Pharm Quiz 4

A nurse is preparing to administer metoprolol 5 mg IV bolus to a client for heart rate control. Available is metoprolol injection 1mg/mL. How many mL shold the nurse administer per dose?

5 mL

A nurse is preparing to administer digoxin to a 6-month old infant. Prior to administering the dose, the nurse measures the apical heart rate. The nurse should withhold the dose if the infant's apical heart rate is less than what rate?

90 - Bradycardia is an adverse effect of digoxin. Expected apical heart rates vary considerably according to age. The nurse shold withhold the digoxin dose for heart rate of 60/min of below in an adult, 70/min or below in a child, and 90/min or below in an infant.

A nurse is providing teaching to a client who has angina pectoris and a new prescription for nitroglycerin sublingual tablets. Which of the following statements by the client indicates an understanding of the teaching? A. "I'll dial 911 if I still have pain after taking 3 nitroglycerin tablets 5 minutes apart." B. "I'll dial 911 if I still have pain after taking 4 nitroglycerin tablets over a 20-minute period." C. "I'll dial 911 when I have pain and then take the nitroglycerin tablets." D. "I'll dial 911 if 1 nitroglycerin tablet does not relieve my pain, and then take up to 2 more tablets 5 minutes apart while waiting."

A. "I'll dial 911 if I still have pain after taking 3 nitroglycerin tablets 5 minutes apart." The client should access emergency services sooner than this. B. "I'll dial 911 if I still have pain after taking 4 nitroglycerin tablets over a 20-minute period." The client should access emergency services sooner than this. C. "I'll dial 911 when I have pain and then take the nitroglycerin tablets." The client should take the first nitroglycerine tablet at the onset of pain and see if it relieves symptoms. D. "I'll dial 911 if 1 nitroglycerin tablet does not relieve my pain, and then take up to 2 more tablets 5 minutes apart while waiting." If 1 nitroglycerine tablet does not relieve the client's pain, he should access emergency services and then take 2 more tablets at 5-minutes intervals if he still has pain.

A nurse is providing discharge teaching to a client who has a new prescription for verapamil for angina. Which of the following instructions should the nurse include? A. "Limit your fluid intake to meal times." B. "Do not take this medication on an empty stomach." C. "Increase your daily fiber intake." D. "You can expect swelling of the ankles while taking this medication."

A. "Limit your fluid intake to meal times." The nurse shold instruct the client to increase fluid intake rather than limit intake to meal times due to the potential adverse effect of constipation. B. "Do not take this medication on an empty stomach." The nurse shodl instruct the client that verpamil can be taken without food. C. "Increase your daily fiber intake." The nurse shodl instruct the client to increase his daily intake of dietary fiber to reduce the risk of constipation associated with verpamil. D. "You can expect swelling of the ankles while taking this medication." The nurse should instruct the client to report any swelling of the ankles of feet to the provider immediately, as these are manifestations of an adverse effect.

A nurse is teaching a client who has angina about nitroglycerin sublingual tablets. Which of the following statements should the nurse include in the teaching? A. "Place one tablet under your tongue every 5 minutes for 30 minutes to relieve chest pain." B. "Nitroglycerin decreases chest pain by dissolving blood clots that are occluding the arteries." C. "You can store the bottle of tablets in your bathroom medicine cabinet." D. "Nitroglycerin dilates cardiac blood vessels to deliver more oxygen to the heart."

A. "Place one tablet under your tongue every 5 minutes for 30 minutes to relieve chest pain." The client should place one tablet under the tongue every 5 min for 15 min, for 3 total doses, to relieve chest pain. B. "Nitroglycerin decreases chest pain by dissolving blood clots that are occluding the arteries." Nitroglycerine relaces the blood vessels, which increases blood an oxygen supply to the heart. Nitroglycerine does not dissolve blood clots. C. "You can store the bottle of tablets in your bathroom medicine cabinet." Nitroglycerine loses its effectiveness after 6 months or after exposure to light or moisture. The cliet shodl not store the tablets in the bathroom. D. "Nitroglycerin dilates cardiac blood vessels to deliver more oxygen to the heart." Nitroglycerine is a nitrate medication that increases collateral blood flow, redistributes blood flow toward the subendocardium, and dilates the coronary ateries.

