Cardio MEDS Path/Pharm 2

67. Atorvastatin has been prescribed for a client. The nurse tells the client that which blood test will be done periodically while the client is taking this medication? 1. Neutrophil count 2. Liver function studies 3. White blood cell (WBC) count 4. Complete blood cell (CBC) count

Correct answer: 2 Rationale: Atorvastatin is a reductase inhibitor (HMG-CoA reductase inhibitor) that is used to treat hypercholesterolemia and hypertriglyceridemia. Because the medication is metabolized in the liver, baseline and periodic liver function tests, as well as cholesterol and triglyceride level determinations, should be done periodically. The tests identified in the remaining options are unrelated to the administration of HMG-CoA reductase inhibitors.

107. A man has developed atrial fibrillation and has been placed on warfarin. The nurse is doing discharge dietary teaching with the client and determines that the client needs additional education if he states that he would choose which food while taking this medication? 1. Cherries 2. Potatoes 3. Broccoli 4. Spaghetti

Correct answer: 3 Rationale: Anticoagulant medications work by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K are often omitted from the diet. Vitamin K is found in large amounts in green leafy vegetables, such as broccoli, cabbage, turnip greens, and lettuce. The other options listed are foods that are lower in vitamin K.

13. A client being treated for heart failure is administered intravenous bumetanide. Which outcome indicates that the medication has achieved the expected effect? 1. Cough becomes productive of frothy pink sputum. 2. Urine output increases from 10 mL/hour to greater than 50 mL hourly. 3. The serum potassium level changes from 3.8 to 3.1 mEq/L (3.8 to 3.1 mmol/L). 4. B-type natriuretic peptide (BNP) factor increases from 200 to 262 pg/mL (200 to 262 ng/L).

Correct answer: 2 Rationale: Bumetanide is a diuretic and expected outcomes include increased urine output, decreased crackles, and decreased weight.

14. Intravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit? 1. Vitamin K 2. Protamine sulfate 3. Potassium chloride 4. Aminocaproic acid

Correct answer: 2 Rationale: The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin sodium. Potassium chloride is administered for a potassium deficit. Aminocaproic acid is the antidote for thrombolytic therapy.

100. The nurse should educate the client receiving pravastatin to immediately report which finding? 1. Fatigue 2. Diarrhea 3. Sore throat 4. Muscle pain

Correct answer: 4 Rationale: Pravastatin is used to treat hyperlipidemia. Muscle pain could indicate rhabdomyolysis, a serious complication of this medication. It must be reported immediately. The remaining options are not associated concerns with the medication.

4. A client who is receiving digoxin daily has a serum potassium level of 3 mEq/L (3 mmol/L) and is complaining of anorexia. The health care provider prescribes a serum digoxin level to be done. The nurse checks the results and should expect to note which level that is outside of the therapeutic range? 1. 0.3 ng/mL 2. 0.5 ng/mL 3. 0.8 ng/mL 4. 1.0 ng/mL

Correct answer: 4 Rationale: The optimal therapeutic range for digoxin is 0.5 to 0.8 ng/mL. If the client is experiencing symptoms such as anorexia and is experiencing hypokalemia as evidenced by a low potassium level, digoxin toxicity is a concern. Therefore, option 4 is correct because it is outside of the therapeutic level and an elevated level.

88. A client with nausea and bradycardia is admitted to a medical unit. The family hands the nurse a small white envelope labeled "heart pill." The envelope is sent to the pharmacy and it is found to be digoxin. A family member states, "That health care provider doesn't know how to take care of my family." Which statement would convey a therapeutic response by the nurse? 1. "Don't worry about this. I'll take care of everything." 2. "You are concerned your loved one receives the best care." 3. "You're right! I've never seen them put pills in an envelope." 4. "I think you're wrong. That health care provider has been in practice for more than 30 years."

Correct answer: 2 Rationale: Option 2 is a therapeutic, nonjudgmental response. The statement reflects the family's concern but remains nonjudgmental. Option 1 dismisses the family's concerns and disempowers the family. Option 3 creates doubt about the health care provider's practice without actually knowing the circumstances. Option 4 is argumentative and nontherapeutic

87. A home health nurse instructs a client about the use of a nitrate patch. The nurse should make which statement to the client to prevent client tolerance to nitrates? 1. "Do not remove the patches." 2. "Have a 12-hour 'no-nitrate' time." 3. "Ensure a 24-hour 'no-nitrate' time." 4. "Keep nitrates on 24 hours, then off 24 hours."

Correct answer: 2 Rationale: To help prevent tolerance, clients need a 12-hour "no-nitrate" time, sometimes referred to as a pharmacological vacation from the medication. The remaining options are incorrect.

56. Acetylsalicylic acid (ASA), or aspirin, has been prescribed for a client with angina, and the client asks the nurse how the medication will help. The nurse responds that this medication has been prescribed for which purpose? 1. To reduce pain 2. To reduce inflammation 3. To inhibit platelet aggregation 4. To maintain a normal body temperature

Correct answer: 3 Rationale: Fenofibrate is a fibric acid derivative that is used to treat hyperlipidemia. Contraindications to the use of fibrates include known medication allergy, severe liver or kidney disease, cirrhosis, and gallbladder disease. Rationale: ASA is a nonsteroidal agent that is prescribed for its antiinflammatory, antipyretic, and anticoagulant properties. All of the options identify actions of this medication; however, for the client with angina, this medication is prescribed to inhibit platelet aggregation.

62. A client admitted to the hospital is taking atenolol. The nurse monitors the client for which sign or symptom of an adverse effect of the medication? 1. Nausea 2. Diaphoresis 3. Hypotension 4. Tachycardia

Correct answer: 3 Rationale: Atenolol is a beta-adrenergic blocker that is used as an antihypertensive, antianginal, and antidysrhythmic. It blocks beta-adrenergic receptors in cardiac tissue and produces the therapeutic effects of slowing the heart rate, decreasing cardiac output, decreasing blood pressure, and decreasing myocardial oxygen demand. Adverse effects include profound bradycardia or hypotension. The remaining options are not adverse effects of this medication. Nausea and diaphoresis are side effects of the medication.

70. Atorvastatin has been prescribed for a client, and the nurse provides instructions to the client about the medication. Which statement by the client indicates the need for further teaching? 1. "This medication will lower my cholesterol level." 2. "I will need to have blood tests drawn while I am taking this medication." 3. "I won't need to adhere to a low-fat diet as long as I take this medication faithfully." 4. "I need to talk to the health care provider before taking any over-the-counter medications."

Correct answer: 3 Rationale: Atorvastatin is a reductase inhibitor (HMG-CoA reductase inhibitor) that is used to treat hypercholesterolemia and hypertriglyceridemia. The client is instructed to follow a recommended diet as an important component of therapy. Liver function tests and cholesterol and triglyceride level determinations will be performed periodically while the client is taking the medication. The client needs to be instructed to consult with the health care provider before taking any over-the-counter medications.

19. The clinic nurse is providing instructions to a client with hypertension who will be taking captopril. Which statement by the client indicates a need for further instruction? 1. "I need to change positions slowly." 2. "I need to avoid taking hot baths or showers." 3. "I need to drink at least 4 quarts (4 liters) of water daily." 4. "I need to sit down and rest if dizziness or lightheadedness occurs."

Correct answer: 3 Rationale: Captopril is an antihypertensive medication (angiotensin-converting enzyme [ACE] inhibitor). Orthostatic hypotension can occur in clients taking this medication. Adequate fluid is important, but 4 quarts (4 liters) of water daily could actually aggravate the hypertension. Clients are advised to avoid standing in one position for long periods, to change positions slowly, and to avoid extreme warmth such as with baths, showers, or heat from the sun in warm weather. The client should be instructed to monitor for signs of orthostatic hypotension, such as dizziness, lightheadedness, weakness, and syncope.

41. Lisinopril has been prescribed for a client. What should the nurse instruct the client about this medication? 1. Take the medication with food only. 2. Discontinue the medication if nausea occurs. 3. Rise slowly from a reclining to a sitting position. 4. Expect to note a full therapeutic effect immediately.

Correct answer: 3 Rationale: Lisinopril is an angiotensin-converting enzyme inhibitor used in the treatment of hypertension. The client should be instructed to rise slowly from a reclining to a sitting position and to dangle the legs from the bed for a few moments before standing to reduce the hypotensive effect. It is not necessary to take the medication with food. If nausea occurs, the client should drink a noncola carbonated beverage and eat salted crackers or dry toast. A full therapeutic effect may be achieved in 1 to 2 weeks.

