PHARM EXAM 4 practice problems

What should the nurse assess in a patient who is prescribed metformin [Glucophage] for treatment of type 2 diabetes?

Renal function

The nurse is caring for a patient who has been taking metformin [Glucophage] for several months. The patient reports abdominal pain. Upon assessment, the nurse detects an irregular heartbeat. What else should the nurse assess to determine the severity of the patient's condition?

Renal functions

Which instruction about clopidogrel (Plavix) should be included in the discharge teaching for a patient who has received a drug-eluting coronary stent?

"Check with your healthcare provider before taking any over-the-counter medications for gastric acidity."

The nurse is beginning a heparin infusion for a patient with evolving stroke. The baseline activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved?

70

Which patient may receive insulin lispro (Humalog)?

A patient with type 2 diabetes mellitus who take metformin (Glucophage)

A patient has been taking spironolactone (Aldactone) to treat heart failure. The nurse will monitor for a. hyperkalemia. b. hypermagnesemia. c. hypocalcemia. d. hypoglycemia

ANS: A Spironolactone is a potassium-sparing diuretic and can cause hyperkalemia

The nurse is caring for a patient who takes warfarin (Coumadin) for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate?

Call the healthcare provider to increase the dose

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

Correct: A Metformin can reach toxic levels in individuals with renal impairment, which is indicated by a rise in the serum creatinine level. The prescriber may need to be notified of the hemoglobin, sodium, and platelet values, but they would not affect the administration of metformin.

Which are adverse effects of alpha blockade? (Select all that apply.) A. Hypertension B. Reflex tachycardia C. Nasal congestion D. Ejaculation E. Hypernatremia

Correct: B, C, E Adverse effects of alpha blockade include reflex tachycardia, nasal congestion, and hypernatremia. Other adverse effects include orthostatic hypotension and inhibition of ejaculation. Hypertension and ejaculation are not adverse effects of alpha blockade. Chapter 18

Before administering metformin [Glucophage], the nurse should notify the prescriber about which laboratory value?

Creatinine (Cr) level of 2.1 mg/dL

Which instruction should the nurse provide when teaching a patient to mix regular insulin and neutral protamine Hagedorn (NPH) insulin in the same syringe?

Draw up the clear regular insulin first, followed by the cloudy NPH insulin

The nurse is caring for a patient receiving clopidogrel (Plavix) to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel?

Omeprazole (Prilosec)

The nurse administers repaglinide [Prandin] to a patient at 8:00 AM. When is the patient at the highest risk for hypoglycemia?

9:00 AM

4. A patient is given a prescription for azithromycin (Zithromax) and asks the nurse why the dose on the first day is twice the amount of the dose on the next 4 days. Which reply by the nurse is correct? a. A large initial dose helps to get the drug to optimal levels in the body faster. b. The first dose is larger to minimize the first pass effect of the liver. c. The four smaller doses help the body taper the amount of drug more gradually d. Tubular reabsorption is faster with initial doses, so more is needed at first.

A

The nurse is caring for a group of patients taking warfarin (Coumadin). Which patient or patients is/are at moderate to high risk for harm as a result of warfarin therapy?

A 79-year-old man with variant genes that code for VKORC1 and CYP2CP. A 26-year-old pregnant woman with new onset of symptoms of a pulmonary embolus. A young adult with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen.

A patient with Stage C heart failure (HF) who has been taking an ACE inhibitor, a beta blocker, and a diuretic begins to have increased dyspnea, weight gain, and decreased urine output. The provider orders spironolactone (Aldactone). The nurse will make sure that the patient: a. does not take potassium supplements. b. monitors for a decreased heart rate. c. takes extra fluids. d. uses a salt substitute instead of salt.

ANS: A Spironolactone is added to therapy for patients with worsening symptoms of HF. Because spironolactone is a potassium-sparing diuretic, patients should not take supplemental potassium. Patients taking digoxin need to monitor their heart rate. Extra fluids are not indicated. Salt substitutes contain potassium

The nurse is caring for an African-American patient who has been taking a beta blocker to treat hypertension for several weeks with only slight improvement in blood pressure. The nurse will contact the provider to discuss a. adding a diuretic medication. b. changing to an ACE inhibitor. c. decreasing the beta blocker dose. d. doubling the beta blocker dose

ANS: A African Americans do not respond well to beta blockers and ACE inhibitors, but do tend to respond to diuretics and calcium channel blockers. Changing to an ACE inhibitor or altering the beta blocker dose are not indicated. Hypertension in African-American patients can be controlled by combining beta blockers with diuretics

A patient begins taking nicotinic acid (Niacin) and reports dizziness and flushing of the skin. The nurse will perform which action? a. Contact the provider to discuss decreasing the dose. b. Counsel the patient to increase fluid intake. c. Request an order for renal function tests. d. Schedule the medication to be taken with meals

ANS: A Flushing of the skin and dizziness are common side effects of nicotinic acid, but with careful drug titration and concomitant use of aspirin, these effects can be minimized. Increasing fluid intake or taking with food does not alter these adverse effects. Nicotinic acid can affect liver enzymes not renal function

The nurse is caring for a patient who develops marked edema and a low urine output as a result of heart failure. Which medication will the nurse expect the provider to order for this patient? a. Digoxin (Lanoxin) b. Furosemide (Lasix) c. Hydrochlorothiazide (HydroDIURIL) d. Spironolactone (Aldactone)

ANS: B Furosemide is a loop diuretic and is given when the patient's condition warrants immediate removal of body fluid, as in heart failure. Digoxin improves cardiac function but does not remove fluid quickly. The other diuretics may be used when immediate fluid removal is not necessary.

