pharm 05 mine

The nurse is reviewing the health care provider's prescription sheet for a preoperative client, which states that the client must be NPO (nothing by mouth) after midnight. Which medication should the nurse clarify to be given and not withheld? 1. Atenolol 2. Atorvastatin 3. Cyclobenzaprine 4. Conjugated estrogen

1. Atenolol Rationale: Atenolol is a beta-blocker. Beta-blockers should not be stopped abruptly, and the health care provider should be contacted about the administration of this medication before surgery. If a beta-blocker is stopped abruptly, the myocardial need for oxygen is increased. Atorvastatin is a cholesterol-lowering medication used to treat high cholesterol. Cyclobenzaprine is a skeletal muscle relaxant. Conjugated estrogen is an estrogen used for hormone replacement therapy in postmenopausal women. The other three medications may be withheld before surgery without undue effects on the client.

The nurse is caring for a client the day after a left total knee arthroplasty surgery. In reviewing the client's past medical history, the nurse notes that the client has a history of urinary incontinence and heart failure, which is managed with a potassium-retaining diuretic and a beta-adrenergic blocker. Which prescription, if not already prescribed, should the nurse contact the health care provider to obtain? 1. Daily electrolytes 2. A 12-lead electrocardiogram 3. Resume the client's dose of metoprolol 4. Insertion of an indwelling urinary catheter

3. Resume the client's dose of metoprolol Rationale: According to The Joint Commission's Surgical Care Improvement Program's core measures, surgery clients on beta-blocker therapy prior to surgery should receive a beta blocker within 24 hours of surgery. Thus, option 3 is the correct option. Beta blockers have been found to decrease the risk for mortality associated with noncardiac surgery in high-risk clients. However, for treatment to be both safe and effective, dosing should begin before surgery and continue for at least 1 month after surgery. In this case, the client was already on the beta-blocker therapy prior to surgery, but it needs to be resumed postoperatively. Option 1 is incorrect, as the client is on a potassium-retaining diuretic so hypokalemia is unlikely to occur. Option 2 is incorrect, as a 12-lead electrocardiogram would have been done prior to surgery and there is no indication that another one is needed. Option 4 is incorrect, as there is nothing that indicates an indwelling urinary catheter is necessary (history of incontinence and diuretic therapy do not necessitate an indwelling urinary catheter) and it should be avoided to prevent developing a catheter-associated urinary tract infection.

The home care nurse visits a client to perform a dressing change on a leg ulcer. The client has diabetes mellitus and a history of cardiac disease and is taking one aspirin daily in addition to other medications as prescribed. The client tells the nurse that dental surgery is scheduled and asks the nurse whether the aspirin should be discontinued. The nurse should make which statement to the client? 1. "The pharmacist should be called." 2. "There is no risk to having such a minor surgery while taking aspirin." 3. "Aspirin has no effect on the surgical procedure and may minimize discomfort." 4. "Dental surgery can safely be done usually 10 days after stopping the aspirin, depending on the health care provider's preference."

4. "Dental surgery can safely be done usually 10 days after stopping the aspirin, depending on the health care provider's preference." Rationale: Aspirin is an antiplatelet agent that affects the platelet for its life, which is 7 to 10 days. For an elective procedure such as dental surgery, aspirin therapy should be stopped approximately 10 days before the procedure (or as prescribed by the health care provider) to prevent bleeding complications. Option 1 is not an appropriate response and places the client's issue on hold. Options 2 and 3 are incorrect.

A client is receiving heparin sodium by continuous intravenous (IV) infusion. The licensed practical nurse (LPN) is concerned that the client received a bolus of medication when the tubing was removed from the IV pump during a gown change. The LPN immediately notifies the registered nurse or health care provider and then checks to see whether which medication is available in the medication supply area in case it is prescribed? A. Protamine sulfate B. Enoxaparin (Lovenox) C. Aminocaproic acid (Amicar) D. Phytonadione (vitamin K)

A. Protamine sulfate If the tubing is removed from an IV pump and the tubing is not clamped, the client will receive a bolus of the solution and the medication contained in the solution. The client who receives a bolus dose of heparin is at risk for bleeding. A partial thromboplastin time (PTT) will be drawn and evaluated. If the results of the PTT are too high, a dose of protamine sulfate, the antidote for heparin, may be prescribed. Amicar is an antifibrinolytic (inhibits clot breakdown). Lovenox is an anticoagulant. Vitamin K is the antidote for warfarin sodium (Coumadin).

The health care provider has prescribed morphine sulfate intravenous push for a client with pulmonary edema. Which therapeutic effects should the nurse expect in this client? Select all that apply. A. Relief of anxiety B. Decreased respiratory rate C. Reduction of oxygen consumption D. Prevention of cardiac dysrhythmias E. Improvement in efficacy of breathing

A. Relief of anxiety C. Reduction of oxygen consumption E. Improvement in efficacy of breathing Pulmonary edema requires pharmacological treatment. Morphine sulfate administrated by intravenous push is used in clients with pulmonary edema for its cardiovascular effects and to relieve anxiety. It relieves anxiety thereby decreasing oxygen demand. It reduces preload and afterload, vasodilating pulmonary and systemic blood vessels, decreasing oxygen demand, and improving efficacy of breathing. Decreasing the respiratory rate and preventing cardiac dysrhythmias are not therapeutic effects of morphine.

A client with coronary artery disease complains of substernal chest pain. After checking the client's heart rate and blood pressure, the nurse administers nitroglycerin, 0.4 mg, sublingually. After 5 minutes, the client states, "My chest still hurts." Which appropriate actions should the nurse should take? Select all that apply. A. Call a code blue. B. Contact the registered nurse. C. Contact the client's family. D. Collect more data on the client's pain level. E. Check the client's blood pressure. F. Administer a second nitroglycerin, 0.4 mg, sublingually.

B. Contact the registered nurse. D. Collect more data on the client's pain level. E. Check the client's blood pressure. F. Administer a second nitroglycerin, 0.4 mg, sublingually. The usual guideline for administering nitroglycerin tablets for a hospitalized client with chest pain is to administer one tablet every 5 minutes PRN for chest pain, for a total dose of three tablets. The registered nurse should be notified of the client's condition, who will then notify the health care provider immediately. In this situation, because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would assess the client's pain level and check the client's blood pressure before administering each nitroglycerin dose. There are no data in the question that indicate the need to call a code blue. In addition, it is not necessary to contact the client's family unless the client has requested this.

The nurse administers oxycodone 5 mg with acetaminophen 500 mg (Percocet) to a patient for postoperative pain. Which patient teaching about the analgesic agent is the nurse's priority before the nurse leaves the patient's room? A. The patient may chew ice chips to relieve dry mouth. B. The patient should call for help before getting up. C. The patient should report any nausea or vomiting. D. The patient may feel flushed or diaphoretic.

B. The patient should call for help before getting up. The nurse instructs the patient to call for help before getting up because oxycodone is an opioid that can cause relaxation of vascular smooth muscle through the release of histamine, thereby blunting the baroreceptor reflex. Because the baroreceptors are less responsive, orthostatic hypotension may result from the pooling of blood in the dilated blood vessels as the system's compensatory mechanism for position changes is impaired. The available blood volume that the cardiovascular system can shunt to the brain when the patient stands is reduced; as a result, the blood pressure falls transiently when the patient stands, increasing the risk of falls and injury. Nausea, constipation, dry mouth, and flushing are common adverse effects of oxycodone; however, they are secondary in importance because the risk of patient injury is a more immediate and serious consequence of therapy.

A client is diagnosed with pulmonary embolism and is to be treated with thrombolytic therapy. The nurse should report which priority data collection finding to the registered nurse before initiating this therapy? A. Adventitious breath sounds B. Temperature of 99.4° F orally C. Blood pressure of 198/110 mm Hg D. Respiratory rate of 28 breaths per minut

C. Blood pressure of 198/110 mm Hg Thrombolytic therapy is contraindicated in a number of preexisting conditions in which there is a risk of uncontrolled bleeding, similar to the case in anticoagulant therapy. Thrombolytic therapy also is contraindicated in severe uncontrolled hypertension because of the risk of cerebral hemorrhage. Therefore, the nurse should report the results of the blood pressure to the registered nurse before initiating therapy. The findings in the remaining options may be present in the client with pulmonary embolism.

A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication? a. Aspirin b. Clopidogrel [Plavix] c. Enoxaparin [Lovenox] d. Warfarin [Coumadin]

ANS: C Enoxaparin is a low-molecular-weight heparin and is used in situations requiring rapid onset of anticoagulant effects, such as massive DVT. Aspirin, clopidogrel, and warfarin are useful for primary prevention but are not used when rapid anticoagulation is required.

The nurse is caring for a client who has been prescribed furosemide (Lasix) and is monitoring for adverse effects associated with this medication. Which should the nurse recognize as potential adverse effects? Select all that apply. A. Nausea B. Tinnitus C. Hypotension D. Hypokalemia E. Photosensitivity F. Increased urinary frequency

B. Tinnitus C. Hypotension D. Hypokalemia Furosemide is a loop diuretic; therefore, an expected effect is increased urinary frequency. Nausea is a frequent side effect, not an adverse effect. Photosensitivity is an occasional side effect. Adverse effects include tinnitus (ototoxicity), hypotension, and hypokalemia and occur as a result of sudden volume depletion.

