Exam 2

A 65-year-old patient is prescribed ipratropium (Atrovent) for the treatment of asthma. Which of the following conditions should be reported to the health care provider before giving this patient the ipratropium? 1. A reported allergy to peanuts 2. A history of intolerance to albuterol (Proventil) 3. A history of bronchospasms 4. A reported allergy to chocolate

1

A male, age 67, reports taking diphenhydramine (Benadryl) for hay fever. Considering this patient's age, the nurse assesses for which of the following findings? 1. A history of prostatic or urinary conditions 2. Any recent weight gain 3. A history of allergic reactions 4. A history of peptic ulcer disease

1

A HCP cautions a patient who is taking guaifenesin (Mucinex) about using combination OTC cold products because A. they can also contain guaifenesin. B. serious interactions are possible. C. rebound congestion is likely. D. drug tolerance is likely.

A

A HCP is talking to a patient who is prescribed albuterol (Proventil) via inhaler and fluticasone (Advair) via inhaler for asthma management. The HCP should tell the patient to use the albuterol inhaler before using the fluticasone inhaler for which of the following reasons? A. Albuterol will increase the absorption of fluticasone. B. Albuterol will decrease inflammation. C. Albuterol will reduce nasal secretions. D. Fluticasone will reduce the adverse effects of albuterol.

A

A HCP is caring for a patient who is about to begin taking simvastatin (Zocor) to treat hypercholesterolemia. The HCP should tell the patient to report which of the following indications of a serious adverse reaction that could warrant stopping drug therapy? A. Bronchoconstriction B. Muscle pain C. Lip numbness D. Somnolence

B

A HCP is caring for a patient who is taking spironolactone (Aldactone) to treat hypertension. Which of the following lab values should alert the HCP to take further action? A. Serum sodium level of 140 mEq/L B. Serum potassium level of 5.2 mEq/L C. Serum chloride level of 100 mEq/L D. Serum magnesium level of 1.9 mEq/L

B

A HCP should question the use of nifedipine (Procardia) for a patient who has a history of which of the following? A. Bradycardia B. Liver disease C. Unstable angina pectoris D. Second-degree AV block

C

Nifedipine (Procardia) 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 (Rationale: Nifedipine (Procardia) may cause hypotension with reflex tachycardia.)

A HCP should explaine to a patient who is prescribed diphenhydramine that the most common side effect associated with the drug is A. muscle tremors B. sedation C. anxiety D. insomnia

B

Legal restrictions apply to the purchase of pseudoephedrine (Sudafed) because of which of the following risks? A. Respiratory depression B. Drug abuse C. Drug tolerance D. Rebound congestion

B

A HCP is advising a patient about the use of cromolyn sodium. Which of the following instructions should the HCP include? A. Report signs of jaundice. B. Anticipate difficulty sleeping. C. Expect a bitter aftertaste. D. Increase calcium and vitamin D intake.

C

When talking with a patient about taking eplerenone (Inspra) to treat hypertension, the HCP should include which of the following instructions? A. Avoid drinking grapefruit juice. B. Use sunscreen and protective clothing. C. Avoid the use of salt substitutes. D. Stop taking the drug if dizziness occurs.

C (Rationale: eplerenone, an aldosterone antagonist, can cause hyperkalemia. Many salt substitutes contain significant amounts of potassium. Patients who take the drug should not use salt substitutes that contain potassium.)

A HCP is assessing a patient following the administration of nifedipine (Procardia). Recognizing the adverse effects of nifedipine, the HCP should be prepared to administer which of the following drugs? A. Prazosin (Minipress) B. Doxazosin (Cardura) C. Propranolol (Inderal) D. Enalapril (Vasotec)

C (Rationale: nifedipine, a CCB, can cause reflex tachycardia, an adverse effect that increases cardiac oxygen demand. Administering a beta blocker, such as propranolol, will minimize this adverse effect.)

A HCP should tell a patient who is taking albuterol (Proventil) to report which of the following possible indications of a serious adverse effect? A. Fever B. Bruising C. Polyuria D. Palpitations

D

The patient has been prescribed oxymetazoline (Afrin) nasal spray for seasonal rhinitis. The nurse will provide which of the following instructions? 1. Limit use of this spray to 5 days or less. 2. The drug may be sedating so be cautious with activities requiring alertness. 3. This drug should not be used in conjunction with antihistamines. 4. This is an OTC drug and may be used as needed for congestion.

