HESI prep Cardio drugs
Digoxin therapeutic range
0.5-2 ng/mL
Normal INR ratio
2-3
A nurse is collecting data from a client and notes that the client is taking atenolol (Tenormin). What has this medication been prescribed to treat?
Hypertension
Atenolol (Tenormin) 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? a) Slows the heart rate b) Increases cardiac output c) Increases myocardial oxygen demand d) Maintains the blood pressure at a level within the 140/90 mm Hg range
a) Slows the heart rate Rationale: Atenolol is a β-adrenergic blocker that is used as an antihypertensive, antianginal, and antidysrhythmic. It blocks β-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.
What should the nurse teach a client about an expected outcome of nesiritide (Natrecor) administration? a) The client will have an increase in urine output. b) The client will have an absence of dysrhythmias. c) The client will have an increase in blood pressure. d) The client will have an increase in pulmonary capillary wedge pressure.
a) The client will have an increase in urine output. Rationale: Nesiritide is a recombinant version of human B-type natriuretic peptide, which vasodilates arteries and veins. It is used for the treatment of decompensated heart failure, increases renal glomerular filtration, and increases urine output. The remaining options are incorrect about the intended effect of this medication.
The nurse has been given a medication prescription to administer intravenous (IV) hydralazine (Apresoline). The nurse obtains which priority piece of equipment needed for use during administration of this medication? a) Pulse oximetry b) Cardiac monitor c) Noninvasive blood pressure cuff d) Nonrebreather oxygen face mask
c) Noninvasive blood pressure cuff Rationale: Hydralazine (vasodilator) 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.
The nurse is monitoring a client who is taking digoxin (Lanoxin) 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
2. Diarrhea 4. Blurred vision 5. Nausea and vomiting Rationale: Digoxin (Lanoxin) 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. Therapeutic levels for digoxin range from 0.5 to 2 ng/mL.
A hospitalized client with coronary artery disease complains of substernal chest pain. After assessing the client's heart rate and blood pressure, a 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.
3. Assess the client's pain level. 4. Check the client's blood pressure. 6. Administer a second nitroglycerin, 0.4 mg, sublingually. Rationale: The usual guidelines for administering nitroglycerin tablets for chest pain to a hospitalized client include administering one tablet every 5 minutes PRN for chest pain, for a total dose of three 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. Additionally it is not necessary to contact the client's family unless he or she has requested this.
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; serum magnesium, 1.2 mg/dL; serum potassium, 4.1 mEq/L; serum creatinine, 0.9 mg/dL. Which result should alert the nurse that the client is at risk for digoxin toxicity? a) Serum calcium level b) Serum potassium level c) Serum creatinine level d) Serum magnesium level
4. Serum magnesium level Rationale: An increased risk of 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 1.6 to 2.6 mg/dL and the results in the correct option are reflective of hypomagnesemia.
A client seen in the health care clinic for follow-up care is taking atorvastatin (Lipitor). The nurse should assess the client for which adverse effect of the medication? a) Earache b) Hearing loss c) Photosensitivity d) Lung congestion
c) Photosensitivity 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 nurse is caring for a client who is taking warfarin (Coumadin), an oral anticoagulant. 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 and ensures that which prescribed medication is available? a) Heparin sulfate b) Protamine sulfate c) Phytonadione (vitamin K) d) Oral potassium supplements
c) Phytonadione (vitamin K)
A health care provider writes a prescription for lisinopril (Zestril) for a hospitalized client. The nurse caring for the client determines that the medication has been prescribed to treat which disorder? a) Hypertension b) Immune disorder c) Venous insufficiency d) Gastroesophageal reflux disorder
a) Hypertension
The nurse prepares to teach a client with subarachnoid hemorrhage about the effects of nimodipine. The nurse plans to explain which information about the purpose of this medication? a) β-Adrenergic blocker that will decrease blood pressure b) Vasodilator that has an affinity for cerebral blood vessels c) Diuretic that will decrease blood pressure by decreasing fluid volume d) Calcium channel blocker that will decrease spasm in cerebral blood vessels
d) Calcium channel blocker that will decrease spasm in cerebral blood vessels 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.
