Pharm II Exam 1 INSTRUCTOR

What client education is important for the client taking potassium chloride?

Administer with plenty of fluid to decrease stomach irritation and discomfort. Some dietary sources of potassium include leafy green vegetables (e.g., spinach, cabbage), tomatoes, cucumbers, zucchini, fruits (e.g., apples, oranges, and bananas), root vegetable (e.g., carrots, radishes), beans, and peas.

What is the max infusion rate (mEq/hr.) for potassium chloride?

As much as 400 mEq may be administered in a 24-hour period while monitoring blood electrolyte concentrations carefully.

9. A nurse is caring for a client who has poison ivy and is prescribed diphenhydramine. Which of the following instructions should the nurse give regarding the adverse effect of dry mouth associated with diphenhydramine? A. "Administer the medication with food." B. "Chew on sugarless gum or suck on hard, sour candies." C. "Place a humidifier at your bedside every evening." D. "Discontinue the medication and notify your provider."

B. "Chew on sugarless gum or suck on hard, sour candies."

23. A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give? A. "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level." B. "A pharmacist is the person to answer that question." C. "Heparin does not dissolve clots. It stops new clots from forming." D. "The oral medication you will take after this IV will dissolve the clot."

C. "Heparin does not dissolve clots. It stops new clots from forming."

Please answer the following questions as true or false. The use of a loop diuretic is the first drug used in the Step Care Management program to treat hypertension.

False

Please answer the following statement as true or false.The primary treatment for congestive heart failure is to make the heart beat harder and faster.

False

Please answer the following statement as true or false.Older adults are more likely to develop adverse effects associated with the use of these drugs—dysrhythmias, hypertension, and congestive heart disease.

False Rationale: Older adults frequently are prescribed one of these drugs. They are more likely to develop adverse effects associated with the use of these drugs— arrhythmias, hypotension, and congestive heart disease. Safety measures may be needed if these effects occur and interfere with the patient's mobility and balance.

What is potassium chloride used to treat?

Prevent or to treat low blood levels of potassium (Hypokalemia)

What is done if infiltration of IV potassium chloride is suspected? Stop infusion immediately

Stop infusion immediately

What is calcium gluconate treat?

Used by injection into a vein to treat low blood calcium, high blood potassium and magnesium toxicity

What are examples of bronchodilators?

1) albuterol 2) formoterol 3) levalbuterol 4) olodaterol 5) salmeterol

What can cause magnesium deficiency?

1. Insomnia 2. Anxiety 3. Muscle cramping 4. Constipation

What is sodium bicarbonate used for?

Used to relieve heartburn and acid indigestion Used to also make your blood or urine less acidic in certain conditions.

What are examples of vasopressors?

1) ephedrine 2) epinephrine 3) dopamine 4) phenylephrine 5)pseudoephedrine 6) oxymetazoline

What are the seven symptoms of magnesium deficiency?

1. Muscle twitches and cramps 2. Mental disorders 3. osteoporosis 4. fatigue and muscle weakness 5. high blood pressure 6. asthma 7. irregular heart beat

24. A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide? A. "Crushing the medication might cause you to have a stomachache or indigestion." B. "Crushing the medication is a good idea, and I can mix it in some ice cream for you." C. "Crushing the medication would release all the medication at once, rather than over time." D. "Crushing is unsafe, as it destroys the ingredients in the medication."

A. "Crushing the medication might cause you to have a stomachache or indigestion."

26. A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching? A. "I have started taking ginger root to treat my joint stiffness." B. "I take this medication at the same time each day." D. "I had my INR checked three weeks ago."

A. "I have started taking ginger root to treat my joint stiffness."

22. A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make? A. "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level" B. "I will call the provider to get a prescription for discontinuing the IV heparin today." C. "Both heparin and warfarin work together to dissolve the clots.". D. "The IV heparin increases the effects of the warfarin and decreases the length of your hospital stay."

A. "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level"

4. A nurse is providing dietary teaching for a client who takes furosemide. The nurse should recommend which of the following foods as the best source of potassium? A. Bananas B. Cooked carrots C. Cheddar cheese D. 2% milk

A. Bananas

18. A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first?A. Check the client's vital signs. B. Request a dietitian consult. C. Suggest that the client rests before eating the meal. D. Request an order for an antiemetic.

