Adams Pharmacology Chapter 23-32

A patient is receiving cholestyramine (Questran) for elevated low-density lipoprotein (LDL) levels. As the nurse completes the nursing care plan, which adverse effects will be included for continued monitoring? 1. Abdominal pain 2. Orange-red urine and saliva 3. Decreased capillary refill time 4. Sore throat and fever

1. Abdominal pain

A patient with a congenital coagulation disorder is given aminocaproic acid (Amicar) to stop bleeding following surgery. The nurse will carefully monitor this patient for development of which adverse effects? (Select all that apply.) 1. Anaphylaxis 2. Hypertension 3. Hemorrhage 4. Headache 5. Hypotension

1. Anaphylaxis 4. Headache 5. Hypotension

The patient's serum sodium value is 152 mEq/L. Which nursing interventions are most appropriate for this patient? (Select all that apply.) 1. Assess for inadequate water intake or diarrhea. 2. Administer a 0.45% NaCl intravenous solution. 3. Hold all doses of glucocorticoids. 4. Notify the healthcare provider. 5. Have the patient drink as much water as possible.

1. Assess for inadequate water intake or diarrhea. 4. Notify the healthcare provider.

Which action by the nurse is most important when caring for a patient with chronic kidney disease who has an order for furosemide (Lasix)? 1. Assess urine output and renal laboratory values for signs of nephrotoxicity. 2. Check the specific gravity of the urine daily. 3. Eliminate potassium-rich foods from the diet. 4. Encourage the patient to void every 4 hours.

1. Assess urine output and renal laboratory values for signs of nephrotoxicity.

What health teaching should the nurse provide for a patient receiving diltiazem (Cardizem)? Select all that apply. 1. Avoid driving or performing other activities requiring mental alertness until the effects of the drug are known. 2. Maintain adequate fluid and fiber intake to facilitate stool passage. 3. Report weight gain of 2 kg (5 lb) per week. 4. Rise slowly from prolonged periods of sitting or lying down. 5. Immediately stop taking the medication if sexual dysfunction is noted.

1. Avoid driving or performing other activities requiring mental alertness until the effects of the drug are known. 2. Maintain adequate fluid and fiber intake to facilitate stool passage. 3. Report weight gain of 2 kg (5 lb) per week. 4. Rise slowly from prolonged periods of sitting or lying down.

Nursing assessment of a patient receiving normal serum albumin for treatment of shock should include which of the following? 1. Breath sounds 2. Serum glucose levels 3. Potassium level 4. Hemoglobin and hematocrit

1. Breath sounds

A patient is starting to receive dobutamine by intravenous infusion for treatment of shock. This drug is particularly useful for which type of shock? 1. Anaphylactic 2. Septic 3. Cardiogenic 4. Hypovolemic

3. Cardiogenic

The patient is receiving hydralazine with isosorbide (BiDil) for heart failure. The nurse should monitor this patient for: 1. Dizziness and rapid heart rate 2. Bleeding 3. Tingling or cramping in the legs 4. Confusion and agitation

1. Dizziness and rapid heart rate

The nursing plan of care for a patient receiving oprelvekin (Neumega) should include careful monitoring for symptoms of which adverse effect? 1. Fluid retention 2. Severe hypotension 3. Impaired liver function 4. Severe diarrhea

1. Fluid retention

A patient has been on long-term therapy with colestipol (Colestid). To prevent adverse effects related to the length of therapy and lack of nutrients, which supplements may be required? (Select all that apply.) 1. Folic acid 2. Vitamins A, D, E, and K 3. Potassium, iodine, and chloride 4. Protein 5. B vitamins

1. Folic acid 2. Vitamins A, D, E, and K

Which assessment findings in a patient who is receiving atenolol (Tenormin) for angina would be cause for the nurse to hold the drug and contact the provider? (Select all that apply.) 1. Heart rate of 50 beats/minute 2. Heart rate of 124 beats/minute 3. Blood pressure 86/56 4. Blood pressure 156/88 5. Tinnitus and vertigo