18. A client is scheduled for a dose of ramipril. The nurse should check which measurement before administering the medication? 1. Weight 2. Apical pulse 3. Blood pressure 4. Potassium level

Correct answer: 3 Rationale: Ramipril is an angiotensin-converting enzyme (ACE) inhibitor, and a serious adverse effect of this medication is profound hypotension. The client's blood pressure should be checked before administration of this medication. The medication does not cause weight gain or loss, bradycardia, or depletion of potassium.

95. In reviewing the medication records of a group of clients, the nurse determines that which client would be at greatest risk for developing hyperkalemia? 1. Client receiving bumetanide 2. Client receiving furosemide 3. Client receiving spironolactone 4. Client receiving hydrochlorothiazide

Correct answer: 3 Rationale: Spironolactone is a potassium-retaining diuretic and competes with aldosterone at receptor sites in the distal tubule, resulting in excretion of sodium, chloride, and water and retention of potassium and phosphate. Use of the medications furosemide, bumetanide, and hydrochlorothiazide could result in hypokalemia.

9. The nurse is planning to administer hydrochlorothiazide to a client. The nurse should monitor for which adverse effects related to the administration of this medication? 1. Hypouricemia, hyperkalemia 2. Increased risk of osteoporosis 3. Hypokalemia, hyperglycemia, sulfa allergy 4. Hyperkalemia, hypoglycemia, penicillin allergy

Correct answer: 3 Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

8. A client is diagnosed with an ST segment elevation myocardial infarction (STEMI) and is receiving a tissue plasminogen activator, alteplase. Which action is a priority nursing intervention? 1. Monitor for kidney failure. 2. Monitor psychosocial status. 3. Monitor for signs of bleeding. 4. Have heparin sodium available.

Correct answer: 3 Rationale: Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin may be administered after thrombolytic therapy, but the question is not asking about follow-up medications.

75. The nurse is administering a dose of intravenous hydralazine to a client. The nurse should ensure that which item is in place before injecting the medication? 1. Central line 2. Foley catheter 3. Pulse oximeter 4. Blood pressure cuff

Correct answer: 4 Rationale: Hydralazine is an antihypertensive medication used in the management of moderate to severe hypertension. The blood pressure and pulse should be monitored frequently after administration, so a blood pressure cuff is one item to have in place. The items in the remaining options are not necessary.

111. A client is receiving scheduled doses of lovastatin. The nurse determines that the medication is having the intended effect if which is noted? 1. Weight loss 2. Increased pulse rate 3. Lowered blood pressure 4. Decreased cholesterol level

Correct answer: 4 Rationale: Lovastatin is an HMG-CoA reductase inhibitor used to lower blood cholesterol levels. It does not induce weight loss, does not stimulate heart rate, and is not an antihypertensive.

102. A client is admitted to the emergency department with a diagnosis of myocardial infarction (MI). The health care provider (HCP) prescribes the administration of alteplase. The registered nurse (RN) preceptor is orienting a new RN in the use of this medication. Which statement by the new RN indicates that teaching has been effective? 1. "Administer the medication within 4 to 6 hours after onset of chest pain." 2. "Administer the medication concurrently with the administration of heparin." 3. "Administer the medication with the administration solution set protected from light." 4. "Administer the medication after the results of all laboratory tests have been received."

Correct answer: 1 Rationale: Alteplase is a fibrinolytic medication. In a client with an acute coronary artery thrombosis that evolves into a transmural MI, fibrinolytic therapy is most effective when started within 4 to 6 hours after onset of symptoms. The solution does not need to be protected from light. Heparin may be administered after the administration of alteplase but not concurrently, and it is not appropriate to wait for all laboratory tests to administer the medication.

16. The nurse is reviewing the record of a client who arrives at the health care clinic. The nurse notes that irbesartan has been prescribed for the client. The nurse should suspect that the client has which condition? 1. Hypertension 2. Hypothyroidism 3. Diabetes mellitus 4. Renal transplant rejection

Correct answer: 1 Rationale: Irbesartan is an angiotensin II type 1 receptor antagonist. It is used to treat hypertension. This medication is not used to treat hypothyroidism, diabetes mellitus, or renal transplant rejection.

23. A client is being discharged on warfarin sodium, and the nurse provides instructions to the client regarding the medication. Which statement, if made by the client, indicates to the nurse that the client understands the teaching provided? 1. "I'll stop my medication if I see bruising." 2. "Stiff joints are common while taking warfarin." 3. "This medication will prevent me from having a stroke." 4. "If I notice blood-tinged urine, I will call the health care provider."

Correct answer: 4 Rationale: Warfarin is an anticoagulant that is used for long-term prophylaxis of thrombosis. Clients must receive detailed instructions on the signs of bleeding. Hematuria is a sign of bleeding, which the client should report. Bruising is a common side effect associated with anticoagulant therapy and is almost unavoidable. The client, however, should not stop the medication if bruising occurs. Stiff joints are unrelated to the use of warfarin, and prevention of a stroke cannot be guaranteed, although risk for thrombotic stroke may be reduced.

6. The nurse is monitoring a client who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this medication? 1. The development of complaints of insomnia 2. The development of audible expiratory wheezes 3. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after 2 doses of the medication 4. A baseline resting heart rate of 88 beats/minute followed by a resting heart rate of 72 beats/minute after 2 doses of the medication

Correct answer: 2 Rationale: Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. Beta blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored

93. A client has developed paroxysmal nocturnal dyspnea. Which medication should the nurse anticipate will be prescribed by the health care provider? 1. Bumetanide 2. Amiodarone 3. Propranolol 4. Streptokin

Correct answer: 1 Rationale: Bumetanide is a diuretic. The paroxysmal nocturnal dyspnea may be caused by increased venous return when the client is lying in bed, and the client needs diuresis. Amiodarone is an antidysrhythmic, Propranolol is a beta blocker, and streptokinase is a thrombolytic.

50. A client taking an angiotensin-converting enzyme (ACE) inhibitor to treat hypertension calls the clinic nurse and reports that he has a dry, nonproductive cough that is very bothersome. The nurse should respond by making which statement? 1. "The medication may need to be changed." 2. "The cough must be the start of a respiratory infection." 3. "The medication needs to be taken with large amounts of water to prevent the cough." 4. "This sometimes happens, and you will need to take a cough medication with each dose of medication."

Correct answer: 1 Rationale: An ACE inhibitor is used to treat hypertension or heart failure. An side effect of ACE inhibitors is a characteristic dry, nonproductive cough. This can be quite bothersome to a client, and the medication may need to be changed. The cough is reversible with discontinuation of therapy. The remaining options are incorrect.

58. Atenolol has been prescribed for a client, and the client asks the nurse about the action of the medication. How should the nurse respond regarding the action of this medication? 1. Slows the heart rate 2. Increases cardiac output 3. Increases myocardial oxygen demand 4. Maintains the blood pressure at a level within the 140/90 mm Hg range

Correct answer: 1 Rationale: Atenolol is a beta-adrenergic blocker that is used as an antihypertensive, antianginal, and antidysrhythmic. It blocks beta-adrenergic receptors in cardiac tissue and produces the therapeutic effects of slowing the heart rate, decreasing cardiac output, decreasing myocardial oxygen demand, and decreasing blood pressure.

57. The nurse is providing education to a client who is being started on atenolol. Which statement by the client indicates that teaching has been effective? 1. "I am taking this medication for hypertension." 2. "It is to help manage my rheumatoid arthritis." 3. "This medication will help my ulcerative colitis." 4. "This medication will reverse my second-degree heart block."

Correct answer: 1 Rationale: Atenolol is a beta-adrenergic blocker that is used as an antihypertensive, antianginal, and antidysrhythmic. It is used to treat conditions such as hypertension and angina pectoris. It is not used to treat the conditions noted in the other options. In addition, its use is contraindicated in the client with heart block greater than first degree.

26. The home care nurse has given instructions to a client who is beginning therapy with digoxin. The nurse determines a need for further teaching if the client makes which statement? 1. "If I miss a dose, I should just take 2 the next day." 2. "I shouldn't change brands without asking the health care provider first." 3. "I should call the health care provider if my daily pulse rate is under 60 or over 100." 4. "The pills should be kept in their original container so they don't get mixed up with my other medicines."

