Pharm Exam 3

This monitoring tool should be utilized during administration of antidysrhythmic drugs to watch for worsening dysrhythmias

ECG

The nurse counsels the parent of a school-age client diagnosed with asthma. The health care provider prescribes albuterol and beclomethasone via metered dose inhaler. Which statement by the parent indicates that teaching is effective? 1. "Albuterol should be taken as needed when my child is short of breath. The Beclomethasone should be taken every day to prevent asthma attacks." 2. "Both of the medications should be taken on a regular basis, at the same time each day." 3. "The Beclomethasone is to be used only when my child is wheezing and is short of breath." 4. "Both inhalers should be used immediately before my child participates in physical exercise."

"Albuterol should be taken as needed when my child is short of breath. The beclomethasone should be taken every day to prevent asthma attacks."

Which instruction should be included in the discharge teaching for a patient with a transdermal nitroglycerin (Nitro-Dur) patch? "Make sure to rub a lotion or cream on the skin before putting on a new patch." "If you get chest pain, apply a second patch next to the first patch." "Apply the patch to a hairless, nonirritated area of the chest, upper arm, back or shoulder." "If you get a headache, remove the patch for 4 hours and then reapply."

"Apply the patch to a hairless, nonirritated area of the chest, upper arm, back or shoulder." A nitroglycerin patch should be applied to a clean, residue-free, hairless, nonirritated area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and if headache occurs, the patient should not change the patch removal schedule to avoid these headaches. Sublingual nitroglycerin should be used to treat chest pain.

A patient has a new order for the adrenergic drug doxazosin (Cardura). When providing education about this drug, the nurse will include which instructions? "The impaired taste associated with this medication usually goes away in 2 to 3 weeks." "Be sure to lie down after taking the first dose, because first-dose hypotension may make you dizzy." "Increase your potassium intake by eating more bananas and apricots." "Weigh yourself daily, and report any weight loss to your prescriber."

"Be sure to lie down after taking the first dose, because first-dose hypotension may make you dizzy."

Which discharge instruction should the nurse include for a patient prescribed an antilipemic medication? "It is important to take a double dose to make up for a missed dose." "Stop taking the medication if it causes nausea and vomiting." "Continue your exercise program and maintain a low-fat diet." "Lifestyle changes are no longer necessary when taking this medication."

"Continue your exercise program and maintain a low-fat diet." Antilipemic medications are in addition to, not a replacement of, therapeutic lifestyle changes used to decrease serum cholesterol. Maintain a low-fat, low-cholesterol diet is an integrated part of a change in lifestyle.

The patient asks the nurse, "What is the difference between dalteparin (Fragmin) and heparin?" What is the nurse's best response? "Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect." "The only difference is that the heparin dosage calculation is based on the patient's weight." "There is really no difference, but dalteparin is preferred because it is less expensive." "I'm not really sure why some health care providers choose dalteparin and some heparin."

"Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect." A low-molecular-weight heparin is more predictable in its effect than regular heparin. Dalteparin is more expensive than heparin and is dosed based on the patient's weight.

The nurse determines the patient has a good understanding of the discharge instructions regarding warfarin (Coumadin) with which patient statement? "I will double my dose if I forget to take it the day before." "I should keep taking ibuprofen for my arthritis." "I should use a soft toothbrush for dental hygiene." "I should decrease the dose if I start bruising easily."

"I should use a soft toothbrush for dental hygiene." The patient should reduce the risk of bleeding, such as using a soft toothbrush. The other choices are inaccurate.

The nurse provides discharge instructions to a patient prescribed cholestyramine (Questran). Which statement by the patient indicates teaching was effective for this drug? "I will increase fiber in my diet and drink more fluids." "This drug can cause flushing, itching and gastrointestinal upset." "I will take Questran 1 hour before my other medications." "I will notify my health care provider if I have muscle pain."

"I will increase fiber in my diet and drink more fluids." Cholestyramine can cause constipation; thus increasing dietary fiber and fluid intake is appropriate. All other drugs should be taken 1 hour before or 4 hours after cholestyramine to facilitate proper absorption.

The client takes beclomethasone by metered dose inhaler (MDI). Which statement made by the client indicates that teaching is successful? "I know it is time to have the prescription refilled when the canister floats in water." "I will rinse my mouth and throat with water after each dose." "I will be sure not to shake the canister before I use it." "If the dose does not help, I will take extra and let the health care provider know the results."

"I will rinse my mouth and throat with water after each dose."

The nurse is teaching a patient about the inhaler Advair (salmeterol/fluticasone). Which statements by the patient indicate a correct understanding of this medication? Select all that apply. "I will rinse my mouth with water after each dose." "I need to use this inhaler whenever I feel short of breath, but not less than 4 hours between doses." "This medication is taken twice a day, every 12 hours." "I can take this inhaler if I get short of breath while exercising." "I will call my doctor if I notice white patches inside my mouth."

"I will rinse my mouth with water after each dose." "This medication is taken twice a day, every 12 hours." "I will call my doctor if I notice white patches inside my mouth."

Which statement by a client best indicates an understanding of the teaching on flunisolide (AeroBid)? "I will wash the plastic inhaler casing once a month." "I will not use my albuterol inhaler while I am taking AeroBid." "I will rinse my mouth with water after each use." "I will take two puffs to treat an acute asthma attack."

"I will rinse my mouth with water after each use." Flunisolide is an inhaled corticosteroid. Rinsing the mouth immediately after each use of the inhaler or nebulizer will help prevent oral candidal infections. It is not used to treat an acute asthma attack and should be taken with the client's bronchodilator medications. The plastic inhaler casing is washed in warm, soapy water every week.

The patient asks the nurse, "How should sublingual nitroglycerin be stored when I travel?" What is the nurse's best response? "It's best to keep it in its original container away from heat and light." "You can put a few tablets in a resealable bag and carry it in your pocket." "You can protect it from heat by placing the bottle in an ice chest." "Keep it in the glove compartment of your car to prevent exposure to heat."

"It's best to keep it in its original container away from heat and light." Although sublingual nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest, where it could freeze. It should not be kept in the glove compartment of a car and needs to be kept away from heat, not in a clear plastic bag.

A patient who is taking a xanthene derivative for chronic bronchitis asks the nurse, "I miss my morning coffee. I can't wait to go home and have some." What is the nurse's best response? "I know how you feel. I'd miss my coffee too." "I can get some coffee for you. I'll be right back." "It's important not to take coffee or other caffeinated products with this medicine as it may cause an increased heart rate as well as other problems." "You've been on this medicine for a few days. I can call your prescriber to ask whether or not you can have some coffee."

"It's important not to take coffee or other caffeinated products with this medicine as it may cause an increased heart rate as well as other problems."

A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold. The nurse will include which instruction? "You won't see effects for at least 1 week." "Continue the spray until nasal stuffiness has resolved." "Limit use of this spray to 3-5 days." "Avoid use of this spray if a fever develops."

"Limit use of this spray to 3-5 days."

During discharge teaching, which statement by the nurse would be MOST appropriate for a patient prescribed a transdermal clonidine (Catapres)? "Prolonged sitting or standing does not cause hypotension symptoms." "Occasional drooling is a common adverse effect of this medication." "Your blood pressure should be checked by your health care provider two to three times a week." "The patch should be applied to a nonhairy site, and you should not suddenly stop using this drug."

"The patch should be applied to a nonhairy site, and you should not suddenly stop using this drug." Transdermal clonidine patches should be applied to nonhairy areas of the skin, and application sites should be rotated. When the patch dosage form is used, it is important to remove the old patch before applying a new one. It must not be discontinued abruptly because it will lead to severe rebound hypertension (sudden high elevation of blood pressure). Prolonged standing can cause venous pooling and hypotension. Dry mouth, not drooling, is a common adverse effect of clonidine.

The nurse performs discharge teaching with a client who is prescribed the anticholinergic inhaler ipratropium bromide (Atrovent). Which statement by the client indicates to the nurse that teaching has been successful? "Nausea and vomiting are common adverse effects of this medication." "I may gain weight as a result of taking this medication." "I will not drink grapefruit juice while taking this drug." "This inhaler is not to be used alone to treat an acute asthma attack."

"This inhaler is not to be used alone to treat an acute asthma attack." Although ipratropium works to prevent bronchoconstriction and thus secondarily leads to bronchodilation, a direct-acting bronchodilator is needed to treat an acute asthma attack.

Which statement by the client demonstrates an understanding about beclomethasone diproprionate (Beconase) mechanism of action? "I will monitor my blood sugar because I may develop drug-induced diabetes." "I only need to take this medication when my symptoms get bad." "This medication will help prevent the inflammatory response of my allergies." "I will need to taper off the medication to prevent acute adrenal crisis."

"This medication will help prevent the inflammatory response of my allergies." Beclomethasone diproprionate is a steroid spray administered nasally. It is used to prevent and treat allergy symptoms. Its effect is localized, and therefore the client does not have systemic adverse effects with the recommended dose. There is no need to taper off gradually as with oral corticosteroids.

A patient who has started taking niacin complains that he "hates the side effects." Which statement by the nurse is most appropriate? "You will soon build up tolerance to these side effects." "You need to take the niacin on an empty stomach." "You can take the niacin every other day if the side effects are bothersome." "Try taking a small dose of ibuprofen (Advil) 30 minutes before taking the niacin."

"Try taking a small dose of ibuprofen (Advil) 30 minutes before taking the niacin."

The nurse is assessing the patient's knowledge regarding drug therapy prescribed for the treatment of hypertension. Which statement by the patient indicates the need for further teaching by the nurse? "I will move slowly from a sitting to standing position." "Blood pressure drugs can cause changes in sexual functioning." "When my blood pressure is over 140/90, I will take my medication." "I will wear a medical alert bracelet."

"When my blood pressure is over 140/90, I will take my medication." Patients must adhere to prescribed antihypertensive regimen to prevent end-organ damage. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, but the medication may produce unwanted adverse effects. Patient teaching is essential.

