of 101° F (38.3° C) b. A patient who is complaining of a mild headache c. A patient with a history of liver disease d. A patient with a history of peptic ulcer disease

ANS: C Liver disease is a contraindication to the use of acetaminophen. Fever and mild headache are both possible indications for the medication. Having a history of peptic ulcer disease is not a contraindication. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 157 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 per minute. The nurse prepares for which priority action at this time? a. Assessment of the patient's pain level b. Immediate intubation and artificial ventilation c. Administration of naloxone (Narcan) d. Close observation of signs of opioid tolerance

ANS: C Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression. This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not appropriate because the patient is still breathing at 7 breaths/min. It would be inappropriate to assess the patient's level of pain. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 153 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class? a. Calcium channel blockers b. Diuretics c. Nonsteroidal anti-inflammatory drugs d. Nitrates

ANS: C Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can reduce the antihypertensive effect of ACE inhibitors. In addition, the use of NSAIDs and ACE inhibitors may also predispose patients to the development of acute renal failure. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 349 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient will be receiving a thrombolytic drug as part of the treatment for acute myocardial infarction. The nurse explains to the patient that this drug is used for which purpose? a. To relieve chest pain b. To prevent further clot formation c. To dissolve the clot in the coronary artery d. To control bleeding in the coronary vessels

ANS: C Thrombolytic drugs lyse, or dissolve, thrombi. They are not used to prevent further clot formation or to control bleeding. As a result of dissolving of the thrombi, chest pain may be relieved, but that is not the primary purpose of thrombolytic therapy. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 414 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

When reviewing the mechanisms of action of diuretics, the nurse knows that which statement is true about loop diuretics? a. They work by inhibiting aldosterone. b. They are very potent, having a diuretic effect that lasts at least 6 hours. c. They have a rapid onset of action and cause rapid diuresis. d. They are not effective when the creatinine clearance decreases below 25 mL/min.

ANS: C. They have a rapid onset of action and cause rapid diuresis The loop diuretics have a rapid onset of action; therefore, they are useful when rapid onset is desired. Their effect lasts for about 2 hours, and a distinct advantage they have over thiazide diuretics is that their diuretic action continues even when creatinine clearance decreases below 25 mL/min.

When administering heparin subcutaneously, the nurse will follow which procedure? a. Aspirating the syringe before injecting the medication b. Massaging the site after injection c. Applying heat to the injection site d. Using a - to -inch 25- to 28-gauge needle

ANS: D A - to -inch 25- to 28-gauge needle is the correct needle to use for a subcutaneous heparin injection. The other options would encourage hematoma formation at the injection site. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 429 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. A patient who has a history of coronary artery disease has been instructed to take one 81-mg aspirin tablet a day. The patient asks about the purpose of this aspirin. Which response by the nurse is correct? a. "Aspirin is given reduce anxiety." b. "It helps to reduce inflammation." c. "Aspirin is given to relieve pain." d. "It will help to prevent clot formation."

ANS: D Aspirin can reduce platelet aggregation; low doses of aspirin (81 to 325 mg once daily) are used for thromboprevention. Higher doses are required for pain relief, reduction of inflammation, and reduction of fever. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 697 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient is receiving thrombolytic therapy, and the nurse monitors the patient for adverse effects. What is the most common undesirable effect of thrombolytic therapy? a. Dysrhythmias b. Nausea and vomiting c. Anaphylactic reactions d. Internal and superficial bleeding

ANS: D Bleeding, both internal and superficial, as well as intracranial, is the most common undesirable effect of thrombolytic therapy. The other options list possible adverse effects of thrombolytic drugs, but they are not the most common effects. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 424 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is preparing to administer dopamine. Which is the correct technique for administering dopamine? a. Orally b. Intravenous (IV) push injection c. Intermittent IV infusions (IV piggyback) d. Continuous IV infusion with an infusion pump

ANS: D Dopamine is available only as an IV injectable drug and is given by continuous infusion, using an infusion pump. The other options are incorrect.

The nurse is reviewing new medication orders for a patient who has an epidural catheter for pain relief. One of the orders is for enoxaparin (Lovenox), a low-molecular-weight heparin (LMWH). What is the nurse's priority action? a. Give the LMWH as ordered. b. Double-check the LMWH order with another nurse, and then administer as ordered. c. Stop the epidural pain medication, and then administer the LMWH. d. Contact the prescriber because the LMWH cannot be given if the patient has an epidural catheter.