Correct answer: 1 Rationale: Client teaching should include taking the dose exactly as prescribed each day. If the client misses a dose and more than 12 hours goes by, that dose should be omitted, and only the next scheduled dose should be taken; the client should not double-dose. The health care provider (HCP) should be consulted before changing brands because the bioavailability of another preparation of the medication may be different. A daily pulse check is necessary, and the client should know the parameters for which the HCP should be called. Clients are advised not to mix digoxin in pill boxes with other medications.

28. A hypertensive client has been prescribed clonidine hydrochloride, a transdermal patch. The nurse provides written instructions to the client on the use of the patch. Which statement by the client indicates the need for further instruction? 1. "I need to change the patch every 24 hours." 2. "I need to apply the patch to a hairless body site." 3. "I need to apply the patch to skin areas that are not broken." 4. "I need to apply the patch to the skin on the upper arm or body."

Correct answer: 1 Rationale: Clonidine is an antihypertensive medication that is applied every 7 days to a hairless intact skin area of the upper arm or torso. The remaining options are correct statements.

85. Levothyroxine is prescribed for a client diagnosed with hypothyroidism. The nurse reviews the client's record and notes that the client is presently taking warfarin. The nurse contacts the health care provider (HCP), anticipating that the HCP will prescribe which medication? 1. A decreased dosage of warfarin 2. An increased dosage of warfarin 3. A decreased dosage of levothyroxine 4. An increased dosage of levothyroxine

Correct answer: 1 Rationale: Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin are enhanced. Therefore, if thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced.

49. The health care provider (HCP) writes a prescription for lisinopril for a hospitalized client. The nurse caring for the client determines that the medication has been prescribed to treat which disorder? 1. Hypertension 2. Immune disorder 3. Venous insufficiency 4. Gastroesophageal reflux disorder

Correct answer: 1 Rationale: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that is used to treat hypertension or heart failure. It is not used to treat immune disorder, venous insufficiency, or gastroesophageal reflux disorder.

118. The nurse is caring for a child with heart failure (HF). The nurse provides instructions to the mother regarding the procedure for administration of the prescribed digoxin. Which statement by the mother indicates a need for further teaching? 1. "I will make sure to mix the medication with food." 2. "I need to take my child's pulse before administering the medication." 3. "If more than 1 dose is missed, I need to call the health care provider." 4. "If my child vomits after being given the medication, I should not repeat the dose."

Correct answer: 1 Rationale: Medication should not be mixed with food because this method of administration would not ensure that the child received the prescribed dose. The parents need to be instructed that if the child vomits after the digoxin is administered, they are not to repeat the dose. In addition, the parents should be instructed that if a dose is missed and is not identified until 4 or more hours later, the dose should not be administered. If more than 1 dose is missed, the health care provider needs to be notified.

32. The nurse has been given a medication prescription to administer intravenous (IV) hydralazine. The nurse obtains which priority piece of equipment needed for use during administration of this medication. 1. Pulse oximetry 2. Cardiac monitor 3. Noninvasive blood pressure cuff 4. Nonrebreather oxygen face mask

Correct answer: 3 Rationale: Hydralazine is an antihypertensive medication used for moderate to severe hypertension. Because the blood pressure and pulse should be monitored frequently after administration, a noninvasive blood pressure cuff should be obtained. The other options are not priority items specific to the use of this medication.

115. A hospitalized client with a history of angina pectoris complains of substernal chest pain. The nurse checks the client's blood pressure and administers nitroglycerin, gr 1/4 sublingually. Five minutes later, the client is still experiencing chest pain. If the blood pressure remains stable, the nurse should take which action next? 1. Administer another nitroglycerin tablet. 2. Administer 10 L of oxygen via nasal cannula. 3. Call for a 12-lead electrocardiogram (ECG) to be performed. 4. Wait an additional 5 minutes, and then give a second nitroglycerin tablet.

Correct answer: 1 Rationale: Nitroglycerin tablets are usually prescribed 1 every 5 minutes PRN (as needed) for chest pain for the hospitalized client, up to a total dose of 3 tablets. The nurse should administer the second tablet. The client with known angina pectoris should have low-flow oxygen at a rate of 1 to 3 L/min via nasal cannula. A 12-lead ECG would be done if prescribed by standing protocol or by individual health care provider prescription.

39. A client who is taking chlorothiazide comes to the clinic for periodic evaluation. In monitoring the client's laboratory test results for medication side effects, what is the clinic nurse most likely to note if a side or adverse effect is present? 1. Hypokalemia 2. Hypocalcemia 3. Hypernatremia 4. Hyperphosphatemia

Correct answer: 1 Rationale: The client taking a potassium-losing diuretic such as chlorothiazide should be monitored for decreased potassium levels. Other possible fluid and electrolyte imbalances that occur with use of this medication include hypercalcemia, hyponatremia, hypophosphatemia, and hypomagnesemia.

31. A health care provider (HCP) prescribes warfarin sodium for a client. The home care nurse visits the client at home and teaches the client about the medication and its administration. Which statement by the client indicates a need for further teaching? 1. "The urine normally changes to orange." 2. "This medicine will still be working 4 to 5 days after it is discontinued." 3. "This medication will require frequent blood work to monitor its effects." 4. "I cannot take aspirin or any aspirin-containing medications while I'm on this medication."

Correct answer: 1 Rationale: Warfarin is an anticoagulant. Bleeding is a concern while the client is taking this medication. Orange urine indicates blood in the urine from an overdose of the medication. Bleeding also may be identified by urine that turns red, smoky, or black. The half-life of the medication is 2 days, the peak effect is between 1 and 3 days, and the anticoagulation effect extends 4 to 5 days after discontinuation. The prothrombin time or international normalized ratio is determined to monitor the clotting mechanism. Aspirin is an antiplatelet agent and would increase the risk of bleeding.

1. Potassium chloride intravenously is prescribed for a client with hypokalemia. Which actions should the nurse take to plan for preparation and administration of the potassium? Select all that apply. 1. Obtain an intravenous (IV) infusion pump. 2. Monitor urine output during administration. 3. Prepare the medication for bolus administration. 4. Monitor the IV site for signs of infiltration or phlebitis. 5. Ensure that the medication is diluted in the appropriate volume of fluid. 6. Ensure that the bag is labeled so that it reads the volume of potassium in the solution.

Correct answer: 1, 2, 4, 5, 6 Rationale: Potassium chloride administered intravenously must always be diluted in IV fluid and infused via an infusion pump. Potassium chloride is never given by bolus (IV push). Giving potassium chloride by IV push can result in cardiac arrest. The nurse should ensure that the potassium is diluted in the appropriate amount of diluent or fluid. The IV bag containing the potassium chloride should always be labeled with the volume of potassium it contains. The IV site is monitored closely because potassium chloride is irritating to the veins and there is risk of phlebitis. In addition, the nurse should monitor for infiltration. The nurse monitors urinary output during administration and contacts the health care provider if the urinary output is less than 30 mL/hour. The following are all the option DIVs for the individual question types They should be the same size as the option-area DIV above.

47. A client with pulmonary edema has a prescription to receive morphine sulfate intravenously. The nurse should determine that the client is experiencing an intended effect of the medication as indicated by which assessment finding? 1. Increased pulse rate 2. Relief of apprehension 3. Decreased urine output 4. Increased blood pressure

Correct answer: 2 Morphine sulfate reduces anxiety and dyspnea in the client with pulmonary edema. It also promotes peripheral vasodilation and causes blood to pool in the periphery. It decreases pulmonary capillary pressure, which reduces fluid migration into the alveoli. The client receiving morphine sulfate is monitored for signs and symptoms of respiratory depression and extreme drops in blood pressure, especially when it is administered intravenously. The findings in the remaining options are unrelated to the action of morphine sulfate.

2. A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hour. The nurse determines that the client is receiving the therapeutic effect based on which results? 1. Prothrombin time of 12.5 seconds 2. Activated partial thromboplastin time of 60 seconds 3. Activated partial thromboplastin time of 28 seconds 4. Activated partial thromboplastin time longer than 120 seconds

Correct answer: 2 Rationale: Common laboratory ranges for activated partial thromboplastin time (aPTT) are 30 to 40 seconds. Because the aPTT should be 1.5 to 2.5 times the normal value, the client's aPTT would be considered therapeutic if it was 60 seconds. Prothrombin time assesses response to warfarin therapy.