A client receives a prescription for clopidogrel. Which laboratory result is important for the nurse to monitor based on this new prescription? 1. Hemaglobin & Hematocrit (H&H) 2. Platelet count 3. International normalized ratio (INR) 4. Activated partial thromboplastin time (aPTT)

1. Hemaglobin & Hematocrit (H&H)

A client is prescribed a subcutaneous injection of heparin 5000 units. Which technique will the nurse use to administer this medication? 1. Massage the injection site 2. Avoid aspirating after inserting the needle 3. Use a 1-inch, 18- to 20- gauge needle 4. Administer in the deltoid muscle

2. Avoid aspirating after inserting the needle

In reviewing the history of a newly admitted cardiac patient, the nurse knows that the patient would have a contraindication to antilipemic therapy if which condition is present? 1. Coronary artery disease 2. Liver disease 3. Diabetes mellitus 4. Renal disease

2. Liver disease

A client receiving an IV infusion of heparin has an activated partial thromboplastin time (aPTT) that is greater than 150 seconds. Which action is most appropriate for the nurse to take? 1. Stop the heparin and administer protamine sulfate 2. Stop the heparin and notify the health care provider 3. Maintain the heparin at the current infusion rate. 4. Increase the infusion rate and notify the health care provider

2. Stop the heparin and notify the health care provider

A client experiences a pulmonary embolism after abdominal surgery. Which information in the client's history will contraindicate the use of thrombolytic therapy? 1. Has type 2 diabetes mellitus. 2. Takes medications as needed for angina pectoris. 3. Is recovering from a concussion that occurred 3 weeks ago 4. Uses an inhaler for treatment of asthma

3. Is recovering from a concussion that occurred 3 weeks ago

When preparing to administer intravenous furosemide (Lasix) to a patient with renal dysfunction, the nurse will administer the medication no faster than which rate? 6 mg/min 4 mg/min 2 mg/min 8 mg/min

4 mg/min Furosemide controlled infusion rate should not exceed at a rate of 4 mg/min in patients with renal failure.

The nurse obtains a history from a client who is prescribed rosuvastatin. Which client report is most important for the nurse to report to the health care provider? 1. Rash 2. Headache 3. Abdominal pain 4. Muscle tenderness

4. Muscle tenderness

A patient who has a history of asthma is experiencing an acute episode of shortness of breath and needs to take a medication for immediate relief. The nurse will choose which medication that is appropriate for this situation? A beta agonist, such as albuterol An leukotriene receptor antagonist, such as montelukast A corticosteroid, such as fluticasone An anticholinergic, such as ipratropium

A beta agonist, such as albuterol

The nurse knows that an antitussive cough medication would be the best choice for which patient? A patient with a productive cough A patient with chronic paranasal sinusitis A patient who has had recent abdominal surgery A patient who has influenza

A patient who has had recent abdominal surgery

The nurse is reviewing the use of antitussive drugs. Antitussive drugs would be most appropriate for which patient: A patient who has pneumonia with a productive cough. A patient who has a tracheostomy and thick mucus secretions. A patient who has had a productive cough for 2 weeks A patient with a persistent non-productive dry cough.

A patient with a persistent non-productive dry cough.

A patient is in an urgent-care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment: A short-acting beta2 agonist such as albuterol An anticholinergic such as ipratropium (Atrovent) A long-acting beta2 agonist such as Salmeterol A corticosteroid such as Fluticasone

A short-acting beta2 agonist such as albuterol The short-acting beta2 agonists are commonly used during the acute phase of an asthmatic attack to reduce airway constriction quickly and to restore airflow to normal levels. The other drugs listed are not appropriate for acute asthma attacks. Anticholinergic drugs and long-acting beta2 agonists are used to prevent attacks; corticosteroids are used to reduce airway inflammation.

This drug is used to protect the kidneys in diabetic patients by decreasing the glomerulus pressure

ACE inhibitors

a dry cough is one of the classic adverse effects of this group of drugs

ACE inhibitors

The nurse notes in a patient's medical record that nesiritide (Natrecor) has been ordered. Based on this order, the nurse interprets that the patient has which disorder? Atrial fibrillation Pulmonary hypertension Systolic heart failure Acutely decompensated heart failure with dyspnea at rest

Acutely decompensated heart failure with dyspnea at rest

To decrease the skin flushing adverse effect reaction of niacin (nicotinic acid), which action should the nurse take? Administer niacin with a liquid antacid. Administer aspirin 30 minutes before each dose. Give niacin with all other morning medications. Apply cold compresses to the head and neck.

Administer aspirin 30 minutes before each dose. To help minimize the adverse effect flushing of the skin, the patient should take a small dose of aspirin or nonsteroidal antiinflammatory drugs 30 minutes before taking niacin, but only as prescribed or recommended by the health care provider.

The nurse is administering an IV solution that contains potassium chloride to a patient in the critical care unit who has a severely decreased serum potassium level. Which action(s) by the nurse are appropriate? Administer the potassium by slow IV bolus Administer the potassium at a rate no faster than 20 mEq/hr Monitor the patient's cardiac rhythm with a heart monitor use an infusion pump for the administration of IV potassium chloride Administer the potassium IV push

Administer the potassium at a rate no faster than 20 mEq/hr Monitor the patient's cardiac rhythm with a heart monitor use an infusion pump for the administration of IV potassium chloride Administer the potassium IV push

The nurse is reviewing a patient's medication orders for prn (as necessary) medications that can be given to a patient who has bronchitis with a productive cough. Which drug will the nurse choose? An antitussive An expectorant An antihistamine A decongestant

An expectorant

A patient who has been taking antihypertensive drugs for a few months complains of having a persistent dry cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs? Calcium channel blockers Angiotensin Converting Enzyme Inhibitors Beta blockers Angiotensin II Receptor Blockers

Angiotensin Converting Enzyme Inhibitors

A client is making an appointment for allergy testing. The nurse instructs the client not take what class of medications at least 4 days before allergy testing? Antitussives Decongestants Antihistamines Bronchodilators

Antihistamines An allergist will usually recommend discontinuation of antihistamine drug therapy at least 4 days before allergy testing.

The nurse would question the use of milrinone (Primacor) in a patient with which condition? Mitral valve prolapse Aortic regurgitation Systolic heart failure Acute renal failure

Aortic regurgitation Milrinone (Primacor), a PDI, is contraindicated in severe aortic or pulmonary valvular disease and in diastolic heart failure.

A patient prescribed digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg for the treatment of systolic heart failure states, "I am starting to see yellow halos around lights." Which action will the nurse take? Perform a visual acuity test on each eye. Assess for other symptoms of digoxin toxicity. Prepare to administer digoxin immune fab (Digifab). Document the finding and reassess in 1 hour.

Assess for other symptoms of digoxin toxicity. Yellow-green halos around objects is a symptom of digoxin toxicity. Other signs and symptoms of digoxin toxicity include headache, dizziness, confusion, nausea, and blurred vision. Electrocardiogram findings show heart block, atrial tachycardia with block, or ventricular dysrhythmias.

A patient is taking digoxin (Lanoxin) and a loop diuretic daily. When the nurse enters the room with the morning medications, the patient states, "I am seeing a funny yellow color around the lights." What is the nurse's next action? Reassure the patient that this is a common side effect of Digoxin Assess the patient for symptoms of digoxin toxicity. Administer the digoxin and diuretic together as ordered. Withhold the next dose of the diuretic.

Assess the patient for symptoms of digoxin toxicity.

To prevent the occurrence of cinchonism in a patient prescribed quinidine (Quindex), which instruction is MOST important for the nurse to provide for this patient? Increase dietary intake of potassium. Avoid drinking grapefruit juice. Advise the patient to wear sunscreen every day. Remind the patient to change positions slowly.

Avoid drinking grapefruit juice. Grapefruit juice can inhibit the metabolism of quinidine, which increases the risk of cinchonism.

Which statement needs to be included when the nurse provides patient education for a patient with heart failure who is taking daily doses of spironolactone (Aldactone)? Be sure to eat foods that are high in potassium Avoid foods that are high in potassium Avoid grapefruit juice while taking this medication A low-fiber diet will help prevent adverse effects of this medication

Avoid foods that are high in potassium

The patient's serum digoxin level is 0.4 ng/mL. How does the nurse interpret this laboratory value result for digoxin? Normal therapeutic level Below the therapeutic level A toxic serum blood level Above the therapeutic level

Below the therapeutic level Therapeutic serum digoxin levels are 0.5 to 2 ng/mL.

A patient who is prescribed tamsulosin (Flomax) does not have a history of hypertension. The nurse knows this medication is also used for what condition? Migraine headache Pulmonary emboli Subarachnoid hemorrhage Benign prostatic hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) Alpha1 blockers have beneficial in the treatment of BPH. The blocking of alpha1-adrenergic receptors decreases the urine outflow obstruction related to BPH by preventing smooth muscle contractions in the bladder neck and urethra.

Which statement by the nurse explains to the patient the action of cholestyramine (Questran) to decrease blood lipid levels? Inhibits lipolysis in adipose tissue and decreases the hepatic synthesis of triglycerides in the liver. Stimulates the biliary system to increase excretion of dietary cholesterol. Binds to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces. Inhibits absorption of dietary cholesterol in the small and large intestine.

Binds to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces. Cholestyramine is an anion exchange resin that binds to bile acids in the small intestine to form an insoluble complex that is excreted in the feces. The liver must then use cholesterol to synthesize more bile.

The nurse will assess a patient receiving gemfibrozil (Lopid) and warfarin (Coumadin) for the increased risk of which adverse effect? Bleeding Clotting Vitamin K toxicity Deep vein thrombosis

Bleeding Gemfibrozil can bind with vitamin K in the intestinal tract, reducing vitamin K absorption. Because vitamin K is the antidote for warfarin, a lack of vitamin K increases the anticoagulant effect of warfarin and thus the risk of bleeding.

The nurse would question a prescription for colesevelam (Welchol) in a patient with which condition? Hepatic disease Bowel obstruction Renal disease Glaucoma

Bowel obstruction Colesevelam (Welchol) is contraindicated in patients with a history of bowel obstruction.

When caring for a patient with angina pectoris, the nurse would question a prescription for a noncardioselective beta blocker in a patient with which preexisting condition? Atrial fibrillation Bronchial asthma Myocardial infarction Hypertension

Bronchial asthma Noncardioselective beta blockers should be used with caution in patients with bronchial asthma, because any level of blockade of beta2-receptors can promote bronchoconstriction.

