2: EAQ & Practice Q's

A patient with a serum cholesterol level of 275 mg/dL is prescribed simvastatin [Zocor]. What instructions should the nurse provide to the patient? Select all that apply. A. "Avoid taking the drug with grapefruit juice." B. "Notify your healthcare provider if your urine becomes discolored." C. "Notify your healthcare provider if muscle pain occurs within 1 day." D. "Notify your healthcare provider if muscle pain occurs after 3 days." E. "Take aspirin [Ecotrin] 30 minutes before taking simvastatin [Zocor]."

A. "Avoid taking the drug with grapefruit juice." B. "Notify your healthcare provider if your urine becomes discolored." D. "Notify your healthcare provider if muscle pain occurs after 3 days." ***Simvastatin [Zocor] is a HMG Co-A reductase inhibitor that causes rhabdomyolysis as an adverse effect. Grapefruit juice inhibits the enzyme CYP3A4 that is required for the metabolism of simvastatin [Zocor]. This will increase levels of the drug in the body, resulting in rhabdomyolysis. Rhabdomyolysis is associated with the breakdown of muscle proteins that are excreted in the urine, changing the color of the urine. Simvastatin [Zocor] starts acting after 3 days of administration and can cause muscle pains. These should be reported to the healthcare provider as it may progress to rhabdomyolysis if simvastatin [Zocor] administration is not stopped. Muscle pain after one day may be due to some other cause and not the drug. Taking a small dose of aspirin [Ecotrin] is suggested before taking niacin [Nicobid] to reduce the incidence of cutaneous flushing.

When teaching a patient about the drug metoprolol, what information will the nurse include in the teaching plan? A. "Do not stop the medication abruptly." B. "Stop the medication if you feel tired." C. "If you have gastric upset, take the medication with an antacid." D. "Use a hot tub daily to help vasodilation so that the medication will work more effectively."

A. "Do not stop the medication abruptly." ***The medication cannot be stopped abruptly as this can cause rebound hypertension. The medication should not be taken with an antacid as this may delay absorption. The patient is typically tired at the beginning of therapy and should not stop the medication. Using a hot tub or staying in hot water for long periods is not recommended.

The nurse is teaching a patient about the appropriate dose for acetaminophen. What should the nurse include? Select all that apply. A. "Do not take more than 4000 mg per day." B. "Undernourished patients should not take acetaminophen." C. "Drinking alcohol and taking acetaminophen will cause death." D. "There are no risks associated with acetaminophen consumption." E. "Watch over-the-counter medications for acetaminophen in the product to prevent an overdose."

A. "Do not take more than 4000 mg per day." E. "Watch over-the-counter medications for acetaminophen in the product to prevent an overdose." ***Over-the-counter medication such as cold medications can contain acetaminophen, which could increase the dosage. The maximum daily dosage is 4000 mg. While drinking alcohol increases the risk for liver damage, the recommendation is to decrease the dosage to 2000 mg for those individuals who drink more than three alcoholic beverages per day. Undernourished individuals should decrease the dosage to no more than 3000 mg per day.

The nurse is teaching the patient why hypertension must be treated. What information should be included in the teaching plan? Select all that apply. A. "Hypertension is a risk factor for stroke." B. "Hypertension is a risk factor for diabetes." C. "Hypertension is a risk factor for heart failure." D. "Hypertension is a risk factor for emphysema." E. "Hypertension is a risk factor for cardiovascular disease."

A. "Hypertension is a risk factor for stroke." C. "Hypertension is a risk factor for heart failure." E. "Hypertension is a risk factor for cardiovascular disease." ***Hypertension is a risk factor for cardiovascular disease, stroke, and heart failure. It is not a risk factor for emphysema or diabetes.

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 will rise slowly when changing from a sitting to a standing position." B. "I need to increase my intake of fluids and foods that are high in fiber." C. "I can take this medication in the morning to reduce nighttime urination." D. "My heart rate may slow down with this drug. I will call if my pulse is below 60."

A. "I will rise slowly when changing from a sitting to a standing position." ***Vasodilators may cause postural hypotension and reflex tachycardia. Patients should be taught to move slowly when changing positions to prevent dizziness.

A patient receiving atorvastatin [Lipitor] therapy to reduce high cholesterol levels calls the clinic and reports, "I am experiencing severe pain in both my legs." What is the nurse's best response? A. "Stop taking the drug and visit the clinic immediately." B. "Continue taking the drug; leg pain is a common side effect." C. "Stop taking the drug if the symptoms persist for another week." D. "Continue taking the drug along with niacin [Niaspan] and a pain killer."

A. "Stop taking the drug and visit the clinic immediately." ***The patient may have pain in both legs due to myopathy, an adverse effect of atorvastatin [Lipitor]. It progresses to a life-threatening condition called rhabdomyolysis, which involves the breakdown of muscle proteins leading to renal failure and death. The nurse should instruct the patient to stop taking the drug and immediately visit the clinic. The nurse will not instruct the patient to continue the drug as it is a life-threatening condition and requires immediate medical attention. The nurse will instruct the patient to watch for the symptoms; rhabdomyolysis further worsens the patient's condition, leading to renal failure. Administration of niacin [Niaspan], along with atorvastatin [Lipitor], further increases the breakdown of muscle proteins and causes rhabdomyolysis. The nurse should ask the patient to stop taking the medication until confirming the cause of the leg pain.

A patient is receiving an intravenous infusion of heparin to treat a pulmonary embolism. What laboratory value will the nurse monitor to evaluate treatment with this medication? A. Activated partial thromboplastin time (aPTT) B. Prothrombin time (PT) C. Platelet count D. Hemoglobin and hematocrit

A. Activated partial thromboplastin time (aPTT) ***The most commonly used laboratory value that monitors the effect of heparin is the activated partial thromboplastin time (aPTT).

A nurse provides discharge instructions for a patient who is taking acetaminophen [Tylenol] after surgery. The nurse should instruct the patient to avoid which product while taking acetaminophen? A. Alcoholic drinks B. Leafy green foods C. Bananas D. Dairy products

A. Alcoholic drinks ***Through several mechanisms, regular alcohol consumption while taking acetaminophen [Tylenol] increases the risk of liver injury when dosages are excessive. Therapeutic doses of acetaminophen [Tylenol] may be safe for patients who drink alcohol; however, the U.S. Food and Drug Administration (FDA) requires that acetaminophen [Tylenol] labels state an alcohol warning for patients who consume three or more drinks a day to consult their prescriber to determine whether acetaminophen [Tylenol] can be taken safely. It is not necessary to avoid leafy green foods, bananas, or dairy products when taking acetaminophen.

A patient has been prescribed celecoxib [Celebrex] to treat arthritis. The nurse will contact the healthcare provider if the patient shows symptoms of which condition? A. Anemia B. Cataracts C. Glaucoma D. Hyperthyroidism

A. Anemia ***Celecoxib [Celebrex] is a COX-2 inhibitor that is contraindicated in patients with anemia. Celecoxib can cause an increased risk of gastrointestinal adverse effects, including bleeding, which can worsen anemia. The other conditions are not contraindications for use of the COX-2 inhibitor.

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine? I do not need anything for pain; I need something for my cough." Which effect of codeine will the nurse discuss with the patient? A. Antitussive B. Expectorant C. Immunostimulant D. Immunosuppressant

A. Antitussive ***Codeine provides both analgesic and antitussive therapeutic effects. Hence, it is administered to patients with pneumonia. Codeine does not have immunostimulant, immunosuppressant, or expectorant actions.

The nurse administers candesartan [Atacand] to a patient. Which assessment finding should the nurse use as a clinical indicator of the therapeutic effectiveness of the medication? A. Blood pressure reduction B. Serum potassium retention C. Peripheral perfusion reduction D. Pulmonary congestion retention

A. Blood pressure reduction ***All angiotensin receptor blockers (ARBs), such as candesartan [Atacand], are approved for hypertension. Reduction in blood pressure equals those seen with angiotensin-converting enzyme (ACE) inhibitors. ARBs will decrease pulmonary congestion. Because ARBs promote vasodilation, the nurse expects the patient's extremities to be warm and pink from increased perfusion. In contrast to ACE inhibitors, ARBs do not cause clinically significant hyperkalemia.