A. Check the client's vital signs.

You are caring for a child who has been diagnosed with a heart problem. Propanolol has been ordered for this patient. What would be considered in calculating a child's dose? A. Child's body weight and age B. Child's body mass C. Child's age in months and height D. Child's age and body mass index

A. Child's body weight and age

3. A nurse is providing teaching to a client who has renal failure and an elevated phosphorous level. The provider instructed the client to take aluminum hydroxide 300 mg PO three times daily. For which of the following adverse effects should the nurse inform the client? A. Constipation C. Headache D. Muscle spasms

A. Constipation

19. A nurse is caring for a client who is taking lisinopril. Which of the following outcomes indicates a therapeutic effect of the medication? A. Decreased blood pressure B. Increase of HDL cholesterol C. Prevention of bipolar manic episodes D. Improved sexual function

A. Decreased blood pressure

21. A nurse is providing teaching to a client who has hypertension and a new prescription for captopril. Which of the following instructions should the nurse provide? A. Do not use salt substitutes while taking this medication. B. Take the medication with food. C. Count your pulse rate before taking the medication. D. Expect to gain weight while taking this medication.

A. Do not use salt substitutes while taking this medication.

What is an indication for use non-selective adrenergic blocking agents? A. Essential hypertension B. Malignant hypertension C. Secondary hypertension D. Malignant hyperthermia

A. Essential hypertension

32. A nurse is obtaining a medical history from a client who is to start warfarin therapy and currently uses herbal supplements at home. The nurse should inform the client that which of the following herbal supplements can interact adversely with warfarin? A. Feverfew B. Black cohosh C. Echinacea D. Flaxseed

A. Feverfew

40. A nurse in a coronary care unit is admitting a client who has had CPR following a cardiac arrest. The client is receiving lidocaine IV at 2 mg/min. When the client asks the nurse why he is receiving that medication, the nurse should explain that it has which of the following actions? A. Prevents dysrhythmias B. Slows intestinal motility C. Dissolves blood clots D. Relieves pain

A. Prevents dysrhythmias

15. A nurse is monitoring a client who received epinephrine for angioedema after a first dose of losartan. Which of the following data indicates a therapeutic response to the epinephrine? A. Respirations are unlabored. B. Client reports decreased groin pain of 3 on a 1 to 10 scale. C. The client's blood pressure when arising from resting position is at premedication levels. D. The client tolerates a second dose of medication with no greater than 1+ peripheral edema.

A. Respirations are unlabored.

14. 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? A. Sedation B. Constipation C. Hypertension D. Bradycardia.

A. Sedation

12. A nurse is assessing a client who is receiving dopamine IV to treat left ventricular failure. Which of the following findings should indicate to the nurse that the medication is having a therapeutic effect? A. Systolic blood pressure is increased B. Cardiac output is reduced C. Apical heart rate is increased D. Urine output is reduced

A. Systolic blood pressure is increased

16. A nurse is preparing to transfuse one unit of packed RBC to a client who experienced a mild allergic reaction during a previous transfusion. The nurse should administer diphenhydramine prior to the transfusion for which of the following allergic responses? A. Urticaria B. Fever C. Fluid overload D. Hemolysis

A. Urticaria

36. A nurse is caring for a client who has cirrhosis and a prothrombin time of 30 seconds. Which of the following medications should the nurse plan to administer? A. Vitamin K B. Heparin C. Warfarin D. Ferrous sulfate

A. Vitamin K

42. Agent(s) may be effective in terminating paroxysmal supraventricular tachycardia (PSVT)? A. adenosine (Adenocard) B. methoxamine (Vasoxyl) C. propranolol (Inderal) D. all of the above

A. adenosine (Adenocard)

What is an adrenergic agent?

Adrenergic drugs acts either by enhancing or reducing the activity of the various components of the sympathetic divisions of the ANS. Sympathomimetic or adrenergic stimulants, Sympatholytics, antiadrenergic or adrenegic blocking agents.

13. A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects? A. Hyperglycemia B. Adrenocortical insufficiency C. Severe dehydration D. Rebound pulmonary congestion

B. Adrenocortical insufficiency

The mechanism of action of an ACE inhibitor is the blocking of ACE from converting angiotensin I to angiotensin II. What does this cause? A. Decrease in serum potassium levels B. Decrease in aldosterone production C. Sodium and fluid loss D. Increase in blood pressure

B. Decrease in aldosterone production

1. A nurse is providing discharge teaching for a client who has pulmonary edema and is about to start taking furosemide. Which of the following instructions should the nurse include? A. Take aspirin if headaches develop. B. Eat foods that contain plenty of potassium. C. Expect some swelling in the hands and feet. D. Take the medication at bedtime.

B. Eat foods that contain plenty of potassium.

20. A nurse is providing discharge teaching for a client who has pulmonary edema and is about to start taking furosemide. Which of the following instructions should the nurse include? A. Take aspirin if headaches develop. B. Eat foods that contain plenty of potassium. C. Expect some swelling in hands and feet D. Take the medication at bedtime.

