Pharmacology Unit 6, Ch 34 Antihyperlidemia Drug, Ch 35 AntiHTN drugs, Ch 38 Cardiotonic and Idiotropic Drugs

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A nurse is reviewing the medical records of several clients who have come to the clinic for a visit. The nurse determines that a client with which blood pressure readings would be identified as prehypertensive?

128/86 mm Hg

Which is considered preHTN?

136/84

Whci serum digoxin level in an adult would mostly indicate digoxin toxicity

2.0

A nurse caring for a client with atrial fibrillation who is started on digoxin therapy is required to monitor plasma drug levels. The nurse would report which level to the primary health care provider?

2.2

Total cholesterol level

200-239

When educating a group of nursing students on the signs of heart failure, the nurse mentions that the ejection fraction is altered in heart failure. The students demonstrate understanding of the information when they identify which ejection fraction as suggesting heart failure?

38%

28. A client receives his prescribed daily digoxin at 9 a.m. today. The nurse would expect to obtain a serum drug level at which time?

4 pm

HDL level

40-60

26. A client is prescribed digoxin IV as a loading dose. The nurse would expect to administer the drug over which time frame?

5 minutes

A client is prescribed clonidine as a transdermal patch. After instructing the client about this drug, the nurse determines that the teaching was successful when the client states that the patch should remain in place for how long?

7 days

LDL level

<100

A client arrives at the urgent care center complaining of chest pain and is diagnosed with angina pectoris. Which of the following would the nurse expect to be prescribed? A. Nicardipine B. Hydralazine C. Minoxidil D. Nimodipine

A Nicardipine Feedback: Nicardipine is the drug used in the treatment of angina. Nicardipine is a calcium channel blocker used as an antianginal drug. Hydralazine and minoxidil are vasodilators primarily used to treat hypertension. Nimodipine is a calcium channel blocker used to treat subarachnoid hemorrhage.

A client is prescribed an antihypertensive drug. Which of the following would the nurse include in the teaching plan to promote the best outcome for the client? Select all that apply.

A) "Never discontinue use of the antihypertensive drug except on the advice of the physician." B) "Avoid the use of nonprescription drugs unless approved by the physician." C) "Avoid alcohol unless its use has been approved by the physician" E) "Notify the physician if the diastolic pressure suddenly increases to 130 mm Hg or higher."

15. After teaching a group of nursing students about hypertension, the instructor determines that the teaching was successful when the students identify which of the following as a risk factor for development of hypertension? Select all that apply.

A) Advancing age B) Family history D) Cigarette smoking E) Chronic alcohol consumption

A client comes to the clinic for a visit. The client has been taking digoxin for several months. While interviewing the client, the nurse suspects the client is experiencing digoxin toxicity based on which of the following? Select all that apply.

A) Anorexia B) Weakness E) Disorientation

The nurse should educate the client to avoid which of the following nonprescription medications without permission from the physician, as they can interfere with the action of cardiotonic drugs? Select all that apply.

A) Antacids B) Antidiarrheals E) Allergy products

8. Before administering a cardiotonic drug to a client, which of the following would be most important for the nurse to assess? Select all that apply.

A) Apical-radial pulse rate B) Respiratory rate D) Weight measurement E) Blood pressure

A nurse is preparing to administer a cardiotonic drug via IM injection based on the understanding of which of the following about this route? Select all that apply.

A) Appropriate when IV access is not available B) Site massage necessary after injection D) Amount given no more than 2 mL E) Injection deep into the muscle

6. The nurse is reviewing a client's medical record for predisposing factors for myopathy requiring that the client be started on low doses of statins and titrated as tolerated or until cholesterol goals are met. Which of the following would the nurse identify as one of these factors? Select all that apply.

A) Asian descent B) Severe renal insufficiency D) Use of cyclosporine

The use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are contraindicated in clients with which of the following medical conditions? Select all that apply.

A) Bilateral stenosis B) Angioedema C) Pregnancy

Which drugs should not be taken with food

A) Captopril B) Moexipril

A nurse is explaining how statin drugs help lower cholesterol, LDL, and triglycerides. Which of the following would the nurse include in the explanation? Select all that apply.

A) Decreased absorption of cholesterol from the GI tract B) Promotion of cholesterol breakdown

Prior to administering an antihyperlipidemic drug to a client, which of the following would the nurse assess? Select all that apply

A) Dietary history B) Vital signs D) Weight

When reviewing the medical record of a client who is prescribed a cardiotonic, which condition would lead the nurse to contact the primary health care provider because the drug is contraindicated for use? Select all that apply.

A) Digitalis toxicity C) Cardiac tamponade E) Ventricular tachycardia

The nurse is assessing a client diagnosed with left ventricular dysfunction. Which of the following would the nurse most likely assess? Select all that apply

A) Dyspnea B) Moist cough C) Restlessness

help control the nausea and anorexia that may occur as an adverse reaction during digoxin therapy, the nurse should recommend which of the following? Select all that apply.

A) Eating frequent smaller meals B) Restricting fluids at mealtime C) Maintaining good oral hygiene E) Avoiding fluid intake 1 hour before and after meals

A client has a nursing diagnosis of Activity Intolerance related to fatigue and weakness. Which of the following would be appropriate for the nurse to include in the client's plan of care?

A) Encouraging ambulation as tolerated E) Promoting rest periods throughout the day as necessary

A) Find local resources in the community for taking blood pressure. B) Teach client how to properly record weight and blood pressure. C) Schedule regular monitoring of weight and blood pressure.

A client is prescribed nicotinic acid. When teaching the client about this drug, which of the following would the nurse include as a normal skin reaction that may occur? Select all that apply.

A) Flushing B) Sensations of warmth C) Tingling

A client is receiving atorvastatin. The nurse would be alert to client complaints of which of the following? Select all that apply

A) Headache C) Insomnia E) Constipation

5. A nurse is caring for a client experiencing a hypertensive emergency. The nurse understands that if blood pressure is not lowered immediately, damage to which of the following can occur? Select all that apply.

A) Heart B) Kidneyss E) Eyes

A) Hypertension increases the buildup of atherosclerotic plaque. B) Hypertension increases risk of stroke. E) Hypertension increases the workload of the heart.

A nurse would administer the prescribed digoxin (Lanoxin) cautiously for a client with which electrolyte imbalances? Select all that apply

A) Hypokalemia C) Hypocalcemia E) Hypomagnesemia

A nurse is preparing to administer a prescribed cardiotonic to a client. The nurse understands that the drug is being administered to achieve which of the following? Select all that apply.

A) Improved myocardial contractility B) Increased myocardial efficiency E) Improved profusion to all body tissues

A nurse is preparing to administer gemfibrozil to a client. The nurse understands that this drug lowers cholesterol via which of the following mechanisms? Select all that apply.

A) Increases excretion of cholesterol D) Reduces production of triglycerides

9. Before administering a cardiotonic drug, the nurse would expect which of the following laboratory tests to be completed? Select all that apply.

A) Liver function tests B) Renal function tests C) Complete blood count D) Electrolyte levels

A client is prescribed a cardiotonic drug. The nurse would expect to administer which of the following in conjunction with this drug as part of the treatment for heart failure? Select all that apply.

A) Loop diuretics B) Angiotensin-converting enzyme inhibitors (ACEIs) E) Beta blockers

When teaching a client newly diagnosed with hypertension, which instructions would the nurse incorporate into the teaching plan? Select all that apply

A) Lose weight. B) Stop smoking. C) Reduce stress.

Which of the following should be included by the nurse during client teaching to improve client outcomes for a client receiving antihyperlipidemic drugs? Select all that apply.

A) Measures to minimize gastrointestinal upset B) Consultation with a dietitian for assistance with diet teaching D) Focus on the importance of taking drug exactly as prescribed E) Instruction in possible adverse reactions and signs and symptoms to report to primary health care provider

17. Which of the following would the nurse include in the client teaching about HMG-CoA reductase inhibitors (statins)? Select all that apply.

A) Photosensitivity can occur. B) The drug should be continued even if the client feels better.. D) Juices other than grapefruit juice are okay to use. E) Statins should be administered in the evening.

Before administering an antihypertensive, the nurse should complete which of the following assessments? Select all that apply.

A) Pulse rate on both arms C) Blood pressure in the sitting position D) Blood pressure on both arms

A) Reason for taking the prescribed drug B) Drug name C) Correct dose D) Frequency of administration E) Dosage form

3. A client with hypertension is to receive a calcium channel blocker. The nurse understands that this class of drug leads to which of the following? Select all that apply.

A) Relaxation of blood vessels B) Increased oxygen supply to the heart C) Reduced workload on the heart D) Decreased blood pressure

12. The nurse should advise the client to do which of the following to reduce the risk of falls due to orthostatic hypotension from antihypertensive drugs? Select all that apply.

A) Sit on the bed for 1 or 2 minutes when rising from a lying position. D) Have someone assist the client if dizziness or weakness occurs.

4. The nurse discusses the benefit of adding a statin drug to a client's medication regimen based on the understanding that this group of drugs can reduce the risk of death from which of the following? Select all that apply.

A) Stroke B) Transient ischemic attacks

A nurse is obtaining a lipoprotein profile for a client diagnosed with hyperlipidemia. Which of the following measurements would be obtained? Select all that apply.

A) Total cholesterol B) Triglycerides C) LDL

The nurse should notify the primary health care provider when which of the following occur while a client is receiving an antihypertensive? Select all that apply.

A) Weight gain of 2 lb or more per day C) Edema

A client taking bile acid resins can become vitamin deficient in which

A,D,E

A nurse is caring for a client taking a cholestyramine drug. What instructions should the nurse give to this client to prevent constipation? A. "Eat foods high in dietary fiber" B. "Follow a complete liquid diet" C. "Be sure to stay on complete bed rest" D. "Take the water-soluble form of vitamin A"

A. "Eat foods high in dietary fiber" Feedback: The nurse should instruct the client taking a cholestyramine drug to eat foods high in dietary fiber to prevent constipation. The nurse need not instruct the client to have a complete liquid diet or complete bed rest; instead, the nurse should instruct the client to exercise to prevent constipation. Clients are asked to take a water-soluble form of vitamin A if they are experiencing impaired digestion of fats and absorption of the fat-soluble vitamins due to long-term therapy of bile acid sequestrants.

A client is prescribed an antihypertensive drug. Which of the following would the nurse include in the teaching plan to promote the best outcome for the client? Select all that apply. A. "Never discontinue use of the antihypertensive drug except on the advice of the physician" B. 'Avoid the use of nonprescription drugs unless approved by the physician" C. "Avoid alcohol unless its use has been approved by the physician" D. "Know that unexplained weakness or fatigue is a normal adverse reaction" E. "Notify the physician if the diastolic pressure suddenly increases to 130 mmHg or higher"

A. "Never discontinue use of the antihypertensive drug except on the advice of the physician" B. 'Avoid the use of nonprescription drugs unless approved by the physician" C. "Avoid alcohol unless its use has been approved by the physician" E. "Notify the physician if the diastolic pressure suddenly increases to 130 mmHg or higher" Feedback: Common adverse reactions seen with atenolol, a beta-adrenergic blocker, include bradycardia, dizziness, fatigue, weakness, hypotension, nausea, vomiting, diarrhea, and nervousness. Cough is associated with ACE inhibitors. Hyperkalemia is associated with eplerenone and aliskiren. Constipation is not a common adverse reaction with atenolol.