A patient has a prescription for hypertension that blocks both alpha and beta receptors. Which drug will the nurse administer? A. Carvedilol B. Reserpine C. Methyldopa D. Propranolol

A. Carvedilol ***Carvedilol is unusual in that it can block alpha1 receptors as well as beta receptors. Reserpine is an adrenergic neuron blocker. Methyldopa is a centrally acting alpha2 agonist. Propranolol is a beta-adrenergic blocker.

The nurse is teaching a patient prescribed captopril [Capoten] for the treatment of hypertension. Which instructions should the nurse include? Select all that apply. A. Expect a persistent dry cough. B. Take the medication with food. C. Expect a sore throat and fever. D. Avoid potassium salt substitutes. E. Report difficulty in breathing immediately.

A. Expect a persistent dry cough. D. Avoid potassium salt substitutes. E. Report difficulty in breathing immediately. ***Salt substitutes contain potassium and may increase the risk of hyperkalemia with angiotensin-converting enzyme (ACE) inhibitors. A persistent, dry, nonproductive cough may develop. Angioedema includes edema of the tongue, glottis, and pharynx that may cause difficulty breathing, which requires immediate medical attention. Captopril [Capoten] must be taken at least one hour before meals. A sore throat and fever are not expected adverse effects. ACE inhibitors can lower white cell count and decrease the body's ability to fight an infection. Early signs of infection include fever and sore throat.

Which patient symptoms should alert the nurse to be concerned about digoxin [Lanoxin] toxicity? Select all that apply. A. Fatigue B. Vomiting C. Constipation D. Blurred vision E. Muscle weakness

A. Fatigue B. Vomiting D. Blurred vision ***Fatigue, vomiting, and blurred vision are common noncardiac symptoms that can provide advance warning of digoxin toxicity. Muscle weakness is an early sign of hypokalemia. Constipation is not a symptom of digoxin toxicity.

The nurse is preparing to administer an oral dose of digoxin [Lanoxin]. The apical pulse rate is 64. Which nursing action is most appropriate? A. Give the medication. B. Obtain a serum digoxin level. C. Notify the healthcare provider. D. Assess for signs of digoxin toxicity.

A. Give the medication. ***Determine heart rate and rhythm prior to administration. If heart rate is less than 60 beats/min or if a change in rhythm is detected, withhold digoxin and notify the healthcare provider.

The nurse is caring for a patient who has coronary heart disease (CHD). The nurse tells the patient, "Your cholesterol levels are abnormal; you are at a high risk of having a heart attack." What did the nurse discover regarding the lipoprotein levels in the patient's blood report? A. High levels of low-density lipoproteins (LDL) B. High levels of high-density lipoproteins (HDL) C. Low levels of very-low-density lipoproteins (VLDL) D. Low levels of intermediate-density lipoproteins (IDL)

A. High levels of low-density lipoproteins (LDL) ***High level of low-density lipoproteins (LDL) refers to high cholesterol levels in the blood, as LDL is almost entirely composed of cholesterol. This cholesterol is bad cholesterol, which promotes the formation of atherosclerotic plaque resulting in CHD. High-density lipoproteins (HDL) are good cholesterol, which has a cardioprotective action. Low levels of very-low-density lipoproteins (VLDL) are due to a low fat diet; however, it does not cause high cholesterol levels. Low levels of intermediate-density lipoproteins (IDL) do not increase the risk of CHD; they are useful for the production of bile acids.

A patient has been receiving long-term prednisone therapy for treatment of rheumatoid arthritis. The chart indicates that the patient has developed Cushing's syndrome. When performing a physical assessment, the nurse anticipates finding all but which manifestation of Cushing's syndrome? A. Hypoglycemia B. Muscle weakness C. Glucosuria D. "Buffalo hump"

A. Hypoglycemia ***Cushing's syndrome is manifested by hyperglycemia, glycosuria, fluid and electrolyte disturbances, osteoporosis, muscle weakness, cutaneous striations, and lowered resistance to infection. Redistribution of fat produces a "potbelly," "moon face," and "buffalo hump."

A patient takes daily low-dose aspirin for protection against myocardial infarction and stroke. Which medication will the nurse teach the patient to avoid taking with aspirin? A. Ibuprofen [Motrin] B. Zolpidem [Ambien] C. Loratadine [Claritin] D. Diphenhydramine [Benadryl]

A. Ibuprofen [Motrin] ***Ibuprofen [Motrin] can block the antiplatelet effects of aspirin; therefore, patients who take low-dose aspirin to protect against myocardial infarction and thrombosis should avoid taking ibuprofen [Motrin]. It is not necessary to avoid taking zolpidem [Ambien], loratadine [Claritin], or diphenhydramine [Benadryl] while taking aspirin.

When will the nurse administer hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins)? A. In the evening B. With breakfast C. With an antacid D. On an empty stomach

A. In the evening ***The liver produces the majority of cholesterol during the night. Thus, it is best to give HMG-CoA reductase inhibitors (statins), which work to decrease this synthesis, during the evening so that blood levels are highest coinciding with this production. Since this drug has a tendency to elevate the liver enzyme level, it may not be advisable to take the drug on an empty stomach. Since the liver produces the majority of cholesterol during the night, it is not ideal to give the drug during breakfast. An antacid is generally given to prevent stomach upset.

A patient drinks five to six alcoholic beverages per day and takes acetaminophen [Tylenol] for pain relief. The nurse should caution the patient to do what? A. Limit intake of acetaminophen to less than 2000 mg/day B. Avoid taking acetaminophen for pain C. Take acetaminophen with food to reduce the risk of liver damage D. Avoid taking any pain reliever other than acetaminophen

A. Limit intake of acetaminophen to less than 2000 mg/day ***Patients who drink three or more alcoholic beverages per day should limit their acetaminophen dosage to less than 2000 mg/day to prevent hepatic injury.

Which agent is most likely to cause serious respiratory depression as a potential adverse reaction? A. Morphine [Duramorph] B. Pentazocine [Talwin] C. Hydrocodone [Lortab] D. Nalmefene [Revex]

A. Morphine [Duramorph] ***Morphine is a strong opioid agonist and as such has the highest likelihood of causing respiratory depression. Pentazocine, a partial agonist, and hydrocodone, a moderate to strong agonist, may cause respiratory depression, but they do not do so as often or as seriously as morphine. Nalmefene, an opioid antagonist, would be used to reverse respiratory depression with opioids.

A patient with cardiovascular disease is taking rosuvastatin [Crestor]. Which finding would indicate a potential adverse effect of this drug? A. Muscle pain and tenderness B. Platelet count of 100 × 103/mm3 C. Blood pressure of 140/90 mm Hg D. Wheezing and shortness of breath

A. Muscle pain and tenderness ***The statins, such as rosuvastatin [Crestor], typically are well tolerated; however, in rare cases they can cause the serious adverse effect of myopathy and rhabdomyolysis. If unexplained muscle pain and tenderness develop, the prescriber should be notified. The other effects would not likely be caused by rosuvastatin [Crestor].

Which medication is used to reverse life-threatening complications caused by an opioid analgesic? A. Naloxone [Narcan] B. Flumazenil [Romazicon] C. Acetylcysteine [Mucomyst] D. Methylprednisolone [Solu-Medrol]

A. Naloxone [Narcan] ***Naloxone is the opioid antagonist that will reverse the effects, both adverse and therapeutic, of opioid analgesics. Acetylcysteine is the antidote for acetaminophen overdose. Methylprednisolone is a glucocorticoid that is used as an antiinflammatory. Flumazenil, a benzodiazepine antidote, can be used to acutely reverse the sedative effects of benzodiazepines.

