Pharm Exam 4- Questions
A patient with angina pectoris is prescribed sublingual nitroglycerin. Which statement made by the patient indicates understanding of the medication teaching?
"I may experience a headache as a side effect." Headaches and dizziness are a normal side effect because nitro is a vasodilator
A nurse instructs a patient about signs and symptoms of digoxin toxicity. The nurse determines that teaching is successful if the patient makes which statement?
"I should report any muscle weakness or nausea." Muscle weakness, nausea, fatigue and halo indicate toxicty
The nurse teaches a patient about benazepril [Lotensin]. Which statement by the patient requires an intervention by the nurse?
"I use NoSalt instead of salt to season foods." Salt sub= high in K, and ACE-Is cause hyperkalemia "-pril" = ACE-I
The nurse teaches a patient diagnosed with chronic stable angina about the mechanism of action of nitroglycerin. The nurse should include which instruction?
"Nitroglycerin dilates veins, which decreases the amount of oxygen needed by the heart." Stable angina- occurs b/c of increase demand for oxygen. Goal of nitro is to decrease O2 demand Varient angina- caused by decreased supply of oxygen. Goal of nitro is to increase O2 supply
A patient is prescribed a nitroglycerin transdermal patch. The nurse should include which statement when teaching the patient how to use this medication?
"Remove the patch at bedtime." Patch needs to be removed for 10-12 hours to avoid developing tolerance
A patient is prescribed sustained-release oral nitroglycerin capsules for chronic stable angina. The nurse should include which instruction?
"Sit or lie down if dizziness or lightheadedness occurs." Nitro is a vasodilator
The nurse instructs a patient about taking nifedipine [Procardia XL]. Which statement made by the patient indicates an understanding of medication teaching?
"The pill should be swallowed whole." Never crush or chew extended release PO meds
Clonidine is approved for the treatment of which conditions?
-ADHD -Hypertension -Severe pain
Which are therapeutic uses of verapamil?
-Angina of effort -Cardiac dysrhythmias -Essential hypertension Verampamil is a calcium channel blocker that acts on heart and VSM
Which are adverse effects of alpha blockade?
-Cardiac dysrhythmias -Heart failure -Stage fright (PRN)
Which patient would most likely be prescribed sodium nitroprusside [Nitropress]?
A patient with a hypertensive crisis in the intensive care unit sodium nitroprusside is DOC for hypertensive emergency
1. A prescriber orders clonidine [Kapvay] ER tablets for a 12-year-old child. The nurse understands that this drug is being given to treat which condition?
ADHD
A nurse is caring for a patient who is receiving verapamil [Calan] for hypertension and digoxin [Lanoxin] for heart failure. The nurse will observe this patient for:
AV blockade. Both supress impulse conduction
A patient is receiving an intravenous infusion of heparin to treat a pulmonary embolism. What laboratory value will the nurse monitor to evaluate treatment with this medication?
Activated partial thromboplastin time (aPTT) PTT w/ heparin should be 60-80
What is the antidote for heparin?
Protamine sulfate Heparin OD is hemorrhaging. OD is when platelet levels are < 100,000
Cholestyramine has been prescribed for a patient. Which instruction should the nurse include in patient teaching?
Cholestyramine can impair absorption of fat-soluble vitamins. Cholestyramine is an old bile acid sequestrant
A patient is prescribed verapamil [Calan]. The nurse should assess the patient for which common adverse effects?
Constipation, headache, and edema of the ankles and feet Verapamil = CCB
1. 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?
Furosemide- a loop diuretic Pink frothy sputum= pulmonary edema Loops are used for pulmonary edema b/c of fast onset.
A nurse is caring for a patient who is receiving a drug that causes constriction of arterioles. The nurse expects to observe which effect from this drug?
Decreased stroke volume (constriction of arterioles decreases stoke volume)
A patient complains to the nurse that the clonidine [Catapres] recently prescribed for hypertension is causing drowsiness. Which response by the nurse to this concern is appropriate?
Drowsiness is a common side effect initially, but it will lessen with time. Clonadine is an alpha-2 agent and can cause temporary drownsiness
A patient with severe hypertension is prescribed minoxidil. Which medications will the nurse expect to be administered to reduce adverse responses to minoxidil?