Which drug class is used to treat both hypertension and antidysrhythmias? Direct-acting vasodilators Alpha-adrenergic-blocking Sodium channel blockers Calcium channel blockers

Calcium channel blockers Calcium channel blockers are effective in treating both hypertension and dysrhythmias secondary to their negative inotropic and chronotropic effects.

Before administering an LTRA medication, the nurse would assess the client for allergies to which substance? (Select all that apply.) Select all that apply. Latex Cellulose Chlorhexidine Povidone Lactose

Cellulose Chlorhexidine Povidone Lactose Allergies to povidone, lactose, titanium dioxide, or cellulose derivatives are important to note because these are inactive ingredients in LTRAs.

What body system will the nurse assess for known common adverse effects of traditional antihistamines? Respiratory Gastrointestinal Central nervous Cardiovascular

Central nervous The most common adverse effect of antihistamines is drowsiness, but the sedative effects vary among antihistamine drug classes.

Before administering eplerenone (Inspra) to a patient, what is the priority nursing action? Auscultate heart sounds. Obtain serum thiocyanate level. Assess level of consciousness. Check serum electrolytes.

Check serum electrolytes. Eplerenone (Inspra) is contraindicated in patients with an elevated serum potassium level (greater than 5.5 mEq/L) or severe renal impairment. Therefore, it is imperative that the nurse assess the patient's most recent serum electrolytes before administering this medication.

The patient is prescribed ibutilide (Corvert), a class III antiarrhythmic drug. The nurse understands this drug has been prescribed for which reason? Conversion of recent-onset atrial fibrillation and flutter Treatment of PSVT Conversion of life-threatening ventricular dysrhythmias Treatment of dysrhythmias in patients with acute renal failure

Conversion of recent-onset atrial fibrillation and flutter Ibutilide is specifically indicated only for treatment of recent-onset atrial fibrillation and flutter.

The nurse is preparing to administer digoxin (Lanoxin) 0.25mg intravenous push to a patient. Which is an expected patient outcome related to the administration of digoxin? Low serum potassium Reduction in urine output Increase in blood pressure Decrease in the heart rate

Decrease in the heart rate Digoxin has a negative chronotropic effect (decreased heart rate).

A patient receiving IV nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's best action? Recheck the patient's vital signs in 1 hour. Assess the patient's lung sounds. Increase the IV nitroglycerin by 10 mcg/min. Decrease the IV nitroglycerin by 10 mcg/min.

Decrease the IV nitroglycerin by 10 mcg/min. Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 minutes while changing the rate of the IV nitroglycerin infusion.

What is the classification of carvedilol (Coreg)? Beta blocker ACE inhibitor Alpha2 blocker Dual-action alpha1 and beta receptor blocker

Dual-action alpha1 and beta receptor blocker Carvedilol blocks both the alpha1and beta receptors of the adrenergic nervous system.

The nurse reviews an adult patient's laboratory values and notes a digoxin level of 11 ng/mL and a serum potassium level of 6.2 mEq/L. The nurse would notify the health care provider and anticipate which medication will be prescribed to administer? Atropine Digoxin immune Fab Sodium polystyrene sulfonate (Kayexalate) Epinephrine (Adrenalin)

Digoxin immune Fab Digoxin immune Fab is indicated for severe digoxin toxicity in patients with the following clinical findings: hyperkalemia (serum potassium level higher than 5 mEq/L) with digoxin toxicity; life-threatening digoxin overdose (more than 10 mg digoxin in adults; more than 4 mg digoxin in children); and life-threatening cardiac dysrhythmias, sustained ventricular tachycardia or fibrillation, and severe sinus bradycardia or heart block unresponsive to atropine treatment or cardiac pacing.

The nurse is conducting a community education program. When explaining different medication regimens to treat hypertension, it would be accurate to state that African Americans probably respond best to which combination of medications? Diuretics and calcium channel blockers ACE inhibitors and diuretics Diuretics and beta blockers ACE inhibitors and beta blockers

Diuretics and calcium channel blockers Research has demonstrated that African Americans do not typically respond therapeutically to beta blockers or ACE inhibitors. They respond better to diuretics and calcium channel blockers.

The nurse is giving an antihistamine and will observe the patient for which side effects? (Select all that apply.) Hypertension Dizziness "Hangover" effect Drowsiness Tachycardia Dry mouth

Dizziness "Hangover" effect Drowsiness Dry mouth

A patient is taking guaifenesin as part of treatment for a sinus infection. Which instruction will the nurse include during patient teaching? Report clear-colored sputum to the prescriber Drink extra fluid to help loosen and liquefy secretions Avoid driving a car or operating heavy machinery because of the sedating effects Report symptoms that last longer than 2 days.

Drink extra fluid to help loosen and liquefy secretions Forcing fluids helps to loosen and liquefy secretions. The patient must be fully aware that any fever, chest tightness, change in sputum from clear to colored, difficult or noisy breathing, activity intolerance, or weakness should be reported. The patient also must report to the prescriber a fever of higher than 100.4 F (38 C). Decongestants do not cause sedation.

The nurse understands a patient who is treated for hypertension may be switched to an angiotensin receptor blocker (ARB) because of which angiotensin-converting enzyme (ACE) inhibitor adverse effect? Dry, nonproductive cough Hypokalemia Fatigue Orthostatic hypotension

Dry, nonproductive cough ACE inhibitors block the breakdown of bradykinins and may cause a dry, nonproductive cough. ARBs do not block this breakdown, thus minimizing this adverse effect. ACE inhibitors and ARBs are equally effective for the treatment of hypertension, but ARBs do not cause cough.

It is MOST important for the nurse to instruct a patient prescribed nitroglycerin to avoid which substance? Potassium-sparing diuretics Grapefruit juice Erectile dysfunction drugs Antacids

Erectile dysfunction drugs Concurrent administration of nitrate drugs and erectile dysfunction drugs such as sildenafil citrate (Viagra), tadalafil (Cialis), and vardenafil (Levitra) can cause an additive hypotensive effect.F

Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) are generally administered at which time of day? Evening 12:00 noon Afternoon Morning

Evening The liver produces the majority of cholesterol during the night. Thus, statin drugs, which decrease the cholesterol synthesis, are generally administered in the evening or bedtime so that the peak drug levels coincide with cholesterol production.

The nurse enters the room of a client with an admitting diagnosis of confusion and angina pectoris. The nurse opens the client's gown to remove the nitroglycerin patch for the night. The nurse does not find the patch where charting indicated it was placed. What action does the nurse take first? Find the patch and dispose of it. Clean the site thoroughly with alcohol Ask the client what happened to the patch Administer nitroglycerin sublingually.

Find the patch and dispose of it.

which action by the nurse is most appropriate for a patient receiving an infusion of packed red blood cells? Flush the IV line with normal saline before the blood is added to the infusion Flush the IV line with dextrose before the blood is added to the infusion Check the patient's vital signs once the infusion is completed Anticipate that flushed skin and fever are expected reactions to a blood transfusion

Flush the IV line with normal saline before the blood is added to the infusion

During the IV administration of a hypertonic saline solution to treat a patient with severe hyponatremia, the nurse monitors for which signs and symptoms of hypernatremia? Flushed skin and increased thirst Mental confusion and seizures Vomiting and diarrhea Lethargy and hypotension

Flushed skin and increased thirst Hypertonic saline solutions administered to raise sodium levels may cause hypernatremia. Thus, very close monitoring for signs and symptoms of hypernatremia is needed. Flushed skin and increased thirst are signs and symptoms of hypernatremia. The other choices are signs and symptoms of hyponatremia.

The nurse is preparing an infusion for a patient who has a deficiency in clotting factors. What type of infusion is most appropriate? Albumin 5% Packed RBCs Whole blood Fresh frozen plasma

Fresh frozen plasma

The nurse recognizes that the patient understands the teaching about warfarin (Coumadin) when the patient verbalizes an increased risk of bleeding with concurrent use of which herbal product? (Select all that apply.) Select all that apply. Garlic St. John's wort Glucosamine Dong quai Ginkgo

Garlic, ginkgo, dong quai, and St. John's wort alter blood coagulation and may increase the risk of bleeding when given concurrently with oral anticoagulants. Glucosamine does not affect coagulation.

A patient with elevated triglyceride levels unresponsive to HMG-CoA reductase inhibitors will most likely be prescribed which drug? Colestipol (Colestid) Gemfibrozil (Lopid) Simvastatin (Zocor) Cholestyramine (Questran)

Gemfibrozil (Lopid) Gemfibrozil, a fibric acid derivative, promotes catabolism of triglyceride-rich lipoproteins

When assessing a patient who is to receive a decongestant, the nurse will recognize that a potential contraindication to this drug would be which condition? Glaucoma Fever Peptic ulcer disease Allergic rhinitis

Glaucoma

For a patient prescribed hydrochlorothiazide (HydroDIURIL), the nurse should closely monitor which laboratory test value? Chloride Calcium Glucose Sodium

Glucose Thiazide and thiazide-like diuretics are associated with adverse metabolic effects of hyperglycemia; therefore, close monitoring of blood glucose levels are needed. Other metabolic disturbances include hyperlipidemia and hyperuricemia.

The nurse will teach a patient who will be taking Nitroglycerin (Nitrostat) about which common adverse effect of this drug? Blurred vision Dizziness Headache Weakness

Headache

A patient is taking a decongestant to help reduce symptoms of a cold. The nurse will instruct the patient to observe for which possible symptom, which may indicate an adverse effect of this drug? Increased cough Dry mouth Slower heart rate Heart palpitations

Heart palpitations

The nurse would question a prescription for simvastatin (Zocor) in a patient with which condition? Hepatic disease Diabetes Leukemia Heart failure

Hepatic disease Simvastatin (Zocor) can cause an increase in liver enzymes and thus should not be used in patients with preexisting liver disease.

The nurse is caring for a patient who has peripheral edema and is hypotensive after receiving 5000 mL of normal saline intravenous (IV). The nurse anticipates administering which IV solution to correct the fluid imbalance? Lactated Ringer's solution 3% saline solution D5W Hetastarch (Hespan)

Hetastarch (Hespan) The patient needs to increase intravascular fluid volume. Hetastarch will enable this because it is a colloid that will increase osmotic pull from the extravascular spaces to the intravascular space. A 3% saline solution is also hypertonic, but its use is not preferred secondary to risk of hypernatremia.