1. Heart rate of 50 beats/minute 3. Blood pressure 86/56

Lisinopril (Prinivil) is part of the treatment regimen for a patient with heart failure. The nurse monitors the patient for the development of which adverse effects of this drug? (Select all that apply.) 1. Hyperkalemia 2. Hypocalcemia 3. Cough 4. Dizziness 5. Heartburn

1. Hyperkalemia 3. Cough 4. Dizziness

Common adverse effects of antidysrhythmic medications include which of the following? (Select all that apply.) 1. Hypotension 2. Hypertension 3. Dizziness 4. Weakness 5. Panic attacks

1. Hypotension 3. Dizziness 4. Weakness

The nurse evaluates the effectiveness of dopamine therapy for a patient in shock. Which of the following may indicate treatment is successful? (Select all that apply.) 1. Improved urine output 2. Increased blood pressure 3. Diminished breath sounds 4. Slight hypotension 5. Intact peripheral pulses

1. Improved urine output 2. Increased blood pressure

When monitoring for therapeutic effect of any anti-dysrhythmic drug, the nurse would be sure to assess which essential parameter? 1. Pulse 2. Blood pressure 3. Drug level 4. Hourly urine output

1. Pulse

An older adult patient diagnosed with iron-deficiency anemia will be taking ferrous sulfate (Feosol). The nurse will teach which of the required administration guidelines to the patient? (Select all that apply.) 1. Take the tablets on an empty stomach if possible. 2. Increase fluid intake and increase dietary fiber while taking this medication. 3. If liquid preparations are used, dilute with water or juice and sip through a straw placed in the back of the mouth. 4. Crush or dissolve sustained-release tablets in water if they are too big to swallow. 5. Take the drug at bedtime for best results.

1. Take the tablets on an empty stomach if possible. 2. Increase fluid intake and increase dietary fiber while taking this medication. 3. If liquid preparations are used, dilute with water or juice and sip through a straw placed in the back of the mouth.

What patient education should be included for a patient receiving enoxaparin (Lovenox)? (Select all that apply.) 1. Teach the patient or caregiver to give subcutaneous injections at home. 2. Teach the patient or caregiver not to take any over-the-counter drugs without first consulting with the healthcare provider. 3. Teach the patient to observe for unexplained bleeding, such as pink, red, or dark brown urine or bloody gums. 4. Teach the patient to monitor for the development of deep vein thrombosis. 5. Teach the patient about the importance of drinking grapefruit juice daily.

1. Teach the patient or caregiver to give subcutaneous injections at home. 2. Teach the patient or caregiver not to take any over-the-counter drugs without first consulting with the healthcare provider. 3. Teach the patient to observe for unexplained bleeding, such as pink, red, or dark brown urine or bloody gums. 4. Teach the patient to monitor for the development of deep vein thrombosis.

The patient in hypovolemic shock is prescribed an infusion of lactated Ringer's. What is the purpose for infusing this solution in shock? (Select all that apply.) 1. The solution will help to replace fluid and promote urine output. 2. The solution will draw water into cells. 3. The solution will draw water from cells to blood vessels. 4. The solution will help to maintain vascular volume. 5. The solution is used to provide adequate calories for metabolic needs.

1. The solution will help to replace fluid and promote urine output. 4. The solution will help to maintain vascular volume.

The nurse weighs the patient who is on an infusion of lactated Ringer's postoperatively and finds that there has been a weight gain of 1.5 kg since the previous day. What would be the nurse's next highest priority? 1. Check with the patient to determine whether there have been any dietary changes in the last few days. 2 Assess the patient for signs of edema and blood pressure for possible hypertension 3. Contact dietary to change the patient's diet to reduced sodium. 4. Request a diuretic from the patient's provider.