A nurse in a provider's clinic is assesing a client who takes sublingual nitroglycerine for stable angina. The client reports getting a headache each time he takes the medication.Which of the following statements should the nurse make? A. "Take only one dose of nitroglycerine to reduce the risk of getting a headache." B. "There's nothing that can be done to relieve the headaches that nitroglycerine causes." C. "Try taking a mild analgesic to relieve the headache." D. "We will ask the provider to prescribe a different medication for you."

A. "Take only one dose of nitroglycerine to reduce the risk of getting a headache." Sublingual nitroglycerine may be taken up to three times, five minutes apart. Reducing the number of doses may not relieve the angina pain. B. "There's nothing that can be done to relieve the headaches that nitroglycerine causes." The headaches associated with nitroglycerine use dimiish over time. Until then, headaches can be relieved by mild analgesics. C. "Try taking a mild analgesic to relieve the headache." Headache is a common side effect of nitroglycerine. The nuse shold suggest conservative measures, such as taking aspirin, acetaminophen, or some other mild analgesic, to manage the headache. Generally, headaches that are a side effect of nitroglycerine are transient. D. "We will ask the provider to prescribe a different medication for you." Nitroglycerine is the rug of choice for acute angina attacks. The headaches associated with its use diminish over time. Until then, headaches can be relieved by mild analgesics.

A nurse is teaching a client who has a new prescription for colesevelam to lower his low-density lipoprotein level. Which of the following instructions should the nurse include? A. "Take this medication 4 hours after other medications." B. "Reduce fluid intake." C. "Take this medication on an empty stomach." D. "Chew tablets before swallowing."

A. "Take this medication 4 hours after other medications." The client shoudl take this medication 4 hors after other medications to increase absorption of the medication. B. "Reduce fluid intake." The client should increase FIBER and FLUID intake to reduce the risk for constipation. C. "Take this medication on an empty stomach." The client should take the medication with meals. D. "Chew tablets before swallowing." The client should swallow tablets whole to increase absorption.

A nurse is teaching a client who has angina pectoris about starting therapy with SL nitroglycerin tablets. The nurse should include which of the following instructions regarding how to take the medication? A. "Take this medication after each meal and at bedtime." B. "Take one tablet every 15 min during an acute attack." C. "Take one tablet at the first indication of chest pain." D. "Take this medication with 8 oz of water."

A. "Take this medication after each meal and at bedtime." The client shodl take nitroglycerin tablets on a PRN basis, not routinely at specific times. B. "Take one tablet every 15 min during an acute attack." If one tablet does not relieve the client's pain, he should access emergency services and then take two more at 5-min intervals if he still has pain. C. "Take one tablet at the first indication of chest pain." The client should take nitroglycerin as soon as he feels pain, pressure, or tightness in his cheat and not wait until his chest pain is severe. D. "Take this medication with 8 oz of water." Nitroglycerin tablets are sublingual. The client shoudl place them under the tongue, not swallow them with water.

A nurse is caring for client who has a prescription for digoxin 0.25 mg PO daily. The amount available is digoxin 0.125 mg tab. The client's current vital signs are: blood pressure 144/96 heart rate 54/min respirations 18/min temperature 98.6 F Which of the following actions should the nurse take? A. Administer digoxin 0.125 mg. B. Administer digoxin 0.25 mg. C. Withhold the digoxin dose for elevated blood pressure. D. Withhold the digoxin dose for decreased pulse rate.

A. Administer digoxin 0.125 mg. The nurse shold not administer a reduced dose of digoxin, as the client's heart rate is less than 60/min, or administer a different ose without a written Rx from the provider. B. Administer digoxin 0.25 mg. The nurse shoudl not administer the prescribed dose of digoxin as the client's heart rate is less than 60/min. C. Withhold the digoxin dose for elevated blood pressure. The nurse should withhold the prescribed dose of digoxin as the client's heart rate is less than 60/min. D. Withhold the digoxin dose for decreased pulse rate. The nurse should withhold the prescribed dose of digoxin as the client's heart rate is less than 60/min, and notify the provider.

A nurse is teaching a client who has a new R for transdermal nitroglycerin to treat angina pectoris. Which of the following instructions shold the nurse include in the teaching? A. Apply a new transdermal patch once a week. B. Apply the transdermal patch in the morning. C. Aply the transdermal patch in the same location as the previous patch. D. Apply a new transdermal patch when chest pain is experienced.