When assessing a patient taking triamterene (Dyrenium), the nurse would monitor for which possible adverse effect? Hyperkalemia Hypoglycemia Hypernatremia Hypokalemia

Hyperkalemia Triamterene is a potassium-sparing diuretic, and therefore hyperkalemia is a possible adverse effect.

Potassium-sparing diuretics may cause which common adverse reactions? (Select all that apply.) Select all that apply. Dizziness Hyperkalemia Headache Muscle weakness Mental confusion

Hyperkalemia, dizziness, and headache are common adverse effects associated with potassium-sparing diuretics.

When giving decongestants, the nurse must remember that these drugs have alpha-adrenergic-stimulating effects that may result in which effect? Fever Bradycardia Hypertension CNS depression

Hypertension

The nurse would question a prescription for pseudoephedrine (Sudafed) in a client with a history of which condition? Pneumonia Peptic ulcer disease Hypertension Osteoporosis

Hypertension Adrenergic drugs are contraindicated in clients with hypertension, narrow-angle glaucoma, diabetes, uncontrolled cardiovascular disease, hyperthyroidism, prostatitis, or a known hypersensitivity to such drugs.

The nurse should question a prescription for a calcium channel blocker in a patient with which condition? Dysrhythmia Hypotension Angina pectoris Increased intracranial pressure

Hypotension Calcium channel blockers cause smooth muscle vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension.

When administering nitroprusside (Nipride) by continuous intravenous infusion, the nurse monitors for which symptom of drug toxicity? Wheezing Hypotension Fever Hyperglycemia

Hypotension The main symptom of sodium nitroprusside overdose or toxicity is excessive hypotension.

Which statement by the patient reflects the need for additional patient education about the calcium channel blocker diltiazem (Cardizem)? I can take this drug to stop an attack of angina I understand that food and antacids alter the absorption of this oral drug When the long acting forms are taken, the drug cannot be crushed This drug may cause blood pressure to drop, so I need to be careful when getting up

I can take this drug to stop an attack of angina

The nurse provides an albuterol nebulizer treatment to a client recovering from respiratory failure. Which finding does the nurse expect to observe after treatment? Increased productive cough Increased breath sounds in the upper lobes Decreased crackles in the lower lobes Increased ability to speak in full sentences Bilateral hand tremors

Increased productive cough Increased breath sounds in the upper lobes Increased ability to speak in full sentences Bilateral hand tremors

A pregnant woman is experiencing hypertension. The nurse knows that which drug is commonly used for a pregnant patient who is experiencing hypertension? Hydrochlorothiazide Methyldopa Captopril Mannitol

Methyldopa

A patient who is prescribed an anticoagulant requests an aspirin (acetylsalicylic acid) for headache relief. What is the nurse's best action? Administer 650 mg of acetylsalicylic acid and reassess pain in 30 minutes Inform the patient of potential drug interactions with anticoagulants. Explain that a common initial adverse effect is a headache for this drug. Explain that acetylsalicylic acid is contraindicated and administer ibuprofen.

Inform the patient of potential drug interactions with anticoagulants. Patients taking an anticoagulant should not use medications that would further increase the risk of bleeding.

By which action does atorvastatin (Lipitor) decrease lipid levels? Inhibiting HMG-CoA reductase, the enzyme responsible for the biosynthesis of cholesterol in the liver Decreasing the amount of triglycerides produced by the liver and increasing the removal of triglycerides by the liver Binding to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces Stimulating the gallbladder and biliary system to increase excretion of dietary cholesterol

Inhibiting HMG-CoA reductase, the enzyme responsible for the biosynthesis of cholesterol in the liver Atorvastatin (Lipitor) is an HMG-CoA reductase inhibitor that inhibits HMG-CoA reductase, the enzyme needed to make cholesterol in the liver.

What is the mechanism of action of ezetimibe (Zetia)? Binds to bile acids in the intestine, inhibiting its reabsorption into the blood. Inhibits absorption of dietary and biliary cholesterol in the small intestine. Decreases the adhesion of cholesterol in the arteries. Inhibits the biosynthesis of cholesterol in the liver.

Inhibits absorption of dietary and biliary cholesterol in the small intestine. Ezetimibe selectively inhibits absorption of cholesterol in the small intestine.

The nurse is providing education to a client with a history of chronic nasal congestion secondary to allergic rhinitis. Which class of medications should the nurse anticipate the provider would recommend for the client to use on a long-term basis? Intranasal steroids Expectorants Antihistamines Antitussives

Intranasal steroids Inhaled intranasal steroids and anticholinergic drugs are not associated with rebound congestion and are often used prophylactically to prevent nasal congestion in clients with chronic upper respiratory tract symptoms. Local intranasal steroids would have the least likely possible systemic adverse effects of all the medication classes possible to use for chronic and long term use.

The prescriber has changed the patient's medication regimen to include the leukotriene receptor antagonist montelukast (Singulair) to treat asthma. The nurse will emphasize which point about this medication? The proper technique for inhalation must be followed The patient needs to keep it close by at all times to treat acute asthma attacks It needs to be taken every day on a continuous schedule, even if symptoms improve. When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued.

It needs to be taken every day on a continuous schedule, even if symptoms improve. These drugs are indicated for chronic, not acute, asthma and are to be taken every day on a continuous schedule, even if symptoms improve. These drugs are taken orally.

A patient is experiencing a rapid dysrhythmia, and the nurse is preparing to administer adenosine. Which is the correct administration technique for this drug? It should be given as an intravenous drip infusion. It should be taken with food or milk It should be given as a fast intravenous push It should be given intravenously, slowly, over at least 5 minutes

It should be given as a fast intravenous push

A gardener needs an adrenergic decongestant because of seasonal allergy problems and asks the nurse whether he should take an oral form or a nasal spray. The nurse's answer considers that one benefit of orally administered decongestants is Immediate onset A more potent effect Lack of rebound congestion Shorter duration

Lack of rebound congestion Drugs administered by the oral route produce prolonged decongestant effects, but the onset of action is more delayed and the effect less potent than those of decongestants applied topically. However, the clinical problem of rebound congestion associated with topically administered drugs is almost nonexistent with oral dosage forms

A patient prescribed spironolactone (Aldactone) asks the nurse to assist with food choices that are low in potassium. The nurse would recommend which food choices? (Select all that apply.) Select all that apply. Lean meat Winter squash Apples Bananas Pineapple

Lean Meat Apples Pineapple Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Bananas and winter (not summer) squash are high in potassium and should be avoided in patients taking spironolactone.

What advantage does loratadine (Claritin) have compared with traditional antihistamines such as diphenhydramine (Benadryl)? Less sedative effect Minimal gastrointestinal upset Increase in bronchodilation Decreased risk of cardiac dysrhythmias

Less sedative effect Loratadine is a nonsedating antihistamine and it does not readily distribute into the central nervous system, which diminishes the sedative effects associated with traditional antihistamines.

Which laboratory value would the nurse assess before administering zafirlukast (Accolate) to a client? Renal function tests Complete blood count Liver enzymes Cardiac enzymes

Liver enzymes Because use of zafirlukast may lead to liver dysfunction, liver enzyme levels should be monitored regularly, especially early in the course of therapy.

To assess for a potentially serious adverse effect to HMG-CoA reductase inhibitors, the nurse should monitor which laboratory results? Serum electrolytes Urine specific gravity Liver function studies Complete blood count

Liver function studies HMG-CoA reductase inhibitors can cause hepatic toxicity; thus, liver function studies are often measured every 6 to 8 weeks for the first 6 months of statin therapy and then every 3 to 6 months, depending on the prescriber and the patient situation.

The nurse is discussing use of antihistamines for allergic rhinitis. Which medications would be included in the list of H1 antagonists used in the treatment of allergic rhinitis? (Select all that apply.) Select all that apply. Nizatidine (Axid) Loratadine (Claritin) Fexofenadine (Allegra) Ranitidine (Zantac) Cetirizine (Zyrtec)

Loratadine (Claritin) Fexofenadine (Allegra) Cetirizine (Zyrtec)

When caring for a patient with a serum potassium of 2.8 mEq/L, what is the priority nursing intervention when giving IV replacement therapy? Apply ice packs to site of IV administration. Maintain infusion rate at no greater than 20 mEq/hr. Administer potassium as a bolus over 10 minutes. Teach the patient signs and symptoms of hypokalemia.

Maintain infusion rate at no greater than 20 mEq/hr. Too rapid an infusion of potassium may cause cardiac arrest. Therefore, IV potassium infusion rates should not exceed 20 mEq/hr.

A patient with diabetes has a new prescription for a thiazide diuretic. Which statement will the nurse include when teaching the patient about the thiazide drug? There is nothing for you to be concerned about when you are taking the thiazide drug. Be sure to avoid foods that are high in potassium You will need to take the drug at night to avoid interactions with the diabetes medication Monitor your blood glucose levels closely, because the thiazide diuretic may cause the levels to increase.

Monitor your blood glucose levels closely, because the thiazide diuretic may cause the levels to increase.

The nurse is providing discharge teaching for a patient about potential serious adverse effects to simvastatin (Zocor). Which symptom may indicate the patient is experiencing a serious adverse effect to this medication? Muscle pain Itching Headache Weight loss

Muscle pain Unexplained muscle pain and soreness are symptoms of a relatively uncommon but serious adverse effect of rhabdomyolysis associated with statin drugs and must be immediately reported to the health care provider.

When teaching a patient about symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which symptom occurs? Diaphoresis Constipation Blurred vision Muscle weakness

Muscle weakness Muscle weakness is a common symptom of hypokalemia. The other answers are incorrect.

