Pharm Quiz 4
Which are therapeutic uses for verapamil? Select all that apply. Suppression of preterm labor Essential hypertension Cardiac dysrhythmias Sick sinus syndrome Angina of effort
Essential hypertension Cardiac dysrhythmias Angina of effort
A nurse provides teaching to a patient with angina who also has type 2 diabetes mellitus, asthma, and hypertension. Which statement by the patient indicates a need for further teaching? "Long-acting, slow-release calcium channel blockers can help with anginal pain." "Beta blockers can help me control hypertension." "I should begin regular aerobic exercise." "An ACE inhibitor, in addition to nitroglycerin, will lower my risk of cardiovascular death."
"Beta blockers can help me control hypertension." - Beta blockers can be used for angina in most patients but are contraindicated in patients with asthma, because they cause bronchoconstriction
A nurse is teaching nursing students about the use of alpha-adrenergic antagonists. Which statement by a student indicates the need for further teaching? "Dilation of veins by alpha-adrenergic antagonists improves cardiac output." "Alpha-adrenergic antagonists block alpha1 receptors on arterioles and veins." "Dilation of arterioles has a direct effect on arterial pressure." "Venous dilation by alpha-adrenergic antagonists indirectly lowers arterial pressure."
"Dilation of veins by alpha-adrenergic antagonists improves cardiac output."
A nurse is providing discharge teaching instructions for a patient taking cholestyramine [Questran]. Which statement made by the patient demonstrates a need for further teaching? "I will take digoxin 4 hours after taking the cholestyramine." "I can take cholestyramine with my hydrochlorothiazide." "I will take warfarin [Coumadin] 1 hour before my medicine." "I will increase the fluids and fiber in my diet."
"I can take cholestyramine with my hydrochlorothiazide."
A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient? ACE inhibitors Direct-acting vasodilators Thiazide diuretics Beta blockers
ACE inhibitors
A patient with asthma and depression develops stable angina. In addition to organic nitrites, which other medications will be used to treat this condition? Select all that apply. ACE inhibitors Calcium channel blockers Beta blockers Antiplatelet drugs Cholesterol-lowering drugs
ACE inhibitors Calcium channel blockers Antiplatelet drugs Cholesterol-lowering drugs
A nurse is teaching a patient who will begin taking verapamil [Calan] for hypertension about the drug's side effects. Which statement by the patient indicates understanding of the teaching? "I may become constipated, so I should increase fluids and fiber." "I may have swelling of my hands and feet, but this will subside." "I may need to increase my digoxin dose while taking this drug." "I may experience a rapid heart rate as a result of taking this drug."
"I may become constipated, so I should increase fluids and fiber."
A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] and digoxin. The prescriber has ordered spironolactone [Aldactone] to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching? "I can expect improvement within a few hours after taking this drug." "I need to stop taking potassium supplements." "I should watch closely for dehydration." "I should use salt substitutes to prevent toxic side effects."
"I need to stop taking potassium supplements."
A patient with migraines is started on a beta blocker. The nurse explains the benefits of taking the medication for migraines. Which statement by the patient indicates an understanding of the medication's effects? "I need to take it every day to reduce the frequency of migraines." "I will take it to shorten the duration of my migraines." "I will take this drug when a migraine starts." "I will take it as needed to get relief from migraines."
"I need to take it every day to reduce the frequency of migraines."
The nurse is discussing home management with a patient who will begin taking an alpha-adrenergic antagonist for hypertension. Which statement by the patient indicates understanding of the teaching? "I should not drive while taking this medication." "I need to stop the medication if my heart rate increases." "I should take the first dose at bedtime." "I will stop taking the medication if I feel dizzy."
"I should take the first dose at bedtime."
A nurse is caring for a patient who will begin taking hydralazine to treat hypertension. Which statement by the patient indicates understanding of the nurse's teaching about this drug? "I will need to ask for assistance when getting up out of a chair." "This drug may cause excessive hair growth on my face, arms, and back." "I may develop joint pain, but this side effect will decrease over time." "I will also take a beta blocker medication with this drug to prevent rapid heart rate."
"I will also take a beta blocker medication with this drug to prevent rapid heart rate."
A patient who has been taking verapamil [Calan] for hypertension complains of constipation. The patient will begin taking amlodipine [Norvasc] to avoid this side effect. The nurse provides teaching about the difference between the two drugs. Which statement by the patient indicates that further teaching is needed? "I will need to take a beta blocker to prevent reflex tachycardia." "I should notify the provider if I have swelling of my hands and feet." "I can expect dizziness and facial flushing with nifedipine." "I will need to take this drug once a day."
