Pharmacology questions for Heart Failure drugs

A pediatric patient weighing 66 lb is prescribed digoxin 12 mcg/kg in 3 evenly divided doses a day. How much will the nurse administer per dose? __

120mcg/dose

The nurse is caring for a pediatric patient with a prescription for 0.2 mg/kg bolus of verapamil. What is the correct dose for a pediatric patient with a weight of 34 lb? __

3.1 mg

The nurse is giving discharge instructions to a patient prescribed warfarin for atrial fibrillation. Which statement by the patient indicates a need for further instruction from the nurse? a. "I will increase the dark green leafy vegetables in my diet." b. "I will avoid activities that have a risk for injury such as contact sports." c. "I will contact my health care provider if I develop excessive bruising." d. "I will take my medication in the early evening each day."

a. "I will increase the dark green leafy vegetables in my diet." --Dark green leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Therefore, it is important to maintain a consistent daily intake of vitamin K and avoid eating large amounts of these foods.

During discharge teaching, which statement by the nurse would be most appropriate for a patient prescribed a transdermal clonidine? a. "The patch should be applied to a nonhairy site, and you should not suddenly stop using this drug." b. "Occasional drooling is a common adverse effect of this medication." c. "Your blood pressure should be checked by your health care provider two to three times a week." d. "Prolonged sitting or standing does not cause hypotension symptoms."

a. "The patch should be applied to a nonhairy site, and you should not suddenly stop using this drug." --Transdermal clonidine patches should be applied to nonhairy areas of the skin, and application sites should be rotated. When the patch dosage form is used, it is important to remove the old patch before applying a new one. It must not be discontinued abruptly because it will lead to severe rebound hypertension (sudden high elevation of blood pressure). Prolonged standing can cause venous pooling and hypotension. Dry mouth, not drooling, is a common adverse effect of clonidine.

A patient prescribed digoxin 0.25 mg and furosemide 40 mg for the treatment of systolic heart failure states, "I am starting to see yellow halos around lights." What is the appropriate nursing intervention? a. Assess for other symptoms of digoxin toxicity. b. Document the finding and reassess in 1 hour. c. Perform a visual acuity test on each eye. d. Prepare to administer digoxin immune fab.

a. Assess for other symptoms of digoxin toxicity. --Yellow-green halos around objects are a symptom of digoxin toxicity. Other signs and symptoms of digoxin toxicity include headache, dizziness, confusion, nausea, and blurred vision. Electrocardiogram findings show heart block, atrial tachycardia with block, or ventricular dysrhythmias.

The nurse recognizes that the patient understands the teaching about warfarin when the patient verbalizes an increased risk of bleeding with concurrent use of which herbal product/products? (Select all that apply.) a. Dong Quai b. Glucosamine c. Gingko d. garlic e. St. John's Wort

a. Dong Quai c. Gingko d. garlic e. St. John's Wort --Garlic, ginkgo, dong quai, and St. John's wort alter blood coagulation and may increase the risk of bleeding when given concurrently with oral anticoagulants. Glucosamine does not affect coagulation.

What is the classification of carvedilol? a. Dual-action alpha1 and beta receptor blocker b. ACE inhibitor c. Beta blocker d. Alpha2 blocker

a. Dual-action alpha1 and beta receptor blocker --Carvedilol blocks both the alpha1 and beta receptors of the adrenergic nervous system

Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) are generally administered at which time of day? a. Evening b. 12:00 noon c. Morning d. Afternoon

a. Evening --The liver produces the majority of cholesterol during the night. Thus, statin drugs, which decrease the cholesterol synthesis, are generally administered in the evening or bedtime so that the peak drug levels coincide with cholesterol production.

Why does the health care provider prescribe furosemide 40 mg twice a day by mouth for a patient with a history of renal insufficiency? a. Furosemide is effective in treating patients with impaired kidney function. b. Furosemide helps the kidney with reabsorption of sodium and water. c. Furosemide has an antagonist effect to prevent respiratory alkalosis. d. Furosemide is effective in treating patients with hypoaldosteronism.

a. Furosemide is effective in treating patients with impaired kidney function. --Furosemide effectiveness continues in impaired renal function. When creatinine clearance decreases below 25 L/min (normal is 125 L/min), the loop diuretics can still work.

For a patient prescribed hydrochlorothiazide, the nurse should closely monitor which laboratory test value? a. Glucose b. calcium c. Chloride d. Sodium

a. Glucose --Thiazide and thiazide-like diuretics are associated with adverse metabolic effects of hyperglycemia; therefore, close monitoring of blood glucose levels are needed. Other metabolic disturbances include hyperlipidemia and hyperuricemia.