The nurse recognizes what absolute contraindication to the administration of a thrombolytic to a patient having an acute myocardial infarction? History of intracranial hemorrhage Active peptic ulcer disease Presenting BP of 180/110 mm Hg Pregnancy

History of intracranial hemorrhage Thrombolytics are absolutely contraindicated in patients with a history of intracranial hemorrhage, intracranial neoplasms, or intracerebral ischemic effect in the previous 3 months (unless occurring within the last 3 hours, when a thrombolytic would be considered). The other factors are relative contraindications and would require vigilant monitoring.

Which drug should the nurse give to a postoperative patient who received IV pain medication in the postanesthesia room and is now unable to be aroused and has a respiratory rate of 6? Buprenorphine Hydromorphone Naloxone Oxymorphone

Naloxone is the most commonly used opioid antagonist. It is used to reverse opioid overdose and opioid-induced respiratory depression. Buprenorphine is a mixed agonist/antagonist. Hydromorphone and oxymorphone are themselves opioids.

Put the phases of the renin-angiotensin-aldosterone system in the order of their occurrence, beginning with the first event. 1 Renal release of renin 2 Cortical release of aldosterone 3 Conservation of sodium 4 Vasoconstriction by angiotensin II

1 Renal release of renin 4 Vasoconstriction by angiotensin II 2 Cortical release of aldosterone 3 Conservation of sodium Hypovolemia and hypotension each stimulate the kidneys to release renin, permitting the conversion of angiotensin I to angiotensin II. Angiotensin II vasoconstricts vessels and stimulates the adrenal cortex to release aldosterone. Aldosterone increases sodium reabsorption and potassium excretion.

The nurse receives a telephone call from the postanesthesia care unit stating that a client is being transferred to the surgical unit. The nurse plans to take which action first on arrival of the client? 1. Assess the patency of the airway. 2. Check tubes or drains for patency. 3. Check the dressing to assess for bleeding. 4. Assess the vital signs to compare with preoperative measurements

1. Assess the patency of the airway. Rationale: The first action of the nurse is to assess the patency of the airway and respiratory function. If the airway is not patent, the nurse must take immediate measures for the survival of the client. The nurse then takes vital signs followed by checking the dressing and the tubes or drains. The other nursing actions should be performed after a patent airway has been established.

A client is admitted to the ambulatory surgery center for elective surgery. The nurse asks the client whether any food, fluid, or medication was taken today. Which medication, if taken by the client, should indicate to the nurse the need to contact the health care provider? 1. A beta-blocker 2. An antibiotic 3. An anticoagulant 4. A calcium-channel blocker

3. An anticoagulant Rationale: An anticoagulant suppresses coagulation by inhibiting clotting factors. A client admitted for elective surgery should have been instructed to discontinue the anticoagulant 7 to 10 days preoperatively. Even if this were unscheduled surgery, the nurse should notify the health care provider. Vitamin K can be given for reversal of its action, but the client may still have an increased risk of bleeding. The other medications listed are commonly taken and do not constitute an increased risk for the client.

A client has received atropine sulfate intravenously during a surgical procedure. The nurse should monitor the client for which side effect of the medication in the immediate postoperative period? 1. Diarrhea 2. Bradycardia 3. Urinary retention 4. Excessive salivation

3. Urinary retention Rationale: Atropine sulfate is an anticholinergic medication that causes tachycardia, drowsiness, blurred vision, dry mouth, constipation, and urinary retention. The nurse monitors the client for any of these effects in the immediate postoperative period.

The nurse prepares a client 1 hour prior to surgery. Which assessment finding does the nurse need to communicate to the health care provider (HCP) at this time? 1. Allergy to peanuts 2. Potassium is 3.6 mEq/L (3.6 mmol/L) 3. History of obstructive sleep apnea 4. Daily garlic capsules, last dose yesterday morning

4. Daily garlic capsules, last dose yesterday morning Rationale: Option 4 is the correct answer, as garlic can increase bleeding and should be discontinued for 2 to 3 weeks before surgery. Options 1 and 3 are incorrect, as they are not findings that the HCP needs to be immediately notified of because neither warrants a delay or cancellation of the surgery. Option 2 is incorrect because it is a normal potassium level.

A preoperative client has received a dose of scopolamine as prescribed by the anesthesiologist. The nurse should assess the client for which anticipated side effect of this medication? 1. Diaphoresis 2. Pupillary constriction 3. Increased urinary output 4. Dry oral mucous membranes

4. Dry oral mucous membranes Rationale: Scopolamine is an anticholinergic medication that causes the frequent side effects of dry mouth, urinary retention, decreased sweating, and dilation of the pupils. The other options are incorrect.

A nurse is caring for a patient who is taking an angiotensin-converting enzyme inhibitor and develops a dry, nonproductive cough. What is the nurse's priority action? A. Call the health care provider to switch the medication. B. Assess the patient for other symptoms of upper respiratory infection. C. Instruct the patient to take antitussive medication until the symptoms subside. D. Tell the patient that the cough will subside in a few days.

A. Angiotensin-converting enzyme inhibitors prevent the breakdown of bradykinin, frequently causing a nonproductive cough. Angiotensin receptor blocking agents do not block this breakdown, thus minimizing this annoying side effect. The patient should be switched to a different medication if the side effect cannot be tolerated.

Before discharging a patient with a prescription for nabumetone (Relafen), the nurse instructs the patient to avoid taking other substances that will increase the risk of bleeding. Which substance(s) does the nurse tell the patient to avoid? (Select all that apply.) A. Garlic B. Aspirin C. Alcohol D. Valerian E. Caffeine F. Diuretics

A. Garlic B. Aspirin C. Alcohol Although aspirin is better tolerated than most other nonsteroidal antiinflammatory drugs (NSAIDs), the nurse instructs the patient to avoid it, along with alcohol and large quantities of garlic, to minimize the risk of bleeding during therapy with the NSAID nabumetone. Valerian increases the risk of hepatic toxicity, and the therapeutic effectiveness of diuretics is reduced when these drugs are combined with NSAID therapy. Caffeine can increase gastric acid release but is not necessarily associated with adverse effects when combined with an NSAID.

The nurse is reviewing the lipid profile of a patient with coronary artery disease. Which one of the following laboratory findings is a matter for concern? A. HDL cholesterol level of 35 mg/dl B. HDL cholesterol level of 65 mg/dl C. LDL cholesterol level of 100 mg/dl D. LDL cholesterol level of 120 mg/dl

A. HDL cholesterol level of 35 mg/dl A low HDL cholesterol level, below 40 mg/dl, is a positive risk factor for coronary artery disease. The other results are considered optimal or desirable.

The nurse administers digoxin (Lanoxin) to a patient with heart failure. Which patient assessment data should the nurse use to determine that therapy is effective? (Select all that apply.) A. Heart rate of 70 beats/min B. Prolonged PR interval C. Use of one pillow to sleep D. Bilateral peripheral edema E. Serum potassium 4.0 mEq/L F. Bilateral clear breath sounds

A. Heart rate of 70 beats/min C. Use of one pillow to sleep F. Bilateral clear breath sounds Digoxin increases myocardial contractility and slows the heart rate, increasing cardiac output. It is effective therapy for a patient with heart failure and a heart rate of 70 beats/min. This rate allows the heart to fill and empty more effectively because the faster the heart beats, the less it is able to fill; the improved filling improves cardiac output. The patient should also have clear lungs, showing that the heart is effectively moving blood from the lungs through the heart to the system without backing up into the lungs. This is the same reason that the patient can use a single pillow to sleep; orthopnea caused by pulmonary edema that requires the patient to sleep with two or more pillows is a characteristic of heart failure. A prolonged PR interval on the electrocardiogram demonstrates the negative dromotropic effect of digoxin; however, a prolonged PR interval reflects first-degree atrioventricular block, an adverse effect of digoxin. Peripheral edema indicates hypervolemia, which is characteristic of heart failure. Normal serum potassium is an indicator neither of heart failure nor of effective digoxin therapy.

A patient taking a loop diuretic such as furosemide (Lasix) should be monitored for which of the following adverse effects? (Select all that apply.) A. Hyponatremia B. Dehydration C. Hypotension D. Hypoglycemia E. Hyperglycemia F. Nephrotoxicity G. Hyperuricemia

A. Hyponatremia B. Dehydration C. Hypotension E. Hyperglycemia G. Hyperuricemia Hyponatremia, dehydration, hypotension, hyperglycemia, and hyperuricemia are all potential adverse effects of furosemide. In addition, ototoxicity, hypokalemia, and hypochloremia may occur. Hypoglycemia and nephrotoxicity are not potential adverse effects.

Why are angiotensin-converting enzyme (ACE) inhibitors contraindicated in hypovolemia or hypotension? (Select all that apply.) A. They relax vascular smooth muscle. B. They inhibit formation of angiotensin II. C. They promote sodium and water retention. D. They can decrease the serum potassium level. E. They decrease myocardial oxygen demand. F. They decrease systemic vascular resistance.

A. They relax vascular smooth muscle. B. They inhibit formation of angiotensin II. E. They decrease myocardial oxygen demand. F. They decrease systemic vascular resistance. In hypovolemia, the patient lacks sufficient blood volume to maintain an adequate blood pressure; in hypotension, the patient's vasculature lacks enough muscle tone or enough blood volume to maintain the blood pressure. Hypovolemia and hypotension can be improved by vasoconstriction or increased blood volume; hence, ACE inhibitors are contraindicated in hypovolemia or hypotension because they promote vasodilation by blocking the formation of angiotensin II, a potent vasoconstrictor, resulting in decreased systemic vascular resistance and vasodilation. ACE inhibitors also decrease myocardial oxygen consumption, but this is potentially beneficial in hypotension and hypovolemia. ACE inhibitors can increase serum potassium and promote sodium and water excretion.