The nurse is reviewing the medications that have been ordered for a patient for whom a loop diuretic has just been prescribed. The loop diuretic may have a possible interaction with which of the following? A. Vitamin A B. Warfarin C. penicillins D. NSAIDs

NSAIDs

The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class? Diuretics Calcium channel blockers Nitrates NSAIDs

NSAIDs

To prevent cerebral artery spasms after a subarachnoid hemorrhage, the nurse anticipates administering which calcium channel blocker? Amlodipine (Norvasc) Nimodipine (Nimotop) Diltiazem (Cardizem) Verapamil (Calan)

Nimodipine (Nimotop) Nimodipine crosses the blood-brain barrier and has a greater effect on the cerebral arteries than on other arteries in the body; thus, it is indicated for the treatment of cerebral artery spasm after subarachnoid hemorrhage.

Before administering isosorbide mononitrate (Imdur) sustained-release tablet to a patient, what is the priority nursing intervention? Remind the patient to take the tablet before meals. Emphasize that the patient should swallow the tablet whole. Obtain a blood pressure reading. Advise the patient that Tylenol is used to treat headache.

Obtain a blood pressure reading. Mononitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.

When evaluating a patient's use of a metered-dose inhaler (MDI), the nurse notes that the patient is unable to coordinate the activation of the inhaler with her breathing. What intervention is most appropriate at this time? Notify the doctor that the patient is unable to use the MDI Obtain an order for a peak flow meter Obtain an order for a spacer device Ask the prescriber if the medication can be given orally.

Obtain an order for a spacer device

For a patient receiving a positive inotropic drug, which nursing assessments should be performed? (Select all that apply.) Select all that apply. Obtain daily weights. Check apical pulse. Auscultate lung sounds. Review red blood cell count. Monitor serum electrolytes.

Obtain daily weights. Check apical pulse. Auscultate lung sounds. Monitor serum electrolytes. Lung sounds and daily weights are appropriate assessments related to the treatment of heart failure with inotropic drugs. The apical pulse and serum electrolytes are important assessments related to potential adverse reactions (bradycardia, toxicity with hypokalemia).

Acetazolamide (Diamox) is used to treat which conditions? (Select all that apply.) Select all that apply. Open-angle glaucoma High-altitude sickness Dry eye syndrome Cardiac dysrhythmias Edema associated with heart failure

Open-angle glaucoma High-altitude sickness Edema associated with heart failure Acetazolamide causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat high-altitude sickness, edema secondary to heart failure, open-angle glaucoma, and rarely as an antiepileptic drug. It is not used for treatment of dry eye syndrome or cardiac dysrhythmias.

When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects? Fatigue and depression Anxiety and palpitations Headache and rapid heart rate Oral candidiasis and dry mouth

Oral candidiasis and dry mouth Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids. The other responses are incorrect.

A patient is taking a xanthine derivative (theophylline) as part of treatment for chronic obstructive pulmonary disease. The nurse will monitor for adverse effects associated with the use of xanthine derivatives, such as: Diarrhea Palpitations Bradycardia Drowsiness

Palpitations The common adverse effects of the xanthine derivatives include nausea, vomiting, and anorexia. In addition, gastroesophageal reflux has been observed to occur during sleep in patients taking these drugs. Cardiac adverse effects include sinus tachycardia, extrasystole, palpitations, and ventricular dysrhythmias. Transient increased urination and hyperglycemia are other possible adverse effects.

Which are therapeutic effects of digoxin (Lanoxin)? Positive inotropic, negative chronotropic, and negative dromotropic Negative inotropic, negative chronotropic, and negative dromotropic Positive inotropic, positive chronotropic, and negative dromotropic Positive inotropic, negative chronotropic, and positive dromotropic

Positive inotropic, negative chronotropic, and negative dromotropic Digoxin increases cardiac contractility (positive inotropic effect), decreases heart rate (negative chronotropic effect), and decreases conductivity (negative dromotropic effect).

Which medication should the nurse question if prescribed together with ACE inhibitors? Docusate sodium (Colace) Furosemide (Lasix) Potassium chloride (K-Dur) Morphine

Potassium chloride (K-Dur) ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion; thus, a decrease in aldosterone production can result in an increase in serum potassium.

In assessing a patient before administration of a cardiac glycoside, the nurse knows that which lab result can increase the toxicity of the drug? Calcium level 10 mg/dL Potassium level 4.9 mEq/L Sodium level 140 mEq/L Potassium level 2.8 mEq/L

Potassium level 2.8 mEq/L

For patients prescribed amiodarone (Cordarone), the nurse should monitor for which potential adverse effects of this drug? (Select all that apply.) Select all that apply. Hypothyroidism Visual halos Photosensitivity Blue gray skin discoloration overgrowth of gum tissue diarrhea

Potential adverse effects from amiodarone include visual halos, photosensitivity, photophobia, dry eyes, bluish skin discoloration, hyperthyroidism, hypothyroidism, constipation, and decreased libido.

ACE inhibitors and ARBs both work to decrease blood pressure by which action? Enhance sodium and water resorption Increase the breakdown of bradykinin Prevent the formation of angiotensin II Prevent aldosterone secretion

Prevent aldosterone secretion Whereas ACE inhibitors block the formation of angiotensin II, ARBs allow the formation of angiotensin II but block its effect at the receptors. Without the receptors stimulated (because of either drug), aldosterone secretion is inhibited, preventing the reabsorption of sodium and water.

This is the antidote for Heparin

Protamine Sulfate

For a patient receiving an IV infusion of alteplase (Activase), which nursing actions should be taken? (Select all that apply.) Select all that apply. Record vital signs and report changes. Assess for cardiac dysrhythmias. Observe for signs and symptoms of bleeding. Administer injections intramuscularly. Monitor for an increase in liver enzymes.

Record vital signs and report changes. Assess for cardiac dysrhythmias. Observe for signs and symptoms of bleeding.

During a teaching session for a patient who will be receiving a new prescription for the LTRA montelukast (Singulair), the nurse will tell the patient that the drug has which therapeutic effect? Improves the respiratory drive Loosens and removes thickened secretions Reduces inflammation in the airway Stimulates immediate bronchodilation

Reduces inflammation in the airway

While the nurse is providing care to a patient, the health care provider prescribes an IV potassium chloride infusion. For which condition would this prescription be given? Multiple Sclerosis Cirrhosis of the liver Renal Failure Hypertension

Renal Failure

The nurse is caring for a patient prescribed amiodarone (Cordarone). The nurse knows the MOST serious adverse effect of this medication can occur in which body system? Immune Nervous Gastrointestinal Respiratory

Respiratory Pulmonary toxicity is the most serious potential adverse effect of amiodarone.

After the patient takes a dose of an inhaled corticosteroid, such as fluticasone (Flovent), what is the most important action the patient needs to do next? Hold the breath for 60 seconds. Rinse out the mouth with water. Follow the corticosteroid with a bronchodilator inhaler, if ordered. Repeat the dose in 15 minutes if the patient feels short of breath.

Rinse out the mouth with water.

When the nurse is checking the lab data for a patient taking spironolactone (aldactone) which result would be a potential concern? Serum sodium level of 140 mEq/L Serum calcium level of 10.2 mg/dL Serum potassium level of 5.8 mEq/L Serum magnesium level of 2.0 mg/dL

Serum potassium level of 5.8 mEq/L

A patient has been receiving an aminophylline (xanthine derivative) infusion for 24 hours. The nurse will assess for which adverse effect when assessing the patient during the infusion? CNS depression Sinus tachycardia Increased appetite Temporary urinary retention

Sinus tachycardia

The nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of these diuretics? Acetazolamide Hydrochlorothiazide Furosemide Spironolactone

Spironolactone

A patient receiving an IV infusion of one unit of packed red blood cells suddenly develops shortness of breath, chills, and is feeling hot. What is the nurse's priority action? Check the vital signs. Notify the health care provider. Maintain a patent IV line with normal saline. Stop the blood transfusion.

Stop the blood transfusion. These are symptoms of a blood transfusion reaction. Thus, the nurse's priority action is to immediately stop the blood transfusion.

An older adult patient has been discharged following treatment for a mild case of heart failure. He will be taking a loop diuretic. Which instruction(s) form the nurse are appropriate? Take the diuretic at the same time each morning Take the diuretic only if you notice swelling in your feet Be sure to stand up slowly because the medicine may make you feel dizzy if you stand up quickly Drink at least 8 glasses of water each day Here is a list of foods that are high in potassium; you need to avoid these Please call your doctor immediately if you notice muscle weakness or increased dizziness

Take the diuretic at the same time each morning Be sure to stand up slowly because the medicine may make you feel dizzy if you stand up quickly Please call your doctor immediately if you notice muscle weakness or increased dizziness

a 68 year old male has been taking the nitrate isosorbid dinitrate (isordil) for 2 years for angina. He recently has been experiencing erectile dysfunction and wants a prescription for sildenafil (viagra). Which response would the nurse most likely hear from the prescriber? He will have to be switched to isosorbid mononitrate if he wants to take sildenafil Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists I'll write a prescription, bu if he uses it, he needs to stop taking the isosorbide for one dose These drugs are compatible with each other, so I'll write a prescription

Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists

The nurse is providing education to a patient prescribed spironolactone (Aldactone) and furosemide (Lasix). What information does the nurse explain to the patient? This combination promotes diuresis but decreases the risk of low levels of potassium. This combination maintains water balance to protect against dehydration and electrolyte imbalance. The lowest dose of two different types of diuretics are more effective than a large dose of one type. Using two drugs increases blood osmolality and the glomerular filtration rate.

This combination promotes diuresis but decreases the risk of low levels of potassium. Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes potassium loss.

A client is prescribed albuterol two puffs and beclomethasone two puffs. Which information will the nurse provide when instructing the client on the use of these inhalers? Use the albuterol inhaler and then use the beclomethasone inhaler. Use the beclomethasone inhaler and then the albuterol inhaler. Take one puff of each inhaler, wait a minute, and then repeat the process. Use either inhaler first as long as the medications are separated by 2 minutes.

Use the albuterol inhaler and then use the beclomethasone inhaler.

Phosphodiesterase inhibitors (PDIs) have an added advantage in treating heart failure. These drugs cause a positive inotropic effect and what other effect? Platelet inhibition Vasoconstriction Vasodilation Bronchodilation

Vasodilation PDIs are also called inodilators because they have both positive inotropic and vasodilatory effects.

