Pharm 3

Which finding suggests that a patient is experiencing an adverse effect of metoprolol (Lopressor)? A) The patient complains of headaches. B) The patient's potassium level is 3.3 mEq/L. C) The patient's resting heart rate is 58 beats per minute on the cardiac monitor. D) The PR interval on the patient's cardiac rhythm strip is 0.32 seconds.

D) The PR interval on the patient's cardiac rhythm strip is 0.32 seconds.

For all patients undergoing percutaneous coronary intervention (PCI), which drug is recommended to be combined with clopidogrel [Plavix]?

Aspirin

The nurse is preparing to administer an intravenous (IV) nitroglycerin infusion. For which patient should the nurse question the healthcare provider's prescription to administer IV nitroglycerin infusion?

A patient with a right ventricular infarction, confirmed by right-sided ECG changes

Teaching for a patient with angina who is being discharged with a prescription for nitroglycerin sublingual tablets should include which instruction? A) "Store the tablets in their original dark container." B) "The tablets are only good for 1 month after the container is opened." C) "Sublingual nitroglycerin tablets are also effective when swallowed whole." D) "Effects of sublingual nitroglycerin begin in 5 to 10 minutes."

A) "Store the tablets in their original dark container."

Patients receiving nitroglycerin are at risk for which adverse effects? (Select all that apply.) A) Headache B) Wheezing C) Dizziness D) Tachycardia E) Bradycardia

A) Headache C) Dizziness D) Tachycardia

The nurse understands that ventricular fibrillation is a common cause of death after myocardial infarction (MI). Which drug should be readily available to treat ventricular fibrillation?

Amiodarone [Cordarone]

The nurse is conducting discharge teaching for a patient with a new prescription for transdermal nitroglycerin. Which statement by the patient indicates a need for further teaching? A) "I will remove my patch at bedtime each evening." B) "I will limit my alcohol to one drink per day." C) "I will not use Viagra as long as I am on nitroglycerin." D) "I will move slowly when changing positions."

B) "I will limit my alcohol to one drink per day."

A patient is receiving isosorbide dinitrate (Isordil) 20 mg 3 times/day for management of newly diagnosed stable angina. Which assessment finding requires immediate intervention by the nurse? A) A change in blood pressure from 122/70 to 108/66 mm Hg B) An increase in the resting heart rate to 110 beats per minute from baseline rates of 68 to 72 beats per minute C) A headache the patient rates as a 5 on a pain scale of 1 to 10 D) Report of increased frequency of urination

B) An increase in the resting heart rate to 110 beats per minute from baseline rates of 68 to 72 beats per minute

Which are the main families of drugs used to prevent or relieve anginal pain? (Select all that apply.) A) Platelet inhibitors B) Beta blockers C) Nitrates D) Calcium channel blockers E) Statins

B) Beta blockers C) Nitrates D) Calcium channel blockers

The nurse is caring for a patient who is receiving enteral feedings because of dysphagia. The physician orders isosorbide mononitrate (Imdur) 60 mg daily via the enteral tube. What would be an appropriate action by the nurse? A) Have the patient swallow the pill, because it cannot be crushed. B) Call the physician about an alternate form of nitrate for administration. C) Crush the Imdur into a fine powder, dilute it with water, and administer it via the enteral tube. D) Place the nitrate under the patient's tongue and let it dissolve, because the person has dysphagia

B) Call the physician about an alternate form of nitrate for administration.

Which medication combination is useful in the treatment of variant angina? A) Metoprolol (Lopressor) and ranozaline (Ranexa) B) Isosorbide dinitrate (Isordil) and metoprolol (Lopressor) C) Diltiazem (Cardizem) and isosorbide mononitrate (Imdur) D) Propranolol (Inderal) and diltiazem (Cardizem)

C) Diltiazem (Cardizem) and isosorbide mononitrate (Imdur)

The nurse is monitoring a patient receiving ranolazine (Ranexa) for angina. Which finding indicates an adverse effect of this drug? A) Blood pressure of 90/50 mm Hg B) Frequent bloody stools C) QT prolongation on the electrocardiogram D) Respiratory rate of 11 breaths per minute

C) QT prolongation on the electrocardiogram

The nurse is caring for a patient receiving nitrates for relief of angina. What pharmacodynamic action is responsible for the relief of anginal pain with nitrates? A) Vasoconstriction leads to improved cardiac output. B) Decreased force of contraction leads to decreased oxygen demand. C) Vasodilation leads to decreased preload, which decreases oxygen demand. D) Influx of calcium ions leads to relaxation of vascular smooth muscle.

C) Vasodilation leads to decreased preload, which decreases oxygen demand.

The nurse in the emergency department is receiving a report on a patient diagnosed with ST-elevation myocardial infarction (STEMI). What are the common biochemical markers and symptoms for a STEMI? (Select all that apply.)

Chest pain and electrocardiographic (ECG) changes Elevated troponin T level Elevated creatinine kinase level Weakness diaphoresis

Which activity noted by the home care nurse indicates that the patient needs further teaching about topical nitroglycerin ointment A) The patient rotates the application sites to minimize skin irritation. B) The patient uses the applicator paper to measure the prescribed dose. C) The patient removes ointment from a previous dose before applying the next dose. D) The patient applies the prescribed ribbon of ointment to the applicator paper and places it on the chest.

D) The patient applies the prescribed ribbon of ointment to the applicator paper and places it on the chest.

Which drug would not be included in the treatment plan for a patient who will undergo a primary percutaneous coronary intervention (PCI)?

Diltiazem [Cardizem]

A patient is admitted to the emergency department complaining of chest pain, and the electrocardiogram (ECG) shows an evolving ST-segment elevation myocardial infarction (STEMI). What intervention should the nurse anticipate?

Have the patient chew a 325-mg aspirin.

A patient is admitted to the emergency department with a diagnosis of ST-segment elevation myocardial infarction (STEMI). Which is the priority nursing action?

Having the patient chew a 325-mg aspirin

Which adverse effect is the greatest concern with thrombolytic therapy?

Intracranial hemorrhage

The nurse is teaching a patient who has had an ST-segment elevation myocardial infarction (STEMI) about home medications. Which agent represents a drug category that should be taken by all post-MI patients?

Metoprolol [Lopressor]

Which medication is the treatment of choice for ST-segment elevation myocardial infarction (STEMI)-associated pain?

Morphine

Which is the most beneficial treatment for patients experiencing an ST-segment elevation myocardial infarction (STEMI)?

Reperfusion therapy

A patient who has been taking an antihypertensive medication for several years is recovering from a myocardial infarction. The prescriber changes the patient's medication to an ACE inhibitor. The patient asks the nurse why a new drug is necessary. What is the nurse's response? a. "ACE inhibitors can prevent or reverse pathologic changes in the heart's structure." b. "ACE inhibitors help lower LDL cholesterol and raise HDL cholesterol." c. "ACE inhibitors increase venous return to the heart, improving cardiac output." d. "ACE inhibitors regulate electrolytes that affect the cardiac rhythm."

a. "ACE inhibitors can prevent or reverse pathologic changes in the heart's structure."

A nurse is giving aspirin to a patient during acute management of STEMI. The patient asks why a chewable tablet is given. Which response by the nurse is correct? a. "Aspirin is absorbed more quickly when it is chewed." b. "Chewing aspirin prevents it from being metabolized by the liver." c. "Chewing aspirin prevents stomach irritation." d. "More of the drug is absorbed when aspirin is chewed."

a. "Aspirin is absorbed more quickly when it is chewed."

8. A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching? a. "Beta blockers block the actions of angiotensin II." b. "Beta blockers decrease heart rate and contractility." c. "Beta blockers decrease peripheral vascular resistance." d. "Beta blockers decrease the release of renin."

a. "Beta blockers block the actions of angiotensin II."

3. A nurse is teaching a patient who will begin taking verapamil [Calan] for hypertension about the drug's side effects. Which statement by the patient indicates understanding of the teaching? a. "I may become constipated, so I should increase fluids and fiber." b. "I may experience a rapid heart rate as a result of taking this drug." c. "I may have swelling of my hands and feet, but this will subside." d. "I may need to increase my digoxin dose while taking this drug."

a. "I may become constipated, so I should increase fluids and fiber."

A nurse is teaching a patient about the use of sildenafil [Viagra] for erectile dysfunction. Which statement by the patient indicates understanding of the teaching? a. "If my erection lasts longer than 4 hours, I should contact my provider." b. "I should not use nitroglycerin within 12 hours of using sildenafil." c. "I should take this drug about 15 minutes before sexual activity." d. "This drug may cause me to have an erection when I don't want one."

a. "If my erection lasts longer than 4 hours, I should contact my provider."

A nursing student is helping to care for a patient who takes verapamil for stable angina. The nurse asks the student to explain the purpose of verapamil in the treatment of this patient. Which statement by the student indicates a need for further teaching? a. "It relaxes coronary artery spasms." b. "It reduces peripheral resistance to reduce oxygen demands." c. "It reduces the heart rate, AV conduction, and contractility." d. "It relaxes the peripheral arterioles to reduce afterload."

a. "It relaxes coronary artery spasms."

Lovastatin [Mevacor] is prescribed for a patient for the first time. The nurse should provide the patient with which instruction? a. "Take lovastatin with your evening meal." b. "Take this medicine before breakfast." c. "You may take lovastatin without regard to meals." d. "Take this medicine on an empty stomach."

a. "Take lovastatin with your evening meal."

A patient who has renal impairment will begin taking ranolazine [Ranexa] as an adjunct to nitroglycerine to treat angina. What will the nurse include when teaching this patient? a. "You will need to monitor your blood pressure closely while taking this drug." b. "You should take this drug 1 hour before or 2 hours after a meal." c. "You may experience rapid heart rate while taking this medication." d. "You do not need to worry about drug interactions with this medication."

a. "You will need to monitor your blood pressure closely while taking this drug."