Which statement about acute pain management is true? A. Treatment begins with an opioid. B. PRN drug administration is preferred. C. Parenteral medications are preferred. D. NSAIDs are effective for managing acute pain.

A. Treatment begins with an opioid. Treatment of acute pain begins with opioids and is best managed with around-the-clock drug administration. Parenteral formulations are not necessarily needed or appropriate for all acute pain. NSAIDs are more effective for managing chronic pain.

A child is being sent home on digoxin (Lanoxin) after being diagnosed with a congenital heart defect. The medication needs to be given once a day. Which should the nurse reinforce in the teaching plan for the family? A. "You may give the medication using a medication dropper." B. "Give the medication in the morning 20 to 30 minutes before a feeding." C. "If your child vomits the dose, repeat the dose and then resume the schedule in the morning." D. "If you forget to give the medication in the morning, omit the dose and resume it the following morning."

B. "Give the medication in the morning 20 to 30 minutes before a feeding." Digoxin should be given in the morning before a feeding so that a parent can get in the routine of administering the medication. The medication must be accurately measured and drawn up in a syringe, never measured in a dropper. If the dose is vomited, it is skipped that day and the dose is resumed the next day. If the medication is forgotten in the morning, it is given as soon as remembered that day.

The nurse is teaching a patient with newly diagnosed angina about sublingual nitroglycerin tablets. Which of the following nursing statements should be included in the teaching session? (Select all that apply.) A. "The tablet should be dissolved on top of the tongue and then the residue swallowed after the tablet dissolves." B. "If chest pain occurs, place a tablet under the tongue and let it dissolve fully." C. "If the first tablet does not relieve the pain, 2 additional tablets may be taken one at a time at 5-minute intervals." D. "If chest pain occurs, have someone call 911 immediately while you take the first dose of nitroglycerin." E. "If pain is not relieved within 15 minutes, call 911 immediately." F. "Unused medication can be kept up to 1 year after the bottle is opened."

B. "If chest pain occurs, place a tablet under the tongue and let it dissolve fully." C. "If the first tablet does not relieve the pain, 2 additional tablets may be taken one at a time at 5-minute intervals." E. "If pain is not relieved within 15 minutes, call 911 immediately." If chest pain occurs, a nitroglycerin tablet should be placed under the tongue and left there until it dissolves completely. As many as 3 tablets may be taken one at a time at 5-minute intervals. If chest pain is not gone within 15 minutes, the patient should seek medical help immediately by calling 911. Instruct patients to write the date on which the bottle was opened on the label and to discard unused tablets after 6 months.

The nurse administers benazepril (Lotensin) to a patient with heart failure. Which parameter should the nurse assess to evaluate the therapeutic effectiveness of benazepril in this patient? A. Mental status B. Breath sounds C. Peripheral pulses D. Serum potassium

B. Breath sounds The nurse assesses the patient's breath sounds as a means of evaluating the therapeutic effectiveness of angiotensin-converting enzyme (ACE) inhibitors because in heart failure the lungs fill with fluid. ACE inhibitors cause vasodilation, resulting in decreased afterload and increased excretion of sodium and, therefore, water. These effects decrease the blood pressure and blood volume; as the patient's fluid volume decreases, the lungs should clear or improve. Although the patient may feel better with the administration of ACE inhibitors, mental status is a nonspecific, nonsensitive indicator of heart failure or the effectiveness of therapy. Peripheral edema is a suitable patient assessment with which to determine the therapeutic effectiveness of an ACE inhibitor. The serum potassium level may be affected by ACE inhibitor therapy; however, this is a potential adverse effect of therapy and not a determinant of the drug's effectiveness.

Atenolol hydrochloride (Tenormin) is prescribed for a hospitalized client. The nurse should perform which as a priority action before administering the medication? A. Listen to the client's lung sounds. B. Check the client's blood pressure. C. Check the recent electrolyte levels. D. Assess the client for muscle weakness.

B. Check the client's blood pressure. Atenolol hydrochloride is a beta blocker used to treat hypertension. Therefore, the priority nursing action before administration of the medication is to check the client's blood pressure. The nurse also checks the client's apical heart rate. If the systolic blood pressure is below 90 mm Hg or the apical pulse is 60 beats per minute or lower, the medication is withheld and the registered nurse and/or health care provider is notified. The nurse should check baseline renal and liver function tests. The medication may cause weakness, and the nurse should assist the client with activities if weakness occurs.

Which statement indicates the patient understands discharge instructions regarding cholestyramine (Questran)? A. "I will take Questran 1 hour before my other medications." B. "I will increase fiber in my diet." C. "I will weigh myself weekly." D. "I will have my blood pressure checked weekly."

B. Cholestyramine can cause constipation; thus, increasing fiber in the diet is appropriate. All other drugs should be taken 1 hour before or 4 hours after cholestyramine to facilitate proper absorption.

A client has taken his first dose of lisinopril (Zestril) about 2 hours ago and begins to develop fullness in his face and hoarseness. Which action should the nurse take first? A. Ask the client when the hoarseness first developed. B. Determine the client's ability to breathe effectively. C. Determine the client's blood pressure to determine effectiveness. D. Instruct the client to stay in the resting position to prevent dizziness.

B. Determine the client's ability to breathe effectively. The client is experiencing angioedema, an adverse effect of the medication, which involves facial swelling and hoarseness. Assessing the ability to breathe effectively takes priority over assessing the blood pressure, preventing dizziness, or determining how long the client has been hoarse.

The nurse is discussing the possible adverse effects of low-dose (81 mg daily) aspirin therapy as prophylaxis against myocardial infarction. Which one of the following problems should the nurse recognize as a risk associated with this therapy? A. Diarrhea B. GI bleeding C. Tinnitus D. Joint pain

B. GI bleeding Even at low doses, aspirin increases the risk for GI bleeding and hemorrhagic stroke.

Aldosterone is released from the adrenal cortex in response to what? A. Bradycardia B. Hypovolemia C. Hypernatremia D. Low urine output

B. Hypovolemia Aldosterone is released by inappropriate sympathetic stimulation in the stress response and in response to hypovolemia (low blood volume) or hypotension to conserve sodium, resulting in sodium and water retention, increased blood volume, and increased blood pressure. Bradycardia should not stimulate the release of aldosterone as long as cardiac output is stable and renal perfusion is adequate. Hyponatremia and excessive urine output are more likely to stimulate the release of aldosterone.

A male patient who experiences gout has a serum urate level of 5 mg/dL and inadequate urate excretion. Which medication indicated in the treatment of gout is the best choice to improve the excretion of urate for this patient? A. Colchicine B. Probenecid (Benemid) C. Allopurinol (Zyloprim) D. Indomethicin (Indocin)

B. Probenecid (Benemid) Probenecid, a uricosuric agent, is indicated in the treatment of gout for patients who excrete urate poorly because it inhibits the reabsorption of urate in the proximal convoluted tubule. This should improve renal urate excretion and help prevent future attacks of gout. Allopurinol, a second-line therapy, helps inhibit uric acid production. Colchicine, another second-line therapy, reduces the inflammation from urate crystals. Indomethicin is an NSAID indicated in the symptomatic treatment of gout.

A male patient with coronary artery disease and diabetes mellitus has resistant hypertension despite therapy with benazepril (Lotensin). Which antihypertensive agent should the nurse avoid administering to this patient? A. Felodipine (Plendil) B. Propranolol (Inderal) C. Benazepril (Lotensin) D. Candesartan (Atacand)

B. Propranolol (Inderal) A nonselective beta-adrenergic blocker such as propranolol can mask the clinical indicators of hypoglycemia by blocking the sympathetic stimulation caused by a low blood sugar level. Therefore, propranolol is contraindicated for use in patients with diabetes mellitus. The remaining antihypertensive agents offer no contraindication to use in a patient with diabetes.

Which physiologic responses to angiotensin II are diminished by the administration of an angiotensin-converting enzyme inhibitor? (Select all that apply.) A. Renin release B. Water retention C. Vasoconstriction D. Sodium retention E. Afterload reduction F. Aldosterone secretion

B. Water retention C. Vasoconstriction D. Sodium retention F. Aldosterone secretion Aldosterone secretion Correct Angiotensin II vasoconstricts, increases afterload, and stimulates the release of aldosterone, which increases sodium and water retention. Renin release precedes angiotensin II formation.

A client with heart failure is being discharged to home and will be taking furosemide (Lasix). The nurse determines that teaching has been effective if the client makes which statement? A. "I will take my pulse every day." B. "I will measure my urine output." C. "I will weigh myself every day." D. "I will check my ankles every day for swelling."

C. "I will weigh myself every day." A client taking furosemide must be able to monitor fluid status throughout therapy. Monitoring daily weight is the easiest and most accurate way to accomplish this. Options 2 and 4 are incorrect because of the difficulty of assessing fluid status accurately in this way. Additionally, in order for option 2 to be correct, fluid intake would also need to be measured. Option 1 is incorrect and unrelated to the administration of furosemide.

A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin sodium (Coumadin). The nurse is told that the client's prothrombin time is 18 seconds with a control of 11 seconds. Which action should the nurse plan? A. Double the next dose of warfarin sodium. B. Withhold the next dose of warfarin sodium. C. Administer the next dose of warfarin sodium. D. Cut the next dose of warfarin sodium in half.

C. Administer the next dose of warfarin sodium. The therapeutic range for prothrombin time (PT) is one and one half to two times the control for clients at high risk for thrombus. Based on the client's control value, the therapeutic range for this individual is 16.5 to 22 seconds. The nurse should administer the next dose as usual.

Heparin sodium is prescribed for the client. Which laboratory result indicates that the heparin is prescribed at a therapeutic level? A. Prothrombin time (PT) of 21 seconds B. Thrombocyte count of 100,000 cells/mm3 C. International normalized ratio (INR) of 2.3 D. Activated partial thromboplastin time (aPTT) of 55 seconds

D. Activated partial thromboplastin time (aPTT) of 55 seconds The aPTT will assess the therapeutic effect of Heparin sodium. The PT and INR will assess for the therapeutic effect of warfarin sodium (Coumadin). A decreased thrombocyte count can cause bleeding.

A client complaining of not feeling well is seen in a clinic. The client is taking several medications for the control of heart disease and hypertension. These medications include a beta blocker, digoxin (Lanoxin), and a diuretic. A tentative diagnosis of digoxin toxicity is made. Which assessment data supports this diagnosis? A. Dyspnea, edema, and palpitations B. Chest pain, hypotension, and paresthesia C. Double vision, loss of appetite, and nausea D. Constipation, dry mouth, and sleep disorder

C. Double vision, loss of appetite, and nausea Double vision, loss of appetite, and nausea are signs of digoxin toxicity. Additional signs of digoxin toxicity include bradycardia, difficulty reading, visual alterations such as green and yellow vision or seeing spots or halos, confusion, vomiting, diarrhea, decreased libido, and impotence.

A patient with acute pulmonary edema is receiving furosemide (Lasix). What assessment finding indicates to the nurse that the intervention is working? A. Potassium level decreased from 4.5 to 3.5 mEq/L B. Improvement in mental status C. Lungs clear D. Output 30 mL/hr

C. Furosemide (Lasix) is a potent, rapid-acting diuretic that would be the drug of choice to treat acute pulmonary edema. Furosemide should not cause a drastic change in output or decrease in potassium level, and there is no evidence that it will create any change in mental status.

The nurse is assessing a patient who is taking furosemide (Lasix). The patient's potassium level is 3.4 mEq/L; chloride is 90 mmol/L, and sodium is 140 mEq/L. Based on the nurse's understanding of the laboratory results, what prescribed therapy can the nurse anticipate administering? A. Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly. B. Administer sodium polystyrene sulfonate. C. Administer 2 mEq potassium chloride per kilogram per day IV. D. Administer calcium acetate, two tablets three times per day.

C. Furosemide is a potent loop diuretic, resulting in the loss of potassium as well as water, sodium, and chloride. The patient needs chloride replacement. Normal potassium level is 3.5 to 5.2 mEq/L; normal sodium level is 135 to 147 mEq/L, and normal chloride level is 95 to 107 mEq/L. Potassium is never given by rapid infusion.

Which patient would the nurse need to assess first if the patient is receiving mannitol (Osmitrol)? A. A 67-year-old patient with type 1 diabetes mellitus B. A 21-year-old patient with a head injury C. A 47-year-old patient with anuria D. A 55-year-old patient receiving cisplatin to treat ovarian cancer

C. Mannitol (Osmitrol) is not metabolized but excreted unchanged by the kidneys. Potential water intoxication could occur if mannitol is given to a patient with anuria. Mannitol is safe to use with diabetic patients and those with head injuries, and it may function as a nephroprotectant when cisplatin is being used.

A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention? A. Monitor for renal kidney failure. B. Monitor psychosocial status. C. Monitor for signs of bleeding. D. Have heparin sodium available.

C. Monitor for signs of bleeding. Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin is given after thrombolytic therapy, but the question is not asking about follow-up medications.

Isosorbide mononitrate (Imdur) is prescribed for a client with angina pectoris. The client tells the nurse that the medication is causing a chronic headache. Which action should the nurse suggest to the client? A. Cut the dose in half. B. Discontinue the medication. C. Take the medication with food. D. Contact the health care provider (HCP).

C. Take the medication with food. Isosorbide mononitrate is an antianginal medication. Headache is a frequent side effect of isosorbide mononitrate and usually disappears during continued therapy. If a headache occurs during therapy, the client should be instructed to take the medication with food or meals. It is not necessary to contact the HCP unless the headaches persist with therapy. It is not appropriate to instruct the client to discontinue therapy or adjust the dosages.

A patient taking prazosin (Minipress) has a blood pressure of 140/90 mm Hg and is complaining of swollen feet. What is the nurse's best action? A. Hold the medication. B. Call the health care provider. C. Determine the patient's history. D. Weigh the patient.

C. The desired therapeutic effect of prazosin (Minipress) may not fully occur for 4 weeks. The nurse does not know how long the patient has been on this medication. There is no need to hold the medication. It is more important to determine the patient's history prior to weighing the patient or calling the health care provider, since symptoms may be the result of the medication not yet achieving the full therapeutic effect.

Which conditions are indications for nitroglycerin (Nitro-Bid)? (Select all that apply.) A. Hypertension B. Dysrhythmias C. Variant angina D. Unstable angina E. Preload reduction F. Myocardial infarction

C. Variant angina D. Unstable angina E. Preload reduction F. Myocardial infarction Treatment of angina pectoris is the main indication for nitroglycerin. This drug causes venodilation, leading to decreased preload, myocardial workload, and oxygen consumption. Nitroglycerin is indicated for the treatment of vasospastic angina, to reduce preload in pulmonary edema, for unstable angina, and in the treatment of an acute myocardial infarction to dilate coronary arteries.

A nurse is monitoring a patient with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective? A. Blood pressure of 120/80 mm Hg B. Heart rate of 70 beats per minute C. ECG without evidence of ST changes D. Patient stating that pain is 0 out of 10

D. The patient taking nitroglycerin should expect the therapeutic effect of absence of chest pain. It is unrealistic to expect that the patient's blood pressure, heart rate, and ECG will all be in completely normal range since variations in blood pressure and heart rate will occur as part of daily life and the patient may have some underlying cardiac disease that is producing the angina.

Which finding in the patient receiving heparin would require an immediate intervention by the nurse? A aPTT of 45 B WBC of 8.5 C RBCs of 4.2 D Platelet count of 80,00

D Platelet count of 80,000 A platelet count of less than 100,000 indicates thrombocytopenia. Because the patient is receiving heparin, which interferes with normal coagulation, adequate platelets are necessary to prevent hemorrhage in the event of trauma or bleeding.

A client is on nicotinic acid (niacin) for hyperlipidemia, and the nurse reinforces instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? A. "It is not necessary to avoid the use of alcohol." B. "The medication should be taken with meals to decrease flushing." C. "Clay-colored stools are a common side effect and should not be of concern." D. "Ibuprofen (Motrin IB) taken 30 minutes before the nicotinic acid should decrease the flushing."

D. "Ibuprofen (Motrin IB) taken 30 minutes before the nicotinic acid should decrease the flushing." Flushing is a side effect of this medication. Aspirin or a nonsteroidal anti-inflammatory drug can be taken 30 minutes before taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this side effect. The medication should be taken with meals; this will decrease gastrointestinal upset. Taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be immediately reported to the health care provider (HCP).

The nurse is reviewing a medication history on a patient taking an ACE inhibitor. The nurse plans to contact the health care provider if the patient is also taking which medication? A. Docusate sodium (Colace) B. Furosemide (Lasix) C. Morphine sulfate D. Spironolactone (Aldactone)

D. ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion—decreased aldosterone can result in increased serum potassium levels. Spironolactone is a potassium-sparing diuretic and should not be administered with an ACE inhibitor.

A client is taking ticlopidine hydrochloride. The nurse tells the client to avoid which substance while taking this medication? A. Vitamin C B. Vitamin D C. Acetaminophen (Tylenol) D. Acetylsalicylic acid (aspirin)

D. Acetylsalicylic acid (aspirin) Ticlopidine hydrochloride is a platelet aggregation inhibitor. It is used to decrease the risk of thrombotic strokes in clients with precursor symptoms. Because it is an antiplatelet agent, other medications that precipitate or aggravate bleeding should be avoided during its use. Therefore, aspirin or any aspirin-containing product should be avoided.

The nurse has provided discharge instructions to a client being placed on long-term anticoagulant therapy with warfarin sodium (Coumadin). The nurse reminds the client to do which? A. Reduce alcohol intake to 12 oz daily. B. Alternate the timing of the daily dose. C. Take any over-the-counter medications as needed. D. Avoid taking products containing acetylsalicylic acid (aspirin).

D. Avoid taking products containing acetylsalicylic acid (aspirin). Warfarin sodium is an anticoagulant. The client should avoid taking aspirin because of its antiplatelet properties and should avoid taking other over-the-counter medications without checking with the health care provider first because they could contain ingredients that would interact with the warfarin sodium. The client should avoid alcohol while taking warfarin sodium, per health care provider's directions. The client should take the medication at the same time each day to increase compliance and keep therapeutic blood levels stable.

A client who has developed atrial fibrillation that is not responding to medication therapy has begun taking warfarin (Coumadin). The nurse is reinforcing dietary discharge teaching with the client. The nurse should plan to teach the client to avoid which food while taking this medication? A. Cherries B. Potatoes C. Spaghetti D. Broccoli

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

A client with heart failure who is taking furosemide (Lasix) and digoxin (Lanoxin) calls the nurse and complains of anorexia and nausea. The nurse should take which action? A. Administer an antiemetic. B. Hold the morning dose of furosemide. C. Administer the daily dose of digoxin. D. Check the result of the potassium level drawn 3 hours ago.