2 Assess the patient for signs of edema and blood pressure for possible hypertension

A patient diagnosed with pernicious anemia is to start cyanocobalamin (Nascobal) injections. Which patient statements demonstrates an understanding of the nurse's teaching? (Select all that apply.) 1. "I need to be careful to avoid infections." 2. "I will need to take this drug for the rest of my life." 3. ."I should increase my intake of foods that contain vitamin B12 4. "I need to take the liquid preparation through a straw." 5. "I may be able to switch over to nasal sprays once my vitamin B12

2. "I will need to take this drug for the rest of my life." 5. "I may be able to switch over to nasal sprays once my vitamin B12

A patient is receiving 5% dextrose in water (D5W). Which statements is correct? 1. The solution may cause hypoglycemia in the patient who has diabetes. 2. The solution may be used to dilute mixed intravenous drugs. 3. The solution is considered a colloid solution. 4. The solution is used to provide adequate calories for metabolic needs.

2. The solution may be used to dilute mixed intravenous drugs.

The patient is being discharged with nitroglycerin (Nitrostat) for sublingual use. While planning patient education, what instruction will the nurse include? 1. "Swallow three tablets immediately for pain and call 911." 2. "Put one tablet under your tongue for chest pain. If pain does not subside, call 911." 3. "Call your healthcare provider when you have chest pain. She will tell you how many tablets to take." 4. "Place three tablets under your tongue and call 911."

2. "Put one tablet under your tongue for chest pain. If pain does not subside, call 911."

The nurse is caring for a patient with chronic hypertension. The patient is receiving losartan (Cozaar) daily. Which patient manifestations would the nurse conclude is an adverse effect of this medication? (Select all that apply.) 1. Tremors 2. Dizziness 3. Drowsiness 4. Hypoglycemia 5. Angioedema

2. Dizziness 4. Hypoglycemia 5. Angioedema

A patient is given a prescription for propranolol (Inderal) 40 mg bid. What is the most important instruction the nurse should give to this patient? 1. Take this medication on an empty stomach, as food interferes with its absorption. 2. Do not stop taking this medication abruptly; the dosage must be decreased gradually if it is discontinued. 3. If the patient experiences any disturbances in hearing, the patient should notify the healthcare provider immediately. 4. The patient may become very sleepy while taking this medication; do not drive.

2. Do not stop taking this medication abruptly; the dosage must be decreased gradually if it is discontinued.

A patient who is experiencing shock is started on norepinephrine (Levophed) by intravenous drip. Why must the nurse conduct frequent inspections of the intravenous insertion site while the patient remains on this drug? 1. The patient's blood pressure may rise if the site is occluded. 2. Extravasation and leakage at the intravenous site may cause local tissue damage. 3. Bleeding may occur from the site due to localized drug effects. 4. The patient's blood pressure may drop precipitously if the intravenous runs too quickly.

2. Extravasation and leakage at the intravenous site may cause local tissue damage.

When planning to teach the patient about the use of epoetin alfa (Epogen, Procrit), which instructions would the nurse give? 1. Eating raw fruits and vegetables must be avoided. 2. Frequent rest periods should be taken to avoid excessive fatigue. 3. Skin and mucous membranes should be protected from traumatic injury. 4. Exposure to direct sunlight must be minimized and sunscreen used when outdoors.

2. Frequent rest periods should be taken to avoid excessive fatigue.

The patient is to begin taking atorvastatin (Lipitor) and the nurse is providing education about the drug. Which symptom related to this drug should be reported to the healthcare provider? 1. Constipation 2. Increasing muscle or joint pain 3. Hemorrhoids 4. Flushing or "hot flash"

2. Increasing muscle or joint pain

The nurse is instructing a patient on home use of niacin and will include important instructions on how to take the drug and about its possible adverse effects. Which of the following may be expected adverse effects of this drug? (Select all that apply.) 1. Fever and chills 2. Intense flushing and hot flashes 3. Tingling of the fingers and toes 4. Hypoglycemia 5. Dry mucous membranes

2. Intense flushing and hot flashes 3. Tingling of the fingers and toes

The patient is taking atenolol (Tenormin) and doxazosin (Cardura). What is the rationale for combining two antihypertensive drugs? 1. The blood pressure will decrease faster. 2. Lower doses of both drugs may be given with fewer adverse effects. 3. There is less daily medication dosing. 4. Combination therapy will treat the patient's other medical conditions.