ANS: D LMWHs are contraindicated in patients with an indwelling epidural catheter; they can be given 2 hours after the epidural is removed. This is very important to remember, because giving an LMWH with an epidural has been associated with epidural hematoma. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 416 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A pregnant woman is experiencing hypertension. The nurse knows that which drug is commonly used for a pregnant patient who is experiencing hypertension? a. Mannitol (Osmitrol) b. Enalapril (Vasotec) c. Hydrochlorothiazide (HydroDIURIL) d. Methyldopa (Aldomet)

ANS: D Methyldopa is used in the treatment of hypertension during pregnancy. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 347 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

A 14-year-old patient has been treated for asthma for almost 4 months. Two weeks ago, she was given salmeterol as part of her medication regimen. However, her mother has called the clinic to report that it does not seem to work when her daughter is having an asthma attack. Which response by the nurse is appropriate? a. "It takes time for a therapeutic response to develop." b. "She is too young for this particular medication; it will be changed." c. "She needs to take up to two puffs every 4 hours to ensure adequate blood levels." d. "This medication is indicated for prevention of bronchospasms, not for relief of acute symptoms."

ANS: D Salmeterol is indicated for the prevention of bronchospasms, not treatment of acute symptoms. The dosage is usually two puffs twice daily, 12 hours apart, for maintenance effects in patients older than 12 years of age. The other options are incorrect.

5. A mother brings her toddler into the emergency department and tells the nurse that she thinks the toddler has eaten an entire bottle of chewable aspirin tablets. The nurse will assess for which most common signs of salicylate intoxication in children? a. Photosensitivity and nervousness b. Tinnitus and hearing loss c. Acute gastrointestinal bleeding d. Hyperventilation and drowsiness

ANS: D The most common manifestations of chronic salicylate intoxication in adults are tinnitus and hearing loss. Those in children are hyperventilation and CNS effects, such as dizziness, drowsiness, and behavioral changes. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 696 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

An older adult patient will be taking a vasodilator for hypertension. Which adverse effect is of most concern for the older adult patient taking this class of drug? a. Dry mouth b. Restlessness c. Constipation d. Hypotension

ANS: D The older adult patient is more sensitive to the blood pressure-lowering effects of vasodilators, and consequently experience more problems with hypotension, dizziness, and syncope. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 355 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be needed. Which answer by the nurse is the correct response? a. "This therapy will take about 3 months." b. "This therapy will take about a year." c. "This therapy will go on until your symptoms disappear." d. "Therapy for high blood pressure is usually lifelong."

ANS: D There is no cure for the disease, and treatment will be lifelong. The other answers are not appropriate. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 355 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient asks the nurse why he has to be on two medications. The nurse's response is based on which rationale? a. The oral and injection forms work synergistically. b. The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used alone. c. Oral anticoagulants are used to reach an adequate level of anticoagulation when heparin alone is unable to do so. d. Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels.

ANS: D This overlap therapy is required in patients who have been receiving heparin for anticoagulation and are to be switched to warfarin so that prevention of clotting is continuous. This overlapping is done purposefully to allow time for the blood levels of warfarin to rise, so that when the heparin is eventually discontinued, therapeutic anticoagulation levels of warfarin will have been achieved. Recommendations are to continue overlap therapy of the heparin and warfarin for at least 5 days; the heparin is stopped after day 5 when the international normalized ratio (INR) is above 2. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 417 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

When assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency, which would include what symptoms? (Select all that apply.) a. Dyspnea b. Constipation c. Tinnitus d. Muscle weakness e. Anorexia f. Lethargy

ANS: D, E, F Symptoms of hypokalemia include anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension. The other symptoms are not associated with hypokalemia.

Furosemide (Lasix) is prescribed for a patient who is about to be discharged, and the nurse provides instructions to the patient about the medication. Which statement by the nurse is correct? a. "Take this medication in the evening." b. "Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and dates." c. "If you experience weight gain, such as 5 pounds or more per week, be sure to tell your physician during your next routine visit." d. "Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes."

ANS: D. "Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes." Orthostatic hypotension is a possible problem with diuretic therapy. Foods high in potassium should be eaten more often, and the drug needs to be taken in the morning so that the diuretic effects do not interfere with sleep. A weight gain of 5 pounds or more per week must be reported immediately

The nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of these diuretics? a. Hydrochlorothiazide (HydroDIURIL) b. Furosemide (Lasix) c. Acetazolamide (Diamox) d. Spironolactone (Aldactone)

ANS: D. Spironolactone (Aldalactone) Spironolactone (Aldactone) is a potassium-sparing diuretic, and patients taking this drug must be monitored for signs of hyperkalemia. The other drugs do not cause hyperkalemia but instead cause hypokalemia

While admitting a patient for treatment of an acetaminophen (Tylenol) overdose, the nurse prepares to administer which medication to prevent toxicity? Naloxone (Narcan) Phytonadione (vitamin K) Acetylcysteine (Mucomyst) Methylprednisolone (Solu-Medrol)

Acetylcysteine (Mucomyst) Acetylcysteine is the antidote for acetaminophen overdose. It must be administered as a loading dose followed by subsequent doses every 4 hours for 17 additional doses and started as soon as possible after the acetaminophen ingestion (ideally within 12 hours)

An intravenous dose of midazolam (Versed) has been prescribed for a patient before a colonoscopy. What does the nurse teach the patient is the most common adverse effect of this medication?