The nurse is teaching a patient about sublingual nitroglycerin administration. What information will the nurse include when teaching this patient? a. Call 911 if pain does not improve after three doses. b. If pain persists after one dose, administer a second dose. c. Swallow the tablet with small sips of water. d. Take the first tablet while sitting or lying down.

ANS: D Because nitroglycerin can cause hypotension, patients should be cautioned to take them while sitting or lying down. If pain is not better or has worsened 5 minutes after the first dose, patients should call 911. The tablets must dissolve under the tongue and should not be swallowed

The laboratory calls the nursing unit to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate?

Call the healthcare provider to discuss the reduction or withdrawal of heparin

A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to administer which drug? A. Furosemide (Lasix) B. Hydrochlorothiazide (HydroDIURIL) C. Mannitol (Osmitrol) D. Spironolactone (Aldactone)

Correct: A Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is needed. This patient shows severe signs of congestive heart failure with respiratory distress and pulmonary edema and needs immediate mobilization of fluid. Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema, because their diuretic effects are less rapid. Mannitol is indicated for patients with increased intracranial pressure and must be discontinued immediately if signs of pulmonary congestion or heart failure occur. Chapter 41

A female patient with essential hypertension is being treated with hydralazine (Apresoline) 25 mg twice daily. The nurse assesses the patient and notes a heart rate of 96 beats per minute and a blood pressure of 110/72 mm Hg. The nurse will request an order to: A. administer a beta blocker. B. administer a drug that dilates veins. C. reduce the dose of hydralazine. D. give the patient a diuretic.

Correct: A This patient is showing signs of reflex tachycardia, so a beta blocker is indicated to slow the heart rate. Patients with heart failure who take hydralazine often require the addition of isosorbide dinitrate, which also dilates veins. There is no indication for reducing the dose of hydralazine. A diuretic can be given with hydralazine if sodium and water retention is present. Chapter 46

A nursing student asks a nurse why a patient in hypertensive crisis is receiving both intravenous sodium nitroprusside (Nitropress) and oral hydralazine (Apresoline). The nurse will explain that this is done to prevent: A. cyanide poisoning. B. fluid retention. C. rebound hypertension. D. reflex tachycardia.

Correct: C Sodium nitroprusside acts rapidly and is given only intravenously. Rebound hypertension occurs immediately when the IV is stopped, so an oral antihypertensive should be given simultaneously. Cyanide poisoning can occur with sodium nitroprusside, but giving hydralazine does not counter this adverse effect. Hydralazine does not prevent fluid retention or reflex tachycardia. Chapter 46

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

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

A 63-year-old male patient has been receiving a heparin infusion for 2 days for treatment of pulmonary embolism. Which symptom most clearly relates to an adverse effect of heparin?

Discolored urine

Which instruction should the nurse give when a patient receiving metformin [Glucophage] therapy will undergo angiography?

Do not take your metformin on the day of the test

Which technique is most appropriate regarding mixing insulin when a patient must administer 30 units regular insulin and 70 units neutral protamine Hagedorn (NPH) insulin in the morning?

Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin.

A patient with deep vein thrombosis is receiving an intravenous (IV) heparin infusion. He asks the nurse how this medication will help him. The nurse's response is accurately based on which concept?

Heparin suppresses coagulation by helping antithrombin perform its natural functions

Which is the most appropriate action for the nurse who is told that a patient typically takes his glipizide (Glucotrol) with food?

Inform the patient that it is better to take the medication 30 minutes before a meal

Which long-acting insulin mimics natural, basal insulin with its duration of 24 hours?

Insulin glargine (Lantus)

The nurse knows that which statement is accurate for enoxaparin (Lovenox)?

It reduces the activity of factor Xa more than the activity of thrombin

A patient admitted with atrial fibrillation is receiving a continuous heparin infusion as well as daily warfarin (Coumadin). What is an appropriate action by the nurse?

Notify the healthcare provider that the INR is 3 and anticipate that the heparin will be discontinued

An operating room nurse prepares a patient who has type 2 diabetes for surgery. Which type of insulin should the nurse administer?

Regular insulin (Humulin R)

The nurse observes that A1C levels are elevated in a patient who is taking metformin [Glucophage] for type 2 diabetes. Which class of drugs is likely to be prescribed to this patient?

Sulfonylureas

A patient is taking glipizide [Glucotrol] and a propranolol. A nurse is teaching hypoglycemia awareness and should warn the patient about the absence of which symptom caused by the propranolol?

Tachycardia

A patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine [Lantus]. Which information is essential for the nurse to teach this patient?

This medication has a duration of action of 24 hours

A patient is scheduled to start taking insulin glargine [Lantus]. Which information should the nurse give the patient regarding this medication?

This medication provides blood glucose control for 24 hours

Which statement by a nursing student about insulin glargine [Lantus] indicates effective learning?

You cannot mix this insulin in the same syringe with regular insulin

What should the nurse instruct a patient who is prescribed repaglinide (Parandin) for type 2 diabetes?

You need to eat a meal after each dose

What should the nurse teach a patient who takes metformin [Glucophage] for type 2 diabetes?

You should take the medication with food

Which information should the nurse include in the teaching plan for a patient who has been prescribed repaglinide (Prandin)?