The nurse would question a prescription for simvastatin in a patient with which condition? a. Hepatic disease b. Diabetes c. Heart failure d. Leukemia

a. Hepatic disease --Simvastatin can cause an increase in liver enzymes and thus should not be used in patients with pre-existing liver disease.

For a patient receiving a positive inotropic drug, which nursing assessments should be performed? (Select all that apply.) a. Monitor serum electrolytes. b. Obtain daily weights. c. Auscultate lung sounds. d. Review red blood cell count. e. Check apical pulse.

a. Monitor serum electrolytes. b. Obtain daily weights. c. Auscultate lung sounds. e. check apical pulse --Lung sounds and daily weights are appropriate assessments related to the treatment of heart failure with inotropic drugs. The apical pulse and serum electrolytes are important assessments related to potential adverse reactions (bradycardia, toxicity with hypokalemia).

Which are therapeutic effects of digoxin? a. Positive inotropic, negative chronotropic, and negative dromotropic b. Positive inotropic, negative chronotropic, and positive dromotropic c. Negative inotropic, negative chronotropic, and negative dromotropic d. Positive inotropic, positive chronotropic, and negative dromotropic

a. Positive inotropic, negative chronotropic, and negative dromotropic --Digoxin increases cardiac contractility (positive inotropic effect), decreases heart rate (negative chronotropic effect), and decreases conductivity (negative dromotropic effect).

Which medication would the nurse question if prescribed together with ACE inhibitors? a. Potassium chloride b. Morphine c. Furosemide d. Docusate sodium

a. Potassium chloride --ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion; thus, a decrease in aldosterone production can result in an increase in serum potassium.

ACE inhibitors and ARBs both work to decrease blood pressure by which action? a. Prevent aldosterone secretion b. Prevent the formation of angiotensin II c. Enhance sodium and water resorption d. Increase the breakdown of bradykinin

a. Prevent aldosterone secretion --Whereas ACE inhibitors block the formation of angiotensin II, ARBs allow the formation of angiotensin II but block its effect at the receptors. Without the receptors stimulated (because of either drug), aldosterone secretion is inhibited, preventing the reabsorption of sodium and water.

When teaching a patient about beta blockers such as atenolol and metoprolol, it is important for the nurse to instruct the patient about what infomration? a. abrupt medication withdrawal may lead to rebound hypertension b. these medications may be taken with antacids to minimize gastrointestinal distress c. hot baths and showers will help increase the therapeutic effects of this drug d. alcohol intake is encouraged for vasodilating effects

a. abrupt medication withdrawal may lead to rebound hypertension --These drugs should not be withdrawn abruptly; the medications should be tapered over 1 to 2 weeks. Antacids should not be taken with beta blockers because they may decrease absorption

Beta blockers are used to treat which conditions? (Select all that apply.) a. angina pectoris b. hypertension c. cardiac dysrhythmias d. Raynaud's disease e. COPD

a. angina pectoris b. hypertension c. cardiac dysrhythmias --Beta blockers are effective in treating hypertension (secondary to negative inotropic effects), angina pectoris (decreases cardiac workload when decreasing heart rate and contractility), and cardiac dysrhythmias (decreasing heart rate and conductivity). Beta blockers can exacerbate COPD because they block beta2 receptors and subsequent bronchodilation. Raynaud's disease may be treated with alpha, not beta, blockers.

A nurse is planning care for a client who is receiving furosemide IV for peripheral edema. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) a. assess for tinnitus b. report urine output of 50mL/hr c. Monitor blood potassium levels d. elevate the head of the bed slowly before ambulation e. recommend eating a banana daily

a. assess for tinnitus c. Monitor blood potassium levels d. elevate the head of the bed slowly before ambulation e. recommend eating a banana daily

A nurse is reviewing the health record of a client who asks about using propranolol to treat hypertension. The nurse should recognize which of the following conditions is a contraindication for taking propranolol? a. asthma b. glaucoma c. hypertension d. tachycardia

a. asthma

The nurse knows which drug is an example of a cardioselective beta blocker? a. atenolol b. sotalol c. labetalol d. propranolol

a. atenolol

A nurse is teaching a client who has a new prescription for digoxin to treat heart failure. Which of the following instructions should the nurse include in the teaching? a. contact the provider if heart rate is les than 60/min b. check pulse rate for 30 seconds and multipky by 2 c. increase intake of sodium d. take with food if nausea occurs

a. contact the provider if heart rate is les than 60/min

a nurse is providing teaching to a client who has a new prescription for digoxin. The nurse should instruct the client to monitor and report which of the following adverse effect that is a manifestation digoxin toxicity? (Select all that apply) a. fatigue b. constipation c. anorexia d. rash e. blurred vision

a. fatigue c. anorexia e. blurred vision

Potassium-sparing diuretics may cause which common adverse reactions? (Select all that apply.) a. headache b. muscle weakness c. dizziness d. hyperkalemia e. mental confusion

a. headache c. dizziness d. hyperkalemia --Hyperkalemia, dizziness, and headache are common adverse effects associated with potassium-sparing diuretics.

Acetazolamide is used to treat which conditions? (Select all that apply.) a. high-altitude motion sickness b. Dry eye syndrome c. Edema associated with heart failure d. Cardiac dysrhythmias e. Open-angle glaucoma

a. high-altitude motion sickness c. Edema associated with heart failure e. Open-angle glaucoma

A nurse is teaching a client who has a new prescription for verapamil to control hypertension. Which of the following instructions should the nurse include? a. increase amount of fiber in the diet b. drink grapefruit juice daily to increase Vitamin C intake c. decrease the amount of calcium in the diet d. withhold food for 1 hr after medication is taken

a. increase amount of fiber in the diet

When teaching a patient about symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which symptom occurs? a. muscle weakness b. blurred vision c. constipation d. diaphoresis

a. muscle weakness

A nurse is providing information to a client who has a new prescription for hydrochlorothiazide. Which of the following information should the nurse include? a. take the medication with food b. plan to take the medication at bedtime c. expect increased swelling of the ankles d. fluid intake should be limited in the morning

a. take the medication with food

A nurse is providing teaching to a client who is starting simvastatin. Which of the following information should the nurse inclucde in the teaching? a. take this medication in the evening b. change positions slowly when rising c. maintain a steady intake of green leafy veggies d. consume no more than 1L/day of fluid

a. take this medication in the evening --cholesterol is synthesized in the body during the night time to increase effectiveness

Which statement does the nurse include when completing discharge education for a patient prescribed metoprolol? a. "If you become dizzy, do not take your medication for 2 days and then restart on the third day. b. "If you take your pulse and it is less than 60 beats/min, hold your medicine and call your health care provider for instructions." c. "This medication may make you fatigued; increasing caffeine in your diet may help alleviate this problem." d. "Increase your intake of green leafy vegetables to prevent bleeding problems that can be caused by this medication."

b. "If you take your pulse and it is less than 60 beats/min, hold your medicine and call your health care provider for instructions." --Beta blockers have a negative chronotropic effect and could cause symptomatic bradycardia or heart block. The health care provider should be consulted before administering to a patient with bradycardia (heart rate <60 beats/min).

A patient is prescribed oral anticoagulant therapy while still receiving IV heparin infusion. The patient is concerned about risk for bleeding. What is the nurse's best response? a. "Because of your mechanical valve replacement, it is especially important for you to be fully anticoagulated, and the heparin and warfarin together are more effective than one alone." b. "It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin infusion is continued to help prevent blood clots until the warfarin reaches its therapeutic effect." c. "Because you are now getting out of bed and walking around, you have a higher risk of blood clot formation and therefore need to be on both medications." d. "Bleeding is a common adverse effect of taking warfarin. If bleeding occurs, your health care provider will prescribe an injection of medication to stop the bleeding."

b. "It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin infusion is continued to help prevent blood clots until the warfarin reaches its therapeutic effect." --Warfarin works by decreasing the production of clotting factors. However, it takes 4 to 5 days for the body to use up present clotting factors and thus achieve a full therapeutic anticoagulant effect. Because of this, heparin is continued until this is achieved.

A patient asks the nurse about using potassium supplements while taking spironolactone. What is the nurse's best response? a. "I would recommend that you take two multivitamins every day." b. "This diuretic is potassium sparing, so there is no need for extra potassium." c. "You will need to take potassium supplements for the medication to be effective." d. "I will call your health care provider and discuss your concern."

b. "This diuretic is potassium sparing, so there is no need for extra potassium." --Spironolactone is a potassium-sparing diuretic, and thus the patient does not need potassium supplementation. Intake of excess potassium may lead to hyperkalemia.

The patient's serum digoxin level is 0.4 ng/mL. How does the nurse interpret this laboratory value result for digoxin? a. Normal therapeutic level b. Below the therapeutic level c. Above the therapeutic level d. A toxic serum blood level

b. Below the therapeutic level --Therapeutic serum digoxin levels are 0.5 to 2 ng/mL.

