A+P Hypertensive meds/ electrolytes

The nurse explains that which beta blocker category is preferred for treating hypertension? a. Beta1 blocker b. Beta2 blocker c. Beta1 and beta2 blockers d. Beta2 and beta3 blockers

Beta1 blocker

Metoprolol (Toprol XL) is added to the pharmacologic therapy of a diabetic female diagnosed with stage 2 hypertension initially treated with Furosemide (Lasix) and Ramipril (Altace). An expected therapeutic effect is: 1. Decrease in heart rate. 2. Lessening of fatigue. 3. Improvement in blood sugar levels. 4. Increase in urine output.

Decrease in heart rate.

The nurse acknowledges that the first-line drug for treating this client's blood pressure might be which drug? a. Diuretic b. Alpha blocker c. ACE inhibitor d. Alpha/beta blocker

Diuretic

Nitroprusside (Nitropress) is prescribed for a client admitted with a blood pressure of 220/110. What action by a new nurse would require intervention by the charge nurse? The nurse inserts a Foley catheter. The nurse documents the IV rate and status of site every 15 minutes. The nurse uses electronic monitoring of blood pressure every hour. The nurse cautions the client to call for assistance before getting out of bed.

The nurse uses electronic monitoring of blood pressure every hour. Rationale: Nitroprusside decreases blood pressure instantaneously. Vital signs must be monitored very closely—e.g., every 5-15 minutes.

The nurse knows that which diuretic is most frequently combined with an antihypertensive drug? a. chlorthalidone b. hydrochlorothiazide c. bendroflumethiazide d. potassium-sparing diuretic

hydrochlorothiazide

The nurse is reviewing a medication history on a client taking an ACE inhibitor. The nurse plans to contact the health care provider if the client is also taking which medication? a. docusate sodium (Colace) b. furosemide (Lasix) c. morphine sulfate d. spironolactone (Aldactone)

spironolactone (Aldactone)

When caring for a pt diagnosed with hypocalcemia, which of the following should the nurse additionally assess in the pt? 1. other electrolyte disturbances 2. hypertension 3. visual disturbances 4. drug toxicity

Answer: 1 Rationale 1: The pt diagnosed with hypocalcemia may also have high phosphorus or decreased magnesium levels

What is the best information for the nurse to provide to the client who is receiving spironolactone (Aldactone) and furosemide (Lasix) therapy? a. "Moderate doses of two different diuretics are more effective than a large dose of one." b. "This combination promotes diuresis but decreases the risk of hypokalemia." c. "This combination prevents dehydration and hypovolemia." d. "Using two drugs increases the osmolality of plasma and the glomerular filtration rate."

"This combination promotes diuresis but decreases the risk of hypokalemia."

A client who has increased intracranial pressure is receiving mannitol (Osmitrol) Which of the following findings should the nurse report to the provider? 1. Blood Glucose 150 mg/dL 2. U/O 40mL/hour 3. Dyspnea 4. Headache

3. Dyspnea -- can indicate HF, and adverse effect of mannitol. The nurse should stop the medication and notify the provider.

A client is taking clonidine (Catapres) for treatment of hypertension. The nurse should teach the client about which of the following common adverse effects of this drug? Select all that apply. 1. Dry mouth. 2. Hyperkalemia. 3. Impotence. 4. Pancreatitis. 5. Sleep disturbance.

1, 3, 5. Clonidine (Catapres) is a central-acting adrenergic antagonist. It reduces sympathetic outflow from the central nervous system. Dry mouth, impotence, and sleep disturbances are possible adverse effects. Hyperkalemia and pancreatitis are not anticipated with use of this drug.

A nurse is planning care for a client who is receiving furosemide (Lasix) IV for peripheral edema. Which of the following should the nurse include in the plan of care? SELECT ALL THAT APPLY 1. Assess for tinnitus 2. Report U/O of 50 mL/hr 3. Monitor serum potassium levels 4. Elevate the head of the bed slowly before ambulation. 5. Recommend eating a banana daily.

1. Assess for tinnitus 3. Monitor serum potassium levels 4. Elevate the head of the bed slowly before ambulation. 5. Recommend eating a banana daily.

A nurse is reviewing the health record of a client who is starting propranolol (Inderal) to treat HT. Which of the following conditions is a contraindication for taking propranolol? 1. Asthma 2. Diabetes 3. Angina 4. Tachycardia

1. Asthma -- Proranolol is a non-selective beta adrenergic blocker that blocks both beta 1&2 receptors. Blockade of beta2 receptors in the lungs causes broncho-constriction, so it is contraindicated in clients who have asthma.

What is the nurse's primary concern regarding fluid & electrolytes when caring for an elderly pt who is intermittently confused? 1. risk of dehydration 2. risk of kidney damage 3. risk of stroke 4. risk of bleeding

1. risk of dehydration Rationale 1: As an adult ages, the thirst mechanism declines. Adding this in a pt with an altered level of consciousness, there is an increased risk of dehydration & high serum osmolality.

The nurse knows that the client's cholesterol level should be within which range? a. 150 to 200 mg/dL b. 200 to 225 mg/dL c. 225 to 250 mg/dL d. Greater than 250 mg/dL

150 to 200 mg/dL

When caring for a patient who has started anticoagulant therapy with warfarin (Coumadin), the nurse knows not to expect therapeutic benefits for: At least 12 hours The first 24 hours 2-3 days

2-3 days

A nurse is reviewing a client's medication history and notes that the client is taking digoxin (Lanoxin), an anti-HT med & NSAIDs. The client has a new prescription for toresmide (Demadex). The nurse should plan to monitor for which of the following medication interactions. SELECT ALL THAT APPLY 1. decrease in serum digoxin level 2. Hypokalemia 3. Hypotension 4. Low urine output 5. Ventricular dysrhythmias

2. Hypokalemia (adverse effect of Loop --> dig toxicity) 3. Hypotension (monitor when other anti-HT drugs are being admin) 4. Low urine output (when Loop & NSAID b/c NSAID decrease blood flow to kidneys which reduces the diuretic effect.) 5. Ventricular dysrhythmias (can occur with dig toxicity with toresmide & digoxing)

A nurse is monitoring a client who is receiving spironolactone (Aldactone) which of the following findings should the nurse report to the provider? 1. Serum sodium 148 mEq/L 2. U/O of 120 mL in 4 hours 3. Serum potassium of 5.2 mEq/L 4. Blood pressure 140/90 Hg

3. Serum potassium of 5.2 mEq/L -- indicates hyperkalemia. Because spironolactone causes potassium retention, the nurse should withhold the medication and notify the provider.