After teaching a group of nursing students about hypertension, the instructor determines that the teaching was successful when the students identify which of the following as a risk factor for development of hypertension? Select all that apply. A. Advancing age B. Family history C. Caucasian race D. Cigarette smoking E. Chronic alcohol consumption

A. Advancing age B. Family history D. Cigarette smoking E. Chronic alcohol consumption Feedback: Risk factors for hypertension include advancing age, family history, cigarette smoking, and chronic alcohol consumption. African American race is also a risk factor.

A nurse reviews a client's medication history for drugs that might interact with the client's prescribed nitrate therapy. Which of the following if administered with nitrates would the nurse identify as causing severe hypotension and possible cardiovascular collapse? Select all that apply. A. Alcohol B. Beta-2 agonists C. HMG-CoA reductase inhibitors D. Angiotensin-converting enzyme inhibitors E. Phosphodiesterase inhibitors

A. Alcohol E. Phosphodiesterase inhibitors Feedback: Alcohol and phosphodiesterase inhibitors when administered with nitrates can cause severe hypotension and possible cardiovascular collapse.

The nurse is reviewing a client's medical record for predisposing factors for myopathy requiring that the client be started on low doses of statins and titrated as tolerated or until cholesterol goals are met. Which of the following would the nurse identify as one of these factors? Select all that apply. A. Asian descent B. Severe renal insufficiency C. Use of antihistamines D. Use of cyclosporine E. Cigarette smoking

A. Asian descent B. Severe renal insufficiency D. Use of cyclosporine Feedback: Predisposing factors for myopathy with statin therapy include Asian descent, severe renal insufficiency, and use of cyclosporine.

A client is prescribed metolazone. As part of the client's teaching plan, the nurse instructs the client to increase his consumption of potassium-rich foods. The nurse determines that the teaching was successful when the client identifies which of the following as a good choice? Select all that apply. A. Bananas B. Shrimp C. Asparagus D. Salmon E. Peanuts

A. Bananas C. Asparagus D. Salmon E. Peanuts Feedback: The top 10 foods with the highest amount of potassium per serving include white beans, dark leafy greens, baked potatoes with skin on, dried apricots, acorn squash, plain low-fat yogurt, salmon, avocado, mushrooms, and bananas. Fruit high in potassium include apricots, prunes, dried currants/raisins, dates, figs, dried coconut, avocado, bananas, oranges, nectarines, and peaches. Vegetables high in potassium include sun-dried tomatoes, spinach, Swiss chard, mushrooms, sweet potato, kale, Brussels sprouts, zucchini, green beans, and asparagus. Other sources include chocolate, molasses, nuts, and nut butters.

A. Bilateral stenosis B. Angioedema C. Pregnancy Feedback: The use of ACEIs and ARBs is contraindicated if the client has impaired renal function, heart failure, salt or volume depletion, bilateral stenosis, angioedema, or is pregnant.

Which of the following does the nurse need to include as part of the physical assessment of a client with angina pain? Select all that apply. A. Blood pressure B. Apical pulse C. Oxygen saturation D. Radial pulse E. Respiratory rate

A. Blood pressure B. Apical pulse D. Radial pulse E. Respiratory rate Feedback: The nurse's physical assessment of a client with angina should include blood pressure, respiratory rate, and apical and radial pulses. The physical assessment may also include weight, inspection of the extremities for edema, and auscultation of the lungs, depending on the type of heart failure.

A client is prescribed verapamil as treatment for his angina. Which of the following would the nurse include in the teaching plan for the client? Select all that apply. A. Caplets may be opened and sprinkled on food B. Drug should be administered without regard to meals C. Table coverings can be expelled in the stool D. Caplets should be swallowed whole E. Drug should be administered with a meal

A. Caplets may be opened and sprinkled on food C. Table coverings can be expelled in the stool E. Drug should be administered with a meal Feedback: Verapamil frequently causes GI upset and should be administered with a meal. Caplets may be opened and sprinkled on food or mixed in liquids for clients who have difficulty swallowing. Sometimes the tablet coverings are expelled in the stool.

A nurse is providing care to a client who has an allergy to sulfamethoxazole/trimethoprim. The nurse underneath that the client may have cross- sensitivity reactions with which of the following diuretics? Select all that apply. A. Cholorothiazide B. Furosemide C. Chlorthalidone D. Metrolazone E. Spironolactone

A. Chlorothiazide C. Chlorthalidone D. Metrolazone Feedback: A cross-sensitivity reaction may occur with the thiazides (chlorothiaide, chlorthalidone, and metrolazone) and sulfonamides (sulfamethoxazole).

A client is prescribed verapamil. The nurse would alert the client to the possibility of which of the following as most common? Select all that apply. A. Constipation B. Tachycardia C. Tachypnea D. Hypotension E. Headache

A. Constipation E. Headache Feedback: The most common adverse reactions associated with verapamil are constipation and headache. Hypotension is associated with nitrate therapy. Tachycardia and tachypnea are not associated with verapamil.

The nurse assesses for which of the following in a client receiving a calcium channel blocker? Select all that apply. A. Crackles B. Bradycardia C. Wheezing D. Dyspnea E. Peripheral edema

A. Crackles D. Dyspnea E. Peripheral edema Feedback: A client receiving a calcium channel blocker should be monitored for signs of heart failure (dyspnea, weight gain, peripheral edema, abnormal lung sounds such as crackles or rales, jugular vein distention. The physician should be notified immediately if any of these signs develop.

A nurse is explaining how statin drugs help lower cholesterol, LDL, and triglycerides. Which of the following would the nurse include in the explanation? Select all that apply. A. Decreased absorption of cholesterol from the GI tract B. Promotion of cholesterol breakdown C. Formation of a substance that is excreted in the feces D. Decreased breakdown of fat to cholesterol E. Inhibition of cholesterol production

A. Decreased absorption of cholesterol from the GI tract B. Promotion of cholesterol breakdown Feedback: Statins inhibit the manufacture of cholesterol or promote the breakdown of cholesterol. The bile acid resins bind to bile acids to form an insoluble substance that cannot be absorbed by the intestine, so it is excreted in the feces.

A nurse is reviewing the medical record of several clients who are prescribed amiloride. The nurse would identify a client with which condition as being at highest risk for developing hyperkalemia? Select all that apply. A. Diabetes B. Hypertension C. Renal disease D. Epilepsy E. Asthma

A. Diabetes C. Renal disease Feedback: Hyperkalemia is most likely to occur in clients with an inadequate fluid intake and urine output, those with diabetes or renal disease, the elderly, and those who are severly ill.

Prior to administering an antihyperlipidemic drug to a client, which of the following would the nurse assess? Select all that apply. A. Dietary history B. Vital signs C. Blood glucose D. Weight E. Input and output

A. Dietary history B. Vital signs D. Weight Feedback: Before administering an antihyperlipidemic drug, the nurse would assess a lipid profile, liver function tests, dietary history, vital signs, and weight and inspect for xanthomas.

A nurse is assessing a client after administering a diuretic. Which of the following would lead the nurse to suspect that the client is experiencing a fluid and electrolyte imbalance? Select all that apply. A. Dry mouth B. Diaphoresis C. Muscle cramps D. Hypertension E. Tachycardia

A. Dry mouth C. Muscle cramps E. Tachycardia Feedback: Warning signs of a fluid and electrolyte imbalance include dry mouth, thirst, lethargy, weakness, drowsiness, restlessness, muscle pain or cramps, confusion, GI disturbances, hypotension, oliguria, tachycardia, and seizures.

A client has a nursing diagnosis of Activity Intolerance related to fatigue and weakness. Which of the following would be appropriate for the nurse to include in the client's plan of care? Select all that apply. A. Encouraging ambulation as tolerated B. Maintaining bed rest as much as possible C. Mandating the use of assistive devices D. Encouraging activities early in the morning when fatigue is less E. Promoting rest periods throughout the day as necessary

A. Encouraging ambulation as tolerated E. Promoting rest periods throughout the day as necessary Feedback: The client is encouraged to walk and ambulate as he or she can tolerate. Assistive devices may be used if needed, but these should not be mandated for use. The client can gradually increase tolerance by increasing the daily amount of activity. Planning rest periods according to the individual's tolerance is appropriate. Rest can take many forms, such as sitting in a chair, napping, watching television, or sitting with legs elevated.

A client with hypertension comes to the clinic for a follow-up visit. Which of the following would be appropriate for the nurse to do when assisting the client in managing his hypertension? Select all that apply. A. Find local resources in the community for taking blood pressure B. Teach client how to properly record weight and blood pressure C. Schedule regular monitoring of weight and blood pressure D. Schedule an appointment to see a cardiologist E. Schedule an appointment to see a nephrologist

A. Find local resources in the community for taking blood pressure B. Teach client how to properly record weight and blood pressure C. Schedule regular monitoring of weight and blood pressure Feedback: In the ambulatory care setting, the nurse helps plan a schedule of regular monitoring of weight and blood pressure, finds local resources for taking blood pressure in the community, and teaches the client how to record weight and blood pressure readings.

A client is prescribed nicotinic acid. When teaching the client about this drug, which of the following would the nurse include as a normal skin reaction that may occur? Select all that apply. A. Flushing B. Sensations of warmth C. Tingling D. Rash E. Pustule formation

A. Flushing B. Sensations of warmth C. Tingling Feedback: Generalized skin flushing, a sensation of warmth, and severe itching and tingling can occur with the administration of nicotinic acid, especially at higher doses.

A client is prescribed amiloride. The nurse would administer this drug cautiously if the client had a history of which of the following? Select all that apply. A. Gout B. Asthma C. Diabetes D. HIV E. Hepatic disease

A. Gout C. Diabetes E. Hepatic disease Feedback: Potassium-sparing diuretics, like amiloride, should be used cautiously in clients with gout, diabetes, and hepatic disease.

A client is receiving atorvastatin. The nurse would be alert to client complaints of which of the following? Select all that apply. A. Headache B. Sedation C. Insomnia D. Diarrhea E. Constipation

A. Headache C. Insomnia E. Constipation Feedback: Atorvastatin is an HMG-CoA reductase inhibitor (statin). Adverse reactions of statins include headache, dizziness, insomnia, flatulence, abdominal pain, cramping, constipation, and nausea.

A nurse is teaching a client who is prescribed nitrate therapy about adverse reactions. When discussing headaches associated with nitrates, which of the following would the nurse include? Select all that apply. A. Headaches should decrease with continued therapy B. Headaches may be relieved with the use of aspirin or acetaminophen C. Headaches should be avoided by altering the dosage schedule D. Headaches are a serious adverse reaction and should be reported immediately E. Headaches may be a marker of the drug's effectiveness

A. Headaches should decrease with continued therapy B. Headaches may be relieved with the use of aspirin or acetaminophen E. Headaches may be a marker of the drug's effectiveness Feedback: Headaches are a common adverse reaction of nitrates but should decrease with continued therapy. Headaches should be reported if they become severe or persist. Headaches may be a marker of the nitrate's effectiveness, and clients should not alter the dosing schedule to avoid headaches. Headaches may be treated with acetaminophen or aspirin.

A nurse is caring for a client experiencing a hypertensive emergency. The nurse understands that if blood pressure is not lowered immediately, damage to which of the following can occur? Select all that apply. A. Heart B. Kidneys C. Gallbladder D. Pancreas E. Eyes

A. Heart B. Kidneys E. Eyes Feedback: A hypertensive emergency, if not recognized and treated quickly, can result in damage to target organs including the heart, kidneys, and eyes.