A client with hypertension has begun taking spironolactone (Aldactone). The nurse teaches the client to limit intake of which food? a) Rice b) Salad c) Oatmeal d) Citrus fruits
d) Citrus fruits
Atorvastatin (Lipitor) 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? a) Neutrophil count b) Liver function studies c) White blood cell count d) Complete blood cell (CBC) count
b) Liver function studies
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 (Accupril) shortly before the time that the cough began. How should the nurse interpret the development of the cough? a) An early indication of heart failure b) Caused by neutropenia as a result of therapy c) Caused by a concurrent upper respiratory infection d) An expected although bothersome side effect of therapy
d) An expected although bothersome side effect of therapy
A hypertensive client has been prescribed clonidine hydrochloride (Catapres-TTS), 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? a) "I need to change the patch every 24 hours." b) "I need to apply the patch to a hairless body site." c) "I need to apply the patch to skin areas that are not broken." d) "I need to apply the patch to the skin on the upper arm or body."
a) "I need to change the patch every 24 hours." Rationale: Clonidine is an antihypertensive medication that is applied every 7 days to a hairless intact skin area of the upper arm or torso.
A health care provider (HCP) prescribes warfarin sodium (Coumadin) 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? a) "The urine normally changes to orange." b) "This medicine will still be working 4 to 5 days after it is discontinued." c) "This medication will require frequent blood work to monitor its effects." d) "I cannot take aspirin or any aspirin-containing medications while I'm on this medication."
a) "The urine normally changes to orange." Rationale: Warfarin (Coumadin) 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 (INR) is determined to monitor the clotting mechanism. Aspirin is an antiplatelet agent and would increase the risk of bleeding.
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? a) An expected medication side effect b) An allergic reaction to nitroglycerin c) An early sign of tolerance to the medication d) A warning that the medication should not be used again
a) An expected medication side effect 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 (Tylenol). The other options are incorrect interpretations.
A nurse is caring for a client with hyperlipidemia who is taking cholestyramine (Questran). Which nursing assessment is most significant for this client relative to the medication therapy? a) Observe for joint pain. b) Auscultate bowel sounds. c) Assess deep tendon reflexes. d) Monitor cardiac rate and rhythm
b) Auscultate bowel sounds. Rationale: Cholestyramine is used to treat hyperlipidemia. The site of action of the medication is the bowel; therefore option 2 is correct.
The health care provider has prescribed clonidine (Catapres) for a client with hypertension. The nurse should inform the client that which is a side effect of this medication? a) Diarrhea b) Constipation c) Hypertension d) Increased salivation
b) Constipation Rationale: Clonidine is an antihypertensive medication. Side effects of clonidine include dry mouth, drowsiness, constipation, and hypotension.
The nurse is caring for a client who is receiving dopamine. Which potential problem is a priority concern for this client? a) Fluid overload b) Peripheral vasoconstriction c) Inability to perform self-care d) Inability to discriminate hot or cold sensations
b) Peripheral vasoconstriction Rationale: The client who is receiving dopamine therapy should be assessed for peripheral vasoconstriction related to the action of the medication.
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? a) Increased pulse rate b) Relief of apprehension c) Decreased urine output d) Increased blood pressure
b) Relief of apprehension Rationale: 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.
A client with heart failure is scheduled to be discharged to home with digoxin (Lanoxin) and furosemide (Lasix) 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? a) Sudden increase in appetite b) Weight gain of 2 to 3 lb in a few days c) Increased urine output during the day d) Cough accompanied by other signs of respiratory infection
b) Weight gain of 2 to 3 lb in a few days 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 (Lasix). A cough resulting from respiratory infection does not necessarily indicate that heart failure is worsening.
The home care nurse visits a client with a diagnosis of unstable angina. The client is taking acetylsalicylic acid (aspirin) on a daily basis to reduce the risk of myocardial infarction (MI). Which medication dose would the nurse expect the client to be taking? a) 300 to 325 mg daily b) 650 to 700 mg daily c) 1.3 g daily d) 3 g daily
a) 300 to 325 mg daily Rationale: Acetylsalicylic acid (aspirin) may be used to reduce the risk of recurrent transient ischemic attacks (TIAs) or stroke or reduce the risk of MI in clients with unstable angina or a history of previous MI. The normal dose for clients being treated with acetylsalicylic acid to decrease thrombosis and MI is 300 to 325 mg daily, and some health care providers may prescribe an even lower dose. Clients taking aspirin to prevent TIAs usually are prescribed 1.3 g daily in two to four divided doses. Clients with rheumatoid arthritis may be treated with 3.2 to 6 g daily in divided doses.