A postoperative patient has an epidural infusion of morphine sulfate [Astramorph]. The patient's respiratory rate declines to 8 breaths per minute. Which medication would the nurse anticipate administering? A. Naloxone [Narcan] B. Acetylcysteine [Mucomyst] C. Methylprednisolone [Solu-Medrol] D. Protamine sulfate

A. Naloxone [Narcan] ***Naloxone is a narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

When assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find? Select all that apply. A. Nausea B. Diarrhea C. Urinary retention D. Decreased peristalsis E. Delayed gastric emptying

A. Nausea C. Urinary retention D. Decreased peristalsis E. Delayed gastric emptying ***Morphine sulfate causes a decrease in gastrointestinal motility (delayed gastric emptying and decreased peristalsis). This leads to constipation, not diarrhea. Morphine can also cause urinary retention and nausea.

The nurse is caring for a patient who takes an angiotensin-converting enzyme (ACE) inhibitor. If the patient develops a persistent nonproductive cough, what should the nurse do? A. Notify the provider of the new development. B. Tell the patient that the cough will subside in a few days. C. Assess the patient for other symptoms of upper respiratory infection. D. Instruct the patient to take antitussive medication until the symptoms subside.

A. Notify the provider of the new development. ***Angiotensin-converting enzyme (ACE) inhibitors prevent the breakdown of bradykinins, frequently causing a nonproductive cough. The patient should be switched to a different medication if the side effect cannot be tolerated. The cough will not subside in a few days. This is not a sign of infection but is a known side effect of ACE inhibitors. Medications will not make the cough subside.

The nurse reviews the medication treatment regimen for a patient with chronic hypertension. To promote optimal medication adherence, which frequency of drug dosing should the nurse advocate for this patient? A. Once a day B. Every 8 hours C. Four times a day D. Three times a day

A. Once a day ***A major cause of treatment failure in patients with chronic hypertension is lack of adherence to a prescribed regimen. To promote adherence, the dosing schedule should be as simple as possible, just once or twice daily dosing

Which assessment is most important for the nurse to obtain prior to administering digoxin to a patient with heart failure? A. Pulse B. Blood pressure C. Respiratory rate D. Weight in kilograms

A. Pulse ***It is crucial to measure the patient's pulse before administering digoxin because digoxin causes a decrease in heart rate. In fact, if the heart rate is below 60, digoxin cannot be given. Respiratory rate is not a priority before administration of digoxin because it does not cause respiratory depression. Blood pressure is not as important as pulse because digoxin increases the strength of cardiac contractions. Weight in kilograms is not necessary before administering digoxin.

The nurse is reviewing the chart for a patient who has been receiving an angiotensin-converting enzyme (ACE) inhibitor for 4 days. Which finding would cause the nurse to hold the ACE inhibitor until evaluated by the patient's primary care provider? A. Reports sore throat B. Has bronchial asthma C. Diabetic with nephropathy D. No history of renal artery stenosis

A. Reports sore throat ***Sore throat is a sign of neutropenia in a patient receiving an angiotensin-converting enzyme (ACE) inhibitor. Neutropenia, with its associated risk of infection, is a rare but serious complication. Calcium channel blockers (CCB), verapamil, and hydrochlorothiazide can be used safely in patients with bronchial asthma, a condition that precludes the use of beta2-adrenergic antagonists. ACE inhibitors can benefit patients with diabetic nephropathy, slowing the progression of renal disease. ACE inhibitors can cause severe renal insufficiency in patients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney; however, this patient has no history of this.

After surgery, a patient has morphine prescribed for postoperative pain. It is most important for the nurse to make which assessment? A. Respiratory rate B. Heart rate C. Pain level D. Constipation

A. Respiratory rate ***Monitoring the respiratory rate in all patients who are receiving morphine is a priority. If the respiratory rate is 12 or fewer breaths per minute, the nurse should withhold the medication and notify the prescriber.

The provider has to increase the fentanyl dose for a patient who has been taking fentanyl long term to achieve pain relief. What will the nurse communicate to the oncoming shift? A. The patient has developed tolerance. B. The patient has developed cross-tolerance. C. The patient will probably experience an overdose. D. The patient will probably experience an abstinence syndrome.

A. The patient has developed tolerance. ***Tolerance can be defined as a state in which a larger dose is required to produce the same response that could formerly be produced with a smaller dose. The provider did not switch drugs, just the dose so cross-tolerance cannot occur. Cross-tolerance exists among the opioid agonists (eg, oxycodone, methadone, fentanyl, codeine, and heroin). Accordingly, individuals tolerant to one of these agents will be tolerant to all the others. The patient has developed a tolerance so an overdose is unlikely. The provider did not stop the drug, so abstinence syndrome cannot occur. Abstinence syndrome will occur if drug use is abruptly stopped.

The nurse is caring for a patient prescribed digoxin [Lanoxin] for heart failure. Which finding would require immediate attention by the nurse? A. Vomiting and diarrhea B. Heart rate of 68 beats/min C. Digoxin level of 0.7 ng/mL D. Potassium level of 3.7 mEq/L

A. Vomiting and diarrhea ***Vomiting and diarrhea can lead to hypokalemia, which increases the risk of digoxin toxicity. These symptoms, along with nausea, fatigue, and visual disturbances, also may precede digoxin toxicity and warrant further attention. A heart rate of 68 beats/min, potassium level of 3.7 mEq/L, and digoxin level of 0.7 ng/mL (0.5 to 0.8 being the optimal range) are within the normal range.

The nurse assesses a patient's pulse before administering digoxin and notes a rate of 55 beats/min. What is the priority intervention by the nurse? A. Withhold the dose. B. Administer the drug. C. Check potassium level before giving. D. Reduce the dose to half the prescribed dose.

A. Withhold the dose. ***If heart rate is less than 60 beats/min or if a change in rhythm is detected, digoxin should be withheld and the prescriber notified. Checking potassium level before giving is not a priority as the drug should not be administered with this pulse rate. Administering the drug to a patient in such a condition would reduce the patient's heart rate, causing bradycardia. Administering the drug by reducing the dose to half would worsen the condition by causing bradycardia, and the nurse should not administer a drug to a patient without the prescription of a provider.

A patient is ordered the following inhalers, a bronchodilator (ipratropium) and a gluco-corticoid (Beclamethasone). The nurse will A. administer the bronchodilator 5 minutes before the glucocorticoid. B. mix the drugs and administer them together. C. administer the glucocorticoid 10 minutes before the bronchodilator. D. administer the glucocorticoid immediately after the bronchodilator.

A. administer the bronchodilator 5 minutes before the glucocorticoid. ***When a bronchodilator and a glucocorticoid inhaler are ordered together, the bronchodilator is administered first. The nurse should then wait for 5 minutes before administering the glucocorticoid. This allows time for bronchodilation to occur so the glucocorticoid is deposited deep into the respiratory system.

The healthcare provider prescribes lovastatin [Mevacor] for a patient discharged from the hospital post-myocardial infarction. Which instructions are most appropriate for the nurse to include in the patient's teaching plan? Select all that apply. A. "Take your medication in the morning, with a full glass of water, for best results." B. "Do not start any new medications without first talking to your healthcare provider." C. "Before starting this medication a blood test will be done to check your total cholesterol level and to measure liver enzymes." D. "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains." E. "Take one 325-mg aspirin 30 minutes before your dose to lessen the problem of flushing and itching that can occur with this drug."

B. "Do not start any new medications without first talking to your healthcare provider." C. "Before starting this medication a blood test will be done to check your total cholesterol level and to measure liver enzymes." D. "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains." ***Lovastatin [Mevacor], simvastatin [Zocor], and atorvastatin [Lipitor] levels may be elevated when these drugs are combined with other drugs that inhibit CYP3A4. Caution is warranted if these drugs are combined,. Before starting a statin, obtain a baseline lipid profile that includes total cholesterol and obtain baseline liver function tests (LFTs). The statins are taken once daily with food. It is recommended to take them with the evening meal because endogenous cholesterol synthesis increases during the night. The statins do not typically cause flushing and itching; that effect occurs with niacin [Niacor]. A diet low in total fat and saturated fat is recommended when antilipemic drugs are prescribed.