Amnesia Versed is known to cause amnesia and anxiolysis (reduced anxiety) as well as sedation and is most commonly used preoperatively for certain procedures.

A patient receiving IV nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's best action? A. Assess the patient's lung sounds. B. Decrease the IV nitroglycerin by 10 mcg/min. C. Increase the IV nitroglycerin by 10 mcg/min. D. Recheck the patient's vital signs in 1 hour.

B

The nurse is teaching treatment of acute chest pain for a patient prescribed nitroglycerin (Nitrostat) sublingual tablets. Which instructions should the nurse include? A. Take five tablets every 3 minutes for chest pain. B. Sit or lie down before taking medication. C. Chew or swallow the tablet for the quickest effect. D. Keep the tablets locked in a safe place until you need them.

B

Which statement by the patient demonstrates a need for further education regarding nitroglycerin (Nitrostat) sublingual tablets? A. "I should keep my nitroglycerin in a cool, dry place." B. "I can take up to four tablets at 5-minute intervals for chest pain." C. "If I get a headache, I should keep taking my nitroglycerin and use Tylenol to relieve my headache." D. "I should change positions slowly to avoid getting dizzy from the drug's effect on my blood pressure."

B

For patients prescribed amiodarone (Cordarone), the nurse should monitor for which potential adverse effects of this drug? (Select all that apply.) a. Diarrhea b. Visual halos c. Hypothyroidism d. Photosensitivity e. Overgrowth of gum tissue f. Blue gray skin discoloration

B,C,D,F

The nurse recognizes that adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptors? a. Dopaminergic b. Beta1-adrenergic c. Beta2-adrenergic d. Alpha1-adrenergic

B2. Remember A1 - VasoConstrictor B1 - Heart B2 - Lungs

A patient prescribed digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg for the treatment of systolic heart failure states, "I am starting to see yellow halos around lights." Which action will the nurse take? a. Perform a visual acuity test on each eye. b. Document the finding and reassess in 1 hour. c. Assess for other symptoms of digoxin toxicity. d. Prepare to administer digoxin immune fab (Digifab).

C

A patient who is taking nitroglycerin (Nitrostat) sublingual tablets is complaining of flushing and headaches. What is the nurse's best response? A. "Put a cold wet washcloth or use an icepack on your forehead and lie down in a quiet place." B. "Stop taking the nitroglycerin because you are experiencing an allergic reaction to the medication." C. "These are the most common adverse effects of nitroglycerin. They should subside with continued use of nitroglycerin." D. "Immediately notify your health care provider because these symptoms are not related to the sublingual nitroglycerin."

C

Calcium channel blockers reduce myocardial oxygen demand by decreasing afterload. How would the nurse explain afterload to the patient? A. It is the contractility of the heart muscle. B. It is the total volume of blood in the heart. C. It is the force against which the heart must pump. D. It is the pressure within the four chambers of the heart.

C

It is MOST important for the nurse to instruct a patient prescribed nitroglycerin to avoid which substance? A. Antacids B. Grapefruit juice C. Erectile dysfunction drugs D. Potassium-sparing diuretics

C

The nurse is caring for a patient prescribed amiodarone (Cordarone). The nurse knows the MOST serious adverse effect of this medication can occur in which body system? a. Nervous b. Immune c. Respiratory d. Gastrointestinal

C

The nurse is preparing to administer digoxin (Lanoxin) 0.25mg intravenous push to a patient. Which is an expected patient outcome related to the administration of digoxin? a. Low serum potassium b. Reduction in urine output c. Decrease in the heart rate d. Increase in blood pressure

C

The nurse is providing discharge teaching for a patient with a new prescription for nitroglycerin (Nitrostat) sublingual tablets. Which statement by the patient indicates an understanding of the nurse's discharge instructions about this medication? A. "My nitroglycerin tablets are not affected by cold or heat." B. "I can take some aspirin if I get a headache related to nitroglycerin." C. "I will keep my nitroglycerin tablets in their original glass container." D. "I will need to refill my prescription when I feel burning under my tongue."

C

When caring for a patient with angina pectoris, the nurse would question a prescription for a noncardioselective beta blocker in a patient with which preexisting condition? A. Hypertension B. Atrial fibrillation C. Bronchial asthma D. Myocardial infarction

C

Which are therapeutic effects of digoxin (Lanoxin)? a. Positive inotropic, positive chronotropic, and negative dromotropic b. Positive inotropic, negative chronotropic, and positive dromotropic c. Positive inotropic, negative chronotropic, and negative dromotropic d. Negative inotropic, negative chronotropic, and negative dromotropic

C

The nurse is administering a stat dose of epinephrine. Epinephrine is appropriate for which situation?