Which patient below would have a potassium level of 5.5? A 76 year old who reports taking lasix four times a day A patient with Addison's disease A 55 year old woman who have been vomiting for 3 days consistently A patient with liver failure

A patient with Addison disease suffers from increased potassium levels due to adrenal insufficiency. Therefore, potassium levels higher than 5.1 may present in patients with Addison's disease.

A patient is diagnosed with hypertension and nadolol (Corgard) is prescribed. The nurse should consult with the health care provider before giving this medication upon finding a history of a. asthma. b. peptic ulcer disease. c. alcohol dependency. d. myocardial infarction (MI).

ANS: A Nonselective β-blockers block β1- and β2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. β-blockers will have no effect on the patient's peptic ulcer disease or alcohol dependency. β-blocker therapy is recommended after MI.

Which assessment finding for a patient who is receiving furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider? a. Blood glucose level of 180 mg/dL b. Blood potassium level of 3.0 mEq/L c. Early morning BP reading of 164/96 mm Hg d. Orthostatic systolic BP decrease of 12 mm Hg

ANS: B Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider should be notified of the potassium level immediately and administration of potassium supplements initiated. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg is common and will require intervention only if the patient is symptomatic.

The nurse in the emergency department received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first? a. 52-year-old with a BP of 212/90 who has intermittent claudication b. 43-year-old with a BP of 190/102 who is complaining of chest pain c. 50-year-old with a BP of 210/110 who has a creatinine of 1.5 mg/dL d. 48-year-old with a BP of 200/98 whose urine shows microalbuminuria

ANS: B The patient with chest pain may be experiencing acute myocardial infarction and rapid assessment and intervention is needed. The symptoms of the other patients also show target organ damage, but are not indicative of acute processes.

The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is most important to report to the health care provider? a. Urine output over 8 hours is 200 mL less than the fluid intake. b. The patient is unable to move the left arm and leg when asked to do so. c. Tremors are noted in the fingers when the patient extends the arms. d. The patient complains of a severe headache with pain at level 8/10 (0 to 10 scale).

ANS: B The patient's inability to move the left arm and leg indicates that a hemorrhagic stroke may be occurring and will require immediate action to prevent further neurologic damage. The other clinical manifestations also likely are caused by the hypertension and will require rapid nursing actions, but they do not require action as urgently as the neurologic changes.

The nurse obtains this information from a patient with prehypertension. Which finding is most important to address with the patient? a. Low dietary fiber intake b. No regular aerobic exercise c. Weight 5 pounds above ideal weight d. Drinks wine with dinner once a week

ANS: B The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a risk factor for hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is high in fiber, but increasing fiber alone will not prevent hypertension from developing. The patient's alcohol intake will not increase the hypertension risk.

Which action will be included in the plan of care when the nurse is caring for a patient who is receiving sodium nitroprusside (Nipride) to treat a hypertensive emergency? a. Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night. b. Assist the patient up in the chair for meals to avoid complications associated with immobility. c. Use an automated noninvasive blood pressure machine to obtain frequent BP measurements. d. Place the patient on NPO status to prevent aspiration caused by nausea and the associated vomiting.

ANS: C Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line. The patient will require frequent assessments, so allowing 6 to 8 hours of undisturbed sleep is not appropriate. When patients are receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary.

Which information should the nurse include when teaching a patient with newly diagnosed hypertension? a. Dietary sodium restriction will control BP for most patients. b. Most patients are able to control BP through lifestyle changes. c. Hypertension is usually asymptomatic until significant organ damage occurs. d. Annual BP checks are needed to monitor treatment effectiveness.

ANS: C Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes and sodium restriction are used to help manage blood pressure, but drugs are needed for most patients. BP should be checked by the health care provider every 3 to 6 months.

The RN is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside (Nipride). Which of the following nursing actions can the nurse delegate to an experienced LPN/LVN? a. Titrate nitroprusside to maintain BP at 160/100 mm Hg. b. Evaluate effectiveness of nitroprusside therapy on BP. c. Set up the automatic blood pressure machine to take BP every 15 minutes. d. Assess the patient's environment for adverse stimuli that might increase BP.

ANS: C LPN/LVN education and scope of practice include correct use of common equipment such as automatic blood pressure machines. The other actions require more nursing judgment and education and should be done by RNs.

After giving a patient the initial dose of oral labetalol (Normodyne) for treatment of hypertension, which action should the nurse take? a. Encourage oral fluids to prevent dry mouth or dehydration. b. Instruct the patient to ask for help if heart palpitations occur. c. Ask the patient to request assistance when getting out of bed. d. Teach the patient that headaches may occur with this medication.

ANS: C Labetalol decreases sympathetic nervous system activity by blocking both α- and β-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart palpitations, dehydration, and headaches are possible side effects of other antihypertensives.

A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and has a BP of 240/118 mm Hg. Which question should the nurse ask first? a. Did you take any acetaminophen (Tylenol) today? b. Do you have any recent stressful events in your life? c. Have you been consistently taking your medications? d. Have you recently taken any antihistamine medications?

ANS: C Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP but not usually to the level seen in this patient.

The charge nurse observes a new RN doing discharge teaching for a hypertensive patient who has a new prescription for enalapril (Vasotec). The charge nurse will need to intervene if the new RN tells the patient to a. check the BP with a home BP monitor every day. b. move slowly when moving from lying to standing. c. increase the dietary intake of high-potassium foods. d. make an appointment with the dietitian for teaching.

ANS: C The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect. The other teaching by the new RN is appropriate for a patient with newly diagnosed hypertension who has just started therapy with enalapril.