Levothyroxine (Synthroid) is prescribed for a client diagnosed with hypothyroidism. The nurse reviews the client's record and notes that the client is presently taking warfarin (Coumadin). The nurse contacts the health care provider (HCP), anticipating that the HCP will prescribe which medication? a) A decreased dosage of warfarin b) An increased dosage of warfarin c) A decreased dosage of levothyroxine d) An increased dosage of levothyroxine
a) A decreased dosage of warfarin Rationale: Levothyroxine (Synthroid) accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin (Coumadin) 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.
A client has developed paroxysmal nocturnal dyspnea. Which medication should the nurse anticipate will be prescribed by the health care provider? a) Bumetanide b) Lidocaine (Xylocaine) c) Propranolol (Inderal LA) d) Streptokinase (Streptase)
a) Bumetanide 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. Lidocaine (Xylocaine) is an antidysrhythmic, Propranolol (Inderal LA) is an α-blocker, and streptokinase (Streptase) is a thrombolytic.
The nurse is reviewing the record of a client who arrives at the health care clinic. The nurse notes that irbesartan (Avapro) has been prescribed for the client. The nurse should suspect that the client has which condition? a) Hypertension b) Hypothyroidism c) Diabetes mellitus d) Renal transplant rejection
a) Hypertension
A client who is taking chlorothiazide (HydroDIURIL) 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 effect is present? a) Hypokalemia b) Hypocalcemia c) Hypernatremia d) Hyperphosphatemia
a) Hypokalemia 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.
A client has been prescribed pindolol (Visken) for hypertension. The nurse provides anticipatory guidance, knowing that which common side effect of this medication may decrease client compliance? a) Impotence b) Mood swings c) Increased appetite d) Difficulty swallowing
a) Impotence Rationale: A common side effect of β-adrenergic blocking agents such as pindolol is impotence. Other common side effects include fatigue and weakness. Central nervous system side effects are rarer and include mental status changes, nervousness, depression, and insomnia. Mood swings, increased appetite, and difficulty swallowing are not side effects of this medication.
The nurse is providing instructions to a client with chronic atrial fibrillation who is being started on quinidine sulfate. The nurse should plan to provide which instruction to the client? a) Wear a Medic-Alert bracelet. b) Take the medication only on an empty stomach. c) Stop taking the prescribed digoxin (Lanoxin) when this medication is started. d) Open the sustained-release capsules and mix with applesauce if the medication is difficult to swallow.
a) Wear a Medic-Alert bracelet. Rationale: The client should be instructed to wear a Medic-Alert bracelet or tag and continue taking digoxin as prescribed. The client should be instructed to take quinidine sulfate exactly as prescribed. The client should not chew the sustained-release capsules or open the capsules and mix them with food. Quinidine sulfate is administered for atrial flutter or fibrillation only after the client has been digitalized.
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 (Activase). To achieve the best therapeutic outcome, the nurse understands this medication must be administered at which time? a) Within 4 to 6 hours after onset of chest pain b) Concurrently with the administration of heparin c) With the administration solution set protected from light d) After the results of all laboratory tests have been received
a) Within 4 to 6 hours after onset of chest pain 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.
The nurse has provided instructions to a client receiving enalapril maleate (Vasotec). Which statement by the client indicates a need for further instruction? a) "I need to rise slowly from a lying to sitting position." b) "I need to notify the health care provider if fatigue occurs." c) "I need to notify the health care provider (HCP) if a sore throat occurs." d) "I know that several weeks of therapy may be required for the full therapeutic effect."
b) "I need to notify the health care provider if fatigue occurs." 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 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.
The clinic nurse is providing instructions to a client with hypertension who will be taking captopril (Capoten). Which statement by the client indicates a need for further instruction? a) "I need to change positions slowly." b) "I need to avoid taking hot baths or showers." c) "I need to drink at least 4 quarts of water daily." d) "I need to sit down and rest if dizziness or lightheadedness occurs."
c) "I need to drink at least 4 quarts of water daily." 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 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.
A client is to be discharged from the hospital on quinidine gluconate to control ventricular ectopy. The nurse provides instructions to the client about the medication. Which statement by the client indicates a need for further instruction? a) "The best time to schedule this medication is with meals." b) "I need to avoid alcohol, caffeine, and cigarettes while I am on this medication." c) "I need to stop the medication immediately if diarrhea, nausea, or vomiting occurs." d) "I need to take this medication regularly, even if the heartbeat feels strong and regular."
c) "I need to stop the medication immediately if diarrhea, nausea, or vomiting occurs." Rationale: Quinidine gluconate is an antidysrhythmic medication used to maintain normal sinus rhythm after conversion of atrial fibrillation or atrial flutter. Diarrhea, nausea, vomiting, loss of appetite, and dizziness all are common side effects of quinidine gluconate. If any of these occur, the health care provider (HCP) or the nurse should be notified; however, the medication should never be discontinued abruptly. Rapid decrease in medication levels of antidysrhythmics could precipitate dysrhythmia. The other options indicate correct information.