B. Eat foods that contain plenty of potassium.

35. A nurse is receiving a client who is immediately postoperative following hip arthroplasty. Which of the following medications should the nurse plan to administer for DVT prophylaxis? A. Aspirin PO B. Enoxaparin subcutaneous C. Heparin infusion D. Warfarin PO

B. Enoxaparin subcutaneous

17. A nurse is caring for a client who has heart failure and is receiving IV furosemide. The nurse should monitor the client for which of the following electrolyte imbalances? A. Hypernatremia B. Hyperuricemia C. Hypercalcemia D. Hyperchloremia

B. Hyperuricemia

41. A nurse is preparing to administer verapamil by IV bolus to a client who is having cardiac dysrhythmias. For which of the following adverse effects should the nurse monitor when giving this medication? A. Hyperthermia B. Hypotension C. Ototoxicity D. Muscle pain

B. Hypotension

The nurse is caring for a patient who has presented to the emergency department with signs and symptoms of an acute MI. While making an initial assessment of this patient the nurse notes the patient has had adverse reactions to digoxin and a history of congestive heart failure. The physician writes admission orders. Which of the following drugs would be of concern? A. Furosemide (Lasix) B. Milrinone (Primacor) C. Propranolol (Inderal) D. Aspirin

B. Milrinone (Primacor)

25. A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin? A. Hemoglobin (Hgb) B. Prothrombin time (PT) D. Activated partial thromboplastin time (aPTT)

B. Prothrombin time (PT)

39. A nurse is reviewing the health history for a client who has angina pectoris and a prescription for propranolol hydrochloride PO 40 mg twice daily. Which of the following findings in the history should the nurse report to the provider? A. The client has a history of hypothyroidism. B. The client has a history of bronchial asthma. C. The client has a history of hypertension. D. The client has a history of migraine headaches.

B. The client has a history of bronchial asthma.

5. A nurse is caring for a client who has a prescription for potassium chloride (KCL) 20 mEq PO daily. The nurse reviews the client's most recent laboratory results and finds the client's potassium level is 5.2 mEq/L. Which of the following actions should the nurse take? A. Give the ordered KCL as prescribed. B. Omit the KCL dose and document it was not given. C. Call the prescribing physician and inform her of the client's serum potassium level results. D. Call the lab to verify the client's results.

C. Call the prescribing physician and inform her of the client's serum potassium level results.

29. A nurse is caring for a client who is postoperative following hip arthroplasty. The nurse should anticipate which of the following prescriptions for this client? A. Aspirin B. Clopidogrel C. Enoxaparin D. Alteplase

C. Enoxaparin

2. A nurse is caring for a client whose serum potassium level is 5.3 mEq/L. Which of the following scheduled medications should the nurse plan to administer?A. Lisinopril B. Digoxin C. Furosemide D. Potassium iodide

C. Furosemide

28. A nurse is preparing to administer heparin to a client. Which of the following actions should the nurse plan to take? A. Use a 22-gauge needle to inject the medication. B. Use a 1-inch needle to inject the medication. C. Inject the medication into the abdomen above the level of the iliac crest. D. Massage the injection site after administration of the medication.

C. Inject the medication into the abdomen above the level of the iliac crest.

31. A nurse is caring for a client who is receiving heparin by continuous IV infusion. Which of the following medications should the nurse plan to administer in the event of an overdose? A. Iron B. Glucagon C. Protamine D. Vitamin K

C. Protamine

8. A nurse is providing teaching to a client who has asthma and a new prescription for inhaled beclomethasone. Which of the following instructions should the nurse provide? A. Check the pulse after medication administration. B. Take the medication with meals C. Rinse the mouth after administration. D. Limit caffeine intake

C. Rinse the mouth after administration.

The patient asks the nurse to explain the type of angina he is experiencing. The nurse explains the pain is due to the imbalance of myocardial supply and demand. What type of angina does this describe? A. Unstable B. Prinzmetal's C. Stable D. Ischemic

C. Stable

6. A nurse is providing teaching for a client who is on diuretic therapy and has a new prescription for potassium chloride (KCL) 20 mEq extended-release PO daily. Which of the following instructions should the nurse provide about the new prescription? A. Take the extended-release tablets on an empty stomach. B. Add an antacid if the medication causes indigestion. C. Take the extended-release tablets whole. D. Expect urinary output to decrease while on this medication.

C. Take the extended-release tablets whole.

34. A nurse is preparing to administer enoxaparin to a client. Which of the following actions should the nurse plan to take? A. Insert the needle at a 45o angle. B. Aspirate for a blood return before depressing the plunger. C. The nurse should not expel the air bubble in the prefilled syringe. D. Administer the medication 2.54 cm (1 in) from the umbilicus.

C. The nurse should not expel the air bubble in the prefilled syringe.

Alpha1- selective adrenergic blocking agents are to be used with caution in what population of patients? A. Those with hepatic disease B. Those with hypotension C. Those with congestive heart failure D. Those with respiratory distress

C. Those with congestive heart failure

The nurse is caring for a 27-year-old African American woman who was just prescribed an ACE inhibitor for management of her hypertension. What should be advised related to contraception? A. The use of spermicidal jellies is recommended. B. The mini pill is the contraception method of choice. C. Use barrier contraceptives to prevent pregnancy while taking these drugs. D. No special precautions need to be taken.