During change-of-shift report, the nurse obtains this information about a hypertensive patient who received the first dose of propranolol (Inderal) during the previous shift. Which information indicates that the patient needs immediate intervention? a. The patient's most recent BP reading is 156/94 mm Hg. b. The patient's pulse has dropped from 64 to 58 beats/minute. c. The patient has developed wheezes throughout the lung fields. d. The patient complains that the fingers and toes feel quite cold.

ANS: C The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective β-blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes are associated with β-receptor blockade but do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated; however, this is not as urgently needed as addressing the bronchospasm.

Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient? a. Obtain a BP reading in each arm and average the results. b. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second. c. Have the patient sit in a chair with the feet flat on the floor. d. Assist the patient to the supine position for BP measurements.

ANS: C The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, but the results of the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2 to 3 mm Hg per second.

A 52-year-old patient who has no previous history of hypertension or other health problems suddenly develops a BP of 188/106 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that a. a BP recheck should be scheduled in a few weeks. b. the dietary sodium and fat content should be decreased. c. there is an immediate danger of a stroke and hospitalization will be required. d. more diagnostic testing may be needed to determine the cause of the hypertension.

ANS: D A sudden increase in BP in a patient over age 50 with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will need rapid treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable lev

The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril (Accupril). Which patient statement indicates that more teaching is needed? a. "The medication may not work as well if I take any aspirin." b. "The doctor may order a blood potassium level occasionally." c. "I will call the doctor if I notice that I have a frequent cough." d. "I won't worry if I have a little swelling around my lips and face."

ANS: D Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy.

When a patient with hypertension who has a new prescription for atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit, the BP is unchanged from the previous visit. Which action should the nurse take first? a. Provide information about the use of multiple drugs to treat hypertension. b. Teach the patient about the reasons for a possible change in drug therapy. c. Remind the patient that lifestyle changes also are important in BP control. d. Question the patient about whether the medication is actually being taken.

ANS: D Since noncompliance with antihypertensive therapy is common, the nurse's initial action should be to determine whether the patient is taking the atenolol as prescribed. The other actions also may be implemented, but these would be done after assessing patient compliance with the prescribed therapy.

A patient has just been diagnosed with hypertension and has a new prescription for captopril (Capoten). Which information is important to include when teaching the patient? a. Check BP daily before taking the medication. b. Increase fluid intake if dryness of the mouth is a problem. c. Include high-potassium foods such as bananas in the diet. d. Change position slowly to help prevent dizziness and falls.

ANS: D The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change. Increasing fluid intake may counteract the effect of the medication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP does not need to be checked at home by the patient before taking the medication. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.

When analyzing an arterial blood gas report of a pt with COPD & respiratory acidosis, the nurse anticipates that compensation will develop through which of the following mechanisms? 1. The kidneys retain bicarbonate. 2. The kidneys excrete bicarbonate. 3. The lungs will retain carbon dioxide. 4. The lungs will excrete carbon dioxide.

Answer: 1 Rationale 1: The kidneys will compensate for a respiratory disorder by retaining bicarbonate.

The nurse is assessing a client who is taking furosemide (Lasix). The client's potassium level is 3.4 mEq/L, chloride is 90 mmol/L, and sodium is 140 mEq/L. What is the nurse's primary intervention? a. Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly. b. Administer Kayexalate. c. Administer 2 mEq potassium chloride per kilogram per day IV. d. Administer PhosLo, two tablets three times per day.

Administer 2 mEq potassium chloride per kilogram per day IV.

The client has an international normalized ratio (INR) value of 1.5. What action will the nurse take? a. Administer an additional dose of warfarin (Coumadin). b. Hold the next dose of warfarin (Coumadin). c. Increase the heparin drip rate. d. Administer protamine sulfate.

Administer an additional dose of warfarin (Coumadin).

The nurse is planning care for a pt with fluid volume overload & hyponatremia. Which of the following should be included in this pt's plan of care? 1. Restrict fluids. 2. Administer intravenous fluids. 3. Provide Kayexalate. 4. Administer intravenous normal saline with furosemide.

Answer: 1 Rationale 1: The nursing care for a pt with hyponatremia is dependent on the cause. Restriction of fluids to 1,000 mL/day is usually implemented to assist sodium increase & to prevent the sodium level from dropping further due to dilution.

A patient is admitted to the ER with the following findings: heart rate of 110 (thready upon palpation), 80/62 blood pressue, 25 ml/hr urinary output, and Sodium level of 160. What interventions do you expect the medical doctor to order for this patient? Restrict fluid intake and monitor daily weights Administer hypertonic solution of 5% Dextrose 0.45% Sodium Chloride and monitor urinary output Administer hypotonic IV fluid and administer sodium tablets. No interventions are expected

Administer hypertonic solution of 5% Dextrose 0.45% Sodium Chloride and monitor urinary output The patient must be re-hyrdated and the sodium levels should be decreased at the same time. So a hypertonic solution of 5% dextrose and 0.45% NA will help do this. The solution is hypertonic because of the 5% Dextrose which will rapidly metabolize to the cells. When the dextrose metabolizes to the cells it leaves behind 0.9% NA which acts as a isotonic solution. This allows the 0.45% NA to act as a hypotonic solution to repair the vascular compartment. After these fluids are infused the patient's NA level should decrease, BP increase, HR return to normal etc. It is a complicated physiological process because the Dextrose has unique capabilities when it is metabolized....although the solution is labeled as hypertonic it becomes a hypotonic solution when the Dextrose is metabolized by the cells.

A client has been admitted through the emergency department and requires emergency surgery. The client has been receiving heparin. What nursing intervention is essential? a. Teach the client about the phenytoin. b. Administer protamine sulfate. c. Assess the INR before surgery. d. Administer vitamin K.

Administer protamine sulfate.

A nurse is preparing to administer enoxaparin sodium (Lovenox) to a client for prevention of deep vein thrombosis. What is an essential nursing intervention? a. Draw up the medication in a syringe with a 22-gauge, 1-½ inch needle. b. Utilize the Z-track method to inject the medication. c. Administer the medication into subcutaneous tissue. d. Rub the administration site after injecting.

Administer the medication into subcutaneous tissue.