A client with hypertension has a new prescription for a medication called moexipril (Univasc). The nurse plans to provide written directions that tell the client to take the medication at which time? a) At bedtime b) With meals c) 1 hour before meals d) With a snack in late afternoon
c) 1 hour before meals Rationale: Moexipril (Univasc) is an angiotensin-converting enzyme (ACE) inhibitor. The client should be instructed to take the medication at least 1 hour before meals. The other ACE inhibitor that should be taken 1 hour before meals is captopril (Capoten).
The nurse is preparing to administer furosemide (Lasix) 40 mg by intravenous (IV) injection (IV push) to a client. The nurse should administer the medication over which time period? a) 10 seconds b) 30 seconds c) 1 minute d) 5 minutes
c) 1 minute 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 1 and 2 identify administration times that are too rapid and could cause adverse effects. Option 4 is too slow of a time period for administration and may affect effectiveness of the IV medication.
The nurse is reviewing the assessment findings for a client who has been taking spironolactone (Aldactone) 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? a) Client complaint of dry skin b) A potassium level of 3.5 mEq/L c) A potassium level of 5.8 mEq/L d) Client complaint of constipation
c) A potassium level of 5.8 mEq/L Rationale: Spironolactone (Aldactone) is a potassium-retaining diuretic. Side 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 effects include nausea, vomiting, cramping, diarrhea, headache, ataxia, drowsiness, confusion, and fever.
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? a) Evaluate pupil response. b) Place the client on the left side. c) Administer the prescribed analgesic. d) Notify the health care provider (HCP) immediately.
c) Administer the prescribed analgesic.
A client is scheduled for a dose of ramipril (Altace). The nurse should check which measurement before administering the medication? a) Weight b) Apical pulse c) Blood pressure d) Potassium level
c) Blood pressure Rationale: Ramipril (Altace) is an angiotensin-converting enzyme (ACE) inhibitor, and a serious side effect of this drug 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.
The health care provider (HCP) writes a prescription for atorvastatin (Lipitor) 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? a) Renal calculi b) Chronic heart failure c) Cirrhosis of the liver d) Coronary artery disease
c) Cirrhosis of the liver
Fenofibrate (Tricor) is prescribed for a client with hyperlipidemia. The nurse reviews the client's medical history for the presence of what condition that contraindicates the use of this medication? a) Angina b) Mitral valve stenosis c) Cirrhosis of the liver d) Coronary artery disease
c) Cirrhosis of the liver Rational: 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.
A client who began medication therapy with prazosin hydrochloride (Minipress) 1 week earlier arrives at the health care clinic for follow-up evaluation and care. The nurse interprets that the client is experiencing the expected benefit of therapy if which is noted? a) Increased pulse b) Increased platelet count c) Decreased blood pressure d) Decreased blood glucose level
c) Decreased blood pressure 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.
Atenolol (Tenormin) has been prescribed for a client, and the client asks the nurse about the side effects of the medication. What should the nurse tell the client is an occasional side effect of this medication? a) Dry skin b) Flushing c) Decreased libido d) Increased blood pressure
c) Decreased libido Rationale: Atenolol is a β-adrenergic blocker that is used as an antihypertensive, antianginal, and antidysrhythmic. It blocks β-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. Frequent side effects include hypotension manifested as dizziness, nausea, diaphoresis, headache, cold extremities, fatigue, and constipation or diarrhea. Occasional side effects include insomnia, flatulence, urinary frequency, and impotence or decreased libido.
Atorvastatin (Lipitor) has been prescribed for a client, and the client asks the nurse about the action of the medication. How should nurse respond about the action of this medication? a) Increases plasma cholesterol b) Increases plasma triglycerides c) Decreases low-density lipoproteins (LDLs) d) Decreases high-density lipoproteins (HDLs)
c) Decreases low-density lipoproteins (LDLs) 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).
Atorvastatin (Lipitor) has been prescribed for a client, and the client asks the nurse about the side effects of the medication. What should the nurse tell the client is a frequent side effect of this medication? a) Tremors b) Lethargy c) Headache d) Tiredness
c) Headache 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 nurse is planning to administer hydrochlorothiazide to a client. The nurse understands that which is a concern related to the administration of this medication? a) Hypouricemia, hyperkalemia b) Increased risk of osteoporosis c) Hypokalemia, hyperglycemia, sulfa allergy d) Hyperkalemia, hypoglycemia, penicillin allergy
c) Hypokalemia, hyperglycemia, sulfa allergy 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.