96. The nurse is caring for a client who is receiving dopamine. Which potential problem is a priority concern for this client? 1. Fluid overload 2. Peripheral vasoconstriction 3. Inability to perform self-care 4. Inability to discriminate hot or cold sensations

Correct answer: 2 Rationale: The client who is receiving dopamine therapy should be assessed for peripheral vasoconstriction related to the action of the medication. The remaining options are not related directly to this medication therapy

84. A client in the postpartum care unit who is recovering from disseminated intravascular coagulopathy is to be discharged on low dosages of an anticoagulant medication. In developing home care instructions for this client, the nurse should include which priority safety instruction regarding this medication? 1. Avoid brushing the teeth. 2. Avoid taking acetylsalicylic acid (aspirin). 3. Avoid walking long distances and climbing stairs. 4. Avoid all activities because bruising injuries can occur.

Correct answer: 2 Rationale: Aspirin can interact with the anticoagulant medication to increase clotting time beyond therapeutic ranges. Avoiding aspirin is a priority. The client does not need to avoid brushing the teeth; however, the client should be instructed to use a soft toothbrush. Walking and climbing stairs are acceptable activities. Not all activities need to be avoided.

106. Atenolol hydrochloride is prescribed for a hospitalized client. The nurse should perform which action as a priority before administering this medication? 1. Listen to the client's lung sounds. 2. Check the client's blood pressure. 3. Assess the client for muscle weakness. 4. Check the client's most recent electrolyte levels.

Correct answer: 2 Rationale: Atenolol hydrochloride is a beta blocker that is used to treat hypertension. Therefore, the priority nursing action before administration of the medication is to check the client's blood pressure. The nurse also checks the client's apical heart rate. If the systolic blood pressure is lower than 90 mm Hg or the apical pulse is 60 beats/min or slower, the medication is withheld and the health care provider is notified. The nurse checks baseline renal and liver function tests. The medication can cause weakness, and the nurse would assist the client if weakness with activities occurs.

59. The health care provider (HCP) writes a prescription for atenolol for a client who was admitted to the hospital. The nurse contacts the HCP to verify the prescription if which finding is noted in the assessment data? 1. Temperature is 100.1°F (37.8°C). 2. Apical heart rate is 48 beats/min. 3. Blood pressure is 138/82 mm Hg. 4. Pedal pulses are bounding and strong.

Correct answer: 2 Rationale: Atenolol is a beta-adrenergic blocker that is used as an antihypertensive, antianginal, and antidysrhythmic. It blocks beta-adrenergic receptors in cardiac tissue and produces the therapeutic effects of slowing the heart rate, decreasing cardiac output, decreasing blood pressure, and decreasing myocardial oxygen demand. Contraindications to the medication include severe bradycardia, cardiac failure, cardiogenic shock, and heart block greater than first degree. The remaining options are not contraindications to this medication.

63. Atenolol has been prescribed for a client, and the nurse provides instructions to the client about the medication. Which statement by the client indicates the need for further teaching? 1. "I need to rise slowly from a lying to a sitting position." 2. "If I feel that my heart rate is too low, I should stop the medication." 3. "It will take 1 to 2 weeks before my blood pressure becomes controlled." 4. "I should avoid tasks that require alertness until I know how the medication will affect my body."

Correct answer: 2 Rationale: Atenolol is a beta-adrenergic blocker that is used as an antihypertensive, antianginal, and antidysrhythmic. It blocks beta-adrenergic receptors in cardiac tissue and produces the therapeutic effects of slowing the heart rate, decreasing cardiac output, decreasing blood pressure, and decreasing myocardial oxygen demand. The client should not abruptly stop the medication. Abrupt withdrawal may result in sweating, palpitations, headache, and tremulousness and may precipitate heart failure or myocardial infarction in a client with cardiac disease. Abrupt withdrawal can also cause rebound hypertension. A pulse of 60 or below should be reported to the health care provider. The statements made by the client in the remaining options are correct.

60. Atenolol has been prescribed for a hospitalized client. The nurse should check which item before administering this medication? 1. Pedal pulses 2. Apical heart rate 3. Most recent potassium level 4. Most recent electrolyte levels

Correct answer: 2 Rationale: Atenolol is a beta-adrenergic blocker that is used as an antihypertensive, antianginal, and antidysrhythmic. It blocks beta-adrenergic receptors in cardiac tissue and produces the therapeutic effects of slowing the heart rate, decreasing cardiac output, decreasing blood pressure, and decreasing myocardial oxygen demand. The nurse should check the client's apical heart rate and blood pressure immediately before administering the medication. If the heart rate is 60 beats/min or lower or if the systolic blood pressure is less than 90 mm Hg, the medication is withheld and the health care provider is contacted. The remaining options are unrelated to the administration of this medication.

21. A client who had surgery 3 days earlier is receiving heparin sulfate by subcutaneous injection every 12 hours. In planning for the client's morning care, the priority nursing intervention is which action? 1. Allow the client to sit only at the bedside. 2. Assist the client to shave using an electric razor. 3. Monitor the prothrombin time (PT) every 4 hours. 4. Tell the client that brushing the teeth is not allowed.

Correct answer: 2 Rationale: Clients receiving heparin are at risk for bleeding. An electric razor rather than a straight blade razor is used for shaving. Allowing the client to only sit on the side of the bed and prohibiting brushing of the teeth are inappropriate and unnecessary nursing actions. It is not necessary to monitor laboratory values every 4 hours when the client is taking subcutaneous heparin. The PT is monitored when the client is taking warfarin.

46. A client with heart failure is scheduled to be discharged to home with digoxin and furosemide as daily prescribed medications. The nurse tells the client to report which finding as an indication that the medications are not having the intended effect? 1. Sudden increase in appetite 2. Weight gain of 2 to 3 lb in a few days 3. Increased urine output during the day 4. Cough accompanied by other signs of respiratory infection

Correct answer: 2 Rationale: Clients with heart failure should immediately report weight gain, loss of appetite, shortness of breath with activity, edema, persistent cough, and nocturia. An increase in urine output during the day is expected with diuretic therapy. A cough resulting from respiratory infection does not necessarily indicate that heart failure is worsening.

103. The nurse is preparing to administer furosemide to a client with a diagnosis of heart failure. Which is the most important laboratory test result for the nurse to check before administering this medication? 1. Creatinine level 2. Potassium level 3. Cholesterol level 4. Blood urea nitrogen (BUN)

Correct answer: 2 Rationale: Furosemide is a loop diuretic. The medication causes a decrease in the client's electrolytes, especially potassium, sodium, and chloride. Administering furosemide to a client with low electrolyte levels could precipitate ventricular dysrhythmias. Both BUN and creatinine reflect renal function. The cholesterol level is unrelated to the administration of this medication.

37. A client in the hospital emergency department who received nitroglycerin for chest pain has obtained relief but now complains of a headache. The nurse should interpret that this client is most likely experiencing which condition? 1. An allergic reaction to nitroglycerin 2. An expected medication side effect 3. An early sign of tolerance to the medication 4. A warning that the medication should not be used again

Correct answer: 2 Rationale: Headache is a frequent side effect of nitroglycerin, resulting from its vasodilator action. It often subsides as the client becomes accustomed to the medication and is effectively treated with acetaminophen. The other options are incorrect interpretations.

78. The nurse has given a client information about the use of nitroglycerin sublingual tablets. The client has a prescription for PRN (as needed) use if chest pain occurs. Which client statement indicates an understanding of this medication? 1. "It's best to keep this medication in a shirt pocket close to the body." 2. "I need to discard unused tablets 6 to 9 months after the bottle is opened." 3. "I will avoid using the medication until the chest pain actually begins and gets worse." 4. "I can take aspirin for any headache that occurs when I first start taking the nitroglycerin."

Correct answer: 2 Rationale: Nitroglycerin may be self-administered sublingually 5 to 10 minutes before an activity that could trigger chest pain. Tablets should be discarded 6 to 9 months after opening the bottle (expiration date on the bottle should always be checked), and a new bottle of pills should be obtained from the pharmacy. Nitroglycerin is very unstable and is affected by heat and cold, so it should not be kept close to the body (warmth) in a shirt pocket; rather, it should be kept in a jacket pocket or purse. Headache often occurs with early use and diminishes in time. Acetaminophen, rather than acetylsalicylic acid (aspirin), may be used to treat headache.