A nurse caring for a client with diabetes controlled with metformin recently began taking a drug for edema. The nurse notices that the client's blood glucose levels are increasing. Which of the following diuretics are likely to cause hyperglycemia? Select all that apply. A. Hydrochlorothiazide B. Furosemide C. Chlorthalidone D. Acetazolamide E. Metolazone

A. Hydrochlorothiazide C. Chlorthalidone E. Metolazone Feedback: Thiazide diuretics, like hydrochlorothiazide, chlorthalidone, and metolazone, can result in hyperglycemia in clients receiving antidiabetic drugs, like metformin.

A nurse is preparing to administer spironolactone to a client. The nurse would contact the primary health care provider about the need to change the order if the client has a history of which of the following? A. Hyperkalemia B. Liver disease C. Gout D. Diabetes

A. Hyperkalemia Feedback: the nurse should know that potassium-sparing diuretics are contraindicated in clients with hyperkalemia and are not recommended for children. Potassium-sparing diuretics should be used cautiously in clients with liver disease, diabetes, or gout, but these conditions do not contraindicate the use of potassium diuretics.

When developing a presentation for a local community group on hypertension, the nurse integrates information about the importance of blood pressure control. Which of the following would the nurse include? Select all that apply. A. Hypertension increases the buildup of atherosclerotic plaque B. Hypertension increases risk of stroke. C. Hypertension increased risk of colorectal carcinoma D. Hypertension increases risk of liver disease E. Hypertension increases the workout of the heart

A. Hypertension increases the buildup of atherosclerotic plaque B. Hypertension increases risk of stroke E. Hypertension increased the workload of the heart Feedback: Hypertension is serious, because it causes the heart to work too hard and contribures to atherosclerosis. It also increases the risk of heart disease, heart failure (HF), kidney disease, blindness, and stroke. Hypertension is not assoiateed with colorectal carcinoma or liver disease.

The nurse understands that the use of diuretics is contraindicated in clients with which of the following? Select all that apply. A. Hyponatremia B. Hypokalemia C. Hypertension D. Anuria E. Asthma

A. Hyponatremia B. Hypokalemia D. Anuria Feedback: Diuretics are contraindicted in clients with known hypersensitivity to the drugs, electrolyte imbalance (hyponatremia and hypokalemia), severe kidney or liver dysfunction, and anuria.

When reviewing a client's history, the nurse notes that the client uses garlic to promote cardiovascular health. The nurse understands that which of the following is a benefit of its use? Select all that apply. A. Improved LDL-to-HDL ratio B. Lower serum triglyceride levels C. Lower blood pressure D. Prevention of atherosclerosis E. Reduced risk for blood clots

A. Improved LDL-to-HDL ratio B. Lower serum triglyceride levels C. Lower blood pressure D. Prevention of atherosclerosis Feedback: The benefits of garlic include lowering serum cholesterol and triglyceride levels, improving the ratio of HDL to LDL cholesterol, lowering blood pressure, and helping to prevent the development of atherosclerosis.

A nurse instructs a client who is taking oral nitrates to store the drug in which manner? Select all that apply. A. In its original container B. With the container lid tightly sealed C. With other medications in the container D. In a plastic pill box so doses are not missed E. Away from light exopsure

A. In its original container B. With the container lid tightly sealed E. Away from light exposure Feedback: The proper storage of oral nitroglycerin includes keeping tablets and capsules in their original container, never mixing oral nitroglycerin with other drugs in a container, never storing oral nitroglycerin in a plastic container, keeping the drug away from light, and always replacing the container tightly and as soon as the drug is removed.

A client with hypertension has a fungal infection and has been prescribed fluconazole for the fungal infection and losartan for hypertension. The nurse would be alert for which of the following? A. Increased risk of adverse effects of losartan B. Increased risk of hypersensitivity reaction C. Decreased hypotensive effect of losartan D. Increased risk of hypoglycemia

A. Increased risk of adverse effects of losartan Feedback: Increased risk of antihypertensive effects and adverse reactions are associated with the concomitant use of fluconazole and losartan.. Decreased hypotensive effect of losartan is seen with use of indomethacin and does not occur with the concomitant use of these drugs. Increased risk of hypoglycemia and increased risk of hypersensitivity do not occur with the concomitant use of these drugs.

A nurse is preparing to administer gemfibrozil to a client. The nurse understands that this drug lowers cholesterol via which of the following mechanisms? Select all that apply. A. Increases excretion of cholesterol B. Reduces very-low-density lipoproteins (VLDLs) C. Increases breakdown of VLDLs D. Reduces production of triglycerides E. Inhibits cholesterol formation

A. Increases excretion of cholesterol D. Reduces production of triglycerides Feedback: Gemfibrozil increases the excretions of cholesterol and reduces the production of triglycerides. The drug does not reduce CLDLs, increase VLDL breakdown, or inhibit cholesterol formation.

A nurse is preparing to administer spironolactone to a client. When reviewing the client's medical record, the nurse would be alert for the development of hyperkalemia if the client was also receiving which of the following? A. Lisinopril (Prinivil) B. Metoprolol (Lopressor) C. Terazosin (Hytrin) D.. Diltiazem ( Cardizem)

A. Lisinopril (Prinivil) Feedback: Spironolactone when given with ACE inhibitors (lisinopril) can lead to hyperkalemia. Hyperkalemia is not associated with the combination of spironolactone and metoprolol, terazosin, or diltiazem.

The nurse is to administer bumetanide. The nurse reviews the client's medication history for possible interacting drugs. Which of the following, if found, would the nurse identify as having an increased risk for toxicity? Select all that apply. A. Lithium B. Phenytoin C. Gentamicin D. Warfarin E. Digoxin

A. Lithium C. Gentamicin D. Warfarin E. Digoxin Feedback: Loop diuretics, like bumetanide, can increase toxicity of the following medications: lithium (Eskalith), gentamicin, warfarin (Coumadin), and digoxin (Lanoxin). A decrease in diuretic effect occurs when bumetanide is given with phenytoin.

When teaching a client newly diagnosed with hypertension, which instructions would the nurse incorporate into the teaching plan? Select all that apply. A. Lose weight B. Stop smoking C. Reduce stress D. Decrease exercise E. Increase sodium intake

A. Lose weight B. Stop smoking C. Reduce stress Feedback: Nonpharmacologic management of hypertension should include weight loss, stress reduction, regular aerobic exercise, smoking cessation, moderation of alcohol, and decreased sodium intake.

Which of the following should be included by the nurse during client teaching to improve client outcomes for a client receiving antihyperlipidemic drugs? Select all that apply. A. Measures to minimize gastrointestinal upset B. Consultation with a dietitian for assistance with diet teaching C. Emphasis on the fact that drug therapy alone will significantly lower blood cholesterol levels D. Focus on the importance of taking drug exactly as prescribed E. Instruction in possible adverse reactions and signs and symptoms to report to primary health care provider

A. Measures to minimize gastrointestinal upset B. Consultation with a dietitian for assistance with diet teaching D. Focus on the importance of taking drug exactly as prescribed E. Instruction in possible adverse reactions and signs and symptoms to report to primary health care provider Feedback: Client teaching includes measures to minimize gastrointestinal upset, consultation with a dietician to assist with diet planning and teaching, focus on the need to take the drug exactly as prescribed, and information about possible adverse reactions including those that need to be reported to the primary health care provider. The nurse should emphasize that drug therapy alone will NOT significantly lower blood cholesterol levels.

Prior to administering an antianginal drug, the nurse should assess which of the following? Select all that apply. A. Pain B. Physical appearance C. Lung sounds D. Heart sounds E. Vital signs

A. Pain B. Physical appearance C. Lung sounds E. Vital signs Feedback: Before administering an antianginal agent, the nurse would assess the client's pain, history of medication allergies and disease processes, physical appearance, and lungs for adventitious sounds and obtain a baseline electrocardiogram and vital signs.

A nurse may notice a decrease in diuretic effect when furosemide (Lasix) is given with which of the following drugs? Select all that apply. A. Phenytoin B. Naproxen C. Digoxin D. Lithium E. Ibuprofen

A. Phenytoin B. Naproxen E. Ibuprofen Feedback: A nurse may notice a decrease in diuretic effect when furosemide (Lasix) is given with the following drugs: hydantoins (phenytoin) and NSAIDs (naproxen and ibuprofen). There is an increased risk of lithium toxicity if furosemide is given with lithium. An increased risk of cardiac arrhythmias occurs when digoxin is given with furosemide.

Which of the following would the nurse include in the client teaching about HMG-CoA reductase inhibitors (statins)? Select all that apply. A. Photosensitivity can occur B. The drug should be continued even if the client feels better C. Muscle pain and weakness are normal D. Juices other than grapefruit juice are okay to use E. Statins should be administered in the evening

A. Photosensitivity can occur B. The drug should be continued even if the client feels better D. Juices other than grapefruit juice are okay to use E. Statins should be administered in the evening Feedback: When teaching about statins, the nurse should include information about the possibility of photosensitivity, the need to continue the drug even if feeling better, juices other than grapefruit juice as appropriate, and administration in the evening. Muscle pain and weakness should be reported to the client's physician as soon as they occur.

After teaching a group of nursing students about antihypertensive drugs, the instructor determines a need for additional teaching when the students identify which of the following as an angiotensin-converting enzyme inhibitor? A. Pindolol B. Benazepril C. Quinapril D. Enalapril

A. Pindolol Feedback: Pindolol is a beta-adrenergic blocker. Benzapril, quinapril, and enalapril are ACEs.

Before administering an antihypertensive, the nurse should complete which of the following assessments? Select all that apply. A. Pulse rate on both arms B. Pulse rate on one arm C. Blood pressure in the sitting position D. Blood pressure on both arms E. Blood pressure on one arm

A. Pulse rate on both arms C. Blood pressure in the sitting position D. Blood pressure on both arms Feedback: Preadministration assessment for antihypertensives should include blood pressure and pulse rate on both arms with the client in standing, sitting, and lying positions.

The nurse is preparing a client for discharge. The client is prescribed antihyperlipidemic drug therapy. The nurse would include which of the following in the discharge teaching? Select all that apply. A. Reason for taking the prescribed drug B. Drug name C. Correct dose D. Frquency of administration E. Dosage form

A. Reason for taking the prescribed drug B. Drug name C. Correct dose D. Frquency of administration E. Dosage form Feedback: The nurse should review the reasons for the drug and prescribed therapy, including drug name, form and method off preparation, correct dose, and frequency of administration, as part of a client's discharge counseling.

A client with hypertension is to receive a calcium channel blocker. The nurse understands that this class of drug leads to which of the following? Select all that apply. A. Relaxation of blood vessels B. Increased oxygen supply to the heart C. Reduced workload on the heart D. Decreased blood pressure E. Increased workload on the kidneys

A. Relaxation of blood vessels B. Increased oxygen supply to the heart C. Reduced workload on the heart D. Decreased blood pressure Feedback: The use of calcium channel blockers results in relaxation of blood vessels, increased oxygen supply to the heart, reduced workload on the heart, and decreased blood pressure.

When discussing the use of antianginal drugs for the treatment of cardiac disease, a nurse would expect to include which of the following? Select all that apply. A. Relief of pain of acute angina attacks B. Reduction in serum triglyceride levels C. Prevention of angina attacks D. Elevation of high-density lipoproteins (HDLs) E. Treatment of chronic stable angina pectoris

A. Relief of pain of acute angina attacks C. Prevention of angina attacks E. Treatment of chronic stable angina pectoris Feedback: Antianginal drugs are used to relieve the pain of acute angina attacks, prevent angina attacks, and treat chronic stable angina pectoris. Antianginals have no effect on HDLs or triglycerides.