The nurse is assessing a patient who has been prescribed atorvastatin [Lipitor]. What instruction should the nurse provide for the patient to ensure proper administration of the medication? A. "Take the drug after breakfast." B. "Take the drug in the evening." C. "Take the drug with an antacid." D. "Take the drug on an empty stomach."

B. "Take the drug in the evening." ***Cholesterol production by the liver usually occurs at night; thus, statin drugs such as atorvastatin [Lipitor] work by decreasing the cholesterol synthesis and are generally administered in the evening to reduce cholesterol production. All statins should be taken once daily during the evening meal or at bedtime. The drug need not be administered after breakfast because cholesterol level production is lesser in the mornings. Antacids may not be administered along with the drug as it doesn't cause gastric irritation. The desired therapeutic effects may not be produced if the drug is administered on an empty stomach.

The nurse is caring for a patient who states, "I probably shouldn't take aspirin. Won't it make my stomach hurt?" What is the nurse's best response to the patient? A. "Try taking the aspirin with milk." B. "You can try enteric-coated aspirin." C. "You should take ibuprofen instead." D. "I'll get you a prescription pain reliever."

B. "You can try enteric-coated aspirin." ***Gastric distress is a common problem with uncoated aspirin. Enteric-coated tablets can be used. Changing to another medication is not the first intervention in this case, and ibuprofen can also cause gastric distress. Milk may not relieve gastric distress.

Which patient assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker (CCB)? A. Absence of dizziness B. Absence of chest pain C. Decreased swelling in the ankles D. Decreased eczematous eruptions

B. Absence of chest pain ***Calcium channel blockers (CCBs) are given for angina, so an absence of chest pain is a therapeutic effect as is decreased blood pressure and dysrhythmias. Dizziness may be a side effect of the medication. Decreased swelling is not a therapeutic effect of CCBs; in fact, some may cause peripheral edema. Eczematous eruptions are an adverse effect of CCBs in older patients.

After administering acetylcysteine [Mucomyst] to a patient who overdosed on acetaminophen [Tylenol], a nurse should recognize which outcome as an indicator of the therapeutic effects of acetylcysteine? A. Clear breath sounds B. Absence of jaundice C. Palpable pedal pulses D. Increased bowel sounds

B. Absence of jaundice ***Acetylcysteine [Mucomyst] substitutes for depleted glutathione in the reaction that removes the toxic metabolite of acetaminophen [Tylenol] (which accumulates with acetaminophen poisoning) and thereby minimizes liver damage. Severe hepatic injury may occur with acetaminophen [Tylenol] poisoning, which is manifested by jaundiced sclera and skin. The assessment of bowel sounds, breath sounds, and pedal pulses is not used to determine the therapeutic effects of acetylcysteine [Mucomyst] for the treatment of acetaminophen overdose.

The nurse is monitoring a patient with suspected digoxin toxicity. Which assessment findings would be consistent with digoxin toxicity? Select all that apply. A. Diarrhea B. Anorexia C. Vomiting D. Dry cough E. Visual disturbances

B. Anorexia C. Vomiting E. Visual disturbances ***Anorexia, vomiting, visual disturbances (blurred or yellow vision or appearance of halos around dark objects), fatigue, and nausea frequently foreshadow more serious toxicity (dysrhythmias) and should be reported immediately. Dry cough is a common side effect associated with angiotensin-converting enzyme inhibitors. Digoxin rarely causes diarrhea.

A patient is prescribed celecoxib [Celebrex] and warfarin [Coumadin]. The nurse should monitor the patient for what? A. Renal toxicity B. Bleeding C. Stroke symptoms D. Dysrhythmias

B. Bleeding ***Celecoxib may increase the anticoagulant effects of warfarin; the risk of bleeding is increased.

A patient is prescribed hydralazine [Apresoline] for the treatment of essential hypertension. Which expected adverse effects should the nurse discuss with the patient? Select all that apply. A. Nausea B. Fatigue C. Dizziness D. Headache E. Joint pain

B. Fatigue C. Dizziness D. Headache ***Some of the common adverse effects of hydralazine [Apresoline] include fatigue, dizziness, and headache. Nausea is associated with minoxidil [Loniten]. Joint pain is not a common adverse effect of hydralazine.

The nurse assesses a patient who takes ibuprofen [Advil] on a regular basis. Which finding does the nurse know is an adverse effect of ibuprofen [Advil] therapy? A. Hives B. Hematemesis C. Dysmenorrhea D. Jaundice

B. Hematemesis ***Ibuprofen is a member of the nonaspirin first-generation nonsteroidal anti-inflammatory drugs (NSAIDs). Through inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), ibuprofen poses a risk for gastric ulceration and bleeding, which may lead to hematemesis. Ibuprofen is used to reduce inflammation, fever, and pain and therefore is effective in reducing dysmenorrhea (painful menstrual cramping). It is not known to cause hives or jaundice, which are signs of impaired liver function.

Which information from the patient will most likely promote adherence to the medication regimen? A. I feel good even without my medication. B. I will need to take this for the rest of my life. C. I can take these drugs to cure my hypertension. D. I hope this will prevent complications in the future.

B. I will need to take this for the rest of my life. ***For treatment to be effective, medication must be taken lifelong. It is difficult to convince people who are feeling good to take drugs that may make them feel worse. Some people may decide that exposing themselves to the negative effects of therapy today is paying too high a price to avoid the adverse consequences of hypertension at some indefinite time in the future. Patients must understand that drugs do not cure hypertension—they only control symptoms.

The nurse is planning care for a patient receiving morphine sulfate [Duramorph] by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug? A. Administering a cough suppressant B. Inserting a Foley catheter C. Administering an antidiarrheal D. Monitoring liver function tests

B. Inserting a Foley catheter ***Morphine can cause urinary hesitancy and urinary retention. If bladder distention or inability to void is noted, the prescriber should be notified. Urinary catheterization may be required. Morphine acts as a cough suppressant and an antidiarrheal, so neither of those types of drugs would be needed to counteract an adverse effect of morphine. Liver toxicity is not a common adverse effect of morphine.

The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? A. Apolipoprotein B-100 B. Low-density lipoprotein (LDL) C. High-density lipoprotein (HDL) D. Very-low-density lipoprotein (VLDL)

B. Low-density lipoprotein (LDL) ***Cholesterol is the primary core lipid of low-density lipoproteins (LDLs), which are responsible for carrying cholesterol to tissues outside the liver. Of all the lipoproteins, LDLs are the most significant contributors to coronary atherosclerosis. When pharmacologic agents are used to lower cholesterol, the primary goal is to reduce elevated LDL levels.

The nurse has just administered the initial dose of enalapril [Vasotec] to a newly admitted patient with hypertension. What is the priority nursing intervention over the next several hours? A. Check the heart rate. B. Monitor blood pressure. C. Auscultate lung sounds. D. Draw a potassium level.

B. Monitor blood pressure. ***First-dose hypotension is a serious potential adverse effect of angiotensin-converting enzyme (ACE) inhibitors such as enalapril [Vasotec]. Monitoring the blood pressure is the priority nursing intervention. If hypotension develops, the nurse will place the patient in the supine position and possibly increase intravenous fluids. The other interventions may be appropriate for this patient; however, in the hours immediately after the first dose of an ACE inhibitor, monitoring of the blood pressure is most important.

The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform? A. Administer a smaller dose and record the findings. B. Notify the healthcare provider and delay drug administration. C. Hold the drug, record the assessment, and recheck in 1 hour. D. Administer the prescribed dose and notify the healthcare provider.

B. Notify the healthcare provider and delay drug administration. ***Respiratory depression is a side effect of opioid analgesia. Therefore, because the patient's respiratory rate is below normal, the nurse should withhold the morphine and notify the healthcare provider.

The nurse is caring for a newly admitted patient who will begin heparin therapy. While documenting the patient's history, the nurse notes that the patient is currently undergoing treatment with enoxaparin. What is the nurse's highest priority? A. Notify the provider that the patient is at risk for an allergic reaction. B. Notify the provider that the patient should not be started on heparin. C. Notify the provider that the dosage of heparin will need to be increased. D. Notify the provider that the dosage of heparin will need to be decreased.