When teaching a patient regarding the administration of digoxin (Lanoxin), the nurse instructs the patient not to take this medication with which food? Scrambled eggs French toast Wheat bran Bananas

Wheat bran Encourage patients to avoid using antacids or eating ice cream, milk products, yogurt, cheese (dairy products), or bran for 2 hours before or 2 hours after taking medication to avoid interference with the drugs absorption.

A patient about to receive a morning dose of digoxin has an apical pulse of 53 beats/minute. What will the nurse do next? Administer half the dose and recheck the pulse in one hour Check the radial pulse for one full minute Withhold the dose and notify the prescriber Administer the dose

Withhold the dose and notify the prescriber

When giving antihypertensive drugs, the nurse will consider giving the first dose at bedtime for which class of drugs? a. Alpha blockers such as doxazosin (Cardura) b. Diuretics such as furosemide (Lasix) c. ACE inhibitors such as captopril (Capoten) d. Vasodilators such as hydralazine (Apresoline)

a. Alpha blockers such as doxazosin (Cardura)

the nurse should teach the patient to limit use of this category of drug to 5 days or less to prevent rebound nasal congestion

adrenergic decongestants

The nurse should teach the patient to use this bronchodilator during an acute asthma attack

albuterol

This is a potentially life threatening adverse effect of ACE inhibitors and less commonly ARBs

angioedema

A 56-year-old man started antihypertensive drug therapy 3 months earlier and is in the office for a follow-up visit. While the nurse is taking his blood pressure, he informs the nurse that he has had some problems with sexual intercourse. Which would be the most appropriate response by the nurse? a. "Not to worry. Eventually, tolerance will develop" b. "The physician can work with you on changing the dose and/or drugs" c. "Sexual dysfunction happens with this therapy, you will have to learn to accept it" d. "This is an unusual occurrence, but it is important to stay on your medications"

b. "The physician can work with you on changing the dose and/or drugs"

A patient has a new prescription for an ACE inhibitor. During a review of the patient's list of current medications, which would cause concern for a possible interaction with this new prescription? (Select all that apply.) a. A benzodiazepine taken as needed for allergies b. A potassium supplement taken daily c. An oral anticoagulant taken daily d. An opioid used for occasional severe pain e. An NSAID taken as needed for headaches

b. A potassium supplement taken daily

When a patient is being taught about the potential adverse effects of an ACE inhibitor, which of these effects should the nurse mention as probably occurring when this drug is taken to treat hypertension? a. Diarrhea b. Nausea c. Dry, nonproductive cough d. Sedation

c. Dry, nonproductive cough

The nurse is administering antihypertensive drugs to older adult patients. The nurse knows that which adverse effect is of most concern for these patients? a. Dry mouth b. Hypotension c. Restlessness d. Constipation

b. Hypotension

Diabetic taking this anti-hypertensive class of drugs should be warned that it may cause and mask the symptoms of hypoglycemia

beta blockers

These categories of drugs treat angina by reducing the heart rate and lowering oxygen demand

beta blockers and calcium channel blockers

signs of toxicity of this drug include anorexia, nausea, and halo vision of yellow and purple

digoxin

The nurse will be sure to check an apical pulse before administering these two groups of drugs used for heart failure

digoxin and beta blockers

A patient has been placed on a milrinone (Primacor) infusion as part of the therapy for end-stage heart failure. What adverse effect of this drug will the nurse watch for when assessing this patient during the infusion? Cardiac dysrhythmias Nausea and vomiting Hypertension Hyperkalemia

cardiac dysrhythmias

When monitoring lab tests for a patient receiving thiazide and loop diuretics, the nurse knows to look for decreased serum levels of potassium increased serum levels of calcium decreased serum levels of glucose increased serum levels of sodium

decreased serum levels of potassium

When teaching a patient about a new prescription for carvedilol (Coreg), the nurse explains that this medication reduces blood pressure by which action? (Select all that apply.) Select all that apply. Decreases heart rate Promotes excretion of sodium Relaxes muscle tone Peripheral vasodilation Increases urine output

decreases heart rate peripheral dilation Carvedilol (Coreg) has the dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade).

This drug is useful in the treatment of a-fib and heart failure because it slows the heart rate but also increases myocardial contractility

digoxin

While monitoring a patient who is receiving an infusion of a crystalloid solution, the nurse will monitor for which potential problem? bradycardia hypotension decreased skin turgor fluid overload

fluid overload

When assessing a patient who is about to receive an albumin infusion, the nurse knows that a contraindication to albumin would be acute liver failure heart failure severe burns fluid-volume defecit

heart failure

An elderly patient will be taking a vasodilator for hypertension. Which adverse effect is of most concern for the older adult patient taking this class of drug? Constipation Dry mouth Restlessness Hypotension

hypotension

The nurse is assessing a patient who has a new prescription for vorapaxar (zontivity). Which of the conditions are contraindications to the use of vorapaxar? select all that apply. impaired renal function impaired liver function history of myocardial infarction peripheral artery disease history of stroke

impaired renal function impaired liver function history of stroke

When counseling a male patient about the possible adverse effects of antihypertensive drugs, the nurse will discuss which potential problem? Impotence Increased libido Paresthesia Constipation

impotence

The nurse should teach the patient to rinse their mouth out after use of this drug

inhaled corticosteroids

This group of medications are used to treat asthma through their anti-inflammatory effects

inhaled corticosteroids

a patient taking an alpha 1 blocker like Tamusolin for BPH should be aware of this potential side effect that puts them at risk for falls

orthostatic hypotension

A patient is taking an aminoglycoside antibiotic for pneumonia, and will also be taking the loop diuretic furosemide (Lasix) due to fluid overload. The nurse will monitor carefully for which potential effect from the interaction of these two drugs? Nephrotoxicity Ototoxicity Pulmonary fibrosis Hepatotoxicity

ototoxicity

The primary electrolyte that needs to be monitored in the administration of furosemide

potassium

When preparing an IV solution that contains potassium, the nurse knows that a contraindication to the potassium infusion would be diarrhea serum sodium level of 145 mEq/L serum potassium level of 5.6 mEq/L dehydration

serum potassium level of 5.6 mEq/L

A patient is about to receive a dose of the nonprotein plasma expander dextran. The nurse knows that this product is indicated for which type of blood loss? slow loss of 20% or less slow loss of 20% to 50% Slow loss of over 50% or acute loss of 20% loss of 80% or more

slow loss of 20% to 50%

A patient has a digoxin level of 1.4 ng/mL. The nurse interprets that this level is Indicative of toxicity Subtherapeutic Supratherapeutic Therapeutic

therapeutic

A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which class is likely to be used initially? Loop Potassium-sparing Osmotic Thiazide

thiazide

This group of diuretics should not be given to a patient with an elevated creatinine clearance

thiazides

The nurse knows to give furosemide slowly to avoid this adverse effect

tinnitus/ototoxicity

When giving adenosine for SVT, the nurse should monitor the patient for this expected effect

transitory asystole

The nurse is discussing with the client the management of symptoms of an upper respiratory tract infection. Which classes of medications are often used in treating the symptoms of upper respiratory tract infections? (Select all that apply.) Antibiotics Antihistamines Antitussives Expectorants Nasal decongestants

Antihistamines, antitussives, expectorants, nasal decongestants Treatment of the common symptoms of upper respiratory tract infections involves the combined use of antihistamines, nasal decongestants, antitussives, and expectorants. Upper respiratory tract infections are often viral or allergic in nature and the symptoms would not be managed with antibiotics.

Which statement by the patient demonstrates a need for further education regarding nitroglycerin (Nitrostat) sublingual tablets? "I should keep my nitroglycerin in a cool, dry place." "I should change positions slowly to avoid getting dizzy from the drug's effect on my blood pressure." "If I get a headache, I should keep taking my nitroglycerin and use Tylenol to relieve my headache." "I can take up to four tablets at 5-minute intervals for chest pain."

"I can take up to four tablets at 5-minute intervals for chest pain." Patients are taught to take up to three sublingual tablets 5 minutes apart. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after one dose, the patient (or family member) must call 911 immediately. The patient can take one more tablet while awaiting emergency care and a third tablet 5 minutes later, but no more than three tablets total. Patients should always sit or lie down before taking this medication.

The nurse is giving discharge instructions to a patient prescribed warfarin (Coumadin) for atrial fibrillation. Which statement by the patient indicates a need for further instruction from the nurse? "I will take my medication in the early evening each day." "I will contact my health care provider if I develop excessive bruising." "I will increase the dark green leafy vegetables in my diet." "I will avoid activities that have a risk for injury such as contact sports."

"I will increase the dark green leafy vegetables in my diet." Dark green leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Therefore, it is important to maintain a consistent daily intake of vitamin K and avoid eating large amounts of these foods.

The nurse is providing discharge teaching for a patient with a new prescription for nitroglycerin (Nitrostat) sublingual tablets. Which statement by the patient indicates an understanding of the nurse's discharge instructions about this medication? "I will need to refill my prescription when I feel burning under my tongue." "I can take some aspirin if I get a headache related to nitroglycerin." "I will keep my nitroglycerin tablets in their original glass container." "My nitroglycerin tablets are not affected by cold or heat."

"I will keep my nitroglycerin tablets in their original glass container." The sublingual dosage form of nitroglycerin needs to be kept in its original amber-colored glass container with metal lid to avoid loss of potency from exposure to heat, light, moisture, and cotton filler. It should be replaced every 3 to 6 months in order to maintain potency. Potency of the sublingual nitroglycerin is noted if there is burning or stinging when the medication is placed under the tongue; if the medication does not burn, then the drug has lost its potency, and a new prescription must be obtained. Headaches associated with nitrates last approximately 20 minutes (with sublingual forms) and may be managed with acetaminophen.

The patient states to the nurse, "My friend said nitroglycerin relieves angina pain by reducing preload. What is preload?" Which statement by the nurse explains preload to this patient? "It is dilation of arteries and veins throughout the body." "It is the oxygen demand of the heart." "It is the pressure against which the heart must pump." "It is the blood return to the heart."

"It is the blood return to the heart." Preload is determined by the amount of blood in the ventricle just before contraction.