An older adult client is prescribed a diuretic and an antihypertensive drug as treatment for his hypertension. The client tells the nurse that he has been perspiring a lot lately and has had some diarrhea. Which nursing diagnosis would the nurse most likely identify as a priority? A. Risk for Deficient Fluid Volume B. Ineffective Sexuality Patterns C. Activity Intolerance D. Acute Pain

A. Risk for Deficient Fluid Volume Feedback: Risk for Deficient Fluid Volume would be the most likely priority because the client is receiving a diuretic and an antihypertensive drug. The risk increased if the client is older or confused. Ineffective Sexuality Patterns would be appropriate if the client were to experience sexual dysfunction related to drug therapy. Activity Intolerance would be appropriate if the client complained of feeling tired and weak. Acute Pain would be related to the development of a headache that may occur with angiotensin II receptor blockers or antiadrenergics.

A client is prescribed nitrate therapy as treatment for angina. On a follow-up visit to the clinic, the client tells the nurse that he gets dizzy and weak when he takes the medication. The nurse would identify which nursing diagnosis as most likely? A. Risk for Injury B. Risk for Infection C. Deficient Fluid Volume D. Acute Pain

A. Risk for Injury Feedback: The client is at risk for injury because of his complaints of dizziness and weakness. there is no indication that the client is experiencing an infection or has a fluid volume deficit. Complaints of pain would lead to a nursing diagnosis of Acute Pain.

A client, aged 60 years, is receiving nitroprusside for hypertensive emergency. The nurse would be alert for the development of which of the following? A. Significant hypotension B. Rebound hypertension C. Blindness D. Stroke

A. Significant hypotension Feedback: An older adult client is at risk for significant hypotension when receiving nitroprusside. To prevent this, the dosage should be reduced during the initial period of therapy. Rebound hypertension, stroke, and blindness will not occur during nitroprusside therapy.

The nurse should advise the client to do which of the following to reduce the risk of falls due to orthostatic hypotension from antihypertensive drugs? Select all that apply. A. Sit on the bed for 1 or 2 minutes when rising from a lying position B. Rise quickly from a chair when moving to a standing position C. Take the antihypertensive less frequently if hypotension occurs D. Have someone assist the client if dizziness or weakness occurs E. Increase salt intake to counteract the hypotension

A. Sit on the bed for 1 or 2 minutes when rising from a lying position D. Have someone assist the client if dizziness or weakness occurs Feedback: The nurse explains that when rising from a lying position, the client should sit on the edge of the bed for 1 or 2 minutes; the client should rise slowly from a chair and then stand for 1 or 2 minutes; and when symptoms of orthostatic hypotension occur, someone assisting the client in getting out of bed or a chair can decrease the risk of falls due to orthostatic hypotension.

A nurse is administering acetazolamide to a client. The nurse understands that this drug leads to excretion of which of the following? Select all that apply. A. Sodium B. Magnesium C. Potassium D. Bicarbonate E. Chloride

A. Sodium C. Potassium D. Bicarbonate Feedback: Carbonic anhydrase inhibitors, like acetazolamide, result in the excretion of sodium, potassium, bicarbonate, and water.

The nurse discusses the benefit of adding a statin drug to a client's medication regimen based on the understanding that this group of drugs can reduce the risk of death from which of the following? Select all that apply. A. Stroke B. Transient ischemic attack C. Kidney disease D. Hepatic disease E. Cancer

A. Stroke B. Transient ischemic attack Feedback: The use of statins in clients with hyperlipidemia with or without clinically evident coronary heart disease can reduce the risk of death from stroke and transient ischemic attacks.

A nurse is caring for a client with increased intraocular pressure who is receiving urea. After administering the drug, the nurse would assess the client for which of the following? A. Syncope B. Cramping C. Photosensitivity D. Blurred vision

A. Syncope Feedback: The nurse should observe the client for syncope after administering urea. Other adverse reactions associated with the administration of urea include headache, nausea, vomiting, and fluid and electrolyte imbalance. Cramping is an adverse reaction of the drug spironolactone. The nurse should observe the client for photosensitivity after administering triamterene. Blurred vision is an adverse reaction of mannitol.

A client with hypercholesterolemia is prescribed lovastatin. When instructin the client how to take the drug, which of the following would the nurse include? A. Taking the drug with his evening meal B. Combining the drug with the artificial sweetener aspartame C. Mixing the drug with highly fluid soups or pulpy fruits D. Taking the drug with grapefruit juice

A. Taking the drug with his evening meal Feedback: For the self-administration of lovastatin, the nurse should suggest the client take the drug with his evening meal. Cholestyramine powder is mixed with highly fluid soups or pulpy fruits. Cholestyramine is available combined with the artificial sweetener aspartame. The client should not drink grapefruit juice when taking lovastatin.

A client with hyperlipidemia has been prescribed niacin by a physician. Which of the following adverse reactions should the nurse monitor for in the client? A. Tingling B. Constipation C. Diarrhea D. Cholelithiasis

A. Tingling Feedback: The nurse should monitor for tingling in the client as an adverse reaction to the drug niacin. Constipation, diarrhea, and cholelithiasis are adverse reactions to the drug fenofibrate.

A nurse is obtaining a lipoprotein profile for a client diagnosed with hyperlipidemia. Which of the following measurements would be obtained? Select all that apply. A. Total cholesterol B. Triglycerides C. LDL D. ALT E. AST

A. Total cholesterol B. Triglycerides C. LDL Feedback: A lipoprotein profile is a laboratory test that reports total cholesterol, LDL, HDL, and triglycerides. AST and ALT are values that would be reported from liver function tests.

A nurse is preparing to administer nitroglycerin intravenously. Which of the following would be important for the nurse to keep in mind? Select all that apply A. Using glass bottles B. Using non-polyvinyl chloride (PVC) infusion sets C. Administering the drug as an IV bolus D. Diluting the drug with normal saline E. Using a gravity flow rate of infusion

A. Using glass bottles B. Using non-polyvinyl chloride (PVC) bolus D. Diluting the drug with normal saline Feedback: When administering IV nitroglycerin, the nurse should dilute it with normal saline or 5% dextrose in water, administer the drug by continuous infusion using an infusion pump for accuracy, and use glass IV bottles and non-PVC infusion sets. The dose is regulated based on client response.

When applying nitroglycerin ointment, which of the following would be appropriate? Select all that apply. A. Wear plastic disposable gloves B. Apply entire tube of ointment to client's skin C. Use the same application site each time ointment is applied D. Cleanse the area of skin before application E. Use the upper arms and legs for application

A. Wear plastic disposable gloves D. Cleanse the area of skin before application E. Use the upper arms and legs for application Feedback: The nurse should wear plastic gloves while administering ointment and use application paper to measure and apply ointment to the client's chest, abdomen, or upper arms and legs. The application site should be rotated and cleansed with each application.

Prior to the administration of furosemide (Lasix), a nurse would assess which of the following? Select all that apply. A. Weight B. Blood glucose C. Pulse D. Temperature E. Respiratory rate

A. Weight C. Pulse D. Temperature E. Respiratory rate Feedback: Before administering furosemide (Lasix), the nurse takes the vital signs (blood pressure, pulse, temperature, respiratory rate, and weight). there is no need to assess the client's blood glucose.

The nurse should notify the primary health care provider when which of the following occur while a client is receiving an antihypertensive? Select all that apply. A. Weight gain of 2 lb or more per day B. Headache C. Edema D. Insomnia E. Sedation

A. Weight gain of 2 lb or more per day C. Edema Feedback: The nurse should notify the primary health care provider if a client has a weight gain of 2 lb or more per day or edema of the hands, fingers, feet, legs, or sacral area.

While reviewing a client's lab work, the nurse notices the client's potassium is elevated. The nurse checks the client's medication record. Which of the following, if found, would the nurse identify as contributing to the client's elevated potassium level? Select all that apply.

B) Aliskiren E) Eplerenone

13. Which of the following is true with regard to oral administration of cardiotonic drugs? Select all that apply.

B) Alternating between oral dosage forms is avoided. C) Tablets can be crushed and mixed with food or fluids. D) Oral dosage forms can be administered without regard to meals.

4. After receiving a loading dose of milrinone (Primacor), the nurse would assess the client for which of the following as most likely? Select all that apply.

B) Angina D) Headache

A client is experiencing constipation due to an antihyperlipidemic drug. The client asks the nurse how to manage this problem. Which suggestion would be most appropriate? Select all that apply.

B) Increase your fluid intake. C) Eat foods rich in dietary fiber. D) Be sure to exercise every day. E) Use a stool softener.

A nurse is instructing a client about his prescribed antihypertensive therapy with captopril. Which of the following instructions would the nurse include in the teaching plan? Select all that apply.

B) Informing the client about the possibility of a cough D) Taking measures to reduce injury from hypotension

nurse is reviewing a client's laboratory test results after being on statin therapy for several months. Which of the following would the nurse interpret as indicating effectiveness of the drug? Select all that apply.

B) LDL cholesterol 80 mg/dL E) HDL cholesterol 60 mg/dL

11. After teaching a group of nursing students about digoxin, the instructor determines that the teaching was successful when the students identify which of the following as true regarding the monitoring of plasma digoxin levels? Select all that apply.

B) Levels should be drawn immediately before the next dose. C) Levels should be drawn 6 to 8 hours after the last dose. D) Levels of greater than 2 ng/mL are considered toxic.

B) Lower serum triglyceride levels C) Lower blood pressure D) Prevention of atherosclerosis

8. A client is starting cholestyramine therapy for the treatment of hyperlipidemia. When teaching the client about possible adverse reactions, which of the following would the nurse include? Select all that apply.

B) Malabsorption of vitamin K C) Aggravation of hemorrhoids D) Flatulence

A client is receiving pravastatin. The nurse understands that which of the following should be avoided with this client to prevent the risk of myopathy? Select all that apply.

B) Niacin (Niaspan) C) Clarithromycin (Biaxin) E) Verapamil (Calan)

B) Pregnancy C) Serious hepatic disease E) Lactation

2. A nursing instructor is conducting a class on heart failure and the events that occur. The instructor describes which of the following as a result of increases in neurohormonal activity that occur with heart failure? Select all that apply.

B) Remodeling of the cardiac muscle cells C) Hypertrophy of the heart D) Increased need for oxygen E) Cardiac necrosis

16. A nurse checks the serum digoxin level of a client and finds it to be increased. Which of the following would the nurse identify as possibly associated with this increase?

B) Verapamil (Calan) C) Clarithromycin (Biaxin) E) Spironolactone (Aldactone)

After administering an antihyperlipidemic drug, the nurse continues to assess which of the following? Select all that apply.

B) Vital signs C) Assessment of bowel function

After teaching a client about how to use translingual nitroglycerin spray, the nurse determines that the teaching was successful when the client states which of the following? Select all that apply. A. "I need to shake the canister before use" B. "I will place one to two metered doses under my tongue at the start of an attack" C. "I'm not to use this form to prevent an attack" D. "I should not exceed three metered doses in 15 minutes" E. "I can spray the drug onto or under the tongue"

B. "I will place one to two metered doses under my tongue at the start of an attack" D. "I should not exceed three metered doses in 15 minutes" E. "I can spray the drug onto or under the tongue" Feedback: Nitroglycerin translingual spray can be used prophylactically 5 to 10 minutes prior to engaging in activities that precipitate an anginal attack. The client should not shake the canister before use. At the onset of an anginal attack, the client should spray one or two metered doses onto or under the tongue and not exceed three metered doses within 15 minutes. The client should clean the canister as directed on the package.