Which patients may receive hydralazine to treat hypertension? (Select all that apply.) a. A 1-month-old infant b. A 5-year-old child c. A pregnant woman d. A mother breast-feeding a newborn e. An older adult ANS: A, B, E

a. A 1-month-old infant b. A 5-year-old child e. An older adult

A patient with hypertension is admitted to the hospital. On admission the patient's heart rate is 72 beats per minute, and the blood pressure is 140/95 mm Hg. After administering an antihypertensive medication, the nurse notes a heart rate of 85 beats per minute and a blood pressure of 130/80 mm Hg. What does the nurse expect to occur? a. A decrease in the heart rate back to baseline in 1 to 2 days b. An increase in the blood pressure within a few days c. An increase in potassium retention in 1 to 2 days d. A decrease in fluid retention within a week

a. A decrease in the heart rate back to baseline in 1 to 2 days

2. A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient? a. ACE inhibitors b. Beta blockers c. Direct-acting vasodilators d. Thiazide diuretics

a. ACE inhibitors

A patient with asthma and depression develops stable angina. In addition to organic nitrites, which other medications will be used to treat this condition? (Select all that apply.) a. ACE inhibitors b. Antiplatelet drugs c. Beta blockers d. Calcium channel blockers e. Cholesterol-lowering drugs

a. ACE inhibitors b. Antiplatelet drugs d. Calcium channel blockers e. Cholesterol-lowering drugs

Patients with a history of myocardial infarction should take which medications indefinitely? (Select all that apply.) a. ACE inhibitors b. Alteplase c. Aspirin d. Beta blockers e. Clopidogrel

a. ACE inhibitors c. Aspirin d. Beta blockers

1. A nurse is caring for a patient who is receiving verapamil [Calan] for hypertension and digoxin [Lanoxin] for heart failure. The nurse will observe this patient for: a. AV blockade. b. gingival hyperplasia. c. migraine headaches. d. reflex tachycardia.

a. AV blockade.

A patient with stable exertional angina has been receiving a beta blocker. Before giving the drug, the nurse notes a resting heart rate of 55 beats per minute. Which is an appropriate nursing action? a. Administer the drug as ordered, because this is a desired effect. b. Withhold the dose and notify the provider of the heart rate. c. Request an order for a lower dose of the medication. d. Request an order to change to another antianginal medication.

a. Administer the drug as ordered, because this is a desired effect.

Which are therapeutic uses for verapamil? (Select all that apply.) a. Angina of effort b. Cardiac dysrhythmias c. Essential hypertension d. Sick sinus syndrome e. Suppression of preterm labor

a. Angina of effort b. Cardiac dysrhythmias c. Essential hypertension

A patient arrives in the emergency department complaining of muscle weakness and drowsiness. The nurse notes a heart rate of 80 beats per minute, a respiratory rate of 18 breaths per minute, and a blood pressure of 90/50 mm Hg. The electrocardiogram reveals an abnormal rhythm. The nurse will question the patient about which over-the-counter medication? a. Antacids b. Aspirin c. Laxatives d. Potassium supplements

a. Antacids

A patient arrives in the emergency department complaining of chest pain that has lasted longer than 1 hour and is unrelieved by nitroglycerin. The patient's electrocardiogram reveals elevation of the ST segment. Initial cardiac troponin levels are negative. The patient is receiving oxygen via nasal cannula. Which drug should be given immediately? a. Aspirin 325 mg chewable b. Beta blocker given IV c. Ibuprofen 400 mg orally d. Morphine intravenously

a. Aspirin 325 mg chewable

A patient who has erectile dysfunction asks about medications to treat this disorder, but tells the nurse he doesn't want to have to plan sexual activity several hours in advance. Which medication will the nurse expect the provider to order for this patient? a. Avanafil [Stendra] b. Sildenafil [Viagra] c. Tadalafil [Cialis] d. Vardenafil [Levitra]

a. Avanafil [Stendra]

While performing an admission assessment on a patient, the nurse learns that the patient is taking furosemide [Lasix], digoxin, and spironolactone [Aldactone]. A diet history reveals the use of salt substitutes. The patient is confused and dyspneic and complains of hand and foot tingling. Which is an appropriate nursing action for this patient? a. Contact the provider to request orders for an electrocardiogram and serum electrolyte levels. b. Evaluate the patient's urine output and request an order for intravenous potassium. c. Hold the next dose of furosemide and request an order for intravenous magnesium sulfate. d. Request an order for intravenous insulin to help this patient regulate extracellular potassium.

a. Contact the provider to request orders for an electrocardiogram and serum electrolyte levels.

A patient who is taking warfarin [Coumadin] has just vomited blood. The nurse notifies the provider, who orders lab work revealing a PT of 42 seconds and an INR of 3.5. The nurse will expect to administer: a. phytonadione (vitamin K1) 1 mg IV over 1 hour. b. phytonadione (vitamin K1) 2.5 mg PO. c. protamine sulfate 20 mg PO. d. protamine sulfate 20 mg slow IV push.

a. phytonadione (vitamin K1) 1 mg IV over 1 hour

A patient with angina who uses sublingual nitroglycerin tells the nurse that the episodes are increasing in frequency and usually occur when the patient walks the dog. The patient reports needing almost daily doses of the nitroglycerin and states that one tablet usually provides complete relief. What will the nurse do? a. Contact the provider to suggest ordering a transdermal patch for this patient. b. Question the patient about consumption of grapefruit juice. c. Suggest that the patient limit walking the dog to shorter distances less frequently. d. Suggest that the patient take two tablets of nitroglycerin each time, because the symptoms are increasing in frequency.

a. Contact the provider to suggest ordering a transdermal patch for this patient.

4. The nurse is caring for a patient who is taking a vasodilator that dilates capacitance vessels. The nurse will expect which effect in this patient? a. Decrease in cardiac work b. Increase in cardiac output c. Increase in tissue perfusion d. Increase in venous return

a. Decrease in cardiac work

A nurse is caring for a patient who is receiving a drug that causes constriction of arterioles. The nurse expects to observe which effect from this drug? a. Decreased stroke volume b. Increased stroke volume c. Decreased myocardial contractility d. Increased myocardial contractility

a. Decreased stroke volume

Besides having diuretic effects for patients with congestive heart failure, thiazides are also used to treat what? (Select all that apply.) a. Diabetes insipidus b. Hepatic failure c. Increased intracranial pressure d. Intraocular pressure e. Postmenopausal osteoporosis

a. Diabetes insipidus b. Hepatic failure e. Postmenopausal osteoporosis

A patient is admitted to the hospital after several days of vomiting and diarrhea. After an initial bolus of isotonic (0.9%) sodium chloride solution, the prescriber orders dextrose 5% in normal saline (D5NS) with 20 mEq potassium chloride to infuse at a maintenance rate. What should the nurse review before implementing this order? (Select all that apply.) a. Electrocardiogram b. Arterial blood gas levels c. Serum electrolyte levels d. Serum glucose level e. Urine output

a. Electrocardiogram c. Serum electrolyte levels e. Urine output

8. An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide [HydroDIURIL]. Before administering this medication, the nurse reviews the patient's chart. Which laboratory value causes the nurse the most concern? a. Elevated creatinine clearance b. Elevated serum potassium level c. Normal blood glucose level d. Low levels of low-density lipoprotein (LDL) cholesterol

a. Elevated creatinine clearance

7. A nurse is obtaining a medication history on a newly admitted patient, who reports taking minoxidil for hypertension. Admission vital signs reveal a heart rate of 78 beats per minute and a blood pressure of 120/80 mm Hg. What is an important part of the initial assessment for this patient? a. Evaluating ankle edema b. Monitoring for nausea and vomiting c. Noting the presence of hypertrichosis d. Obtaining a blood glucose

a. Evaluating ankle edema

A patient is being started on nicotinic acid [Niaspan] to reduce triglyceride levels. The nurse is providing patient education and should include teaching about which adverse effects? (Select all that apply.) a. Facial flushing b. Constipation c. Hypoglycemia d. Gastric upset e. Itching

a. Facial flushing d. Gastric upset e. Itching

1. A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to administer which drug? a. Furosemide [Lasix] b. Hydrochlorothiazide [HydroDIURIL] c. Mannitol [Osmitrol] d. Spironolactone [Aldactone]

a. Furosemide [Lasix]

13. Which two-drug regimen would be appropriate for a patient with hypertension who does not have other compelling conditions? a. Hydrochlorothiazide and nadolol b. Hydralazine and minoxidil c. Spironolactone and amiloride d. Trichlormethiazide and hydrochlorothiazide

a. Hydrochlorothiazide and nadolol

3. A patient has three separate blood pressure (BP) readings of 120/100 mm Hg, 138/92 mm Hg, and 126/96 mm Hg. Which category describes this patient's BP? a. Hypertension b. Isolated systolic hypertension c. Normal d. Prehypertension

a. Hypertension

A nurse administers an ACE inhibitor to a patient who is taking the drug for the first time. What will the nurse do? a. Instruct the patient not to get up without assistance. b. Make sure the patient takes a potassium supplement. c. Report the presence of a dry cough to the prescriber. d. Request an order for a diuretic to counter the side effects of the ACE inhibitor.

a. Instruct the patient not to get up without assistance.

6. A patient with hypertension with a blood pressure of 168/110 mm Hg begins taking hydrochlorothiazide and verapamil. The patient returns to the clinic after 2 weeks of drug therapy, and the nurse notes a blood pressure of 140/85 mm Hg and a heart rate of 98 beats per minute. What will the nurse do? a. Notify the provider and ask about adding a beta blocker medication. b. Reassure the patient that the medications are working. c. Remind the patient to move slowly from sitting to standing. d. Request an order for an electrocardiogram.

a. Notify the provider and ask about adding a beta blocker medication.

12. A hospitalized patient has a blood pressure of 145/96 mm Hg. The nurse caring for this patient notes that the blood pressure the day before was 132/98 mm Hg. The patient reports ambulatory blood pressure readings of 136/98 and 138/92 mm Hg. The patient has a history of a previous myocardial infarction and has adopted a lifestyle that includes use of the DASH diet and regular exercise. What will the nurse do? a. Notify the provider and discuss ordering a beta blocker for this patient. b. Notify the provider and suggest a thiazide diuretic as initial therapy. c. Order a diet low in sodium and high in potassium for this patient. d. Recheck the patient's blood pressure in 4 hours to verify the result.

a. Notify the provider and discuss ordering a beta blocker for this patient.

6. A patient who was in a motor vehicle accident sustained a severe head injury and is brought into the emergency department. The provider orders intravenous mannitol [Osmitrol]. The nurse knows that this is given to: a. reduce intracranial pressure. b. reduce renal perfusion. c. reduce peripheral edema. d. restore extracellular fluid.

a. reduce intracranial pressure.

Which are contraindications for taking sildenafil [Viagra]? (Select all that apply.) a. Patients who are taking nitroglycerin for angina pectoris b. Patients with nonarteritic ischemic optic neuropathy (NAION) in one eye c. Patients with BPH who are taking alpha1-adrenergic antagonists d. Patients with a blood pressure of 100/60 mm Hge. Patients with a history of myocardial infarction (MI) in the past 6 months

a. Patients who are taking nitroglycerin for angina pectoris b. Patients with nonarteritic ischemic optic neuropathy (NAION) in one eye c. Patients with BPH who are taking alpha1-adrenergic antagonists

15. A patient with a recent onset of nephrosclerosis has been taking an ACE inhibitor and a thiazide diuretic. The patient's initial blood pressure was 148/100 mm Hg. After 1 month of drug therapy, the patient's blood pressure is 130/90 mm Hg. The nurse will contact the provider to discuss: a. adding a calcium channel blocker to this patient's drug regimen. b. lowering doses of the antihypertensive medications. c. ordering a high-potassium diet. d. adding spironolactone to the drug regimen.

a. adding a calcium channel blocker to this patient's drug regimen.

6. A female patient with essential hypertension is being treated with hydralazine 25 mg twice daily. The nurse assesses the patient and notes a heart rate of 96 beats per minute and a blood pressure of 110/72 mm Hg. The nurse will request an order to: a. administer a beta blocker. b. administer a drug that dilates veins. c. reduce the dose of hydralazine. d. give the patient a diuretic.

a. administer a beta blocker.

A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that the patient's INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider and: a. administer the dose as ordered. b. request an order to decrease the dose. c. request an order to give vitamin K (phytonadione). d. request an order to increase the dose.

a. administer the dose as ordered.

A patient who was injured at home is brought to the emergency department. The nurse caring for this patient notes a respiratory rate of 32 breaths per minute and a heart rate of 90 beats per minute. The injuries are minor, but the patient is inconsolable and hysterical. The nurse expects that initial management will include: a. administering a gas mixture of 5% carbon dioxide (CO2). b. providing 100% oxygen via nasal cannula. c. giving sodium bicarbonate IV. d. providing sedatives to calm the patient.

a. administering a gas mixture of 5% carbon dioxide (CO2).

5. A patient who took an overdose of verapamil has been treated with gastric lavage and a cathartic. The emergency department nurse assesses the patient and notes a heart rate of 50 beats per minute and a blood pressure of 90/50 mm Hg. The nurse will anticipate: a. administering intravenous norepinephrine (NE) and atropine and glucagon. b. assisting with direct-current (DC) cardioversion. c. placing the patient in an upright position. d. preparing to administer a beta blocker.

a. administering intravenous norepinephrine (NE) and atropine and glucagon.

A patient is taking a drug that interferes with venous constriction. The nurse will tell the patient to: a. ask for assistance when getting out of bed. b. expect bradycardia for a few days. c. notify the provider if headache occurs. d. report shortness of breath.

a. ask for assistance when getting out of bed.''

The nurse has just received an order for tenecteplase [TNKase] for a patient experiencing an acute myocardial infarction. The nurse should administer this drug: a. by bolus injection. b. by infusion pump over 24 hours. c. slowly over 90 minutes. d. via monitored, prolonged infusion.

a. by bolus injection.

2. A patient is taking a vasodilator that relaxes smooth muscles in veins. To help minimize drug side effects, the nurse caring for this patient will: a. caution the patient not to get up abruptly. b. encourage the patient to increase fluid intake. c. tell the patient to report shortness of breath. d. warn the patient about the possibility of bradycardia.

a. caution the patient not to get up abruptly.

A nurse is assessing a patient who has heart failure. The patient complains of shortness of breath, and the nurse auscultates crackles in both lungs. The nurse understands that these symptoms are the result of: a. decreased force of ventricular contraction. b. increased force of ventricular contraction. c. decreased ventricular filling. d. increased ventricular filling.

a. decreased force of ventricular contraction.

A male patient tells the nurse he awakens once or twice each night to void and has difficulty starting his stream of urine. He describes these symptoms as "annoying." The patient's provider examines him and notes that the prostate is moderately enlarged. The patient is sexually active and tells the nurse that he does not want to take any medication that will interfere with sexual function. The nurse anticipates the provider will order: a. doxazosin [Cardura]. b. finasteride [Proscar]. c. silodosin [Rapaflo]. d. a transurethral prostatectomy.

a. doxazosin [Cardura].

A patient is taking a calcium channel blocker (CCB) for stable angina. The patient's spouse asks how calcium channel blockers relieve pain. The nurse will explain that CCBs: a. help relax peripheral arterioles to reduce afterload. b. improve coronary artery perfusion. c. increase the heart rate to improve myocardial contractility. d. increase the QT interval.

a. help relax peripheral arterioles to reduce afterload.

A child who ingested a handful of aspirin tablets from a medicine cabinet at home is brought to the emergency department. The nurse caring for the child notes a respiratory rate of 48 breaths per minute. The nurse understands that this child's respiratory rate is the result of the body's attempt to compensate for: a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.

a. metabolic acidosis.

16. A 5-year-old patient seen in an outpatient clinic is noted to have hypertension on three separate visits. Ambulatory blood pressure monitoring confirms that the child has hypertension. As an initial intervention with the child's parents, the nurse will expect to: a. perform a detailed health history on the child. b. provide teaching about antihypertensive medications. c. reassure the parents that their child may outgrow this condition. d. teach the parents about lifestyle changes and a special diet.

a. perform a detailed health history on the child.

4. A nurse is teaching a group of nursing students about antidysrhythmic medications. Which statement by a student indicates understanding of the teaching? a."Antidysrhythmic drugs can cause new dysrhythmias or worsen existing ones." b."Adverse effects of these drugs are mainly noncardiac in nature." c."For most antidysrhythmic drugs, there is evidence of reduced mortality." d."Use of these drugs may be necessary even if the benefits are unknown."

a."Antidysrhythmic drugs can cause new dysrhythmias or worsen existing ones."

10. A nurse is providing teaching to a patient who is admitted to the hospital for initiation of treatment with amiodarone [Cordarone] for atrial fibrillation that has been refractory to other medications. Which statement by the patient indicates a need for further teaching? a."I may have itching, malaise, and jaundice, but these symptoms will subside. "b."I need to use sunblock to help keep my skin from turning bluish gray." c."I should not drink grapefruit juice while taking this medication." d."I should report shortness of breath and cough and stop taking the drug immediately."

a."I may have itching, malaise, and jaundice, but these symptoms will subside.

3. A nurse is teaching a patient who is about to undergo direct-current (DC) cardioversion to treat atrial flutter. The patient has been taking verapamil and warfarin for 6 months. Which statement by the patient indicates understanding of the teaching? a."I may need long-term therapy with another cardiac medication after the procedure." b."I should stop taking warfarin a few days before the procedure." c."I will need to take a beta blocker after the procedure to prevent recurrence of atrial flutter." d."I will not have to take antidysrhythmia medications after the procedure."

a."I may need long-term therapy with another cardiac medication after the procedure."

5. A patient is recovering from a myocardial infarction but does not have symptoms of heart failure. The nurse will expect to teach this patient about: a.ACE inhibitors and beta blockers. b.biventricular pacemakers. c.dietary supplements and exercise. d.diuretics and digoxin.

a.ACE inhibitors and beta blockers

Which medications are included in first-line therapy for heart failure? (Select all that apply.) a.Agents that inhibit the renin-angiotensin-aldosterone system (RAAS) b.Aldosterone antagonists c.Beta blockers d.Cardiac glycosides e.Diuretics

a.Agents that inhibit the renin-angiotensin-aldosterone system (RAAS) c.Beta blockers e.Diuretics

9. A patient has heart failure and is taking an ACE inhibitor. The patient has developed fibrotic changes in the heart and vessels. The nurse expects the provider to order which medication to counter this development? a.Aldosterone antagonist b.Angiotensin II receptor blocker (ARB) c.Beta blocker d.Direct renin inhibitor (DRI)

a.Aldosterone antagonist

9. A prescriber has ordered propranolol [Inderal] for a patient with recurrent ventricular tachycardia. The nurse preparing to administer this drug will be concerned about what in the patient's history? a.Asthma b.Exercise-induced tachyarrhythmias c.Hypertension d.Paroxysmal atrial tachycardia associated with emotion

a.Asthma

1. Which two classes of antidysrhythmic drugs have nearly identical cardiac effects? a.Beta blockers and calcium channel blockers b.Beta blockers and potassium channel blockers c.Calcium channel blockers and sodium channel blockers d.Sodium channel blockers and potassium channel blockers

a.Beta blockers and calcium channel blockers

10. The potassium-sparing diuretic spironolactone [Aldactone] prolongs survival and improves heart failure symptoms by which mechanism? a.Blocking aldosterone receptors b.Increasing diuresis c.Reducing venous pressure d.Reducing afterload

a.Blocking aldosterone receptors

18. A patient has been taking digoxin [Lanoxin] 0.25 mg, and furosemide [Lasix] 40 mg, daily. Upon routine assessment by the nurse, the patient states, "I see yellow halos around the lights." The nurse should perform which action based on this assessment? a.Check the patient for other symptoms of digitalis toxicity. b.Withhold the next dose of furosemide. c.Continue to monitor the patient for heart failure. d.Document the findings and reassess in 1 hour.

a.Check the patient for other symptoms of digitalis toxicity.

A patient will be taking amiodarone [Cordarone]. Which baseline tests are necessary before this medication is started? (Select all that apply.) a.Chest radiograph and pulmonary function tests b.Complete blood count with differential c.Ophthalmologic examination d.Renal function tests e.Thyroid function tests

a.Chest radiograph and pulmonary function tests c.Ophthalmologic examination e.Thyroid function tests

6. A patient with volume overload begins taking a thiazide diuretic. The nurse will tell the patient to expect which outcome when taking this drug? a.Improved exercise tolerance b.Increased cardiac output c.Prevention of cardiac remodeling d.Prolonged survival

a.Improved exercise tolerance

14. A patient with heart failure who has been given digoxin [Lanoxin] daily for a week complains of nausea. Before giving the next dose, the nurse will: a.assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per minute. b.contact the provider to report digoxin toxicity. c.request an order for a decreased dose of digoxin. d.review the serum electrolyte values and withhold the dose if the potassium level is greater than 3.5 mEq/L.

a.assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per minute.