2. Lower doses of both drugs may be given with fewer adverse effects.

Which nursing intervention is most important when caring for a patient receiving dextran 40 (Gentran 40)? 1. Assess the patient for deep vein thrombosis. 2. Observe for signs of fluid overload. 3. Encourage fluid intake. 4. Monitor arterial blood gases.

2. Observe for signs of fluid overload.

Nifedipine (Procardia XL) has been ordered for a patient with hypertension. In the care plan, the nurse includes the need to monitor for which adverse effect? 1. Rash and chills 2. Reflex tachycardia 3. Increased urinary output 4. Weight loss

2. Reflex tachycardia

The nurse is providing teaching to a patient who has been prescribed furosemide (Lasix). Which of the following should the nurse teach the patient? 1. Avoid consuming large amounts of kale, cauliflower, or cabbage. 2. Rise slowly from a lying or sitting position to standing. 3. Count the pulse for one full minute before taking this medication. 4. Restrict fluid intake to no more than 1 L per 24-hour period.

2. Rise slowly from a lying or sitting position to standing.

A patient with significant hypertension unresponsive to other medications is given a prescription for hydralazine. An additional prescription of propranolol (Inderal) is also given to the patient. The patient inquires why two drugs are needed. What is the nurse's best response? 1. Giving the two drugs together will lower the blood pressure even more than just one alone. 2. The hydralazine may cause tachycardia and the propranolol will help keep the heart rate within normal limits. 3. The propranolol is to prevent lupus erythematosus from developing. 4. Direct-acting vasodilators such as hydralazine cause fluid retention, and the propranolol will prevent excessive fluid buildup.

2. The hydralazine may cause tachycardia and the propranolol will help keep the heart rate within normal limits.

Erectile dysfunction drugs such as sildenafil (Viagra) are contraindicated in patients taking nitrates for angina. What is the primary concern with concurrent administration of these drugs? 1. They contain nitrates, resulting in an overdose. 2. They also decrease blood pressure through vasodilation and may result in prolonged and severe hypotension when combined with nitrates. 3. They will adequately treat the patient's angina as well as erectile dysfunction. 4. They will increase the possibility of nitrate tolerance developing and should be avoided unless other drugs can be used.

2. They also decrease blood pressure through vasodilation and may result in prolonged and severe hypotension when combined with nitrates.

A patient has started clopidogrel (Plavix) after experiencing a transient ischemic attack. What is the desired therapeutic effect of this drug? 1. Anti-inflammatory and antipyretic effects 2. To reduce the risk of a stroke from a blood clot 3. Analgesic as well as clot-dissolving effects 4. To stop clots from becoming emboli

2. To reduce the risk of a stroke from a blood clot

To best monitor for therapeutic effects from filgrastim (Granix, Neupogen), the nurse will assess which laboratory finding? 1. Hemoglobin and hematocrit 2. White blood cell or absolute neutrophil counts 3. Serum electrolytes 4. Red blood cell count

2. White blood cell or absolute neutrophil counts

The patient receiving heparin therapy asks how the "blood thinner" works. What is the best response by the nurse? 1. "Heparin makes the blood less thick." 2. "Heparin does not thin the blood but prevents clots from forming as easily in the blood vessels." 3. "Heparin decreases the number of platelets so that blood clots more slowly." 4. "Heparin dissolves the clot."

3. "Heparin decreases the number of platelets so that blood clots more slowly."

The patient is prescribed digoxin (Lanoxin) for treatment of heart failure. Which statement by the patient indicates the need for further teaching? 1. "I may notice my heart rate decrease." 2. "I may feel tired during early treatment." 3. "This drug should cure my heart failure." 4. "My energy level should gradually improve."

3. "This drug should cure my heart failure."