110. A client has recently begun medication therapy with propranolol. The long-term care nurse should plan to notify the health care provider (HCP) if which assessment finding is noted? 1. Complaints of insomnia 2. Audible expiratory wheezes 3. Decrease in heart rate from 86 to 78 beats/min 4. Decrease in blood pressure from 162/90 to 136/84 mm Hg

Correct answer: 2 Rationale: Propranolol is a beta blocker. Audible expiratory wheezes could indicate bronchospasm, a serious adverse reaction. Beta blockers that are not cardioselective, such as propranolol, may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Insomnia is a frequent mild side effect and should continue to be monitored. A normal decrease in heart rate and blood pressure is expected.

109. The nurse is providing medication information to a client who is beginning medication therapy with enalapril. The nurse should tell the client that which is an anticipated, although unpleasant, side effect of this medication? 1. Rapid pulse 2. Persistent dry cough 3. Increased blood pressure 4. Metallic taste in the mouth

Correct answer: 2 Rationale: The principal side and adverse effects of enalapril, an angiotensin-converting enzyme (ACE) inhibitor, are persistent cough, first-dose hypotension, and hyperkalemia. The medication is used to treat hypertension. A persistent dry cough is a harmless side effect, although it can be disturbing. If this side effect occurs and is troublesome, the health care provider should be notified so that the medication can be changed to a different one. A rapid pulse and metallic taste in the mouth are not side or adverse effects of this medication.

48. The nurse has provided instructions to a client receiving enalapril maleate. Which statement by the client indicates a need for further instruction? 1. "I need to rise slowly from a lying to a sitting position." 2. "I need to notify the health care provider if fatigue occurs." 3. "I need to notify the health care provider if a sore throat occurs." 4. "I know that several weeks of therapy may be required for the full therapeutic effect."

Correct answer: 2 Rationale: To reduce the hypotensive effect of this medication, the client is instructed to rise slowly from a lying to a sitting position and to permit the legs to dangle from the bed momentarily before standing. If fatigue occurs, it is not necessary to notify the health care provider (HCP); the client is encouraged to pace activities. The client should report signs of a sore throat or fever to the HCP because these may indicate infection. The client should be notified that several weeks may be needed for the full therapeutic effect of blood pressure reduction. The client also should be instructed not to skip doses or discontinue the medication because severe rebound hypertension could occur.

112. A client taking verapamil has been given information about side effects of this medication. The nurse determines that the client understands the information if the client states to watch for which most common side effect of this medication? 1. Weight loss 2. Constipation 3. Nasal stuffiness 4. Abdominal cramping

Correct answer: 2 Rationale: Verapamil is a calcium channel blocker. The most common complaint with the use of verapamil is constipation. Other frequent side effects are dizziness, facial flushing, headache, and edema of the hands and feet. Weight loss, nasal stuffiness, and abdominal cramping are not associated with the use of this medication.

7. A client with a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium 7.5 mg at 5:00 p.m. daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. The nurse should take which action based on the client's laboratory results? 1. Collaborate with the health care provider (HCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed. 2. Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed. 3. Collaborate with the HCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range. 4. Collaborate with the HCP to continue the heparin infusion at the same rate and to discuss use of dabigatran etexilate in place of warfarin sodium.

Correct answer: 2 Rationale: When a client is receiving warfarin for clot prevention due to atrial fibrillation, an INR of 2 to 3 is appropriate for most clients. Until the INR has achieved a therapeutic range, the client should be maintained on a continuous heparin infusion with the aPTT ranging between 60 and 80 seconds. Rationale: Signs of toxicity from procainamide include confusion, dizziness, drowsiness, decreased urination, nausea, vomiting, and tachydysrhythmias. If the client complains of dizziness, the nurse should assess the vital signs first. Although measuring the heart rate on the rhythm strip and obtaining a 12-lead electrocardiogram may be interventions, these would be done after the vital signs are taken. Nitroglycerin is a vasodilator and will lower the blood pressure. Therefore, the nurse should collaborate with the HCP to obtain a prescription to increase the heparin infusion and to administer the warfarin as prescribed.

52. The nurse prepares to teach a client with subarachnoid hemorrhage about the effects of nimodipine. The nurse plans to explain which information about the type and action of this medication? 1. Beta-adrenergic blocker that will decrease blood pressure 2. Vasodilator that has an affinity for cerebral blood vessels 3. Diuretic that will decrease blood pressure by decreasing fluid volume 4. Calcium channel blocker that will decrease spasm in cerebral blood vessels

Correct answer: 4 Rationale: Nimodipine is a calcium channel-blocking agent that has an affinity for cerebral blood vessels. It is used to prevent or control vasospasm in cerebral blood vessels, thereby reducing the chance for rebleeding. It is typically prescribed for 3 weeks' duration.

11. The nurse is monitoring a client who is taking digoxin for adverse effects. Which findings are characteristic of digoxin toxicity? Select all that apply. 1. Tremors 2. Diarrhea 3. Irritability 4. Blurred vision 5. Nausea and vomiting

Correct answer: 2, 4, 5 Rationale: Digoxin is a cardiac glycoside. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea. Subsequent manifestations include headache; visual disturbances such as diplopia, blurred vision, yellow-green halos, and photophobia; drowsiness; fatigue; and weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. The optimal therapeutic range for digoxin is 0.5 to 0.8 ng/mL.

53. A client is being treated for moderate hypertension and has been taking diltiazem for several months. The client schedules an appointment with the health care provider because of episodes of chest pain, and Prinzmetal's angina is diagnosed. The client asks the nurse which therapeutic effects the medication will provide and the nurse provides education. Which statement by the client indicates that the teaching has been effective? 1. "It increases the force of contraction of heart tissues." 2. "It increases oxygen demands within the myocardium." 3. "It prevents an influx of calcium ions in the smooth muscle." 4. "It leads to an increase in calcium absorption in the smooth muscle."

Correct answer: 3 Rationale: Diltiazem is a calcium channel blocker that inhibits calcium influx through the slow channels of the membrane of smooth muscle cells. These medications decrease myocardial oxygen demands and block calcium channels, thereby decreasing the force of contraction of the ventricular tissue.

17. The home care nurse instructs a client on how to administer enoxaparin subcutaneously. Which statement, if made by the client, indicates an understanding of how to administer this medication? 1. "I need to hold my skin flat before I put the needle into my skin." 2. "I need to massage the skin with the alcohol wipe after I give the injection." 3. "A syringe that has a small 5⁄8-inch (1.5 cm) needle is used to administer the injection." 4. "I need to pull back on the syringe and aspirate before pushing the medication into my skin."

Correct answer: 3 Rationale: A subcutaneous injection of enoxaparin is performed using the same technique as for a heparin injection. The client should use a 25- to 27-gauge, 5⁄8-inch (1.5 cm) needle to prevent hematoma formation at the injection site. The client should be taught to bunch the skin rather than placing it flat. The client should not aspirate before injecting the medication and should not massage the area after injection.

66. The health care provider (HCP) writes a prescription for atorvastatin for a client who was admitted to the hospital. The nurse contacts the HCP to verify the prescription if which finding is noted in the assessment data? 1. Renal calculi 2. Chronic heart failure 3. Carcinoid of the liver 4. Coronary artery disease

Correct answer: 3 Rationale: Atorvastatin is a (HMG-CoA) reductase inhibitor that is used to treat hypercholesterolemia and hypertriglyceridemia. Contraindications to the medication include active liver disease, unexplained elevated liver function tests, pregnancy, and lactation. The conditions noted in the remaining options are not contraindications to this medication.

68. Atorvastatin has been prescribed for a client, and the client asks the nurse about the side and adverse effects of the medication. What should the nurse tell the client is a frequent side effect of this medication? 1. Tremors 2. Lethargy 3. Headache 4. Tiredness

Correct answer: 3 Rationale: Atorvastatin is a reductase inhibitor (HMG-CoA reductase inhibitor) that is used to treat hypercholesterolemia and hypertriglyceridemia. A frequent side effect is headache. Occasional side effects include myalgia, rash or pruritus (signs of an allergic reaction), flatulence, and dyspepsia. The symptoms in the remaining options are not side and adverse effects of this medication.