A client who has been taking warfarin (Coumadin) is admitted with coffee-ground emesis. What is the nurse's primary action? a. Administer vitamin E. b. Administer vitamin K. c. Administer protamine sulfate. d. Administer calcium gluconate.

Administer vitamin K.

Which patient is at most risk for fluid volume deficient? A patient who has been vomiting and having diarrhea for 2 days. A patient with continous nasogastric suction. A patient with an abdominal wound vac at intermittent suction. All of the above are correct.

All of the above are correct.

Which patient is at more risk for an electrolyte imbalance?* An 8 month old with a fever of 102.3 'F and diarrhea A 5 year old with RSV A healthy 87 year old with intermittent episodes of gout A 55 year old diabetic with nausea and vomiting

An 8 month old with a fever of 102.3 'F and diarrhea The 8 month old with a fever of 102.3 'F and diarrhea is the correct answer. Infants (age 1 and under) and older adults are at a higher risk of fluid-related problems than any other age group. This is because infants have the highest amount of total body fluid (80% of the body is made up of fluid) and if any type of illness especially GI effects the body this increases the chances of an electrolyte imbalance.

The nurse is planning care for a pt with severe burns. Which of the following is this pt at risk for developing? 1. intracellular fluid deficit 2. intracellular fluid overload 3. extracellular fluid deficit 4. interstitial fluid deficit

Answer: 1 Rationale 1: Because this pt was severely burned, the fluid within the cells is diminished, leading to an intracellular fluid deficit.

An elderly postoperative pt is demonstrating lethargy, confusion, & a resp rate of 8 per minute. The nurse sees that the last dose of pain medication administered via a pt controlled anesthesia (PCA) pump was within 30 minutes. Which of the following acid-base disorders might this pt be experiencing? 1. respiratory acidosis 2. metabolic acidosis 3. respiratory alkalosis 4. metabolic alkalosis

Answer: 1 Rationale 1: Acute respiratory acidosis occurs due to a sudden failure of ventilation. Overdoses of narcotic or sedative medications can lead to this condition.

A pt prescribed spironolactone is demonstrating ECG changes & complaining of muscle weakness. The nurse realizes this pt is exhibiting signs of which of the following? 1. hyperkalemia 2. hypokalemia 3. hypercalcemia 4. hypocalcemia

Answer: 1 Rationale 1: Hyperkalemia is serum potassium level greater than 5.0 mEq/L. Decreased potassium excretion is seen in potassium-sparing diuretics such as spironolactone. Common manifestations of hyperkalemia are muscle weakness & ECG changes.

The nurse is caring for a pt diagnosed with renal failure. Which of the following does the nurse recognize as compensation for the acid-base disturbance found in pts with renal failure? 1. The pt breathes rapidly to eliminate carbon dioxide. 2. The pt will retain bicarbonate in excess of normal. 3. The pH will decrease from the present value. 4. The pt's oxygen saturation level will improve.

Answer: 1 Rationale 1: In metabolic acidosis compensation is accomplished through increased ventilation or "blowing off" C02. This raises the pH by eliminating the volatile respiratory acid & compensates for the acidosis.

When caring for a group of pts, the nurse realizes that which of the following health problems increases the risk for metabolic alkalosis? 1. bulimia 2. dialysis 3. venous stasis ulcer 4. COPD

Answer: 1 Rationale 1: Metabolic alkalosis is cause by vomiting, diuretic therapy or nasogastric suction, among others. A pt with bulimia may engage in vomiting or indiscriminate use of diuretics.

A pt is diagnosed with severe hyponatremia. The nurse realizes this pt will mostly likely need which of the following precautions implemented? 1. seizure 2. infection 3. neutropenic 4. high-risk fall

Answer: 1 Rationale 1: Severe hyponatremia can lead to seizures. Seizure precautions such as a quiet environment, raised side rails, & having an oral airway at the bedside would be included.

The nurse is caring for a pt who is anxious & dizzy following a traumatic experience. The arterial blood gas findings include: pH 7.48, PaO2 110, PaCO2 25, & HCO3 24. The nurse would anticipate which initial intervention to correct this problem? 1. Encourage the pt to breathe in & out slowly into a paper bag. 2. Immediately administer oxygen via a mask & monitor oxygen saturation. 3. Prepare to start an intravenous fluid bolus using isotonic fluids. 4. Anticipate the administration of intravenous sodium bicarbonate.

Answer: 1 Rationale 1: This pt is exhibiting signs of hyperventilation that is confirmed with the blood gas results of respiratory alkalosis. Breathing into a paper bag will help the pt to retain carbon dioxide & lower oxygen levels to normal, correcting the cause of the problem.

A pt is prescribed 20 mEq of potassium chloride. The nurse realizes that the reason the pt is receiving this replacement is 1. to sustain respiratory function. 2. to help regulate acid-base balance. 3. to keep a vein open. 4. to encourage urine output.

Answer: 2 Rationale 1: Potassium does not sustain respiratory function. Rationale 2: Electrolytes have many functions. They assist in regulating water balance, help regulate & maintain acid-base balance, contribute to enzyme reactions, & are essential for neuromuscular activity. Rationale 3: Intravenous fluids are used to keep venous access not potassium. Rationale 4: Urinary output is impacted by fluid intake not potassium.

The pt, newly diagnosed with diabetes mellitus, is admitted to the emergency department with nausea, vomiting, & abdominal pain. ABG results reveal a pH of 7.2 & a bicarbonate level of 20 mEq/L. Which other assessment findings would the nurse anticipate in this pt? Select all that apply. 1. tachycardia 2. weakness 3. dysrhythmias 4. Kussmaul's respirations 5. cold, clammy skin

Answer: 2,3,4 Rationale: Further assessment findings of this condition are weakness, bradycardia, dysrhythmias, general malaise, decreased level of consciousness, warm flushed skin, & Kussmaul's respirations. Rationale: These ABG results, coupled with the pt's recent diagnosis of diabetes mellitus & history of vomiting would lead the nurse to suspect metabolic acidosis. Further assessment findings of this condition are weakness, bradycardia, dysrhythmias, general malaise, decreased level of consciousness, warm flushed skin, & Kussmaul's respirations.