C. Use barrier contraceptives to prevent pregnancy while taking these drugs.

Side effects of sodium bicarbonate

Cerebral hemorrhage Swelling (edema) High blood sodium levels Low blood calcium levels Low blood potassium levels Muscle spasms (associated with low calcium levels

What are the common adverse effects of magnesium sulfate injections?

Circulatory collapse Respiratory paralysis Low core body temperature (Hypothermia) Excess fluid in the lungs (pulmonary edema) - back flow into the lungs Depressed/poor reflexes Low blood pressure (hypotension) Flushing Drowsiness

what does magnesium sulfate injection treat?

Control low blood levels of magnesium Used for pediatric acute nephritis and Used to prevent seizures in pre-eclampsia, eclampsia, or toxemia of pregnancy Used to treat torsades de pointes, asthma exacerbations, constipation, and barium poising

37. A nurse is teaching a client who reports taking gingko biloba to improve his memory. Which of the following adverse effects should the nurse include? A. Bad breath B. Decreased alertness C. Breast enlargement D. Bleeding gums

D. Bleeding gums

7. A nurse is completing a medication history for a client who reports using over- the-counter calcium carbonate antacid. Which of the following recommendations should the nurse make about taking this medication? A. Decrease bulk in the diet to counteract the adverse effect of diarrhea. B. Take the medication with dairy products to increase absorption. C. Reduce sodium intake. D. Drink a glass of water after taking the medication.

D. Drink a glass of water after taking the medication.

27. A nurse is completing a medical interview with a client who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the client can potentiate the effects of warfarin? A. The client follows a low-fat diet to reduce cholesterol. B. The client drinks a glass of grapefruit juice every day. C. The client sprinkles flax seeds on food 1 hr before taking the anticoagulant. D. The client uses garlic to lower cholesterol levels.

D. The client uses garlic to lower cholesterol levels.

38. A nurse is caring for a client who is on warfarin therapy for atrial fibrillation. The client's INR is 5.2. Which of the following medications should the nurse prepare to administer? A. Epinephrine B. Atropine C. Protamine D. Vitamin K

D. Vitamin K

Why must the IV site be monitored when IV Potassium Chloride is infusing?

It is a vesicant medication- BURNS WHEN INFUSED [A vesicant is defined as a drug that is capable of causing tissue injury.]

47. A nurse is caring for a client who is having thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparins effects?

Protamine Sulfate

What is the affect of vasopressors?

These drugs stimulate smooth muscle contraction in the blood vessels which causes your blood vessels to become narrow. This effect also causes your blood pressure to increase. Increasing blood pressure can help treat shock. Narrowing blood vessels can help stop bleeding. It can also help keep anesthetics (drugs that numb your body) from spreading by closing off nearby blood vessels.

What is Sodium Polystyrene Sulfonate (Kayexalate) used for? [potassium-removing agent]

To treat hyperkalemia by excreting excess potassium

44. Which medications are included in first-line therapy for heart failure (select all that apply) a. Agents that inhibit the renin-angiotensin-aldosterone system (RAAS) b. Aldosterone antagonists c. Beta blockers d. Cardiac glycosides e. Diuretics

a. Agents that inhibit the renin-angiotensin-aldosterone system (RAAS) c. Beta blockers e. Diuretics

43. The nurse suspects the client may have toxic levels of digoxin in the bloodstream when what is assessed? (select all that apply) a. Irregular heart rhythms b. Nausea c. Anorexia d. Cough e. Peripheral edema

a. Irregular heart rhythms b. Nausea c. Anorexia

What are the adverse effects of kayexalate?

a. Nausea b. Vomiting c. Constipation d. Diarrhea

What is an adrenergic agonist?

are drugs that lead to stimulation of the adrenergic receptors. In doing so, adrenergic agonists generally simulate activation of certain aspects of the sympathetic nervous system and are thus also known as "sympathomimetics". - calm you down when your body is in "fight or flight mode" why they are used to lower heart rate

46. A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin? a. Hemoglobin (Hgb) b. Prothrombin time (PT) c. Bleeding time d. Activated partial thromboplastin time (aPTT)

b. Prothrombin time (PT)

45.A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give? a. It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level. b. A pharmacist is the person to answer that question. c. Heparin does not dissolve clots. It stops new clots from forming. d. The oral medication you will take after this IV will dissolve the clot.

c. Heparin does not dissolve clots. It stops new clots from forming.

What is the goal for adrenergic drugs?

increase blood pressure constrict blood vessels open the airways leading to the lungs increase heart rate stop bleeding

What is a common side effect of kayexalate?

loss of appetite