You will need to be sure you eat as soon as you take this medication

A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to administer which drug? a. Furosemide (Lasix) b. Hydrochlorothiazide (HydroDIURIL) c. Mannitol (Osmitrol) d. Spironolactone (Aldactone)

ANS A

A prescriber has ordered propranolol (Inderal) for a patient with recurrent ventricular tachycardia. The nurse preparing to administer this drug will be concerned about what in the patient's history? a. Asthma b. Exerciseinduced tachyarrhythmias c. Hypertension d. Paroxysmal atrial tachycardia associated with emotion

ANS A

An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide (HydroDIURIL). Before administering this medication, the nurse reviews the patient's chart. Which laboratory value causes the nurse the most concern? a. Elevated creatinine clearance b. Elevated serum potassium level c. Normal blood glucose level d. Low levels of lowdensity lipoprotein (LDL) cholesterol

ANS A

A nurse is preparing to administer digoxin (Lanoxin) to a patient. The patient's heart rate is 62beats per minute, and the blood pressure is 120/60 mm Hg. The last serum electrolyte value showed a potassium level of 5.2 mEq/L. What will the nurse do? a.Contact the provider to request an increased dose of digoxin. b.Give the dose of digoxin and notify the provider of the potassium level. c.Request an order for a diuretic. d.Withhold the dose and notify the provider of the heart rate.

ANS B The patient's serum potassium level is above normal limits, but only slightly. An elevated potassium level can reduce the effects of digoxin, so there is no risk of toxicity. There is no indication that an increased dose of digoxin is needed. There is no indication for a diuretic. The heart rate is acceptable; doses should be withheld if the heart rate is less than 60 beats per minute

3. A patient with type I diabetes is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol (Lopressor). What education should the nurse provide to the patient? a. Metoprolol has no effect on diabetes mellitus or on your insulin requirements. b. Metoprolol interferes with the effects of insulin, so you may need to increase your insulin dose. c. Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely. d. ÒMetoprolol may potentiate the effects of the insulin, so the dose should be reduced.

ANS C

7. A nurse is reviewing a patientÕs medications before administration. Which drug to drug interactions should most concern the nurse in a patient with a history of heart failure and a potassium level of 5.5 mEq/L? a. Furosemide (Lasix) and enalapril (Vasotec) b. Amlodipine (Norvasc) and spironolactone (Aldactone) c. Eplerenone (Inspra) and spironolactone (Aldactone) d. Metoprolol (Lopressor) and furosemide (Lasix)

ANS C

A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed the angiotensinconverting enzyme (ACE) inhibitor captopril (Capoten) concurrently with spironolactone (Aldactone). Morning laboratory results reveal a serum sodium level of 144 mg/dL, a serum potassium level of 5.1 mEq/L, and a blood glucose level of 128 mg/dL. Which intervention is appropriate? a. Administer the medications as ordered. b. Ask the patient about the use of salt substitutes. c. Contact the provider to report the laboratory values. d. Request an order for furosemide (Lasix).

ANS C

A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this patient in the past. Which could be a probable cause of the test result? a. A loading dose was not given. b. The drug was not completely dissolved in the IV solution. c. The patient is taking another medication that binds to serum albumin. d. The medication is being given at a frequency that is longer than its halflife.

ANS C

A patient who stops taking an ACE inhibitor because of its side effects will begin taking an angiotensin II receptor blocker (ARB) medication. Which side effect of ACE inhibitors will not occur with an ARB medication? a. Angioedema b. Cancer c. Cough d. Renal failure

ANS C

A patient with type I diabetes is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol (Lopressor). What education should the nurse provide to the patient? a. Metoprolol has no effect on diabetes mellitus or on your insulin requirements. b. Metoprolol interferes with the effects of insulin, so you may need to increase your insulin dose. c. Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely. d. ÒMetoprolol may potentiate the effects of the insulin, so the dose should be reduced.

ANS C

5. A patient with hypertension is taking furosemide (Lasix) for congestive heart failure. The prescriber orders digoxin to help increase cardiac output. What other medication will the nurse expect to be ordered for this patient? a. Bumetanide (Bumex) b. Chlorothiazide (Diuril) c. Hydrochlorothiazide (HydroDIURIL) d. Spironolactone (Aldactone)

ANS D

A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient? a. The fetus most likely will have serious congenital defects. b. The fetus must be monitored closely while the patient is taking this drug. c. The patient's prescriber probably will change her medication to an ARB. d. The patient should stop taking the medication and contact her provider immediately.

ANS D

A patient who has recently had a myocardial infarction (MI) will begin taking clopidogrel (Plavix) to prevent a second MI. Which medication will the nurse expect the provider to order as adjunctive therapy for this patient? a. Aspirin b. Enoxaparin sodium (Lovenox) c. Ticagrelor (Brilinta) d. Warfarin (Coumadin)

ANS: A Aspirin is often used with clopidogrel to inhibit platelet aggregation to increase the effectiveness of this drug. Enoxaparin is used to prevent venous thrombosis. Ticagrelor is similar to clopidogrel and is not used along with clopidogrel. Warfarin is used to prevent thrombosis

The nurse is assessing a patient who takes warfarin (Coumadin). The nurse notes a heart rate of 92 beats per minute and a blood pressure of 88/78 mm Hg. To evaluate the reason for these vital signs, the nurse will assess the patient's a. gums, nose, and skin. b. lung sounds and respiratory effort. c. skin turgor and oral mucous membranes. d. urine output and level of consciousness

ANS: A An increased heart rate followed by a decreased systolic pressure can indicate a fluid volume deficit caused by internal or external bleeding. The nurse should examine the patient's mouth, nose, and skin for bleeding. These vital signs do not indicate a pulmonary problem. Skin turgor and mucous membranes as well as urine output and level of consciousness may be assessed to determine the level of fluid deficit, but finding the source of blood loss is more important. Signs of gastrointestinal bleeding should also be assessed.