A. Apply a new transdermal patch once a week. The client should apply a new patch each day, not once a week. B. Apply the transdermal patch in the morning. The client should apply the patch every morning and leave it in place for 12 to 14 hors, then remove it in the evening. C. Aply the transdermal patch in the same location as the previous patch. The client shold rotate the sites used for patch placement to aoid areas of local skin irritation. D. Apply a new transdermal patch when chest pain is experienced. The transdermal route of nitroglycerin has a delayed onset of action, making it suitable for prophylaxis use but not for immediate relief of chest pain.

A nurse is providing teaching to a client who has a new prescription for digoxin. The nurse should instruct the client to monitor and report which of the following adverse effects that is a manifestation digoxin toxicity? (Select all that apply) A. Fatigue B. Constipation C. Anorexia D. Rash E. Diplopia (Blurred vision)

A. Fatigue B. Constipation C. Anorexia D. Rash E. Diplopia (Blurred vision)

A nurse is providing teaching a client who has stable angina and a new prescription for transdermal nitroglycerin. Which of the following instructions should the nurse include? (SATA) A. Apply the patch to a hairless area and rotate sites. B. Apply a new patch each morning. C. Remove the path for 10 to 12 hours daily. D. Apply the path to dry skin and cover the area with plastic wrap. E. Apply a new patch at the onset of anginal pain.

A. Apply the patch to a hairless area and rotate sites. Hair can interfere with the adhesion of the patch. Rotating sites helps prevent skin irritation. B. Apply a new patch each morning. Therapeutic preventative effects of transdermal nitroglycerin patches begin 30 to 60 min after application and last up to 14 hours. C. Remove the path for 10 to 12 hours daily. Removing the patches for 10 to 12 hrs each day helps prevent tolerance to the medication. D. Apply the path to dry skin and cover the area with plastic wrap. These instructions apply to topical nitroglycerin ointment, not nitroglycerin patches. E. Apply a new patch at the onset of anginal pain. Nitroglycerin patches prevent angina attacks. They do not treat acute angina attacks.

A nurse is caring for a client who has HF and a new prescription for furosemide. Which of the following lab values should then nurse review before administering furosemide? A. Bananas B. Cooked carrots C. Cheddar cheese D. 2% milk

A. Bananas The nurse should determine that bananas are the best food souce to recommend because 1 cup of bananas contains 806 mg of K+. In addition to the potassium supplements the provider might prescribe, the client shoudl increase his daily intake of foods that have high potassium content, such as bananas, orange juice, and spinach. B. Cooked carrots The nurse should recommend a different food because there is another choice that contains more potassium. C. Cheddar cheese The nurse should recommend a different food because there is another choice that contains more potassium. D. 2% milk The nurse should recommend a different food because there is another choice that contains more potassium.

A nurse is teaching a client who has a new prescription for digoxin to treat heart failure. Which of the following instructions should the nurse include in the teaching? A. Contact provider if heart rate is less than60/min. B. Check pulse rate for 30 seconds and multiply result by 2. C. Increase intake of sodium. D. Take with food if nausea occurs.

A. Contact provider if heart rate is less than60/min. No rationales were included

A nurse is caring for a client who has acute respiratory distress syndrome and requires mechanical ventilation. The client receives a prescription for pancuronium. The nurse recognizes that this medication is for which of the following purposes? A. Decrease chest wall compliance. B. Suppress respiratory effort. C. Induce sedation. D. Decrease respiratory secretions.

A. Decrease chest wall compliance. Neuromuscular blocking agents, such as pancuronium, induce paralysis by relaxing skeletal muscles, which improves chest wall compliance. B. Suppress respiratory effort. Neuromuscular blocking agents, such as pancuronium, induce paralysis and suppress the client's respiratory efforts to the point of apnea, allowing the mechanical ventilator to take over the work of breathing for the client. This terapy is especially helpful for a client who has ARDS and poor lung compliance. C. Induce sedation. Neuromuscular blocking agents, such as pancuronium, induce paralysis and have no sedative effect at all. A sedative or analgesic shold be prescribed as an adjunt to the pancuronium. D. Decrease respiratory secretions. Neuromuscular blocking agents, such as pancuronium, induce paralysis. An adverse effect of this medication is increased production of respiratory secretions.