Cardiac arrest

When assessing a patient for adverse effects related to morphine sulfate (MS Contin), which clinical findings is the nurse MOST likely to find? (Select all that apply.) Diarrhea Weight gain Constipation Inability to void Excessive bruising

Constipation inability to void Morphine sulfate causes a decrease in GI motility (delayed gastric emptying and slowed peristalsis). This leads to constipation, not diarrhea. Morphine can also cause urinary retention (inability to void)

A patient is receiving lidocaine (Xylocaine) by continuous intravenous (IV) infusion. The nurse understands this medication is prescribed for what condition? a. Atrial fibrillation b. Sinus bradycardia c. First-degree heart block d. Ventricular dysrhythmias

D

The nurse reviews an adult patient's laboratory values and notes a digoxin level of 11 ng/mL and a serum potassium level of 6.2 mEq/L. The nurse would notify the health care provider and anticipate which medication will be prescribed to administer? a. Sodium polystyrene sulfonate (Kayexalate) b. Atropine c. Epinephrine (Adrenalin) d. Digoxin immune Fab

D

The patient's serum digoxin level is 0.4 ng/mL. How does the nurse interpret this laboratory value result for digoxin? a. Normal therapeutic level b. A toxic serum blood level c. Above the therapeutic level d. Below the therapeutic level

D

Which instruction should be included in the discharge teaching for a patient with a transdermal nitroglycerin (Nitro-Dur) patch? A. "If you get chest pain, apply a second patch next to the first patch." B. "If you get a headache, remove the patch for 4 hours and then reapply." C. "Make sure to rub a lotion or cream on the skin before putting on a new patch." D. "Apply the patch to a hairless, nonirritated area of the chest, upper arm, back or shoulder."

D

A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of intravenous penicillin. Which drug will the nurse expect to use to treat this condition? a. Ephedra b. Epinephrine c. Phenylephrine d. Pseudoephedrine

Epinephrine. Epinephrine is the drug of choice for the treatment of anaphylaxis

A patient is admitted to the hospital with a diagnosis of benzodiazepine overdose. The nurse anticipates the health care provider will prescribe which antidote for benzodiazepine overdose?

Flumazenil (Romazicon) Flumazenil is the antidote for benzodiazepine overdose. The other options are only effective against opioid agonist effects.

In developing a plan of care for a patient receiving morphine sulfate (MS Contin), which nursing diagnosis has the highest priority? Acute pain related to metastatic tumor cancer Impaired gas exchange related to respiratory depression Constipation related to decreased GI motility Risk for injury related to CNS adverse effects

Impaired gas exchange related to respiratory depression Using Maslow's hierarchy of needs and the ABCs of prioritization, impaired gas exchange is a priority over pain, constipation, and a risk for injury. If a patient cannot oxygenate sufficiently, all of the other problems will not matter because the patient will not live to worry about them.

Which NSAID would the nurse anticipate administering parenterally for the treatment of acute postoperative pain? Ketorolac (Toradol) Diclofenac (Cataflam) Allopurinol (Zyloprim) Indomethacin (Indocin)

Ketorolac (Toradol) Ketorolac can be administered by injection (intramuscularly or intravenously) and is indicated for the short-term treatment of moderate to severe acute pain.

The health care provider prescribes dantrolene (Dantrium) to a patient immediately after surgery. The nurse is aware this medication is used to treat what condition?

Malignant hyperthermia Dantrolene is a direct acting skeletal muscle relaxant and is the drug of choice to treat malignant hyperthermia, a possible complication of generalized anesthesia.

The nurse is caring for a patient with opioid addiction. The nurse anticipates that the patient will be prescribed which medication? Naloxone (Narcan) Meperidine (Demerol) Morphine (MS Contin) Methadone (Dolophine)

Methadone (Dolophine) Methadone is a synthetic opioid analgesic with gentler withdrawal symptoms and is the drug of choice for detoxification treatment

A patient needs to switch analgesic drugs secondary to an adverse reaction to the current treatment regimen. The patient is concerned that the new prescription will not provide optimal pain control. The nurse's response is based on knowledge that doses of analgesics are determined using an equianalgesic table with which drug prototype? Meperidine Fentanyl Codeine Morphine

Morphine An equianalgesic table is a conversion chart for commonly used opioids. It identifies oral and parenteral dosages that provide comparable analgesia. The equianalgesic table identifies dosages of various narcotics that are equal to 10 mg of morphine. It is important to use when changing to a new opioid or different route. Morphine is the drug prototype for all opioid drugs

Which medication is used to treat a patient with severe adverse effects of a narcotic analgesic? Naloxone (Narcan) Acetylcysteine (Mucomyst) Methylprednisolone (Solu-Medrol) Flumazenil (Romazicon)

Naloxone (Narcan) Naloxone is the narcotic antagonist that will reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

ANS: A Having a "narrow therapeutic index" means that there is a small difference between safe and toxic drug levels. These drugs require monitoring of therapeutic plasma levels. The other options are incorrect.

Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic means that a.the safe and the toxic plasma levels of the drug are very close to each other. b.phenytoin has a low chance of being effective. c.there is no difference between safe and toxic plasma levels. d.a very small dosage can result in the desired therapeutic effect.

In monitoring a patient for adverse effects related to morphine sulfate (MS Contin), the nurse assesses for stimulation of which area in the central nervous system (CNS)? The cough reflex center Sympathetic baroreceptors The chemoreceptor trigger zone Autonomic control over circulation

The chemoreceptor trigger zone Morphine sulfate can irritate the gastrointestinal (GI) tract, causing stimulation of the chemoreceptor trigger zone in the brain, which in turn causes nausea and vomiting

ANS: A Scrupulous dental care is necessary to prevent gingival hypertrophy during therapy with phenytoin. Alcohol and other central nervous system depressants may cause severe sedation. Consistent dosing is important to maintain therapeutic drug levels. Therapy with AEDs usually must continue for life and must not be stopped once seizures stop.

The nurse has given medication instructions to a patient receiving phenytoin (Dilantin). Which statement by the patient indicates that the patient has an adequate understanding? a."I will need to take extra care of my teeth and gums while on this medication." b."I can go out for a beer while on this medication." c."I can skip doses if the side effects bother me." d."I will be able to stop taking this drug once the seizures stop."

ANS: B Intravenous phenytoin is given only with normal saline solution to prevent precipitation formation caused by incompatibilities. The IV push dose must be given slowly (not exceeding 50 mg/min in adults), and the patient must be monitored for bradycardia and decreased blood pressure.

The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action is correct when administering this drug? a.Give the dose as a fast intravenous (IV) bolus. b.Mix the drug with normal saline, and give it as a slow IV push. c.Mix the drug with dextrose (D5W), and give it as a slow IV push. d.Mix the drug with any available solution as long as the administration rate is correct.

ANS: B With carbamazepine, autoinduction occurs and leads to lower-than-expected drug concentrations. Therefore, the dosage may have to be adjusted with time. The other options are incorrect.

The nurse is monitoring a patient who has been taking carbamazepine (Tegretol) for 2 months. Which effects would indicate that autoinduction has started to occur? a.The drug levels for carbamazepine are higher than expected. b.The drug levels for carbamazepine are lower than expected. c.The patient is experiencing fewer seizures. d.The patient is experiencing toxic effects from the drug.

ANS: B Phenobarbital has the longest half-life of all standard AEDs, including those listed in the other options, so it allows for once-a-day dosing.

The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing? a.levetiracetam (Keppra) b.phenobarbital c.valproic acid (Depakote) d.gabapentin (Neurontin)

The nurse would monitor an older adult patient prescribed a benzodiazepine for treatment of insomnia for which potential adverse effect?

Unsteady gait Benzodiazepine doses for children and older adults should be small with gradual increases to avoid ataxia (unsteady gait) and excessive sedation. Thus, these patients should be closely monitored for these adverse effects.

The nurse is preparing to administer an intravenous injection of morphine to a patient. The nurse assesses a respiratory rate of 10 breaths/min. Which action should the nurse perform? Administer the next prescribed dose intramuscularly. Administer a smaller dose and document in the patient's record. Withhold the medication and notify the health care provider. Check the pulse oximeter reading and reevaluate respiratory rate in 1 hour.

Withhold the medication and notify the health care provider. Respiratory depression is an adverse effect of opioid analgesia. Therefore, because the patient's respiratory rate is below normal, the nurse should withhold the morphine and notify the health care provider

A 62-year-old man is to receive lidocaine as treatment for a symptomatic dysrhythmia. Upon assessment, the nurse notes that he has a history of alcoholism and has late-stage liver failure. The nurse will expect which adjustments to his drug therapy? A. The dosage will be reduced by 50%. B. A diuretic will be added to the lidocaine. C. The lidocaine will be changed to an oral dosage form. D. An increased dosage of lidocaine will be prescribed so as to obtain adequate blood levels.

a

A patient is in the emergency department with a new onset of rapid-rate atrial fibrillation, and the nurse is preparing a continuous infusion. Which drug is most appropriate for this dysrhythmia? A. Diltiazem (Cardizem) B. Atenolol (Tenormin) C. Lidocaine D. Adenosine (Adenocard)

a

Which statement by the patient reflects the need for additional patient education about the calcium channel blocker diltiazem (Cardizem)? a. "I can take this drug to stop an attack of angina." b. "I understand that food and antacids alter the absorption of this oral drug." c. "When the long-acting forms are taken, the drug cannot be crushed." d. "This drug may cause my blood pressure to drop, so I need to be careful when getting up."

a. "I can take this drug to stop an attack of angina."