A patient with heart failure who has been given digoxin (Lanoxin) daily for a week complains of nausea. Before giving the next dose, the nurse will: a.assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per minute. b.contact the provider to report digoxin toxicity. c.request an order for a decreased dose of digoxin. d.review the serum electrolyte values and withhold the dose if the potassium level is greater than 3.5 mEq/L

ANS: A Anorexia, nausea, and vomiting are the most common adverse effects of digoxin and should cause nurses to evaluate for more serious signs of toxicity. If the HR is greater than 60 beats per minute, the dose may be given. Nausea by itself is not a sign of toxicity. A decreased dose is not indicated. A serum potassium level less than 3.5 mEq/L is an indication for withholding the dose

A patient is taking clopidogrel bisulfate (Plavix). When teaching this patient about dietary restrictions while taking this medication, the nurse will instruct the patient to avoid excessive consumption of which food? a. Garlic b. Grapefruit c. Green, leafy vegetables d. Red meats

ANS: A Patients taking this drug may experience increased bleeding when taken with garlic. There is no restriction for grapefruit as there is with many other medications. Green, leafy vegetables should be restricted in patients taking warfarin. Red meats are not contraindicated

A nursing student asks why the anticoagulant heparin is given to patients who have disseminated intravascular coagulation (DIC) and are at risk for excessive bleeding. The nurse will explain that heparin is used in this case for which reason? a. To decrease the risk of venous thrombosis b. To dissolve blood clots as they form c. To enhance the formation of fibrous clots d. To preserve platelet function

ANS: A The primary use of heparin for patients with DIC is to prevent venous thrombosis, which can lead to pulmonary embolism or stroke. Heparin does not break down blood clots, enhance the formation of fibrous clots, or preserve platelet function.

A patient with heart failure who has been given digoxin (Lanoxin) daily for a week complains of nausea. Before giving the next dose, the nurse will: a.assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per minute. b.contact the provider to report digoxin toxicity. c.request an order for a decreased dose of digoxin. d.review the serum electrolyte values and withhold the dose if the potassium level is greater than 3.5 mEq/L.

ANS: AAnorexia, nausea, and vomiting are the most common adverse effects of digoxin and should cause nurses to evaluate for more serious signs of toxicity. If the HR is greater than 60 beats per minute, the dose may be given. Nausea by itself is not a sign of toxicity. A decreased dose is not indicated. A serum potassium level less than 3.5 mEq/L is an indication for withholding the dose.

A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide (HydroDIURIL) and digoxin. The prescriber has ordered spironolactone (Aldactone) to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching? a. I can expect improvement within a few hours after taking this drug. b. I need to stop taking potassium supplements. c. I should use salt substitutes to prevent toxic side effects. d. I should watch closely for dehydration.

ANS: B

The nurse is caring for a patient who is receiving clopidogrel (Plavix). The patient calls the nurse to report flulike symptoms. The nurse notes a heart rate of 76 beats per minute, a blood pressure of 110/76 mm Hg, and a respiratory rate of 20 breaths per minute. The nurse suspects that the patient is experiencing which condition? a. Anaphylaxis b. An expected drug side effect c. Hemorrhage d. Possible myocardial infarction

ANS: B Flulike symptoms are a side effect of clopidogrel. The patient has normal vital signs. Anaphylaxis is characterized by respiratory distress and hypotension. Hemorrhage is characterized by tachycardia and hypotension

The nurse is caring for a patient who is receiving clopidogrel (Plavix). The patient calls the nurse to report flulike symptoms. The nurse notes a heart rate of 76 beats per minute, a blood pressure of 110/76 mm Hg, and a respiratory rate of 20 breaths per minute. The nurse suspects that the patient is experiencing which condition? a. Anaphylaxis b. An expected drug side effect c. Hemorrhage d. Possible myocardial infarction

ANS: B Flulike symptoms are a side effect of clopidogrel. The patient has normal vital signs. Anaphylaxis is characterized by respiratory distress and hypotension. Hemorrhage is characterized by tachycardia and hypotension

A patient asks the nurse why nitroglycerin is given sublingually. The nurse will explain that nitroglycerin is administered by this route for which reason? a. To avoid hypotension b. To increase absorption c. To minimize gastrointestinal upset d. To prevent hepatotoxicity

ANS: B Nitroglycerin is given sublingually to avoid first-pass metabolism by the liver, which would occur if the drug is swallowed. It does not prevent hypotension. Gastrointestinal upset and hepatotoxicity usually do not occur.

A patient has been receiving intravenous heparin. When laboratory tests are drawn, the nurse has difficulty stopping bleeding at the puncture site. The patient has bloody stools and is reporting abdominal pain.The nurse notes elevated partial thromboplastin time (PTT) and activated partial thromboplastin time (aPTT). Which action will the nurse perform? a. Ask for an order for oral warfarin (Coumadin). b. Obtain an order for protamine sulfate. c. Request an order for vitamin K. d. Suggest that the patient receive subcutaneous heparin.