A nurse is reviewing the laboratory results of a client who has liver failure with ascites and is receiving spironolactone. Which of the following findings should the nurse expect? A. Decreased sodium levels B. Decreased phosphate levels C. Decreased potassium levels D. Decreased chloride level

A. Decreased sodium levels The nurse should expect a decreased sodium level. Sprinolactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in an icnreased excretion of sodium. B. Decreased phosphate levels The nurse should not expect a decreased phosphate level. Spironalactone inhibits the action of aldosterone, resulting in the retention of phosphate. C. Decreased potassium levels The nurse should not expect a decreased potassium level. Spironalactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in the retention of potassium. D. Decreased chloride level The nurse shoudl not expect a decreased chloride level. Spironalactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in the retention of chloride.

A nurse is caring for a client who is prescribed isosorbide mononitrate for chronic stable angina and develops reflex tachycardia. Which of the following medications should the nurse expect to administer? A. Furosemide B. Captopril C. Ranolazine D. Metoprolol

A. Furosemide B. Captopril C. Ranolazine D. Metoprolol No rationales

A nurse is caring for a client who has heart failure and a new prescription for furosemide. For which of the following adverse effects should the nurse monitor? A. Hypervolemia B. Hypertension C. Hypokalemia D. Hypoglycemia

A. Hypervolemia Hypovolemia, not hypervolemia, is an adverse effect of furosemide. B. Hypertension Hypotension, not hypertension, is an adverse effect of furosemide. C. Hypokalemia Hypokalemia is an adverse effect of furosemide. D. Hypoglycemia Hyperglycemia, not hypoglycemia, is an adverse effect of hypoglycemia.

A charge nurse is teaching a group of nurses about agonists and antagonists. The nurse shold include in the teaching that which of the following agonist medications binds to receptors and causes activation that affects the cardiovascular system? A. Insulin B. Epinephrine C. Morphine D. Norethindrone

A. Insulin The nurse should include that insulin is an agonist that activates the receptors that affect glucose metabolism in clients who have diabetes mellitus. B. Epinephrine The nurse shold include that epinephrine is an agonist that activates the receptors that affect the cardiovasculat system in clients who are at risk for cardiac collapse. C. Morphine The nurse should include that morphine is an agonist that activates the receptors that affect the CNS and relieve the client's pain. D. Norethindrone The nurse should include that northindrone is an agonist that activates thre recpotrs for progesterone foud in oral contraceptives taken by the client.

A nurse is assessing a client who is taking lisinopril to treat hypertension. Which of the following findings is a priority to report? A. Nasal congestion B. Swelling of the tongue C. Dry cough D. Nausea

A. Nasal congestion Nasal congestion is non-urgent because it is a mild adverse effect of lisinopril; therefore, there is another finding that is the priority. B. Swelling of the tongue When using the urgent vs. non-urgent approach to client care, the nurse determines that the priority finding is swelling of the tongue, which is a manifestation of angioedema. The nurse should withhold the medication and notify the provider immediately if the client reports swelling of the tongue or throat. Other manifestations include giant wheals and edema of the tongue, glttis, and pharync. Severe reactions are treated with subcutaneous epinephrine. If angioedema develops, AEC inhibitors are discontinued. C. Dry cough Dry cough is non-urgent because it is a mild adverse effect of lisinopril; therefore, there is another finding that is the priority. D. Nausea Nausea is non-urgent because it is a mild adverse effect of lisinopril; therefore, there is another finding that is the priority.

A nurse is monitoring a client who received epinephrine for angioedema after a first dose of losartan. Which of the following data indicates a therapeutic response to the epinephrine? A. Respirations are unlabored B. Client reports decreased groin pain of 3 on a 1 to 10 scale C. The client's blood pressure when arising from resting position is at premedication levels D. The client tolerates a second dose of medication