B. 128/86 mmHg Feedback: Prehypertension is classified as a systolic blood pressure ranging between 120 and 139 mmHg or a diastolic pressure ranging between 80 and 89 mmHg. A systolic pressure below 120 mmHg and a diastolic pressure below 80 mmHg is considered normal. Stage 1 hypertension would be characterized by a systolic pressure between 140 and 159 mmHg or a diastolic pressure between 90 and 99 mmHg. Stage 2 hypertension would be characterized by a systolic pressure of 160 mmHg or greater or a diastolic pressure of 100 mmHg or greater.

When describing the different classes of diuretics, the nursing instructor would include which of the following as sulfonamides, with nonbacteriostatic action, that inhibit the enzyme carbonic anhydrase? Select all that apply. A. Furosemide B. Acetazolamide C. Hydrochlorothiazide D. Methazolamide E. Torsemide

B. Acetazolamide D. Methazolamide Feedback: Acetazolamide and methazolamide are carbonic anhydrase inhibitors. Furosemide and torsemide are loop diuretics. Hydrochlorothiazide is a thiazide diuretic.

B. Aliskiren E. Eplerenone Feedback: Direct renin inhibitors such as aliskiren and the drug eplerenone can cause hyperkalemia. Atenolol and metoprolol are beta blockers. Clonidine is a centrally acting adrenergic drug.

After administering metolazone to a client, the nurse monitors for signs of hypokalemia, including which of the following? Select all that apply. A. Diarrhea B. Anorexia C. Depression D. Hypoglycemia E. Drowsiness

B. Anorexia C. Depression E. Drowsiness Feedback: The following are sings of hypokalemia: anorexia, nausea, vomiting, depression, confusion, cardiac arrhythmias, impaired thought process, and drowsiness.

A client who is prescribed niacin comes to the clinic complaining of significant skin flushing and itching. The client states, "It's really uncomfortable, so much so that I almost stopped taking the drug." The nurse informs the primary health care provider. Which of the following would the nurse anticipate that the primary health care provider may recommend? A. Prednisone B. Aspirin C. Ibuprofen D. Hydrocortisone

B. Aspirin Feedback: Aspirin may be recommended before taking niacin preparations to reduce adverse reactions when niacin causes skin reactions that are severe or cause extreme discomfort.

A physician has prescribed bumetanide for a client with high blood pressure who also has renal insufficiency. Which of the following instructions should the nurse include in the teaching plan for this client? A. Avoid salt substitutes containing potassium B. Avoid over-the-counter drugs for cold symptoms C. Always take the drug before meals D. Omit the drug dose when feeling dizzy

B. Avoid over-the-counter drugs for cold symptoms Feedback: The nurse should instruct the hypertensive client to avoid medications that increase blood pressure, such as OTC drugs for appetite suppression and cold symptoms. The nurse should instruct clients taking potassium-sparing diuretics, not loop diuretics such as bumetanide, to refrain from using salt substitutes containing potassium. The nurse need not instruct the client to take the drug before meals since doing so will not decrease the client's blood pressure. The nurse should instruct the client to observe caution while driving or performing hazardous tasks when dizziness or weakness occurs. In such cases, the nurse instructs the client to rise slowly from a sitting or lying position and avoid standing in one place for an extended time.

When providing care to a client with hypertension who is receiving antihypertensive therapy, which assessment would be the highest priority? A. Pain rating B. Blood pressure monitoring C. Weight measurement D. Complaints of adverse reactions

B. Blood pressure monitoring Feedback: Although assessing for pain, measuring weight, and assessing for complaints of adverse reactions are important, monitoring the client's blood pressure would have the highest priority because the drug therapy regimen may need to be adjusted or changed if the client's response is inadequate.

When educating a group of nursing students on the mechanism of action of angiotensin-converting enzyme inhibitor (ACEI) drugs, the instructor identifies which of the following as the action brought about by aldosterone? A. Inhibits renin secretion B. Causes sodium and water retention C. Causes excess potassium retention D. Promotes angiotensin I conversion

B. Causes sodium and water retention Feedback: Aldosterone causes retention of sodium and water. This in turn causes a rise in blood pressure. ACEIs act by inhibiting the conversion of angiotensin I to angiotensin II. Aldosterone does not inhibit the release of renin and is not involved in the retention of potassium. Angiotensin-converting enzymes, and not aldosterone, are involved in the conversion of angiotensin I to angiotensin II.

A nurse is caring for a client with increased intracranial pressure caused by cerebral edema. The physician has prescribed mannitol. After administering the drug, the nurse should do which of the following? A. Monitor blood pressure every 4 hours B. Check response of pupils to light C. Monitor client for joint pain D. Monitor serum uric acid concentrations

B. Check response of pupils to light Feedback: When caring for a client who has been given mannitol for intracranial pressure, the nurse should perform neurologic assessments such as response of the pupils to light, level of consciousness, or response to a painful stimulus at the time intervals ordered by the primary health care provider. The nurse monitors the client for joint pain and other discomforts when the client is administered thiazide diuretics for renal impairment. When caring for clients taking thiazide diuretics, the nurse also monitors the serum uric acid concentrations because these drugs may precipitate an acute attack of gout. The nurse needs to monitor the client's blood pressure every 30 to 60 minutes when caring for a client receiving the osmotic diuretic mannitol or urea for the treatment of increased intracranial pressure caused by cerebral edema.

The nurse instructs a client suffering from frequent angina attacks to keep a record of each attack. Which of the following would the nurse instruct the client to record? select all that apply. A. Blood pressure B. Date of attack C. Time of attack D. Drug used to relieve the acute pain E. Dose of drug used to relieve the acute pain

B. Date of attack C. Time of attack D. Drug used to relieve the acute pain E. Dose of drug used to relieve the acute pain Feedback: Clients should keep a record of the frequency of acute angina attacks including date of attack, time of attack, and drug and dose used to relieve the acute pain. The client should bring this record to each physician visit.

A physician has prescribed furosemide to a client with pulmonary edema. The client informs the nurse that he is also taking phenytoin as treatment for seizures. The nurse would assess the client closely for which of the following? A. Increased risk of bleeding B. Decreased diuretic effectiveness C. Increased blood glucose levels D. Increased seizure episodes

B. Decreased diuretic effectiveness Feedback: The nurse should monitor for decreased diuretic effectiveness in the client as the effect of the interaction between furosemide and hydantoins. When the client is administered loop diuretics with anticoagulants or thrombolytics, there is an increased risk of bleeding. Increased blood glucose may occur when thiazide diuretics are given with antidiabetic drugs. Decreased effectiveness of hydantoins, such as manifested by increased seizure activity, is not known to occur as a result of the effect of the interaction between furosemide and hydantoins, and so the nurse need not monitor for the same in the client.

When a nurse is obtaining a history from a client regarding angina pain, which of the following should be included? Select all that apply. A. Duration of the pain B. Events that relieve anginal pain C. Events that trigger anginal pain D. Description of the pain E. Whether the pain radiates

B. Events that relieve anginal pain C. Events that trigger anginal pain D. Description of the pain E. Whether the pain radiates Feedback: A client history regarding anginal pain should include a description of the pain, whether the pain radiates and to where it radiates, what events appear to trigger the pain, and what events appear to relieve the pain.

A nurse is administering a diuretic that inhibits reabsorption of sodium and chloride ions in the distal and proximal tubules and in the loop of Henle. Which of the following might the nurse be administering? Select all that apply. A. Chlorothiazide B. Furosemide C. Bumetanide D. Mannitol E. Spironolactone

B. Furosemide C. Bumetanide Feedback: Loop diuretics, like furosemide (Lasix) and bumetanide (Bumex), cause dieresis by inhibiting reabsorption of sodium and chloride ions in the distal and proximal tubules and in the loop of Henle. Thiazide and related diuretics such as chlorothiazide inhibit the reabsorption of sodium and chloride ions in the ascending portion of the loop of Henle and the early distal tubule of the nephron. Osmotic diuretics such as mannitol increase the density of the filtrate in the glomerulus. Potassium-sparing diuretics such as spironolactone work by blocking the reabsorption of sodium in the kidney tubules, thereby increasing sodium and water in the urine.

In which of the following situations would a nurse withhold the antianginal medication and contact the physician? Select all that apply. A. Heart rate above 50 bpm B. Heart rate below 50 bpm C. Systolic blood pressure below 90 mmHg D. Diastolic blood pressure below 90 mmHg E. Respiratory rate below 20 breaths per minute

B. Heart rate below 50 bpm C. Systolic blood pressure below 90 mmHg Feedback: A nurse would withhold the antianginal medication and contact the physician if a client's heart rate was below 50 bpm or systolic blood pressure drops below 90 mmHg.

A client is receiving a diuretic for the treatment of hypertension. Which of the following conditions should the nurse monitor for in clients taking diuretics? A. Hyperkalemia B. Hyponatremia C. Hypomagnesemia d. Hypocalcemia

B. Hyponatremia Feedback: The nurse should assess for hyponatremia in clients receiving diuretics. Diuretic usage causes electrolyte disturbances such as hyponatremia and hypokalemia. The nurse should inform the primary health care provider if signs and symptoms of electrolyte imbalance occur. Hyperkalemia, hypomagnesemia, and hypocalcemia do not occur in clients taking diuretics.

A client is experiencing constipation due to an antihyperlipidemic drug. The client asks the nurse how to manage this problem. Which suggestion would be most appropriate? Select all that apply. A. Stop taking the antihyperlipidemic medication B. Increase your fluid intake C. Eat foods rich in dietary fiber D. Be sure to exercise every day E. Use a stool softener

B. Increase your fluid intake C. Eat foods rich in dietary fiber D. Be sure to exercise every day E. Use a stool softener Feedback: Constipation resulting from an antihyperlipidemia drug can be treated by increasing fluid intake, consuming food rich in dietary fiber, exercising daily, and using a stool softener or laxative if needed.

A primary health care provider has prescribed a loop diuretic for a client with hypertension. The client also has diabetes mellitus. The nurse would assess the client for which of the following after administering the drug? A. Sudden pain in the joints B. Increased blood glucose levels C. Occurrence of gout attacks D. Sudden increase in weight

B. Increased blood glucose level Feedback: The nurse should monitor for increased blood glucose levels in the diabetic client receiving a loop diuretic. The blood glucose levels may be elevated or urine may test positive for glucose. Thiazide diuretic agents may cause gout attacks and sudden joint pain. The nurse need not monitor for a sudden increase in weight as the administration of loop diuretics to a diabetic client will not cause this.

A nurse is instructing a client about his prescribed antihypertensive therapy with captopril. Which of the following instructions would the nurse include in the teaching plan? Select all that apply. A. Taking the drug with meals to decrease GI upset B. Informing the client about the possibility of a cough C. Crushing the capsule before taking it D. Taking measures to reduce injury from hypotension E. Reporting any swelling of the face, throat, or extremities

B. Informing the client about the possibility of a cough D. Taking measure to reduce injury from hypotension Feedback: The client needs to know that some clients experience a dry cough that does not subside until drug therapy is discontinued and this reaction may need to be tolerated. In addition, these drugs may cause a significant drop in blood pressure after the final dose, so the client needs to take measures to reduce the risk of injury from the drug's effects. The ACE inhibitors, captopril and moexipril, should be taken 1 hour before or 2 hours after meals to enhance absorption. The drugs are sustained-release capsules that should not be crushed, opened, or chewed. ACEIs do not cause angioedema.

