NUR 302 - Pharmacology Exam 3 Study Questions

most likely to occur while he is reclining on the hospital stretcher? a. symptomatic hypotension b. headache c. GI distress d. nausea

b.

The healthcare provider prescribes heparin 2500 units subcutaneous daily. The drug is available in 10,000 units per mL. How may milliliters will the nurse give?

0.25 mL

The patient's heparin is infusing at 11 mL/hr. The bag of fluid is mixed 25,000 units of heparin in 250 mL D5W. What hourly dose is the patient receiving?

1100 units/hr

The healthcare provider prescribes heparin 900 units/hr. The label on the IV bag reads Heparin 10,000 units in 500 mL D5W. How many mL/hr will deliver the correct dose?

45 mL

Which instruction should the nurse provide when teaching a patient to mix regular insulin and NPH insulin in the same syringe? A. "Draw up the clear regular insulin first, followed by the cloudy NPH insulin." B. "It is not necessary to rotate the NPH insulin vial when it is mixed with regular insulin." C. "The order of drawing up insulin does not matter as long as the insulin is refrigerated." D. "Rotate subcutaneous injection sites each day among the arm, thigh, and abdomen."

A. "Draw up the clear regular insulin first, followed by the cloudy NPH insulin." To ensure a consistent response, only NPH insulin is appropriate for mixing with a short-acting insulin. Unopened vials of insulin should be refrigerated; current vials can be kept at room temperature for up to 1 month. Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could alter the pharmacokinetics of subsequent doses taken out of the regular insulin vial. NPH insulin is a cloudy solution, and it should always be rotated gently to disperse the particles evenly before loading the syringe. Subcutaneous injections should be made using one region of the body (eg, the abdomen or thigh) and rotated within that region for 1 month.

A teaching plan for a patient who is taking lispro [Humalog] should include which instruction by the nurse? A. "Inject this insulin with your first bite of food, because it is very fast acting." B. "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack." C. "This insulin needs to be mixed with regular insulin to enhance the effects." D. "To achieve tight glycemic control, this is the only type of insulin you'll need."

A. "Inject this insulin with your first bite of food, because it is very fast acting." Lispro is a rapid-acting insulin and has an onset of action of 15 to 30 minutes with a peak action of about 2 hours, not 8 to 10 hours. Because of its rapid onset, it is administered immediately before a meal or with meals to control the blood glucose rise after meals. Lispro insulin must be combined with an intermediate- or a long-acting insulin, not regular insulin (which also is a short-duration insulin), for glucose control between meals and at night. To achieve tight glycemic control, patients must combine different types of insulin based on their duration of action.

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

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

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

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

Before administering celecoxib [Celebrex], it is most important for the nurse to assess the patient for a history of what? A. Allergy to sulfonamides B. History of hepatitis C C. Hypothyroidism D. Diabetes mellitus

A. Allergy to sulfonamides Celecoxib contains a sulfur molecule and therefore can precipitate an allergic reaction in patients allergic to sulfonamides. Accordingly, the drug should be avoided by patients with a sulfa allergy. The other conditions listed should be part of the nurse's assessment but are not the most important.

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

A. Analyze heart rate and rhythm. Before giving digoxin, the nurse will assess the heart rate and rhythm. The dosage will be held and the prescriber notified if the heart rate is below 60 beats per minute or if the cardiac rhythm has changed. Digoxin can cause bradycardia and electrical changes in the heart.

A patient is scheduled to start taking insulin glargine [Lantus]. On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication? A. Blood glucose control for 24 hours B. Mealtime coverage of blood glucose C. Less frequent blood glucose monitoring D. Peak effect achieved in 2 to 4 hours

A. Blood glucose control for 24 hours Insulin glargine is administered as a once-daily subcutaneous injection for patients with type 1 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration, up to 24 hours, with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.

The nurse knows that diuretics mostly affect which function of the kidneys? A. Cleansing and maintenance of extracellular fluid volume B. Maintenance of acid-base balance C. Excretion of metabolic waste D. Elimination of foreign substances

A. Cleansing and maintenance of extracellular fluid volume Most diuretics block sodium and chloride reabsorption, thus affecting the maintenance of extracellular fluid volume.

Before administering metformin [Glucophage], the nurse should notify the prescriber about which laboratory value? A. Creatinine (Cr) level of 2.1 mg/dL B. Hemoglobin (Hgb) level of 9.5 gm/dL C. Sodium (Na) level of 131 mEq/dL D. Platelet count of 120,000/mm3

A. Creatinine (Cr) level of 2.1 mg/dL Metformin can reach toxic levels in individuals with renal impairment, which is indicated by a rise in the serum creatinine level. The prescriber may have to be notified of the hemoglobin, sodium, and platelet values, but they would not affect the administration of metformin.

The nurse should monitor for which adverse effect after administering hydrochlorothiazide [HydroDIURIL] and digoxin [Lanoxin] to a patient? A. Digoxin toxicity B. Decreased diuretic effect C. Dehydration D. Heart failure

A. Digoxin toxicity Digoxin levels have an inverse relationship with potassium levels. Because hydrochlorothiazide can lower potassium levels, combined use of hydrochlorothiazide and digoxin poses a risk for elevated digoxin levels and ensuing digoxin toxicity.

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

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

Which medications should be used with caution in a hypertensive diabetic patient? Select all that apply. A. Furosemide [Lasix] B. Metoprolol [Lopressor] C. Diltiazem [Cardizem] D. Hydrochlorothiazide [HCTZ] E. Enalapril [Vasotec]

A. Furosemide [Lasix], B. Metoprolol [Lopressor] and D. Hydrochlorothiazide [HCTZ] Hydrochlorothiazide and furosemide promote hyperglycemia, and metoprolol suppresses glycogenolysis and can mask signs of hypoglycemia. Therefore, these medications should be administered with caution to patients with diabetes. Diltiazem and enalapril do not cause either of these effects.

A nurse teaches a patient who takes daily low-dose aspirin for protection against myocardial infarction and stroke to avoid also taking which medication? A. Ibuprofen [Motrin] B. Zolpidem [Ambien] C. Loratadine [Claritin] D. Diphenhydramine [Benadryl]

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

The nurse is administering intravenous lidocaine [Xylocaine] to a patient with a ventricular dysrhythmia. What is the priority nursing intervention to prevent a potential complication with this drug? A. Monitor the electrocardiogram (ECG). B. Obtain a complete blood count. C. Instruct to report any chest pain. D. Keep naloxone [Narcan] at the bedside.

A. Monitor the electrocardiogram (ECG). Continuous ECG monitoring is required during lidocaine infusions to evaluate cardiac response and adjust dosage accordingly and detect toxicity. Blood counts are not necessary, because lidocaine is not linked to blood dyscrasias. Lidocaine preferably is given intravenously (IV) rather than intramuscularly (IM). Sudden onset of chest pain is a sign of arterial embolism, which is a possible adverse effect of quinidine, not lidocaine. Naloxone is a reversal agent for opioids and is not used with lidocaine.

A patient is receiving a continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor? Select all that apply. A. Platelets B. Vitamin K C. Prothrombin time (PT) D. International normalized ratio (INR) E. Activated partial thromboplastin time (aPTT)

A. Platelets, and E. Activated partial thromboplastin time (aPTT) To reduce the risk of heparin-induced thrombocytopenia (HIT), platelet counts should be monitored. Heparin therapy is monitored by measuring the laboratory test activated partial thromboplastin time (aPTT). Warfarin therapy is monitored by measuring prothrombin time (PT) and results are expressed as an international normalized ratio (INR). Vitamin K is not monitored for a heparin infusion.

A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan? A. Refer the patient to a diabetes educator because the result reflects poor glycemic control. B. Glycemic control is adequate; no changes are needed. C. Hypoglycemia is a risk; teach the patient the symptoms. D. Instruct the patient to limit activity and weekly exercise.

A. Refer the patient to a diabetes educator because the result reflects poor glycemic control. Glycated hemoglobin (HbA1c) is a measure of plasma glucose levels on average over the previous 2- to 3-month period. The target value is 6.5% or lower. If it is greater than 6.5%, a diabetes educator is an additional resource who can facilitate lifestyle, exercise, and medication changes. Hypoglycemia is not a concern, because elevated HbA1c levels indicate poor glycemic control. Exercise should be part of an overall management program, because it counteracts insulin resistance.

In the failing heart, arterial pressure falls, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. The nurse understands increased sympathetic activity will produce which response? A. Tachycardia B. Bradypnea C. Hypotension D. Hypoglycemia

A. Tachycardia Increased sympathetic activity results in an increased heart rate (tachycardia), increased contractility, increased venous tone, and increased arteriolar tone (elevated blood pressure). Sympathetic stimulation also causes bronchodilation (not bradypnea) and possibly hyperglycemia.

The nurse is providing discharge teaching for a patient with a new prescription for a nitroglycerin transdermal patch. Which statement by the patient indicates a need for further teaching? A. "I will remove my patch at bedtime each evening." B. "I will limit my alcohol to one drink per day." C. "I will not use Viagra as long as I am on nitroglycerin." D. "I will move slowly when changing positions."

B. "I will limit my alcohol to one drink per day." Alcohol can intensify the hypotensive effects of nitrates, so the patient should avoid alcohol. Patients develop tolerance to nitrates rather quickly. Patients receiving transdermal nitrates are recommended to have 10 to 12 hours of patch-free time each evening. Sildenafil [Viagra] and other drugs for erectile dysfunction also can cause significant hypotension with nitroglycerin and are contraindicated. Nitroglycerin causes orthostatic hypotension; therefore, patients should change positions slowly.

A nurse caring for a patient who has diabetic ketoacidosis recognizes which characteristics in the patient? Select all that apply. A. Type 2 diabetes B. Altered fat metabolism leading to ketones C. Arterial blood pH of 7.35 to 7.45 D. Sudden onset, triggered by acute illness E. Plasma osmolality of 300 to 320 mOsm/L

B. Altered fat metabolism leading to ketones, d. Sudden onset, triggered by acute illness and E. Plasma osmolality of 300 to 320 mOsm/L Diabetic ketoacidosis is the most severe manifestation of insulin deficiency in patients with type 1 diabetes. It develops and worsens acutely over several hours to days. Alterations in fat metabolism lead to the production of ketones and ketoacids. Increased ketoacid levels lead to a fall in arterial blood pH below 7.35. Altered glucose metabolism leads to hyperglycemia, water loss, and an elevated plasma osmolality (285 to 295 mOsm/L).

A patient is receiving isosorbide dinitrate [Isordil] 20 mg 3 times per day for management of newly diagnosed stable angina. Which assessment finding would require an immediate nursing intervention? A. A change in blood pressure from 122/70 to 108/66 mm Hg B. An increase in the resting heart rate to 110 beats per minute from baseline rates of 68 to 72 beats per minute C. A headache the patient rates as a 5 on a pain scale of 0 to 10 D. Report of increased frequency of urination

B. An increase in the resting heart rate to 110 beats per minute from baseline rates of 68 to 72 beats per minute Because nitrates lower blood pressure, isosorbide dinitrate can activate the baroreceptor reflex, causing sympathetic stimulation of the heart; this negates the benefits of treatment with nitrates, because it increases the cardiac oxygen demand. For these reasons, addressing the tachycardia becomes the nurse's immediate priority. A decrease in blood pressure would be expected, and there is no indication the patient is experiencing side effects of decreased cardiac output. Headache is an adverse effect and should be treated (eg, with acetaminophen), but it does not require immediate intervention. Increased frequency of urination may be related to the presence of a urinary tract infection and requires follow-up, but it is not the immediate concern.

Which classes of medications are prescribed as initial therapy for hypertension after a myocardial infarction (MI)? A. Diuretic and beta blocker B. Beta blocker and ACE inhibitor C. ACE inhibitor and calcium channel blocker D. Diuretic and calcium channel blocker

B. Beta blocker and ACE inhibitor Beta blockers and ACE inhibitors, as well as aldosterone antagonists, are the drug classes recommended for initial therapy of hypertension after an MI. Diuretics and calcium channel blockers are not part of initial therapy for hypertension after an MI.

The nurse is caring for a patient prescribed a cholesterol-lowering drug. Which drug is least likely to cause systemic side effects? A. Simvastatin [Zocor] B. Colesevelam [Welchol] C. Nicotinic acid [Niaspan] D. Gemfibrozil [Lopid]

B. Colesevelam [Welchol] Colesevelam, a bile acid sequestrant, is a nonabsorbable resin that works directly in the gastrointestinal tract. Because it and other bile acid sequestrants (eg, cholestyramine [Questran] and colestipol [Colestid]) are not absorbed, they do not have systemic effects. The bile acid sequestrants' most common complication is constipation. The other agents have potential systemic adverse effects.

A patient is prescribed lisinopril [Prinivil] 40 mg by mouth once a day for hypertension. For which therapeutic effect will the nurse monitor? A. Slowing of the heart rate B. Decrease in blood pressure C. Symptoms such as dizziness and fainting D. Pulse oximetry oxygen saturation of 100%

B. Decrease in blood pressure The therapeutic effect of ACE inhibitors is to reduce blood pressure in patients with hypertension. ACE inhibitors do not affect patients' heart rate. Dizziness and fainting are symptoms of hypotension. ACE inhibitors do not affect oxygen saturation.

The nurse is caring for a patient who has diabetes and hypertension. Which medication is most likely to be prescribed to treat this patient's hypertension? A. Hydrochlorothiazide [HCTZ] B. Enalapril [Vasotec] C. Propranolol [Inderal] D. Methyldopa [Aldomet]

B. Enalapril [Vasotec] Preferred antihypertensives for patients with diabetes include ACE inhibitors (enalapril), ARBs, and calcium channel blockers. ACE inhibitors are particularly useful, because they slow the progression of diabetic nephropathy in addition to lowering blood pressure. Thiazide diuretics promote hyperglycemia and are used with caution.

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

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

A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. What medication would be appropriate for this patient who has a history of heparin-induced thrombocytopenia (HIT)? A. Warfarin [Coumadin] B. Lepirudin [Refludan] C. Bivalirudin [Angiomax] D. Eptifibatide [Integrilin]

B. Lepirudin [Refludan] Lepirudin [Refludan] and argatroban are indicated for the treatment of thrombosis in patients with a history of HIT. Because these medications are given as an initial IV bolus followed by a continuous infusion, the desired effect of direct thrombin inhibition is achieved more quickly. Because of warfarin's delayed onset of effects, it is not useful in emergency situations, such as pulmonary embolism (PE). Intravenous bivalirudin given in combination with aspirin helps prevent clot formation in patients undergoing coronary angioplasty. Eptifibatide [Integrilin], a glycoprotein IIb/IIIa receptor inhibitor, is an antiplatelet drug that is used short term to prevent ischemic events in patients who have acute coronary syndrome or who are undergoing percutaneous coronary intervention.

The nurse is caring for a patient with bipolar disorder treated with lithium [Eskalith]. The patient has a new prescription for captopril [Capoten] for hypertension. The combination of these two drugs makes which assessment particularly important? A. Potassium level B. Lithium level C. Creatinine level D. Blood pressure

B. Lithium level ACE inhibitors, such as captopril, can cause lithium accumulation. Lithium levels should be monitored on a regular basis. ACE inhibitors can cause hyperkalemia, renal insufficiency in some patients, and hypotension. However, the combination of lithium and captopril would not increase the risk of these effects.

The nurse is caring for a patient with hypertension who is receiving verapamil [Calan]. The patient has a healthy heart. What pharmacodynamic effects does the nurse expect from this drug? Multiple Answers A. Peripheral vasoconstriction B. Peripheral vasodilation C. Coronary vasodilation D. Increased heart rate E. Increased force of contraction

B. Peripheral vasodilation and C. Coronary vasodilation Verapamil causes peripheral vasodilation and coronary vasodilation, which lead to decreased blood pressure and improved coronary perfusion. It does not cause vasoconstriction and usually has little effect on the heart rate or contractility in healthy hearts.

A patient who has type 2 diabetes is taking nateglinide [Starlix]. Which response should a nurse expect the patient to have if the medication is achieving the desired therapeutic effect? A. Inhibition of carbohydrate digestion B. Promotion of insulin secretion C. Decreased insulin resistance D. Inhibition of ketone formation

B. Promotion of insulin secretion Nateglinide is a meglitinide medication that acts to increase pancreatic insulin release. It is used as an adjunct to calorie restriction and exercise to maintain glycemic control in patients with type 2 diabetes. It does not act to reduce insulin resistance or inhibit carbohydrate digestion. It should not be used to manage diabetic ketone formation, because its glucose-lowering effects are too slow to be of benefit.

The nurse is interpreting an electrocardiogram (ECG). Which component represents the depolarization of the ventricles? A. P wave B. QRS complex C. ST segment D. T wave

B. QRS complex An electrocardiogram has several components. The P wave is caused by depolarization in the atria; the QRS complex is caused by depolarization of the ventricles; and the T wave is caused by repolarization of the ventricles. The ST segment may be depressed in some clinical conditions.

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

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

A nurse assesses a patient who is taking pramlintide [Symlin] with mealtime insulin. Which finding requires immediate follow-up by the nurse? A. Skin rash B. Sweating C. Itching D. Pedal edema

B. Sweating Pramlintide is a new type of antidiabetic medication used as a supplement to mealtime insulin in patients with type 1 and 2 diabetes. Hypoglycemia, which is manifested by sweating, tremors, and tachycardia, is the adverse reaction of most concern. Skin rash, itching, and edema are not adverse effects of pramlintide.

The heart undergoes cardiac remodeling during the initial phase of heart failure. Which cardiac geometric change occurs during heart failure? A. Ventricular constriction B. Ventricular wall thickening C. Ventricular atrophy D. Ventricles become more cylindric

B. Ventricular wall thickening An increase in ventricular wall thickness, also called ventricular hypertrophy, is characteristic of the remodeling process during the initial phase of heart failure. The ventricles also dilate and become more spherical (less cylindric). This change in cardiac shape typically occurs after cardiac injury under the influence of the neurohormonal systems, such as the sympathetic nervous system and renin-angiotensin-aldosterone system.

Which instruction about clopidogrel [Plavix] should the nurse include in the discharge teaching for a patient who has received a drug-eluting coronary stent? A. "Constipation is a common side effect of clopidogrel, so take a stool softener daily." B. "If you see blood in your urine or black stools, stop the clopidogrel immediately." C. "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." D. "Keep the amounts of foods containing vitamin K, such as mayonnaise, canola and soybean oil, and green, leafy vegetables, consistent in your diet."

C. "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." Proton pump inhibitors (PPIs), such as omeprazole [Prilosec], and CYP2C1 inhibitors, such as cimetidine [Tagamet], can be purchased over the counter to treat heartburn. However, patients taking clopidogrel should consult their healthcare provider before using them. PPIs and CYP2C1 inhibitors can reduce the antiplatelet effects of clopidogrel. Diarrhea (5% incidence), not constipation, is a side effect of clopidogrel. Patients should immediately contact their healthcare provider if signs of bleeding occur, such as bloody urine, stool, or emesis. The drug should not be stopped until the prescriber advises it, because this could lead to coronary stent restenosis. Consistency of vitamin K intake is indicated while taking warfarin [Coumadin].

The nurse is evaluating the teaching done with a patient who has a new prescription for fosinopril [Monopril]. Which statement by the patient indicates a need for further teaching? A. "I can take this medicine with breakfast each morning." B. "I will call if I notice a rash or wheals on my skin." C. "I will use a salt substitute to lower my sodium intake." D. "I will call if I develop a bothersome cough."

C. "I will use a salt substitute to lower my sodium intake." Salt substitutes contain potassium and may increase the risk of hyperkalemia with ACE inhibitors, such as fosinopril. The patient should not take potassium supplements or use salt substitutes. The other statements are appropriate for this patient.