69. A client seen in the health care clinic for follow-up care is taking atorvastatin. The nurse should assess the client for which adverse effect of the medication? 1. Earache 2. Hearing loss 3. Photosensitivity 4. Lung congestion

Correct answer: 3 Rationale: Atorvastatin is a reductase inhibitor (HMG-CoA reductase inhibitor) that is used to treat hypercholesterolemia and hypertriglyceridemia. Adverse effects include photosensitivity and the potential for developing cataracts. The symptoms in the remaining options are not side and adverse effects of this medication.

65. Atorvastatin has been prescribed for a client, and the client asks the nurse about the action of the medication. How should the nurse respond? 1. "It increases plasma cholesterol." 2. "It increases plasma triglycerides." 3. "It decreases low-density lipoproteins (LDLs)." 4. "It decreases high-density lipoproteins (HDLs)."

Correct answer: 3 Rationale: Atorvastatin is a reductase inhibitor (HMG-CoA reductase inhibitor) that is used to treat hypercholesterolemia and hypertriglyceridemia. It decreases LDL cholesterol and plasma triglycerides and increases HDL cholesterol (the good cholesterol). The remaining options are not actions of this medication

80. The nurse has given a client the prescribed dose of intravenous hydralazine. The nurse evaluates the effectiveness of the medication by monitoring which client parameter? 1. Pulse rate 2. Urine output 3. Blood pressure 4. Potassium level

Correct answer: 3 Rationale: Bumetanide is a loop diuretic that is not potassium retaining. The value given for potassium is below the therapeutic range of 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L) for this electrolyte. The nurse should notify the HCP before giving the dose so that potassium supplementation may be prescribed. The results listed in the remaining options identify normal values. Rationale: Hydralazine is an antihypertensive medication used in the management of moderate to severe hypertension. It is a vasodilator medication that decreases afterload. The blood pressure needs to be monitored. The remaining options are unrelated to the use of this medication.

114. The nurse has a prescription to give a client a scheduled dose of digoxin. Prior to administering the medication, the nurse should assess for which manifestations that could indicate digoxin toxicity? 1. Dyspnea, edema, and palpitations 2. Chest pain, hypotension, and paresthesias 3. Double vision, loss of appetite, and nausea 4. Constipation, dry mouth, and sleep disorder

Correct answer: 3 Rationale: Double vision, loss of appetite, and nausea are signs of digoxin toxicity. Other signs of digoxin toxicity include bradycardia, visual alterations (such as green and yellow vision, or seeing spots or halos), confusion, vomiting, diarrhea, decreased libido, and impotence. The other options are incorrect because they do not identify manifestations of digoxin toxicity.

82. The nurse has conducted medication instructions with a client receiving lovastatin. Which periodic blood study will be necessary and included in the client's instructions? 1. Bleeding time 2. Blood glucose levels 3. Liver function studies 4. Complete blood cell count

Correct answer: 3 Rationale: Lovastatin is a reductase inhibitor. It results in an increase in high-density lipoprotein cholesterol and a decrease in triglycerides and low-density lipoprotein cholesterol. This medication is converted by the liver to active metabolites and therefore is not used in clients with active hepatic disease or elevated transaminase levels. Because it is metabolized by the liver, clients are recommended to have periodic liver function studies. Periodic cholesterol levels also are needed to monitor the effectiveness of therapy. The medication does not affect bleeding time, blood glucose, or cells examined in a complete blood cell count.

101. The nurse has completed medication administration that included a nitroglycerin. Within minutes, the client is complaining of a headache. Which is the priority nursing action at this time? 1. Evaluate pupil response. 2. Place the client on the left side. 3. Administer the prescribed analgesic. 4. Notify the health care provider (HCP) immediately.

Correct answer: 3 Rationale: Nitroglycerin causes vasodilation. The major side effect of nitroglycerin is a headache that can be alleviated by an analgesic. It is an expected response to the medication, and the HCP does not need to be notified. Placing the client on the left side will not alleviate the headache. There is no indication for the need to evaluate pupil response.

119. A client is scheduled to receive a daily morning dose of furosemide. Which client laboratory result warrants a call to the health care provider (HCP) prior to the medication administration? 1. Serum sodium of 135 mEq/L (135 mmol/L) 2. Serum calcium of 10.4 mg/dL (2.6 mmol/L) 3. Serum potassium of 2.8 mEq/L (2.8 mmol/L) 4. Fasting blood glucose of 110 mg/dL (6 mmol/L)

Correct answer: 3 Rationale: Potassium is lost through increased secretion in the distal nephron from the effects of furosemide. If serum potassium falls below 3.5 mEq/L (3.5 mmol/L), fatal dysrhythmias may result. The HCP should be notified of the results so that the value can be corrected before administration of an additional dose of furosemide. The values in the remaining options would not warrant an immediate call to the HCP.

72. A client with cardiac disease has begun taking propranolol, and the nurse provides information to the client about the medication. The nurse should tell the client to contact the health care provider (HCP) if which symptoms develop? 1. Insomnia and headache 2. Nausea and constipation 3. Night cough and dyspnea 4. Drowsiness and nightmares

Correct answer: 3 Rationale: Propranolol is a beta-adrenergic blocker that is used as an antihypertensive, antianginal, antidysrhythmic, and antimigraine medication. It may precipitate heart failure or myocardial infarction in clients with cardiac disease. Signs of heart failure include dyspnea (particularly on exertion or lying down), night cough, peripheral edema, and distended neck veins. If signs of heart failure occur, the HCP should be notified. The symptoms noted in the remaining options identify effects of this medication that do not warrant HCP notification if they occur.

86. A new registered nurse (RN) prepares to administer sodium polystyrene sulfonate to a client. Before administering the medication, the nurse reviews the action of the medication with another RN. Which statement by the new RN indicates that the teaching has been effective? 1. "Bicarbonate is exchanged for primarily sodium ions." 2. "Potassium ions are exchanged for primarily sodium ions." Rationale: Dipyridamole combined with warfarin sodium is prescribed to protect the client's artificial heart valves. Dipyridamole does not prevent strokes, heart attacks, or hypertension. 3. "Sodium ions are exchanged for primarily potassium ions." 4. "Sodium ions are exchanged for primarily bicarbonate ions."

Correct answer: 3 Rationale: Sodium polystyrene sulfonate {Kayexalate} is a cation exchange resin used for the treatment of hyperkalemia. The resin passes through the intestine or is retained in the colon. It releases sodium ions primarily in exchange for potassium ions. The therapeutic effect occurs 2 to 12 hours after oral administration and longer after rectal administration. Therefore, the remaining options are incorrect.

76. The nurse is performing an assessment on a client with a diagnosis of chronic angina pectoris. The client is receiving sotalol orally daily. Which assessment finding indicates to the nurse that the client is experiencing a side or adverse effect related to the medication? 1. Dry mouth 2. Diaphoresis 3. Palpitations 4. Difficulty swallowing

Correct answer: 3 Rationale: Sotalol is a beta-adrenergic blocking agent. Side and adverse effects include bradycardia, palpitations, difficulty breathing, irregular heartbeat, signs of heart failure, and cold hands and feet. Gastrointestinal disturbances, anxiety and nervousness, and unusual tiredness and weakness also can occur.

94. A home health care nurse is visiting an older client at home. Furosemide is prescribed for the client and the nurse teaches the client about the medication. Which statement, if made by the client, indicates the need for further teaching? 1. "I will sit up slowly before standing each morning." 2. "I will take my medication every morning with breakfast." 3. "I need to drink lots of coffee and tea to keep myself healthy." 4. "I will call my health care provider if my ankles swell or my rings get tight."

Correct answer: 3 Rationale: Tea and coffee are stimulants and mild diuretics. These are a poor choice for hydration. Sitting up slowly prevents postural hypotension. Taking the medication at the same time each day improves compliance. Because furosemide is a diuretic, the morning is the best time to take the medication so as not to interrupt sleep. Notification of the health care provider is appropriate if edema is noticed in the hands, feet, or face or if the client is short of breath.

20. A thrombolytic is administered in the hospital emergency department to a client who has had a myocardial infarction. The client's spouse asks the nurse about the purpose of the medication. The nurse bases the response on which fact regarding this medication? 1. Thrombolytics suppress the production of fibrin. 2. Thrombolytics act to prevent thrombus formation. 3. Thrombolytics act to dissolve thrombi that have already formed. 4. Thrombolytics have been proved to reverse all detrimental effects of heart attacks.