A 28-year-old male pt is admitted with diabetic ketoacidosis. The nurse realizes that this pt will have a need for which of the following electrolytes? 1. sodium 2. potassium 3. calcium 4. magnesium

Answer: 4 Rationale 4: One risk factor for hypomagnesaemia is an endocrine disorder, including diabetic ketoacidosis.

In report from a transferring facility you receive information that your patient's Magnesium level is 1.2. When the patient arrives you are ordered by the doctor to administer Magnesium Sulfate via IV. Which of the following interventions takes priority? Monitor the patient's for reduced deep tendon reflexes and initiate seizure precautions Set-up IV Atropine at bedside due to the bradycardia effects of Magnesium Sulfate Set-up bedside suction None of the above are correct

As the nurse administering Magnesium sulfate IV, you must monitor for reduced deep tendon reflexes because the patient could quickly develop hypermagnesemia. In addition, seizure precautions should be initiated due to the patient's low magnesium level.

The nurse is aware that which group(s) of antihypertensive drugs are less effective in African-American clients? a. Diuretics b. Calcium channel blockers and vasodilators c. Beta blockers and ACE inhibitors d. Alpha blockers

Beta blockers and ACE inhibitors

The nurse is teaching a client about clopidogrel (Plavix). What is important information to include? a. Constipation may occur. b. Hypotension may occur. c. Bleeding may increase when taken with aspirin. d. Normal dose is 25 mg tablet per day.

Bleeding may increase when taken with aspirin.

A client receiving furosemide (Lasix) as an adjunct to treatment of hypertension returns for follow-up. Which of the following objective data should the nurse consider when determining the effectiveness of the drug therapy? Blood pressure log notes blood pressure 120/70-134/88 since discharge. Weight loss of six pounds in the past month Frequency of voiding of at least six times per day Absence of edema in lower extremities

Blood pressure log notes blood pressure 120/70-134/88 since discharge. Rationale: Maintenance of blood pressure within normal limits indicates that treatment goals are achieved. Absence of edema, weight loss, and urinating all indicate that the diuretic has promoted fluid loss, but are not the best measure of the drug's effectiveness for hypertension.

A nurse is caring for a client who is taking an angiotensin-converting enzyme inhibitor and develops a dry, nonproductive cough. What is the nurse's priority action? a. Call the health care provider to switch the medication. b. Assess the client for other symptoms of upper respiratory infection. c. Instruct the client to take antitussive medication until the symptoms subside. d. Tell the client that the cough will subside in a few days.

Call the health care provider to switch the medication.

When a newly admitted client is placed on heparin, the nurse acknowledges that heparin is effective for preventing new clot formation in clients who have which disorder(s)? (Select all that apply.) a. Coronary thrombosis b. Acute myocardial infarction c. Deep vein thrombosis (DVT) d. Cerebrovascular accident (CVA) (stroke) e. Venous disorders

Coronary thrombosis b. Acute myocardial infarction c. Deep vein thrombosis (DVT) d. Cerebrovascular accident (CVA) (stroke) e. Venous disorders

An elderly pt who is being medicated for pain had an episode of incontinence. The nurse realizes that this pt is at risk for developing 1. dehydration. 2. over-hydration. 3. fecal incontinence. 4. a stroke.

Correct Answer: 1 Rationale 1: Functional changes of aging also affect fluid balance. Older adults who have self-care deficits, or who are confused, depressed, tube-fed, on bed rest, or taking medications (such as sedatives, tranquilizers, diuretics, & laxatives), are at greatest risk for fluid volume imbalance.

The most important factor in regulating the caliber of blood vessels, which determines resistance to flow, is: Hormonal secretion Independent arterial wall activity The influence of circulating chemicals The sympathetic nervous system

The sympathetic nervous system

A client with hyperaldosteronism is prescribed spironolactone (Aldactone). What assessment finding would the nurse evaluate as a positive outcome? a. Decreased potassium level b. Decreased crackles in the lung bases c. Decreased aldosterone d. Decreased ankle edema

Decreased aldosterone

Which assessment indicates a therapeutic effect of mannitol (Osmitrol)? a. Decreased intracranial pressure b. Decreased potassium c. Increased urine osmolality d. Decreased serum osmolality

Decreased intracranial pressure

Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide (HydroDIURIL)? a. Sodium level of 140 mEq/L b. Fasting blood glucose level of 140 mg/dL c. Calcium level of 9 mg/dL d. Chloride level of 100 mEq/L

Fasting blood glucose level of 140 mg/dL

The nurse is caring for a client with hypertension who is prescribed Clonidine transdermal preparation. What is the correct information to teach this client? a. Change the patch daily at the same time. b. Remove the patch before taking a shower or bath. c. Do not take other antihypertensive medications while on this patch. d. Get up slowly from a sitting to a standing position.

Get up slowly from a sitting to a standing position.

A client receiving HCTZ 25 mg q.d. and digoxin 0.125 mg q.d. complains of nausea and vomiting, and of seeing halos around lights. The client's serum digoxin level is 2.5 ng. The appropriate nursing intervention is to: Administer both drugs as ordered. Document the findings; the lab results are within normal limits. Hold the digoxin and HCTZ. Hold the digoxin, and give HCTZ as ordered.

Hold the digoxin and HCTZ. Rationale: Thiazide diuretics increase serum digitalis levels by promoting potassium loss, which increases the risk of digoxin toxicity. A digitalis level above 2.0 ng is toxic.

The nurse preparing to administer HCTZ (Hydrodiuril) 25 mg to a client with hypertension checks laboratory values and finds that the potassium level is 2.8 mEq. The appropriate action is to: Give the client a banana, and recheck the potassium level. Hold the medication, and notify the health care provider. Administer the drug with orange juice. Administer the drug as ordered, and continue to monitor the potassium level.

Hold the medication, and notify the health care provider. Rationale: The normal serum potassium level is 3.5-5.0. HCTZ is a potassium-depleting drug. The drug should be held until a consultation with the health care provider takes place.