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

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

The healthcare provider orders furosemide [Lasix] 20 mg IV twice daily. The medication available is furosemide [Lasix] 10 mg/mL. How many mL will the nurse administer with each dose? A. 0.5 mL B. 1 mL C. 2 mL D. 4 mL

C. 2 mL The healthcare provider has ordered 20 mg of furosemide [Lasix], which is available in 10 mg/mL. Multiply 10 mg/mL by 2 to equal 20 mg/2 mL. The nurse will administer 2 mL of furosemide to equal 20 mg with each dose.

The healthcare provider orders mannitol 72 gm infusion over 24 hours. The nurse plans to set the infusion pump for how many grams per hour? A. 1 gm B. 2 gm C. 3 gm D. 4 gm

C. 3 gm To infuse 72 grams over 24 hours, divide 72 by 24 for the total per hour. 72 divided by 24 equals 3 grams per hour.

A patient with an acute myocardial infarction is prescribed an intravenous (IV) bolus of tenecteplase [TNKase]. The patient weighs 160 pounds. The nurse will administer what dosage? A. 30 mg B. 35 mg C. 40 mg D. 45 mg

C. 40 mg 160 lbs is 72.72 kg. Body weight of 70 to 79.9 kg is prescribed 40 mg of tenecteplase as a single IV bolus.

A patient with an elevated triglyceride level is prescribed a sustained-release form of nicotinic acid [Slo-Niacin]. Which laboratory value is most important for the nurse to monitor for in this patient? A. Blood urea nitrogen (BUN) B. Complete blood count (CBC) C. Alanine aminotransferase (ALT) D. Creatine kinase (CK)

C. Alanine aminotransferase (ALT) The alanine aminotransferase (ALT or SGPT) would receive priority, because nicotinic acid is hepatotoxic and severe liver injury has been reported. Hepatotoxicity is more common with the sustained-release, controlled-release, or timed-released formulation.

The nurse is caring for several patients. For which patient diagnosis would a prescription for nifedipine [Adalat] be least appropriate? A. Angina pectoris B. Essential hypertension C. Atrial fibrillation D. Vasospastic angina

C. Atrial fibrillation Nifedipine produces very little blockade of the calcium channels of the heart; therefore, it is ineffective for treating dysrhythmias, such as atrial fibrillation. Therapeutic uses for nifedipine include the treatment of angina pectoris, essential hypertension, and vasospastic angina.

Which statements about the care of a patient with aspirin poisoning does the nurse identify as true? Select all that apply. A. Warming blankets are routinely used to raise the patient's temperature. B. Diuretics and fluid restrictions are needed to correct the fluid overload commonly seen with aspirin poisoning. C. Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylates. D. Activated charcoal is contraindicated in the treatment of aspirin poisoning. E. Hemodialysis or peritoneal dialysis can accelerate salicylate removal.

C. Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylates. and E. Hemodialysis or peritoneal dialysis can accelerate salicylate removal. Aspirin poisoning is an acute medical emergency that requires hospitalization. Treatment is largely supportive and consists of external cooling (eg, sponging with tepid water), infusion of fluids (to correct dehydration and electrolyte loss), infusion of bicarbonate (to reverse acidosis and promote renal excretion of salicylates), and mechanical ventilation (if respiration is severely depressed). Absorption of aspirin can be reduced by gastric lavage and by giving activated charcoal. If necessary, hemodialysis or peritoneal dialysis can accelerate salicylate removal.

A patient who took NPH insulin at 0800 reports feeling weak and tremulous at 1700. Which action should the nurse take? A. Take the patient's blood pressure. B. Give the patient's PRN dose of insulin. C. Check the patient's capillary blood sugar. D. Advise the patient to lie down with the legs elevated.

C. Check the patient's capillary blood sugar. The patient is showing symptoms of hypoglycemia at 5 PM. NPH has a peak action of 8 to 10 hours after administration. Based on the duration of action of NPH insulin, the patient's hypoglycemic symptoms are from the 8 AM injection of NPH insulin. An injection of NPH insulin at 2 AM, 1 PM, or 3 PM would not cause hypoglycemic symptoms based on the average duration of action of NPH insulin.

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

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

The nurse plans to closely monitor for which clinical manifestation after administering furosemide [Lasix]? A. Decreased pulse B. Decreased temperature C. Decreased blood pressure D. Decreased respiratory rate

C. Decreased blood pressure High-ceiling loop diuretics, such as furosemide, are the most effective diuretic agents. They produce more loss of fluid and electrolytes than any others. A sudden loss of fluid can result in decreased blood pressure. When blood pressure drops, the pulse probably will increase rather than decrease. Lasix should not affect respirations or temperature. The nurse should also closely monitor the patient's potassium level.

Which medication is not associated with prolongation of the QT interval? A. Dofetilide [Tikosyn] B. Sotalol [Betapace] C. Diltiazem [Cardizem] D. Dronedarone [Multaq]

C. Diltiazem [Cardizem] Diltiazem does not prolong the QT interval. Dofetilide, sotalol, and dronedarone prolong the QT interval, putting the patient at risk for torsades de pointes.

The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin? A. Heart rate of 60 beats per minute B. Blood pressure of 160/88 mm Hg C. Discolored urine D. Inspiratory wheezing

C. Discolored urine The primary and most serious adverse effect of heparin is bleeding. Bleeding can occur from any site and may be manifested in various ways, including reduced blood pressure, increased heart rate, bruises, petechiae, hematomas, red or black stools, cloudy or discolored urine, pelvic pain, headache, and lumbar pain.

The nurse is caring for a patient prescribed aliskiren [Tekturna]. How does this medication lower blood pressure? A. It blocks the conversion of angiotensin I to angiotensin II. B. It prevents angiotensin II from binding to its receptors. C. It inhibits the conversion of angiotensinogen into angiotensin I. D. It selectively blocks aldosterone receptors in the kidneys.

C. It inhibits the conversion of angiotensinogen into angiotensin I. Aliskiren is the first direct renin inhibitor on the market. It binds with renin and thus inhibits the conversion of angiotensinogen to angiotensin I. The other items describe ACE inhibitors, ARBs, and selective aldosterone receptor blockers.

The nurse knows that which statement is accurate for enoxaparin [Lovenox]? A. It equally reduces the activity of thrombin and factor Xa. B. It has selective inhibition of factor Xa and no effect on thrombin. C. It reduces the activity of factor Xa more than the activity of thrombin. D. It has a lower bioavailability and shorter half-life than unfractionated heparin.

C. It reduces the activity of factor Xa more than the activity of thrombin. Enoxaparin acts primarily on factor Xa and also, but to a lesser degree, on thrombin. Unfractionated heparin equally reduces the action of thrombin and factor Xa. Fondaparinux [Arixtra] causes selective inhibition of factor Xa. Low-molecular-weight (LMW) heparins, such as enoxaparin, have greater bioavailability and a longer half-life than unfractionated heparin.

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

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

A patient is scheduled to start taking aspirin for the treatment of rheumatoid arthritis. The nurse anticipates that which medication most likely will be prescribed? A. Docusate sodium [Colace] B. Ascorbic acid (vitamin C) C. Pantoprazole [Protonix] D. Furosemide [Lasix]

C. Pantoprazole [Protonix] Aspirin inhibits COX-2 and thus suppresses inflammation and reduces moderate pain and fever. It also suppresses COX-1, which increases the risk for gastric ulceration and bleeding. This risk can be reduced through administration of a proton pump inhibitor, such as pantoprazole [Protonix]. It is not necessary for a patient to take vitamin C or docusate sodium while taking aspirin. Although aspirin may cause sodium and water retention in patients who have pre-existing renal dysfunction, it is not necessary for all patients to take furosemide [Lasix] with aspirin.

The nurse is caring for a patient who takes spironolactone [Aldactone] and quinapril [Accupril] for treatment of heart failure. What finding indicates a potential interaction between these two drugs? A. Elevated serum quinapril level B. Heart rate of 58 beats per minute C. Potassium level of 5.7 mEq/L D. Glucose level of 180 mg/dL

C. Potassium level of 5.7 mEq/L Both spironolactone, a potassium-sparing diuretic, and quinapril, an angiotensin-converting enzyme (ACE) inhibitor, can increase potassium levels. These agents together do not increase quinapril levels, lower the heart rate, or raise the blood glucose level.

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

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

The nurse is caring for a patient with renal artery stenosis who has been prescribed benazepril [Lotensin]. Which laboratory result indicates an adverse effect of this drug? A. Potassium level of 3.2 mEq/L B. Blood glucose level of 180 mg/dL C. Serum creatinine level of 2.3 mg/dL D. Uric acid level of 10 mg/dL

C. Serum creatinine level of 2.3 mg/dL Patients with bilateral renal artery stenosis are at increased risk for renal insufficiency and failure with angiotensin-converting enzyme (ACE) inhibitors, such as benazepril. ACE inhibitors do not typically cause hypokalemia, hyperglycemia, or hyperuricemia.

A patient is taking glipizide [Glucotrol] and a beta-adrenergic medication. A nurse is teaching hypoglycemia awareness and should warn the patient about the absence of which symptom? A. Vomiting B. Muscle cramps C. Tachycardia D. Chills

C. Tachycardia Glipizide is a sulfonylurea oral hypoglycemic medication that acts to promote insulin release from the pancreas. Beta-adrenergic blockers can mask early signs of sympathetic system responses to hypoglycemia; the most important of these is tachycardia, which is the most common adverse effect of glipizide. Vomiting, muscle cramps, and chills are not symptoms of activation of the sympathetic nervous system that arise when glucose levels fall.

The nurse is caring for a patient receiving nitrates for relief of angina. What pharmacodynamic action is responsible for the relief of anginal pain with nitrates? A. Vasoconstriction leads to improved cardiac output. B. Decreased force of contraction leads to decreased oxygen demand. C. Vasodilation leads to decreased preload, which decreases oxygen demand. D. Influx of calcium ions leads to relaxation of vascular smooth muscle.

C. Vasodilation leads to decreased preload, which decreases oxygen demand. The primary action of nitroglycerin is vasodilation, which leads to decreased venous return, decreased ventricular filling, and decreased preload, thus reducing oxygen demand on the heart.