A. Respirations are unlabored. Losartan is an angiotensin receptor blocker (ARB). Both ARBs and angiotensin converting enzyme (ACE) inhibitors have the adverse effect of angioedema. The primary symptom of angioedema is swelling of the tonue, glottis, and pharynx. This results in limitations or blockage of the airway. Angioedema causes the capillaries to become more permeable, resulting in fluid shifting into the subcutaneous tissues. Although the mouth and throat are most often affected, any area may be involved in the process. Untreated, angioedema can result in death. Improvement of respiratory effort following the administration of epinephrine is the most important therapeutic indicator. B. Client reports decreased groin pain of 3 on a 1 to 10 scale. Although edema can occur in any area, the groin is not affected specifically by the disorder. Angioplasty and angiograms most often utilize the fermoral vessels, but the prefix "angio" is a general term for blood vessel rather than a reference to the femoral area. C. The client's blood pressure when arising from resting position is at premedication levels. Hypotension is a common side effect of angiotensin II receptor blockers (ARBs) such as losartan. For this side effect, the nurse should monitor blood pressure when the client changes position. However, angioedema is an adverse reaction that can result in swelling of the lips, tongue, and glottis. The client experiences extreme respiratory distress. D. The client tolerates a second dose of medication with no greater than 1+ peripheral edema. Peripheral edema is not usually associated with angioedema. The edema that is significant in this client occurs in the lips, mouth, and throat, causing airway obstruction. Once the client has this response, the client must know to never take any medication in the angiotensin II receptor blocker classification.

A nurse is providing is providing teaching to a client who has stable angina and a new prescription for nitroglycerin oral, sustained release capsules. Which of the following instructions should the nurse include? A. Stop taking the medication if side effects are troublesome. B. Swallow the capsules whole. C. Take 1 capsule at the onset of anginal pain. D. Take the medication with meals.

A. Stop taking the medication if side effects are troublesome. Abruptly discontinuing the use of long-acting nitroglycerine capsules can cause vasospasm. B. Swallow the capsules whole. The client shold swallow the capsules whole and not chew or crush them or place them under the tongue. C. Take 1 capsule at the onset of anginal pain. Sustained-release capsules are not used for acute attacks of angina. D. Take the medication with meals. The client shodl take the medication on an empty stomach 1 hr before or 2 hrs after a meal with 8 oz of water.

A nurse is completing a medical interview with a pt who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the pt can potentiate the effect of warfarin? A. The client follows a low-fat diet to reduce cholesterol. B. The client drinks a glass of grapefruit juice every day. C. The client sprinkles flax seeds on food 1 hr before taking the anticoagulant. D. The client uses garlic to lower cholesterol levels.

A. The client follows a low-fat diet to reduce cholesterol. A low-fat diet shold not potentiate the action of warfarin. B. The client drinks a glass of grapefruit juice every day. Grapefruit juice can interfere with the metabolism of statins, not warfarin. C. The client sprinkles flax seeds on food 1 hr before taking the anticoagulant. Flax seed can affect the absorption of medications and should be taken 1 hr before or 2 hrs after medications. D. The client uses garlic to lower cholesterol levels. The nurse should recognize that garlic can potentiate the action of the warfarin.

A nurse is assessing a pt who has hypercholesterolemia and is receiving simvastatin. Which of the following findings should the nurse recognize as a potential adverse effect? A. Urinary retention B. Muscle weakness C. Orthostatic hypotension D. Blurred vision

A. Urinary retention Urinary retention is not an adverse effect of simvastatin. B. Muscle weakness Myopathy is an adverse effect of this medication. Signs of myopathy include muscle aches, tenderness, and muscle weakness. C. Orthostatic hypotension Orthostatic hypotension is not an adverse effect of simvastatin. D. Blurred vision Blurred vision is not an adverse effect of simvastatin.

A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following actions is appropriate? A. Withholding the medication if the heart rate is above 100/min. B. Instructing the client to eat foods that are low in potassium. C. Measuring apical pulse rate for 30 seconds before administration. D. Evaluating the client for nausea, vomiting, and anorexia.

A. Withholding the medication if the heart rate is above 100/min. The nurse shold withhold the medication if the client's heart rate is below 60/min. B. Instructing the client to eat foods that are low in potassium. The client should eat foods high in potassium to prevent hypokalemia, which increases the risk of digoxin toxicity. C. Measuring apical pulse rate for 30 seconds before administration. The nurse should evaluate the apical pulse rate for 60 seconds. D. Evaluating the client for nausea, vomiting, and anorexia. Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity.