Pharm Exam 3

The client taking niacin is complaining of flushing that occurs after taking his normal dose. The nurse should notify the provider to discontinue the medication due to this adverse effect? Select one: True False

False

A nurse is preparing to administer diphenhydramine 30 mg IM stat to a client who is having an allergic reaction. Available is diphenhydramine 50 mg/1 mL. How many mL should the nurse administer?

0.6mL

The lipoprotein that carries the most cholesterol is which of the following? Select one: a. LDL b. HDL c. VLDL

LDL

The nurse knows that emphysema may be caused by a genetic deficiency of alpha-1 antitrypsin or by smoke/pollution exposure. Select one: True False

True

Which of the following carries the most triglycerides? Select one: a. LDL b. VLDL c. HDL

VLDL

The nurse is caring for a client with left-sided heart failure only. The nurse would expect to find which of the following signs/symptoms due to left-sided heart failure? Select one: a. auscultation of crackles in the lungs b. hepatomegaly c. peripheral edema d. increased JVD

A

Which of the following is a side effect of lisinopril? Select one: a. cough b. diarrhea c. suicidal thoughts d. nausea

A

Cystic fibrosis is characterized by which of the following? Select one: a. Decreases in Sodium Depletion b. Excess mucous in the lungs c. Increased pancreatic enzymes d. Rare respiratory infections

B

The nurse is caring for a client diagnosed with right-sided heart failure. The nurse would expect which of the following symptoms to be present? Select one: a. crackles auscultated in lungs b. increased JVD c. cough d. blood-tinged sputum

B

The nurse will monitor for which of the following signs / symptoms of digoxin toxicity? Select one: a. diarrhea b. seeing halos c. chest pain d. nausea

B

Which of the following conditions can lead to digoxin toxicity and therefore should be monitored for and avoided? Select one: a. hyperkalemia b. hypokalemia c. hypochloremia d. hyponatremia

B

The nurse is caring for a patient who has received anesthesia and opioids. The patient is at risk for which type of primary respiratory failure? Select one: a. Ventilation-Perfusion Mismatch b. Hypoventilation c. Impaired Diffusion d. Hyperventilation

B The patient would be at risk for hypoventilation due to the side effects of anesthesia and opioid administration will may suppress the Central Nervous system and the drive to breathe, resulting in hypercapnia. The correct answer is: Hypoventilation

The nurse knows that stimulation of the sympathetic nervous system will result in which of the following? Select one: a. hypoventilation b. bronchoconstriction c. hypercapnia d. bronchodilation

D Stimulation of the sympathetic nervous system will result in increased RR, hyperventilation, bronchodilation and hypocapnia. The correct answer is: bronchodilation

Mucolytic

→ acetylcysteine

Mast cell stabilizer

→ cromolyn,

Antitussive

→ dextromethorphan,

Intranasal corticosteroid

→ fluticasone

Expectorant

→ guaifenesin

Nasal decongestant

→ oxymetazoline

A home health nurse visits a client who has COPD and receives oxygen at 2 L/min via nasal cannula. The client reports difficulty breathing. Which of the following actions is the nurse's priority? Select one: a. Increase the oxygen flow to 3 L/min. b. Assess the client's respiratory status. c. Call emergency services for the client. d. Have the client cough and expectorate secretions.

B 2) Assess the client's respiratory status. Answer Rationale: The first action the nurse should take using the nursing process is to collect data from the client. The nurse should immediately assess the client's respiratory status before determining the appropriate interventions.

A pre-renal cause of acute renal failure is which of the following a. Benign prostatic hypertrophy b. Malignant tumor obstructing the ureter c. Hypovolemia d. Nephrotoxic drugs e. Kidney transplant rejection

C

The nurse is caring for a patient who is a post-operative knee replacement. The nurse would initiate which of the following therapies to prevent/treat atelectasis? Select one: a. Administer anti-inflammatories b. Decrease the head of the bed c. Turning, coughing & deep breathing d. Decrease fluid intake

C The correct answer is: Turning, coughing & deep breathing

A 52-year-old man who is moderately obese has recently been diagnosed with hypertension by his primary care provider. Which of the client's following statements indicates a need for further health promotion teaching? a. "I'm trying to cut back on the amount of salt that I cook with and add to my food." b. "I'm planning to lose 15 pounds before the end of this year." c. "I'm resolving to eat organic foods from now on and to drink a lot more water." d. "I've starting going to the gym before work three times a week."

C Weight loss, exercise, and salt reduction are all useful strategies in the management of hypertension. An organic diet and increased fluid intake are not known to reduce blood pressure.

A nurse is providing teaching to a client who has emphysema and a new prescription for theophylline. Which of the following instructions should the nurse provide? Select one: a. Administer the medication with food. b. Consume a high-protein diet. c. Increase fluids to 1L/per day. d. Avoid caffeine while taking this medication.

C CORRECT: 3) Avoid caffeine while taking this medication. Answer Rationale:The nurse should instruct the client that caffeine should be avoided while taking theophylline, as it can increase central nervous system stimulation.

A patient with chronic COPD is at risk for developing right sided heart failure due to their respiratory disorder (also called corpulmonale). A patient with right sided heart failure would have which of the following symptoms? Select one: a. fluid in the lungs b. decreased liver size c. left ventricular hypertrophy d. jugular venous distention

D Right sided heart failure occurs due to increased pulmonary hypertension (increased pressure in the pulmonary artery) that caused increased afterload for the right ventricle, which results in right ventricular enlargement/hypertrophy and then an increase in right atrial pressure that leads to increased jugular venous distention, liver enlargement (from fluid) and peripheral edema. Pulmonary edema or fluid in the lungs occurs with left ventricular failure. The correct answer is: jugular venous distention

A patient taking a calcium channel blocker is seen in the clinic and diagnosed with drug toxicity. When collecting the nursing history, what finding would indicate the likely cause of this drug toxicity? a. Intake of aged cheese b. The use of eggs in the diet c. Intake of alcohol d. The ingestion of grapefruit juice

D The calcium channel blockers are a class of drugs that interact with grapefruit juice. When grapefruit juice is present in the body, the concentrations of calcium channel blockers increase, sometimes to toxic levels. Advise patients to avoid drinking grapefruit juice taking a calcium channel blocker. If a patient on a calcium channel blocker reports toxic effects, ask whether he or she is drinking grapefruit juice. Use of alcohol could be important if the patient was ingesting large amounts, but that would not be the most likely cause of drug toxicity. Eggs and cheese should not exert any fooddrug interaction.

A nurse on a medical-surgical unit is performing an admission assessment of a client who has COPD with emphysema. The client reports that he has a frequent productive cough and is short of breath. The nurse should anticipate which of the following assessment findings for this client? Select one: a. Respiratory alkalosis b. Petechiae on chest c. Oxygen saturation level 96% d. Increased anteroposterior diameter of the chest

D CORRECT Increased anteroposterior diameter of the chest Answer Rationale:The nurse should anticipate an increased anteroposterior diameter of the chest (barrel chest) because of chronic hyperinflation of the lungs.

A nurse is teaching a client about taking diphenhydramine. The nurse should explain to the client that which of the following is an adverse effect of this medication? Select one: a. sedation b. constipation c. hypertension d. bradycardia

A Diphenhydramine can cause sedation, hypotension, diarrhea, and palpitations. It is used to treat rhinitis, allergies, and insomnia

The emergency department nurse is asked to prepare a nitroprusside (Nitropress) infusion for a patient being brought to the hospital in an ambulance. The nurse knows this drug is only used in what circumstances? a. Hypertensive emergencies b. Hypertension complicated by symptoms of a stroke c. Hypertension associated with diabetic ketoacidosis d. Hypertension in a patient having a myocardial infarction

A Most of the vasodilators are reserved for use in severe hypertension or hypertensive emergencies. These include hydralazine, minoxidil, and nitroprusside. The presence of absence of a comorbidity does not increase the likelihood of use. These drugs are used when blood pressure is extremely high and needs to be reduced quickly.

While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which of the following physiologic processes? a. Peripheral vascular resistance b. Electrical impulses in the heart c. Release of stress hormones d. Rigidity of the ventricular walls

A The systolic and diastolic components of blood pressure are determined by cardiac output and total peripheral vascular resistance and can be expressed as the product of the two (blood pressure = cardiac output × total peripheral resistance). The body maintains its blood pressure by adjusting the cardiac output to compensate for changes in peripheral vascular resistance, and it changes the peripheral vascular resistance to compensate for changes in cardiac output. Electrical impulses from the SA node regulate heart rate. Release of stress hormones and rigidity of the ventricular walls do not primarily influence BP; however, they may impact this secondarily.