A patient who is taking nitroglycerin (Nitrostat) sublingual tablets is complaining of flushing and headaches. What is the nurse's best response? "Put a cold wet washcloth or use an icepack on your forehead and lie down in a quiet place." "These are the most common adverse effects of nitroglycerin. They should subside with continued use of nitroglycerin." "Stop taking the nitroglycerin because you are experiencing an allergic reaction to the medication." "Immediately notify your health care provider because these symptoms are not related to the sublingual nitroglycerin."

"These are the most common adverse effects of nitroglycerin. They should subside with continued use of nitroglycerin." Headache, flushing of the face, dizziness, and fainting are the most common adverse effects of nitroglycerin and the headache generally subsides after the start of therapy.

Client teaching regarding the use of leukotriene receptor antagonists (LTRAs) drugs such as zafirlukast (Accolate) would include which statement by the nurse? "It will take about 3 or 4 weeks before you notice a therapeutic effect." "This medication works by preventing the inflammation that causes your asthma attack." "Increase fiber and fluid in your diet to prevent the common adverse effect of constipation." "Take the medication when you are short of breath and begin wheezing."

"This medication works by preventing the inflammation that causes your asthma attack." LTRAs drugs block the inflammatory response of leukotrienes and thus the trigger for asthma attacks. Response to these drugs is usually noticed within 1 week. They are not used to treat acute asthma attacks. Diarrhea, not constipation, is a common adverse effect of montelukast and zafirlukast

Which statement by the nurse should be included when teaching a client about the proper use of metered-dose inhalers? "After you inhale the medication once, repeat until you obtain relief." "Make sure that you puff out air several times after you inhale the medication." "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler." "Wait 1 to 2 minutes before you take a second puff of the same drug."

"Wait 1 to 2 minutes before you take a second puff of the same drug." If a second puff of the same drug is ordered, instruct the client to wait 1 to 2 minutes between puffs. If a second type of inhaled drug is prescribed, instruct the client to wait 2 to 5 minutes between the medications or to take as prescribed.

The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin (Hemochron)? Complete blood count Activated partial thromboplastin time (aPTT) Blood urea nitrogen Prothrombin time (PT)

Activated partial thromboplastin time (aPTT) Heparin dosing is based on aPTT results. The PT is reflective of warfarin's anticoagulant effect.

The nurse is reviewing the protocol for administration of IV adenosine (Adenocard). What is the MOST important nursing intervention to remember when giving this medication? Monitor the infusion site for hematoma. Assess for burning sensation at the IV site. Flush the IV catheter with normal saline. Administer it as a fast IV push.

Administer it as a fast IV push. Adenosine must be given as rapidly as possible because it has an extremely short half-life of less than 10 seconds. For this reason, it is administered only IV and only as a fast IV push.

To prevent the development of tolerance to nitroglycerin (Nitro-Bid) transdermal patch, the nurse instructs the patient to perform which action? Use the nitroglycerin patch for acute episodes of angina only. Apply the nitroglycerin patch in the morning and remove it at night for 8 hours. Switch to sublingual nitroglycerin when the systolic blood pressure is greater than 140 mm Hg. Apply a new nitroglycerin patch every other day.

Apply the nitroglycerin patch in the morning and remove it at night for 8 hours. To avoid development of tolerance to transdermal nitroglycerin patches, maintain an 8-hour nitrate-free period each day. A common regimen with transdermal patches is to remove them at night for 8 hours and apply a new patch in the morning.

When applying nitroglycerin (Nitro-Bid) ointment, the nurse should perform which action? Massage and then gently rub the ointment into the skin. Apply a thick layer of ointment on the nitroglycerin paper. Use the fingers to spread the ointment evenly over a 3-inch area. Apply the ointment to a nonhairy part of the upper torso.

Apply the ointment to a nonhairy part of the upper torso. Use the proper dosing paper supplied by the drug company to apply a thin layer of ointment on clean, dry, hairless skin of the upper arms or body. Avoid areas below the knees and elbows. Wear gloves to avoid contact with the skin and subsequent absorption. Do not rub the ointment into the skin; cover the area with an occlusive dressing if not provided (e.g., plastic wrap).

Before administering a dose of an antidysrhythmic drug to a patient, what is the priority nursing assessment? Measure urine output and specific gravity. Check apical pulse and blood pressure. Evaluate peripheral pulses and level of consciousness. Obtain temperature and pulse oximetry on room air.

Check apical pulse and blood pressure. Antidysrhythmic drugs can cause both hypotension and bradycardia; therefore, it is important to assess blood pressure and apical pulse before administration.

For a patient receiving IV nitroglycerin (Tridil), what are the priority nursing interventions? (Select all that apply.) Select all that apply. Check the heart rate. Monitor blood pressure. Measure intake and output. Assess for worsening chest pain. Auscultate lung sounds.

Check the heart rate. Monitor blood pressure. Assess for worsening chest pain. IV nitroglycerin can cause sudden and severe hypotension, worsening of chest pain, and significant changes in heart rate (less than 60 beats/min or greater than 100 beats/min).

Sodium channel blockers are considered which class of antidysrhythmic drugs? Class III Class II Class IV Class I

Class I The Vaughan Williams classification is the most commonly used system to classify antidysrhythmic drugs. There are four major classes of antidysrhythmic drugs: I, II, III, and IV. Sodium channel blockers are classified as class I drugs.

Which medication is an antiplatelet drug? Clopidogrel (Plavix) Alteplase (Activase) Enoxiparin (Lovenox) Heparin (Hemochron)

Clopidogrel (Plavix) Clopidogrel (Plavix) is an antiplatelet drug. Enoxaparin and heparin are anticoagulants. Alteplase is a thrombolytic drug.

The nurse is providing care to a client prescribed a nonselective adrenergic agonist bronchodilator. Which condition documented in the client's medical history would alert the nurse to question this prescription? Coronary artery disease Thrombocytopenia Chronic obstructive pulmonary disease Mycobacterium tuberculosis

Coronary artery disease Nonselective adrenergic agonist bronchodilators stimulate beta1 receptors in the heart and beta2 receptors in the lungs. Stimulation of beta1 receptors can increase heart rate and contractility, increasing oxygen demand. This increased oxygen demand may lead to angina or myocardial ischemia in clients with coronary artery disease.

Calcium channel blockers have which pharmacodynamic effect? Positive chronotropic Shortened refractory period Positive inotropic Coronary vasodilation

Coronary vasodilation Calcium channel blockers cause coronary vasodilation, a negative inotropic effect, a negative chronotropic effect, and a negative dromotropic effect.

Discharge teaching to a patient receiving a beta-agonist bronchodilator should emphasize reporting which side effect? Tachycardia Nonproductive cough Hypoglycemia Sedation

Tachycardia A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia, and increased alertness.

The nurse understands that a patient receiving nitroglycerin should be monitored for which common adverse effects associated with this medication? (Select all that apply.) Dizziness Blurred vision Hypotension Flushing Headache

The common adverse effects of nitroglycerin include flushing of the face, dizziness, fainting, headache, and hypotension.

When providing general education on use of over-the-counter (OTC) medications for allergies, which instruction should the nurse be sure to include? Discontinue use 4 days before allergy testing. It may cause dry mouth and difficulty urinating. Do not use in children younger than 2 years of age unless prescribed. The medication treats the signs and symptoms but is not a cure.

Do not use in children younger than 2 years of age unless prescribed. OTC medications for allergies are not recommended for children younger than 2 years of age unless prescribed by a health care provider.

The nurse is discussing use of antitussive medications with a client. What common adverse effect does the nurse include in the client teaching? Diarrhea and abdominal cramping Drowsiness and dizziness Flushing and decreased heart rate Tremors and palpitations

Drowsiness and dizziness Antitussive medications suppress cough through its action on the central nervous system, thus causing drowsiness and dizziness.

A nurse with adequate knowledge about the administration of IV nitroglycerin will recognize that which statement is correct? the IV form is given by IV push injection because the iv forms are short lived, the dosing must be every two hours IV nitroglycerin must be protected from exposure to light through the use of special tubing IV nitroglycerin can be given via gravity drip infusions

IV nitroglycerin must be protected from exposure to light through the use of special tubing

Which instruction should the nurse include when teaching a client who is prescribed an expectorant? Take a drug with oral codeine when cough worsens Increase fluid intake to decrease viscosity of secretions. Take the medication once a day at bedtime. Restrict fluids to decrease mucus production.

Increase fluid intake to decrease viscosity of secretions. Expectorant drugs are used to decrease viscosity of secretions and allow them to be more easily expectorated. Increasing fluid intake helps this action.

A nurse is providing education to a client taking two different bronchodilator medications. The nurse identifies which characteristic as the advantage of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil)? Shorter onset of action Extended time of action Longer duration of action Quicker peak action

Longer duration of action Salmeterol has a longer duration of action, requiring the client to use it only twice a day instead of three or four times a day with albuterol.

Enoxaparin sodium (Lovenox) is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This medication is in which drug class? Oral anticoagulant Glycoprotein IIb/IIIa inhibitor Low-molecular-weight heparin Thrombolytic drug

Low-molecular-weight heparin Enoxaparin is a low-molecular-weight heparin.

While observing a patient self-administer enoxaparin (Lovenox), the nurse identifies the need for further teaching when the patient performs which self-injection action? Massages the site after administration of the medication Does not aspirate before injecting the medication Administers the medication into subcutaneous (fatty) tissue Injects the medication greater than 2 inches away from the umbilicus

Massages the site after administration of the medication It is not recommended to massage the area of injection of anticoagulants because of the increased risk of hematoma formation.

The nurse understands adenosine (Adenocard) is used to treat which condition? Atrial fibrillation Second-degree atrioventricular block Paroxysmal supraventricular tachycardia (PSVT) Atrial flutter

Paroxysmal supraventricular tachycardia (PSVT) The only therapeutic indication of use for adenosine is the treatment of PSVT.

Before emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin? Vitamin K (Phytonadione) Protamine (Protamine sulfate) Phenytoin (Dilantin) Vitamin E

Protamine (Protamine sulfate) Protamine sulfate binds with heparin in the bloodstream to inactivate it and thus reverse its effect.

The nurse is teaching treatment of acute chest pain for a patient prescribed nitroglycerin (Nitrostat) sublingual tablets. Which instructions should the nurse include? Keep the tablets locked in a safe place until you need them. Chew or swallow the tablet for the quickest effect. Take five tablets every 3 minutes for chest pain. Sit or lie down before taking medication.