A client receiving amlodipine for angina is complaining of dizziness. Which of the following interventions should the nurse implement to help alleviate the condition? A. Apply a cold cloth over the forehead B. Instruct the client to lie down C. Instruct the client to drink more water D. Reduce the dosage of amlodipine

B. Instruct the client to lie down Feedback: Dizziness is a common central nervous system adverse effect seen with calcium channel blocker use. The nurse should instruct the client to lie down until the dizziness passes. Applying a cold cloth over the forehead will not relieve the dizziness. The dosage should not be reduced or altered unless instructed by the health care provider. Increasing the fluid consumption will also not help in alleviating dizziness.

After reviewing information about antianginal drugs, a student demonstrates understanding by identifying which of the following as indicated for the prevention of angina pectoris? Select all that apply. A. Diltiazem B. Isosorbide mononitrate C. Topical nitroglycerin D. Oral nitroglycerin E. Amlodipine

B. Isosorbide mononitrate C. Topical nitroglycerin D. Oral nitroglycerin Feedback: All nitrates are indicated for the prevention of angina pectoris. Diltiazem and amlodipine are used to treat chronic stable angina.

A nurse is reviewing a client's laboratory test results after being on statin therapy for several months. Which of the following would the nurse interpret as indicating effectiveness of the drug? Select all that apply. A. Total cholesterol 220 mg/dL B. LDL cholesterol 80 mg/dL C. HDL cholesterol 30 mg/dL D. LDL cholesterol 165 mg/dL E. HDL cholesterol 60 mg/dL

B. LDL cholesterol 80 mg/dL E. HDL cholesterol 60 mg/dL Feedback: Effectiveness of therapy would be indicated by values that are low or optimal . This would include a total cholesterol below 200 mg/dL, LDL less than 100 mg/dL, and HDL greater than 40 mg/dL.

A client is starting cholestyramine therapy for the treatment of hyperlipidemia. When teaching the client about possible adverse reactions, which of the following would the nurse include? Select all that apply. A. Diarrhea B. Malabsorption of vitamin K C. Aggravation of hemorrhoids D. Flatulence E. Myopathy

B. Malabsorption of vitamin K C. Aggravation of hemorrhoids D. Flatulence Feedback: Adverse reactions reported with the use of bile acid resins, such as cholestyramine, include constipation (that can become severe), aggravation of hemorrhoids, abdominal cramps, flatulence, nausea, increased bleeding related to vitamin K malabsorption, and vitamin A and D deficiencies.

A client is receiving pravastatin. The nurse understands that which of the following should be avoided with this client to prevent the risk of myopathy? Select all that apply. A. Quinapril (Accupril) B. Niacin (Niaspan) C. Clarithromycin (Biaxin) D. Albuterol (Proventil) E. Verapamil (Calan)

B. Niacin (Niaspan) C. Clarithromycin (Biaxin) E. Verapamil (Calan) Feedback: Niacin, clarithromycin, and verapamil when coadminstered to a client taking a statin, like pravastatin, can result in increased myopathy.

A nurse is caring for a client receiving gemfibrozil. Which of the following would the nurse include in the teaching plan for this client? A. Take the drug along with meals B. Observe caution while driving C. Take a single dose once daily in the evening D. Be alert for mild to severe facial flushing

B. Observe caution while driving Feedback: When preparing a teaching plan for the client receiving the fibric acid derivative gemfibrozil, the nurse should instruct the client to observe caution while driving. Rosuvastatin calcium is taken as a single dose once daily in the evening. The nurse instructs a client prescribed nicotinic acid to take it along with meals; it may also cause mild to severe facial flushing.

A client has a nursing diagnosis of Acute Pain related to angina. When teaching a client about antianginal drugs, the nurse would explain which of the following about pain relief? Select all that apply. A. Pain will only occur during prolonged exercise B. Pain may be less intense C. Pain may not be completely relieved D. Pain may be less frequent E. Pain will worsen with continues use

B. Pain may be less intense C. Pain may not be completely relieved D. Pain may be less frequent Feedback: Although some clients experience complete angina pain relief, it may not be completely relieved in all clients. In some clients pain may be less intense or less frequent or may only occur during prolonged exercise.

A nurse is reviewing the medical record of a client who is prescribed statin therapy. The nurse understands that this class of drugs is contraindicated in clients with which of the following conditions? Select all that apply. A. Kidney disease B. Pregnancy C. Serious hepatic disease D. Carcinoma of the breast E. Lactation

B. Pregnancy C. Serious hepatic disease E. Lactation Feedback: Statin drugs are contraindicated in individuals with known hypersensitivity to the drugs or serious liver disease and during pregnancy (category X) and lactation.

A client with very high serum triglyceride levels is prescribed the fibric acid derivative clofibrate. The nurse understands that this drug would be contraindicated if the client has which condition? A. Endocrine disorder B. Primary biliary cirrhosis C. Arterial bleeding D. Respiratory depression

B. Primary biliary cirrhosis Feedback: the fibric acid derivative clofibrate is contraindicated in clients with primary biliary cirrhosis. The use of clofibrate is not contraindicated in clients with an endocrine disorder. The HMG-CoA reductase inhibitors are used with caution in clients with a history of endocrine disorders. Niacin is contraindicated in clients with arterial bleeding. The fibric acid derivative clofibrate is not contraindicated in clients with respiratory depression.

A client who is prescribed losartan for hypertension has stopped taking the drug immediately after experiencing adverse reactions. The nurse would be alert for which of the following due to abrupt discontinuation? A. Breathing difficulty B. Rebound hypertension C. Orthostatic hypotension D. Anginal attacks

B. Rebound hypertension Feedback: Rebound hypertension will occur in clients when antihypertensives are abruptly discontinued. In rebound hypertension, there is a sudden rise in blood pressure when the antihypertensives are withheld. Orthostatic hypotension, angina attacks, and breathing difficulty are the adverse reactions associated with antihypertensive drug usage and may not occur on stopping the drug.

A client who is receiving diuretic therapy comes to the clinic for a follow-up visit. The client states that his mouth is often dry and that he is "urinating like there is no tomorrow." Assessment reveals dry mucous membranes and decreased skin turgor. Which nursing diagnosis would the nurse most likely identify? A. Risk for Injury B. Risk for Deficient Fluid Volume C. Impaired Urinary Elimination D. Deficient Knowledge

B. Risk for Deficient Fluid Volume Feedback: Based on the client's report and assessment findings, a nursing diagnosis of Risk for Deficient Fluid Volume would be most appropriate. Risk for Injury would be appropriate if the client was complaining of dizziness on changing positions or changes in heart rate and rhythm. Although the client is experiencing frequency, that is the intended effect of the drug. Although possible, there is no evidence provided to support a nursing diagnosis of Deficient Knowledge.

During a routine check-up of a 45-year-old client with renal disease, the nurse observes an increase in the client's blood pressure. The nurse identifies this as most likely which of the following? A. Essential hypertension B. Secondary hypertension C. Rebound hypertension D. Hypertensive emergency

B. Secondary hypertension Feedback: Secondary hypertension results as a consequence of renal impairment. In secondary hypertension there is usually a known cause for the development of hypertension. Renal disease is one of the causes of secondary hypertension. When there is no known cause of hypertension, it is called essential hypertension. Rebound hypertension occurs when a client abruptly stops taking antihypertensive medication. Hypertensive emergency is a high blood pressure state, which has to be lowered immediately.

A client is receiving treatment for angina with a vasodilator. The nurse instructs the client to notify his primary health care provider about which of the following? Select all that apply. A. Weight loss of 2 lb in a week B. Swelling of the extremities C. Episodes of dyspnea D. Heart rate increased by about 10 bpm E. Fainting

B. Swelling of the extremities C. Episode of dyspnea E. Fainting Feedback: The primary health care provider should be notified if the client experiences a heart rate of 20 bpm or more above the normal rate; rapid weight gain of 5 lb or more; unusual swelling of he extremities, face, or abdomen; dyspnea; angina; severe indigestion; or fainting.

After administering an antihyperlipidemic drug, the nurse continues to assess which of the following? Select all that apply. A. Blood glucose B. Vital signs C. Assessment of bowel function D. Input and output E. Stool sample

B. Vital signs C. Assessment of bowel function Feedback: Clients on antihyperlipidemic medications should have vital signs checked and bowel function assessed because an adverse reaction to these drugs is constipation. Constipation may become serious if not treated early in the medication regimen.

A nurse administers a thiazide diuretic to a client with renal compromise as prescribed by the primary health care provider. Which action by the nurse would be most appropriate if the client's blood urea nitrogen level increases? A. Give prescribed magnesium supplements B. Withhold the next dose of the drug C. Administer the drug in a diluted form D. Increase the fluid intake for the client

B. Withhold the next dose of the drug Feedback: The nurse should withhold the drug or discontinue its use if the blood urea nitrogen (BUN) rises in the client with renal compromise who is receiving a thiazide diuretic. Magnesium supplements or add-ons may be provided to clients taking loop diuretics as they are prone to magnesium deficiency. The nurse should encourage fluid intake to prevent a fluid volume deficit in elderly clients who are particularly prone to fluid volume deficit and electrolyte imbalances when taking a diuretic. The nurse need not administer the drug in a diluted form since doing so will not have an effect on the blood urea nitrogen level.

When providing care to a client with hypertension who is receiving antihypertensive therapy, which assessment would be the highest priority?

BP monitoring

C) Bile emulsifies fat and lipids. D) Bile is secreted by the liver.

14. A client is prescribed atenolol. After administering the drug, the nurse would be alert for which of the following? Select all that apply.

C) Bradycardia D) Dizziness

18. A client is receiving warfarin therapy as part of the treatment plan for atrial fibrillation. The client is also to begin therapy with cholestyramine. When assessing the client, the nurse would be alert for which of the following? Select all that apply.

C) Subtherapeutic INR E) Calf pain and warmth

C) Swelling of the face D) Swelling of the throat

10. A client is currently taking propranolol (Inderal) for hypertension, glipizide (Glucotrol) for diabetes, and acetaminophen (Tylenol) for osteoarthritis. If cholestyramine was given to this client, which of the following would likely result? Select all that apply.

C) The client would experience an increase in blood pressure due to decreased absorption of propranolol. E) The client would experience hyperglycemia from decreased absorption of glipizide.

A nurse is caring for a client who is prescribed transdermal nitroglycerin for angina. The nurse instructs the client to apply the patch for how long? A. 4 to 6 hours B. 6 to 8 hours C. 10 to 12 hours D. 12 to 14 hours

C. 10 to 12 hours Feedback: The transdermal nitroglycerin patch should be applied every day for 10 to 12 hours. If the patch is applied for a shorter time, the therapeutic dosage may not be delivered. Applying the patch for a longer time will result in the development of tolerance to the antianginal effects. Applying the patch in the morning and leaving it on for 10 to 12 hours, followed by a patch-free period of 10 to 12 hours, delays the development of tolerance.

C. 7 days Feedback: The nurse should ensure that the transdermal patch is intact for a period of 1 week. A clonidine transdermal patch should be applied to a hairless area over the torso for 1 week. If the patch loosens before 7 days, it has to be reinforced. The nurse has to mark the date of placement and the date of removal of the patch on the surface of the patch.

A nurse is caring for a client with edema. The physician has prescribed diuretic therapy for the client. Which of the following would be most appropriate for the nurse to do? A. Ask the client to decrease fluid intake B. Gradually increase the drug dosage C. Administer the drug early in the day D. Encourage the client to exercise

C. Administer the drug early in the day Feedback: The nurse should administer the drug early in the day to prevent any nighttime sleep disturbance caused by increased urination when caring for a client receiving diuretic therapy for acute renal failure. The nurse need not ask the client to decrease fluid intake, gradually increase the drug dosage, or encourage the client to exercise as these are not appropriate interventions and will not help in reducing the discomfort caused by increased urination.

A client is prescribed a diuretic that is to be taken twice a day. When instructing the client about the schedule for administration, the nurse would suggest that the client take the drug at which times? A. In the early morning and at bedtime B. After lunch and dinner C. At breakfast and midafternoon D. Midmorning and before dinner

C. At breakfast and midafternoon Feedback: Twice-a-day dosing should be administered early in the morning (e.g., 7 a.m.) and early afternoon (e.g., 2 p.m.) to prevent the drug from interfering with the client's sleep.

After teaching a group of nursing students about bile acids, the instructor determines that the teaching was successful when the students identify which of the following as true about bile? Select all that apply. A. Bile is manufactured by the gallbladder B. Bile is stored in the liver C. Bile emulsifies fat and lipids D. Bile is secreted by the liver E. Bile is classified as a hormone

C. Bile emulsifies fat and lipids D. Bile is secreted by the liver Feedback: Bile is manufactured and secreted by the liver and stored in the gallbladder; it emulsifies fat and lipids, and these products pass through the intestine.

A nurse is educating a client with hypertension who is prescribed losartan about the drug's action. Which of the following would the nurse incorporate into the teaching about this drug? A. Blocking aldosterone receptors B. Preventing conversion of angiotensin I C. Blocking angiotensin II receptors D. Preventing renin secretion

C. Blocking angiotensin II receptors Feedback: Losartan is an angiotensin II receptor antagonist, acting to block the angiotensin I receptors. By blocking the angiotensin II receptor, the renin-angiotensin system is stopped and consequently blood pressure is reduced. Drugs such as captopril prevent the conversion of angiotensin I. Losartan does not prevent renin secretion. Losartan does not block aldosterone receptors.

When caring for a client with angina, the nurse instructs the client to place the nitroglycerin tablet between the cheek and the gums. Which form of nitroglycerin is the nurse administering? A. Sublingual B. Transdermal C. Buccal D. Translingual

C. Buccal Feedback: The nurse is referring to the buccal route of administration. When administering buccal nitroglycerin, the nurse should instruct the client to place the tablet between the cheek and gums or the lips and gums above the incisors. The nurse should instruct the client to allow the tablet to dissolve and not to chew the tablet. Nitrates can also be given by the sublingual, and translingual routes mentioned. When administering nitroglycerin sublingually, it should be placed under the tongue. In the transdermal route, the patch is applied directly onto the front or back of the chest. In the translingual route, the spray is directed under or onto the tongue.

The nurse is providing care to a client being treated for a hypertensive emergency. Which of the following would be appropriate for the nurse to do? A. Take a blood pressure every 30 minutes B. Alternate the arms for assessing the blood pressure and pulse C. Continuously monitor the client's status D. Measure the pulse rate every hour

C. Continuously monitor the client's status Feedback: When the patient has severe hypertension, does not have the expected response to drug therapy, or is critically ill, continuous monitoring is performed. The blood pressure should be taken in the same arm and same position each time.

A nurse is caring for a client with edema due to congestive heart failure (CHF). The primary health care provider has prescribed indapamide. The client is also receiving digoxin. Which intervention would be most appropriate for the nurse to implement? A. Encourage oral fluids at frequent intervals during waking hours B. Encourage the client to eat or drink between meals and in the evening C. Frequently monitor the client's pulse rate and rhythm D. Closely monitor the client for signs of hyperkalemia

C. Frequently monitor the client's pulse rate and rhythm Feedback: Clients receiving a diuretic, particularly a loop or thiazide diuretic such as indapamide, and a digitalis glycoside concurrently require frequent monitoring of the pulse rate and rhythm because of the possibility of cardiac arrhythmias. Any significant changes in the pulse rate and rhythm are immediately reported to the primary health care provider. The nurse should encourage oral fluids at frequent intervals during waking hours when caring for older clients to prevent a fluid volume deficit. In such cases the nurse should also encourage elderly clients to eat or drink between meals and in the evening. The nurse must closely observe clients receiving a potassium-sparing diuretic for signs of hyperkalemia, a serious and potentially fatal electrolyte imbalance.

A nurse suspects that a client who is receiving acetazolamide is developing hyponatremia based on assessment of which of the following? Select all that apply. A. Bradycardia B. Anorexia C. Hypotension D. Hypoglycemia E. Decreased skin turgor

C. Hypotension E. Decreased skin turgor Feedback: The following are signs of hyponatremia: cold, clammy skin; decreased skin turgor; confusion; hypotension; irritability; and tachycardia.

A client is receiving pravastatin to reduce the risk of coronary heart disease due to hyperlipidemia. The client is also receiving amiodarone for an arrhythmia. The nurse understands that the client is at risk for which of the following based on these two drugs? A. Increased anticoagulant effect B. Increased hypoglycemic effect C. Increased risk of myopathy D. Decreased effects of pravastatin

C. Increased risk of myopathy Feedback: When the HMG-CoA reductase inhibitor pravastatin is administered with amiodarone, the nurse should monitor the client for increased risk of myopathy as an effect of the interaction between the two drugs. Increased anticoagulant effect is observed in clients receiving warfarin along with pravastatin. Increased hypoglycemic effects are observed in clients receiving sulfonylureas with fibric acid derivatives. The interaction of pravastatin with amiodarone does not decrease the effect of pravastatin.

A client is receiving mannitol as treatment to promote diuresis in acute renal failure. The nurse would expect to administer the drug by which route? A. Intramuscularly B. Subcutaneously C. Intravenously D. Orally

C. Intravenously Feedback: Mannitol is administered intravenously. It is not given intramuscularly, subcutaneously, or orally.

A nurse in a health care facility is caring for a client receiving colesevelam. The nurse would anticipate administering this drug cautiously to a client with which condition? A. Diabetes B. Peptic ulcer disease C. Liver disease D. Unstable angina

C. Liver disease Feedback: Colesevelam is administered with caution in clients with liver disease. Fibric acid derivatives are administered with caution in clients with peptic ulcer disease and diabetes. Niacin is used with caution in clients with unstable angina.

When instructing the client on how to use the prescriber nitroglycerin ointment, the nurse would tell the client to use which of the following to determine the amount? A. A teaspoon B. Length of a finger C. Paper applicator D. The size of the previous dose

C. Paper applicator Feedback: The topical ointment is supplied with a paper applicator to determine the amount of drug to be used. No other method is appropriate.

A nurse is conducting a community presentation on heart disease, cholesterol, and risk factors. The nurse determines that the class has been successful when the class identifies which of the following as true? A. Low-fat diet raises LDL cholesterol levels B. Being overweight causes HDL levels to go up C. Physical activity raises HDL cholesterol levels D. Excess body weight causes LDL cholesterol to go down

C. Physical activity raises HDL cholesterol levels Feedback: Saturated fat and cholesterol in the food raises total and LDL cholesterol levels. Being overweight can make LDL cholesterol levels go up and HDL levels go down. Increased physical activity helps to lower LDL cholesterol and raise HDL cholesterol levels.

A client is being discharged after being treated with nitroglycerin for angina. Which of the following instructions should the nurse include in the teaching plan for the client? A. Store the nitroglycerin capsules in a plastic container B. Place the nitroglycerin capsules along with other tablets C. Recap the container tightly after taking out the capsules D. Do not store nitroglycerin in a dark container

C. Recap the container tightly after taking out the capsules Feedback: The nurse should instruct the client to recap the container tightly after taking out the nitroglycerin capsule. This is to ensure that the potency of nitroglycerin is not lost on exposure to air. Nitroglycerin should be stored in a dark container and protected from direct light exposure. The nurse should instruct the client to never store nitroglycerin under bright sunlight or in a plastic container. Nitroglycerin deteriorates when stored in plastic containers and on exposure to air and light. The nurse should instruct the client not to store nitroglycerin along with other drugs, as it loses its potency.

A client is receiving warfarin therapy as part of the treatment plan for atrial fibrillation. The client is also to begin therapy with cholestyramine. When assessing the client, the nurse would be alert for which of the following? Select all that apply. A. Bruising B. Blood in the stool C. Subtherapeutic INR D. Supratherapeutic INR E. Calf pain and warmth

C. Subtherapeutic INR Feedback: Coadministration of warfarin and cholestyramine can result in a decreased anticoagulant effect, leading to subtherapeutic INR and increased chance of clotting (signs and symptoms of DVT or PE).

Angioedema is a potentially life-threatening medical condition that is associated with some classes of antihypertensive medications. The nurse suspects that a client is experiencing angioedema based on which assessment finding? Select all that apply. A. Heart rate above 100 beats per minute B. Fever greater than 100 degrees F C. Swelling of the face D. Swelling of the throat E. Blood pressure above 170/100 mmHg

C. Swelling of the face D. Swelling of the throat Feedback: Angioedema presents with swelling of the face, lips, throat, or extremities.

A client is currently taking propranolol (Inderal) for hypertension, glipizide (Glucotrol) for diabetes, and acetaminophen (Tylenol) for osteoarthritis. If cholestyramine was given to this client, which of the following would likely result? Select all that apply. A. The client would experience hypoglycemia from increased absorption of glipizide B. The client would experience decreased analgesia from decreased absorption of acetaminophen C. The client would experience an increase in blood pressure due to decreased absorption of propranolol D. The client would experience hypotension from increased absorption of propranolol E. The client would experience hyperglycemia from decreased absorption of glipizide

C. The client would experience an increase in blood pressure due to decreased absorption of propranolol E. The client would experience hyperglycemia from decreased absorption of glipizide Feedback: The use of bile acid resins, like cholestyramine, decreases the absorption of some medications including glipizide and propranolol. This decreased absorption could result in hyperglycemia and an increase in blood pressure for this particular client.

A client is being discharged after being treated with nitroglycerin for an acute anginal attack. Which of the following instructions should the nurse provide the client regarding the administration of nitroglycerin ointment. A. Apply a thick layer of the ointment B. Rub the ointment onto the skin C. Use an applicator for applying the ointment D. Apply on the same site during every application

C. Use an applicator for applying the ointment Feedback: The nurse should instruct the client to use an applicator for applying the nitroglycerin ointment. The ointment should not come in contact with the skin of the person applying it, as it gets easily absorbed. The nurse should instruct the client to apply a thin layer of the ointment on the skin using an applicator. The nurse must instruct the client not to rub the ointment while applying as it delivers large amounts of the drug into the system. The nurse should not apply the ointment on the same site during every application. The application site should be rotated to prevent inflammation of the area.

11. When teaching a client about the prescribed clonidine transdermal medication, which of the following would the nurse most likely include? Select all that apply.

D) A different body area should be selected for each application. E) The patch should be applied to a hairless area.

When teaching a client about the prescribed clonidine transdermal medication, which of the following would the nurse most likely include? Select all that apply. A. A new patch is applied daily B. If the patch loosens, a new patch should be applied C. The use of the adhesive overlay is not necessary D. A different body area should be selected for each application E. The patch should be applied to a hairless area

D. A different body area should be selected for each application E. The patch should be applied to a hairless area Feedback: The patch is applied to a hairless area of intact skin on the upper arm or torso; the patch is kept in place for 7 days. The adhesive overlay is applied directly over the system to ensure the patch remains in place for the required time. A different body area is selected for each application. If the patch loosens before 7 days, the edges can be reinforced with nonallergenic tape. The date the patch was placed and the date the patch is to be removed can be written on the surface of the patch with a fiber-tipped pen.