The nurse is reviewing drug interactions with a male patient who has a prescription for isosorbide dinitrate (Isordil) as treatment for angina symptoms. Which substances listed below could potentially result in a drug interaction? (Select all that apply.) a. A glass of wine b. Thyroid replacement hormone c. tadalafil (Cialis), an erectile dysfunction drug d. metformin (Glucophage), an antidiabetic drug e. carvedilol (Coreg), a beta blocker

a. A glass of wine c. tadalafil (Cialis), an erectile dysfunction drug e. carvedilol (Coreg), a beta blocker

When titrating intravenous nitroglycerin, which assessment findings does the nurse monitor? (Select all that apply.) a. Blood pressure b. Heart rate c. Chest pain d. Respiratory rate

a. Blood pressure b. Heart rate c. Chest pain

Nitrates relieve angina pain by reducing preload. How would the nurse explain the term preload to a patient? a. It is the blood volume within the heart. b. It is the pressure within the superior vena cava. c. It is the pressure against which the heart must pump. d. It is the oxygen demand of the heart.

a. It is the blood volume within the heart

6. The nurse is administering an intravenous infusion of a phosphodiesterase inhibitor to a patient who has heart failure. The nurse will evaluate the patient for which therapeutic effects? (Select all that apply.) a. Positive inotropic effects b. Vasodilation c. Decreased heart rate d. Increased blood pressure e. Positive chronotropic effects

a. Positive inotropic effects b. Vasodilation e. Positive chronotropic effects

2. The nurse is monitoring for adverse effects in a patient who is receiving an amiodarone (Cordarone) infusion. Which are adverse effects for amiodarone? (Select all that apply.) A. Tachycardia B. Constipation C. Chest pain D. QT prolongation E. Headache F. Hypotension G. Blue-gray coloring of the skin on the face, arms, and neck

b d f g

6. When the nurse is teaching a patient about taking an ant dysrhythmic drug, which statements by the nurse are correct? (Select all that apply.) a. "Take the medication with an antacid if stomach upset occurs." b. "Do not chew sustained-release capsules." c. "If weight gain of 5 pounds within 1 week occurs, notify your physician at the next office visit." d. "If you experience severe adverse effects, stop the drug and notify your physician." e. "You may take the medication with food if stomach upset occurs."

b. "Do not chew sustained-release capsules." e. "You may take the medication with food if stomach upset occurs."

A 68-year-old man has been taking the nitate isosorbide dinitrate (Isordil) for 2 years for angina. He recently has been experiencing erectile dysfunction and wants a prescription for sildenafil (Viagra). Which response would the nurse most likely hear from the prescriber? a. "He will have to be swithced to isosorbide mononitrate if he wants to take sildenafil." b. "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exist." c. "I'll write a prescription, but if he uses it, he needs to stop taking the isosorbide for one dose." d. "These drugs are compatible with each other, and so I'll write a prescription."

b. "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exist."

3. The nurse is teaching a patient about self-administration of enoxaparin (Lovenox). Which statement will be included in this teaching session? a. "We will need to teach a family member how to give this drug in your arm." b. "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel." c. "This drug needs to be taken at the same time every day with a full glass of water." d. "Be sure to massage the injection site thoroughly after giving the drug."

b. "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel."

5. A patient has a new prescription for an ACE inhibitor. During a review of the patient's list of current medications, which would cause concern for a possible interaction with this new prescription? (Select all that apply.) a. A benzodiazepine taken as needed for allergies b. A potassium supplement taken daily c. An oral anticoagulant taken daily d. An opioid used for occasional severe pain e. An NSAID taken as needed for headaches

b. A potassium supplement taken daily e. An NSAID taken as needed for headaches

6. A patient is starting warfarin (Coumadin) therapy as part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy? (Select all that apply.) a. Teach proper subcutaneous administration. b. Administer the oral dose at the same time every day. c. Assess carefully for excessive bruising or unusual bleeding. d. Monitor laboratory results for a target INR of 2 to 3. e. Monitor laboratory results for a therapeutic aPTT value of 1.5 to 2.5 times the control value.

b. Administer the oral dose at the same time every day. c. Assess carefully for excessive bruising or unusual bleeding. d. Monitor laboratory results for a target INR of 2 to 3.