8. A patient with Stage C heart failure (HF) who has been taking an ACE inhibitor, a beta blocker, and a diuretic begins to have increased dyspnea, weight gain, and decreased urine output. The provider orders spironolactone [Aldactone]. The nurse will instruct the patient to: a.avoid potassium supplements. b.monitor for a decreased heart rate. c.take extra fluids. d.use a salt substitute instead of salt.

a.avoid potassium supplements

4. A patient newly diagnosed with heart failure is admitted to the hospital. The nurse notes a pulse of 90 beats per minute. The nurse will observe this patient closely for: a.decreased urine output. b.increased blood pressure. c.jugular vein distension. d.shortness of breath.

a.decreased urine output.

13. A prescriber orders verapamil [Covera-HS] for a patient who is taking digoxin [Lanoxin] and warfarin. The nurse will expect the prescriber to ____ the dose of ____. a.lower; digoxin b.increase; digoxin c.lower; warfarin d.increase; warfarin

a.lower; digoxin

A patient who recently started therapy with an HMG-COA reductase inhibitor asks the nurse, "How long will it take until I see an effect on my LDL cholesterol?" The nurse gives which correct answer? a. "It will take 6 months to see a change." b. "A reduction usually is seen within 2 weeks." c. "Blood levels normalize immediately after the drug is started." d. "Cholesterol will not be affected, but triglycerides will fall within the first week."

b. "A reduction usually is seen within 2 weeks."

A nurse provides teaching to a patient with angina who also has type 2 diabetes mellitus, asthma, and hypertension. Which statement by the patient indicates a need for further teaching? a. "An ACE inhibitor, in addition to nitroglycerin, will lower my risk of cardiovascular death." b. "Beta blockers can help me control hypertension." c. "I should begin regular aerobic exercise." d. "Long-acting, slow-release calcium channel blockers can help with anginal pain."

b. "Beta blockers can help me control hypertension."

A patient with variant angina wants to know why a beta blocker cannot be used to treat the angina. Which response by the nurse is correct? a. "A beta1-selective beta blocker could be used for variant angina." b. "Beta blockers do not help relax coronary artery spasm." c. "Beta blockers do not help to improve the cardiac oxygen supply." d. "Beta blockers promote constriction of arterial smooth muscle."

b. "Beta blockers do not help relax coronary artery spasm."

9. A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] and digoxin. The prescriber has ordered spironolactone [Aldactone] to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching? a. "I can expect improvement within a few hours after taking this drug." b. "I need to stop taking potassium supplements." c. "I should use salt substitutes to prevent toxic side effects." d. "I should watch closely for dehydration."

b. "I need to stop taking potassium supplements."

3. A nurse is caring for a patient who will begin taking hydralazine to treat hypertension. Which statement by the patient indicates understanding of the nurse's teaching about this drug? a. "I will need to ask for assistance when getting up out of a chair." b. "I will also take a beta blocker medication with this drug to prevent rapid heart rate." c. "I may develop joint pain, but this side effect will decrease over time." d. "This drug may cause excessive hair growth on my face, arms, and back."

b. "I will also take a beta blocker medication with this drug to prevent rapid heart rate."

5. A nurse is reviewing the phenomenon of reflex tachycardia with a group of nursing students. Which statement by a student indicates understanding of this phenomenon? a. "Baroreceptors in the aortic arch stimulate the heart to beat faster." b. "Reflex tachycardia can negate the desired effects of vasodilators." c. "Reflex tachycardia is more likely to occur when beta blockers are given." d. "Venous dilation must occur for reflex tachycardia to occur."

b. "Reflex tachycardia can negate the desired effects of vasodilators."

A patient has begun taking an HMG-COA reductase inhibitor. Which statement about this class of drugs made by the nurse during patient education would be inappropriate? a. "Statins reduce the risk of morbidity from influenza." b. "You should come into the clinic for liver enzymes in 1 month." c. "Statins reduce the risk of coronary events in people with normal LDL levels." d. "You should maintain a healthy lifestyle and avoid high-fat foods."

b. "You should come into the clinic for liver enzymes in 1 month."

A patient arrives in the emergency department after becoming dehydrated. Based on the patient's history, the provider determines that isotonic dehydration has occurred. Which solution will the nurse expect to infuse to treat this patient? a. 0.45% sodium chloride in sterile water b. 0.9% sodium chloride in sterile water c. 3% sodium chloride in sterile water d. 5% dextrose solution

b. 0.9% sodium chloride in sterile water

A patient is admitted to the hospital with unstable angina and will undergo a percutaneous coronary intervention. Which drug regimen will the nurse expect to administer to prevent thrombosis in this patient?a. Aspirin, clopidogrel, omeprazole b. Aspirin, heparin, abciximab [ReoPro] c. Enoxaparin [Lovenox], prasugrel [Effient], warfarin [Coumadin] d. Heparin, alteplase, abciximab [ReoPro]

b. Aspirin, heparin, abciximab [ReoPro]

A patient is admitted to the coronary care unit from the emergency department after initial management of STEMI. A primary percutaneous coronary intervention has been performed. The nurse notes an initial heart rate of 56 beats per minute and a blood pressure of 120/80 mm Hg. The patient has a history of stroke and a previous myocardial infarction. Which order will the nurse question? a. Aspirin b. Beta blocker c. Clopidogrel d. Heparin

b. Beta blocker

A patient who is receiving reperfusion therapy has a history of heparin-induced thrombosis (HIT). The patient has a creatinine clearance of 28 mL/min. In addition to the fibrinolytic agent, which medication will the nurse expect to administer to this patient? a. Aspirin b. Bivalirudin [Angiomax] c. Clopidogrel [Plavix] d. Fondaparinux [Arixtra]

b. Bivalirudin [Angiomax]

A female patient who begins taking spironolactone [Aldactone] as an adjunct to furosemide [Lasix] complains that her voice is deepening. What will the nurse do? a. Contact the provider to obtain an order for a complete blood count (CBC) and liver function tests. b. Explain that this drug binds with receptors for steroid hormones, causing this effect. c. Report this side effect to the provider and request another medication for this patient. d. Teach the patient to report any associated cough, which may indicate a more severe side effect.

b. Explain that this drug binds with receptors for steroid hormones, causing this effect.

A patient with congestive heart failure is admitted to the hospital. During the admission assessment, the nurse learns that the patient is taking a thiazide diuretic. The nurse notes that the admission electrolyte levels include a sodium level of 142 mEq/L, a chloride level of 95 mEq/L, and a potassium level of 3 mEq/L. The prescriber has ordered digoxin to be given immediately. What will the nurse do initially? a. Give the digoxin and maintain close cardiac monitoring. b. Hold the digoxin and report the laboratory values to the provider. c. Hold the thiazide diuretic and give the digoxin. d. Request an order for an electrocardiogram (ECG).

b. Hold the digoxin and report the laboratory values to the provider.

A provider has ordered captopril [Capoten] for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nurse is correct? a. Administer the captopril and monitor for adverse effects. b. Hold the dose and notify the provider. c. Request an order to administer fosinopril instead of captopril. d. Reassure the patient that this is not a serious side effect.

b. Hold the dose and notify the provider.

17. The nurse is caring for a pregnant patient who is in labor. The woman reports having had mild preeclampsia with a previous pregnancy. The nurse notes that the woman has a blood pressure of 168/102 mm Hg. The nurse will contact the provider to request an order for which drug? a. Angiotensin-converting enzyme (ACE) inhibitor b. Hydralazine (Apresoline) c. Magnesium sulfate d. Sodium nitroprusside

b. Hydralazine (Apresoline)

A patient with a history of hypertension is admitted for a procedure. If the patient's arterial pressure decreases, which clinical manifestation would the nurse expect to see? a. Decreased heart rate b. Increased heart rate c. Decreased blood pressure d. Syncope

b. Increased heart rate

A patient collapses after running a marathon on a hot day and is brought to the emergency department to be treated for dehydration. The nurse will expect to provide which therapy? a. Intravenous hypertonic fluids given slowly over several hours b. Intravenous hypotonic fluids administered in stages c. Intravenous isotonic fluids given as a rapid bolus d. Oral electrolyte replacement fluids with potassium

b. Intravenous hypotonic fluids administered in stages

A patient will begin taking dabigatran etexilate [Pradaxa] to prevent stroke. The nurse will include which statement when teaching this patient? a. Dabigatran should be taken on an empty stomach to improve absorption. b. It is important not to crush, chew, or open capsules of dabigatran. c. The risk of bleeding with dabigatran is less than that with warfarin [Coumadin]. d. To remember to take dabigatran twice daily, a pill organizer can be useful.

b. It is important not to crush, chew, or open capsules of dabigatran.

Which order for potassium (KCl) would the nurse question? (Select all that apply.) a. NS with 20 mEq KCl to start after patient voids b. NS with 60 mEq KCl for a patient with a serum potassium of 3.2 mEq/L c. K-Dur, 1 tablet daily for a patient in diabetic ketoacidosis d. K-Dur, 1 tablet with a full glass of water e. Potassium chloride, 10 mEq rapid IV push ANS: B, C, E

b. NS with 60 mEq KCl for a patient with a serum potassium of 3.2 mEq/L c. K-Dur, 1 tablet daily for a patient in diabetic ketoacidosis e. Potassium chloride, 10 mEq rapid IV push

A patient with angina who is taking ranolazine [Ranexa] has developed a respiratory infection and a dysrhythmia. The provider has ordered azithromycin [Zithromax] for the infection and amlodipine for the dysrhythmia. A nursing student caring for this patient tells the nurse that the patient's heart rate is 70 beats per minute, and the blood pressure is 128/80 mm Hg. The nurse asks the student to discuss the plan for this patient's care. Which action is correct? a. Observe the patient closely for signs of respiratory toxicity. b. Question the order for azithromycin [Zithromax]. c. Report the patient's increase in blood pressure to the provider. d. Request an order for a different calcium channel blocker.

b. Question the order for azithromycin [Zithromax].