The nurse will assess a patient receiving gemfibrozil and warfarin for the increased risk of which adverse effect? a. Deep vein thrombosis b. Bleeding c. Clotting d. Vitamin K toxicity

b. Bleeding --Gemfibrozil can bind with vitamin K in the intestinal tract, reducing vitamin K absorption. Because vitamin K is the antidote for warfarin, a lack of vitamin K increases the anticoagulant effect of warfarin and thus the risk of bleeding.

Which medication is an antiplatelet drug? a. Enoxaparin b. Clopidogrel c. Alteplase d. Heparin

b. Clopidogrel --Clopidogrel is an antiplatelet drug. Enoxaparin and heparin are anticoagulants. Alteplase is a thrombolytic drug.

Calcium channel blockers have which pharmacodynamic effect? a. Shortened refractory period b. Coronary vasodilation c. Positive inotropic d. Positive chronotropic

b. Coronary vasodilation --Calcium channel blockers cause coronary vasodilation, a negative inotropic effect, a negative chronotropic effect, and a negative dromotropic effect.

Which laboratory test result is a common adverse effect of furosemide? a. Hypernatremia b. Hypokalemia c. Hypophosphatemia d. Hyperchloremia

b. Hypokalemia --Furosemide is a potent loop diuretic, and the most common adverse effect of loop diuretics is electrolyte imbalances. This results in major electrolyte losses of potassium and sodium and, to a lesser extent, calcium.

What is the mechanism of action of ezetimibe? a. Decreases the adhesion of cholesterol in the arteries. b. Inhibits absorption of dietary and biliary cholesterol in the small intestine. c. Binds to bile acids in the intestine, inhibiting its reabsorption into the blood. d. Inhibits the biosynthesis of cholesterol in the liver.

b. Inhibits absorption of dietary and biliary cholesterol in the small intestine. --Ezetimibe selectively inhibits absorption of cholesterol in the small intestine.

Enoxaparin sodium is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This medication is in which drug class? a. Thrombolytic drug b. Low-molecular-weight heparin c. Oral anticoagulant d. Glycoprotein IIb/IIIa inhibitor

b. Low-molecular-weight heparin

To prevent cerebral artery spasms after a subarachnoid hemorrhage, the nurse anticipates administering which calcium channel blocker? a. Amlodipine b. Nimodipine c. Diltiazem d. Verapamil

b. Nimodipine --Nimodipine crosses the blood-brain barrier and has a greater effect on the cerebral arteries than on other arteries in the body; thus, it is indicated for the treatment of cerebral artery spasm after subarachnoid hemorrhage.

What is the priority nursing diagnosis for a patient prescribed metoprolol? a. Risk for injury related to possible adverse effects of the adrenergic blockers b. Risk for decreased cardiac tissue perfusion related to effects of medication c. Deficient knowledge related to lack of information about the therapeutic regimen d. Acute confusion related to adverse central nervous system effects of the drug

b. Risk for decreased cardiac tissue perfusion related to effects of medication --Using the ABCs of prioritization, risk for decreased cardiac tissue perfusion puts the patient at highest risk. Although the other nursing diagnoses are pertinent, they are not the priority.

Before administering eplerenone to a patient, what is the priority nursing action? a. auscultate heart sounds b. check serums electrolyte levels c. Obtain serum thiocyanate level. d. Assess level of consciousness.

b. check serums electrolyte levels --Eplerenone is contraindicated in patients with an elevated serum potassium level (>5.5 mEq/L) or severe renal impairment. Therefore, it is imperative that the nurse assesses the patient's most recent serum electrolytes before administering this medication.

A nurse is monitoring a cleint who takes aspirin daily. THe nurse should identify which of the following manifestations as adverse effects of aspirin? (Select all that apply) a. hypertension b. coffee-ground emesis c. tinnitus d. paresthesias of the extremities e. nausea

b. coffee-ground emesis c. tinnitus e. nausea

The nurse understands a patient who is treated for hypertension may be switched to an angiotensin receptor blocker (ARB) because of which angiotensin-converting enzyme (ACE) inhibitor adverse effect? a. fatigue b. dry, nonproductive cough c. hypokalemia d. orthostatic hypotension

b. dry, nonproductive cough --ACE inhibitors block the breakdown of bradykinins and may cause a dry, nonproductive cough. ARBs do not block this breakdown, thus minimizing this adverse effect. ACE inhibitors and ARBs are equally effective for the treatment of hypertension, but ARBs do not cause cough.