A patient with heart failure has an order for lisinopril (Prinivil, Zestril). Which condition in the patient's history would lead the nurse to confirm the order with the provider? 1. A history of hypertension previously treated with diuretic therapy 2. A history of seasonal allergies currently treated with antihistamines 3. A history of angioedema after taking enalapril (Vasotec) 4. A history of alcoholism, currently abstaining

3. A history of angioedema after taking enalapril (Vasotec)

Darbepoetin (Aranesp) is ordered for each of the following patients. The nurse would question the order for which condition? 1. A patient with chronic renal failure 2. A patient with AIDS who is receiving anti-AIDS drug therapy 3. A patient with hypertension 4. A patient on chemotherapy for cancer

3. A patient with hypertension

A patient with deep vein thrombosis is receiving an infusion of heparin and will be started on warfarin (Coumadin) soon. While the patient is receiving heparin, what laboratory test will provide the nurse with information about its therapeutic effects? 1. Antithrombin III 2. International normalized ratio (INR) 3. Activated partial thromboplastin time (aPTT) 4. Platelet count

3. Activated partial thromboplastin time (aPTT)

The patient has been given a prescription of hydro-chlorothiazide (Microzide) as an adjunct to treatment of hypertension and returns for a follow-up check. Which is the most objective data for determining the therapeutic effectiveness of the furosemide? 1. Absence of edema in lower extremities 2. Weight loss of 13 kg (6 lb) 3. Blood pressure log notes blood pressure 120/70 mmHg to 134/88 mmHg since discharge 4. Frequency of voiding of at least 6 times per day

3. Blood pressure log notes blood pressure 120/70 mmHg to 134/88 mmHg since discharge

A patient is receiving PlasmaLyte for treatment of hypovolemic shock. When monitoring for therapeutic effects, which of the following will the nurse expect to occur? 1. Breath sounds are clear. 2. Potassium, glucose, and sodium levels remain within normal range. 3. Blood pressure returns to within normal range and urine output increases. 4. The pulse rate and ECG return to normal rate and pattern.

3. Blood pressure returns to within normal range and urine output increases.

A patient is receiving a thrombolytic drug, alteplase (Activase), following an acute myocardial infarction. Which effect is most likely attributed to this drug? 1. Skin rash with urticaria 2. Wheezing with labored respirations 3. Bruising and epistaxis 4. Temperature elevation of 38.2 °C (100.8 °F)

3. Bruising and epistaxis

Which of the following clinical manifestations may indicate that the patient taking metolazone (Zaroxolyn) is experiencing hypokalemia? 1. Hypertension 2. Polydipsia 3. Cardiac dysrhythmias 4. Skin rash

3. Cardiac dysrhythmias

The patient who has not responded well to other therapies has been prescribed milrinone (Primacor) for treatment of his heart failure. What essential assessment must the nurse make before starting this drug? 1. Weight and presence of edema 2. Dietary intake of sodium 3. Electrolytes, especially potassium 4. History of sleep patterns and presence of sleep apnea

3. Electrolytes, especially potassium

A patient has been ordered gemfibrozil (Lopid) for hyperlipidemia. The nurse will first validate the order with the healthcare provider if the patient reports a history of which disorder? 1. Hypertension 2. Angina 3. Gallbladder disease 4. Tuberculosis

3. Gallbladder disease

Verapamil (Calan, Covera-HS, Verelan) should be used with extra caution or is contraindicated in patients with which cardiovascular condition? 1. Hypertension 2. Tachycardia 3. Heart failure 4. Angina

3. Heart failure

The patient admitted for heart failure has been receiving hydrochlorothiazide (Microzide). Which laboratory levels should the nurse carefully monitor? (Select all that apply.) 1. Platelet count 2. White blood cell count 3. Potassium 4. Sodium 5. Uric acid

3. Potassium 4. Sodium 5. Uric acid

Nitroglycerin patches have been ordered for a patient with a history of angina. What teaching will the nurse give to this patient? 1. Keep the patches in the refrigerator. 2. Use the patches only if the chest pain is severe. 3. Remove the old patch and wait 6-12 hours before applying a new one. 4. Apply the patch only to the upper arm or thigh areas.