D. Check the result of the potassium level drawn 3 hours ago. Anorexia and nausea are two of the common symptoms associated with digoxin toxicity, which is compounded by hypokalemia. The nurse should first check the results of the potassium level. This would provide additional data to report to the health care provider, which is a key follow-up nursing action. The nurse would not hold the furosemide without a prescription to do so, given the information provided. The nurse would withhold the digoxin and notify the registered nurse, who would contact the health care provider because digoxin toxicity is suspected. The nurse would not administer an antiemetic without further investigating the client's problem. The digoxin blood level should also be checked.

Which antihypertensive agents are most likely to cause tachycardia? (Select all that apply.) A. Valsartan (Diovan) B. Lisinopril (Prinivil) C. Aliskiren (Tekturna) D. Diazoxide (Hyperstat) E. Treprostinil (Remodulin) F. Hydralazine (Apresoline)

D. Diazoxide (Hyperstat) F. Hydralazine (Apresoline) Direct-acting vasodilators such as hydralazine and diazoxide work by dilating the peripheral vasculature and are likely to cause tachycardia because vasodilators decrease the blood pressure by way of direct action on vascular smooth muscle. As the body tries to compensate for a sudden decrease in oxygenated blood, the baroreceptors are stimulated, thereby increasing the heart rate to improve oxygen delivery to the tissues. Valsartan (angiotensin II receptor blocker), lisinopril (angiotensin-converting enzyme inhibitor), eplerenone (aldosterone blocker), and aliskiren (renin inhibitor) are less likely to cause reflex tachycardia because none of these agents acts by exerting direct smooth muscle relaxation.

A client with diabetes mellitus who has been controlled with daily insulin has been placed on atenolol (Tenormin) for the control of angina pectoris. Because of the effects of atenolol, the nurse determines that which is the most reliable indicator of hypoglycemia? A. Sweating B. Tachycardia C. Nervousness D. Low blood glucose level

D. Low blood glucose level β-Adrenergic blocking agents, such as atenolol, inhibit the appearance of signs and symptoms of acute hypoglycemia, which would include nervousness, increased heart rate, and sweating. Therefore, the client receiving this medication should adhere to the therapeutic regimen and monitor blood glucose levels carefully. Option 4 is the most reliable indicator of hypoglycemia.

A patient is receiving gentamicin as treatment for a surgical wound infection. Because this patient has been retaining fluid, the physician orders furosemide (Lasix). Which adverse effect may occur if these two drugs are given together? A. Orthostatic hypotension B. Hepatotoxicity C. Hyperglycemia D. Ototoxicity

D. Ototoxicity Furosemide can cause transient hearing loss, which is increased if other ototoxic drugs (such as gentamicin) are given at the same time. Combined use of these drugs should be avoided.

A male patient who weighs 68 kg comes to the emergency department and states that he has just swallowed a bottle of aspirin. The bottle contained 90 tablets, 325 mg per tablet. Which goal is the nurse's priority? A. Restoring the acid-base balance B. Checking the patient's neurologic status C. Assessing the patient for occult bleeding D. Protecting the patient from injury

D. Protecting the patient from injury The patient has ingested almost 30 g of aspirin, or 430 mg/kg body weight, indicating that he is likely experiencing acute salicylate toxicity. The nurse's priority is to protect the patient from injury. Because the circumstances that led to the aspirin ingestion are unknown (the patient may be at risk for suicide) and because his physiological status is uncertain, the nurse plans to stop the absorption of the aspirin. The nurse will implement nursing care to help restore the acid-base balance because the patient is likely to have metabolic acidosis.

Which adverse effect of allopurinol limits its clinical usefulness? A. Bleeding B. Pulmonary edema C. Respiratory failure D. Severe skin reaction

D. Severe skin reaction Allopurinol is generally well tolerated, but the rare possibility of toxic epidermal necrolysis does exist. Other adverse effects of therapy include agranulocytosis, aplastic anemia, exfoliative dermatitis, and Stevens-Johnson syndrome.

The nurse is caring for a 70-year-old patient who has recently begun taking amlodipine (Norvasc) 5 mg/day to control hypertension. The nurse notes mild edema of the patient's ankles, a blood pressure of 130/70 mm Hg, and a heart rate of 80 beats per minute. The patient reports flushing and dizziness. The nurse will notify the provider and a. ask to decrease the dose to 2.5 mg/day. b. discuss twice daily dosing. c. request an order for a diuretic. d. suggest adding propranolol to the regimen.

a. ask to decrease the dose to 2.5 mg/day.

The nurse is caring for a patient who experiences a rapid rise in blood pressure. The nurse will contact the provider to discuss administering which medication? a. Amlodipine (Norvasc) b. Nifedipine (Procardia) c. Nifedipine extended release (Procardia XL) d. Verapamil (Calan)

b. Nifedipine (Procardia)

The nurse is caring for a client receiving digoxin (Lanoxin). The nurse monitors the client for which early manifestation of digoxin toxicity? A. Anorexia B. Photophobia C. Facial pain D. Yellow color perception

A. Anorexia Digoxin is a cardiac glycoside used to manage and treat heart failure and to control ventricular rates in clients with atrial fibrillation. The most common early symptoms of toxicity include gastrointestinal disturbances such as anorexia, nausea, and vomiting. Neurological abnormalities also can occur early and include fatigue, headache, depression, weakness, drowsiness, confusion, and nightmares. Facial pain, personality changes, and ocular disturbances (photophobia, light flashes, halos around bright objects, yellow or green color perception) are also signs of toxicity but are not early signs.

While assessing a patient who has been taking triamterene (Dyrenium) for hypertension, the nurse looks for signs of hyperkalemia. Which of the following signs point to hyperkalemia? (Check all that apply.) A. Confusion B. Intestinal dilation and ileus C. Numbness or tingling of the hands and feet D. Paralysis of skeletal muscle E. Anxiety F. Weakness

A. Confusion C. Numbness or tingling of the hands and feet E. Anxiety F. Weakness Confusion, anxiety, weakness, and numbness or tingling of the hands and feet are possible signs of hyperkalemia. Intestinal dilation, ileus, and paralysis of skeletal muscle are signs of possible hypokalemia.

As the nurse is assessing a patient who is taking a thiazide diuretic, the lab calls to report that the patient's serum potassium level is 5.9 mEq/L. Which diagnostic test should be scheduled in response to this finding? A. Electrocardiogram (ECG) B. Urinalysis C. Serum BUN and creatinine levels D. Liver function studies

A. Electrocardiogram (ECG) Hyperkalemia causes alterations in the ECG and cardiac rhythm and may lead to cardiac dysrhythmias or even cardiac arrest if the serum potassium level reaches 8 to 9 mEq/L.

Which assessment indicates to the nurse a therapeutic effect of mannitol (Osmitrol) has been achieved? A. Decreased intracranial pressure B. Decreased potassium C. Increased urine osmolality D. Decreased serum osmolality

A. Mannitol (Osmitrol) is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This will decrease intracranial pressure, increase excretion of medications, decrease urine osmolality, and increase serum osmolality.

Which intervention is essential before the nurse administers tenecteplase (TNKase)? A. Perform all necessary venipunctures. B. Administer aminocaproic acid (Amicar). C. Have the patient void. D. Assess for allergies to iodine.

A. TNKase is a thrombolytic agent that can interfere with the body's clotting ability. Therefore, all invasive procedures should be completed before administering this drug.

A patient who has taken warfarin [Coumadin] for a year begins taking carbamazepine. The nurse will anticipate an order to: a. decrease the dose of carbamazepine. b. increase the dose of warfarin. c. perform more frequent aPTT monitoring. d. provide extra dietary vitamin K.

ANS: B Carbamazepine is a powerful inducer of hepatic drug-metabolizing enzymes and can accelerate warfarin degradation. The warfarin dose should be increased if the patient begins taking carbamazepine. Decreasing the dose of carbamazepine is not indicated. It is not necessary to perform more frequent aPTT monitoring or to add extra vitamin K.

* A patient who is taking clopidogrel [Plavix] calls the nurse to report black, tarry stools and coffee-ground emesis. The nurse will tell the patient to: a. ask the provider about using aspirin instead of clopidogrel. b. consume a diet high in vitamin K. c. continue taking the clopidogrel until talking to the provider. d. stop taking the clopidogrel immediately.

ANS: C Patients who experience bleeding should be warned not to stop taking the clopidogrel until the prescriber says they should, since abrupt withdrawal may precipitate a thrombotic event. Taking aspirin with an active GI bleed is contraindicated. Warfarin is a vitamin K inhibitor; consuming extra vitamin K will not reverse the effects of clopidogrel.

You notice that a patient is moaning quietly after undergoing a painful procedure. You check the electronic medication sheet and find that an analgesic was administered 10 minutes earlier. You sit down next to the patient and gently stroke his hand while you talk to him about his children. Which nonpharmacologic pain-reduction strategy are you implementing?

B. Distraction and cutaneous stimulation Talking with the patient about a topic of interest provides distraction. Stroking the patient's hand gently is an example of cutaneous stimulation.