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? a) Reduce pain. b) Reduce inflammation. c) Inhibit platelet aggregation. d) Maintain a normal body temperature.
c) Inhibit platelet aggregation.
A client receiving total parenteral nutrition (TPN) has a history of heart failure. The health care provider has prescribed furosemide (Lasix) 40 mg by mouth daily to prevent fluid overload. Which laboratory value should the nurse monitor to identify the presence of an adverse effect from this medication? a) Sodium b) Glucose c) Potassium d) Magnesium
c) Potassium Rationale: Furosemide is a potassium-losing diuretic, and insufficient replacement of potassium may lead to hypokalemia. Although the sodium, glucose, and magnesium levels may be monitored, these laboratory values are not specific to administering furosemide.
A client is being treated for moderate hypertension and has been taking diltiazem (Cardizem) 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 nurse understands that this medication will provide which therapeutic effect for this new diagnosis? a) Increases oxygen demands within the myocardium b) Increases the force of contraction of ventricular tissues c) Prevents influx of calcium ions in vascular smooth muscle d) Leads to an increase in calcium absorption in the vascular smooth muscle
c) Prevents influx of calcium ions in vascular smooth muscle 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.
Lisinopril (Prinivil) has been prescribed for a client. What should the nurse instruct the client to do? a) Take the medication with food only. b) Discontinue the medication if nausea occurs. c) Rise slowly from a reclining to a sitting position. d) Expect to note a full therapeutic effect immediately
c) Rise slowly from a reclining to a sitting position. 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.
A nurse prepares to administer sodium polystyrene sulfonate (Kayexalate) to a client. Before administering the medication, the nurse reviews the action of the medication and understands that which is released by this medication? a) Bicarbonate in exchange for primarily sodium ions b) Potassium ions in exchange for primarily sodium ions c) Sodium ions in exchange for primarily potassium ions d) Sodium ions in exchange for primarily bicarbonate ions
c) Sodium ions in exchange for primarily potassium ions Rationale: Sodium polystyrene sulfonate 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.
A client is taking amiloride (Midamor) 10 mg orally daily. What medication instruction should the nurse provide to the client? a) Take the dose without food. b) Eat foods with extra sodium. c) Take the dose in the morning. d) Withhold the dose if the blood pressure is high.
c) Take the dose in the morning. Rationale: Amiloride is a potassium-retaining diuretic used to treat edema or hypertension. The daily dose should be taken in the morning to avoid nocturia, and the medication should be taken with food to increase bioavailability. Sodium should be restricted or limited as prescribed. Increased blood pressure is not a reason to withhold the medication; rather, it may be an indication for its use.
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? a) Thrombolytics suppress the production of fibrin. b) Thrombolytics act to prevent thrombus formation. c) Thrombolytics act to dissolve thrombi that have already formed. d) Thrombolytics have been proved to reverse all detrimental effects of heart attacks.
c) Thrombolytics act to dissolve thrombi that have already formed. 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 nurse has completed giving medication instructions to a client receiving benazepril (Lotensin). Which client statement indicates to the nurse that the client needs further instruction? a) "I need to change positions slowly." b) "I will monitor my blood pressure every week." c) "I will report signs and symptoms of infection immediately." d) "I can use salt substitutes freely and eat foods high in potassium."
d) "I can use salt substitutes freely and eat foods high in potassium." Rationale: The client taking an angiotensin-converting enzyme 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. Additionally, salt substitutes and high-potassium foods should be avoided because they contain potassium and increase the risk for hyperkalemia.
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? a) "I need to wait until the next day to apply a new patch if it falls off." b) "I need to alternate daily dosage times to prevent tolerance to the medication." c) "I need to place the patch in the area of a skin fold to promote better adherence." d) "I need to apply the patch in the morning and leave it in place for 12 to 14 hours as directed."
d) "I need to apply the patch in the morning and leave it in place for 12 to 14 hours as directed." 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.