ANS: B Protamine sulfate is given as an antidote to heparin when patient's clotting times are elevated. Oral warfarin will not stop the anticoagulant effects of heparin. Vitamin K is used as an antidote for warfarin. Administering heparin by another route is not indicated when there is a need to reverse the effects of heparin

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 mm Hg 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

ANS: 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 nurse is caring for a patient who is to begin receiving a thiazide diuretic to treat heart failure. When performing a health history on this patient, the nurse will be concerned about a history of which condition? a. Asthma b. Glaucoma c. Gout d. Hypertension

ANS: C Thiazides block uric acid secretion and elevated levels can contribute to gout. Patients with a history of gout should take thiazide diuretics with caution; they may need behavioral and/or pharmacologic changes to their gout treatment

A patient takes an ACE inhibitor to treat hypertension and tells the nurse that she wants to become pregnant. She asks whether she should continue taking the medication while she is pregnant. What will the nurse tell her? a. Controlling her blood pressure will decrease her risk of preeclampsia. b.Ask the provider about changing to an ARB during pregnancy. c.Continue taking the ACE inhibitor during her pregnancy. d.Discuss using methyldopa instead while she is pregnant

ANS: D Methyldopa has limited effects on uteroplacental and fetal hemodynamics and does not adversely affect the fetus or neonate. Controlling blood pressure does not lower the risk of preeclampsia. ACE inhibitors and ARBs are specifically contraindicated during pregnancy

The nurse is caring for a patient who is taking hydrochlorothiazide (HydroDIURIL) and digoxin (Lanoxin). Which potential electrolyte imbalance will the nurse monitor for in this patient? a. Hypermagnesemia b. Hypernatremia c. Hypocalcemia d. Hypokalemia

ANS: D Thiazide diuretics can cause hypokalemia, which enhances the effects of digoxin and can lead to digoxin toxicity. Thiazides can cause hypercalcemia.

A patient who uses transdermal nitroglycerin reports having headaches. The nurse will counsel the patient to perform which action? a. Call 911 when this occurs. b. Notify the provider. c. Reapply the patch three times daily. d. Take acetaminophen as needed.

ANS: D Headaches are one of the most common side effects of nitroglycerin, but they may become less frequent; acetaminophen is generally recommended for pain. The headaches are not an emergency, and the patient does not need to call 911 or notify the provider. The patch is applied once daily.

The nurse performs a medication history and learns that the patient takes a thiazide diuretic and digoxin (Lanoxin). The nurse will question the patient to ensure that the patient is also taking which medication? a. Cortisone b. Lidocaine c. Nitroglycerin d. Potassium

ANS: D If a patient is taking digoxin and a potassium-wasting diuretic such as thiazide, the patient should also take a potassium supplement to prevent hypokalemia that could result in digoxin toxicity. It is not necessary to take cortisone, lidocaine, or nitroglycerin unless the patient has symptoms that warrant these drugs

A female patient has serum lipid levels performed, which reveal a total cholesterol of 285 mg/dL, triglycerides of 188 mg/dL, a low-density lipoprotein (LDL) of 175 mg/dL, and a high-density lipoprotein (HDL) of 40 mg/dL. The patient's blood pressure is 138/72 mm Hg. The nurse may expect the provider to order which medication for this patient? a. Amlodipine and atorvastatin (Caduet) b. Colestipol HCl (Colestid) c. Fenofibrate (TriCor) d. Niacin and lovastatin (Advicor

ANS: D The combination drug of niacin and lovastatin is indicated for hypercholesterolemia and mixed dyslipidemia. Niacin raises HDL, so would be helpful in this patient who has low HDL. Combination drugs are used to enhance the antihyperlipidemic effect. Amlodipine and atorvastatin in combination are used for patients with hyperlipidemia and elevated blood pressure. Colestipol HCl is used to reduce cholesterol and LDL levels but has no effect on HDL or triglycerides. Fenofibrate is used to treat type IV and V hyperlipidemia, characterized by elevated very-low-density lipoprotein and triglycerides

A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient? A. ACE inhibitors B. Beta blockers C. Direct-acting vasodilators D. Thiazide diuretics

Correct: A ACE inhibitors slow the progression of kidney injury in diabetic patients with renal damage. Beta blockers can mask signs of hypoglycemia and must be used with caution in diabetics. Direct-acting vasodilators are third-line drugs for chronic hypertension. Thiazide diuretics promote hyperglycemia. Chapter 47

An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide (HydroDIURIL). Before administering this medication, the nurse reviews the patient's chart. Which laboratory value causes the nurse the most concern? A. Elevated creatinine clearance B. Elevated serum potassium level C. Normal blood glucose level D. Low levels of low-density lipoprotein (LDL) cholesterol

Correct: A Hydrochlorothiazide should not be given to patients with severe renal impairment; therefore, an elevated creatinine clearance would cause the most concern. Thiazide diuretics are potassium-wasting drugs and thus may actually improve the patient's potassium level. Thiazides may elevate the serum glucose level in diabetic patients. Thiazides increase LDL cholesterol; however, this patient's levels are low, so this is not a risk. Chapter 41

A patient arrives in the emergency department complaining of muscle weakness and drowsiness. The nurse notes a heart rate of 80 beats per minute, a respiratory rate of 18 breaths per minute, and a blood pressure of 90/50 mm Hg. The electrocardiogram reveals an abnormal rhythm. The nurse will question the patient about which over-the-counter medication? A. Antacids B. Aspirin C. Laxatives D. Potassium supplements

Correct: A Hypermagnesemia can occur when patients are taking magnesium-containing antacids. Symptoms include muscle weakness, sedation, hypotension, and ECG changes. Aspirin would cause metabolic acidosis. Laxatives can contribute to hypokalemia. Potassium supplements would cause hyperkalemia. Chapter 42

A patient with a recent onset of nephrosclerosis has been taking an ACE inhibitor and a thiazide diuretic. The patient's initial blood pressure was 148/100 mm Hg. After 1 month of drug therapy, the patient's blood pressure is 130/90 mm Hg. The nurse will contact the provider to discuss: A. adding a calcium channel blocker to this patient's drug regimen. B. lowering doses of the antihypertensive medications. C. ordering a high potassium diet. D. adding spironolactone to the drug regimen.