The nurse provides discharge instructions to a patient prescribed verapamil [Calan] SR 120 mg PO daily for essential hypertension. Which statement by the patient indicates understanding of the medication? A. "I will take the medication with grapefruit juice each morning." B. "I should expect occasional loose stools from this medication." C. "I'll need to reduce the amount of fiber in my diet." D. "I must make sure I swallow the pill whole."

D. "I must make sure I swallow the pill whole." "SR" indicates that the drug is sustained release; therefore, the patient must swallow the pill intact, without chewing or crushing, which would result in a bolus effect. Grapefruit juice should be avoided, because it can inhibit intestinal and hepatic metabolism of the drug, thereby raising the drug level. Constipation, not loose stools, is a common side effect of Calan; increasing fluids and dietary fiber can help prevent this adverse effect.

Which needle length and gauge should the nurse choose to administer subcutaneous heparin? A. ½ inch; 20 gauge B. 1½ inch; 18 gauge C. 1 inch; 26 gauge D. 1 inch; 25 gauge

D. 1 inch; 25 gauge Heparin should be administered subcutaneously into the fatty layer of the abdomen with a ½- to -inch needle, 25 or 26 gauge. The only appropriate option for injection in the list shown is the -inch, 25-gauge needle.

A nurse instructs the parent of a child with influenza that which medication or medications may be used safely to reduce fever? Select all that apply. A. Ibuprofen [Advil] B. Naproxen [Aleve] C. Aspirin [Bayer] D. Acetaminophen [Tylenol] E. Indomethacin [Indocin]

D. Acetaminophen [Tylenol] The use of NSAIDs, which include ibuprofen [Advil], naproxen [Aleve], indomethacin [Indocin], and especially aspirin [Bayer], by children with influenza or chickenpox may precipitate Reye's syndrome. This is a potentially fatal multisystem organ disease. Acetaminophen [Tylenol] may be used safely to reduce fever in children with influenza.

A patient with heart failure has developed a cough while taking an angiotensin-converting enzyme (ACE) inhibitor. The health care provider discontinued the ACE inhibitor and prescribed an angiotensin II receptor blocker (ARB) as an alternative to the ACE inhibitor. The patient continues to have symptoms of heart failure despite using an ARB. Which medication should the nurse anticipate will be prescribed? A. Eplerenone [Inspra] B. Triamterene [Dyrenium] C. Hydrochlorothiazide [Microzide] D. BiDil [Isosorbide Dinitrate and Hydralazine]

D. BiDil [Isosorbide Dinitrate and Hydralazine] BiDil is a fixed-dose combination of isosorbide dinitrate plus hydralazine and it can be used for patients who cannot tolerate ACE inhibitors or ARBs. BiDil is approved specifically for treating heart failure in blacks.

The nurse is caring for a patient who takes warfarin [Coumadin] for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate? A. Administer intravenous (IV) push protamine sulfate. B. Continue with the current prescription. C. Prepare to administer vitamin K. D. Call the healthcare provider to increase the dose.

D. Call the healthcare provider to increase the dose. An INR in the range of 2 to 3 is considered the level for warfarin therapy. For a level of 1.2, the nurse should contact the healthcare provider to discuss an order for an increased dose.

A patient is admitted to the hospital with a diagnosis of hypertension. The nurse understands that which medication works by preventing angiotensin II from binding with its receptor sites? A. Quinapril [Accupril] B. Aliskiren [Tekturna] C. Eplerenone [Inspra] D. Candesartan [Atacand]

D. Candesartan [Atacand] Candesartan is an angiotensin II receptor blocker (ARB) and thus prevents the binding of angiotensin II at its receptor sites. Quinapril is an ACE inhibitor; aliskiren is a direct renin inhibitor, and eplerenone is a selective aldosterone receptor blocker.

A nurse instructs a patient to discontinue the scheduled use of high-dose aspirin before undergoing which procedures? Select all that apply. A. Routine dental cleaning B. Removal of a skin mole C. Cataract surgery D. Cholecystectomy E. Hysterectomy

D. Cholecystectomy and E. Hysterectomy Aspirin promotes bleeding by causing irreversible suppression of platelet aggregation. High-dose aspirin should be discontinued 1 week before elective surgery (cholecystectomy, hysterectomy). There is no need to stop aspirin before procedures with a low risk of bleeding, such as dental cleaning or dermatologic or cataract surgery.

In which situation is dronedarone [Multaq] contraindicated? A. PR intervals of 240 msec B. QT intervals of less than 500 msec C. Resting heart rate of 55 beats per minute D. Concomitant administration of amitriptyline [Elavil]

D. Concomitant administration of amitriptyline [Elavil] Drugs and supplements that prolong the QT interval (eg, phenothiazines, tricyclic antidepressants, amitriptyline, class I and class III antidysrhythmics) can intensify dronedarone-induced QT prolongation, thereby increasing the risk of torsades de pointes. These drugs are contraindicated for use with dronedarone. Dronedarone is contraindicated when the PR intervals are greater than 280 msec; the QT interval is greater than 500 msec; and the heart rate is less than 50 beats per minute.

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

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

A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which action in the body? A. It stimulates the pancreas to reabsorb glucose. B. It promotes the synthesis of amino acids into glucose. C. It stimulates the liver to convert glycogen to glucose. D. It promotes the passage of glucose into cells for energy.

D. It promotes the passage of glucose into cells for energy. The hormone insulin promotes the passage of glucose into cells, where it is metabolized for energy. Insulin does not stimulate the pancreas to reabsorb glucose or synthesize amino acids into glucose. It does not stimulate the liver to convert glycogen into glucose.

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

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

Fondaparinux [Arixtra] is not approved for use in which circumstance? A. Prevention of deep vein thrombosis (DVT) after knee replacement B. Treatment of acute pulmonary embolism (PE) (in conjunction with warfarin) C. Prevention of deep vein thrombosis (DVT) after abdominal surgery D. Prevention of ischemic complications in patients with unstable angina

D. Prevention of ischemic complications in patients with unstable angina Enoxaparin [Lovenox], not Arixtra, is approved for use in preventing ischemic complications in patients with unstable angina, non-Q-wave myocardial infarction (MI), and ST-segment elevation myocardial infarction (STEMI). Arixtra is approved for (1) preventing DVT after hip surgery, knee replacement, and abdominal surgery and (2) treating acute PE and acute DVT in conjunction with warfarin.

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

D. Serum uric acid level of 10.4 mg/dL Hyperuricemia is a side effect of thiazide diuretics. Normal uric acid levels typically range from 3.6 to 8.5 mg/dL. Hyperglycemia, not hypoglycemia, and hypokalemia, not hyperkalemia, are side effects of thiazides. A serum sodium of 135 mEq/L is a normal value.

A nurse is caring for a patient receiving dronedarone [Multaq] for treatment of atrial fibrillation. What electrocardiogram (ECG) change indicates an adverse effect of this medication? A. Previously upright T waves now are inverted. B. Previously rounded, upright P waves now are notched. C. ST segments previously on the baseline now are depressed. D. The QT-interval measurement changes from 400 msec to 520 msec.

D. The QT-interval measurement changes from 400 msec to 520 msec. Dronedarone prolongs the QT interval by about 10 msec. A QT-interval measurement of 400 msec in a normal heart rate (60 to 100 beats per minute) is normal. Prolongation to 520 msec would increase the risk of torsades de pointes. Newly inverted T waves and ST-segment depression can be signs of ischemia or infarction and warrant further investigation through analysis of troponin levels. Notched P waves can be a sign of valvular heart disease and are unrelated to treatment with dronedarone.

4-year-old Jenny got into the medicine cabinet and ingested "many" of Grandma Joan's glyburide tablets. Jenny arrives at the ED via ambulance with her frantic parents. She is only semi-conscious and has vomited once. Jenny's fingerstick blood glucose is 40 mg/dL. What do you need to do? a. place a nasogastric tube since this patient needs gastric lavage. b. start an IV right away c. give Jenny several teaspoons of sugar d. administer IM epinephrine

b.

74 year-old Mr. Dempsey was brought to the hospital and diagnosed with MI (myocardial infarction). His condition deteriorated in the emergency department. He went into ventricular fibrillation. Defibrillation was successful, converting him to normal sinus rhythm. He was started on amiodarone infusion and transferred to the intensive care unit. The nurse should be alert for which of following adverse effects after the intravenous administration of this antidysrhythmic? a. hypertension b. hypotension c. acute renal failure d. CNS depression

b.

A patient with a pulmonary embolism is going to be discharged from the hospital on warfarin. The nurse knows that ___________ will be checked daily, and that the patient is likely to be at a therapeutic level in _________________. a. PTT; 4-5 days b. INR; several days c. PT (prothrombin time); a few months d. INR; 24 hours

b.

Jack is 17 years old. He has Type I diabetes. He has arrived at Baxter State Park for a 3-day camping trip realizes his insulin is not with him. He tells his friends "I'll be okay for a day. We'll get my medicine tomorrow." They spend the day hiking vigorously. Jack drinks lots of water and feels "fine." The following morning, he is so tired he won't get out of his sleeping bag, and his friends keep having to shake him awake. They notice that he is breathing fast and his breath smells sweet. What has happened to Jack? a. He has developed severe hypoglycemia b. He has developed diabetic ketoacidosis (DKA) c. He has developed Hyperglycemia Hyperosmolar Nonketotic Sydrome (HHNS) d. He has developed heat stroke

b.

Mr. Ennis developed severe constipation and had to be taken from the nursing home where he lives to the emergency department where a manual rectal disimpaction was performed. He is on many medications including: aspirin, enalapril, diltiazem, lovastatin, and tamsulosin. Which of his medications is most likely to have contributed to his condition? a. tamsulosin b. diltiazem c. pravastatin d. aspirin

b.

Mr. James has just strated therapy with enalapril (Vasotec). Which of the following adverse reactions is most likely to cause him to stop his therapy? a. constipation b. cough c. GI distress d. sexual dysfunction

b.

Mr. Lewis has just started atenolol for his hypertension and frequent episodes of atrial fibrillation. He calls the clinic pleased to report a morning blood pressure of 120/73. He is concerned, however, that he is a bit more "winded," and has started coughing. His feet are swelling and he has gained 5 pounds over two days. He wonders if he's "retaining fluid." You suggest that he come in to be examined, knowing that beta blockers can occasionally aggravate: a. asthma b. heart failure c. renal insufficiency d. coronary artery disease

b.

Mrs. Garcia is a 76 year-old patient who is living with heart failure and type II diabetes, which she's had for 30 years. Her medical history is also notable for degenerative joint disease in her neck. Her medication list includes: enalapril, atenolol, hydrochlorothiazide, insulin, glipizide, and ibuprofen. She arrives at clinic for a health-check, as she does every 6 months. Upon review of her labs, you note that her BUN and creatinine are elevated. Her blood pressure is 156/100. She has 2+ proteinuria on her urine dipstick. You discuss changes that need to be made in Mrs. Garcia's drug regimen with the doctor caring for her. Her enalapril dosage is adjusted and you advise her to stop taking: a. atenolol b. ibuprofen c. insulin d. glipizide

b.

Ms. Thomas is a 32 year-old primagravida patient at 27 weeks gestation who suddenly developed severe shortness of breath. She is diagnosed with a pulmonary embolism and started on IV heparin per hospital protocol. 10,000 units of heparin have infused. The nurse is called to the bedside urgently when the patient reports passage of a large dark purple stool and passage of some obvious bright red blood with the bowel movement. The patient feels "like she might pass out." BP is 100/55, HR 110. Stat labs are run and the doctor on call decides to reverse the heparin immediately. Which would be an appropriate medication order from the physician on-call? a. vitamin K (phytonadione), 1 mg, IV, over 15 minutes b. protamine sulfate, 100 mg, IV, over 20 minutes c. vitamin K, 1 mg, subQ, x1 dose d. protamine sulfate, 1000 mg, IV, over 20 minutes

b.

The nurse enters the room of 69-year-old Mrs.Davis who is taking valsartan, metoprolol, furosemide, and digoxin for heart failure. She reports nausea and irritability and has also noticed a "fuzzy haze" around objects in the room. The nurse suspects drug toxicity and will obtain a ______________ level as well as serum ____________________. a. digoxin; sodium b. digoxin; potassium c. fursosemide; sodium d. furosemide; potassium

b.

58 year-old Mr. Andersen is being treated for hypertension with hydrochlorothiazide. After 2 weeks of therapy, his potassium level is 2.9 mEq/L (N = 3- 5.5). He is started 20 mEq oral potassium daily. His serum potassium level continues to be low (2.9 mEq/L) after several weeks have passed. Which drug might be added to his regimen? a. metoprolol b. verapamil c. triamterine d. furosemide

c.

Ibuprofen and aspirin are both NSAIDs. However, there are a few key differences between the two drugs. Which of the following might be a complication of therapy with ibuprofen, but not a complication of treatment with of aspirin? a. bleeding in the brain after head trauma b. peptic ulcer c. MI (myocardial infarction) d. decline in renal function

c.

Jack (from problem #17) arrives in your ED. What are you going to administer? a. IM Glucagon b. intravenous insulin glargine c. intravenous regular insulin d. intravenous dextrose

c.

Mrs. Callahan is a 62-year-old patient with diabetes and hypertension. She had an MI (myocardial infarction) a year ago. She brings you the list of medications she is taking, which include: lisinipril, metoprolol, aspirin, eplerenone, lovastatin, nitroglycerin, insulin, and rapaglinide. Mindful of the need to watch her diet, she has lowered her intake of saturated fat, sugar, and salt. She is using No Salt (a popular salt substitute). Which drugs on her medication list will have a potentially concerning interaction with the substitute? a. lovastatin and lisinipril b. aspirin and nitroglycerin c. eplerenone and lisinipril d. lisinipril and aspirin

c.

Mrs. Ellis is a 75 year-old admitted to the cardiac intensive care unit after suffering a myocardial infarction (MI). She has been placed on continuous cardiac monitoring. You are the nurse coming on shift, and note a change in her rhythm. Her PR interval is lengthening. After consultation with the on-call cardiologist, it is determined that she has developed a second-degree bundle branch block. Which of the following drugs is likely to make this condition worse? a. simvastatin b. enoxaparin c. verapamil d. enalapril

c.

You are a circulating nurse called into the operating room of Dr. Cutler, who is performing surgery on a patient's deviated nasal septum. The patient is bleeding profusely, and Dr. Cutler is sweating profusely. You look over the patient's chart and, with a sinking feeling, realize that you must tell the easily-angered Dr. Cutler that this patient has not discontinued his: a. daily acetaminophen b. daily enalapril c. daily aspirin d. daily hydrochlorothiazide

c.

Your 72 year-old patient has experienced "fluttering in her chest" for the past year and is now experiencing episodes of near-syncope. An EKG is performed and the patient is diagnosed with chronic atrial fibrillation. She is started on a beta blocker and feels much better. However, you know that it is important for her to be on another medication. What is that medication? a. verapamil (Calan-SR) b. nitroglycerin c. warfarin (Coumadin) d. atorvastatin (Lipitor)

c.

Consider the effect nitroglycerin has on the cardiovascular system. This drug reduces: a. afterload b. conduction delay at the AV node c. myocardial contractility d. preload

d.

Mr. Wendell is a 59 year-old patient newly diagnosed with Type II diabetes. He is coming to terms with the demands of his disease. You have discussed the importance of limiting portion size and the amount of refined sugar and fat in his diet. He have also commended him for starting a regular exercise regimen. You ask him to show you the record of his blood glucose measurements and he tells you "Oh they are fine, when I check them, although I don't check as often as I was asked to." You reinforce the benefits of tight-glycemic control early in the disease, and after discussion with the provider, send him to the lab for a hemoglobin A1C measurement. His hemoglobin A1C is 9%. Over the past 2-3 months, Mr. Wendell's blood glucose has averaged: a. 300 mg/dL b. 183 mg/dL c. 154 mg/dL d. 212 mg/dL

d.

Your 65-year-old patient in the cardiac unit has just been started on an HMG-CoA reductase inhibitor. You are looking over his labs. What test results are you hoping to see before giving him his medication? a. CBC (complete blood count) b. EKG c. electrolyte panel d. liver function tests

d.

The patient's heparin is infusing at 28 mL/hr. The bag of fluid is mixed 20,000 units of heparin in 500 mL D5W. What hourly dose is the patient receiving?

1120 units/hr

Which drug is the most effective for lowering LDL cholesterol? A. Atorvastatin [Lipitor] B. Cholestyramine [Questran] C. Gemfibrozil [Lopid] D. Ezetimibe [Zetia]

A. Atorvastatin [Lipitor] The statin drugs, such as atorvastatin, are the most effective drugs for lowering LDL cholesterol. They are better tolerated, have fewer adverse effects, and produce better clinical outcomes than any other agents available for lowering LDL.

What is the most common sustained dysrhythmia among the U.S. population? A. Atrial fibrillation B. Atrial flutter C. Sustained supraventricular tachycardia (SVT) D. Ventricular premature beats (VPBs)

A. Atrial fibrillation Atrial fibrillation is the most common dysrhythmia, affecting approximately 2.6 million in the United States. This problem not only disrupts cardiac function but also carries a high risk of embolic stroke.

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

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

The nurse is teaching a patient with essential hypertension who has a new prescription for verapamil [Calan]. Which statements by the patient indicate that the teaching was effective? Multiple Answers A. "I will increase my intake of fluid and foods high in fiber." B. "I should stay out of direct sunlight to prevent exposing my skin to the sun." C. "I will call my healthcare provider if I notice swelling in my ankles." D. "I need to avoid salt substitutes and potassium supplements." E. "I may notice easy bruising and bleeding with this drug."

A. "I will increase my intake of fluid and foods high in fiber." and C. "I will call my healthcare provider if I notice swelling in my ankles." Verapamil often causes constipation and can also cause peripheral edema. Patients should take measures to prevent constipation and should call about new symptoms of peripheral edema. Patients taking verapamil should not experience photosensitivity, hyperkalemia, or increased bruising and bleeding.

A patient with angina is being discharged with a prescription for nitroglycerin sublingual tablets. Which instruction should the nurse include? A. "Store the tablets in the original container and tightly close it after use." B. "The tablets are only good for 1 month after the container is opened." C. "Sublingual nitroglycerin tablets are also effective when swallowed whole." D. "Effects of sublingual nitroglycerin begin in 5 to 10 minutes."

A. "Store the tablets in the original container and tightly close it after use." Sublingual nitroglycerin tablets should be stored moisture free at room temperature in their original container, which should be closed tightly after use. If stored correctly, the tablets should remain effective until the expiration date on the container. Sublingual nitroglycerin tablets are ineffective when swallowed whole. Effects of nitroglycerin begin in 1 to 3 minutes.

A patient with nonvalvular atrial fibrillation is to be discharged on dabigatran etexilate [Pradaxa]. Which statement should the nurse include in the discharge teaching? A. "The medication must be stored in the manufacturer-supplied bottle." B. "Once a new bottle is opened, the capsules maintain efficacy for 90 days." C. "If you have difficulty swallowing the capsule, you can open it and mix it with food." D. "You will need to learn how to give yourself a subcutaneous injection in your abdomen."

A. "The medication must be stored in the manufacturer-supplied bottle." Dabigatran is unstable, especially when exposed to moisture, and should be stored in the manufacturer-supplied bottle, which has a desiccant cap. Current labeling of the pill bottle indicates that once the bottle is opened, the pills should be used within 30 days. However, recent evidence indicates that they maintain efficacy for 60 days, provided they have been stored in the original container. Capsules should be swallowed intact, because chewing, crushing, or opening enhances absorption by 75% and increases the risk of bleeding. The medication is administered orally, not subcutaneously.