B. Notify the provider that the patient should not be started on heparin. ***A potential medication error is to give heparin in combination with enoxaparin.

A patient has been receiving codeine for pain and has developed tolerance to the drug. The provider wants to change the patient's pain medication. Which prescription will the nurse question? A. Morphine B. Pentazocine C. Levorphanol D. Oxymorphone

B. Pentazocine ***Pentazocine would cause the nurse to question the prescription since it is an agonist-antagonist. When administered alone, the agonist-antagonist opioids produce analgesia. However, if given to a patient who is taking a pure opioid agonist (like codeine) long term (as indicated by the mention that the patient has developed drug tolerance), these drugs can antagonize analgesia caused by the pure agonist. Morphine, levorphanol, and oxymorphone are all opioid agonists and would not cause this problem.

A patient reports having taken morphine for the past 6 months. Which medication, if ordered by the physician, should the nurse question? A. Promethazine [Phenergan] B. Pentazocine [Talwin] C. Methylnaltrexone [Relistor] D. Dextromethorphan [Delsym]

B. Pentazocine [Talwin] ***Pentazocine is an agonist-antagonist opioid. If pentazocine is given to a patient who is physically dependent on a pure opioid agonist such as morphine, withdrawal or abstinence syndrome will occur. Before an agonist-antagonist is administered, the patient should be slowly withdrawn from the opioid agonist. Promethazine is an antiemetic that may be given with opioids to reduce nausea and vomiting, but it may also result in increased constipation and urinary retention. Methylnaltrexone is a selective mu opioid antagonist indicated for opioid-induced constipation; the drug does not block opioid receptors in the CNS. Methylnaltrexone does not decrease analgesia and cannot precipitate opioid withdrawal. Dextromethorphan may increase analgesia and reduce tolerance to morphine.

Which assessment finding indicates that the patient has overdosed on morphine sulfate? A. Blood in urine B. Pinpoint pupils C. Increased peristalsis D. Increased urinary output

B. Pinpoint pupils ***Morphine sulfate is an opioid drug used for pain management. After administration of morphine sulfate, the nurse should assess the patient's pupillary reaction to light. Pinpoint pupils, when accompanied by decreased responsiveness and respiratory depression, may indicate an overdose of morphine sulfate. Overdose of morphine sulfate does not cause blood in the urine. Increased peristalsis is not a sign of morphine sulfate overdose. Constipation due to decreased peristalsis is an adverse effect associated with morphine sulfate. Administration of opioid drugs causes urinary retention. Therefore, increased urinary output is not observed in the patient.

A patient who has rheumatoid arthritis is scheduled to start taking celecoxib [Celebrex]. A nurse should recognize which factor from the patient's history as a contraindication to taking this medication? A. Hypothyroidism B. Recent heart bypass surgery C. Positive tuberculin skin test result D. Allergy to penicillin

B. Recent heart bypass surgery ***Celecoxib [Celebrex] should be avoided in patients who have undergone recent heart bypass surgery. Because it does not inhibit COX-1, platelet aggregation is not suppressed. It does inhibit COX-2 in blood vessels, which results in increased vasoconstriction. Unimpeded platelet aggregation and increased vasoconstriction pose a higher risk of thrombotic events in patients with certain cardiovascular risk factors. Hypothyroidism, a penicillin allergy, and a positive tuberculin skin test result are not contraindications to taking celecoxib [Celebrex].

Which factor will the nurse consider while planning pharmacologic therapy for a patient with pain? A. Analgesics should be administered as needed to minimize adverse effects. B. Relief of chronic pain is best obtained by administering analgesics around the clock. C. Patients should request analgesics when the pain level reaches a 3 on a scale of 1 to 10. D. Narcotic analgesics should not be used for more than 24 hours because of the risk of addiction.

B. Relief of chronic pain is best obtained by administering analgesics around the clock. ***Studies have demonstrated that for chronic pain such as pain due to cancer, analgesics administered around-the-clock rather than on an as-needed basis provide the optimal pain relief. Narcotic analgesics have a potential for addiction, but pain management is more important. A rating of 3 on the pain scale indicates effective pain relief.

A patient has been taking morphine for postoperative pain. Before discharge, what patient teaching should be provided? Select all that apply. A. Increase rest periods B. Take a stool softener C. Decrease the medication dosage D. Eat more animal protein and dairy E. Increase fluid intake throughout the day

B. Take a stool softener E. Increase fluid intake throughout the day ***Constipation is one of the major side effects of morphine administration. It may be managed with increased intake of fluids, the use of stool softeners such as docusate sodium [Colace], or the use of stimulants such as bisacodyl [Dulcolax] or senna [Senokot]. Agents such as lactulose [Enulose], sorbitol (E420), and polyethylene glycol [Miralax] also have been proven effective. Less commonly used are bulk-forming laxatives such as psyllium [Metamucil], for which increased fluid intake is especially important to avoid fecal impactions or bowel obstructions. Adequate rest is required for a patient who has undergone surgery. It is, however, not an important part of patient teaching. The details of medication dosage are provided in the discharge summary. It is not necessary to decrease the dosage of medication. Animal protein and dairy products are not foods that should be recommended to a postoperative patient. Instead, the patient should increase the intake of foods that are high in fiber.

The nurse is working on a postoperative unit in which pain management is part of routine care. Which statement is the most helpful in guiding clinical practice in this setting? A. At least 30% of the U.S. population is prone to drug addiction and abuse. B. The development of opioid dependence is rare when opioids are used for acute pain. C. Morphine is a common drug of abuse in the general population. D. The use of PRN (as needed) dosing provides the most consistent pain relief without risk of addiction.

B. The development of opioid dependence is rare when opioids are used for acute pain. ***The development of dependence on or addiction to opioids as a result of clinical exposure is extremely rare. In fact, some estimate that only 25% of patients receive doses of opioids that are sufficient to relieve suffering. Only about 8% of the population is estimated to be prone to drug abuse. Morphine is a drug of abuse, but this fact is not helpful in guiding clinical practice. A patient-controlled analgesia (PCA) pump provides the most consistent pain relief, better than PRN and fixed-dosing schedules.

Which patient receiving losartan [Cozaar] should be monitored closely while receiving this therapy? A. The patient with constipation B. The patient with an elevated creatinine level C. The patient with a heart rate of 90 beats/min D. The patient with a potassium level of 3.4 mEq/L

B. The patient with an elevated creatinine level ***Losartan [Cozaar] has been shown to be beneficial in patients with hypertension and heart failure. Patients with renal or hepatic dysfunction should be assessed carefully due to the potential for toxicity and increased side effects. An elevated creatinine level is an indication of renal dysfunction. The other findings are not.

The nurse is caring for a patient with hypercholesterolemia who is taking 20 mg of simvastatin [Zocor] as prescribed. After a few days, the patient's urinalysis reports indicated the presence of myoglobin. What instruction would the nurse receive from the primary healthcare provider? A. "Give 10 mg of medication daily." B. "Give the medication before meals." C. "Discontinue administering the medication." D. "Give the medication with 250 mL of water."

C. "Discontinue administering the medication." ***The presence of myoglobin in the urine indicates that the patient has rhabdomyolysis, an adverse effect of statins such as simvastatin [Zocor]. Rhabdomyolysis is characterized by the breakdown of muscle proteins and can be fatal. The primary healthcare provider would instruct the nurse to discontinue the medication. Reducing the dose of the medication to 10 mg, giving the medication before meals, or administering the medication with high amounts of fluids does not prevent rhabdomyolysis.

The nurse should include which statement(s) when teaching a patient about the use of acetaminophen [Tylenol]? Select all that apply. A. "Use of this drug can prevent heart attack and stroke." B. "The most common side effect of treatment with this drug is kidney failure." C. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." D. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." E. "Acetaminophen is a useful drug for the treatment of inflammation such as rheumatoid arthritis."

C. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." D. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." ***Acetaminophen [Tylenol] is used to treat fever and pain. It is not an antiinflammatory drug. The most serious side effect of acetaminophen therapy is liver failure; therefore, the healthcare provider should be notified if indications of jaundice are seen, such as yellowing of the skin or sclera. Acetaminophen therapy has no antiplatelet activity; therefore, it is not used to prevent heart attack or stroke. Routine use of acetaminophen may blunt the immune response to vaccines; therefore, it should be avoided as routine treatment for vaccine-associated fever and pain.

The nurse will include which statements when teaching a patient about the use of acetaminophen [Tylenol]? (Select all that apply.) A. "Acetaminophen is a useful drug for the treatment of inflammation, such as a rheumatoid arthritis." B. "The most common side effect of treatment with the drug is kidney failure." C. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." D. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." E. "Use of this drug can prevent heart attack and stroke."

C. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." D. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." ***Acetaminophen [Tylenol] is used to treat fever and pain. It is not an anti-inflammatory drug. The most serious side effect of acetaminophen therapy is liver failure; therefore, the healthcare provider should be notified if indications of jaundice are seen, such as yellowing of the skin or sclera. Acetaminophen therapy has no antiplatelet activity; therefore, it is not used to prevent heart attack or stroke. Routine use of acetaminophen may blunt the immune response to vaccines; therefore, it should be avoided as routine treatment for vaccine-associated fever and pain.

The nurse is teaching a patient with cancer about a new prescription for a fentanyl [Sublimaze] patch, 25 mcg/hr, for chronic back pain. Which statement is the most appropriate to include in the teaching plan? A. "You will need to change this patch every day, regardless of your pain level." B. "This type of pain medication is not as likely to cause breathing problems." C. "With the first patch, it will take about 24 hours before you feel the full effects." D. "Use your heating pad for the back pain. It will also improve the patch's effectiveness."

C. "With the first patch, it will take about 24 hours before you feel the full effects." ***Full analgesic effects can take up to 24 hours to develop with fentanyl patches. Most patches are changed every 72 hours. Fentanyl has the same adverse effects as other opioids, including respiratory depression. Patients should avoid exposing the patch to external heat sources, because this may increase the risk of toxicity.

In which patient would a low-dose aspirin be contraindicated? A. A patient with thrombosis B. A patient with a heart problem C. A patient with a hemorrhagic stroke D. A patient with a deep vein thrombosis

C. A patient with a hemorrhagic stroke ***The patient contraindicated to take a low-dose aspirin is the patient with a hemorrhagic stroke. The patient with a thrombosis, deep vein thrombosis, and a heart problem would benefit from a low-dose aspirin.

The nurse is instructing a patient about potential adverse effects of a prescribed angiotensin-converting enzyme (ACE) inhibitor. The nurse should instruct the patient to immediately seek medical attention if which adverse effect occurs? A. Fatigue B. Diarrhea C. Angioedema D. Dry, nonproductive cough

C. Angioedema ***Angioedema is a strong vascular reaction involving inflammation of submucosal tissue (eg, laryngeal edema) and can result in anaphylaxis. Fatigue and a dry, nonproductive cough are adverse reactions but are not life-threatening. Diarrhea is not an adverse effect.

During administration of alteplase [Activase], the patient's IV site starts to ooze blood around the catheter. Which action by the nurse is most appropriate? A. Discontinue the infusion of alteplase. B. Assess the patient's vital signs. C. Apply direct pressure over the puncture site. D. Administer aminocaproic acid [Amicar].

C. Apply direct pressure over the puncture site. ***Alteplase may cause bleeding, and the management of bleeding depends on its severity. Oozing at sites of cutaneous puncture can be controlled with direct pressure or a pressure dressing. If severe bleeding occurs, alteplase should be discontinued. Excessive fibrinolysis can be reversed with IV aminocaproic acid [Amicar], a compound that prevents activation of plasminogen and directly inhibits plasmin.

Which assessment finding in a patient taking nonsteroidal anti-inflammatory drugs (NSAIDs) requires immediate intervention? A. Headache B. Palpitations C. Black, tarry stools D. Nonproductive cough

C. Black, tarry stools ***Black, tarry stools may indicate bleeding higher up in the gastrointestinal tract. This is a serious side effect that requires immediate intervention. Headaches, nonproductive coughs, and palpitations are not usually side effects of NSAID therapy.

Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]? A. Capillary refill B. Homans' sign C. Blood pressure D. Peripheral pulses

C. Blood pressure ***Hydralazine [Apresoline] is a vasodilator that causes arteriolar dilation, decreased resistance, and decreased blood pressure. Monitoring of the blood pressure and heart rate is the highest assessment priority.

When assessing a patient for adverse effects of morphine sulfate, which finding would a nurse expect? A. Diarrhea B. Insomnia C. Drowsiness D. Increased bowel sounds

C. Drowsiness ***Morphine sulfate depresses the central nervous system, resulting in drowsiness. It also causes a decrease in gastrointestinal motility leading to constipation. Morphine sulfate can cause constipation, not increased bowel sounds. This effect is helpful in treating diarrhea. Morphine sulfate does not cause insomnia. It is an opioid and causes drowsiness.

How often does the nurse tell the patient to change a fentanyl [Duragesic] transdermal patch? A. Once a week B. Every 24 hours C. Every 72 hours D. When pain recurs

C. Every 72 hours ***The fentanyl [Duragesic] transdermal delivery system is designed to slowly release analgesic over a 72-hour period. Fentanyl [Duragesic] patches are used for nonescalating pain and not for acute pain relief. A new patch needs to be applied every 72 hours.

The nurse assesses a patient who takes ibuprofen [Advil] on a regular basis. Which finding in the patient would prompt the nurse to contact the healthcare provider immediately? A. Jaundice B. Drowsiness C. Hematemesis D. Dysmenorrhea

C. Hematemesis ***Ibuprofen is a member of the nonaspirin, first-generation nonsteroidal anti-inflammatory drugs (NSAIDs). Through inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), ibuprofen poses a risk for gastric ulceration and bleeding, which may lead to hematemesis (vomiting of blood). Ibuprofen is used to reduce inflammation, fever, and pain and therefore is effective in reducing dysmenorrhea (painful menstrual cramping). It is not known to cause drowsiness or jaundice.

A nurse administers naloxone [Narcan] to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication? A. Drowsiness B. Tics and tremors C. Increased pain D. Nausea and vomiting

C. Increased pain ***Naloxone reverses the effects of narcotics. Although the patient's respiratory status will improve after administration of naloxone, the pain will be more acute.

A patient with systemic lupus erythematosus is prescribed prednisone. It is most important for the nurse to monitor the patient for what? A. Hypotension B. Elevated potassium levels C. Neck and back pain D. Hypoglycemia

C. Neck and back pain ***Neck and back pain from a vertebral compression fracture may occur because of the development of osteoporosis as a result of glucocorticoid therapy. Other possible adverse effects of prednisone include hypertension, hypokalemia, and hyperglycemia.

A patient has been prescribed pharmacologic doses of glucocorticoids. It is most important for the nurse to teach the patient to do what? A. Increase intake of dietary sodium. B. Take antibiotics to prevent infection. C. Never abruptly withdraw therapy. D. Have an eye examination every year.

C. Never abruptly withdraw therapy. ***Abrupt withdrawal of glucocorticoids may cause adrenal insufficiency or an adrenal crisis. Infection should be prevented, but the use of antibiotics without a known infection is inappropriate. Eye examinations are recommended every 6 months for patients on glucocorticoid therapy. Sodium restriction may be prescribed.

The nurse is caring for a patient who is scheduled to begin treatment with carvedilol [Coreg]. While updating the history, the patient tells the nurse that he experiences frequent attacks of asthma. What is the nurse's highest priority action? A. Expect a decreased effect from the medication. B. Expect an increased effect from the medication. C. Notify the healthcare provider of this information. D. Monitor the patient for a toxic reaction to the drug.

C. Notify the healthcare provider of this information. ***Carvedilol [Coreg] should be used with caution in patients with a history of asthma. The priority for the nurse is to notify the healthcare provider of this information.