Correct: A In patients with renal disease, the goal of antihypertensive therapy is to lower the blood pressure to 130/80 mm Hg or less. Adding a third medication is often indicated. Lowering the dose of the medications is not indicated because the patient's blood pressure is not in the target range. Adding potassium to the diet and using a potassium-sparing diuretic are contraindicated. Chapter 47

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

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

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

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

A patient who was in a motor vehicle accident sustained a severe head injury and is brought into the emergency department. The provider orders intravenous mannitol (Osmitrol). The nurse knows that this is given to: A. reduce intracranial pressure. B. reduce renal perfusion. C. reduce peripheral edema. D. restore extracellular fluid.

Correct: A Mannitol is an osmotic diuretic that is used to reduce intracranial pressure by relieving cerebral edema. The presence of mannitol in blood vessels in the brain creates an osmotic force that draws edematous fluid from the brain into the blood. It can also be used to increase renal perfusion. It can cause peripheral edema and is not used to restore extracellular fluid. Chapter 41

A child who ingested a handful of aspirin tablets from a medicine cabinet at home is brought to the emergency department. The nurse caring for the child notes a respiratory rate of 48 breaths per minute. The nurse understands that this child's respiratory rate is the result of the body's attempt to compensate for: A. metabolic acidosis. B. metabolic alkalosis. C. respiratory acidosis. D. respiratory alkalosis.

Correct: A Metabolic acidosis can result from the ingestion of aspirin. The body responds by hyperventilating to reduce CO2, which represents volatile carbonic acid, and raise pH. This child has a rapid respiratory rate in response to metabolic acidosis. In patients with metabolic alkalosis, the body responds with hypoventilation in an effort to increase the CO2 level. Patients with respiratory acidosis usually have retention of CO2 secondary to hypoventilation, and compensation is the result of retention of bicarbonate by the kidneys, which is a slow process. Respiratory alkalosis is caused by hyperventilation; treatment involves having the patient rebreathe CO2 or administering sedatives. Chapter 42

A patient will begin taking propranolol (Inderal) for hypertension. Which statement by the nurse is important when teaching this patient about the medication? A. "Check your hands and feet for swelling and report that to your provider." B. "It is safe to take this medication with a calcium channel blocker." C. "Stop taking the drug if you become short of breath." D. "Take your pulse and do not take the medication if your heart rate is fast.

Correct: A Patients taking propranolol can develop heart failure because of the suppression in myocardial contractility. Patients should be taught to watch for signs, which include shortness of breath, night coughs, and swelling of the extremities. Use of these agents with calcium channel blockers is contraindicated, because the effects are identical and excessive cardiosuppression can occur. Shortness of breath should be reported to the provider, but abrupt cessation of the drug can cause rebound cardiac excitability. Propranolol reduces the heart rate and should not be given if the pulse is less than 60 beats per minute. Chapter 18

While performing an admission assessment on a patient, the nurse learns that the patient is taking furosemide (Lasix), digoxin, and spironolactone (Aldactone). A diet history reveals the use of salt substitutes. The patient is confused and dyspneic and complains of hand and foot tingling. Which is an appropriate nursing action for this patient? A. Contact the provider to request orders for an electrocardiogram and serum electrolyte levels. B. Evaluate the patient's urine output and request an order for intravenous potassium. C. Hold the next dose of furosemide and request an order for intravenous magnesium sulfate. D. Request an order for intravenous insulin to help this patient regulate extracellular potassium.

Correct: A This patient is taking a potassium-sparing diuretic and is ingesting dietary potassium in salt substitutes. The patient shows signs of hyperkalemia: confusion, shortness of breath, and tingling of the hands and feet. The cardiac effects can be fatal, especially if a patient also is taking digoxin. The most appropriate first action would be to obtain an ECG and serum electrolyte levels to evaluate the extent of the patient's hyperkalemia. The patient does not need increased potassium. Furosemide is a potassium-wasting diuretic and would be helpful. Magnesium sulfate is not indicated. Until the patient's status has been assessed further, intravenous insulin is not indicated. Chapter 42

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

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

Which two-drug regimen would be appropriate for a patient with hypertension who does not have other compelling conditions? A. Hydrochlorothiazide and nadolol B. Hydralazine and minoxidil C. Spironolactone and amiloride D. Trichlormethiazide and hydrochlorothiazide

Correct: A When using two or more drugs to treat hypertension, each drug should come from a different class. Hydrochlorothiazide is a diuretic and nadolol is a beta blocker, so this choice is appropriate. Hydralazine and minoxidil are both vasodilators. Spironolactone and amiloride are both potassium-sparing diuretics. Trichlormethiazide and hydrochlorothiazide are both thiazide diuretics. Chapter 4

Besides having diuretic effects for patients with congestive heart failure, thiazides are also used to treat what? (Select all that apply.) A. Diabetes insipidus B. Hepatic failure C. Increased intracranial pressure D. Incorrect Intraocular pressure E. Postmenopausal osteoporosis

Correct: A, B, E

A patient with congestive heart failure is admitted to the hospital. During the admission assessment, the nurse learns that the patient is taking a thiazide diuretic. The nurse notes that the admission electrolyte levels include a sodium level of 142 mEq/L, a chloride level of 95 mEq/L, and a potassium level of 3 mEq/L. The prescriber has ordered digoxin to be given immediately. What will the nurse do initially? A. Give the digoxin and maintain close cardiac monitoring. B. Hold the digoxin and report the laboratory values to the provider. C. Hold the thiazide diuretic and give the digoxin. D. Request an order for an electrocardiogram (ECG).