Furosemide [Lasix] and propranolol [Inderal] Beta blocker and diuretic will decrease risk of reflex tachycardia
A patient with heart failure who takes furosemide [Lasix] is diagnosed with bacterial pneumonia. Which medication, if ordered by the physician, should the nurse question?
Gentamicin Furosemide and aminoglycosides cause ototoxicity
The nurse administers an intravenous infusion of amiodarone [Coredarone] to a patient to prevent recurrent episodes of ventricular fibrillation. It is most important for the nurse to assess the patient for which condition?
Hypotension Amiodarone lowers BP. other baseline tests include chest x-ray, EKG, TSH, LFT
A nurse is teaching a patient who will begin taking verapamil [Calan] for hypertension about the drug's side effects. Which statement by the patient indicates understanding of the teaching?
I may become constipated, so I should increase fluids and fiber. Verampamil is a calcium channel blocker that acts on heart and VSM
A prescriber has ordered clonidine [Catapres] for a patient who has hypertension. The nurse teaches the patient about the side effects of this drug. Which statement by the patient indicates understanding of the teaching?
I should chew sugar-free gum or drink water to reduce dry mouth. Clonadine is an alpha-2 agent and can cause xerostomia (dry mouth)
The nurse is discussing home management with a patient who will begin taking an alpha-adrenergic antagonist for hypertension. Which statement by the patient indicates understanding of the teaching?
I should take the 1st dose at bedtime. Alpha-1 blockers can cause orthostatic hypotension with 1st dose, so it needs to bed taken in bed
While giving discharge instructions to a patient who will be taking cholestyramine [Questran], the nurse wants to assess the patient's understanding of the treatment. Which statement made by the patient best demonstrates a need for additional teaching?
I will weigh myself weekly. Weight check daily
A nurse is providing teaching for a patient with stable angina who will begin taking nitroglycerin. Which statement by the patient indicates understanding of the teaching?
If I take nitroglycerin before exertion, I can reduce the chance of an anginal attack. can be used profilactically
The nurse cares for a patient receiving digoxin [Lanoxin]. What indicates to the nurse that treatment with this medication is effective?
Improved cardiac output Digoxin is used to increase cardiac output
A nurse is reviewing a patient's medications and realizes that gemfibrozil [Lopid] and warfarin [Coumadin] are to be administered concomitantly. Which effect will the nurse anticipate in this patient?
Increased anticoagulant effects Warfarin + fibrates= increased risk for bleeding Gemfibrozil is a fibrate ("-fibr")
A patient with a history of hypertension is admitted for a procedure. If the patient's arterial pressure decreases, which clinical manifestation would the nurse expect to see?
Increased heart rate- Reflex tachycardia Medications that cause dilation cause reflex tachycardia
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?
Increased serum creatinine increased serum creatinine= decreased creatinine clearance
A patient who is hospitalized for an infection takes eplerenone [Inspra] for heart failure. Which medication, if ordered by the physician, should the nurse question?
Intraconazole Strong CYP inhibitors like itraconazole should be avoided because elperenone uses CYP3A4 Elperenone = aldosterone agent
A patient with type 1 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?
Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely.
A patient who is taking simvastatin [Zocor] develops an infection and the provider orders azithromycin [Zithromax] to treat the infection. The nurse should be concerned if the patient complains of:
Muscle pain Rhabdomylosis and myopathy are ADEs of statins. When using simvistatin avoid azithromycin and other macrolides b/c they are inhibitors
A patient is taking a beta1-adrenergic drug to improve the stroke volume of the heart. The nurse caring for this patient knows that this drug acts by increasing:
Myocardial contractility (Beta 1 drugs activate receptors on the myocardium for increased contractility)
A patient with hypertension with a blood pressure of 168/110 mm Hg begins taking hydrochlorothiazide and verapamil. The patient returns to the clinic after 2 weeks of drug therapy, and the nurse notes a blood pressure of 140/85 mm Hg and a heart rate of 98 beats/min. What will the nurse do?
Notify the provider and ask about adding a beta-blocker medication. Hydrochlorothiazide is a vasodilator and can cause reflex tachycardia. a beta-blocker is given to counteract this
When providing discharge teaching for a patient who has been prescribed furosemide [Lasix], it is most important for the nurse to include which dietary items to prevent adverse effects of furosemide [Lasix] therapy?