The nurse is caring for a group of patients taking warfarin [Coumadin]. Which patients are at moderate to high risk for harm as a result of warfarin therapy? Select all that apply. A. A patient with variant genes that code for VKORC1 and CYP2CP B. A patient with a current INR of 2.2 treated for deep vein thrombosis C. A woman with a new onset of symptoms of a pulmonary embolus D. A patient on day 4 after hip replacement with a new order for warfarin E. A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen

A. A patient with variant genes that code for VKORC1 and CYP2CP, C. A woman with a new onset of symptoms of a pulmonary embolus and E. A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen Patients with genetic alterations in VKORC1 and CYP2CP are at increased risk of warfarin-induced bleeding. An INR of 2.2 indicates a therapeutic warfarin level. Warfarin can cause fetal hemorrhage and is listed as Pregnancy Risk Category X. Warfarin could be prescribed for the prevention of deep vein thrombosis after hip replacement surgery. The day of prescription would not likely be a day to expect a dangerous adverse effect from warfarin, because its half-life is 1.5 to 2 days. Warfarin interacts with many other agents. The greatest risk for harm is when an interacting drug is being added to or deleted from the regimen.

The nurse understands patients receiving nitroglycerin are at risk for which adverse effects? Select all that apply. A. Headache B. Wheezing C. Dizziness D. Tachycardia E. Bradycardia

A. Headache, C. Dizziness and D. Tachycardia The primary adverse effects of nitroglycerin are headache; orthostatic hypotension, which can lead to dizziness; and reflex tachycardia.

A patient with angina pectoris has been prescribed nifedipine [Procardia].Which possible adverse effects should the nurse expect with this medication? Select all that apply. A. Headache B. Constipation C. Nausea and vomiting D. Edema of ankles and feet E. Overgrowth of gum tissue

A. Headache, D. Edema of ankles and feet and E. Overgrowth of gum tissue Some adverse effects of nifedipine are headache, edema of ankles and feet, and gingival hyperplasia (overgrowth of gum tissue). Nifedipine causes very little constipation. Nausea and vomiting are common side effects of clevidipine.

The nurse is reviewing the home medication list with the patient. The nurse recognizes that hydrochlorothiazide is used primarily for which condition? A. Hypertension B. Edema C. Diabetes insipidus D. Protection against postmenopausal osteoporosis

A. Hypertension The primary indication for hydrochlorothiazide is hypertension, a condition for which thiazides are often the drugs of first choice. Hydrochlorothiazides are used for the other conditions, but the primary indication is hypertension.

Which of the following statements about mannitol [Osmitrol] are correct? Multiple answers Select all that apply. A. Mannitol cannot be given orally. B. Mannitol can cause edema. C. Mannitol can cause renal failure. D. Diuresis begins in 30 to 60 minutes after administration. E. Mannitol is a loop diuretic.

A. Mannitol cannot be given orally, B. Mannitol can cause edema, and D. Diuresis begins in 30 to 60 minutes after administration. Mannitol does not diffuse across the GI epithelium and cannot be transported by the uptake systems that absorb dietary sugars. Accordingly, to reach the circulation, the drug must be given parenterally. Diuresis begins in 30 to 60 minutes and persists 6 to 8 hours. Mannitol can leave the vascular system at all capillary beds except those of the brain. When the drug exits capillaries, it draws water along, causing edema. Mannitol is use in prophylaxis of renal failure. Mannitol is an osmotic diuretic, not a loop diuretic.

The nurse is caring for a pregnant patient experiencing a new episode of hypertension. Which medication does the nurse anticipate will be prescribed for this patient? A. Methyldopa [Aldomet] B. Propranolol [Inderal] C. Captopril [Capoten] D. Valsartan [Diovan]

A. Methyldopa [Aldomet] Hypertension is the most common complication of pregnancy, occurring in about 10% of pregnant patients. When drug therapy is initiated during pregnancy, methyldopa is the traditional agent of choice because of its limited effects on the fetus. Patients with preexisting hypertension typically can continue taking the antihypertensives they previously were prescribed except for angiotensin-converting enzyme (ACE) inhibitors, such as captopril; angiotensin II receptor blockers (ARBs), such as valsartan; and direct renin inhibitors, such as aliskiren

Which discharge instructions should the nurse include for a patient prescribed cholestyramine [Questran]? A. Mix the drug with water or juice. B. Take with all other morning medications. C. Take 325 mg of aspirin 30 minutes before each dose. D. Notify the healthcare provider if upper abdominal discomfort occurs.

A. Mix the drug with water or juice. Cholestyramine [Questran] is supplied in powdered form. Mix the powder with liquids that include water, fruit juices, and soups because swallowing it can cause esophageal irritation. Certain oral medications should be administrated 1 hour before the sequestrant or 4 hours after. Flushing can occur with niacin and can be reduced by taking 325 mg of aspirin 30 minutes before each dose. Gemfibrozil and fenofibrate increase the risk of gallstones manifested with symptoms such as upper abdominal discomfort.

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

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

The laboratory calls to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate? A. Notify the healthcare provider to discuss the reduction or withdrawal of heparin. B. Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level. C. Obtain vitamin K and prepare to administer it by intramuscular (IM) injection. D. Observe the patient and monitor the activated partial thromboplastin time (aPTT) as indicated.

A. Notify the healthcare provider to discuss the reduction or withdrawal of heparin. Heparin-induced thrombocytopenia (HIT) is a potential immune-mediated adverse effect of heparin infusions that can prove fatal. HIT is suspected when the platelet counts fall significantly. A platelet count below 100,000/mm3 would warrant discontinuation of the heparin.

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

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

Which are beneficial effects that can be derived from simvastatin [Zocor] and other drugs in this class? Select all that apply. A. Reduction of LDLs B. Elevation of HDLs C. Stabilization of the plaque in coronary arteries D. Reduction of risk of cardiovascular events E. Improvement of liver function

A. Reduction of LDLs B. Elevation of HDLs C. Stabilization of the plaque in coronary arteries D. Reduction of risk of cardiovascular events The statin drugs have many benefits, the most important being reduction of LDLs. They also promote an increase in HDLs, stabilization of atherosclerotic plaque, and reduced inflammation at the plaque site. Among other benefits, they also slow progression of coronary artery calcification. The statins reduce the overall risk of cardiovascular events. They can have serious adverse effects on the liver, but these are relatively rare.

A patient is being discharged from the hospital on warfarin [Coumadin] for deep vein thrombosis prevention. Which instructions should the nurse include in the patient's discharge teaching plan? Select all that apply. A. Wear a medical alert bracelet. B. Check all urine and stool for discoloration. C. Do not start any new medication without first talking to your healthcare provider. D. Enteric-coated aspirin and any aspirin products can be used unless they cause a gastrointestinal ulcer. E. No laboratory or home monitoring of international normalized ratio (INR) is required after the first 6 months.

A. Wear a medical alert bracelet., B. Check all urine and stool for discoloration, and C. Do not start any new medication without first talking to your healthcare provider. Advise the patient to wear some form of identification (eg, Medic Alert bracelet) to alert emergency personnel to warfarin use. Bleeding is a major complication of warfarin therapy. Inform patients about the signs of bleeding, which include discolored urine or stools. Inform patients that warfarin is subject to a large number of potentially dangerous drug interactions. Instruct them to avoid all prescription and nonprescription drugs that have not been specifically approved by the prescriber. Aspirin and aspirin products should be avoided because aspirin can increase the effects of warfarin to promote bleeding and on the gastrointestinal tract to cause ulcers, thereby initiating bleeding. The INR should be determined frequently: daily during the first 5 days, twice a week for the next 1 to 2 weeks, once a week for the next 1 to 2 months, and every 2 to 4 weeks thereafter.

Which instructions should the nurse include when developing a teaching plan for a patient prescribed diltiazem [Cardizem] for atrial fibrillation? Select all that apply. A. Weigh yourself daily at the same time each day. B. The medication will not cause dizziness or headache. C. Notify the healthcare provider if a skin rash develops. D. Do not take daily oral calcium supplements. E. Rise slowly from a lying to a sitting position.

A. Weigh yourself daily at the same time each day., C. Notify the healthcare provider if a skin rash develops and E. Rise slowly from a lying to a sitting position. An adverse effect of diltiazem is heart failure. Daily weighing monitors for signs of fluid retention, which may indicate cardiac dysfunction. Chronic eczematous rash may occur, especially in older patients. Orthostatic hypotension is an adverse effect; patients must be taught to rise slowly from lying to sitting positions. Diltiazem causes vasodilation, which can cause dizziness or headache. Daily calcium supplements do not affect the action of diltiazem.

The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising the blood pressure? A. Angiotensin I B. Angiotensin II C. Angiotensin III D. Renin

B. Angiotensin II Angiotensin II is a potent vasoconstrictor. It participates in all the pathways regulated by the renin-angiotensin-aldosterone system. Angiotensin I is a precursor to angiotensin II; angiotensin III is formed by degradation of angiotensin II and is less potent. Renin catalyzes the conversion of angiotensinogen to angiotensin I.

The nurse is ready to begin a heparin infusion for a patient with evolving stroke. The baseline activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved? A. 50 B. 70 C. 90 D. 110

B. 70 The therapeutic level of heparin is achieved when the aPTT reaches 1.5 to 2 times normal. Thus, a range of 60 to 80 seconds would be appropriate for this patient.

About which patient should the nurse notify the healthcare provider immediately? A. A patient who takes digoxin [Lanoxin] 0.125 mg orally daily with a serum digoxin level of 0.8 ng/mL B. A patient who takes oral spironolactone [Aldactone] 25 mg daily and enalapril [Vasotec] 5 mg daily with a serum potassium level of 5.5 mEq/L C. A patient who takes digoxin [Lanoxin] 0.25 mg orally daily with a serum potassium level of 4.0 mEq/L D. A patient who takes oral lisinopril [Zestril] 5 mg daily and digoxin 0.125 mg daily with a serum digoxin level of 0.5 ng/mL

B. A patient who takes oral spironolactone [Aldactone] 25 mg daily and enalapril [Vasotec] 5 mg daily with a serum potassium level of 5.5 mEq/L Patients who take an aldosterone antagonist (spironolactone) are at risk for developing hyperkalemia. The risk is increased if an aldosterone antagonist and an ACE inhibitor (enalapril) are used together. The normal serum potassium level ranges from 3.5 to 5.0 mEq/mL. This patient is hyperkalemic, which increases the risk for electrocardiographic changes. The optimal range for the serum digoxin level is 0.5 to 0.8 ng/mL. The risk of digoxin toxicity increases when hypokalemia is present (potassium level below 3.5 mEq/L).