A patient has undergone a primary percutaneous coronary intervention with a stent placement. The provider has ordered a daily dose of 81 mg of aspirin and clopidogrel. The patient asks the nurse how long the medications must be taken. What will the nurse tell this patient about the medication regimen? a. This drug regimen will continue indefinitely. b. The clopidogrel will be discontinued in one year and the aspirin will be given indefinitely. c. The aspirin will be discontinued in one year and the clopidogrel will be given indefinitely. d. Both drugs will be discontinued in one year.

b. The clopidogrel will be discontinued in one year and the aspirin will be given indefinitely.

A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98 beats per minute and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in color. A stat CBC shows a platelet count of less than 100,000 mm3. The nurse will: a. administer oxygen and notify the provider. b. discontinue the heparin and notify the provider. c. request an order for protamine sulfate. d. request an order for vitamin K (phytonadione).

b. discontinue the heparin and notify the provider.

A patient is admitted to the emergency department with chest pain. An electrocardiogram shows changes consistent with an evolving myocardial infarction. The patient's cardiac enzymes are pending. The nurse caring for this patient will expect to: a. administer aspirin when cardiac enzymes are completed. b. give alteplase [Activase] within 2 hours. c. give tenecteplase [TNKase] immediately. d. obtain an order for an INR.

b. give alteplase [Activase] within 2 hours

A patient who has taken warfarin [Coumadin] for a year begins taking carbamazepine. The nurse will anticipate an order to: a. decrease the dose of carbamazepine. b. increase the dose of warfarin. c. perform more frequent aPTT monitoring. d. provide extra dietary vitamin K.

b. increase the dose of warfarin.

A patient with new-onset exertional angina has taken three nitroglycerin sublingual tablets at 5-minute intervals, but the pain has intensified. The nurse notes that the patient has a heart rate of 76 beats per minute and a blood pressure of 120/82 mm Hg. The electrocardiogram is normal. The patient's lips and nail beds are pink, and there is no respiratory distress. The nurse will anticipate providing: a. an angiotensin-converting enzyme (ACE) inhibitor. b. intravenous nitroglycerin and a beta blocker. c. ranolazine (Ranexa) and quinidine. d. supplemental oxygen and intravenous morphine.

b. intravenous nitroglycerin and a beta blocker.

A postoperative patient will begin anticoagulant therapy with rivaroxaban [Xarelto] after knee replacement surgery. The nurse performs a history and learns that the patient is taking erythromycin. The patient's creatinine clearance is 50 mL/min. The nurse will :a. administer the first dose of rivaroxaban as ordered. b. notify the provider to discuss changing the patient's antibiotic. c. request an order for a different anticoagulant medication. d. request an order to increase the dose of rivaroxaban.

b. notify the provider to discuss changing the patient's antibiotic.

A 68-year-old male patient receives a prescription for 25-mg tablets of sildenafil [Viagra] for erectile dysfunction. When he asks the nurse how to take the medication, the nurse will tell him to: a. begin taking one tablet twice daily, 12 hours apart. b. start with one tablet about 1 hour before anticipated sexual activity. c. take 25 to 100 mg per dose 30 minutes to 4 hours before sexual activity. d. take two tablets 1 hour before sexual activity with a high-fat meal.

b. start with one tablet about 1 hour before anticipated sexual activity.

5. A patient who does not consume alcohol or nicotine products reports a strong family history of hypertension and cardiovascular disease. The patient has a blood pressure of 126/82 and a normal weight and body mass index for height and age. The nurse will expect to teach this patient about: a. ACE inhibitors and calcium channel blocker medications. b. the DASH diet, sodium restriction, and exercise. c. increased calcium and potassium supplements. d. thiazide diuretics and lifestyle changes.

b. the DASH diet, sodium restriction, and exercise.

14. A nurse is discussing adenosine with a nursing student. Which statement by the student indicates a need for further teaching? a."Adenosine acts by suppressing action potentials in the SA and AV nodes." b."Adenosine can be used to prevent paroxysmal supraventricular tachycardia and Wolff-Parkinson-White syndrome." c."Adenosine has a half-life that lasts only a few seconds and must be given intravenously." d."Adenosine is not effective for treating atrial fibrillation, atrial flutter, or ventricular dysrhythmias."

b."Adenosine can be used to prevent paroxysmal supraventricular tachycardia and Wolff-Parkinson-White syndrome."

2. A patient with atrial fibrillation is taking verapamil [Calan]. The patient has read about the drug on the Internet and wants to know why a drug that affects the rate of ventricular contraction is used to treat an abnormal atrial contraction. What will the nurse tell the patient? a."Drugs that treat ventricular dysrhythmias help to restore normal sinus rhythm." b."Atrial dysrhythmias can have life-threatening effects on ventricular function." c."Treating ventricular dysrhythmias helps prevent the likelihood of stroke." d."When ventricular contraction slows, atrial contraction is also slowed."

b."Atrial dysrhythmias can have life-threatening effects on ventricular function."

6. A nurse provides teaching for a patient who will begin taking procainamide [Procanbid] for long-term suppression of a dysrhythmia. Which statement by the patient indicates a need for further teaching? a."I need to take this drug at evenly spaced intervals around the clock." b."I may have increased bruising, but this is a temporary side effect." c."I should report pain and swelling in my joints when taking this drug." d."I will need to have blood tests at regular intervals while taking this drug."

b."I may have increased bruising, but this is a temporary side effect."

17. An 88-year-old patient with heart failure has progressed to Stage D and is hospitalized for the third time in a month. The nurse will expect to discuss which topic with the patient's family? a.Antidysrhythmic medications b.End-of-life care c.Heart transplantation d.Implantable mechanical assist devices

b.End-of-life care

13. A nurse is preparing to administer digoxin [Lanoxin] to a patient. The patient's heart rate is 62 beats per minute, and the blood pressure is 120/60 mm Hg. The last serum electrolyte value showed a potassium level of 5.2 mEq/L. What will the nurse do? a.Contact the provider to request an increased dose of digoxin. b.Give the dose of digoxin and notify the provider of the potassium level. c.Request an order for a diuretic. d.Withhold the dose and notify the provider of the heart rate.

b.Give the dose of digoxin and notify the provider of the potassium level.

12. A patient asks a nurse why he cannot use digoxin [Lanoxin] for his heart failure, because both of his parents used it for HF. The nurse will explain that digoxin is not the first-line therapy for which reason? a.It causes tachycardia and increases the cardiac workload. b.It does not correct the underlying pathology of heart failure. c.It has a wide therapeutic range that makes dosing difficult. d.It may actually shorten the patient's life expectancy.

b.It does not correct the underlying pathology of heart failure.

7. A nurse is caring for a patient in the intensive care unit who is receiving intravenous lidocaine. The patient is drowsy and confused and reports numbness of the fingers and toes. Which standing order will the nurse initiate at this time? a.Administer diazepam. b.Reduce the rate of infusion. c.Discontinue the infusion. d.Prepare for mechanical ventilation.

b.Reduce the rate of infusion

15. A nursing student asks a nurse how digoxin causes dysrhythmias. The nurse correctly states that digoxin: a.reduces automaticity in the AV node. b.increases automaticity in the Purkinje fibers. c.increases automaticity in the SA node. d.speeds up AV conduction.

b.increases automaticity in the Purkinje fibers.

A nurse is caring for a postoperative patient who has a nasogastric tube with continuous suction. The nurse notes that the patient has shallow respirations and suspects that this patient has developed: a.metabolic acidosis. b.metabolic alkalosis. c.respiratory acidosis. d.respiratory alkalosis.

b.metabolic alkalosis.

A patient has been receiving heparin while in the hospital to treat deep vein thromboses and will be discharged home with a prescription for enoxaparin [Lovenox]. The nurse provides teaching for the nursing student who asks about the advantages of enoxaparin over heparin. Which statement by the student indicates a need for further teaching? a. "Enoxaparin does not require coagulation monitoring." b. "Enoxaparin has greater bioavailability than heparin." c. "Enoxaparin is more cost-effective than heparin." d. "Enoxaparin may be given using a fixed dosage."

c. "Enoxaparin is more cost-effective than heparin."

A nurse is discussing fibrinolytic therapy for the acute phase of STEMI management with a group of nursing students. Which statement by a student indicates understanding of this therapy? a. "Fibrinolytics are effective when the first dose is given up to 24 hours after symptom onset." b. "Fibrinolytics should be given once cardiac troponins reveal the presence of STEMI." c. "Fibrinolytics should be used with caution in patients with a history of cerebrovascular accident." d. "Patients should receive either an anticoagulant or an antiplatelet agent with a fibrinolytic drug."

c. "Fibrinolytics should be used with caution in patients with a history of cerebrovascular accident."

A patient who is taking furosemide [Lasix] and digoxin will begin taking captopril [Capoten]. The nurse is providing information about the drug. Which statement by the patient indicates a need for further teaching? a. "I can use acetaminophen for analgesia if needed." b. "I should stop taking the Lasix about a week before starting the Capoten." c. "I should take this medication on a full stomach." d. "I will need to have blood tests done every 2 weeks for a few months."

c. "I should take this medication on a full stomach."

4. A nurse is preparing to assist a nursing student to administer intravenous verapamil to a patient who also receives a beta blocker. The nurse asks the nursing student to discuss the plan of care for this patient. Which statement by the student indicates a need for further teaching? a. "I will check to see when the last dose of the beta blocker was given." b. "I will monitor vital signs closely to assess for hypotension." c. "I will monitor the heart rate frequently to assess for reflex tachycardia." d. "I will prepare to administer intravenous norepinephrine if necessary."

c. "I will monitor the heart rate frequently to assess for reflex tachycardia."

6. A patient who has been taking verapamil [Calan] for hypertension complains of constipation. The patient will begin taking amlodipine [Norvasc] to avoid this side effect. The nurse provides teaching about the difference between the two drugs. Which statement by the patient indicates that further teaching is needed? a. "I can expect dizziness and facial flushing with nifedipine." b. "I should notify the provider if I have swelling of my hands and feet." c. "I will need to take a beta blocker to prevent reflex tachycardia." d. "I will need to take this drug once a day."

c. "I will need to take a beta blocker to prevent reflex tachycardia."

