NURS 368: Pharmacology Test 2- 44,45,47

A 58-year-old man has recently been prescribed atorvastatin (Lipitor) in an effort to reduce his cholesterol levels. The man has acknowledged the potentially harmful effects of hyperlipidemia and is motivated to make changes to resolve this health problem. What advice should the nurse give to this patient?

"It's a good idea to keep your intake of saturated fat to a bare minimum."

A client who is prescribed digoxin asks the nurse how he should take the drug. Which instruction would be most appropriate?

"Take the drug on an empty stomach at the same time each day." Explanation: Food and antacids interfere with the absorption of the drug. Digoxin should be taken on an empty stomach at approximately the same time each day. If the client takes an antacid, the client should separate the dose of antacid and digoxin by 2 to 4 hours.

You are discharging a patient home on HMG-CoA inhibitor therapy. What statement by the patient demonstrates that they have a clear understanding of the teaching you have done?

"I should take this drug at bedtime, since my body makes lipids mostly at night."

Which substance would a group of students identify as being responsible for breaking up dietary fats into smaller units?

Bile acids

The three major classes of drugs used to control blood lipids are statins, bile acid resins (or sequestrants), and fibrates. Which of the following is a fibrate?

Gemfibrozil

A group of students are reviewing the various antihypertensive agents. The students demonstrate understanding of the information when they identify which of the following as an example of an angiotensin II receptor blocker?

Losartan

A nurse checks a client's blood pressure and finds it to be 130/82. This client should be classified as having which stage of hypertension?

Prehypertension

The nurse monitors which client for an increased risk of digoxin toxicity?

The client with renal dysfunction

A patient has an elevated BUN. The patient has been prescribed digoxin (Lanoxin) for heart failure. What factor is important regarding this patient?

The dose should be decreased in this patient

Nesiritide is a human B-type natriuretic peptide.

True

A patient is being treated for heart failure. Which of the following is indicative of improved heart failure status?

decreased pedal edema

A patient has been prescribed atorvastatin (Lipitor) comes to the clinic with complaints of acute muscle pain not associated with exercise or injury, which indicates potential rhabdomyolysis. The nurse knows that the use of atorvastatin with which of the following products places the patient at risk for rhabdomyolysis?

grapefruit juice consumption

The most common adverse effects of lovastatin include which of the following?

headache and flatulence

Increased levels of low-density lipoprotein (LDL) combined with certain risk factors can lead to the development of which medical condition?

heart disease

LDL

normal 100-129

A patient is prescribed trandolapril (Mavik). What adverse effect should the patient be instructed on that can occur with angiotensin-converting enzyme inhibitor (ACE inhibitor)?

persistent cough

A patient with a history of congestive heart failure is being treated with digoxin (Lanoxin). This medication increases the force of contractions of the heart. What effect improves the contractility of the heart?

positive inotropic effect

A nurse is caring for a patient who is taking digoxin and a loop diuretic. Which of the following would be most important for the nurse to monitor?

potassium levels

Your patient, a 37-year-old woman, presents with a blood pressure of 118/86 mm Hg. She exercises regularly, is weight-appropriate for her height, and indicates no use of tobacco or alcohol. According to the 2003 guidelines, what would her blood pressure classify?

prehypertension

A nurse assessing a patient on digoxin observes features of toxicity. Which of the following visual disturbances should the nurse assess for in such patients?

yellow or green vision

After teaching a group of students about nitroprusside and cyanide toxicity, the instructor determines that the teaching was successful when the students identify which of the following as an assessment finding? Select all that apply.

• Dyspnea • Dilated pupils • Distant heart sounds • Shallow breathing

What information would be included in a lipoprotein profile?

• LDL • Total cholesterol • Triglycerides

Which of the following questions would be most important for a nurse to ask a female patient who is starting on an angiotensin II receptor blocker for hypertension?

"When was your last menstrual period?"

A patient is receiving digoxin. The nurse monitors the patient's digoxin level. Which finding would the nurse interpret as therapeutic?

1.5 ng/mL Therapeutic digoxin levels range from 0.5 ng/mL to 2.0 ng/mL

An appropriate goal for a client taking niacin would be to reduce total serum cholesterol to which level?

<200 mg/dL

A triage nurse in the emergency department suspects that a 78-year-old patient is experiencing severe digoxin toxicity with significant cardiac dysrhythmia. If she is correct, which of the following actions is likely to be taken?

Administer digoxin immune fab

Cheryl is prescribed a cardiac glycoside for the treatment of atrial fibrillation. She tells the nurse that she is concerned about her weight and wants to try this new weight loss program she read about on the Internet. What should a nurse advise her about using cardiac glycosides?

Advise her to avoid most over the counter drugs

A nurse who provides care in a busy clinic is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics in many patients. Treatment of high cholesterol using statins would be contraindicated in which of the following patients?

An obese male client who is a heavy alcohol user and who has cirrhosis of the liver

Mr. Emmeott is seen by the physician for follow-up for diabetic nephropathy. The physician prescribed losartan for the treatment of this condition because the medication has been shown to reduce the rate of end-stage renal disease. Which drug class does this drug belong to?