1

A patient is receiving cholestyramine (Questran) for elevated low-density lipoprotein (LDL) levels. As the nurse completes the nursing care plan, which of the following 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 (Rationale: Obstruction of the GI tract is one of the most serious complications of bile acid sequestrants. Abdominal pain may signal the presence of obstruction.)

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. Prothrombin time (PT) 2. International Normalized Ratio (INR) 3. Activated partial thromboplastin time (aPTT) 4. Platelet count

1 (Rationale: Therapeutic effects of heparin ar monitored by the activated partial thromboplastin time (aPTT). While the client is receiving heparin, the aPPT should be 1.5 to 2 times the patient's baseline, or 60 to 80 seconds. Options 1, 2, and 4 are incorrect. A prothrombin time or INR is used to monitor the effectiveness of warfarin (Coumadin). Platelets are not affected by anticoagulant therapy and are not useful in monitoring the therapeutic effects of the drug.)

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 of the following 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 2 (Rationale: Long-term use of bile acid sequestrants such as colestipol (Colestid) may cause depletion or decreased absorption of folic acid and the fat-soluble vitamins.)

What patient education should be included for a patient receiving enoxaparin (Lovenox)? (Select all that apply.) 1. Teach the patient or family to give subcutaneous injections at home. 2. Teach the patient or family not to take any over-the-counter drugs without first consulting with the health care 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 2 3 4 (Rationale: Enoxaparin is a low-molecular-weight heparin (LMWH). Clients and family can be taught to give subcutaneous injections at home. Teaching should include instruction to not take any other medications without first consulting the health care provider and recognize the signs and symptoms of bleeding. Enoxaparin is given to prevent development of DVT. Clients should be taught signs and symptoms of DVT to observe for and should contact their health care provider immediately if these develop or worsen while on enoxaparin therapy. Option 5 is incorrect. Grapefruit juice is know to alter the metabolism of many drugs in the liver. Even though the enoxaparin is given parentally, it is metabolized in the liver and may be affected by compounds in the grapefruit juice.)

Which of the following 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 bpm 2. Heart rate of 124 bpm 3. Blood pressure 86/56 4. Blood pressure 156/88 5. Tinnitus and vertigo

1 3 (Rationale: Atenolol (Tenormin) decreases blood pressure and heart rate. The administration of this drug may cause significant hypotension and bradycardia in some clients.)

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

1 3 4 (Rationale: Common adverse effects of lisinopril (Prinivil) and other ACE inhibitors include cough, headache, dizziness, change in sensation of taste, vomiting and diarrhea, and hypotension. Hyperkalemia may occur, especially when the drug is taken concurrently with potassium-sparing diuretics.)

A patient is receiving treatment for asthma with albuterol (Proventil). The nurse teaches the patient that while serious adverse effects are uncommon, the following may occur. (Select all that apply.) 1. Tachycardia 2. Sedation 3. Temporary dyspnea 4. Nervousness 5. Headache

1 4 5

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 of the following adverse effects? (Select all that apply.) 1. Anaphylaxis 2. Hypertension 3. Hemorrhage 4. Headache 5. Hypotension

1 4 5 (Rationale: Adverse effects of aminocaproic acid (Amicar) include headache, anaphylaxis, and hypotension. Options 2 and 3 are incorrect. Aminocaproic acid is given to prevent excessive bleeding and hemorrhage in cients with clotting disorders. it may cause hypotension, not hypertension.)

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 health care provider? 1. Constipation 2. Increasing muscle or joint pain 3. Hemorrhoids 4. Flushing or "hot flash"

2 (Rationale: "Statins" (HMG-CoA reductase inhibitors) such as atorvastatin (Lipitor) may cause rhabdomyolysis, a rare but serious adverse effect.)

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."