Oranges, spinach, and potatoes Furosemide is a loop diuretic and is potassium wasting, so K containing foods must be increased
Which patient does the nurse identify as most likely needing an increased dose of warfarin [Coumadin] to have the same anticoagulant effect?
Patient taking oral contraceptives to prevent pregnancy OC can cause coagulation, which would decrease effects of Warfarin
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/min, 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?
Potassium level of 3.5 mEq/L Loops (furosemide) can cause hypokalemia, so when paired with digoxin a low potassium level is concerning because digoxin + hypokalema= dig toxicity
A patient is prescribed hydralazine. What is most important for the nurse to teach the patient?
Prevention of reflex tachycardia- use BB. hydralazine is a vasodilator Hydralazine= direct acting vasodilator Slow acetylators need a lower dose
A patient diagnosed with systemic lupus erythematosus (SLE) develops a dysrhythmia. Which medication, if ordered by the physician, should the nurse question?
Procainamide it already can give a lupus-like reaction, so is not used for patients with lupus
A nurse administers quinidine sulfate to a patient with atrial fibrillation. The nurse should assess the electrocardiogram (ECG) tracing knowing that quinidine sulfate has what effect on the ECG?
Prolongation of the QT interval Arrythmias are caused by QT interval prolongation
A nurse checks a patient's vital signs in the hospital and notes a blood pressure of 146/98 mm Hg. What will the nurse do?
Recheck the patient's BP in other arm Check both arms, especially if there is an abnormality like Stage 1 HT
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:
Reduce intercranial pressure Mannitol is a diuretic, but is not for cardiac use
Which is a possible benefit of taking fish-oil supplements?
Reduced risk of dysrhythmia in patients after myocardial infarction Decreases risk of dysrhythmias for MI and HF patients
A patient is prescribed spironolactone [Aldactone] for treatment of hypertension. Which foods should the nurse teach the patient to avoid?
Salt substitutes Salt subs usually contain K. Spironolactone is a K-sparing diuretic and an aldosterone antagonist
A patient is prescribed digoxin [Lanoxin] and furosemide [Lasix]. It is most important for the nurse to assess which value before administering these medications?
Serum potassium Furosemide causes hypokalemia and digoxin + hypokalemia = toxicity
A 60-year-old African American patient has a blood pressure of 120/80 mm Hg and reports a family history of hypertension. The patient has a body mass index of 22.3. The patient reports consuming alcohol occasionally. Which therapeutic lifestyle change will the nurse expect to teach this patient?
Sodium restriction Sodium has a greater effect on African Americans than alcohol, especially with a family history of HTN
The nurse cares for a patient with a digoxin level of 1.9 ng/mL. Which action would be most appropriate for the nurse to take initially?
Start continuous heart monitoring.
A patient is to receive a scheduled dose of diltiazem [Cardizem]. The nurse should hold the medication and contact the prescriber if which of the following is noted?
The patient is in second-degree heart block. Diltiazem = CCB CCBs block conduction
A nurse has provided education for a patient newly diagnosed with hypertension who is just beginning therapy with antihypertensive medications. Which statement by the patient indicates a need for further teaching?
When my symptoms subside, I may discontinue the medications. Antihypertensives are only stopped if symptoms are controlled after 1 year
A patient is prescribed lovastatin [Mevacor]. The nurse will teach the patient to take the medication at which time?
With the evening meal because increased cholesterol synthesis at night
A nurse prepares to administer propranolol [Inderal] to a patient recovering from acute myocardial infarction. The patient's heart rate is 52 beats/min, and the rhythm is regular. What action should the nurse take next?
Withhold the dose and notify the prescriber. Heart rate should be 60 beats/min or higher
A patient taking a beta blocker complains of shortness of breath. The patient has respirations of 28 breaths per minute, a blood pressure of 162/90 mm Hg, and a pulse of 88 beats/min. The nurse auscultates crackles in all lung fields. The nurse understands that these assessments are consistent with:
left-sided heart failure Left-sided HF: pulmonary Right-sided HF: peripheral