Angiotensin II receptor blockers

What is the most accurate method for preventing adverse effects associated with the use of digoxin?

Assess the patient's heart rate and hold administration if it is less than 60.

A female client presents to the emergency department with nausea, vomiting, and a heart rate of 45 beats per minute. Her husband states that she takes digoxin, Lasix, and nitroglycerin for chest pain. Laboratory results confirm digoxin toxicity. The nurse would expect the physician to order what medication to treat the bradycardia?

Atropine

A patient is receiving inamrinone. Which of the following would lead the nurse to suspect that the patient is experiencing thrombocytopenia?

Bruising

A nurse is educating a patient with hypertension who is prescribed losartan on the mechanism of action of the drug. Which of the following modes of action helps losartan to bring about its antihypertensive effect?

By blocking the angiotensin II receptors

A 46-year-old man with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension by his primary care provider after serial blood pressure readings. The clinician has opted to begin the patient on captopril (Capoten). The patient's nurse should recognize that the therapeutic effect of this drug is achieved in what way?

By inhibiting the transformation of angiotensin I to angiotensin II

A patient is prescribed a cardiotonic medication. Which of the following pre-administration assessments should the nurse perform on this patient?

Check for jugular vein distention

Blood lipids are a category of fatty acids, which are substances used within the body to perform essential functions. Which category of blood lipids is involved in the formation of atherosclerotic plaques?

Cholesterol

Which of the following would be classified as a bile acid sequestrant?

Cholestyramine

A patient who has been taking lovastatin (Mevacor) has seen an improvement in his cholesterol laboratory values; however, the low-density lipoprotein remains elevated. What medication will be added to the medical regime?

Cholestyramine (Questran)

A nurse is caring for a patient admitted to the intensive care unit because of heart failure. The patient is prescribed digoxin. Which of the following nursing diagnoses would be appropriate for this patient?

Decreased Cardiac Output related to altered cardiac function

Recommended treatments for patients with dyslipidemia are made according to their blood levels of total and LDL cholesterol and risk factors for cardiovascular disease. What does the impact of existing cardiovascular disease have on recommendations?

Decreases target serum LDL level

Your 71-year-old male patient has recently been diagnosed with hypertension. Which of the following measurements is a partial indication of effective treatment and management?

Diastolic blood pressure below 90 mm Hg

Key behavioral determinants of blood pressure are related to what factor?

Dietary consumption of calories and salt

A nurse is planning an in-service program for a group of staff nurses about heart failure and its treatment. The nurse would identify which agent as the most commonly used drug for treatment?

Digoxin

After teaching a class of students about heart failure and drug therapy, the instructor determines that the teaching has been successful when the students identify which drug as most often used as treatment?

Digoxin

A male client is diagnosed with heart failure. The physician orders a loading dose of digoxin. Loading doses are necessary for what reason?

Digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading.

What drug is a safe and effective calcium channel blocker only if given as sustained-release or extended-release preparations to treat hypertension?

Diltiazem (Cardizem)

You are teaching your client about nicotinic acid, which the physician has prescribed for treatment of hyperlipidemia. What common adverse effect should you mention to the client?

Flushing of the skin

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

Frequently monitor blood cholesterol.

You are teaching a patient about her newly prescribed digoxin. The patient tells you that she occasionally uses herbal therapies. You should caution the patient against using therapies that involve which of the following herbs?

Ginseng

The pharmacology instructor is discussing medications used in the treatment of dyslipidemia. Which of the following drug classes would the instructor identify as the most widely used dyslipidemia drugs?

HMG-CoA reductase inhibitors

Which drug will be most effective in reducing the major types of dyslipidemia?

HMG-CoA reductase inhibitors

A client is receiving a diuretic as the first-line treatment of mild hypertension. The nurse monitors the client for signs and symptoms of hypokalemia with which agent?

Hydrochlorothiazide

A nurse is preparing to administer inamrinone. The nurse would administer this drug most likely by which route?

IV

What are cardiac glycosides used for?

Increase the force of the contraction of the heart

The patient has been placed on a nitroprusside drip for the treatment of a hypertensive crisis. Which mechanism of action does the nurse know is true for nitroprusside?

It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins.

The nurse is caring for a patient receiving cardiotonic drugs. The patient has edema. Which of the following interventions should be taken to alleviate edema?

Measurement of intake and output

The nurse is preparing to administer digoxin to a 9-month-old infant. What must the nurse do prior to administration of this medication?

Monitor the infant's apical pulse

The ICU nurse is caring for a patient in shock. What is one of the most important functions of the nursing role in caring for this patient?

Monitoring for complications and side effects of treatment

A patient is taking lovastatin (Mevacor). Which of the following is noted as the most common adverse effects?

Nausea, flatulence, and constipation

When dosing digoxin (Lanoxin), which of the following factors are considered?

Patient lean body weight • Patient age • Renal function • Pharmacokinetics • Pharmacodynamics

Which of the following would a nurse expect to assess if a client is experiencing right-sided heart failure?