2 (Rationale: Anticoagulants do not change the viscosity of the blood. Instead, anticoagulants exert a negative charge on the surface of the platelets so that clumping or aggregation of cells is inhibited. )

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 (Rationale: Antiplatelet drugs such as clopidogrel are given to inhibit platelet aggregation and, thus, reduce the risk of thrombus formation. Options 1, 3, and 4 are incorrect. Antiplatelet drugs do not exert anti-inflammatory, antipyretic, or analgesic effects. The antiplatelet and anticoagulant drugs do not prevent emboli formation. Thrombolytics dissolve existing blood clots.)

The patient is being discharged with nitroglycerin (Nitrostat) for sublingual use. While planning patient education, what instructions will the nurse include? 1. "Swallow three tablets immediately for pain and call 911." 2. "Put one tablet under your tongue for chest pain. You may repeat in 5 minutes, taking no more than 3 tablets. If pain does not subside, call 911." 3. "Call your health care provider when you have chest pain. He will tell you how many tablets to take." 4. "Place three tablets under your tongue and call 911."

2 (Rationale: At the initial onset of chest pain, sublingual nitroglycerin is administered and three doses may be taken 5 minutes apart. Pain that persists 5 to 10 minutes after the initial dose may indicate an MI, and the client should seek emergency medical assistance for more definitive diagnosis and care.)

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 (Rationale: Erectile dysfunction drugs such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) decrease BP. When combined with nitrates, severe and prolonged hypotension may result.)

The nurse reviews laboratory studies of a patient receiving digoxin (Lanoxin). Intervention by the nurse is required if the results include which of the following laboratory values? 1. Serum digoxin level of 1.2 ng/dL 2. Serum potassium level of 3 mEq/L 3. Hemoglobin of 14.4 g/dL 4. Serum sodium level of 140 mEq/L

2 (Rationale: Normal serum potassium level is 3.5 to 5 mEq/L. Hypokalemia may predispose the client to digitalis toxicity)

A patient with significant hypertension unresponsive to other medications is given a prescription for hydralazine (Apresoline). 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 BP 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 (Rationale: Propranolol (Inderal) and other beta-blocking drugs are used to prevent reflex tachycardia that may occur as a result of treatment with direct-acting vasodilators. Giving two antihypertensive drugs together may also lower blood pressure further; however, the beta-blocking drugs also lower the heart rate and are given in this case to reduce the change for reflex bradycardia.)

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 (Rationale: The advantage of using a combination of two drugs such as atenolol (Tenormin; a beta blocker) and doxazosin (Cardura; an alpha-1 antagonist) is that lower doses of each may be used, resulting in fewer side effects.)

A patient has been prescribed fluticasone (Flonase) to use with oxymetazoline (Afrin). How should the patient be taught to use these drugs? 1. Use the fluticasone first, then the oxymetazoline after waiting 5 minutes. 2. Use the oxymetazoline first, then the fluticasone after waiting 5 minutes. 3. The drugs may be used in either order. 4. The fluticasone should be used only if the oxymetazoline fails to relieve the nasal congestion.

2 (decongestant before steroid)

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 3 (Rationale: Intense flushing and hot flashes occur in almost every client who is taking niacin. Tingling of the extremities may also occur.)

The nurse is preparing to administer the first dose of enalapril (Vasotec). Identify the potential adverse effects of this medication. (Select all that apply.) 1. Reflex hypertension 2. Hyperkalemia 3. Persistent cough 4. Angioedema 5. Hypotension

2 3 4 5 (Rationale: Side effects of ACE inhibitors such as enalapril (Vasotec) include persistent cough and postural hypotension. Hyperkalemia may occur and can be a major concern for those clients with renal impairment and in clients who are taking potassium-sparing diuretics. Though rare, the most serious adverse effect of ACE inhibitors is the development of angioedema.)

A patient who received a prescription for montelukast (Singulair) returns to his provider's office after three days, complaining that "the drug is not working." She reports mild but continued dyspnea and has had to maintain consistent use of her bronchodilator inhaler, albuterol (Proventil). What does the nurse suspect is the cause of the failure of montelukast? 1. The patient is not taking the drug correctly. 2. The patient is not responding to the drug and will need to be switched to another formulation. 3. The drug has not had sufficient time of use to have full effects. 4. The albuterol inhaler is interacting with the montelukast.