A nurse is planning to administer a first dose of captopril to a client who has hypertension. Which of the following medications can intensify first dose hypotension? (Select all that apply) a. simvastatin b. hydrochlorothiazide c. phenytoin d. clonidine e. aliskiren

b. hydrochlorothiazide d. clonidine e. aliskiren

A nurse is planning care for a client who has a new prescription for torsemide. The nurse should plan to monitor for which of the following conditions as a potential adverse reaction of this medication? (Select all that apply) a. Respiratory acidosis b. hypokalemia c. hypotension d. ototoxicity e. ventricular dysrhythmias

b. hypokalemia c. hypotension d. ototoxicity e. ventricular dysrhythmias

A nurse is planning to administer subQ enoxaparin 40 mg using a prefilled syringe to an adult client following arthroplasty. Which of the following actions should the nurse plan to take? a. expel air bubble from the prefilled syringe before injecting b. insert needle completely into client's tissue c. administer the injection into pts thigh d. aspirate carefully after inserting the needle into the client's skin

b. insert needle completely into client's tissue

A patient prescribed spironolactone asks the nurse to assist with food choices that are low in potassium. The nurse would recommend which food choices? (Select all that apply.) a. winter squash b. lean meat c. bananas d. apples e. pineapple

b. lean meat d. apples e. pineapple

Non-selective beta blockers may be used to treat hypertension and what other conditions? a. heart block b. supraventricular dysrhythmias c. COPD d. heart failure

b. supraventricular dysrhythmias

a nurse is caring for a client who has a new prescription for digoxin and takes multiple other medications. The nurse should recognize that concurrent use of which of the following medications places the client at risk for digoxin toxicity? a. phenytoin b. verapamil c. Warfarin d. aluminum hydroxide

b. verapamil : calcium channel blocker can increase digoxin levels and the nurse should monitor vitals carefully

The nurse determines the patient has a good understanding of the discharge instructions regarding warfarin with which patient statement? a. "I should keep taking ibuprofen for my arthritis." b. "I should decrease the dose if I start bruising easily." c. "I should use a soft toothbrush for dental hygiene." d. "I will double my dose if I forget to take it the day before."

c. "I should use a soft toothbrush for dental hygiene."

The nurse is assessing the patient's knowledge regarding drug therapy prescribed for the treatment of hypertension. Which statement by the patient indicates the need for further teaching by the nurse? a. "I will move slowly from a sitting to standing position." b. "I will wear a medical alert bracelet." c. "When my blood pressure is over 140/90, I will take my medication." d. "Blood pressure drugs can cause changes in sexual functioning."

c. "When my blood pressure is over 140/90, I will take my medication." --pt needs it to keep stead-> do NOT withhold medications even if BP is normal & Patients must adhere to prescribed antihypertensive regimen to prevent end-organ damage.

A patient weighing 44 lb is prescribed a digoxin loading dose of 0.03 mg/kg to be administered in three divided doses. How much will the nurse administer in each dose? a. 0.4 mg b. 0.6 mg c. 0.2 mg d. 0.3 mg

c. 0.2.mg --44 lb is converted to kilograms by dividing 44 by 2.2 kg = 20 kg. 0.03 mg/kg × 20 kg = 0.6 mg. 0.6 mg ÷ 3 doses = 0.2 mg/dose.

When preparing to administer intravenous furosemide to a patient with renal dysfunction, the nurse will administer the medication no faster than which rate? a. 6 mg/min b. 2 mg/min c. 4 mg/min d. 8 mg/min

c. 4 mg/min --Furosemide controlled infusion rate should not exceed at a rate of 4 mg/min in patients with renal failure.

A nurse is completing a nursing history for a client who takes simvastatin. The nurse should identify which of the following disorders as a contraindication to adding ezetimibe to the client's medications? a. history of severe constipation b. history of hypertension c. Active Hepatitis C d. Type 2 diabetes mellitus

c. Active Hepatitis C --ezetimibe is contraindicated in clients who have an active moderate-severe liver disorder, especially if the client is already taking a statin

Which drug class is used to treat both hypertension and dysrhythmias? a. Alpha-adrenergic-blocking b. Calcium channel blockers c. Direct-acting vasodilators d. Sodium channel blockers

c. Calcium channel blockers --Calcium channel blockers are effective in treating both hypertension and dysrhythmias secondary to their negative inotropic and chronotropic effects.