7. A patient has been taking chlorthalidone to treat hypertension. The patient's prescriber has just ordered the addition of spironolactone to the patient's drug regimen. Which statement by the patient indicates a need for further teaching? a. "I should continue following the DASH diet when adding this drug." b. "I should not take an ACE inhibitor when adding this drug." c. "I will need to take potassium supplements when adding this drug." d. "I will not experience a significant increase in diuresis when adding this drug."

c. "I will need to take potassium supplements when adding this drug."

A nurse is providing teaching for a patient with stable angina who will begin taking nitroglycerin. Which statement by the patient indicates understanding of the teaching? a. "I should not participate in aerobic exercise while taking this drug." b. "I should take aspirin daily to reduce my need for nitroglycerin." c. "If I take nitroglycerin before exertion, I can reduce the chance of an anginal attack." d. "I take nitroglycerin to increase the amount of oxygen to my heart."

c. "If I take nitroglycerin before exertion, I can reduce the chance of an anginal attack."

A healthy male patient who does not have erectile dysfunction asks about medications to improve sexual stamina. What will the nurse tell this patient? a. "Medications for ED can improve the duration of erection in healthy men." b. "Medications for ED can improve the quality of erection in healthy men." c. "Medications for ED have no effect on erections in healthy men." d. "Medications for ED will cause priapism in healthy men."

c. "Medications for ED have no effect on erections in healthy men."

A nurse is teaching a nursing student how blood can return to the heart when pressure in the venous capillary beds is very low. Which statement by the student indicates a need for further teaching? a. "Constriction of small muscles in the venous wall increases venous pressure." b. "Negative pressure in the left atrium draws blood toward the heart." c. "Skeletal muscles relax to allow the free flow of blood." d. "Venous valves help prevent the backflow of blood." c. "Skeletal muscles relax to allow the free flow of blood."

c. "Skeletal muscles relax to allow the free flow of blood."

A prescriber orders ramipril [Altace] for an obese patient with type 2 diabetes mellitus who has developed hypertension. The nurse provides teaching before dismissing the patient home. Which statement by the patient indicates understanding of the teaching? a. "I am less likely to develop diabetic nephropathy when taking this medication." b. "I should check my blood sugar more often, because hyperglycemia is a side effect of this drug." c. "Taking this medication helps reduce my risk of stroke and heart attack." d. "This medication will probably prevent the development of diabetic retinopathy."

c. "Taking this medication helps reduce my risk of stroke and heart attack."

A nursing student who is preparing to care for a postoperative patient with deep vein thrombosis asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct? a. "Heparin has a longer half-life." b. "Heparin has fewer adverse effects." c. "The onset of warfarin is delayed." d. "Warfarin prevents platelet aggregation."

c. "The onset of warfarin is delayed."

A patient who takes nitroglycerine to treat stable angina reports having erectile dysfunction and states that he plans to ask his primary provider for a prescription for tadalafil [Cialis]. What will the nurse tell this patient? a. "You may take these two drugs together safely as long as you take them as directed." b. "You should not take tadalafil and nitroglycerine within 30 to 60 minutes of each other." c. "You should discuss another anti-angina medication with your provider." d. "You should avoid sexual activity since this increases oxygen demands on the heart."

c. "You should discuss another anti-angina medication with your provider."

A nurse is reviewing a patient's medications before administration. Which drug-to-drug interactions will most concern the nurse in a patient with a history of heart failure and a potassium level of 5.5 mEq/L? a. Furosemide [Lasix] and enalapril [Vasotec] b. Amlodipine [Norvasc] and spironolactone [Aldactone] c. Captopril [Capoten] and spironolactone [Aldactone] d. Metoprolol [Lopressor] and furosemide [Lasix]

c. Captopril [Capoten] and spironolactone [Aldactone]

10. A patient is taking clonidine for hypertension and reports having dry mouth and drowsiness. What will the nurse tell the patient? a. Beta blockers can reverse these side effects. b. Discontinue the medication immediately and notify the provider. c. Drink extra fluids and avoid driving when drowsy. d. Notify the provider if symptoms persist after several weeks.

c. Drink extra fluids and avoid driving when drowsy.

Which plasma lipoprotein level is most concerning when considering the risk of coronary atherosclerosis? a. Elevated cholesterol b. Elevated high-density lipoprotein c. Elevated low-density lipoprotein d. Elevated very-low-density lipoprotein

c. Elevated low-density lipoprotein

A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication? a. Aspirin b. Clopidogrel [Plavix] c. Enoxaparin [Lovenox] d. Warfarin [Coumadin]

c. Enoxaparin [Lovenox]

A hospitalized patient complains of acute chest pain. The nurse administers a 0.3-mg sublingual nitroglycerin tablet, but the patient continues to complain of pain. Vital signs remain stable. What is the nurse's next step? a. Apply a nitroglycerin transdermal patch. b. Continue dosing at 10-minute intervals. c. Give a second dose of nitroglycerin in 5 minutes. d. Request an order for intravenous nitroglycerin.

c. Give a second dose of nitroglycerin in 5 minutes.

A patient who is a chronic alcoholic is admitted to the hospital. Admission laboratory work reveals a magnesium level of 1.2 mEq/L. The prescriber orders intravenous magnesium sulfate in a 10% solution at a rate of 10 mL/min. What will the nurse do? a. Administer the IV dose as ordered and have calcium gluconate on hand. b. Administer the IV dose and make preparations for mechanical ventilation. c. Hold the IV dose until the infusion rate has been clarified with the provider. d. Request an order for renal function tests before administering the IV dose

c. Hold the IV dose until the infusion rate has been clarified with the provider.

A patient who stops taking an ACE inhibitor because of its side effects will begin taking an angiotensin II receptor blocker (ARB) medication. Which side effect of ACE inhibitors will not occur with an ARB medication? a. Angioedema b. Cough c. Hyperkalemia d. Renal failure

c. Hyperkalemia

1. A nurse is administering a vasodilator that dilates resistance vessels. The nurse understands that this drug will have which effect on the patient? a.Decreased cardiac preload b. Decreased cardiac output c. Increased tissue perfusion d. Increased ventricular contraction

c. Increased tissue perfusion

A patient begins taking an ACE inhibitor and complains of a dry cough. What does the nurse correctly tell the patient about this symptom? a. It indicates that a serious side effect has occurred. b. It is a common side effect that occurs in almost all patients taking the drug. c. It may be uncomfortable enough that the drug will need to be discontinued. d. It occurs frequently in patients taking the drug but will subside over time.

c. It may be uncomfortable enough that the drug will need to be discontinued

9. A patient with hypertension will begin taking an alpha1 blocker. What will the nurse teach this patient? a. A persistent cough is a known side effect of this drug. b. Eat foods rich in potassium while taking this drug. c. Move slowly from sitting to standing when taking this drug. d. Report shortness of breath while taking this drug.

c. Move slowly from sitting to standing when taking this drug.

A patient who has erectile dysfunction asks a nurse whether sildenafil [Viagra] would be a good medication for him to take. Which aspect of this patient's history would be of most concern? a. Benign prostatic hypertrophy b. Mild hypertension c. Occasional use of nitroglycerin d. Taking finasteride

c. Occasional use of nitroglycerin

2. A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide [Lasix]. The nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern? a. Blood glucose level of 120 mg/dL b. Oxygen saturation of 90% c. Potassium level of 3.5 mEq/L d. Sodium level of 140 mEq/L

c. Potassium level of 3.5 mEq/L

Which medications are most likely to cause postural hypotension? (Select all that apply.) a. Minoxidil b. Diltiazem [Cardizem] c. Prazosin [Minipress] d. Captopril [Capoten] e. Losartan [Cozaar]

c. Prazosin [Minipress] d. Captopril [Capoten] e. Losartan [Cozaar]

4. A nurse checks a patient's vital signs in the hospital and notes a blood pressure of 146/98 mm Hg. What will the nurse do? a. Instruct the patient to consume a low-sodium diet. b. Prepare the patient for an electrocardiogram and blood tests. c. Recheck the patient's blood pressure in the other arm. d. Request an order for a thiazide diuretic.

c. Recheck the patient's blood pressure in the other arm.

A patient has undergone a PCI, and the provider orders clopidogrel to be given for 12 months, along with an ACE inhibitor and heparin. What will the nurse do? a. Question the need for heparin. b. Request an order for a beta blocker. c. Request an order for aspirin. d. Suggest ordering clopidogrel for 14 days.

c. Request an order for aspirin.

A nurse is caring for a child whose respirations are shallow and marked by a prolonged expiratory phase. The nurse auscultates wheezes and poor air movement bilaterally. The child's respiratory rate is 26 breaths per minute, and the oxygen saturation is 89%. What does the nurse suspect? a.Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

c. Respiratory acidosis

7. A patient is taking gentamicin [Garamycin] and furosemide [Lasix]. The nurse should counsel this patient to report which symptom? a. Frequent nocturia b. Headaches c. Ringing in the ears d. Urinary retention

c. Ringing in the ears

19. A 60-year-old African American patient has a blood pressure of 120/80 mm Hg and reports a family history of hypertension. The patient has a body mass index of 22.3. The patient reports consuming alcohol occasionally. Which therapeutic lifestyle change will the nurse expect to teach this patient? a. Alcohol cessation b. Potassium supplementation c. Sodium restriction d. Weight loss

c. Sodium restriction

3. A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question? a. Bumetanide [Bumex] b. Furosemide [Lasix] c. Spironolactone [Aldactone] d. Hydrochlorothiazide [HydroDIURIL]

c. Spironolactone [Aldactone]

A patient asks a nurse how nitroglycerin works to relieve anginal pain. The nurse correctly states, "Nitroglycerin: a. dilates coronary arteries to increase blood flow to the heart." b. increases the oxygen supply to the cardiac muscle." c. increases ventricular filling to improve cardiac output." d. promotes vasodilation, which reduces preload and oxygen demand."

d. promotes vasodilation, which reduces preload and oxygen demand."