3

A patient with asthma has a prescription for two inhalers, albuterol (Proventil) and beclomethasone (Qvar). How should the nurse instruct this patient on the proper use of the inhalers? 1. Use the albuterol inhaler, and use the beclomethasone only if symptoms are not relieved. 2. Use the beclomethasone inhaler, and use the albuterol only if symptoms are not relieved. 3. Use the albuterol inhaler, wait 5-10 minutes, then use the beclomethasone inhaler. 4. Use the beclomethasone inhaler, wait 5-10 minutes, then use the albuterol inhaler.

3

Which of the following drugs is most immediately helpful in treating a severe acute asthma attack? 1. Beclomethasone (Qvar) 2. Zileuton (Zyflo CR) 3. Albuterol (Proventil, Ventolin) 4. Salmeterol (Serevent Diskus)

3

Which of the following is the best advice that the nurse can give a patient with viral rhinitis who intends to purchase an over-the-counter combination cold remedy? 1. Dosages in the remedies provide precise dosing for each symptom that you are experiencing. 2. These drugs are best used in conjunction with an antibiotic. 3. It is safer to use a single-drug preparation if you are experiencing only one symptom. 4. Since these drugs are available over the counter, it is safe to use any of them as long as needed.

3 (Rationale: A single agent would be a better choice, so that the patient is not taking unnecessary ingredients. Although convenient, combination cold remedies have disadvantages. These combinations all contain fixed doses, so there is a chance that one ingredient will be therapeutic, whereas another may be excessive or sub- therapeutic.)

A patient with heart failure has an order for lisinopril (Prinivil, Zestril). Which of the following conditions 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 (Rationale: Angioedema is a rare but potentially serious adverse effect from ACE inhibitors; because this client has had a previous reaction to another drug within the same group (enalapril/Vasotec), the nurse should confirm the order with the provider.)

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 (Rationale: Electrolytes, especially potassium for the presence of hypokalemia, should be assessed before beginning milrinone (Primacor) or any phosphodiesterase inhibitor. Hypokalemia should be corrected before administering phosphodiesterase inhibitors because this can increase the likelihood of dysrhythmias.)

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

3 (Rationale: Fibric acid agents (fibrates) may cause or worsen gallbladder disease and the order should be checked with the provider before giving.)

The patient has been given a prescription of furosemide (Lasix) as an adjunct to treatment of hypertension and returns for a follow-up check. Which of the following 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. BP log notes BP 120/70 mmHg to 134/88 mmHg since discharge 4. Frequency of voiding of at least six times per day

3 (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 patient is receiving a thrombolytic drug, alteplase (Activase), following an acute MI. Which of the following effects 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 (110.8 F)

3 (Rationale: Thrombolytic agents such as alteplase (Activase) dissolve existing clots rapidly and continue to have effects for up to 2 to 4 days. All forms of bleeding must be monitored and reported immediately. Options 1, 2, and 4 are incorrect. Skin rash, urticaria, labored respirations with wheezing, or temperature elevation are not directly associated with alteplase and other causes should be investigated.)

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 (Rationale: To prevent the development of nitrate tolerance, nitroglycerin patches are often removed at night for 6 to 12 hours.)

A patient has a prescription for fluticasone (Flonase). Place the following instructions in the order in which the nurse will instruct the patient to use the drug. 1. Instill one spray directed high into the nasal cavity. 2. Clear the nose by blowing. 3. Primer the inhaler prior to first use. 4. Spit out any excess liquid that drains into the mouth.

3 2 1 4

Place the following nursing interventions in order for a patient who is experiencing chest pain. 1. Administer nitroglycerin sublingually. 2. Assess heart rate and blood pressure. 3. Assess the location, quality, and intensity of pain. 4. Document interventions and outcomes. 5. Evaluate the location, quality, and intensity of pain.

3, 2, 1, 5, 4 (Rationale: Prior to administering nitrates for chest pain, the nurse must first assess the location, quality, and intensity of pain. Blood pressure and heart rate should be assessed and the health care provider contacted if the blood pressure is below 90/60 (or below previously established parameters) or if tachycardia is present before administering the dose. Once nitrates are administered, the location, quality, and intensity of the pain are evaluated after 5 minutes. If the pain is still present, the blood pressure and pulse should be reassessed before giving another dose (the second (2) above). Documentation of drug administration and client outcomes is completed after administration and re-evaluation.)

The patient is prescribed digoxin (Lanoxin) for treatment of HF. Which of the following statements 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?

A patient has been using a fluticasone (Flonase) inhaler as a component of his asthma therapy. He returns to his health care provider's office complaining of a sore mouth. On inspection, the nurse notices white patches in the patient's mouth. What is a possible explanation for these findings? 1. The patient has been consuming hot beverages after the use of the inhaler. 2. The patient has limited his fluid intake, resulting in dry mouth. 3. The residue of the inhaler propellant is coating the inside of his mouth. 4. The patient has developed thrush as a result of the fluticasone.

4

The nurse is teaching a patient about the use of dextromethorphan with guaifenesin (Robitussin-DM) syrup for a cough accompanied by thick mucus. Which instruction should be included in the patient's teaching? 1. Lie supine for 30 minutes after taking the liquid. 2. Drink minimal fluids to avoid stimulating the cough reflex. 3. Take the drug with food for best results. 4. Avoid drinking fluids immediately after the syrup but increase overall fluid intake throughout the day.

4

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 (Rationale: Grapefruit juice inhibits the metabolism of statins such as simvastatin (Zocor), allowing them to reach higher serum levels and increasing the risk of adverse effects.)

The teaching plan for a patient receiving hydralazine (Apresoline) should include which of the following points? 1. Returning for monthly urinalysis testing 2. Increasing 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 (Rationale: Hydralazine (Apresoline) commonly causes orthostatic hypotension and the client should be taught to rise slowly from a lying or sitting position to standing.)

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 (Rationale: Lightheadedness and dizziness may occur secondary to the hypotensive effects of the isosorbile (Isordil).)

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 (Rationale: Nadolol (Corgard; a beta blocker) may increase the risk of orthostatic hypotension and the client should be taught to rise slowly to standing from a sitting or lying position.)

For which of the following reasons should a patient attach a spacer to a metered-dose inhaler? A. To increase the amount of drug delivered to the lungs B. To increase the amount of drug delivered to the oropharynx C. To increase the amount of drug delivered on exhalation D. To increase the speed of drug delivery

A

When advising a patient about taking prednisone for chronic asthma, a HCP should include which of the following information? A. Avoid taking NSAIDs B. Rinse your mouth after taking the drug to prevent a yeast infection. C. Stop taking the drug if you become nauseated. D. Change positions slowly when standing up.

A

A HCP is reviewing the history of a patient who is about to begin furosemide (Lasix) therapy to treat hypertension. Which of the following drugs that the patient takes should alert the HCP to take further action? A. Lithium (Lithobid) for bipolar disorder B. Phenytoin (Dilantin) for seizure disorder C. Erythromycin (Erythrocin) for bronchitis D. Warfarin (Coumadin) to prevent blood clots

A (Rationale: furosemide, a high-ceiling loop diuretic, increases sodium loss and can cause reabsorption of lithium, a mood stabilizer. This puts patients taking both drugs at increased risk for lithium toxicity.)

When talking with a patient about taking amiodarone (Cordarone) to treat atrial fibrillation, which of the following should the health care professional tell the patient to avoid? A. Grapefruit juice B. Milk C. Foods high in vitamin K D. NSAIDs

A (Rationale: grapefruit juice, particularly in large amounts, can cause toxicity of potassium channel blockers such as amiodarone.)

A HCP is caring for a patient who is about to begin taking losartan (Cozaar) to treat hypertension. The HCP should tell the patient to report which of the following indications of an adverse reaction to the drug? A. Facial edema B. Sleepiness C. Peripheral edema D. Constipation

A (Rationale: losartan, an ARB, can cause angioedema, often manifesting as redness and swelling around the eyes and lips. Patients who develop this adverse effect should stop taking the drug and seek medical attention.)