3. When assessing for adverse effects of cholinergic-blocking drug therapy, the nurse would expect to find that the patient complains of which drug effect? a. Diaphoresis b. Dry mouth c. Diarrhea d. Urinary frequency

b. Dry mouth

5. A patient has received a double dose of heparin during surgery and is bleeding through the incision site. While the surgeons are working to stop the bleeding at the incision site, the nurse will prepare to take what action at this time? a. Give IV vitamin K as an antidote. b. Give IV protamine sulfate as an antidote. c. Call the blood bank for an immediate platelet transfusion. d. Obtain an order for packed red blood cells.

b. Give IV protamine sulfate as an antidote.

8. The nurse is preparing to administer somatropin (Humatrope) and will monitor the patient for which adverse effects? (Select all that apply) a. Increased blood pressure b. Headache c. Flulike syndrome d. Nausea e. Hyperglycemia f. Fever

b. Headache c. Flulike syndrome e. Hyperglycemia

1. The nurse is administering antihypertensive drugs to older adult patients. The nurse knows that which adverse effect is of most concern for these patients? a. Dry mouth b. Hypotension c. Restlessness d. Constipation

b. Hypotension

8. A patient is taking an aminoglycoside antibiotic for pneumonia, and will also be taking the loop diuretic furosemide (Lasix) due to fluid overload. The nurse will monitor carefully for which potential effect from the interaction of these two drugs? a. Nephrotoxicity b. Ototoxicity c. Pulmonary fibrosis d. Hepatotoxicity

b. Ototoxicity

1. A patient with a rapid, irregular heart rhythm is being treated in the emergency department with adenosine. During administration of this drug, the nurse will be prepared to monitor the patient for which effect? a. Nausea and vomiting b. Transitory asystole c. Muscle tetany d. Hypertension

b. Transitory asystole

1. When teaching the patient about the signs and symptoms of cardiac glycoside toxicity, the nurse should alert the patient to watch for a. visual changes such as photophobia. b. flickering lights or halos around lights. c. dizziness when standing up. d. increased urine output.

b. flickering lights or halos around lights.

A patient is in the intensive care unit because of an acute myocardial infarction. He is experiencing severe ventricular dysrhythmias. The nurse will prepare to give which drug of choice for this dysrhythmia? A. Diltiazem (Cardizem) B. Verapamil (Calan) C. Amiodarone (Cordarone) D. Adenosine (Adenocard)

c

A patient who is taking sublingual nitroglycerin is complaining of flushing and headaches. What is the nurse's best response? a. "This is a normal response to your chest pain." b. "Stop taking the nitroglycerin because you are probably allergic to it." c. "These are the most common side effects of nitroglycerin. They should subside with continued use of nitroglycerin." d. "These symptoms are not related to your sublingual nitroglycerin. You should notify your doctor for diagnostic testing."

c. "These are the most common side effects of nitroglycerin. They should subside with continued use of nitroglycerin."

8. A patient is in the clinic for a follow-up visit. He has been taking amiodarone (Cordarone) for almost 1 year, and today he tells the nurse, "I am noticing some blue color around my face, neck, and upper arms. Is that normal?" Which is the nurse's correct response? a. "This is an expected side effect and should go away soon." b. "This is a harmless effect. As long as the medication is working, we'll just monitor your skin." c. "This can happen with amiodarone. I will let your doctor know about it right away." d. "How much sun exposure have you had recently?"

c. "This can happen with amiodarone. I will let your doctor know about it right away."

When caring for a patient with angina, the nurse would question an order for a noncardioselective beta blocker in a patient with what coexisting medical diagnosis? a. Hypertension b. Atrial fibrillation c. Bronchial asthma d. Myocardial infarction

c. Bronchial asthma

8. A patient with heart failure will be starting the beta blocker metoprolol (Lopressor). The nurse will monitor for which expected cardiovascular effects? (Select all that apply.) a. Increased heart rate b. Increased myocardial contractility c. Delayed AV node conduction d. Reduced heart rate e. Decreased myocardial automaticity

c. Delayed AV node conduction d. Reduced heart rate e. Decreased myocardial automaticity

A nurse with adequate knowledge about the administration of intravenous nitroglycerin will recognize that which statement is correct? a. The intravenous form is given by IV push injection b. Because the intravenous forms are short-lived, the dosing must be every 2 hours c. Intravenous nitroglycerin must be protected from exposure to light use of special tubing. d. Intravenous nitroglycerin can be given via gravity drop infusions.

c. Intravenous nitroglycerin must be protected from exposure to light use of special tubing.