Sit or lie down before taking medication. Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. It should be kept in a readily accessible location for immediate use should chest pain occur. Three tablets may be taken 5 minutes apart. It should be placed under the tongue and allowed to dissolve.

Which herbal product, when taken with theophylline, can decrease theophylline's serum drug levels? Peppermint oil St. John's wort Garlic Echinacea

St. John's wort St. John's wort has been shown to enhance the rate of theophylline metabolism, thus decreasing serum levels.

The nurse notes a patient's international normalized ratio (INR) value of 2.5. What is the meaning of this reported value? The patient's warfarin dose is within the therapeutic range. The patient needs the subcutaneous heparin dose increased. The patient is not receiving enough warfarin for a therapeutic effect. The patient is receiving too much heparin and is at risk for bleeding.

The patient's warfarin dose is within the therapeutic range. INR determination is a routine test to evaluate coagulation while patients are taking warfarin, not heparin. A therapeutic INR is 2 to 3.

The nurse receives laboratory values for a client with a theophylline level of 14 mcg/mL. How does the nurse interpret this theophylline level? Toxic Life threatening Therapeutic Subtherapeutic

Therapeutic The therapeutic theophylline level is 10 to 20 mcg/mL.

What is the role of corticosteroids in the treatment of acute respiratory disorders? They increase gas exchange in the alveoli. They stimulate the immune system. They directly dilate the bronchi. They decrease inflammation.

They decrease inflammation. Corticosteroids can suppress the immune system. They do not directly affect bronchodilation but rather prevent bronchoconstriction as a response to inflammation.

A patient is in the clinic for a follow up visit. He has been taking amiodarone for almost 1 year. Today he tells the nurse, "I am noticing some blue color around my face, neck, and upper arms. Is that normal?" Which is the nurse's correct response? This is an expected side effect and should go away soon This is a harmless effect. As long as the medication is working, we'll just monitor your skin. This can happen with amiodarone. I will let your doctor know right away. How much sun exposure have you had recently?

This can happen with amiodarone. I will let your doctor know right away.

The nurse is preparing a patient with acute chest pain for an emergency angioplasty. The nurse would anticipate administering which medication to prevent platelet aggregation? Warfarin (Coumadin) Aminocaproic acid (Amicar) Protamine (Protamine sulfate) Tirofiban (Aggrastat)

Tirofiban (Aggrastat) Tirofiban is a glycoprotein IIb/IIIa inhibitor that blocks the enzyme essential for platelet aggregation. This is given to prevent the formation of further clots and is faster acting than warfarin. Protamine sulfate is the antagonist for heparin, not an anticoagulant. Aminocaproic acid is an antifibrinolytic, the opposite of what is needed in this situation.

Which dosage form of nitroglycerin has the longest duration of action? Transdermal patch Sublingual tablet Intravenous (IV) infusion Immediate-release tablet

Transdermal patch The transdermal patch has an 8- to 12-hour duration of action compared with 3 minutes to 6 hours for the other dosage forms of nitroglycerin.

A patient is receiving lidocaine (Xylocaine) by continuous intravenous (IV) infusion. The nurse understands this medication is prescribed for what condition? Ventricular dysrhythmias Sinus bradycardia Atrial fibrillation First-degree heart block

Ventricular dysrhythmias Lidocaine is a sodium channel blocker drug used specifically to treat ventricular dysrhythmias.

The nurse is caring for a patient admitted with gastrointestinal bleeding who is anticoagulated with warfarin (Coumadin). Which medication should the nurse anticipate administering? Vitamin E Vitamin K (Phytonadione) Protamine (Protamine sulfate) Calcium gluconate

Vitamin K (Phytonadione) Vitamin K is the antagonist for warfarin.

The nurse is reviewing drug interactions with a male patient who has a prescription for isosorbid dinitrate (isordil) as treatment for angina symptoms. Which substances listed below could potentially result in a drug interaction? select all that apply a glass of wine thyroid replacement hormone tadalfil (cialis), an erectile dysfunction drug metformin (glucophage), an antidiabetic drug carvedilol (Coreg) a beta blocker

a glass of wine tadalfil (cialis), an erectile dysfunction drug carvedilol (Coreg) a beta blocker

While assessing a patient with angina who is to start beta blocker therapy, the nurse is aware that the presence of which condition may be a problem if these drugs are used? hypertension essential tremors exortional angina asthma

asthma

When the nurse is teaching a patient about taking an antidysrhythmic drug, which statements by the nurse are correct? (Select all that apply.) a. "Take the medication with an antacid if stomach upset occurs." b. "Do not chew sustained-release capsules." c. "If weight gain of 5 pounds within 1 week occurs, notify your physician at the next office visit." d. "If you experience severe adverse effects, stop the drug and notify your physician." e. "You may take the medication with food if stomach upset occurs."

b. "Do not chew sustained-release capsules." e. "You may take the medication with food if stomach upset occurs."

The nurse is teaching a patient about self-administration of enoxaparin (Lovenox). Which statement should be included in this teaching session? a. "We will need to teach a family member how to give this drug in your arm." b. "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel." c. "This drug needs to be taken at the same time every day with a full glass of water." d. "Be sure to massage the injection site thoroughly after giving the drug."

b. "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel."

A nurse administering niacin would implement which action to help to reduce adverse effects? a. Give the medication with grapefruit juice b. Administer a small dose of aspirin or an NSAID 30 minutes before the niacin dose. c. Administer the medication on an empty stomach d. Have the patient increase dietary fiber intake.

b. Administer a small dose of aspirin or an NSAID 30 minutes before the niacin dose.

A patient is starting warfarin (Coumadin) therapy as a part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy? (Select all that apply.) a. Teach proper subcutaneous administration b. Administer the oral dose at the same time every day c. Assess carefully for excessive bruising or unusual bleeding d. Monitor laboratory results for a target INR of 2 to 3 e. Monitor laboratory results for a therapeutic aPTT value of 1.5 to 2.5 times the control value.

b. Administer the oral dose at the same time every day c. Assess carefully for excessive bruising or unusual bleeding d. Monitor laboratory results for a target INR of 2 to 3

A patient has received a double dose of heparin during surgery and is bleeding through the incision site. While the surgeons are working to stop the bleeding at the incision site, the nurse will prepare to take what action at this time? a. Give IV vitamin K as an antidote b. Give IV protamine sulfate as an antidote c. Call the blood bank for an immediate platelet transfusion. d. Obtain an order for packed red blood cells

b. Give IV protamine sulfate as an antidote

A patient is receiving dabigatran (Pradaxa), 150 mg twice daily, as part of treatment for atrial fibrillation. Which condition, if present, would be a concern if the patient were to receive this dose? a. Asthma b. Renal impairment c. History of myocardial infarction d. Elevated liver enzymes

b. Renal impairment

A patient with a rapid, irregular heart rhythm is being treated in the emergency department with adenosine. During administration of this drug, the nurse will be prepared to monitor the patient for which effect? a. Nausea and vomiting b. Transitory asystole c. Muscle tetany d. Hypertension

b. Transitory asystole

The nurse is assessing a patient who has been taking quinidine and asks about adverse effects. An adverse effect associated with the use of this drug includes: a. muscle pain b. tinnitus c. chest pain d. excessive thirst

b. tinnitus

A patient calls the family practice office to report that he has seen his pills in his stools when he has a bowel movement. How will the nurse respond? a. "The pills are not being digested properly. You need to take them on an empty stomach." b. "The pills are not being digested properly. You need to take them with food." c. "What you are seeing is the waxy matrix that contained the medication, but the drug has been absorbed." d. "This indicates that you are not tolerating this medication and will need to switch to a different form."

c. "What you are seeing is the waxy matrix that contained the medication, but the drug has been absorbed."

A patient is receiving instructions regarding warfarin therapy and asks the nurse about what medications she can take for headaches. The nurse will tell her to avoid which type of medications? a. Opioids b. acetaminophen (Tylenol) c. NSAIDs d. There are no restrictions while taking warfarin.

c. NSAIDs

When assessing a patient who has been taking amiodarone for 6 months, the nurse monitors for which potential adverse effect? a. Hyperglycemia b. Dysphagia c. Photophobia d. Urticaria

c. Photophobia

The nurse is monitoring a patient who is receiving antithrombolytic therapy in the emergency department because of a possible MI. Which adverse effect would be of the greatest concern at this time? a. Dizziness b. Blood pressure of 130/98 mm Hg c. Slight bloody oozing from the IV insertion site d. Irregular heart rhythm

d. Irregular heart rhythm

The nurse is administering lidocaine and considers which condition, if present in the patient, a caution for the use of this drug? a. Tachycardia b. Hypertension c. Ventricular dysrhythmias d. Renal dysfunction

d. Renal dysfunction

After a nebulizer treatment with the beta agonist albuterol, the patient complains of feeling a little "shaky," with slight tremors of the hands. The patient's heart rate is 98 beats/min, increased from the pretreatment rate of 88 beats/min. The nurse knows that this reaction is an expected adverse effect of the medication. allergic reaction to the medication. indication that he has received an overdose of the medication. idiosyncratic reaction to the medication.

expected adverse effect of the medication.

A patient complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray every 2 to 4 hours for the past 5 days. The nurse's response is based on knowledge that: oxymetazoline should be administered in an hourly regimen for severe congestion. sustained use of nasal decongestants over several days may result in rebound congestion. oxymetazoline is not an effective nasal decongestant. the patient is probably displaying an idiosyncratic reaction to oxymetazoline.

sustained use of nasal decongestants over several days may result in rebound congestion. Oxymetazoline is an effective nasal decongestant, but overuse results in worsening or "rebound" congestion. It should not be used more than every 4 hours.

A patient has a new prescription for transdermal nitroglycerin patches. The nurse teaches the patient that these patches are most appropriately used for which reason? to relieve exertional angina to relieve palpitations to prevent the occurrence of angina to stop an episode of angina

to prevent the occurrence of angina

A patient with angina has been given a prescription for a calcium channel blocker. The nurse knows that this class of drugs is used to treat which type of angina? effort unstable crescendo vasospastic

vasospastic