A HCP is caring for a patient who is about to begin captopril (Capoten) therapy to treat hypertension. When talking with the patient about taking the drug, the HCP should tell her to report which of the following adverse effects because they can indicate a need to stop drug therapy? (Select all that apply.) A. Rash B. Distorted taste C. Swelling of the tongue D. Photosensitivity E. Dry cough

A B C E

A HCP is advising a patient about the adverse effects of pseudoephedrine (Sudafed). Which of the following should the HCP include? (Select all that apply.) A. Restlessness B. Bradycardia C. Insomnia D. Muscle pain E. Anxiety

A C E

A HCP who is advising a patient about the use of an expectorant to treat a cough should explain that this type of drug is effective because it performs which of the following actions? A. Suppresses the cough stimulus B. Reduces surface tension C. Reduces inflammation D. Dries mucous membranes

B

A provider is considering the various drug therapy options for treating a patient's cardiac dysrhythmia. He should be aware that which of the following antidysrhythmic drugs is appropriate only for short-term use because of its severe adverse effects with long-term use? A. Quinidine B. Procainamide C. Nitroglycerin D. Verapamil (Calan)

B

Before prescribing dextromethorphan (Robitussin) to a patient, the PCP should know that, when given with an opioid, the drug can result in which of the following? A. Reduced antitussive effect of dextromethorphan B. Potentiation of the analgesic effect of the opioid C. Increased renal absorption of dextromethorphan D. Delayed analgesic effect of the opioid

B

When explaining how a patient should use ipratropium (Atrovent), a HCP should include which of the following instructions? A. Do not drink anything for 30 min after using the drug. B. Wait 5 min between using the drug and another inhaled drug. C. Use the drug to abort acute bronchoconstriction. D. Check pulse rate after inhaling the drug.

B

When talking with a patient about taking clonidine (Catapres) to treat hypertension, the HCP should explain that discontinuing clonidine therapy abruptly can result in which of the following adverse effects? A. Constipation B. Hypertension C. Drowsiness D. Dry mouth

B (rebound hypertension)

A HCP is caring for a patient who is taking ipratropium (Atrovent). The HCP should explain which of the following adverse effects to the patient? (Select all that apply.) A. Muscle tremors B. Urinary retention C. Dry mouth D. Insomnia E. Tachycardia

B C

A HCP is caring for a patient who is about to begin taking gemfibrozil (Lopid) to treat hypercholesterolemia. Which of the following instructions should the HCP include when talking with the patient about the drug? (Select all that apply.) A. Take the drug with food. B. Report any new intolerance to fried foods. C. Report mx tenderness. D. Expect periodic liver fxn testing. E. Take the drug once a day.

B C D

A HCP is advising a patient about the use of beclomethasone (Beconase AQ) to treat asthma. The HCP should explain that the drug treats asthma because it performs which of the following actions? A. Thins mucous B. Relaxes bronchial smooth muscle C. Decreases inflammation D. Increases the cough threshold

C

A HCP is caring for a patient who has moderate to severe hypertension and is about to begin hydralazine therapy. The HCP should monitor the patient for which of the following adverse reactions to the drug? A. A flu-like syndrome B. Extrapyramidal symptoms C. A lupus-like syndrome D. Hypertensive crisis

C

A HCP is caring for a patient who is having difficulty mobilizing thick respiratory secretions. Which of the following drugs should the HCP expect to administer? A. Ipratropium (Atrovent) B. Beclomethasone (Beconase AQ) C. Acetylcysteine (Acetadote) D. Azelastine (Astelin)

C

A HCP is caring for a patient who is taking codeine. Which of the following is the most important assessment following administration of the drug? A. blood pressure B. apical heart rate C. respirations D. level of consciousness

C

A HCP who is advising a patient about the use of a mucolytic to treat a cough should explain that this type of drug is effective because it performs which of the following actions? A. Suppresses the cough stimulus B. Reduces inflammation C. Thins and loosens mucus D. Dries secretions

C

A HCP who is advising a patient about the use of antihistamines to treat allergic rhinitis should explain that these drugs are effective because they perform which of the following actions? A. Decreases viscosity of nasal secretions B. Blocks H2 receptors C. Prevents histamine from binding to receptors D. Reduces nasal congestion

C

A HCP who is advising a patient about using intranasal glucocorticoids should include which of the following instructions? A. Start at a low dose and gradually increase it. B. Take the drug as needed for nasal congestion. C. Allow at least 2 weeks for the full therapeutic effect. D. Use the drug prior to exercise.