In what part of the conduction pathway in a healthy heart is the electrical impulse delayed to provide time for the blood to fill the ventricles? A. Bundle of His B. AV node C. Purkinje system D. Internodal pathways

B. AV node Impulses originate in the SA node and then travel through the AV node to reach the ventricles. The impulse is delayed at the AV node to provide time for the ventricles to fill before they contract.

A patient develops supraventricular tachycardia (SVT) and is hypotensive. Which medication should the nurse anticipate will be administered? A. Lidocaine [Xylocaine] B. Adenosine [Adenocard] C. Amiodarone [Cordarone] D. Phenytoin [Dilantin]

B. Adenosine [Adenocard] The drug of choice for terminating SVT is adenosine. Lidocaine is used for ventricular dysrhythmias; amiodarone is used for atrial and ventricular dysrhythmias; and phenytoin is used for digoxin-induced dysrhythmias.

Which are the main types of drugs used to prevent or relieve anginal pain? Select all that apply. A. Platelet inhibitors B. Beta blockers C. Nitrates D. Calcium channel blockers E. Statins

B. Beta blockers C. Nitrates D. Calcium channel blockers The three main types of antianginal drugs are organic nitrates, beta blockers, and calcium channel blockers. Platelet inhibitors and statins (unless contraindicated) are incorporated into the treatment plan to reduce the risk of myocardial infarction.

What is the primary benefit of spironolactone [Aldactone] in patients with heart failure? A. Increase in diuresis and fluid loss B. Blockage of aldosterone receptors C. Inhibition of beta activation by norepinephrine D. Stimulation of the renin-angiotensin-aldosterone system

B. Blockage of aldosterone receptors Spironolactone is a potassium-sparing diuretic that has been shown to prolong survival in patients with heart failure. It has only weak diuretic properties. The primary benefit of this drug is blockage of aldosterone receptors. It does not inhibit beta receptors, nor does it stimulate the renin-angiotensin-aldosterone system.

The nurse is caring for a patient who is receiving enteral feedings because of dysphagia. The healthcare provider prescribes isosorbide mononitrate [Imdur] 60 mg SR daily via the enteral tube. What is the most appropriate action by the nurse? A. Have the patient swallow the pill, because it cannot be crushed. B. Call the healthcare provider about an alternate form of nitrate for administration. C. Crush the Imdur into a fine powder, dilute it with water, and administer it via the enteral tube. D. Place the nitrate under the patient's tongue and let it dissolve, because the person has dysphagia.

B. Call the healthcare provider about an alternate form of nitrate for administration. The nurse should contact the prescriber for an alternate form of nitrate, such as a non-sustained-release pill, transdermal patch, topical ointment, or immediate release. Because isosorbide mononitrate is a sustained-release pill, it cannot be crushed. Because the patient has dysphagia, attempting to administer the pill orally could result in aspiration. Sustained-release tablets must be administered whole.

A patient with a deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response? A. Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting factors. B. Heparin suppresses coagulation by helping antithrombin perform its natural functions. C. Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot matrix. D. Heparin inhibits the enzyme responsible for platelet activation and aggregation within vessels.

B. Heparin suppresses coagulation by helping antithrombin perform its natural functions. Heparin is an anticoagulant that works by helping antithrombin inactivate thrombin and factor Xa, reducing the production of fibrin and thus decreasing the formation of clots.

The healthcare provider prescribes an intravenous dose of diltiazem [Cardizem] for treatment of a patient with atrial fibrillation. What is the priority nursing intervention? A. Assist with cardioversion. B. Monitor electrocardiogram. C. Obtain baseline coagulation studies. D. Assess for increased urinary output.

B. Monitor electrocardiogram. Monitor the electrocardiogram (ECG) continuously during IV administration of diltiazem for AV block, sudden reduction in heart rate, and prolongation of the PR or QT interval. Cardioversion is not necessary; however, have equipment for cardioversion available. Baseline laboratory studies are needed for liver and kidney function. Increased urinary output is not an adverse effect of diltiazem.

The nurse is caring for a patient receiving clopidogrel [Plavix] to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel? A. Aspirin [Bayer] B. Omeprazole [Prilosec] C. Acetaminophen [Tylenol] D. Warfarin [Coumadin]

B. Omeprazole [Prilosec] Omeprazole and other proton pump inhibitors may reduce the antiplatelet effects of clopidogrel. Patients sometimes take them to reduce gastric acidity and the risk of gastrointestinal (GI) bleeding.

The nurse is caring for a patient receiving amiodarone [Cordarone]. Which body system should the nurse assess for serious adverse effects of this medication? A. Musculoskeletal B. Respiratory C. Integumentary D. Gastrointestinal

B. Respiratory Pulmonary toxicity is the most serious potential adverse effect of amiodarone. It may manifest as pneumonitis or pulmonary fibrosis, with symptoms such as dyspnea, cough, and chest pain.

A patient is admitted to the unit in a hypertensive emergency and examination reveals papilledema. The nurse should expect which IV medications to be administered to achieve rapid, controlled reduction of the patient's blood pressure? A. Furosemide [Lasix] B. Sodium nitroprusside [Nitropress] C. Metoprolol [Lopressor] D. Diltiazem [Cardizem]

B. Sodium nitroprusside [Nitropress] Hypertensive emergency associated with papilledema, intracranial hemorrhage, myocardial infarction, or acute heart failure is a severe emergency, and the BP must be lowered rapidly (within 1 hour). Intravenous sodium nitroprusside [Nitropress] usually is the drug of choice first used, because its effects begin within seconds of initiation of the continuous IV infusion, and they fade rapidly when the infusion is stopped. Furosemide, metoprolol, and diltiazem are not used for rapid reduction of BP in hypertensive crisis.

A patient diagnosed with a pulmonary embolism is receiving a continuous heparin infusion at 1000 units/hr. Of which findings should the nurse immediately notify the healthcare provider? Select all that apply. A. aPTT of 65 seconds B. aPTT of 40 seconds C. Nosebleeds D. aPTT of 100 seconds E. Platelet count of 300,000/mcL

B. aPTT of 40 seconds C. Nosebleeds D. aPTT of 100 seconds Measurement of the aPTT is essential to determine whether the heparin infusion is having the desired effect. If the normal value of the aPTT is 40 seconds, the goal is to achieve a therapeutic range of a factor of 1.5 to 2 (60 to 80 seconds). Because 40 seconds is too short (increases the risk for clotting) and 100 seconds is too long (increases the risk for bleeding), the physician requires notification for adjustment of the infusion rate. Evidence of bleeding, such as nosebleeds, hematuria, and red or tarry stools, warrant a call to the physician. An aPTT of 65 seconds indicates that a therapeutic effect has been achieved, and a platelet count of 300,000/mcL is within normal limits, indicating no evidence of thrombocytopenia.

The nurse is teaching a patient who has a new prescription for spironolactone [Aldactone]. Which statement by the patient indicates that the teaching was effective? A. "I will use salt substitutes to lower my sodium intake." B. "I will increase my intake of foods that are high in potassium." C. "I will call my doctor if I begin having menstrual irregularities." D. "I will take this medication at bedtime each evening."

C. "I will call my doctor if I begin having menstrual irregularities." Spironolactone is a potassium-sparing, aldosterone-blocking diuretic. As such, it can cause endocrine effects, such as gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of the voice. Patients taking spironolactone should avoid salt substitutes because they contain potassium, and high-potassium foods should be avoided with this drug. Ideally, all diuretics should be taken in the morning to prevent nocturia.

An adult male patient is taking medication for blood pressure management. The patient states to the nurse, "I'm not going to take these drugs anymore, because they are interfering with my sex life." What is the most appropriate response by the nurse? A. "It is unfortunate these drugs can cause erectile dysfunction but managing your blood pressure is more important than your sexual performance." B. "I understand how discouraging it must be to live with this adverse effect, but you could have a stroke if you do not take your blood pressure medications." C. "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect." D. "I am glad you told me about your experience with this common side effect. Sexual performance can be a difficult subject to discuss."

C. "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect." Many antihypertensive medications can produce adverse sexual side effects, including impotence. It is important for the nurse to listen to the patient's concerns and to avoid making value judgments. Other antihypertensive medications may manage this patient's blood pressure without causing adverse sexual effects. Reducing the undesired effects of antihypertensive medication will improve the patient's adherence.

The nurse is teaching a group of patients about dietary approaches to reduce cholesterol levels. Which statement is most important to include in the teaching? A. "Lower your cholesterol to 300 mg/day." B. "Eliminate red meat and pork from your diet." C. "Read food labels and reduce your intake of saturated fats." D. "Reduce salt consumption to keep your sodium intake to 2400 mg/day."

C. "Read food labels and reduce your intake of saturated fats." An increase in dietary cholesterol intake does not produce a large increase in blood cholesterol because of the body's feedback system. When cholesterol intake increases, endogenous production decreases. However, because the body uses dietary saturated fats to make cholesterol, an increase in saturated fat intake can produce a significant increase in blood cholesterol levels. To lower blood cholesterol, it is most important to lower saturated fat intake. Although red meat and pork should be limited, it is not necessary to eliminate them from the diet. Sodium intake is not directly related to lowering cholesterol levels.

What should the nurse include in the discharge teaching for a patient prescribed amiodarone [Cordarone]? Select all that apply. A."Take amiodarone with grapefruit juice." B. "Take the medication on an empty stomach." C. "Wear sunblock and protective clothing when you are outdoors." D. "Check your pulse daily and report excessive slowing to your healthcare provider immediately." E. "Immediately notify your healthcare provider of shortness of breath, cough, or chest pain."

C. "Wear sunblock and protective clothing when you are outdoors." D. "Check your pulse daily and report excessive slowing to your healthcare provider immediately." E. "Immediately notify your healthcare provider of shortness of breath, cough, or chest pain." Patients frequently experience photosensitivity reactions while taking amiodarone. To reduce this risk, patients should avoid sunlamps and wear sunblock and protective clothing when outdoors. Excessive slowing of the heart rate may indicate that the patient is experiencing sinus bradycardia or an AV block. Dyspnea, cough, and chest pain may indicate pulmonary toxicity. Grapefruit juice should be avoided, because it may increase amiodarone levels and thus the risk of toxicity. Gastrointestinal side effects of amiodarone can be reduced by taking the drug on a full stomach.