3. Remove the old patch and wait 6-12 hours before applying a new one.

A patient will be sent home on diuretic therapy and has a prescription for liquid potassium chloride (KCl). What teaching will the nurse provide before the patient goes home? 1. Do not dilute the solution with water or juice; drink the solution straight. 2. Increase the use of salt substitutes; they also contain potassium. 3. Report any weakness, fatigue, or lethargy immediately. 4. Take the medication immediately before bed to prevent heartburn.

3. Report any weakness, fatigue, or lethargy immediately.

While planning for a patient's discharge from the hospital, which teaching points would be included for a patient going home with a prescription for chlorothiazide (Diuril)? 1. Increase fluid and salt intake to make up for the losses caused by the drug. 2. Increase intake of vitamin-C rich foods, such as grapefruit and oranges. 3. Report muscle cramping or weakness to the healthcare provider. 4. Take the drug at night because it may cause drowsiness.

3. Report muscle cramping or weakness to the healthcare provider.

A patient is receiving intravenous sodium bicarbonate for treatment of metabolic acidosis. During this infusion, how will the nurse monitor for therapeutic effect? 1. Blood urea nitrogen (BUN) 2. White blood cell counts 3. Serum pH 4. Kidney function laboratory values

3. Serum pH

The community health nurse is working with a patient taking simvastatin (Zocor). Which patient statement may indicate the need for further teaching about this drug? 1. "I'm trying to reach my ideal body weight by increasing my exercise." 2. "I didn't have any symptoms even though I had high lipid levels. I hear that's common." 3. "I've been taking my pill before my dinner." 4. "I take my pill with grapefruit juice. I've always taken my medications that way."

4. "I take my pill with grapefruit juice. I've always taken my medications that way."

A patient with a history of heart failure will be started on spironolactone (Aldactone). Which drug group should not be used, or used with extreme caution in patients taking potassium-sparing diuretics? 1. Nonsteroidal anti-inflammatory drugs 2. Corticosteroids 3. Loop diuretics 4. Angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers

4. Angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers

The use of procainamide (Pronestyl) is limited to the treatment of life-threatening dysrhythmias because of what potential adverse effect? 1. It can cause rebound hypertension in patients with heart failure. 2. It increases the risk of ketoacidosis in patients with diabetes. 3. It has significant cholinergic effects, causing diarrhea and electrolyte depletion. 4. It causes antinuclear antibodies (ANA) when given long-term, resulting in blood dyscrasias.

4. It causes antinuclear antibodies (ANA) when given long-term, resulting in blood dyscrasias.

The nurse is caring for a patient with chronic stable angina who is receiving isosorbide dinitrate (Isordil). Which of the following are common adverse effects of isosorbide? 1. Flushing and headache 2. Tremors and anxiety 3. Sleepiness and lethargy 4. Light-headedness and dizziness

4. Light-headedness and dizziness

What health teaching should the nurse provide for the patient receiving nadolol (Corgard)? 1. Increase fluids and fiber to prevent constipation. 2. Report a weight gain of 1 kg per month or more. 3. Immediately stop taking the medication if sexual dysfunction occurs. 4. Rise slowly after prolonged periods of sitting or lying down.

4. Rise slowly after prolonged periods of sitting or lying down.

The teaching plan for a patient receiving hydralazine (Apresoline) should include which point? 1. Returning for monthly urinalysis testing 2. Including citrus fruits, melons, and vegetables in the diet 3. Decreasing potassium-rich food in the diet 4. Rising slowly to standing from a lying or sitting position

4. Rising slowly to standing from a lying or sitting position

A patient was admitted from the emergency department after receiving treatment for dysrhythmias. He will be started on amiodarone (Pacerone) due to the lack of therapeutic effects from his other antidysrhythmic therapy. When the nurse checks with him in the afternoon, he complains of feeling lightheaded and dizzy. What will the nurse assess first? 1. Whether there is the possibility of sleep deprivation from the stress of admission to the hospital 2. Whether an allergic reaction is occurring with anticholinergic-like symptoms 3. Whether the amiodarone level is not yet therapeutic enough to treat the dysrhythmias 4. Whether the patient's pulse and blood pressure are within normal limits

4. Whether the patient's pulse and blood pressure are within normal limits