The client has been receiving spironolactone (Aldactone) 50 mg/day for heart failure. The nurse should closely monitor the client for which condition? a. Hypokalemia b. Hyperkalemia c. Hypoglycemia d. Hypermagnesemia

Hyperkalemia

A client has a serum cholesterol level of 265 mg/dL, triglyceride level of 235 mg/dL, and LDL of 180 mg/dL. What do these serum levels indicate? a. Hypolipidemia b. Normolipidemia c. Hyperlipidemia d. Alipidemia

Hyperlipidemia

After obtaining an EKG on a patient you notice that ST depression is present along with an inverted T wave and prominent U wave. What lab value would be the cause of this finding? Potassium level of 2.2 Potassium level of 5.6 Magnesium level of 2.3 Phoshorus level of 2.0

Hypokalemia (normal potassium levels are 3.5 to 5.1) will present with these type of EKG findings

A calcium channel blocker has been ordered for a client. Which condition in the client's history is a contraindication to this medication? a. Hypokalemia b. Dysrhythmias c. Hypotension d. Increased intracranial pressure

Hypotension

10) A nurse is caring for a patient who has had thyroid surgery. The patient's calcium result has returned at 7.5 mg/dL. Which nursing interventions are necessary based on this calcium level? Select all that apply. Implement seizure precautions Assess for positive Chvostek sign in the patient Administer oral digoxin Monitor IV site for phlebitis and irritation Administer intravenous calcium gluconate

Implement seizure precautions Assess for positive Chvostek sign in the patient Monitor IV site for phlebitis and irritation Administer intravenous calcium gluconate Hypocalcemia may develop following some types of medical treatments; it occurs when the patient has low levels of serum calcium. The nurse should protect the patient from complications of the condition, such as seizures. Administration of intravenous calcium may be necessary to correct this electrolyte imbalance. Normal calcium levels are 8.4-10.2 mg/dL. Chvosteks' sign is when you tap the facial nerve and the facial muscle twitches on the respective side called tetany and is a result of hypocalcemia.

A patient is admitted with exacerbation of congestive heart failure. What would you expect to find during your admission assessment? Flat neck and hand veins Furrowed dry tongue Increased blood pressure and crackles throughout the lungs Bradycardia and pitting edema in lower extremities

Increased blood pressure and crackles throughout the lungs The correct answer is increased blood pressure and crackles throughout the lungs. Patients with CHF are in fluid volume overload and the heart can not compensate for the extra fluid volume, therefore, the fluid starts to "backup". You would find an increased blood pressure and crackles in the lungs. You would also see pitting edema in the lower extremities but NOT bradycardia.

Nifedipine (Procardia) 30 mg p.o. is prescribed for a client. The nurse teaches the side effects and instructs the client to immediately report: Blood pressure 110/70-114/78 for two successive readings. Dizziness when changing positions. Increased shortness of breath and orthopnea. Weight loss of two pounds per week.

Increased shortness of breath and orthopnea. Rationale: Nifedipine (Procardia) is a calcium channel blocker. Calcium channel blockers decrease myocardial contractility, increasing the risk of heart failure. Dizziness can occur, especially when the medication is started. The BP is a desired reading.

The nurse is preparing a nitroprusside (Nitropress) IV drip for a client with severe hypertension. Which of the following actions by the nurse reflect correct preparation? (Select all that apply.) Instructs the client to keep the shades in the room closed during the infusion. Keeps an opaque cover over the solution and tubing. Mixes the drug in 250 mL of 5% dextrose and water. Piggybacks the drug into the client's maintenance IV of normal saline solution, NSS. Removes the opaque cover before administering.

Keeps an opaque cover over the solution and tubing. Mixes the drug in 250 mL of 5% dextrose and water. Rationale: Nitropress is only compatible with D5W, and should not be mixed with other solutions or drugs. The drug is light-sensitive and must be covered with an opaque substance, but it would not be necessary to keep the client's room dark.

The client is taking atenolol (Tenormin) and doxazosin (Cardura). what is the rationale for combining 2 anti-HT drugs? 1. BP 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.

Lower doses of both drugs may be given with fewer adverse effects. The advantage of using a combo of 2 drugs like atenolol (Tenormin)-a beta blocker and doxazosin (Cardura) an alpha1 antagonist is that Lower doses of both drugs may be given with fewer adverse effects. FALSE BP will decrease faster--s/b gradually lowered to a safe limit. FALSE There is less daily medication dosing. -- # of doses per day dependent on half-life, not the combo of drugs. Maybe True but NOT Truest Combination therapy will treat the patient's other medical conditions.

Nifedipine (Procardia) has been ordered for a client with HT. In the care plan, the nurse includes the need to monitor for which ADVERSE effect? 1. Rash & chills 2. Reflex tachycardia 3. Increased U/O 4. Weight Loss

Nifedipine (procardia) a CCB may cause hypotension with Reflex Tachycardia.

4) A patient with hypotension is in the emergency department being evaluated. The patients sodium level has come back at 146 mmol/L. What interventions by the nurse would be most appropriate in caring for this patient with hypernatremia? Select all that apply. Administer hypertonic solution by IV as ordered Perform neurological assessments at least every 4 hours Limit oral intake of sodium Encourage the patient to use incentive spirometry Provide pain medication as ordered prn

Perform neurological assessments at least every 4 hours Limit oral intake of sodium Hypernatremia occurs when there is excess sodium in the bloodstream; the normal range of sodium is between 135 and 145 mmol/L. In this situation, the nurse should administer a hypotonic solution in the IV to increase fluid volume, limit oral intake of sodium, and perform neurological assessments, as hypernatremia can cause cognitive changes.

A client comes to the outpatient clinic and tells the nurse that he has had legs pains that began when he walks but cease when he stops walking. Which of the following conditions would the nurse assess for? A An acute obstruction in the vessels of the legs B Peripheral vascular problems in both legs C Diabetes DCalcium deficiency Question 6

Peripheral vascular problems in both legs

The nurse observes a pt's respirations & notes that the rate is 30 per minute & the respirations are very deep. The metabolic disorder this pt might be demonstrating is which of the following? 1. hypernatremia 2. increasing carbon dioxide in the blood 3. hypertension 4. pain

Rationale 2: Acute increases in either carbon dioxide or hydrogen ions in the blood stimulate the respiratory center in the brain. As a result, both the rate & depth of respiration increase. The increased rate & depth of lung ventilation eliminates carbon dioxide from the body, & carbonic acid levels fall, which brings the pH to a more normal range.