2. A patient is receiving instructions regarding warfarin therapy and asks the nurse about what medications she can take for headaches. The nurse will tell her to avoid which type of medication? a. Opioids b. acetaminophen (Tylenol) c. NSAIDs d. There are no restrictions while taking warfarin.

c. NSAIDs

2. When assessing a patient who has been taking amiodarone for 6 months, the nurse monitors for which potential adverse effect? a. Hyperglycemia b. Dysphagia c. Photophobia d. Urticaria

c. Photophobia

4. A patient is receiving dabigatran (Pradaxa), 150 mg twice daily, as part of treatment for atrial fibrillation. Which condition, if present, would be a concern if the patient were to receive this dose? a. Asthma b. Elevated liver enzymes c. Renal impairment d. History of myocardial infarction

c. Renal impairment

A patient has a new prescription for transdermal nitroglycerin patches. The nurse teaches the patient that these patches are most appropriately used for which reason? a. To relieve exertional angina b. To prevent palpitations c. To prevent the occurrence of angina d. To stop an episode of angina

c. To prevent the occurrence of angina

2. During assessment of a patient who is receiving digoxin, the nurse monitors for findings that would indicate an increased possibility of toxicity, such as: a. apical pulse rate of 62 beats/min. b. digoxin level of 1.5 ng/mL. c. serum potassium level of 2.0 mEq/L. d. serum calcium level of 9.9 mEq/L.

c. serum potassium level of 2.0 mEq/L.

A patient has been started on therapy of a continuous infusion of lidocaine after receiving a loading dose of the drug. The nurse will monitor the patient for which adverse effect? A. Drowsiness B. Nystagmus C. Dry mouth D. Convulsions

d

Which statement by the patient demonstrates a need for further education regarding nitroglycerin? a. "If I get a headache, I should keep taking my 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 from the nitroglycerin's effect on my blood pressure." d. "I can take up to four tablets at 5-minute intervals for chest pain."

d. "I can take up to four tablets at 5-minute intervals for chest pain."

5. A patient with diabetes has a new prescription for a thiazide diuretic. Which statement will the nurse include when teaching the patient about the thiazide drug? a. "There is nothing for you to be concerned about when you are taking the thiazide diuretic." b. "Be sure to avoid foods that are high in potassium." c. "You need to take the thiazide at night to avoid interactions with the diabetes medicine." d. "Monitor your blood glucose level closely, because the thiazide diuretic may cause the levels to increase."

d. "Monitor your blood glucose level closely, because the thiazide diuretic may cause the levels to increase."

Patient teaching regarding sublingual nitroglycerin should include which statement? a. "You can take up to five doses every 3 minutes for chest pain." b. "Chew the tablet for the quickest effect." c. "Keep the tablets locked in a safe place until you need them." d. "Sit or lie down after you take a nitroglycerin tablet to prevent dizziness."

d. "Sit or lie down after you take a nitroglycerin tablet to prevent dizziness."

While assessing a patient with angina who is to start beta blocker therapy, the nurse is aware that the presence of which condition may be a problem if these drugs are used? a. Hypertension b. Essential tremors c. Exertional angina d. Asthma

d. Asthma

1. The nurse is monitoring a patient who is receiving antithrombolytic therapy in the emergency department because of a possible MI. Which adverse effect would be of the greatest concern at this time? a. Dizziness b. Blood pressure of 130/98 mm Hg c. Slight bloody oozing from the IV insertion site d. Irregular heart rhythm

d. Irregular heart rhythm

1. The nurse is reviewing the medications that have been ordered for a patient for whom a loop diuretic has just been prescribed. The loop diuretic may have a possible interaction with which of the following? a. Vitamin D b. warfarin c. Penicillins d. NSAIDs

d. NSAIDs

5. The nurse is administering lidocaine and considers which condition, if present in the patient, a caution for the use of this drug? a. Tachycardia b. Hypertension c. Ventricular dysrhythmias d. Renal dysfunction

d. Renal dysfunction

8. A patient with angina has been given a prescription for a calcium channel blocker. The nurse knows that this class of drugs is used to treat which type of angina? a. Effort b. Unstable c. Crescendo d. Vasospastic

d. Vasospastic

5. The nurse is assessing a patient who is receiving a milrinone infusion and checks the patient's cardiac rhythm on the heart monitor. What adverse cardiac effect is most likely to occur in a patient who is receiving intravenous milrinone? a. Tachycardia b. Bradycardia c. Atrial fibrillation d. Ventricular dysrhythmia

d. Ventricular dysrhythmia

A patient is prescribed an opioid analgesic for chronic pain. Which information should the nurse discuss with the patient to minimize the GI adverse effects? Avoid eating foods high in lactobacilli. Increase fluid intake and fiber in the diet. Take the medication on an empty stomach. Take diphenoxylate-atropine (Lomotil) with each dose.

increasing fluid and fiber in the diet. Opioid analgesics decrease GI intestinal motility (peristalsis), leading to constipation. Increasing fluid and fiber in the diet or use of stool softener or mild laxative can prevent constipation.