A nurse is evaluating a patient admitted to the emergency department with an evolving STEMI for possible administration of thrombolytic therapy. Which information, identified during history taking, would contraindicate this type of therapy? a. The patient just completed her last menstrual cycle. b. The patient states that the chest pain started 1 hour ago. c. The patient has a history of a small cerebral aneurysm. d. The patient has hypertension that is well controlled by diuretic therapy.

c. The patient has a history of a small cerebral aneurysm

1. A patient has had blood pressures of 150/95 mm Hg and 148/90 mm Hg on two separate office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient's diagnostic tests are all normal. The nurse will expect this patient's provider to order: a. a beta blocker. b. a loop diuretic and spironolactone. c. a thiazide diuretic. d. counseling on lifestyle changes.

c. a thiazide diuretic.

A patient who is taking clopidogrel [Plavix] calls the nurse to report black, tarry stools and coffee-ground emesis. The nurse will tell the patient to: a. ask the provider about using aspirin instead of clopidogrel. b. consume a diet high in vitamin K. c. continue taking the clopidogrel until talking to the provider. d. stop taking the clopidogrel immediately.

c. continue taking the clopidogrel until talking to the provider.

1. A patient is taking enalapril [Vasotec]. The nurse understands that patients taking this type of drug for heart failure need to be monitored carefully for: a.hypernatremia. b.hypertension. c.hyperkalemia. d.hypokalemia.

c. hyperkalemia.

A patient who is taking simvastatin [Zocor] develops an infection and the provider orders azithromycin [Zithromax] to treat the infection. The nurse should be concerned if the patient complains of: a. nausea. b. tiredness. c. muscle pain. d. headache.

c. muscle pain.

A patient is taking a beta1-adrenergic drug to improve the stroke volume of the heart. The nurse caring for this patient knows that this drug acts by increasing: a. cardiac afterload. b. cardiac preload. c. myocardial contractility. d. venous return.

c. myocardial contractility.

9. A nursing student asks a nurse why a patient in hypertensive crisis is receiving both intravenous sodium nitroprusside [Nitropress] and oral hydralazine. The nurse will explain that this is done to prevent: a. cyanide poisoning. b. fluid retention. c. rebound hypertension. d. reflex tachycardia.

c. rebound hypertension.

18. The nurse is teaching a group of nursing students about dofetilide [Tikosyn] to treat dysrhythmias. Which statement by a student indicates understanding of the teaching? a."Dofetilide is a first-line medication to treat atrial flutter or atrial fibrillation." b."Dofetilide carries a lower risk of causing torsades de pointes than other drugs." c."Dofetilide is used for patients with severe symptoms of atrial dysrhythmias." d."Dofetilide may be safely used as outpatient therapy to treat atrial fibrillation."

c."Dofetilide is used for patients with severe symptoms of atrial dysrhythmias."

2. A nurse is discussing heart failure with a group of nursing students. Which statement by a student reflects an understanding of how compensatory mechanisms can compound existing problems in patients with heart failure? a."An increase in arteriolar tone to improve tissue perfusion can decrease resistance." b."An increase in contractility to increase cardiac output can cause pulmonary edema." c."When the heart rate increases to increase cardiac output, it can prevent adequate filling of the ventricles." d."When venous tone increases to increase ventricular filling, an increase in arterial pressure occurs."

c."When the heart rate increases to increase cardiac output, it can prevent adequate filling of the ventricles."

Which are expected effects of cardiac glycosides? (Select all that apply.) a.Decreased cardiac output b.Decreased force of contraction c.Decreased heart rate d.Modulation of neurohormonal systems e.Positive inotropic effects

c.Decreased heart rate d.Modulation of neurohormonal systems e.Positive inotropic effects

3. A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats per minute, a blood pressure of 150/90 mm Hg, bibasilar crackles, 2+ pitting edema of the ankles, and distension of the jugular veins. The nurse will contact the provider to request an order for which medication? a.ACE inhibitor b.Digoxin [Lanoxin] c.Furosemide [Lasix] d.Spironolactone [Aldactone]

c.Furosemide [Lasix]

7. The nurse educator is providing patient education about the Cardiac Arrhythmia Suppression Trial (CAST). The nurse correctly explains that the trial demonstrated what effect from the pharmacologic suppression of dysrhythmias? a.It reduced mortality by 50% but increased morbidity. b.It significantly reduced the risk of a second myocardial infarction (MI). c.It doubled the risk of a second MI. d.It should be used in all patients who have had an MI, regardless of rhythm.

c.It doubled the risk of a second MI.

8. A patient with diabetes develops ventricular tachycardia and is in the hospital for evaluation of this condition. The nurse reviews the history and learns that the patient takes mexiletine [Mexitil] for pain caused by peripheral neuropathy. What should the nurse do? a.Discuss common side effects associated with taking mexiletine with cardiac agents. b.Understand that this drug will help with both peripheral neuropathy and dysrhythmias. c.Notify the provider to request that another drug be used for peripheral neuropathy pain. d.Request an order for renal function and hepatic function tests.

c.Notify the provider to request that another drug be used for peripheral neuropathy pain.

A patient is taking digoxin [Lanoxin] and develops a dysrhythmia. The nurse reports this finding to the prescriber, who will most likely order what? (Select all that apply.) a.Amiodarone b.Diltiazem c.Phenytoin [Dilantin] d.Quinidine e.Serum electrolytes

c.Phenytoin [Dilantin] e.Serum electrolytes

15. A patient is taking a thiazide diuretic for hypertension and quinidine to treat a dysrhythmia. The prescriber orders digoxin 0.125 mg to improve this patient's cardiac output. The nurse should contact the provider to request: a.adding spironolactone [Aldactone]. b.reducing the dose of digoxin. c.discontinuing the quinidine. d.giving potassium supplements.

c.discontinuing the quinidine.

16. A patient with heart failure who takes a thiazide diuretic and digoxin [Lanoxin] is admitted for shortness of breath. The patient's heart rate is 66 beats per minute, and the blood pressure is 130/88 mm Hg. The serum potassium level is 3.8 mEq/L, and the digoxin level is 0.8 ng/mL. The nurse admitting this patient understands that the patient :a.has digoxin toxicity. b.is showing signs of renal failure. c.is experiencing worsening of the disease. d.needs a potassium-sparing diuretic.

c.is experiencing worsening of the disease.

A female patient who is not taking any other medications is prescribed aliskiren [Tekturna], a direct renin inhibitor (DRI). The nurse reviews medication information with the patient. Which statement by the patient indicates understanding of the teaching? a. "If I get pregnant, I should stop taking this drug by the second trimester." b. "If I take this drug with a high-fat meal, it will be more effective." c. "I should restrict my potassium intake while taking this drug." d. "I should take this medication 1 hour before sitting down to a meal."

d. "I should take this medication 1 hour before sitting down to a meal."

Tadalafil [Cialis] was prescribed 4 weeks ago for a patient with erectile dysfunction. The patient also takes prazosin [Minipress] for hypertension. Which statement by the patient best demonstrates understanding of the use of tadalafil [Cialis]? a. "I can take this up to 2 times a day, just before intercourse." b. "I have a little renal trouble, so I should take a higher dose." c. "I should take this medication with food." d. "I should take this medication no more than once a day."

d. "I should take this medication no more than once a day."

A patient has been taking warfarin [Coumadin] for atrial fibrillation. The provider has ordered dabigatran etexilate [Pradaxa] to replace the warfarin. The nurse teaches the patient about the change in drug regimen. Which statement by the patient indicates understanding of the teaching? a. "I may need to adjust the dose of dabigatran after weaning off the warfarin." b. "I should continue to take the warfarin after beginning the dabigatran until my INR is greater than 3." c. "I should stop taking the warfarin 3 days before starting the dabigatran." d. "I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2."

d. "I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2."

A patient in the emergency department has severe chest pain. The nurse administers morphine intravenously. The patient asks the nurse why morphine is given. Which response by the nurse is correct? a. "Morphine helps by reducing anxiety and relieving pain." b. "Morphine helps by reducing pain and dissolving clots." c. "Morphine helps by relieving pain and lowering blood pressure." d. "Morphine helps by relieving pain and reducing the cardiac oxygen demand."

d. "Morphine helps by relieving pain and reducing the cardiac oxygen demand."

14. A nursing student asks the nurse why multi-drug therapy is often used to treat hypertension. Which statement by the student indicates a need for further teaching? a. "Multi-drug therapy often means that drugs may be given in lower doses." b. "Some agents are used to offset adverse effects of other agents." c. "Treatment of hypertension via different mechanisms increases success." d. "Two or more drugs will lower blood pressure more quickly."

d. "Two or more drugs will lower blood pressure more quickly."

A nurse is discussing the difference between stable and variant angina with a group of nursing students. Which statement by a student indicates the need for further teaching? a. "Beta blockers are effective in stable angina but not in variant angina." b. "In both types of angina, prophylactic treatment is possible." c. "Variant angina is primarily treated with vasodilators to increase oxygen supply." d. "Variant angina is the result of increased oxygen demand by the heart."

d. "Variant angina is the result of increased oxygen demand by the heart."

18. A nurse has provided education for a patient newly diagnosed with hypertension who is just beginning therapy with antihypertensive medications. Which statement by the patient indicates a need for further teaching? a. "I may experience serious long-term problems even if I am not having symptoms." b. "I should report side effects to the provider since other drugs may be substituted." c. "I will need to take medications on a long-term basis." d. "When my symptoms subside, I may discontinue the medications."

d. "When my symptoms subside, I may discontinue the medications."

A nurse is instructing a patient receiving a cholesterol-lowering agent. Which information should the nurse include in the patient education? a. "This medication will replace other interventions you have been trying." b. "It is important for you to double your dose if you miss one to maintain therapeutic blood levels." c. "Stop taking the medication if you experience constipation." d. "You should continue your exercise program to increase your HDL serum levels."

d. "You should continue your exercise program to increase your HDL serum levels."

A male patient is being treated for benign prostatic hyperplasia (BPH) by another provider but cannot remember which drug he is taking. He comes to the clinic seeking treatment for erectile dysfunction and receives a prescription for sildenafil [Viagra]. What will the nurse teach this patient? a. "Sildenafil is not safe to take in conjunction with finasteride [Proscar]." b. "Sildenafil is safe with any medication for benign prostatic hyperplasia." c. "To be safe, you should have a transurethral resection before starting sildenafil." d. "You should not take sildenafil if you are taking silodosin [Rapaflo]."

d. "You should not take sildenafil if you are taking silodosin [Rapaflo]."