A pt with fluid retention related to renal problems is admitted to the hospital. The nurse realizes that this pt could possibly have which of the following electrolyte imbalances? 1. hypokalemia 2. hypernatremia 3. carbon dioxide 4. magnesium

Rationale 2: The kidney is the primary regulator of sodium in the body. Fluid retention is associated with hypernatremia.

An elderly pt comes into the clinic with the complaint of watery diarrhea for several days with abdominal & muscle cramping. The nurse realizes that this pt is demonstrating which of the following? 1. hypernatremia 2. hyponatremia 3. fluid volume excess 4. hyperkalemia

Rationale 2: This elderly pt has watery diarrhea, which contributes to the loss of sodium. The abdominal & muscle cramps are manifestations of a low serum sodium level.

A postoperative pt is diagnosed with fluid volume overload. Which of the following should the nurse assess in this pt? 1. poor skin turgor 2. decreased urine output 3. distended neck veins 4. concentrated hemoglobin & hematocrit levels

Rationale 3: Circulatory overload causes manifestations such as a full, bounding pulse; distended neck & peripheral veins; increased central venous pressure; cough; dyspnea; orthopnea; rales in the lungs; pulmonary edema; polyuria; ascites; peripheral edema, or if severe, anasarca, in which dilution of plasma by excess fluid causes a decreased hematocrit & blood urea nitrogen (BUN); & possible cerebral edema.

A 35-year-old female pt comes into the clinic postoperative parathyroidectomy. Which of the following should the nurse instruct this pt? 1. Drink one glass of red wine per day. 2. Avoid the sun. 3. Milk & milk-based products will ensure an adequate calcium intake. 4. Red meat is the protein source of choice.

Rationale 3: This pt is at risk for developing hypocalcemia. This risk can be avoided if instructed to ingest milk & milk-based products.

The nurse is admitting a pt who was diagnosed with acute renal failure. Which of the following electrolytes will be most affected with this disorder? 1. calcium 2. magnesium 3. phosphorous 4. potassium

Rationale 4: Because the kidneys are the principal organs involved in the elimination of potassium, renal failure

Buerger's disease is characterized by all of the following except: A Arterial thrombosis formation and occlusion B Lipid deposits in the arteries C Redness or cyanosis in the limb when it is dependent D

Redness or cyanosis in the limb when it is dependent

A diuretic is added to the treatment regimen for a client with hypertension. The nurse explains that diuretics help reduce blood pressure by: Removing serum potassium. Dilating peripheral blood vessels. Reducing sympathetic outflow. Constricting blood vessels.

Reducing sympathetic outflow. Rationale: Diuretics decrease blood volume, which in turn decreases the workload of the heart and reduces blood pressure. They do not dilate blood vessels. Some diuretics promote potassium loss, but this does not reduce the blood pressure. Central-acting antihypertensives work by blocking sympathetic outflow.

A client is prescribed a noncardioselective beta1 blocker. What nursing intervention is a priority for this client? a. Assessment of blood glucose levels b. Respiratory assessment c. Orthostatic blood pressure assessment d. Teaching about potential tachycardia

Respiratory assessment

A 24-year old man seeks medical attention for complaints of claudication in the arch of the foot. A nurse also notes superficial thrombophlebitis of the lower leg. The nurse would next assess the client for: A Familial tendency toward peripheral vascular disease B Smoking history C Recent exposures to allergens D History of insect bites

Smoking history

5) A client has +3 pitting edema in their legs and a potassium of 2.3 mEq/L, the nurse knows which of the following diuretic is likely to be ordered? Bumetamide (Bumex) Ethacrynic Acid (Edecrin) Furosemide (Lasix) Spironlactone (Aldactone)

Spironlactone (Aldactone)

A client's blood pressure (BP) is 145/90. According to the guidelines for determining hypertension, the nurse realizes that the client's BP is at which stage? a. Normal b. Prehypertension c. Stage 1 hypertension d. Stage 2 hypertension

Stage 1 hypertension

A client who is taking warfarin (Coumadin) requests an aspirin for headache relief. What is the nurse's best response? a. Administer 650 mg of acetylsalicylic acid (ASA) and reassess pain in 30 minutes. b. Teach the client of potential drug interactions with anticoagulants. c. Explain to the client that ASA is contraindicated and administer ibuprofen as ordered. d. Explain that the headache is an expected side effect and will subside shortly.

Teach the client of potential drug interactions with anticoagulants.

11) The client is being evaluated for a low calcium condition. Clinical manifestations of low calcium include the following. Select all that apply. Tetany Muscle flaccidity Negative Trousseau's sign Positive Chvostek's sign Skeletal fractures

Tetany Positive Chvostek's sign Skeletal fractures

The nurse reviews the teaching plan with a client receiving nifedipine (Procardia). Which of the following client behaviors indicates understanding? The client avoids taking the drug with grapefruit juice. The client consumes three servings of alcohol daily. The client breaks an enteric-coated tablet for ease of swallowing. The client monitors blood pressure every week.

The client avoids taking the drug with grapefruit juice. Rationale: Grapefruit juice increases absorption of nifedipine, resulting in increased serum level. Blood pressure ideally should be monitored more frequently. Alcohol intake of three times a day is excessive. Breaking enteric tablets will interfere with time release of the medication.

Which client will the nurse assess first? a. The client who has been on beta blockers for 1 day. b. The client who is on a beta blocker and a thiazide diuretic. c. The client who has stopped taking a beta blocker due to cost. d. The client who is taking a beta blocker and Lasix (furosemide).

The client who has stopped taking a beta blocker due to cost.

Which patient is at most risk for hypomagnesemia? A 55 year old chronic alcoholic A 57 year old with hyperthroidism A patient reporting overuse of anatacids and laxatives A 25 year old suffering from hypoglycemia

The correct answer is a 55 year old who is a chronic alcoholic. Patients who suffer from alcoholism have an increased secretion of magnesium and usually do not eat a proper diet, therefore, they are at risk for lower magnesium levels.