A child with a right-to-left cardiac shunt is receiving propranolol (Inderal-LA). The health care provider visits the child and writes prescriptions in the child's record. The licensed practical nurse (LPN) reviews the prescriptions and notes that the child is placed on a nothing-by-mouth (NPO) status. The LPN consults with the registered nurse and prepares to monitor which parameter closely? A. Sodium level B. Glucose level C. Blood urea nitrogen D. White blood cell count

B. Glucose level Propranolol, a beta blocker, is used in the palliative treatment of hypercyanotic episodes. It can cause hypoglycemia if administered in a child who is NPO or hypovolemic. The nurse should monitor glucose levels every 4 to 6 hours if the child is NPO or hypovolemic and receiving propranolol. The health care provider should be notified if the glucose level is less than 60 mg/dL. The laboratory tests noted in options 1, 3, and 4 are not related to the administration of this medication.

A patient is prescribed a noncardioselective beta1 blocker. What nursing intervention is a priority for this patient? A. Assessment of blood glucose levels B. Respiratory assessment C. Orthostatic blood pressure assessment D. Teaching about potential tachycardia

B. Noncardioselective beta blockers can cause bronchospasms, and a respiratory assessment is indicated to check for potential respiratory side effects. Assessment of blood glucose and teaching about tachycardia will not be priorities.

A patient who has been taking warfarin (Coumadin) is admitted with coffee-ground emesis. What can the nurse anticipate being prescribed for this patient? A. Vitamin E B. Vitamin K C. Protamine sulfate D. Calcium gluconate

B. Vitamin K is the antagonist for warfarin.

Which patient's statement indicates a need for further medication instruction about colestipol (Colestid)? A. "The medication may cause constipation, so I will increase fluid and fiber in my diet." B. "I should take this medication 1 hour after or 4 hours before my other medications." C. "I might need to take fat-soluble vitamins to supplement my diet." D. "I should stir the powder in as small an amount of fluid as possible to maintain potency of the medication."

D. Colestipol (Colestid) is a powder that must be well-diluted in fluids before administration to avoid esophageal irritation or obstruction and intestinal obstruction. The powder should not be stirred because it may clump; it should be left to dissolve slowly for at least 1 minute.

Which drug, if taken with warfarin, may decrease warfarin's anticoagulant effect? A. Nonsteroidal antiinflammatory drug (NSAID) B. Erythromycin C. Amiodarone D. Rifampin

D. Rifampin Rifampin, when taken with warfarin, reduces warfarin's anticoagulant effect. The other drugs may cause increased bleeding.

The nurse is assessing a client who will be receiving a low molecular weight heparin (LMWH). Which condition, if present, is a contraindication to the use of LMWH? A. The client has an IV line. B. The client has a history of pulmonary embolism. C. The client underwent hip replacement surgery this morning. D. The client has spinal surgery.

D. The client has spinal surgery. The LMWHs are contraindicated for clients with strokes, peptic ulcers, and blood anomalies. These drugs should not be given to clients having eye, brain, or spinal surgery.

The nurse is reinforcing dietary instructions to a client who is taking triamterene (Dyrenium). The nurse instructs the client that it is acceptable to consume which food item daily? A. Apple B. Banana C. Avocado D. Baked potato

A. Apple Triamterene is a potassium-retaining diuretic, which means that the client must avoid the intake of foods high in potassium. Options 2, 3, and 4 are high-potassium food items.

The nurse is counseling a patient about risk factors for coronary artery disease. Which of the following choices are positive risk factors? (Check all that apply.) A. High-density lipoprotein level (HDL) above 40 mg/dl B. High-density lipoprotein level (HDL) below 40 mg/dl C. Female, 45 years or older D. Male, 45 years or older E. Father died of coronary heart disease at age 54 F. Cousin died of coronary heart disease at age 51

B. High-density lipoprotein level (HDL) below 40 mg/dl D. Male, 45 years or older E. Father died of coronary heart disease at age 54 Positive risk factors for coronary artery disease include an HDL level of less than 40 mg/dl, male sex and 45 years or older, female sex and 55 years or older, and family history of coronary heart disease in a first-degree relative (male under age 55 or female under age 65).

A patient is receiving an intravenous heparin drip. Which laboratory value requires immediate action by the nurse? A. Platelet count of 150,000 B. Activated partial thromboplastin time (aPTT) of 120 seconds C. INR of 1.0 D. Blood urea nitrogen (BUN) level of 12 mg/dL

B. The aPTT value of 120 seconds is too prolonged. The heparin drip should be shut off for an hour. The typical aPTT normal reference range for a patient on anticoagulant therapy is 30 to 85 seconds (range may vary slightly depending on the laboratory used). The normal range for BUN is 7 to 20 mg/dL, and the normal platelet range is 150,000 to 450,000.

A client is receiving a continuous intravenous (IV) infusion of heparin in the treatment of deep vein thrombosis. The nurse is told that the client's activated partial thromboplastin time (aPTT) level is 65 seconds and that the client's baseline before the initiation of therapy was 30 seconds. The nurse identifies these results as characteristic of which description? A. Low B. Elevated C. Abnormal D. Within the therapeutic range

D. Within the therapeutic range The normal aPTT varies between 20 and 36 seconds, depending on the type of activator used in testing. The therapeutic dose of heparin for treatment of deep vein thrombosis is to keep the aPTT between 1.5 and 2.5 times normal. Thus, the client's aPTT is within the therapeutic range, and the dose should remain unchanged.

An older female patient who has hypertension and is taking ceftriaxone (Rocephin) tells the nurse that she is taking naproxen (Aleve) for pain in her side but not experiencing much relief. Which NSAID may be indicated for pain relief for this patient? A. Oxaprozin (Daypro) B. Ketoprofen (Orudis) C. Piroxicam (Feldene) D. Celecoxib (Celebrex)

A. Oxaprozin (Daypro) Oxaprozin is indicated for patients at risk for nephrotoxicity. Ketoprofen, piroxicam, and celecoxib are contraindicated for use in this patient.

A client scheduled for surgery receives a dose of scopolamine. The nurse expects to note which side effects of the medication? Select all that apply. 1. Dry mouth 2. Diaphoresis 3. Profuse diarrhea 4. Pupillary dilation 5. Excessive urination

1. Dry mouth 4. Pupillary dilation Rationale: Scopolamine is an anticholinergic medication that causes frequent side effects of dry mouth, urinary retention, decreased sweating, and dilation of the pupils. The other options are incorrect and are not side effects of this medication.

A client who has undergone preadmission testing has had blood drawn for serum laboratory studies, including a complete blood count, coagulation studies, and electrolytes and creatinine levels. Which laboratory result should be reported to the surgeon's office by the nurse, knowing that it could cause surgery to be postponed? 1. Hemoglobin, 8.0 g/dL (80 mmol/L) 2. Sodium, 145 mEq/L (145 mmol/L) 3. Serum creatinine, 0.8 mg/dL (70.6 mmol/L) 4. Platelets, 210,000 mm3 (210 × 109/L)

1. Hemoglobin, 8.0 g/dL (80 mmol/L) Rationale: Routine screening tests include a complete blood count, serum electrolyte analysis, coagulation studies, and a serum creatinine test. The complete blood count includes the hemoglobin analysis. All of these values are within normal range except for hemoglobin. If a client has a low hemoglobin level, the surgery likely could be postponed by the surgeon.

The nurse is assisting in developing a plan of care for a client receiving warfarin sodium (Coumadin). The nurse selects which problem as the priority in caring for this client? A. Potential for injury B. Potential for infection C. Fluid volume overload D. Potential for inability to tolerate activity

A. Potential for injury Anticoagulant therapy predisposes the client to injury because of the inhibitory effects of the medication on the body's normal blood-clotting mechanism. Bruising, bleeding, and hemorrhage may occur in the course of activities of daily living and with other activities. Options 2, 3, and 4 are not specifically related to the care of a client receiving anticoagulants.

A patient has been taking warfarin [Coumadin] for atrial fibrillation. The provider has ordered dabigatran etexilate [Pradaxa] to replace the warfarin. The nurse teaches the patient about the change in drug regimen. Which statement by the patient indicates understanding of the teaching? a. "I may need to adjust the dose of dabigatran after weaning off the warfarin." b. "I should continue to take the warfarin after beginning the dabigatran until my INR is greater than 3." c. "I should stop taking the warfarin 3 days before starting the dabigatran." d. "I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2."

ANS: D When switching from warfarin to dabigatran, patients should stop taking the warfarin and begin taking the dabigatran when the INR is less than 2. It is not correct to begin taking the dabigatran before stopping the warfarin. While warfarin is stopped before beginning the dabigatran, the decision to start taking the dabigatran is based on the patient's INR and not on the amount of time that has elapsed.

The parents of a 4-year-old patient who weighs 22 kg ask the nurse how to treat the child's fever. Which nonsteroidal antiinflammatory drug (NSAID) should the nurse recommend for use in reducing the child's fever? A. Celecoxib (Celebrex) 50 mg twice a day B. Ibuprofen (Motrin) 220 mg every 8 hours C. Indomethacin (Indocin) 12 mg twice a day D. Aspirin (Bayer Aspirin) 220 mg every 4 hours

B. Ibuprofen (Motrin) 220 mg every 8 hours The best NSAID antipyretic to administer to a child is ibuprofen, and a dosage of 220 mg every 8 hours is within the dosing guidelines for this patient's weight. Aspirin is contraindicated in children because of its link to Reye's syndrome. Celecoxib may be indicated, but it is not the best choice; it is a prescription drug and is much more expensive than ibuprofen. Indomethicin is not indicated.