Correct answer: 3 Rationale: Thrombolytics are most effective when started within 4 to 6 hours after symptom onset and act to dissolve or lyse existing thrombi that are causing a blockage. The remaining options are incorrect.

22. A client scheduled to take a subcutaneous anticoagulant at home says to the nurse, "I'm not sure I will be able to take this medication at home." Which statement by the nurse is appropriate? 1. "Maybe your spouse can give you your shots." 2. "You'll be fine once you get used to giving your own shots." 3. "What are your concerns about taking this medication at home?"

Correct answer: 3 Rationale: To reduce the hypotensive effect of this medication, the client is instructed to rise slowly from a lying to a sitting position and to permit the legs to dangle from the bed momentarily before standing. If fatigue occurs, it is not necessary to notify the health care provider (HCP); the client is encouraged to pace activities. The client should report signs of a sore throat or fever to the HCP because these may indicate infection. The client should be notified that several weeks may be needed for the full therapeutic effect of blood pressure reduction. The client also should be instructed not to skip doses or discontinue the medication because severe rebound hypertension could occur.

77. The nurse is caring for a client with hypertension who is receiving torsemide orally daily. Which laboratory test result would indicate to the nurse that the client may be experiencing a side or adverse effect related to the medication? 1. A chloride level of 98 mEq/L (98 mmol/L) 2. A sodium level of 135 mEq/L (135 mmol/L) 3. A potassium level of 3.1 mEq/L (3.1 mmol/L) 4. A blood urea nitrogen (BUN) of 15 mg/dL (5.4 mmol/L)

Correct answer: 3 Rationale: Torsemide {Similar to FURESOMIDE "Lasix"} is a loop diuretic. The medication can produce acute and profound water loss, volume and electrolyte depletion, dehydration, decreased blood volume, and circulatory collapse. The correct option is the only one that indicates an electrolyte depletion, because the normal potassium level is 3.5 to 5.0 mEq/L. The normal chloride level is 98 to 107 mEq/L. The normal sodium level is 135 to 145 mEq/L. The normal blood BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L).

25. The nurse is caring for a client who is taking warfarin. The nurse notes the presence of gross hematuria and large areas of bruising on the client's body. The nurse notifies the health care provider (HCP) and ensures that which prescribed medication is available? 1. Heparin sulfate 2. Protamine sulfate 3. Phytonadione (vitamin K) 4. Oral potassium supplements

Correct answer: 3 Rationale: Warfarin is an oral anticoagulant. The effects of warfarin overdose can be reversed with phytonadione (vitamin K). Vitamin K is an antagonist to the action of warfarin that can reverse warfarin- induced inhibition of clotting factor synthesis. For mild bleeding, vitamin K should be administered orally; a dose of 10 to 20 mg will cause prothrombin levels to normalize within 24 hours. If bleeding is severe, parenteral vitamin K is indicated. Protamine sulfate is the antidote for heparin sulfate, an anticoagulant that would cause increased bleeding. The question presents no data suggesting that potassium supplements are indicated.

104. The nurse is preparing to administer furosemide 40 mg by intravenous (IV) injection (IV push) to a client. The nurse should administer the medication over which time period? 1. 10 seconds 2. 30 seconds 3. 2 minutes 4. 5 minutes

Correct answer: 3 Rationale: When furosemide is administered by IV injection, each 40 mg or fraction thereof should be given over a 1- to 2-minute period. Options of 10 seconds and 30 seconds identify administration times that are too rapid and could cause adverse effects {such as ototoxicity}. Five minutes is too slow of a time period for administration and may affect the effectiveness of the IV medication.

92. A hospitalized client with coronary artery disease complains of substernal chest pain. After assessing the client's heart rate and blood pressure, the nurse administers nitroglycerin, 0.4 mg sublingually. After 5 minutes the client states, "My chest still hurts." Which actions should the nurse take? Select all that apply. 1. Call a Code Blue. 2. Contact the client's family. 3. Assess the client's pain level. 4. Check the client's blood pressure. 5. Contact the health care provider (HCP). 6. Administer a second nitroglycerin, 0.4 mg sublingually.

Correct answer: 3, 4, 6 Rationale: The usual guidelines for administering nitroglycerin tablets for chest pain to a hospitalized client include administering 1 tablet every 5 minutes PRN (as needed) for chest pain, for a total dose of 3 tablets. If the client does not obtain relief after taking a third dose of nitroglycerin, the HCP is notified. Because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would assess the client's pain level and check the client's blood pressure before administering each nitroglycerin dose. There are no data in the question that indicate the need to call a Code Blue. In addition, it is not necessary to contact the client's family unless he or she has requested this.

12. Prior to administering a client's daily dose of digoxin, the nurse reviews the client's laboratory data and notes the following results: serum calcium, 9.8 mg/dL (2.45 mmol/L); serum magnesium, 1.0 mEq/L (0.5 mmol/L); serum potassium, 4.1 mEq/L (4.1 mmol/L); serum creatinine, 0.9 mg/dL (79.5 mcmol/L). Which result should alert the nurse that the client is at risk for digoxin toxicity? 1. Serum calcium level 2. Serum potassium level 3. Serum creatinine level 4. Serum magnesium level

Correct answer: 4 Rationale: An increased risk of Digoxin toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function. The calcium, creatinine, and potassium levels are all within normal limits. The normal range for magnesium is 1.3 to 2.1 mEq/L (0.65 to 1.05 mmol/L) and the results in the correct option are reflective of hypomagnesemia.

35. The nurse notes a persistent, dry cough in an adult client being seen in the ambulatory clinic. When questioned, the client states that the cough began approximately 2 months ago. On further assessment, the nurse learns that the client began taking quinapril shortly before the time that the cough began. How should the nurse interpret the development of the cough? 1. An early indication of heart failure 2. Caused by neutropenia as a result of therapy 3. Caused by a concurrent upper respiratory infection 4. An expected although bothersome side effect of therapy

Correct answer: 4 Rationale: A frequent side effect of therapy with any angiotensin-converting enzyme (ACE) inhibitor, including quinapril, is a persistent, dry cough. In general, the cough does not resolve during the course of medication therapy, so clients should be advised to notify the health care provider if the cough becomes very troublesome. The other options are incorrect.

105. A health care provider (HCP) writes a prescription for digoxin, 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is most important to be sure to implement which measure? 1. Count the radial and carotid pulses every morning. 2. Check the blood pressure every morning and evening. 3. Stop taking the medication if the pulse is faster than 100 beats/min. 4. Withhold the medication and call the HCP if the pulse is slower than 60 beats/min.

Correct answer: 4 Rationale: An important component of taking digoxin is monitoring the pulse rate; however, it is not necessary for the client to take both radial and carotid pulses. It is also unnecessary for the client to check the blood pressure every morning and evening because the medication does not directly affect blood pressure. It is most important for the client to know the guidelines related to withholding the medication and calling the HCP. The client should not stop taking the medication.

3. The nurse provides discharge instructions to a client who is taking warfarin sodium. Which statement, by the client, reflects the need for further teaching? 1. "I will avoid alcohol consumption." 2. "I will take my pills every day at the same time." 3. "I have already called my family to pick up a MedicAlert bracelet." 4. "I will take coated aspirin for my headaches because it will coat my stomach."

Correct answer: 4 Rationale: Aspirin-containing products need to be avoided when a client is taking this medication. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking the prescribed medication at the same time each day increases client compliance. The MedicAlert bracelet provides health care personnel with emergency information.

64. A registered nurse (RN) is orienting a new RN on the use of atorvastatin. Which statement by the new RN indicates that the teaching has been effective? 1. "It is used in heart failure." 2. "It helps to control hypertension." 3. "It helps to reduce episodes of angina pectoris." 4. "It is given to clients with hypercholesterolemia."

Correct answer: 4 Rationale: Atorvastatin is a reductase inhibitor (HMG-CoA reductase inhibitor) that is used to treat hypercholesterolemia and hypertriglyceridemia. The statements made in the remaining options are incorrect.

38. A client who has begun taking betaxolol demonstrates an effective response to the medication as indicated by which nursing assessment finding? 1. Increase in edema to 3+ 2. Weight gain of 5 pounds 3. Decrease in pulse rate from 74 beats/min to 58 beats/min 4. Decrease in blood pressure from 142/94 mm Hg to 128/82 mm Hg

Correct answer: 4 Rationale: Betaxolol is a beta-adrenergic blocking agent used to lower blood pressure, relieve angina, or decrease the occurrence of dysrhythmias. Side and adverse effects include bradycardia and signs and symptoms of heart failure, such as increased edema and weight gain.