When assessing a patient taking triamterene, the nurse would monitor for which possible adverse effect? a. Hypokalemia b. Hypoglycemia c. Hyperkalemia d. Hypernatremia

c. Hyperkalemia --Triamterene is a potassium-sparing diuretic, and therefore hyperkalemia is a possible adverse effect.

The nurse would question a prescription for a calcium channel blocker in a patient with which condition? a. Angina pectoris b. Increased intracranial pressure c. Hypotension d. Dysrhythmia

c. Hypotension --Calcium channel blockers cause smooth muscle vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension.

a nurse is caring for a client who is receiving heparin by continuous IV infusion. The client begins vomiting blood. After the heparin has been stopped, which of the following medications should the nurse prepare to administer? a. Vitamin K1 b. atropine c. Protamine d. calcium gluconate

c. Protamine --reverses anticoagulation effects of heparin

The nurse notes a patient's international normalized ratio (INR) value of 2.5. What is the meaning of this reported value? a. The patient needs the subcutaneous heparin dose increased. b. The patient is not receiving enough warfarin for a therapeutic effect. c. The patient's warfarin dose is within the therapeutic range. d. The patient is receiving too much heparin and is at risk for bleeding.

c. The patient's warfarin dose is within the therapeutic range. --INR determination is a routine test to evaluate coagulation while patients are taking warfarin, not heparin. A therapeutic INR is 2 to 3.

A nurse is monitoring a client who is receiving spironolactone. Which of the following findings should the nurse report to the provider? a. blood sodium of 144 mEq/L b. Urine output of 120 mL in 4 hr c. blood potassium of 5.2 mEq/L d. blood pressure 140/90 mm Hg

c. blood potassium of 5.2 mEq/L

a nurse is collecting data from a client who is taking gemfibrozil. Which of the following assessment findings should the nurse identify as an adverse effect of this medication? a. mental status change b. tremor c. jaundice d. pneumonia

c. jaundice --jaundice, anorexia, and upper abdominal discomfort can be findings of liver impairment-> occur in gemfibrozil

A nurse is caring for a client who has a new prescription for captopril for hypertension. The nurse should monitor the client for which of the following as an adverse effect of this medication? a. hypokalemia b. hypernatremia c. neutropenia d. bradycardia

c. neutropenia

When teaching a patient about a new prescription for carvedilol the nurse explains that this medication reduces blood pressure by which action? (Select all that apply.) a. promotes excretion of sodium b. relaxes muscle tone c. peripheral vasodilation d. decreases heart rate e. increases urine output

c. peripheral vasodilation d. decreases heart rate --Carvedilol has the dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade).

A nurse in a provider's office is monitoring blood electrolytes for four clients who take digoxin. Which of the following electrolyte values increases a client's risk for digoxin toxicity? a. calcium 9.2 mg/dL b. Calcium 10.3 mg/dL c. potassium 3.4 mEq/L d. Potassium 4.8 mEq/L

c. potassium 3.4 mEq/L

When teaching a patient regarding the administration of digoxin, the nurse instructs the patient not to take this medication with which food? a. French toast b. Scrambled eggs c. Wheat bran d. bananas

c. wheat bran --Encourage patients to avoid using antacids or eating ice cream, milk products, yogurt, cheese (dairy products), or bran for 2 hours before or 2 hours after taking medication to avoid interference with the drugs absorption.

Which discharge instruction should the nurse include for a patient prescribed an antilipemic medication? a. "Lifestyle changes are no longer necessary when taking this medication." b. "It is important to take a double dose to make up for a missed dose." c. "Stop taking the medication if it causes nausea and vomiting." d. "Continue your exercise program and maintain a low-fat diet."

d. "Continue your exercise program and maintain a low-fat diet." --Antilipemic medications are in addition to, not a replacement of, therapeutic lifestyle changes used to decrease serum cholesterol. Maintain a low-fat, low-cholesterol diet is an integrated part of a change in lifestyle.

A nurse is teaching a client who is taking digoxin and has a new prescription for colesevelam. Which of the following instructions should the nurse include in the teaching? a. "take digoxin with your morning dose of colesevelam." b. "your sodium and potassium levels will be monitored periodically while taking colesevelam" c. "watch for bleeding and bruising while taking colesevelam" d. "take colesevelam with food and at least one glass of water"

d. "take colesevelam with food and at least one glass of water"

Garlic, ginkgo, dong quai, and St. John's wort alter blood coagulation and may increase the risk of bleeding when given concurrently with oral anticoagulants. Glucosamine does not affect coagulation. a. Complete blood count b. Prothrombin time (PT) c. Blood urea nitrogen d. Activated partial thromboplastin time (aPTT)

d. Activated partial thromboplastin time (aPTT) --Heparin dosing is based on aPTT results. The PT is reflective of warfarin's anticoagulant effect.