A client with chronic atrial fibrillation is being started on quinidine sulfate (Quinidine) as maintenance therapy for dysrhythmia suppression, and the nurse provides instructions to the client about the medication. Which statement by the client indicates a need for further instruction? a) "I will avoid chewing the tablets." b) "I will take the dose at the same time each day." c) "I will take the medication with food if my stomach becomes upset." d) "I will stop taking the prescribed anticoagulant after starting this new medication."
d) "I will stop taking the prescribed anticoagulant after starting this new medication." Rationale: Medication-specific teaching points for quinidine sulfate include to take the medication exactly as prescribed, not to chew the tablets, to take with food if stomach upset occurs, to wear a medical identification (e.g., Medic-Alert) bracelet or tag, and to have periodic checks of heart rhythm and blood counts. The client should not stop taking a prescribed medication unless specifically prescribed by the health care provider.
A client is prescribed nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? a) "It is not necessary to avoid the use of alcohol." b) "The medication should be taken with meals to decrease flushing." c) "Clay-colored stools are a common side effect and should not be of concern." d) "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."
d) "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing." Rationale: Flushing is a side 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 side 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 immediately reported to the health care provider (HCP).
A client is being discharged on warfarin sodium (Coumadin), 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? a) "I'll stop my medication if I see bruising." b) "Stiff joints are common while taking warfarin." c) "This medication will prevent me from having a stroke." d) "If I notice blood-tinged urine, I will call the health care provider."
d) "If I notice blood-tinged urine, I will call the health care provider." Rationale: Warfarin (Coumadin) is an anticoagulant that is used for long-term prophylaxis of thrombosis. Clients must receive detailed instructions regarding 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. Option 2 is unrelated to the use of warfarin, and option 3 is not completely accurate regarding prevention of a stroke.
A health care provider (HCP) prescribes quinidine gluconate for a client. The nurse decides to withhold the medication and contact the HCP if which assessment finding is documented in the client's medical record? a) Muscle weakness b) History of asthma c) Presence of infection d) Complete atrioventricular (AV) block
d) Complete atrioventricular (AV) block Rationale: Quinidine gluconate is an antidysrhythmic medication used to maintain normal sinus rhythm after conversion of atrial fibrillation or atrial flutter. It is contraindicated in complete AV block, intraventricular conduction defects, and abnormal impulses and rhythms caused by escape mechanisms, and with myasthenia gravis. It is used with caution in clients with preexisting muscle weakness, asthma, infection with fever, and hepatic or renal insufficiency.
A client who has begun taking betaxolol (Kerlone) demonstrates an effective response to the medication as indicated by which nursing assessment finding? a) Increase in edema to 3+ b) Weight gain of 5 pounds c) Decrease in pulse rate from 74 beats/min to 58 beats/min d) Decrease in blood pressure from 142/94 mm Hg to 128/82 mm Hg
d) Decrease in blood pressure from 142/94 mm Hg to 128/82 mm Hg Rationale: Betaxolol is a β-adrenergic blocking agent used to lower blood pressure, relieve angina, or decrease the occurrence of dysrhythmias. Side effects include bradycardia and signs and symptoms of heart failure, such as increased edema and weight gain.
A nurse should educate the client receiving pravastatin (Pravachol) to immediately report which finding? a) Fatigue b) Diarrhea c) Sore throat d) Muscle pain
d) Muscle pain Rationale: Pravastatin is used to treat hyperlipidemia. Muscle pain could indicate rhabdomyolysis, a serious complication of this medication. It must be reported immediately.
The nurse has a prescription to give a first dose of hydrochlorothiazide (HydroDIURIL) to an assigned client. The nurse would question the prescription if the client has a history of allergy to which item? a) Iodine b) Shellfish c) Penicillin d) Sulfa drugs
d) Sulfa drugs
A client being treated for heart failure is administered intravenous bumetanide. Which outcome indicates the medication has achieved the expected effect? a) Cough becomes productive of frothy pink sputum b) The serum potassium level changes from 3.8 to 3.1 mEq/L c) B-natriuretic peptide (BNP) factor increases from 200 to 262 pg/mL d) Urine output increases from 10 mL/hour to greater than 50 mL hourly
d) Urine output increases from 10 mL/hour to greater than 50 mL hourly Rationale: Bumetanide is a diuretic and expected outcomes include increased urine output, decreased crackles, and decreased weight.
A health care provider writes a prescription for digoxin (Lanoxin), 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? a) Count the radial and carotid pulses every morning. b) Check the blood pressure every morning and evening. c) Stop taking the medication if the pulse is faster than 100 beats/min. d) Withhold the medication, and call the health care provider if the pulse is slower than 60 beats/min.
d) Withhold the medication, and call the health care provider if the pulse is slower than 60 beats/min.