Which patient does the nurse identify as most likely needing an increased dose of warfarin [Coumadin] to have the same anticoagulant effect? A. Patient taking acetaminophen [Tylenol] for back pain B. Patient taking cimetidine [Tagamet] to prevent gastric ulcers C. Patient taking oral contraceptives to prevent pregnancy D. Patient taking prednisone [Deltasone] for rheumatoid arthritis

C. Patient taking oral contraceptives to prevent pregnancy ***Oral contraceptives decrease the effects of warfarin; therefore, warfarin doses may need to be increased. Acetaminophen and cimetidine increase the effects of warfarin. Prednisone increases the risk of bleeding.

What is the antidote for heparin? A. Ferrous sulfate B. Atropine sulfate C. Protamine sulfate D. Magnesium sulfate

C. Protamine sulfate ***Protamine sulfate is an antidote to severe heparin overdose.

A nurse should recognize that a patient who takes an angiotensin-converting enzyme (ACE) inhibitor while also taking high-dose aspirin is at risk of developing what complication? A. Congestive heart failure B. Liver toxicity C. Renal failure D. Hemorrhage

C. Renal failure ***High-dose aspirin therapy should be avoided in patients taking ACE inhibitors. In susceptible patients, these medications can impair renal function when they are combined with aspirin. Liver toxicity, congestive heart failure, and hemorrhage are not effects of ACE inhibitor and aspirin interactions.

A patient with hypercholesterolemia is prescribed lovastatin [Mevacor]. After reviewing the patient's medical history, the nurse discovers that the medication is not safe to prescribe for the patient and reports this finding to the healthcare provider. What did the nurse find in the patient's medical history? A. The patient has leukemia. B. The patient has renal disease. C. The patient has hepatic disease. D. The patient has chronic pulmonary disease.

C. The patient has hepatic disease. ***Lovastatin [Mevacor] can cause an increase in liver enzymes and should not be prescribed to patients with preexisting liver disease. Statins induce cell death in malignant cells. Cell death occurs via apoptosis and lovastatin [Mevacor] concentrations are used in the treatment of leukemia. Statins slow down the progress of chronic kidney disease by reducing kidney inflammation or improving the function of kidney tissues. Statins reduce chronic obstructive pulmonary disease (COPD).Lovastatin [Mevacor] can be prescribed to the patient with leukemia, renal disease and COPD.

A patient is using a glucocorticoid inhaler. The patient asks the nurse why he has to rinse his mouth out after using the glucocorticoid inhaler. The nurse should inform the patient that rinsing the mouth is done to A. avoid mucous membrane breakdown. B. increase hydration of the oral mucosa. C. decrease risk of infection. D. slow the development of cavities.

C. decrease risk of infection. ***Side effects associated with orally inhaled glucocorticoids are generally local (throat irritation, hoarseness, dry mouth, coughing) rather than systemic. Oral, laryngeal, and pharyngeal fungal infections have occurred. Oropharyngeal infections may be prevented by using a spacer with the inhaler to reduce drug deposits in the oral cavity, rinsing the mouth and throat with water after each dose, and washing the apparatus daily with warm water.

Which comment by a patient indicates correct understanding about the use of enalapril? A. "If I feel tired, I should double the dose." B. "I cannot go out in the sun while on this therapy." C. "I should stop the drug if I have ringing in my ears." D. "If I develop a chronic cough, I need to notify my provider."

D. "If I develop a chronic cough, I need to notify my provider." ***A patient on therapy with an angiotensin-converting enzyme (ACE) inhibitor such as enalapril should report a nonproductive chronic cough, as this is a potential side effect. There is no treatment other than to change the medication therapy. The patient should not double the dose of an antihypertensive. Ringing in the ears in not a concern for ACE inhibitors and the patient need not avoid the sun.

Which prescription will the nurse administer to provide the most safe and effective care to patients with hypertension? A. An adrenergic neuron blocker to a 16-year-old with hypertension B. A beta blocker to an African American patient with hypertension C. A centrally acting alpha2 agonist to a 16-year-old with hypertension D. A calcium channel blocker (CCB) to an African American patient with hypertension

D. A calcium channel blocker (CCB) to an African American patient with hypertension ***CCBs and alpha and beta blockers are also effective in African American patients. In contrast, monotherapy with beta blockers or angiotensin-converting enzyme (ACE) inhibitors is less effective in blacks than in whites. Drugs recommended for treatment of hypertension in children 1 to 18 years old include ACE inhibitors, diuretics, beta blockers, and calcium channel blockers (not centrally acting alpha2 agonist or adrenergic neuron blockers).

A patient's serum digoxin level is noted to be 0.5 ng/mL. Which action by the nurse is appropriate? A. Notify the provider. B. Administer an antidote. C. Hold the ordered dose of digoxin. D. Administer the ordered dose of digoxin.

D. Administer the ordered dose of digoxin. ***Therapeutic serum digoxin levels are 0.5 to 0.8 ng/mL. The patient should receive the next dose to keep the level in therapeutic range. Because the dose is in the therapeutic range, it would not be appropriate to hold the dose, administer an antidote, or notify the provider.

The nurse is preparing to administer a daily dose of digoxin [Lanoxin]. What is the priority nursing intervention? A. Check blood pressure. B. Palpate the pedal pulses. C. Assess for Homans' sign. D. Analyze heart rate and rhythm.

D. Analyze heart rate and rhythm. ***Before giving digoxin [Lanoxin], the nurse should assess heart rate and rhythm. The dosage will be held and the prescriber notified if the heart rate is below 60 beats/min or if the cardiac rhythm has changed. Digoxin [Lanoxin] can cause bradycardia and electrical changes in the heart.

A patient is receiving nifedipine [Adalat CC]. Which adverse effect should the nurse monitor for in this patient? A. Pallor B. Diarrhea C. Backache D. Ankle edema

D. Ankle edema ***Peripheral edema is an adverse effect of nifedipine [Adalat CC]. Headache is an adverse effect, not backache. Diarrhea is not an adverse effect of nifedipine [Adalat CC]. Flushing occurs, not pallor.

The nurse is performing an assessment on a patient. What is essential before opioid administration? A. Ask the patient about pain status and what is preferred for pain. B. Ask the patient about pain status, anxiety level, depressive state, fears, and if there is any anger. C. Ask the patient about pain status, what type of pain medicine is taken at home, and if a pill or an injection is preferred. D. Ask the patient about pain status, location, type of pain, how the pain changes with time, what makes it better, or worse, and how much it impairs the ability to function.

D. Ask the patient about pain status, location, type of pain, how the pain changes with time, what makes it better, or worse, and how much it impairs the ability to function. ***Assessment before opioid administration should include: (1) asking the patient about pain status, (2) where the pain is located, (3) what type of pain is present, (4) how the pain changes with time, (5) what makes it better or worse, and (6) how much it impairs his or her ability to function. It is not as important to ask the patient about what type of medication he or she prefers, what he or she takes at home, the anxiety level, depressive state, fears, or anger.

In monitoring a patient for adverse effects related to morphine sulfate, which is a priority assessment? A. Assess circulation B. Assess cough reflex C. Assess for nausea and vomiting D. Assess respiratory rate and depth

D. Assess respiratory rate and depth ***Morphine sulfate can cause life-threatening respiratory depression. Although nausea can be a side effect of the drug, it will not be life threatening.

A patient with a history of stroke and myocardial infarction (MI) is on a daily aspirin regimen. Which of the following would alert the nurse to contact the primary healthcare provider? A. Temperature 97.9° F B. Heart rate 99 beats/min C. Blood glucose level 78 mg/dL D. Blood pressure 160/94 mm Hg

D. Blood pressure 160/94 mm Hg ***While the temperature is slightly low, it is an insignificant risk. Although the heart rate is slightly high, it does not put the patient at risk. The blood glucose level is within normal limits. An elevated blood pressure over 150/90 mm Hg puts the patient at a greater risk for hemorrhagic stroke. Given the patient's history, the primary care provider should be notified.