Correct: B Potassium depletion is common with thiazide diuretics, and hypokalemia is especially dangerous for patients receiving digoxin, because the drug can precipitate a fatal dysrhythmia and digoxin toxicity. The provider should be notified of the serum potassium level so that it can be corrected before the digoxin is administered. Giving the digoxin could produce a fatal adverse effect, so this is not an appropriate course of action. Holding the thiazide diuretic will not correct the potassium deficiency. An ECG is not the initial priority. Chapter 42

A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide (HydroDIURIL) and digoxin. The prescriber has ordered spironolactone (Aldactone) to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching? A. "I can expect improvement within a few hours after taking this drug." B. "I need to stop taking potassium supplements." C. "I should use salt substitutes to prevent toxic side effects." D. "I should watch closely for dehydration."

Correct: B Spironolactone is a potassium-sparing diuretic used to counter the potassium-wasting effects of hydrochlorothiazides. Patients taking potassium supplements are at risk for hyperkalemia when taking this medication, so they should be advised to stop the supplements. Spironolactone takes up to 48 hours to have effects. Salt substitutes contain high levels of potassium and are contraindicated. Spironolactone is a weak diuretic, so the risk of dehydration is not increased. Chapter 41

The nurse is caring for a pregnant patient who is in labor. The woman reports having had mild preeclampsia with a previous pregnancy. The nurse notes that the woman has a blood pressure of 168/102 mm Hg. The nurse will contact the provider to request an order for which drug? A. Angiotensin-converting enzyme (ACE) inhibitor B. Hydralazine (Apresoline) C. Magnesium sulfate D. Sodium nitroprusside

Correct: B The drug of choice for lowering blood pressure in a patient with severe preeclampsia is hydralazine. Sodium nitroprusside is not indicated. Magnesium sulfate is given as prophylaxis against seizures but does not treat hypertension. ACE inhibitors are contraindicated because of their potential for fetal harm. Chapter 47

A patient who does not consume alcohol or nicotine products reports a strong family history of hypertension and cardiovascular disease. The patient has a blood pressure of 126/82 and a normal weight and body mass index for height and age. The nurse will expect to teach this patient about: A. ACE inhibitors and calcium channel blocker medications. B. the DASH diet, sodium restriction, and exercise. C. increased calcium and potassium supplements. D. thiazide diuretics and lifestyle changes

Correct: B This patient has prehypertension without other risk factors. Lifestyle changes are indicated at this point. If blood pressure rises to hypertension levels, other measures, including drug therapy, will be initiated. Calcium and potassium supplements are not indicated. Chapter 47

A patient with type I diabetes is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol (Lopressor). What education should the nurse provide to the patient? A. "Metoprolol has no effect on diabetes mellitus or on your insulin requirements." B. "Metoprolol interferes with the effects of insulin, so you may need to increase your insulin dose." C. "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely." D. "Metoprolol may potentiate the effects of the insulin, so the dose should be reduced."

Correct: C Because metoprolol may mask the signs of hypoglycemia, the patient should monitor the blood glucose closely and report changes to the prescriber. Metoprolol does have an indirect effect on diabetes mellitus and/or insulin requirements in that it may mask the signs of hypoglycemia, causing the patient to make a healthcare decision based on the drug-to-drug interaction rather than actual physiologic factors. The patient should not increase the insulin, because metoprolol will cause a decrease in blood glucose, increasing the risk of a hypoglycemic reaction. The patient should not reduce the dose of insulin when taking metoprolol, because this might alter serum glucose levels. Chapter 18

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

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

A patient is taking gentamicin (Garamycin) and furosemide (Lasix). The nurse should counsel this patient to report which symptom? A. Frequent nocturia B. Headaches C. Ringing in the ears D. Urinary retention

Correct: C Patients taking furosemide should be advised that the risk of furosemide-induced hearing loss can be increased when other ototoxic drugs, such as gentamicin, are also taken. Patients should be told to report tinnitus or dizziness or hearing loss. Nocturia may be an expected effect of furosemide. Headaches are not likely to occur with concomitant use of gentamicin and furosemide. Urinary retention is not an expected side effect. Chapter 41

A patient has been taking chlorthalidone to treat hypertension. The patient's prescriber has just ordered the addition of spironolactone to the patient's drug regimen. Which statement by the patient indicates a need for further teaching? A. "I should continue following the DASH diet when adding this drug." B. "I should not take an ACE inhibitor when adding this drug." C. "I will need to take potassium supplements when adding this drug." D. "I will not experience a significant increase in diuresis when adding this drug."

Correct: C Spironolactone is given in addition to thiazide diuretics to balance potassium loss caused by the thiazide diuretic. Patients should be advised against taking potassium supplements with spironolactone, because hyperkalemia can result. The DASH diet may be continued. ACE inhibitors are contraindicated because they promote hyperkalemia. Spironolactone does not significantly increase diuresis. Chapter 47

A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten) concurrently with spironolactone (Aldactone). Morning laboratory results reveal a serum sodium level of 144 mg/dL, a serum potassium level of 5.1 mEq/L, and a blood glucose level of 128 mg/dL. Which intervention is appropriate? A. Administer the medications as ordered. B. Ask the patient about the use of salt substitutes. C. Contact the provider to report the laboratory values. D. Request an order for furosemide (Lasix).