The surgeon recommends hip-replacement surgery for a patient who has osteoarthritis and takes aspirin for pain. The patient wants to delay surgery as long as possible but complains that the hip pain is increasing. Which nonsteroidal antiinflammatory drug (NSAID) is contraindicated for use in this patient? A. Ibuprofen (Motrin) B. Ketoralac (Toradol) C. Celecoxib (Celebrex) D. Naproxen (Naprosyn)

B. Ketoralac (Toradol) This patient requires long-term analgesia, so ketorolac is contraindicated because its use is restricted to 5 days. This is because it can adversely affect the kidneys and is likely to cause edema, gastrointestinal pain, dyspepsia, and nausea. Ibuprofen, celecoxib, and naproxen may all be indicated for use in the patient.

Clients who are given a prescription for sildenafil (Viagra) should be taught that a potentially fatal medication interaction can occur with which medication? A. Warfarin (Coumadin) B. Nitroglycerin (Nitrostat) C. Acetaminophen (Tylenol) D. Acetylsalicylic acid (aspirin)

B. Nitroglycerin (Nitrostat) Both sildenafil and nitrates promote vasodilation and hypotension. If these medications are combined, life-threatening hypotension could result. Therefore, sildenafil is contraindicated for clients taking nitrates. At least 24 hours should elapse after the last dose of sildenafil before a nitrate is given. The medications in options 1, 3, and 4 are not contraindicated.

The health care provider who prescribes nitroglycerin for a patient understands that which form of the drug will have the longest duration of action? A. Buccal tablet B. Oral tablet C. Sublingual tablet D. Translingual spray

B. Oral tablet Oral formulations of nitroglycerin are formulated to provide a consistent blood level of medication to prevent angina. Nitroglycerin administered by way of other routes is absorbed quickly, for immediate action during episodes of angina, but provides only short-term effects.

A patient who has severe asthma wants to take ibuprofen (Motrin) for joint pain. Which instruction should the nurse give the patient? A. Try aspirin to relieve the joint pain. B. Take the ibuprofen every 4 to 6 hours. C. Always take ibuprofen with an antacid. D. Replace the ibuprofen with acetaminophen.

D. Replace the ibuprofen with acetaminophen. The nurse instructs the patient to avoid taking ibuprofen or aspirin because they can trigger asthma. Because the asthma is severe, the patient cannot afford the risk. In addition, a patient with obstructive lung disease may require glucocorticoid therapy during an asthmatic crisis; if the patient were to take a nonsteroidal antiinflammatory drug (NSAID) and irritate the gastric mucosa, the combination of a glucocorticoid and NSAID could increase the risk of gastrointestinal bleeding dangerously.

A client who is taking hydrochlorothiazide (HydroDIURIL, HCTZ) has been started on triamterene (Dyrenium) as well. The client asks the nurse why both medications are required. Which response is the most accurate to give to the client? A. Both are weak potassium-excreting diuretics. B. The combination of these medications prevents renal toxicity. C. Hydrochlorothiazide is an expensive medication, so using a combination of diuretics is cost-effective. D. Triamterene is a potassium-retaining diuretic, whereas hydrochlorothiazide is a potassium-excreting diuretic.

D. Triamterene is a potassium-retaining diuretic, whereas hydrochlorothiazide is a potassium-excreting diuretic. Potassium-retaining diuretics include amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium). They are weak diuretics that are used in combination with potassium-excreting diuretics. This combination is useful when medication and dietary supplement of potassium is not appropriate. The use of two different diuretics does not prevent renal toxicity. Hydrochlorothiazide is an effective and inexpensive generic form of the thiazide classification of diuretics.

The nurse prepares morphine sulfate IV for a patient but decides to consult with the pharmacist before administering the medication. Which condition is the most likely reason the nurse has decided to consult the pharmacist? A. Cancer B. Asthma C. Diarrhea D. Anorexia

B. Asthma Morphine should be used with caution in patients with asthma because naturally occurring opioids cause the release of histamine; a release of histamine in a patient with asthma can trigger bronchoconstriction. Because morphine is bound to protein 20% to 35%, the patient's cancer and anorexia are causes for concern because both conditions can result in hypoproteinemia and a lack of protein-binding sites for morphine and, therefore, altered pharmacokinetics of the medication. The administration of morphine can help diminish diarrhea.

The nurse reviews the history for a patient taking atorvastatin (Lipitor). What will the nurse act on immediately? A. The patient takes medications with grape juice. B. The patient takes herbal therapy including kava kava. C. The patient is on oral contraceptives. D. The patient was started on penicillin for a respiratory infection

C. Atorvastatin (Lipitor) increases the estrogen levels of oral contraceptives. The patient's oral contraceptive may need to be altered.

An older female patient who has hypertension and is taking ceftriaxone (Rocephin) tells the nurse that she is taking naproxen (Aleve) for pain in her side but not experiencing much relief. Which action should the nurse implement next? A. Assessing the patient's pain B. Discontinuing the naproxen C. Evaluating the patient's fluid balance D. Assessing the patient for bleeding

A. Assessing the patient's pain The nurse must complete the pain assessment to plan suitable nursing care and wants to rule out renal or urinary tract involvement. This is because the patient has hypertension and is taking naproxen, an NSAID, with a cephalosporin antibiotic; the medications and the hypertension have the potential to cause renal dysfunction, especially in an older adult. Although renal dysfunction may develop quietly, the combination of medication with hypertension warrants further investigation. Ultimately, the nurse should encourage the patient to discontinue any NSAIDs and should provide a list of NSAIDs to avoid. Evaluating the patient's fluid balance and checking for the presence of bleeding are reasonable nursing interventions in an older adult taking NSAIDs because these drugs can cause renal failure and gastrointestinal bleeding, but they are not the first action the nurse should perform.

The nurse is reinforcing medication instructions to a client who has been prescribed simvastatin (Zocor). Which is the action of simvastatin? A. It inhibits hepatic synthesis of cholesterol. B. It increases lipid metabolism of cholesterol. C. It sequesters fat in the colon promoting fecal excretion of cholesterol. D. It increases glomerular filtration promoting renal excretion of cholesterol.

A. It inhibits hepatic synthesis of cholesterol. The process of cholesterol reduction begins with inhibition of hepatic HMG-CoA reductase, the rate-limiting enzyme in cholesterol biosynthesis. In response to decreased cholesterol production, hepatocytes synthesize more HMG-CoA reductase. As a result, cholesterol synthesis is restored. However, for reasons that are not fully understood, inhibition of cholesterol synthesis causes hepatocytes to synthesize more low-density lipoproteins (LDL) receptors. Therefore, options 2, 3, and 4 are incorrect.

The nurse is preparing to administer furosemide (Lasix) to a client with a diagnosis of heart failure. Which is the most important laboratory test result for the nurse to review before administering this medication? A. Potassium level B. Creatinine level C. Cholesterol level D. Blood urea nitrogen (BUN)

A. Potassium level Furosemide is a loop diuretic. The medication causes a decrease in the client's electrolytes, especially potassium, sodium, and chloride. Administering furosemide to a client with a low potassium level could precipitate ventricular dysrhythmias. The options of BUN and creatinine reflect renal function. The cholesterol level is unrelated to the administration of this medication.

A patient who takes warfarin for atrial fibrillation undergoes hip replacement surgery. On the second postoperative day, the nurse assesses the patient and notes an oxygen saturation of 83%, pleuritic chest pain, shortness of breath, and hemoptysis. The nurse will contact the provider to report possible ____ and request an order for ____. a. congestive heart failure; furosemide [Lasix] b. hemorrhage; vitamin K (phytonadione) c. myocardial infarction; tissue plasminogen activator (tPA) d. pulmonary embolism; heparin

ANS: D This patient is exhibiting signs of pulmonary embolism. Heparin is used when rapid onset of anticoagulants is needed, as with pulmonary embolism. The patient would have respiratory cracks and a cough with congestive heart failure. Hemorrhage involves a decrease in blood pressure, bruising, and lumbar pain. The patient has pleuritic pain, which is not consistent with the chest pain of a myocardial infarction.

A male patient with a history of migraine headaches tells the nurse that he has been taking ibuprofen (Motrin) 600 mg three or four times a day for headaches over the past month but that the headaches have not ceased. Which action should the nurse implement? A. Assessing for a history of headaches B. Telling him to stop taking ibuprofen C. Performing a neurologic assessment D. Telling him to take antacids regularly

B. Telling him to stop taking ibuprofen The patient, who has been taking ibuprofen for a month to treat headaches without success, may be experiencing toxicity because one adverse effect of ibuprofen is headaches. Hence, the nurse should instruct the patient to stop taking ibuprofen for headache and collaborate on alternative treatment if necessary.

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

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

The nurse is caring for a client who has been taking diuretics on a long-term basis. The nurse reviews the medication record, knowing that which medications, if prescribed for this client, would place the client at risk for hypokalemia? A. Bumetanide B. Triamterene (Dyrenium) C. Spironolactone (Aldactone) D. Amiloride hydrochloride (Midamor)

A. Bumetanide Bumetanide is a potassium-losing loop diuretic. The client on this medication would be at risk for hypokalemia. Spironolactone, triamterene, and amiloride hydrochloride are potassium-retaining diuretics.