A nurse is caring for a client with angina who is receiving diltiazem. In which of the following conditions should the nurse withhold the drug and notify the health care provider? A. Client's systolic pressure is 110 mmHg B. Client exhibits significant weight loss C. Client experiences lightheadedness D. Client's pulse rate is 45 beats per minute

D. Client's pulse rate is 45 beats per minute Feedback: The nurse should withhold the drug and notify the health care provider when the client's pulse rate is 45 beats per minute. When calcium channel blockers are administered, there may be a fall in the pulse rate. When the pulse rate falls below 50 beats per minute, the nurse should notify the health care provider. When the systolic pressure falls below 90 mmHg, the nurse should notify the primary health care provider. Weight gain, and not weight loss, occurs with the use of calcium channel blockers. The nurse should report weight gain. Lightheadedness is a common central nervous system adverse reaction occurring after taking the drug, and the nurse should instruct the client to lie down until the symptoms pass.

A client with hyperlipidemia is prescribed ezetimibe. Which of the following assessments should the nurse perform during treatment? A. Taking a dietary history of the client B. Inspecting skin and eyelids for evidence of xanthomas C. Obtaining reports of fasting blood sugar levels D. Frequently monitoring blood cholesterol

D. Frequently monitoring blood cholesterol Feedback: The nurse should frequently monitor blood cholesterol as part of the ongoing assessment for a client receiving ezetimibe. Taking a dietary history of the client and inspecting the skin and eyelids for evidence of xanthomas are the preadministration assessments that a nurse should perform for a client receiving ezetimibe. The nurse obtains the reports of fasting blood sugar for a client with diabetes.

After teaching a group of nursing students about diuretics, the instructor determines that the teaching was successful when the students identify which of the following as causing diuresis by increasing the density of filtrate in the glomerulus? Select all that apply. A. Amiloride B. Torsemide C. Ethacrynic acid D. Mannitol E. Urea

D. Mannitol E. Urea Feedback: Osmotic diuretics, like mannitol and urea, cause diuresis by increasing the density of the filtrate in the glomerulus. Amiloride is a potassium-sparing diuretic that acts to block the reabsorption of sodium in the kidney tubules, thereby increasing sodium and water in the urine. Torsemide and ethacrynic acid are loop diuretics that inhibit reabsorption of sodium and chloride in the distal and proximal tubules of the kidney and in the loop of Henle.

A nurse is caring for a client who has been prescribed colestipol granules. Which of the following would the nurse do when administering the drug to the client? A. Mix the granules in 2 to 6 fluid ounces of water B. Take care not to crush the granules C. Give the granules once or twice daily with meals D. Mix the drug in 90 mL of liquid

D. Mix the drug in 90 mL of liquid Feedback: The nurse should mix the drug in 90 mL of liquid, soups, cereals, carbonated drinks, or pulpy fruits when administering the colestipol granules to the client. Cholestyramine powder is mixed in 2 to 6 fluid ounces of water. Colestipol tablets are not crushed. Colesevelam tablets are taken once or twice daily with meals.

After teaching a group of nursing students about antianginal drugs, the instructor determines that the teaching was successful when the students identify which of the following as a calcium channel blocker? A. Minoxidil B. Hydralazine C. Isosorbide D. Nifedipine

D. Nifedipine Feedback: Nifedipine is a calcium channel blocker used to treat angina. Minoxidil and hydralazine are peripheral vasodilators. Isosorbide is a nitrate.

A client is prescribed a bile acid resin and has been taking this therapy long term. The primary health care provider has prescribed vitamin A and D in water-soluble form. Which nursing diagnosis would be most likely? A. Risk for Impaired Skin Integrity B. Constipation C. Risk for Injury D. Risk for Imbalanced Nutrition: Less Than Body Requirements

D. Risk for Imbalanced Nutrition: Less Than Body Requirements Feedback: Bile acid resins may interfere with the digestion of fats and prevent the absorption of the fat-soluble vitamins (vitamins A, D, E, and K) and folic acid. Therefore, the nursing diagnosis of Risk for Imbalanced Nutrition: Less Than Body Requirements would be most appropriate. Adverse reactions associated with nicotinic acid such as flushing would suggest a risk for impaired skin integrity. Constipation would be associated with statin therapy. Risk for Injury may be appropriate for clients taking fibrates or statins.

A nurse is reviewing the laboratory test results of a client who is receiving diuretic therapy. The nurse determines that the client is at risk for electrolyte imbalance based on which results? Select all that apply. A. Potassium 4.5 mEq/L B. Sodium 139 mEq/L C. Magnesium 2.0 mEq/L D. Sodium 124 mEq/L E. Potassium 2.9 mEq/L

D. Sodium 124 mEq/L E. Potassium 2.9 mEq/L Feedback: Sodium levels below 132 mEq/L, such as 124 mEq/L, or above 145 mEq/L would indicate an imbalance. Potassium imbalances would occur with levels below 3.0 mEq/L, such as 2.9 mEq/L, or above 5 mEq/L. A magnesium level of 2.0 mEq/L is within the normal range of 1.5 to 2.5 mEq/L.

A physician prescribes diuretic therapy to a client with nephrotic syndrome. The nurse suspects that the client is hyponatremic based on assessment of which of the following? A. Paresthesias B. Tremors C. Visual hallucination D. Tachycardia

D. Tachycardia Feedback: The nurse should monitor for tachycardia, cold and clammy skin, confusion, and hypotension in the client experiencing hyponatremia. Hyponatremia is excessive loss of sodium and is a common fluid and electrolyte imbalance associated with diuretic therapy. Tremors, visual hallucinations, and paresthesias are the symptoms of hypomagnesemia and not hyponatremia.

Which blood element has a protective property for heart disease?

HDL

Pindolol

32. A client is prescribed a bile acid resin and has been taking this therapy long term. The primary health care provider has prescribed vitamins A and D in water-soluble form. Which nursing diagnosis would be most likely?

Risk for Imbalanced Nutrition: Less Than Body Requirements

A client comes to the clinic complaining of weakness and drowsiness. He states, "I just get so tired sometimes that I can't do what I want to do." The client is receiving digoxin as part of the treatment for heart failure. Which nursing diagnosis would the nurse most likely identify?

activity intolerance

aspirin

Which drugs would expect to be prescribed to help alleviate flushing from niacin?

aspirin

19. When caring for a client who has been digitalized for his heart failure, the nurse observes that the client is experiencing bradycardia. Which of the following would the nurse expect the primary health care provider to prescribe for the client's bradycardia?

atropine

nurse is educating a client with hypertension who is prescribed losartan about the drug's action. Which of the following would the nurse incorporate into the teaching about this drug?

blocking angiotensin 2 receptors

A client is receiving maintenance therapy with digoxin. The nurse understands that which form would be used? Select all that apply.

capsule tablet

causes sodium and water prevention

21. A client is prescribed a cardiotonic medication. Which of the following preadministration assessments should the nurse perform on this client?

check for DVT

When assessing a client taking cholestyramine for vitamin K deficience, the nurse would

check for bruising

Most common advese taking a bile acid resin

constipation

8. The nurse is providing care to a client being treated for a hypertensive emergency. Which of the following would be appropriate for the nurse to do?

continuously monitor the clients status

Antihyperlipidemia drugs work to

decrease cholesterol and triglycerides

A nurse is caring for a client taking a cholestyramine drug. What instructions should the nurse give to this client to prevent constipation?

eat foods in high dietary fiber

Which is commonly associated with dardiomyopathy

ejection fraction below 40%

22. A client with hyperlipidemia is prescribed ezetimibe. Which of the following assessments should the nurse perform during treatment?

frequently monitor blood cholesterol

Which symptom would the client have reported to make the nurse suspicious of toxic reaction

halo in vision field

22. A client is receiving a diuretic for the treatment of hypertension. Which of the following conditions should the nurse monitor for in clients taking diuretics?

hyponatremia

A nurse is monitoring a client who is prescribed milrinone for heart failure. The nurse determines that the client is experiencing an adverse reaction based on assessment of which of the following?

hypotensions

After teaching a client about his prescribed cardiotonic drug therapy, the nurse determines that additional teaching is needed when the client states which of the following

i should call if pulse rate less than 80 bmp

24. A client is receiving pravastatin to reduce the risk of coronary heart disease due to hyperlipidemia. The client is also receiving amiodarone for an arrhythmia. The nurse understands that the client is at risk for which of the following based on these two drugs?

increased risk of myopathy

A client with hypertension has a fungal infection and has been prescribed fluconazole for the fungal infection and losartan for hypertension. The nurse would be alert for which of the following?

increased risks of adverse losartan effects

nurse in a health care facility is caring for a client receiving colesevelam. The nurse would anticipate administering this drug cautiously to a client with which condition

liver disease

25. The nurse is caring for a client receiving a cardiotonic drug. The client has edema. Which assessment would be most important?

measurement if intake and output

Which points is important for the nurse to tell the client when teaching about drug and diet therapy for hyperlipidemia>

med alone will not lower cholesterol

27. A nurse is caring for a client who has been prescribed colestipol granules. Which of the following would the nurse do when administering the drug to the client?

mix drug in 90 mL of water

21. A nurse is caring for a client receiving gemfibrozil. Which of the following would the nurse include in the teaching plan for this client?

observe caution when driving

Lovastatin is best taken

once daily, with evening meal

17. A client has been admitted to a health care center with complaints of dyspnea. The nurse suspects left-sided heart failure based on assessment of which of the following?

orthopnea

physical activity raises HDL cholesterol levels.

Before first dose of ACEI, the nurse assesses a femal client for

positive pregnancy test

A client with very high serum triglyceride levels is prescribed the fibric acid derivative clofibrate. The nurse understands that this drug would be contraindicated if the client has which condition?

primary biliary cirrhosis

22. A nurse is required to care for a child, age 4 years, who is being digitalized. Which of the following changes in the pulse rate indicates that the nurse should withhold the drug?

pulse rate less than 70 beats per minute

Which would the nurse withhold a dose of digoxin and notify pcp

pulse rate of 50 bpm

17. A client who is prescribed losartan for hypertension has stopped taking the drug immediately after experiencing adverse reactions. The nurse would be alert for which of the following due to abrupt discontinuation?

rebound HTN

risk for deficient fluid volume

During a routine check-up of a 45-year-old client with renal disease, the nurse observes an increase in the client's blood pressure. The nurse identifies this as most likely which of the following?

secondary HTN

A client, aged 60 years, is receiving nitroprusside for hypertensive emergency. The nurse would be alert for the development of which of the following?

significant hypotension

A client with heart failure has been digitalized. The client requires long-term digoxin therapy. Which of the following instructions should the nurse provide the client on discharge?

take the drug regularly without skipping a dose.

28. A client with hypercholesterolemia is prescribed lovastatin. When instructing the client how to take the drug, which of the following would the nurse include?

taking the drug with evening meal

A client with hyperlipidemia has been prescribed niacin by a physician. Which of the following adverse reactions should the nurse monitor for in the client?

Pharmacology Unit 6, Ch 34 Antihyperlidemia Drug, Ch 35 AntiHTN drugs, Ch 38 Cardiotonic and Idiotropic Drugs

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