To decrease the skin flushing adverse effect reaction of niacin (nicotinic acid), which action should the nurse take? a. Administer niacin with a liquid antacid. b. Give niacin with all other morning medications. c. Apply cold compresses to the head and neck. d. Administer aspirin 30 minutes before each dose.

d. Administer aspirin 30 minutes before each dose. --To help minimize the adverse effect flushing of the skin, the patient should take a small dose of aspirin or nonsteroidal antiinflammatory drugs 30 minutes before taking niacin, but only as prescribed or recommended by the health care provider.

The nurse would question a prescription for colesevelam in a patient with which condition? a. Glaucoma b. Renal disease c. Hepatic disease d. Bowel obstruction

d. Bowel obstruction --Colesevelam is contraindicated in patients with a history of bowel obstruction.

The nurse is caring for a patient with a history of angina and hypertension who is diagnosed with moderate heart failure. The patient's current medication regimen includes digoxin, furosemide, and quinapril. What medication would the nurse anticipate the health care provider adding to the patient's medication regimen? a. Esmolol b. Propranolol c. Sotalol d. Carvedilol

d. Carvedilol --Carvedilol, a combined alpha1 and beta blocker, has been shown to slow the progression of heart failure and decrease the frequency of hospitalization in patients with mild to moderate (Class II or III) heart failure. Carvedilol is most commonly added to digoxin, furosemide, and angiotensin-converting enzyme inhibitors when used to treat heart failure.

Before administering a dose of an antidysrhythmic drug to a patient, what nursing assessment must be completed? a. Obtain temperature and pulse oximetry on room air. b. Evaluate peripheral pulses and level of consciousness. c. Measure urine output and specific gravity. d. Check apical pulse and blood pressure.

d. Check apical pulse and blood pressure. --Antidysrhythmic drugs can cause both hypotension and bradycardia; therefore, it is important to assess blood pressure and apical pulse before administration.

The nurse is preparing to administer digoxin 0.25 mg intravenous push to a patient. Which is an expected patient outcome related to the administration of digoxin? a. Reduction in urine output b. Increase in blood pressure c. Low serum potassium d. Decrease in the heart rate

d. Decrease in the heart rate --Digoxin has a negative chronotropic effect (decreased heart rate).

The nurse reviews an adult patient's laboratory values and notes a digoxin level of 11 ng/mL and a serum potassium level of 6.2 mEq/L. The nurse would notify the health care provider and anticipate which medication will be prescribed to administer? a. Atropine b. Epinephrine c. Sodium polystyrene sulfonate d. Digoxin immune Fab

d. Digoxin immune Fab --Digoxin immune Fab is indicated for severe digoxin toxicity in patients with the following clinical findings: hyperkalemia (serum potassium level higher than 5 mEq/L) with digoxin toxicity; life-threatening digoxin overdose (more than 10 mg digoxin in adults; more than 4 mg digoxin in children); and life-threatening cardiac dysrhythmias, sustained ventricular tachycardia or fibrillation, and severe sinus bradycardia or heart block unresponsive to atropine treatment or cardiac pacing.

The nurse is conducting a community education program. When explaining different medication regimens to treat hypertension, it would be accurate to state that African Americans often respond better to which combination of medications? a. ACE inhibitors and diuretics b. ACE inhibitors and beta blockers c. Diuretics and beta blockers d. Diuretics and calcium channel blockers

d. Diuretics and calcium channel blockers --Research has demonstrated that African Americans do not typically respond therapeutically to beta blockers or ACE inhibitors. They respond better to diuretics and calcium channel blockers.

To treat a patient with pulmonary edema, the nurse prepares to administer which diuretic to this patient? a. Amiloride b. Spironolactone c. Triamterene d. Furosemide

d. Furosemide --Furosemide is a potent, rapid-acting diuretic that would be the drug of choice to treat pulmonary edema. The other medications are not potent enough to cause the diuresis necessary to treat this condition.

A patient with elevated triglyceride levels unresponsive to HMG-CoA reductase inhibitors will most likely be prescribed which drug? a. Cholestyramine b. Colestipol c. Simvastatin d. Gemfibrozil

d. Gemfibrozil --Gemfibrozil, a fibric acid derivative, promotes catabolism of triglyceride-rich lipoproteins.