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

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

Calcium channel blockers work by reducing calcium influx into the cells of the heart and blood vessels. Calcium channels are coupled to which type of autonomic nervous system receptors? A. Alpha1 B. Alpha2 C. Beta1 D. Beta2

C. Beta1 Calcium channels are coupled to beta1-adrenergic receptors in the heart. For that reason, calcium channel blockers affect the heart in ways similar to the beta blockers. Both types of drugs cause a decrease in the force of contraction, heart rate, and cardiac impulse conduction.

A patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which finding by the nurse most likely indicates an adverse reaction to this drug? A. Urticaria, itching, and flushing B. Blood pressure of 90/50 mm Hg C. Decreasing level of consciousness D. Potassium level of 5.5 mEq/L

C. Decreasing level of consciousness The greatest risk with this drug is bleeding, with intracranial bleeding being the greatest concern. A decreasing level of consciousness indicates intracranial bleeding. Alteplase does not cause an allergic reaction or hypotension. Thrombolytic agents, such as alteplase, do not typically cause an elevated potassium level.

The nurse is caring for a patient prescribed quinidine [Quinaglute] for a supraventricular dysrhythmia. What is a common adverse effect of this drug? A. Constipation B. Urinary retention C. Diarrhea D. Blurred vision

C. Diarrhea Diarrhea and other gastrointestinal problems occur in approximately one third of patients who take quinidine. This is the most common reason patients stop taking the drug.

Which medication combination is useful in the treatment of variant angina? A. Metoprolol [Lopressor] and ranolazine [Ranexa] B. Isosorbide dinitrate [Isordil] and metoprolol [Lopressor] C. Diltiazem [Cardizem] and isosorbide mononitrate [Imdur] D. Propranolol [Inderal] and diltiazem [Cardizem]

C. Diltiazem [Cardizem] and isosorbide mononitrate [Imdur] Variant angina, also known as Prinzmetal's or vasospastic angina, is a result of coronary artery vasospasm. Drug combinations used to prevent and/or relax the coronary artery are calcium channel blockers (eg, diltiazem) and organic nitrates (eg, isosorbide mononitrate). Beta blockers (metoprolol and propranolol) and ranolazine, although effective in stable angina, are ineffective for treating variant angina.

The nurse is planning care for a patient at risk for dysrhythmias. The nurse understands that the Cardiac Arrhythmia Suppression Trial (CAST) confirmed which finding? A. Most atrial rhythm problems should be treated with medication. B. After a myocardial infarction, all dysrhythmias should be treated. C. Dysrhythmias should be treated only when they are symptomatically significant. D. Most rhythm problems result in bradydysrhythmias.

C. Dysrhythmias should be treated only when they are symptomatically significant. The Cardiac Arrhythmia Suppression Trial (CAST) confirmed that all dysrhythmia drugs have prodysrhythmic effects and can worsen existing dysrhythmias and generate new ones. In this study, patients who received encainide and flecainide to prevent rhythm problems after myocardial infarction actually had higher rates of mortality than the control group.

What is the most appropriate nursing consideration for a patient who is prescribed verapamil [Calan] and digoxin [Lanoxin]? A. Restrict intake of oral fluids and high-fiber food. B. Take an apical pulse for 30 seconds before administration. C. Notify the healthcare provider of nausea, vomiting, and visual changes. D. Hold the medications if the heart rate is greater than 110 beats per minute.

C. Notify the healthcare provider of nausea, vomiting, and visual changes. Verapamil can raise digoxin blood serum levels, increasing the risk of digoxin toxicity. Symptoms of digoxin toxicity may include nausea, vomiting, and visual changes. Increase intake of oral fluids and high-fiber food to decrease the adverse effect of constipation. An apical pulse should be taken for a full minute prior to administering digoxin. Verapamil and digoxin can cause bradycardia not tachycardia.

Amiodarone [Cordarone] is prescribed for a patient with atrial fibrillation. What is the most important nursing intervention before administering this medication? A. Document an ophthalmic examination was performed. B. Explain a dermatologic evaluation is needed. C. Obtain baseline serum thyroid and liver function studies. D. Maintain NPO for transesophageal echocardiogram (TEE).

C. Obtain baseline serum thyroid and liver function studies. Amiodarone may cause hypothyroidism or hyperthyroidism and may also injure the liver. Serum thyroid and liver function levels should be assessed before treatment with amiodarone is started and periodically during treatment. Patients who develop changes in visual acuity or peripheral vision while taking amiodarone should have an ophthalmologic evaluation, but this is not necessary before starting therapy. A dermatologic examination and TEE are not necessary before initiation of amiodarone therapy. Although patients with atrial fibrillation are at risk for mural thrombus, amiodarone therapy itself does not pose a risk of systemic embolization.

The nurse is monitoring a patient receiving ranolazine [Ranexa] for angina. Which assessment finding indicates an adverse effect of this drug? A. Blood pressure of 90/50 mm Hg B. Frequent bloody stools C. QT prolongation on the electrocardiogram D. Respiratory rate of 11 breaths per minute

C. QT prolongation on the electrocardiogram Ranolazine can cause an increase in the QT interval on the electrocardiogram (ECG), mostly with increased doses. Other adverse effects include elevated blood pressure, headache, nausea, dizziness, and constipation.

The nurse is caring for a patient with heart failure who needs a diuretic. Which agent is likely to be chosen, because it has been shown to greatly reduce mortality in patients with heart failure? A. Furosemide [Lasix] B. Hydrochlorothiazide [HydroDIURIL] C. Spironolactone [Aldactone] D. Mannitol [Osmitrol]

C. Spironolactone [Aldactone] Spironolactone is a potassium-sparing diuretic used to treat both hypertension and edema. It is a preferred drug in heart failure, because it has been shown to have a cardioprotective effect, reducing mortality in patients with heart failure.

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

C. Vomiting and diarrhea Vomiting and diarrhea can lead to hypokalemia, which increases the risk of digoxin toxicity. These symptoms, along with nausea, fatigue, and visual disturbances, also may precede digoxin toxicity and warrant further attention. The heart rate, potassium level, and digoxin level are within the normal range.

The nurse is teaching a patient about the side effects associated with doxazosin [Cardura]. Which statement by the patient indicates an understanding of the nurse's instructions? A. "I may experience an increase in hair growth as a side effect." B. "I'll notify the healthcare provider if I develop a persistent cough." C. "I'll make sure I include extra sources of potassium in my diet, such as bananas and baked potatoes." D. "When getting out of bed in the morning, I will sit on the side of the bed for several minutes before standing."

D. "When getting out of bed in the morning, I will sit on the side of the bed for several minutes before standing." The most disturbing side effect of alpha blockers, such as doxazosin, is orthostatic hypotension, because it can affect the patient's safety. Patients should change positions slowly and carefully. Excessive hair growth is a side effect of minoxidil. Persistent cough is an adverse effect of ACE inhibitors. Hypokalemia is a side effect of thiazide and loop diuretics, so additional sources of potassium should be incorporated into the diet.

The nurse is caring for a patient prescribed gemfibrozil [Lopid]. For which patient should the nurse question the use of this drug? A. A patient with cardiovascular disease and elevated triglycerides B. A patient with elevated very-low-density lipoprotein (VLDL) levels C. A patient with elevated triglycerides who has not responded to dietary changes D. A patient with history of gallstones and elevated triglycerides

D. A patient with history of gallstones and elevated triglycerides Gemfibrozil is indicated to reduce elevated triglycerides and very-low-density lipoprotein levels primarily in patients who have not responded adequately to diet modification. It can also raise HDL but does not reduce LDL to a significant degree. Gemfibrozil increases the risk of gallstone formation and should not be used in patients with preexisting gallbladder disease.

The home health nurse observes the patient for proper use of topical nitroglycerin ointment. Which action by the patient indicates the need for further teaching? A. Rotates the application sites to minimize skin irritation B. Uses the applicator paper to measure the prescribed dose C. Removes ointment from a previous dose before applying the next dose D. Applies the prescribed ribbon of ointment to the applicator paper and places it on the chest

D. Applies the prescribed ribbon of ointment to the applicator paper and places it on the chest Once the prescribed ribbon of ointment has been squeezed onto the applicator paper provided, the paper is used to spread the ointment over an area at least 2.5 by 3.5 inches. It is then covered with plastic wrap to prevent the ointment from being absorbed into the clothing. There is no mechanistic advantage to applying the ointment on the chest (over the heart). The ointment can be applied to the back, abdomen, or anterior thigh, as well as the chest. Sites should be rotated to minimize skin irritation.

Which medication is most likely to cause the side effect of constipation? A. Nifedipine [Adalat] B. Amlodipine [Norvasc] C. Isradipine [DynaCirc] D. Diltiazem [Cardizem]

D. Diltiazem [Cardizem] Nifedipine, amlodipine, and isradipine, which are dihydropyridine calcium channel blockers, cause less risk of constipation than diltiazem and verapamil.

The nurse caring for a patient taking furosemide [Lasix] is reviewing the patient's most recent laboratory results, which are: sodium, 136 mEq/L; potassium, 3.2 mEq/L; chloride, 100 mEq/L; blood urea nitrogen, 15 mg/dL. What is the nurse's best action? A. Administer Lasix as ordered. B. Place the patient on a cardiac monitor. C. Begin a 24-hour urine collection. D. Hold the Lasix and notify the physician.

D. Hold the Lasix and notify the physician. The nurse's best action is to hold the Lasix and notify the physician. Loop diuretics, such as furosemide, can cause significant potassium loss. The normal potassium level is 3.5 to 5 mEq/L. The remaining electrolyte levels are normal. Administering the Lasix could result in a critically low potassium level. Effects of low potassium include cardiac dysrhythmias. Placing a patient on a cardiac monitor requires a physician's order and would warrant further assessment first, such as taking vital signs and asking the patient whether he or she is having any cardiac-related symptoms. Collecting a 24-hour urine specimen is not appropriate in this case.