A nurse is teaching a client who has asthma about how to use an albuterol inhaler. Which of the following actions by the client indicates an understanding of the teaching? a. The client holds his breath for 10 seconds after inhaling the medication. b. The client exhales as the medication is released from the inhaler. c. The client takes a quick inhalation while releasing the medication from the inhaler. d. The client waits 10 min between inhalations.

A The medication should be retained in the lungs for a minimum of 10 seconds so the maximum amount of the dosage can be delivered properly to the airways. To use the inhaler, the client exhales normally just prior to releasing the medication, inhales deeply as the medication is released, then holds the medication in the lungs for approximately 10 seconds prior to exhaling.

The nurse is caring for a patient with asthma. The nurse knows that the pathophysiology of asthma includes which of the following? Select all that apply a. Impaired mucociliary function b. Inflammation c. Edema d. Decreased airway responsiveness e. Increased airflow f. Bronchodilation

A, B, C The correct answers are: Inflammation, Impaired mucociliary function, Edema

Pleuritic Chest Pain has which of the following characteristics? Select all that apply. a. Localized to one area b. Also called pleurisy or pleuritis c. Continuous and unchanged by breathing d. Unilateral e. Sudden onset

A, B, D, and E The correct answers are: Unilateral, Sudden onset, Localized to one area, Also called pleurisy or pleuritis

Virchow's triad as risk factors for a deep vein thrombosis and pulmonary embolism includes which of the following? Select all that apply a. Venous stasis b. Surgery < 30 minutes c. Venous endothelial injury d. Decrease coagulability

A, C Pulmonary Embolism - occlusion of pulmonary vessel with a thrombus (most common origin is DVT), fat or air bubble Risk factors -Virchow's Triad(venous stasis, hypercoagulability, venous endothelial injury) Also, fractures, oral contraceptives, surgery > 30 minutes (due to immobility)

The nurse is providing drug teaching for a patient who is prescribed enalapril (Vasotec). What drug specific adverse effect will the nurse include in drug teaching? a. sedation b. persistent cough c. rash d. tachycardia

B Benazepril, enalapril, and fosinopril are generally well tolerated but cause an unrelenting cough, possibly related to adverse effects in the lungs, where the angiotensin-converting enzyme is inhibited, which may lead patients to discontinue the drug. This persistent cough develops in approximately 10% to 20% of patients.

A nurse is providing discharge teaching to a client who has asthma and new prescriptions for cromolyn and albuterol, both by nebulizer. Which of the following statements by the client indicates an understanding of the teaching? a. "If my breathing begins to feel tight, I will use the cromolyn immediately." b. "I will be sure to take the albuterol before taking the cromolyn." c. "I will use both medications immediately after exercising." d. "I will administer the medications 10 minutes apart."

B CORRECT: 2) "I will be sure to take the albuterol before taking the cromolyn."Answer Rationale:The client should always use the bronchodilator (albuterol) prior to using the leukotriene modifier (cromolyn). Using the bronchodilator first allows the airways to be opened, ensuring that the maximum dose of medication will get to the client's lungs.

Which of the following is a nonmodifiable risk factor for the development of primary hypertension? a. High salt intake b. African American race c. Male gender d. Obesity

B Hypertension not only is more prevalent in blacks than whites, but also is more severe, tends to occur earlier, and often is not treated early enough or aggressively enough. Blacks also tend to experience greater cardiovascular and renal damage at any level of pressure. High salt intake and obesity are modifiable risk factors for hypertension. Male gender is not identified as a risk factor for hypertension.

The nurse is providing discharge instructions to a 72-year-old patient who has been discharged home on a diuretic. What would the patient's instructions regarding the use of a diuretic at home include? a. Restrict fluids to 500 mL/d to limit the need to urinate b. To weigh themselves on the same scale, at the same time of day, in the same clothing c. Measuring intake and output of urine d. Decrease exercise to conserve energy

B Patients taking a diuretic at home need to learn to weigh themselves every day, at the same time, and in the same clothes to monitor for loss or retention of fluid. They should not be asked to measure urine output or to decrease activity. Restricting fluids can lead to a rebound fluid retention when compensatory mechanisms are activated.

The nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor to a patient who has hypertension. The nurse notes peripheral edema and swelling of the patient's lips. The patient has a blood pressure of 160/80 mmHg and a heart rate of 76 beats per minute. What is the nurse's next action? a. Administer the dose and observe carefully for hypotension b. Hold the dose and notify the provider of a hypersensitivity reaction c. Notify the provider and request an order for a diuretic medication d. Request an order for serum electrolytes and renal function tests

B The patient has signs of angioedema which indicates a hypersensitivity reaction. The nurse should hold the dose and notify the provider. Giving the dose will make the reaction more serious. These are not signs of edema, so a diuretic is not indicated. Electrolytes and renal function tests are not indicated

The class of diuretics that act to block the chloride pump in the distal convoluted tubules and leads to a loss of sodium and potassium and a minor loss of water is what? a. Carbonic anhydrase inhibitors b. Thiazide diuretics c. Osmotic diuretics d. Spirolactone

B Thiazide diuretics work to block the chloride pump, which leads to a loss of sodium, potassium, and some water. They are considered mild diuretics. Carbonic anhydrase inhibitors work to block the formation of carbonic acid and bicarbonate in the renal tubules. Osmotic diuretics use hypertonic pull to remove fluid from the intravascular spaces and to deliver large amounts of water into the renal tubules. Potassium-sparing diuretics, like Spirolactone, are mild and act to spare potassium in exchange for the loss of sodium and water.

The nurse would educate the client taking cholestyramine to monitor for which of the following side effects? Select one: a. vomiting b. constipation c. lightheadedness d. nausea and diarrhea

B constipation

The nurse is caring for a patient diagnosed with ARDs. The nurse knows the following is true regarding ARDs. a. Decreased respiratory rate b. Can be caused by direct or indirect injury to the lungs c. Refractory hypoxemia d. Chest x-ray demonstrates consolidation e. Onset within 12-18 hours (up to 72 hours) after the injury occurs

B, C, D, and E The correct answers are: Can be caused by direct or indirect injury to the lungs, Onset within 12-18 hours (up to 72 hours) after the injury occurs, Refractory hypoxemia, Chest x-ray demonstrates consolidation

A nurse is caring for a client who asks how albuterol helps his breathing. Which of the following responses should the nurse make? (Select all that apply.) a. The medication will stimulate the flow of mucus. b. The medication will prevent wheezing. c. The medication will open the airways. d. The medication will reduce inflammation. e. The medication will decrease coughing episodes.

B, C, E

A client asks why his blood pressure pills seem to make him go to the bathroom to urinate frequently when they are not water pills (diuretics). Which of the following physiologic processes explains the long-term regulation of blood pressure most accurately? a. Actions of the renin-angiotensin-aldosterone system b. Release of antidiuretic hormone (vasopressin) by the posterior pituitary c. Renal monitoring and adjustment of extracellular fluid volume d. Integration and modulation of the autonomic nervous system(ANS)

C Long-term maintenance and control of blood pressure is accomplished primarily through the renal control of fluid balance. These mechanisms function largely by regulating the blood pressure around an equilibrium point, which represents the normal pressure for a given individual. Accordingly, when the body contains too much extracellular fluid, the arterial pressure rises and the rate at which water and sodium are excreted by the kidney is increased. When blood pressure returns to its equilibrium point, water and sodium excretion returns to normal. Hormonal influences, such as th

The nurse is caring for an 80-year-old patient who has just begun taking a thiazide diuretic to treat hypertension. What is an important aspect of care for this patient? a. Encouraging increased fluid intake b. Increasing activity and exercise c. Initiating a fall risk protocol d. Providing a low potassium diet

C Older patients experience a higher risk of orthostatic hypotension when taking antihypertensive medications. Fall risk also increases with a need for increased trips to the bathroom. A fall risk protocol should be implemented. Increasing fluids and activity and limiting potassium are not indicated.

The nurse caring for a client taking atorvastatin would be most concerned with monitoring which laboratory value? Select one: a. blood urea nitrogen (BUN) b. lipase c. liver function tests d. blood glucose

C liver function tests

The best indicator for estimating renal function is a. BUN b. Renal biospy c. Urinalysis d. Glomerular filtration rate

D Glomerular filtration rate (GFR) is the best marker for estimating renal function(Measures the volume of water filtered per minute).

A patient with a pulmonary embolism would have a decrease in the d-dimer blood test. Select one: True False

False

The emergency department (ED) nurse is caring for a patient who is experiencing pulmonary edema. The patient is treated with furosemide (Lasix). What will the nurse monitor? a. Calcium levels b. Potassium levels c. Sodium levels d. Bone marrow function

Furosemide is associated with loss of potassium, so that the patient will need to be monitored carefully for low potassium levels, which could cause cardiac arrhythmias and further aggravate pulmonary edema. The nurse would not monitor sodium or calcium levels or bone marrow function because of the effects of the drug during the acute treatment of pulmonary edema.