C

A patient who is taking digoxin (Lanoxin) develops ECG changes and other manifestations that indicate severe digoxin toxicity. Which of the following drugs should the HCP have available to treat this complication? A. Acetylcysteine (Acetadote) B. Flumazenil (Mazicon) C. Fab antibody fragments (Digibind) D. Deferoxamine (Desferal)

C

A HCP is caring for a patient who is about to begin using transdermal nitroglycerin (Nitro-Dur) to treat angina pectoris. When talking with the patient about the drug, the HCP should include which of the following instructions? (Select all that apply.) A. Apply a new patch at the onset of anginal pain. B. Apply the patch to dry skin and cover the area with plastic wrap. C. Apply the patch to a hairless area and rotate sites. D. Apply a new patch each morning. E. Remove patches for 10-12 hr daily.

C D E

A HCP is caring for a patient who is about to begin taking propranolol (Inderal) to treat a tachydysrhythmia. The HCP should caution the patient about taking which of the following types of OTC drugs? A. Antihistamines B. Potassium supplements C. NSAIDs D. Antacids

D

A HCP should recognize that using pseudoephedrine (Sudafed) to treat allergic rhinitis requires cautious use with patients who have which of the following? A. PUD B. A seizure disorder C. Anemia D. CAD

D

A patient who takes carvedilol (Coreg) for hypertension is about to begin taking an oral antidiabetes drug to manage newly diagnosed type 2 DM. The HCP should make sure the PCP is aware that the patient is at increased risk for which of the following if she takes both drugs? A. Hyperglycemia B. Bradycardia C. Hypotension D. Hypoglycemia

D

When advising a patient about using zileuton (Zyflo) a HCP should include which of the following instructions? A. Check the apical pulse before taking the drug. B. Take the drug prior to exercise. C. Rinse the mouth after using the drug. D. Have lab tests performed at regular intervals.

D

When advising a patient who is beginning fluticasone propionate/salmeterol (Advair) therapy, which of the following instructions should a HCP include? A. Take the drug as needed for acute asthma. B. Follow a low-sodium diet. C. Use an alternate-day dosing schedule. D. Increase weight-bearing activity.

D

Which of the following should a HCP include when advising a patient about the use of montelukast (Singulair)? A. Use a spacer to improve inhalation. B. Take the drug at the onset of bronchospasm. C. Rinse the mouth to prevent an oral fungal infection. D. Take the drug once a day in the evening.

D

A HCP is caring for a patient who has a glomerular filtration rate of 10 mL/min and a reduced urine output. The HCP should question the use of HCTZ for the patient because of which of the following characteristics of the drug? A. The drug can cause hypoglycemia in patients who have low urine output. B. The drug does not reduce BP for patients who have low urine output. C. The drug can increase the risk of pulmonary edema for patients who have renal insufficiency. D. The drug does not promote diuresis for patients who have renal insufficiency.

D (Rationale: adequate kidney function is essential for HCTZ, a thiazide diuretic, to promote urine production and excretion effectively.)

A HCP is about to administer atenolol (Tenormin) to a patient who has hypertension. Which of the following assessments should the HCP perform prior to giving the patient the drug? A. Respiratory rate B. Level of consciousness C. Serum glucose D. Apical pulse

D (Rationale: atenolol, a BB, can cause bradycardia and orthostatic hypotension. HCPs should withhold the drug for an apical HR slower than 60/min.)

A HCP is caring for a patient who is about to begin taking verapamil (Calan) to treat atrial fibrillation. The HCP should tell the patient to avoid grapefruit juice while taking verapamil because it can cause A. tachycardia. B. dehydration. C. diarrhea. D. hypotension.

D (Rationale: large amounts of grapefruit juice increase blood levels of verapamil by inhibiting its metabolism. The excess amount of drug can intensify otherwise therapeutic effects like hypotension, causing serious risks for syncope and dizziness.)