Peripheral edema

A client is receiving inamrinone. Which of the following would be most important for the nurse to monitor?

Platelet count

Your client has acute onset pulmonary edema. He has not experienced a response to digitalization. You would expect which of the following drugs to be used for this client?

Primacor

A provider chooses to treat an African American client suffering from hypertension with a beta blocker and diuretic instead of an ACE inhibitor. The nurse knows that the provider did this for what reason?

Research has shown beta blockers, in combination with diuretics, treat hypertension in African Americans better than ACE inhibitors.

A student asks the instructor what the goal of drug therapy is in hypotension and shock. What would the instructor respond?

Restore and maintain adequate tissue perfusion.

The client has been taking rosuvastatin for hyperlipidemia. She now presents with complaints of severe weakness. She states she can barely move her extremities because she is so weak. The nurse suspects the client has which of the following?

Rhabdomyolysis

A patient is experiencing orthostatic hypotension that is due to his antihypertensive therapy. Which nursing diagnosis would be most appropriate?

Risk for injury

What should the nurse suggest to assist a client to improve his cholesterol levels?

Smoking cessation

A client with a blood pressure of 165/95 mmHg would be in classified as which stage of hypertension?

Stage 2

A patient has had multiple blood pressure readings that indicate he is hypertensive. How is hypertension defined?

Systolic pressure above 140 mm Hg or diastolic pressure above 90 mm Hg

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

Take the drug regularly without skipping a dose

A patient who has an elevated triglyceride level and reduced high-density lipoprotein cholesterol is seen by her primary care physician. What do these laboratory tests indicate in this patient?

The development of metabolic syndrome Metabolic syndrome is noted when the patient has elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose

A patient who is taking a calcium channel blocker calls the clinic nurse with complaints of symptoms of drug toxicity. What would be a priority assessment for the nurse to make on this patient?

The ingestion of grapefruit juice

Your patient, a 37-year-old woman with moderately elevated lipid levels, requests immediate pharmacotherapy for her dyslipidemia. You explain that a period of intensive diet therapy and lifestyle modification will be utilized before drug therapy is considered. You explain the rationale for this regimen as:

Therapeutic lifestyle changes are the preferred method for lowering blood lipids.

Beta-blockers reduce both morbidity and mortality associated with heart failure. By what mechanism do they work in heart failure?

They block the sympathetic response

A patient with metabolic syndrome usually has increased plasminogen activator levels.

True

Vasodilators used to treat heart failure include nitrates and ACE inhibitors

True

Which of the following is an adverse reaction associated with cardiotonic medications?

Visual disturbances

HMG-CoA reductase inhibitors (statins) are in which pregnancy category?

X

A 26-year-old white male patient has been prescribed captopril for hypertension. A nurse has been assigned to the patient to provide education regarding the use of this drug. The nurse will advise the patient that

a persistent, dry cough may occur; however, it is not serious.

The nurse knows that what physiologic changes will effect a client's stroke volume?

changes in heart contraction

Your client's digoxin level is reported to be 2.2 ng/mL. You know that this result indicates:

digitalis toxicity

A 57-year-old female client is postmenopausal. Lifestyle changes have not made a significant impact on her lipids. What would the nurse expect the physician to suggest?

estrogen replacement therapy; increases HDL

An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for

falls

HDL

high is > or equal to 60 low is less than or equal to 40

What is the most common reason for an elevated cholesterol level in a client who does not have a genetic disorder of lipid metabolism?

his dietary intake of saturated fat

A patient with diabetes mellitus is prescribed captopril (Capoten) to treat hypertension. What electrolyte imbalance might the patient be prone to develop?

hyperkalemia

After teaching a group of students about the cardiovascular system and pressures, the students demonstrate understanding of the information when they identify which area as having the highest pressure?

left ventricle

After receiving the results of his echocardiogram, your patient has many questions regarding results and their impact on his lifestyle. He is a 57-year-old Hispanic man with a 10-year history of hypertension. Disturbed by all the dietary changes proposed by the cardiologist, he questions what effect hypertension has on his heart. What is your reply?

myocardium herptrophy

Total cholesterol

normal <200

Triglycerides

normal is < or equal to 150

The nurse is to administer digoxin to a client with heart failure. The nurse auscultates an apical pulse rate of 52. What action should the nurse take?

notify the physician

During a routine check up of a 45-year-old patient with renal disease, the nurse observes an increase in the patient's blood pressure. Which of the following is the most likely consequence of renal impairment?

secondary hypertension

Cholesterol is the base unit for the formation of steroid hormones.

true

Autoregulation of blood flow is directly connected to raising or lowering blood pressure via vasoactive substances. Which of the following are vasoconstrictive substances? Select all that apply.

• Angiotensin II • Endothelin-1

How can the home care nurse assist the client or the client's family members who have hypertension? (Select all that apply.)

• Monitoring for drug effects • Promoting compliance with the prescribed pharmacologic modifications • Promoting compliance with the prescribed lifestyle modifications

Which of the following adverse effects would the nurse include in the teaching plan for a patient receiving fenofibric acid as most common?

• Runny nose • Respiratory infections