A nurse admits a client diagnosed with pneumonia. The client has a history of chronic renal insufficiency, and the health care provider orders furosemide (Lasix) 40 mg twice a day. What is most important to include in the teaching plan for this client? a. That the medication will have to be monitored very carefully owing to the client's diagnosis of pneumonia. b. The fact that Lasix has been proven to decrease symptoms with pneumonia. c. The fact that Lasix has shown efficacy in treating persons with renal insufficiency. d. That the medication will need to be given at a higher than normal dose owing to the client's medical problems.

The fact that Lasix has shown efficacy in treating persons with renal insufficiency.

A client with significant HT unresponsive to other medications is given a prescription for hydralazine (Apresoline) An additional prescription of propranolol (Inderal) is also given to the client. The client inquires why 2 drugs are needed. What is the nurses' best response? 1. Giving the 2 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 hyrdalazine cause fluid retention and the propranolol will prevent excess fluid buildup.

The hydralazine may cause tachycardia and the propranolol will help keep the heart rate within normal limits. hydralazine (Apresoline) -- direct vasodilator propranolol (Inderal) -- beta blockers non-selective

7) A patient has an order for a bolus dose of potassium solution because of his electrolyte levels. The nurse is setting up the bolus to administer. Which information would the nurse include when explaining the bolus to the patient? Select all that apply. The potassium is being administered because the patients potassium level is low The patient will have a cardiac monitor in place when getting the potassium bolus The patient should ensure that he does not develop pain with urination during the bolus Flushing, tachycardia, and a rash on the face and chest are common responses to potassium administration The patient should notify the nurse if he feels pain at the IV site during the administration (

The potassium is being administered because the patients potassium level is low The patient will have a cardiac monitor in place when getting the potassium bolus The patient should notify the nurse if he feels pain at the IV site during the administration

A client is taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg. When the nurse enters the room, the client states, "There are yellow halos around the lights." Which action will the nurse take? a. Evaluate digoxin levels. b. Withhold the furosemide c. Administer potassium. d. Document the findings and reassess in 1 hour.

a. Evaluate digoxin levels.

A client is to be discharged home with a transdermal nitroglycerin patch. Which instruction will the nurse include in the client's teaching plan? a. "Apply the patch to a nonhairy area of the upper torso or arm." b. "Apply the patch to the same site each day." c. "If you have a headache, remove the patch for 4 hours and then reapply." d. "If you have chest pain, apply a second patch next to the first patch."

a. "Apply the patch to a nonhairy area of the upper torso or arm."

Which client assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker? a. Client states that she has no chest pain. b. Client states that the swelling in her feet is reduced. c. Client states the she does not feel dizzy. d. Client states that she feels stronger.

a. Client states that she has no chest pain.

The nurse acknowledges that which condition could occur when taking furosemide? a. Hypokalemia b. Hyperkalemia c. Hypoglycemia d. Hypermagnesemia

a. Hypokalemia

Which assessment finding will alert the nurse to suspect early digoxin toxicity? a. Loss of appetite with slight bradycardia b. Blood pressure 90/60 mm Hg c. Heart rate 110 beats per minute d. Confusion and diarrhea

a. Loss of appetite with slight bradycardia

A client is prescribed losartan (Cozaar). The nurse teaches the client that an angiotensin II receptor blocker (ARB) acts by doing what? a. Inhibiting angiotensin-converting enzyme b. Blocking angiotensin II from AT1 receptors c. Preventing the release of angiotensin I d. Promoting the release of aldosterone

b. Blocking angiotensin II from AT1 receptors

During an admission assessment, the client states that she takes amlodipine (Norvasc). The nurse wishes to determine whether or not the client has any common side effects of a calcium channel blocker. The nurse asks the client if she has which signs and symptoms? (Select all that apply.) a. Insomnia b. Dizziness c. Headache d. Angioedema e. Ankle edema f. Hacking cough

b. Dizziness c. Headache e. Ankle edema

A client is taking warfarin 5 mg/day for atrial fibrillation. The client's international normalized ration (INR) is 3.8. The nurse would consider the INR to be what? a. Within normal range b. Elevated INR range c. Low INR range d. Low average INR range

b. Elevated INR range *therapeutic range is 2.0-3.0

A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. What type of electrolyte imbalance does the nurse expect to occur? a. Hypocalcemia b. Hypokalemia c. Hyperkalemia d. Hypermagnesemia What would cause the same client's electrolyte imbalance? a. High dose of digoxin b. Digoxin taken daily c. Hydrochlorothiazide d. Low dose of hydrochlorothiaizde

b. Hypokalemia c. Hydrochlorothiazide

b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down. The health care provider is planning to discontinue a client's beta blocker. What instruction should the nurse give the client regarding the beta blocker? a. The beta blocker should be abruptly stopped when another cardiac drug is prescribed. b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down. c. The beta blocker dose should be maintained while taking another antianginal drug. d. Half the beta blocker dose should be taken for the next several weeks.

b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down.

The nurse reviews a client's laboratory values and finds a digoxin level of 10 ng/mL and a serum potassium level of 5.9 mEq/L. What is the nurse's primary intervention? a. To administer atropine b. To administer digoxin immune FAB c. To administer epinephrine d. To administer Kayexalate

b. To administer digoxin immune FAB (antidote)

The nurse acknowledges that beta blockers are as effective as antianginals because they do what? a. Increase oxygen to the systemic circulation. b. Maintain heart rate and blood pressure. c. Decrease heart rate and decrease myocardial contractility. d. Decrease heart rate and increase myocardial contractility.

c. Decrease heart rate and decrease myocardial contractility.

c. To block the beta1-adrenergic receptors in the cardiac tissues The beta blocker acebutolol (Sectral) is prescribed for dysrhythmias. The nurse knows that what is the primary purpose of the drug? a. To increase the beta1 and beta2 receptors in the cardiac tissues b. To increase the flow of oxygen to the cardiac tissues c. To block the beta1-adrenergic receptors in the cardiac tissues d. To block the beta2-adrenergic receptors in the cardiac tissues

c. To block the beta1-adrenergic receptors in the cardiac tissues