A patient who is prescribed an anticoagulant requests an aspirin (acetylsalicylic acid) for headache relief. What is the nurse's best action? a. Explain that acetylsalicylic acid is contraindicated and administer ibuprofen. b. Explain that a common initial adverse effect is a headache for this drug. c. Administer 650 mg of acetylsalicylic acid and reassess pain in 30 minutes. d. Inform the patient of potential drug interactions with anticoagulants.

d. Inform the patient of potential drug interactions with anticoagulants. --Patients taking an anticoagulant should not use medications that would further increase the risk of bleeding.

To assess for a potentially serious adverse effect to HMG-CoA reductase inhibitors, the nurse should monitor which laboratory results? a. Urine specific gravity b. Serum electrolytes c. Complete blood count d. Liver function studies

d. Liver function studies --HMG-CoA reductase inhibitors can cause hepatic toxicity; thus, liver function studies are often measured every 6 to 8 weeks for the first 6 months of statin therapy and then every 3 to 6 months, depending on the prescriber and the patient situation.

While observing a patient self-administer enoxaparin, the nurse identifies the need for further teaching when the patient performs which self-injection action? a. Administers the medication into subcutaneous (fatty) tissue b. Does not aspirate before injecting the medication c. Injects the medication greater than 2 inches away from the umbilicus d. Massages the site after administration of the medication

d. Massages the site after administration of the medication --It is not recommended to massage the area of injection of anticoagulants because of the increased risk of hematoma formation.

The nurse is providing discharge teaching for a patient about potential serious adverse effects to simvastatin. Which symptom may indicate the patient is experiencing a serious adverse effect to this medication? a. Headache b. Itching c. Weight loss d. Muscle pain

d. Muscle pain --Unexplained muscle pain and soreness are symptoms of a relatively uncommon but serious adverse effect of rhabdomyolysis associated with statin drugs and must be immediately reported to the health care provider.

The nurse understands that beta blockers produce which cardiovascular effects? a. Negative inotropic, positive chronotropic, and positive dromotropic b. Positive inotropic, negative chronotropic, and negative dromotropic c. Positive inotropic, positive chronotropic, and positive dromotropic d. Negative inotropic, negative chronotropic, and negative dromotropic

d. Negative inotropic, negative chronotropic, and negative dromotropic

Before emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin? a. Phenytoin b. Vitamin E c. Vitamin K d. Protamine

d. Protamine --Protamine sulfate binds with heparin in the bloodstream to inactivate it and thus reverse its effect.

To treat a patient diagnosed with primary hyperaldosteronism, the nurse would expect to administer which diuretic? a. Hydrochlorothiazide b. Furosemide c. Acetazolamide d. Spironolactone

d. Spironolactone --Spironolactone is the direct antagonist for aldosterone.

By which action does atorvastatin decrease lipid levels? a. Binding to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces b. Decreasing the amount of triglycerides produced by the liver and increasing the removal of triglycerides by the liver c. Inhibiting HMG-CoA reductase, the enzyme responsible for the biosynthesis of cholesterol in the liver d. Stimulating the gallbladder and biliary system to increase excretion of dietary cholesterol

d. Stimulating the gallbladder and biliary system to increase excretion of dietary cholesterol --Atorvastatin is an HMG-CoA reductase inhibitor that inhibits HMG-CoA reductase, the enzyme needed to make cholesterol in the liver.

The nurse is providing education to a patient prescribed spironolactone and furosemide. What information does the nurse explain to the patient regarding both medications together? a. This combination maintains water balance to protect against dehydration and electrolyte imbalance. b. Using two drugs increases blood osmolality and the glomerular filtration rate. c. The lowest dose of two different types of diuretics is more effective than a large dose of one type. d. This combination promotes diuresis but decreases the risk of low levels of potassium.

d. This combination promotes diuresis but decreases the risk of low levels of potassium. --Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes potassium loss.

The nurse is caring for a patient admitted with gastrointestinal bleeding who is anticoagulated with warfarin. Which medication should the nurse anticipate administering? a. Protamine b. Vitamin E c. Calcium gluconate d. Vitamin K

d. Vitamin K --Vitamin K is the antagonist for warfarin.

Which is the pharmacological action of propranolol? a. selective alpha-adrenergic antagonist b. beta2 adrenergic antagonist c. beta1 adrenergic antagonist d. non-selective beta adrenergic antagonist

d. non-selective beta adrenergic antagonist --Propranolol is nonselective; it blocks both beta1 and beta2 receptors at therapeutic doses.