The nurse is administering an antihypertensive medication. What assessment finding requires immediate action? A. Calcium level of 8 mEq/dL B. Potassium level of 5 mEq/dL C. Apical pulse of 100 beats/min D. Blood pressure of 80/60 mm Hg

D. Blood pressure of 80/60 mm Hg ***Blood pressure that goes below 100 mm Hg should immediately be reported to the healthcare provider, and the medication should be held. The other assessment findings are within normal limits and do not require immediate action.

A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug? A. Jugular vein distention B. Potassium level of 3.5 mEq/L C. + 2 edema of the lower extremities D. Crackles in the lungs are no longer heard

D. Crackles in the lungs are no longer heard ***Because angiotensin-converting enzyme (ACE) inhibitors promote venous dilation, they provide the therapeutic effect of reducing pulmonary congestion and peripheral edema. Absence of previously heard crackles would be an indicator of effectiveness. Edema and jugular vein distention are manifestations of heart failure. A potassium level of 3.5 mEq/L is a normal value.

The nurse reviews a patient's laboratory values and observes a digoxin level of 2.5 ng/mL and a potassium level of 5.9 mEq/L. Upon physical assessment, the patient begins to experience changes in heart rate and rhythm (dysrhythmias). Which drug should the nurse be prepared to administer? A. Digoxin B. Quinidine C. Potassium supplements D. Digoxin immune Fab antibody fragments

D. Digoxin immune Fab antibody fragments ***When digoxin overdose is especially severe (normal range is 0.5-0.8 ng/mL), digoxin levels can be lowered using digoxin immune Fab antibody fragments. Potassium supplements are helpful when hypokalemia is present, not hyperkalemia. Giving digoxin would make the situation worse. Although the patient has dysrhythmias, quinidine should not be used as it causes plasma levels of digoxin to rise. Rather, phenytoin and lidocaine are most effective.

A postoperative patient who received an intravenous infusion of morphine has a respiratory rate of 8 breaths per minute and is lethargic. Which as-needed medication should the nurse administer to the patient? A. Methadone [Dolophine] B. Nalbuphine [Nubain] C. Tramadol [Ultram] D. Naloxone [Narcan]

D. Naloxone [Narcan] ***After surgery, naloxone may be used to reverse the excessive respiratory and central nervous system depression that can be caused by opioids.

Which assessment finding indicates that the nonsteroidal anti-inflammatory drug has been effective? A. PTT is 100 seconds. B. Patient's bleeding time is prolonged. C. Patient has increased circulation to his legs. D. Pain has decreased from a 6 to a 1 on a scale of 10.

D. Pain has decreased from a 6 to a 1 on a scale of 10. ***Prostaglandins are produced in response to activation of the arachidonic acid pathway. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen work by blocking cyclooxygenase, the enzyme responsible for conversion of arachidonic acid into prostaglandins. Decreasing the synthesis of prostaglandins results in decreased pain and inflammation. The length of the PTT, the bleeding time, and the increased extremity circulation are not therapeutic effects of the medication.

A patient develops hypotension after administration of verapamil. Which intervention is appropriate? A. Administer atropine. B. Perform gastric lavage. C. Assist with cardioversion. D. Place in modified Trendelenburg's position.

D. Place in modified Trendelenburg's position. ***Placing the patient in modified Trendelenburg's position (legs elevated) and administering intravenous (IV) fluids may help with treatment of hypotension. Atropine is administered for bradycardia and atrioventricular (AV) block, not hypotension. Overdoses can be removed from the gastrointestinal (GI) tract with gastric lavage followed by activated charcoal; however, hypotension can occur in the absence of overdose. Hypotension is not treated with cardioversion.

Which assessment is most important for the nurse to monitor in a patient receiving an opioid analgesic? A. Heart rate B. Mental status C. Blood pressure D. Respiratory rate

D. Respiratory rate ***The most serious side effect of narcotic analgesics is respiratory depression. This is the priority for the nurse to monitor. The other assessments should also be made; however, a decrease in respiratory rate is the highest priority for the nurse to address.

The nurse is caring for patients receiving vasodilators. Which instruction should the nurse give the patients to combat a common adverse effect? A. Wear a hat when outdoors. B. Avoid taking with grapefruit juice. C. Drink the oral solution through a straw. D. Rise slowly from a sitting to standing position.

D. Rise slowly from a sitting to standing position. ***Vasodilators place patients at increased risk of falls. Patients should also be taught that they can minimize postural (orthostatic) hypotension by avoiding abrupt transitions from a supine or seated position to an upright position. Grapefruit does not affect the metabolism of vasodilators. Wearing hats and using a straw are not necessary with vasodilators.

A patient is prescribed digoxin to treat heart failure. Which biochemical parameter should be assessed by the nurse to ensure safe drug administration? A. Liver enzyme concentration B. Blood glucose concentration C. Serum calcium concentration D. Serum potassium concentration

D. Serum potassium concentration ***Hypokalemia, usually diuretic induced, is the most frequent underlying cause of dysrhythmias. The nurse should monitor serum potassium concentrations. Because potassium competes with digoxin, when potassium levels are low, binding of digoxin to Na+, K+-ATPase (sodium, potassium-ATPase) increases. This increase can produce excessive inhibition of Na+, K+ -ATPase with resultant toxicity. Digoxin does not have any effect on liver enzymes, blood glucose, or serum calcium. Therefore, assessment of these parameters is not necessary before administering digoxin.

For which type of pain is a fentanyl [Duragesic] transdermal patch best suited? A. Pain after abdominal surgery B. Acute treatment of a migraine headache C. Lower back pain related to lumbar strain D. Severe pain resulting from cancer metastasis

D. Severe pain resulting from cancer metastasis ***Transdermal fentanyl [Duragesic] is indicated only for persistent severe pain in patients who already tolerate opioids because it can cause fatal respiratory depression in patients who are opioid naive. For this reason, the patch is not indicated for acute pain such as postoperative pain, intermittent pain, or pain that responds to a less powerful analgesic.

Which behavior by a patient indicates more teaching is needed about taking diltiazem [Cardizem]? A. Takes with tea B. Takes with lemonade C. Takes with apple juice D. Takes with grapefruit juice

D. Takes with grapefruit juice ***If the patient consumes grapefruit juice, it can raise the levels of diltiazem [Cardizem] and verapamil [Calan]. The other drinks (tea, apple juice, lemonade) can be used by the patient when taking diltiazem [Calan] as they have no significant interaction.

A patient takes oxycodone [OxyContin] 40 mg PO twice daily for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects? A. The patient should take an antacid with each dose. B. The patient should eat foods high in lactobacilli. C. The patient should take the medication on an empty stomach. D. The patient should increase fluid and fiber in the diet.

D. The patient should increase fluid and fiber in the diet. ***Narcotic analgesics reduce intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can help manage this adverse effect. If increased fluid and fiber is not sufficiently effective, use of a laxative may be considered.

Nonaspirin NSAIDs differ from aspirin in all but which way? A. They cause reversible inhibition of COX, so their effects decline as soon as their blood levels decline. B. They can suppress platelet aggregation, but they are not used to prevent MI and stroke. C. They increase the risk of MI and stroke and therefore should be used in the lowest effective dosage for the shortest possible time. D. They are safe to use in children with chickenpox or influenza.

D. They are safe to use in children with chickenpox or influenza. ***As with aspirin, these drugs should not be given to children with chickenpox or influenza, owing to the possibility of precipitating Reye's syndrome. All other statements are true.

The nurse is administering several medications at 8 AM. Which medication will decrease blood pressure by blocking angiotensin II receptor sites? A. Enalapril B. Furosemide C. Eplerenone [Inspra] D. Valsartan [Exforge]

D. Valsartan [Exforge] ***Valsartan [Exforge] is an angiotensin II receptor blocker (ARB) that is indicated for management of hypertension. Furosemide is a loop diuretic. Eplerenone [Inspra] is an aldosterone antagonist. Enalapril is an angiotensin-converting enzyme (ACE) inhibitor.