Correct: C Spironolactone should not be administered with ACE inhibitors, which can also elevate potassium levels. Because the potassium level is elevated, the nurse should not administer the medication and should obtain clarification of the order. There is no need to repeat the potassium level test that was just done this morning. Requesting an order for furosemide is appropriate only after the provider has been notified of the laboratory values. Chapter 41

A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide (Lasix). The nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern? A. Blood glucose level of 120 mg/dL B. Oxygen saturation of 90% C. Potassium level of 3.5 mEq/L D. Sodium level of 140 mEq/L

Correct: C This patient has an irregular, rapid heartbeat that might be caused by a dysrhythmia. This patient's serum potassium level is low, which can trigger fatal dysrhythmias, especially in patients taking digoxin. Furosemide contributes to loss of potassium through its effects on the distal nephron. Potassium-sparing diuretics often are used in conjunction with furosemide to prevent this complication. This patient's serum glucose and sodium levels are normal and of no concern at this point, although they can be affected by furosemide. The oxygen saturation is somewhat low and needs to be monitored, although it may improve with diuresis. Chapter 41

A patient has had blood pressures of 150/95 mm Hg and 148/90 mm Hg on two separate office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient's diagnostic tests are all normal. The nurse will expect this patient's provider to order: A. Incorrect a beta blocker. B. a loop diuretic and spironolactone. C. a thiazide diuretic. D. counseling on lifestyle changes.

Correct: C This patient has primary, or essential, hypertension as evidenced by systolic pressure greater than 140 and diastolic pressure greater than 90, along with normal tests ruling out another primary cause. Thiazide diuretics are first-line drugs for hypertension. Beta blockers are effective, but are most often used to counter reflex tachycardia associated with reduced blood pressure caused by therapeutic agents. Loop diuretics cause greater diuresis than is usually needed and so are not first-line drugs. This patient should be counseled on lifestyle changes as an adjunct to drug therapy, but should also begin drug therapy because hypertension already exists. Chapter 47

A nurse prepares to administer propranolol (Inderal) to a patient recovering from acute myocardial infarction. The patient's heart rate is 52 beats per minute, and the rhythm is regular. What action should the nurse take next? A. Administer the drug as prescribed. B. Request an order for atropine. C. Withhold the dose and document the pulse rate. D. Withhold the dose and notify the prescriber.

Correct: D A beta blocker, such as propranolol, should not be given if the pulse is lower than 60 beats per minute; therefore, the nurse should withhold the dose and notify the prescriber. Administering the dose as prescribed would not be appropriate, because the patient's pulse rate is too slow at this time. The dose should be withheld and the prescriber notified. The patient's heart rate is slow, and atropine may be necessary if the bradycardia persists, but the first step is to withhold the dose of propranolol. Withholding the dose and documenting the pulse rate is an appropriate but incomplete nursing intervention. The nurse must notify the prescriber to obtain further orders related to the medication. Chapter 18

A nurse is caring for a patient with hypertension and diabetes. The patient's prescriber recently ordered an angiotensin-converting enzyme (ACE) inhibitor. Which statement by the patient indicates understanding of the nurse's teaching about this drug? A. "ACE inhibitors only dilate veins, so I may have more edema in my ankles." B. "ACE inhibitors prevent the nervous system from causing increased blood pressure." C. "This drug can also cause shortness of breath because of bronchoconstriction." D. "This drug will help lower my blood pressure and will benefit my kidneys."

Correct: D ACE inhibitors reduce blood pressure and help preserve renal function in people with diabetes. ACE inhibitors dilate both veins and arterioles. ACE inhibitors work on the renin-angiotensin-aldosterone system, not the nervous system. ACE inhibitors do not have effects on the bronchioles of the lungs. Chapter 46

A patient takes an ACE inhibitor to treat hypertension and tells the nurse that she wants to become pregnant. She asks whether she should continue taking the medication while she is pregnant. What will the nurse tell her? A. Controlling her blood pressure will decrease her risk of preeclampsia. B. Ask the provider about changing to an ARB during pregnancy. C. Continue taking the ACE inhibitor during her pregnancy. D. Discuss using methyldopa instead while she is pregnant.

Correct: D Methyldopa has limited effects on uteroplacental and fetal hemodynamics and does not adversely affect the fetus or neonate. Controlling blood pressure does not lower the risk of preeclampsia. ACE inhibitors and ARBs are specifically contraindicated during pregnancy. Chapter 47

A patient is admitted with severe hypertensive crisis. The nurse will anticipate administering which medication? A. Captopril PO B. Hydralazine (Apresoline) 25 mg PO C. Minoxidil 20 mg PO D. Sodium nitroprusside (Nitropress) IV

Correct: D Sodium nitroprusside is the drug of choice for hypertensive emergencies and is given intravenously. ACE inhibitors, such as captopril, are not used. Hydralazine may be used but should be given IV. Minoxidil is effective, but its severe side effects make it a second-line drug. Chapter 46

A patient with hypertension is taking furosemide (Lasix) for congestive heart failure. The prescriber orders digoxin to help increase cardiac output. What other medication will the nurse expect to be ordered for this patient? A. Bumetanide (Bumex) B. Chlorothiazide (Diuril) C. Hydrochlorothiazide (HydroDIURIL) D. Spironolactone (Aldactone)

Correct: D Spironolactone is used in conjunction with furosemide because of its potassium-sparing effects. Furosemide can contribute to hypokalemia, which can increase the risk of fatal dysrhythmias, especially with digoxin administration. The other diuretics listed are all potassium-wasting diuretics. Chapter 41

A patient with type 2 diabetes mellitus receives a prescription for metformin [Glucophage]. Which finding should the nurse recognize as a contraindication to therapy?

Creatinine 1.6 mg/dL

The nurse administers insulin to a patient at 8:30 AM and knows it will peak about 2.5 hours after administration. Which insulin did the nurse administer?

Regular insulin (Humulin R)

A patient has a serum glucose concentration of 375 mg/dL, urine output of 450 mL/hr, and an arterial pH of 7.1. The sliding scale requires intravenous insulin for a blood glucose concentration of more than 350 mg/dL. Which type of insulin is the nurse most likely to administer?

Regular insulin (Novolin R)