71. The nurse is reviewing the use of diltiazem for clients with Prinzmetal's variant angina. The nurse should provide information based on which action of the medication? 1. The medication works by increasing the heart rate. 2. The medication works by constricting peripheral arteries. 3. The medication works by increasing sinoatrial and atrioventricular conduction. 4. The medication works by inhibiting calcium movement across cell membranes of cardiac and smooth muscle.

Correct answer: 4 Rationale: Diltiazem is a calcium channel blocker that inhibits calcium movement across cell membranes of cardiac and smooth muscle. It dilates coronary arteries and peripheral arteries and arterioles. Diltiazem decreases the heart rate and slows sinoatrial and atrioventricular conduction.

89. A client is on enalapril for the treatment of hypertension. The nurse teaches the client to seek emergent care if which is experienced? 1. Nausea 2. Insomnia 3. Dry cough 4. Swelling of the tongue

Correct answer: 4 Rationale: Enalapril is an angiotensin-converting enzyme inhibitor. Angioedema is an adverse effect. Swelling of the tongue and lips can result in airway occlusion. Nausea, insomnia, and a cough can occur as side, not adverse, effects of the medication.

24. A client receives education regarding self-administration of enoxaparin on discharge to home. The client complains, "I feel as if the health care provider is discharging me too soon if I still have to take injections at home." Which response should the nurse make? 1. "Are you not happy about going home?" 2. "Do you want to stay in the hospital forever?" 3. "You'll have to take that up with the health care provider." 4. "Research shows that it is best for clients to administer this medication at home rather than stay in the hospital."

Correct answer: 4 Rationale: Enoxaparin is a low-molecular-weight heparin that can be administered without the usual activated partial thromboplastin time testing that is required with the use of heparin. Statements asking the client about whether he or she is not happy to go home or wants to stay in the hospital forever devalue the client's feelings. Telling the client that you will consult with the health care provider places the client's feelings on hold.

15. A client is prescribed nicotinic acid for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? 1. "It is not necessary to avoid the use of alcohol." 2. "The medication should be taken with meals to decrease flushing." 3. "Clay-colored stools are a common side effect and should not be of concern." 4. "Ibuprofen IB taken 30 minutes before the nicotinic acid should decrease the flushing."

Correct answer: 4 Rationale: Flushing is an adverse effect of this medication. Aspirin or a nonsteroidal antiinflammatory drug can be taken 30 minutes prior to taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this effect. The medication should be taken with meals to decrease gastrointestinal upset; however, taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be reported to the health care provider (HCP) immediately.

73. Hydrochlorothiazide has been prescribed for a client. The nurse contacts the health care provider (HCP) to verify the prescription if which condition is noted in the assessment data? 1. Hypertension 2. Allergy to eggs 3. Nephrotic syndrome 4. Allergy to sulfonamides

Correct answer: 4 Rationale: Hydrochlorothiazide is a diuretic and antihypertensive medication that is used to treat mild to moderate hypertension, edema associated with heart failure, and nephrotic syndrome. The medication is a sulfonamide derivative. A contraindication to the use of this medication is a history of hypersensitivity to sulfonamides. The conditions noted in the remaining options are not contraindications for the use of this medication.

36. A client with angina pectoris has been given a new prescription for nitroglycerin transdermal patches. The client indicates an understanding of how to use this medication administration system by making which statement? 1. "I need to wait until the next day to apply a new patch if it falls off." 2. "I need to alternate daily dosage times to prevent tolerance to the medication." 3. "I need to place the patch in the area of a skin fold to promote better adherence." 4. "I need to apply the patch in the morning and leave it in place for 12 to 14 hours as directed."

Correct answer: 4 Rationale: Nitroglycerin is a coronary vasodilator used for coronary artery disease. The client should apply a new patch each morning and leave it in place for 12 to 14 hours in accordance with health care provider directions. This prevents the client from developing tolerance (as happens with 24-hour use). The client does not need to wait to apply a new patch if it falls off because the medication is released continuously in small amounts through the skin. The client should avoid placing the patch in skin folds or excoriated areas.

29. A client with hypertension has begun taking spironolactone. The nurse teaches the client to limit intake of which food? Rationale: Prazosin hydrochloride is an antihypertensive medication used to treat high blood pressure. A decrease in blood pressure indicates a therapeutic effect from the medication. The items listed in the remaining options are unrelated to the use of this medication. 1. Rice 2. Salad 3. Oatmeal 4. Citrus fruits

Correct answer: 4 Rationale: Spironolactone is a potassium-retaining diuretic that causes hyperkalemia as the principal side or adverse effect. Clients are instructed to restrict their intake of potassium-rich foods, such as citrus fruits and bananas. The other foods listed are appropriate to include in the diet.

33. The nurse is reviewing the assessment findings for a client who has been taking spironolactone for treatment of hypertension. Which, if noted in the client's record, would indicate that the client is experiencing an adverse effect related to the medication? 1. Client complaint of dry skin 2. Client complaint of constipation 3. A potassium level of 3.5 mEq/L (3.5 mmol/L) 4. A potassium level of 5.8 mEq/L (5.8 mmol/L)

Correct answer: 4 Rationale: Spironolactone is a potassium-retaining diuretic. Side and adverse effects include hyperkalemia, dehydration, hyponatremia, and lethargy. Although the concern with most diuretics is hypokalemia, this medication is potassium sparing, which means that the concern with this medication is hyperkalemia. Additional side and adverse effects include nausea, vomiting, cramping, diarrhea, headache, ataxia, drowsiness, confusion, and fever.

81. The nurse has completed giving medication instructions to a client receiving benazepril. Which client statement indicates to the nurse that the client needs further instruction? 1. "I need to change positions slowly." 2. "I will monitor my blood pressure every week." 3. "I will report signs and symptoms of infection immediately." 4. "I can use salt substitutes freely and eat foods high in potassium."

Correct answer: 4 Rationale: The client taking an angiotensin-converting enzyme (ACE) inhibitor is instructed to take the medication exactly as prescribed, to monitor blood pressure weekly, and to continue with other lifestyle changes to control hypertension. The client should change positions slowly to avoid orthostatic hypotension and report fever, mouth sores, or sore throat (neutropenia) to the health care provider. In addition, salt substitutes and high-potassium foods should be avoided because they contain potassium and increase the risk for hyperkalemia.

74. A client is seen in the clinic complaining of anorexia and nausea. The health care provider (HCP) suspects that the client may be experiencing digoxin toxicity. While waiting for test results to become available, the nurse should assess the client for which sign or symptom that would support a diagnosis of digoxin toxicity? 1. Edema 2. Chest pain 3. Constipation 4. Photophobia

Correct answer: 4 Rationale: The most common early manifestations of digoxin toxicity are gastrointestinal disturbances such as anorexia, nausea, and vomiting and neurological disturbances such as fatigue, headache, weakness, drowsiness, confusion, and nightmares. Visual disturbances such as photophobia, light flashes, halos around bright objects, and yellow or green color perception also may occur

117. The nurse is reviewing heparin infusion therapy and pertinent laboratory values to monitor with the nursing student. Which statement by the student indicates that teaching has been effective? 1. "Bleeding time assesses for therapeutic effect of heparin." 2. "Thrombin time assesses for therapeutic effect of heparin." 3. "Prothrombin time assesses for therapeutic effect of heparin." 4. "Partial thromboplastin time assesses for therapeutic effect of heparin."

Correct answer: 4 Rationale: The partial thromboplastin time will assess the therapeutic effect of heparin. The prothrombin time is one test that will assess for the therapeutic effect of warfarin. Bleeding time and thrombin time are hematological studies that may be prescribed for clients with coagulopathy or other disorders.

113. The nurse has a prescription to give a first dose of hydrochlorothiazide to an assigned client. The nurse would question the prescription if the client has a history of allergy to which item? 1. Iodine 2. Shellfish 3. Penicillin 4. Sulfa medications

Correct answer: 4 Rationale: Thiazide diuretics, such as hydrochlorothiazide, are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. A sulfa allergy must be communicated to the pharmacist, health care providers (HCPs), and nurse. The other options are not contraindications for administering the medication.