A patient with a history of elevated triglycerides and LDL cholesterol begins taking nicotinic acid [Niacin]. The patient reports uncomfortable flushing of the face, neck, and ears when taking the drug. What will the nurse advise the patient? a. "Ask your provider about taking an immediate-release form of the medication." b. "Ask your provider about assessing your serum uric acid levels which may be elevated." c. "You should stop taking the Niacin immediately since this is a serious adverse effect." d. "You should take 325 mg of aspirin a half hour before each dose of Niacin to prevent this effect."

d. "You should take 325 mg of aspirin a half hour before each dose of Niacin to prevent this effect."

11. A patient takes an ACE inhibitor to treat hypertension and tells the nurse that she wants to become pregnant. She asks whether she should continue taking the medication while she is pregnant. What will the nurse tell her? a. Controlling her blood pressure will decrease her risk of preeclampsia. b. Ask the provider about changing to an ARB during pregnancy. c. Continue taking the ACE inhibitor during her pregnancy. d. Discuss using methyldopa instead while she is pregnant.

d. Discuss using methyldopa instead while she is pregnant.

A nurse is obtaining a history from a patient who will receive tadalafil [Cialis] for erectile dysfunction. The patient reports that he expects to have sexual activity three or four times a week. What should the nurse tell the patient? a. Adverse effects of tadalafil resolve more quickly than those of sildenafil. b. There is an increased risk of priapism with frequent sexual activity. c. He should take tadalafil 30 to 60 minutes before sexual activity. d. He should talk to his provider about daily dosing of tadalafil.

d. He should talk to his provider about daily dosing of tadalafil.

A patient diagnosed with STEMI is about to undergo a primary percutaneous coronary intervention (PCI). Which combination of pharmacotherapeutic agents will be given to augment this procedure? a. Beta blocker and nitroglycerin b. Abciximab and a fibrinolytic drug c. Angiotensin-converting enzyme (ACE) inhibitor and aspirin d. Heparin, aspirin, and clopidogrel

d. Heparin, aspirin, and clopidogrel

A patient who is recovering from a STEMI 3 months prior is in the clinic for a follow-up evaluation. The patient is taking 81 mg of aspirin, a beta blocker, and an ACE inhibitor daily and uses nitroglycerine as needed for angina. The patient's BMI is 24.5 kg/m2, and serum LDL is 150 mg/dL. The patient has a blood pressure of 135/80 mm Hg. What will the nurse expect the provider to order for this patient? a. An antihypertensive medication b. Counseling about a weight loss diet c. Discontinuing the ACE inhibitor d. High-dose statin therapy

d. High-dose statin therapy

A patient with hypertension is prescribed an angiotensin-converting enzyme (ACE) inhibitor. The nurse reviewing this patient's chart before administering the medication will be most concerned about which other disease process? a. Bronchial asthma b. Coronary artery disease c. Diabetes mellitus d. Renal artery stenosis

d. Renal artery stenosis

4. A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed spironolactone [Aldactone]. The nurse assesses the patient and notes dyspnea, bilateral crackles, and pitting edema in both feet. Which intervention is appropriate? a. Administer the medications as ordered. b. Ask the patient about the use of salt substitutes. c. Contact the provider to request an order for serum electrolytes. d. Request an order for furosemide [Lasix].

d. Request an order for furosemide [Lasix].

8. A patient is admitted with severe hypertensive crisis. The nurse will anticipate administering which medication? a. Captopril PO b. Hydralazine [Apresoline] 25 mg PO c. Minoxidil 20 mg PO d. Sodium nitroprusside [Nitropress] IV

d. Sodium nitroprusside [Nitropress] IV

5. A patient with hypertension is taking furosemide [Lasix] for congestive heart failure. The prescriber orders digoxin to help increase cardiac output. What other medication will the nurse expect to be ordered for this patient? a. Bumetanide [Bumex] b. Chlorothiazide [Diuril] c. Hydrochlorothiazide [HydroDIURIL] d. Spironolactone [Aldactone]

d. Spironolactone [Aldactone]

A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient? a. The fetus most likely will have serious congenital defects. b. The fetus must be monitored closely while the patient is taking this drug. c. The patient's prescriber probably will change her medication to an ARB. d. The patient should stop taking the medication and contact her provider immediately.

d. The patient should stop taking the medication and contact her provider immediately.

A patient taking gemfibrozil [Lopid] and rosuvastatin [Crestor] concurrently begins to complain of muscle aches, fatigue, and weakness. What should the nurse monitor? a. For tendon tenderness b. For a lupus-like syndrome c. The patient's liver function test results d. The patient's creatinine kinase levels

d. The patient's creatinine kinase levels

A 50-year-old female patient asks a nurse about taking aspirin to prevent heart disease. The patient does not have a history of myocardial infarction. Her cholesterol and blood pressure are normal, and she does not smoke. What will the nurse tell the patient? a. Aspirin is useful only for preventing a second myocardial infarction. b. She should ask her provider about using a P2Y12 ADP receptor antagonist. c. She should take one 81-mg tablet per day to prevent myocardial infarction. d. There is most likely no protective benefit for patients her age.

d. There is most likely no protective benefit for patients her age.

A patient who takes warfarin [Coumadin] is brought to the emergency department after accidentally taking too much warfarin. The patient's heart rate is 78 beats per minute and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have any obvious hematoma or petechiae and does not complain of pain. The nurse will anticipate an order for: a. vitamin K (phytonadione). b. protamine sulfate. c. a PTT. d. a PT and an INR.

d. a PT and an INR.

A patient with a history of benign prostatic hyperplasia is admitted to the unit. The patient is taking multiple medications, including terazosin [Hytrin]. During the evening rounds, the patient begins to complain of dizziness and nasal congestion. Upon assessment, the patient is somnolent and has a blood pressure of 101/42 mm Hg. The nurse is correct to suspect: a. priapism. b. sinus infection. c. allergic reaction. d. adverse effects.

d. adverse effects.

A nursing student asks a nurse how beta blockers increase the oxygen supply to the heart in the treatment of anginal pain. The nurse tells the student that beta blockers: a. dilate arterioles to improve myocardial circulation. b. improve cardiac contractility, which makes the heart more efficient. c. increase arterial pressure to improve cardiac afterload. d. increase the time the heart is in diastole.

d. increase the time the heart is in diastole.

2. A patient begins taking nifedipine [Procardia], along with metoprolol, to treat hypertension. The nurse understands that metoprolol is used to: a. reduce flushing. b. minimize gingival hyperplasia. c. prevent constipation. d. prevent reflex tachycardia.

d. prevent reflex tachycardia.

A patient is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes that the patient has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats per minute. The patient's most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The nurse will request an order for: a. a repeat aPTT to be drawn immediately. b. analgesic medication. c. changing heparin to aspirin. d. protamine sulfate.

d. protamine sulfate.

A patient who takes warfarin for atrial fibrillation undergoes hip replacement surgery. On the second postoperative day, the nurse assesses the patient and notes an oxygen saturation of 83%, pleuritic chest pain, shortness of breath, and hemoptysis. The nurse will contact the provider to report possible ____ and request an order for ____. a. congestive heart failure; furosemide [Lasix] b. hemorrhage; vitamin K (phytonadione) c. myocardial infarction; tissue plasminogen activator (tPA) d. pulmonary embolism; heparin

d. pulmonary embolism; heparin

A patient who has begun using transdermal nitroglycerin for angina reports occasional periods of tachycardia. The nurse will expect the prescriber to order: a. digoxin [Lanoxin] to slow the heart rate. b. immediate discontinuation of the nitroglycerin. c. periods of rest when the heart rate increases. d. verapamil as an adjunct to nitroglycerin therapy.

d. verapamil as an adjunct to nitroglycerin therapy.

11. A nurse prepares to administer a scheduled dose of digoxin. The nurse finds a new laboratory report showing a plasma digoxin level of 0.7 ng/mL. What action should the nurse take? a.Withhold the drug for an hour and reassess the level. b.Withhold the drug and notify the prescriber immediately. c.Administer Digibind to counteract the toxicity. d.Check the patient's apical pulse, and if it is within a safe range, administer the digoxin.

d.Check the patient's apical pulse, and if it is within a safe range, administer the digoxin.

12. A prescriber is considering prescribing the amiodarone derivative dronedarone [Multaq] for a patient with atrial flutter. The nurse should be concerned about which of the following? a.History of asthma b.History of hypothyroidism c.PR interval of 260 msec d.QT interval of 520 msec

d.QT interval of 520 msec

11. A patient is in the intensive care unit after a myocardial infarction. The nurse notes that the QT interval on this patient's electrocardiogram has been elongating. The nurse is concerned that which cardiac dysrhythmia may occur? a.AV block b.Bradycardia c.Supraventricular tachycardia d.Torsades de pointes

d.Torsades de pointes

5. A patient is taking digoxin [Lanoxin] and quinidine to treat sustained ventricular tachycardia. Before giving medications, the nurse reviews the patient's electrocardiogram (ECG) and notes a QRS complex that has widened by 50% from the baseline ECG. What will the nurse do? a.Administer the medications as ordered, because this indicates improvement. b.Contact the provider to discuss reducing the digoxin dose. c.Contact the provider to request an increase in the quinidine dose. d.Withhold the quinidine and contact the provider to report the ECG finding.

d.Withhold the quinidine and contact the provider to report the ECG finding.

7. A patient with heart failure who has been taking an ACE inhibitor, a thiazide diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the nurse will expect the provider to evaluate: a.complete blood count. b.ejection fraction. c.maximal exercise capacity. d.serum electrolyte levels.

d.serum electrolyte levels.

16. The nurse is teaching a class on dysrhythmias and associated therapy. The nurse asks the class, "Which cardiac dysrhythmia would result in the lowest cardiac output, and what treatment would be effective?" The class best demonstrates understanding by responding that ____ results in the lowest cardiac output, and treatment includes ____. a.atrial flutter; lidocaine b.tachycardia; atropine c.first-degree heart block; verapamil [Calan] d.ventricular fibrillation; defibrillation

d.ventricular fibrillation; defibrillation