A client with myocardial infarction is a candidate for alteplase (Activase) therapy. The nurse assisting in the care of this client is aware that it will be necessary to monitor for which adverse effect of this therapy? A. Infection B. Bleeding C. Allergic reaction D. Muscle weakness

B. Bleeding Alteplase is a thrombolytic medication, which means that it breaks down or dissolves clots. Because of its action, the principal adverse effect is bleeding. Local or systemic infection could occur with poor aseptic technique during medication administration, but it is rare. Allergic reaction is not a frequent response. Muscle weakness is not an adverse effect of this medication.

A client is being discharged to home following recovery from an anterior myocardial infarction with recurrent angina. The client will be taking diltiazem (Cardizem), isosorbide dinitrate (Isordil), and nitroglycerin (Nitrostat) sublingually as needed, and the nurse reinforces information to the client about the medications. Which statement by the client indicates a need for further teaching about the medications? A. "I will store these medications in a cool place, away from light." B. "All three of these medications will increase blood flow to my heart." C. "All three of these medications will help decrease the intensity of my chest pain." D. "I should notify my doctor immediately if I experience headaches with any of these medications."

D. "I should notify my doctor immediately if I experience headaches with any of these medications." Because of the vasodilating effects of nitrates, headache is a common side effect. Medical attention is not needed unless the headaches increase in severity or frequency. All three medications are nitrates, which improve myocardial circulation by dilating coronary arteries and collateral vessels, thus increasing blood flow to the heart. These medications are used to help prevent the frequency, intensity, and duration of anginal attacks. Nitrates should be stored in a cool place and in a dark container. Heat and light cause these medications to break down and lose their potency.

The nurse has conducted preoperative teaching for a client scheduled for surgery in 1 week. The client has a history of arthritis and has been taking acetylsalicylic acid. The nurse determines that the client needs additional teaching if the client makes which statement? 1. "Aspirin can cause bleeding after surgery." 2. "Aspirin can cause my ability to clot blood to be abnormal." 3. "I need to continue to take the aspirin until the day of surgery." 4. "I need to check with my health care provider about the need to stop the aspirin before the scheduled surgery."

3. "I need to continue to take the aspirin until the day of surgery." Rationale: Antiplatelets alter normal clotting factors and increase the risk of bleeding after surgery. Aspirin has properties that can alter platelet aggregation and should be discontinued at least 48 hours before surgery. However, the client should always check with his or her health care provider regarding when to stop taking the aspirin when a surgical procedure is scheduled. Options 1, 2, and 4 are accurate client statements.

A patient is ordered furosemide (Lasix) to be given via intravenous push. Which interventions will the nurse perform? (Select all that apply.) A. Administer at a rate no faster than 20 mg/min. B. Assess lung sounds before and after administration. C. Assess blood pressure before and after administration. D. Maintain accurate intake and output record. E. Monitor ECG continuously. F. Insert an arterial line for continuous blood pressure monitoring.

A. B. C. D. Furosemide (Lasix) can be infused via intravenous push at the rate of 20 mg/min. Furosemide is a diuretic and will decrease fluid in alveoli, and assessing lung sounds can help to determine therapeutic effect. Blood pressure should decrease with the administration of a diuretic. It is appropriate to monitor before and after administration. It is appropriate to monitor intake and output for a patient receiving a diuretic. There is no need to insert an arterial line to continuously monitor the blood pressure since it should not fluctuate that dramatically. Also, there is no need to continuously monitor ECG since the medication is not cardiotoxic.

What is a priority nursing diagnosis for a patient taking an antihypertensive medication? A. Alteration in cardiac output related to effects on the sympathetic nervous system B. Knowledge deficit related to medication regimen C. Fatigue related to side effects of medication D. Alteration in comfort related to nonproductive cough

A. Circulation is always a priority over fatigue, pain, and knowledge deficit.

The nurse would question an order for colesevelam (Welchol) if the patient has which condition in the medical history? A. Impaction B. Glaucoma C. Hepatic disease D. Renal disease

A. Colesevelam (Welchol) binds with bile in the intestinal tract to form an insoluble complex. It can also bind to other substances and lead to intestinal obstruction.

A patient has been receiving heparin while in the hospital to treat deep vein thromboses and will be discharged home with a prescription for enoxaparin [Lovenox]. The nurse provides teaching for the nursing student who asks about the advantages of enoxaparin over heparin. Which statement by the student indicates a need for further teaching? a. "Enoxaparin does not require coagulation monitoring." b. "Enoxaparin has greater bioavailability than heparin." c. "Enoxaparin is more cost-effective than heparin." d. "Enoxaparin may be given using a fixed dosage."

ANS: C Low-molecular-weight (LMW) heparins have higher bioavailability and longer half-lives, so routine coagulation monitoring is not necessary and fixed dosing is possible. LMW heparins are more expensive, however, so this statement indicates a need for further teaching.

Which information can help the nurse administer opioids more safely? A. Bolus administration is less likely to produce central nervous system changes. B. Respirations may decrease with relaxation and pain relief. C. Opioid antagonists produce more respiratory depression than do opioid agonists. D. Peripheral effects include vasoconstriction and increased blood pressure.

B. Respirations may decrease with relaxation and pain relief. Opioids decrease respirations at all dosages; however, they most often provide pain relief, which therefore eases respirations as long as the patient's respiratory status is stable before the administration of the opioid analgesic. Bolus administration is more likely to provide CNS changes. Opioid antagonists actually improve respiration rather than cause respiratory depression. There are few peripheral effects.

The nurse is reinforcing discharge teaching to the client who was given a prescription for nifedipine (Adalat) for blood pressure management. Which instructions should the nurse reinforce? Select all that apply. A. "Increase water intake." B. "Increase calcium intake." C. "Take pulse rate each day." D. "Weigh at the same time each day." E. "Palpitations may occur early in therapy." F. "Be careful when rising from sitting to standing."

C. "Take pulse rate each day." D. "Weigh at the same time each day." E. "Palpitations may occur early in therapy." F. "Be careful when rising from sitting to standing." Nifedipine is a calcium-channel blocker. Its therapeutic outcome is to decrease blood pressure. Its method of action is blockade of the calcium channels in vascular smooth muscle, promoting vasodilation. Side effects that can occur early in therapy include reflex tachycardia (palpitations) and first-dose hypotension, leading to orthostatic hypotension. Weight should be checked regularly to monitor for early signs of heart failure. Also the client is taught to take his or her own pulse. Nifedipine does not affect serum calcium levels. Increased water intake is not indicated in the client with cardiovascular disease.

The nurse has just reassessed the condition of a postoperative client who was admitted 1 hour ago to the surgical unit. The nurse plans to monitor which parameter most carefully during the next hour? 1. Urinary output of 20 mL/hour 2. Temperature of 37.6°C (99.6°F) 3. Blood pressure of 100/70 mm Hg 4. Serous drainage on the surgical dressing

1. Urinary output of 20 mL/hour Rationale: Urine output should be maintained at a minimum of 30 mL/hour for an adult. An output of less than 30 mL for 2 consecutive hours should be reported to the health care provider. A temperature higher than 37.7°C (100°F) or lower than 36.1°C (97°F) and a falling systolic blood pressure, lower than 90 mm Hg, are usually considered reportable immediately. The client's preoperative or baseline blood pressure is used to make informed postoperative comparisons. Moderate or light serous drainage from the surgical site is considered normal.

A health care provider (HCP) writes a prescription for digoxin (Lanoxin), 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is important to do which? A. Count the radial and carotid pulses every morning. B. Check the blood pressure every morning and evening. C. Stop taking the medication if the pulse is higher than 100 beats per minute. D. Withhold the medication and call the HCP if the pulse is less than 60 beats per minute.

D. Withhold the medication and call the HCP if the pulse is less than 60 beats per minute. An important component of taking this medication is monitoring the pulse rate; however, it is not necessary for the client to take both the radial and carotid pulses. It is not necessary for the client to check the blood pressure every morning and evening because the medication does not directly affect blood pressure. It is most important for the client to know the guidelines related to withholding the medication and calling the HCP. The client should not stop taking a medication.

A client is being treated for heart failure and is receiving digoxin (Lanoxin). The client's vital signs are blood pressure 85/50 mm Hg, pulse 96 beats per minute, respirations 26 breaths per minute. To evaluate therapeutic effectiveness of this medication, the nurse should expect which change in the client's vital signs? A. Blood pressure 85/50 mm Hg, pulse 60 beats per minute, respirations 26 breaths per minute B. Blood pressure 98/60 mm Hg, pulse 80 beats per minute, respirations 24 breaths per minute C. Blood pressure 130/70 mm Hg, pulse 104 beats per minute, respirations 20 breaths per minute D. Blood pressure 110/40 mm Hg, pulse 110 beats per minute, respirations 20 breaths per minute

B. Blood pressure 98/60 mm Hg, pulse 80 beats per minute, respirations 24 breaths per minute The main function of digoxin is inotropic. The increased myocardial contractility is associated with increased cardiac output causing a rise in the blood pressure in a client with heart failure. Digoxin also has a negative chronotropic effect (decreases heart rate) and will therefore cause a slowing of heart rate. As cardiac output improves, there should be an improvement in respirations as well. Therefore, the remaining options are incorrect.

What is the primary indication for the administration of morphine? A. To diminish feelings of anxiety B. To relieve acute and chronic pain C. To induce a state of unconsciousness D. To increase cardiac filling pressures

B. To relieve acute and chronic pain The principal indication for morphine is the relief of moderate to severe pain, including postoperative pain and cancer pain. In addition, morphine is used during acute myocardial infarction to relieve pain, anxiety, and dypsnea and to promote relaxation of vascular smooth muscle. Morphine may also be administered before surgery for sedation.