"I will need to take a beta blocker to prevent reflex tachycardia."
A patient who has been taking verapamil [Calan] for hypertension complains of constipation. The patient will begin taking amlodipine [Norvasc] to avoid this side effect. The nurse provides teaching about the difference between the two drugs. Which statement by the patient indicates that further teaching is needed? "I will need to take a beta blocker to prevent reflex tachycardia." "I will need to take this drug once a day." "I should notify the provider if I have swelling of my hands and feet." "I can expect dizziness and facial flushing with nifedipine."
"I will need to take a beta blocker to prevent reflex tachycardia."
A nurse is providing teaching for a patient with stable angina who will begin taking nitroglycerin. Which statement by the patient indicates understanding of the teaching? "I should take aspirin daily to reduce my need for nitroglycerin." "If I take nitroglycerin before exertion, I can reduce the chance of an anginal attack." "I should not participate in aerobic exercise while taking this drug." "I take nitroglycerin to increase the amount of oxygen to my heart."
"If I take nitroglycerin before exertion, I can reduce the chance of an anginal attack."
A patient with type 1 diabetes is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol [Lopressor]. What education should the nurse provide to the patient? "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely." "Metoprolol has no effect on diabetes mellitus or on your insulin requirements." "Metoprolol may potentiate the effects of the insulin, so the dose should be reduced." "Metoprolol interferes with the effects of insulin, so you may need to increase your insulin dose."
"Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely."
Lovastatin [Mevacor] is prescribed for a patient for the first time. The nurse should provide the patient with which instruction? "Take this medicine on an empty stomach." "Take this medicine before breakfast." "You may take lovastatin without regard to meals." "Take lovastatin with your evening meal."
"Take lovastatin with your evening meal."
A nursing student asks the nurse why multi-drug therapy is often used to treat hypertension. Which statement by the student indicates a need for further teaching? "Some agents are used to offset adverse effects of other agents." "Two or more drugs will lower blood pressure more quickly." "Treatment of hypertension via different mechanisms increases success." "Multi-drug therapy often means that drugs may be given in lower doses."
"Two or more drugs will lower blood pressure more quickly."
A nurse has provided education for a patient newly diagnosed with hypertension who is just beginning therapy with antihypertensive medications. Which statement by the patient indicates a need for further teaching? "I may experience serious long-term problems even if I am not having symptoms." "I should report side effects to the provider since other drugs may be substituted." "When my symptoms subside, I may discontinue the medications." "I will need to take medications on a long-term basis."
"When my symptoms subside, I may discontinue the medications."
A nurse is discussing heart failure with a group of nursing students. Which statement by a student reflects an understanding of how compensatory mechanisms can compound existing problems in patients with heart failure? "When the heart rate increases to increase cardiac output, it can prevent adequate filling of the ventricles." "An increase in arteriolar tone to improve tissue perfusion can decrease resistance." "An increase in contractility to increase cardiac output can cause pulmonary edema." "When venous tone increases to increase ventricular filling, an increase in arterial pressure occurs."
"When the heart rate increases to increase cardiac output, it can prevent adequate filling of the ventricles."
A nurse is instructing a patient receiving a cholesterol-lowering agent. Which information should the nurse include in the patient education? "Stop taking the medication if you experience constipation." "This medication will replace other interventions you have been trying." "It is important for you to double your dose if you miss one to maintain therapeutic blood levels." "You should continue your exercise program to increase your HDL serum levels."
"You should continue your exercise program to increase your HDL serum levels."
A patient asks a nurse how nitroglycerin works to relieve anginal pain. The nurse correctly states, "Nitroglycerin: "dilates coronary arteries to increase blood flow to the heart." "increases the oxygen supply to the cardiac muscle." "promotes vasodilation, which reduces preload and oxygen demand." "increases ventricular filling to improve cardiac output."
"promotes vasodilation, which reduces preload and oxygen demand."
A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats per minute, a blood pressure of 150/90 mm Hg, bibasilar crackles, 2+ pitting edema of the ankles, and distension of the jugular veins. The nurse will contact the provider to request an order for which medication? Digoxin [Lanoxin] Furosemide [Lasix] ACE inhibitor Spironolactone [Aldactone]
Furosemide [Lanoxin]
A nurse prepares to administer a scheduled dose of digoxin. The nurse finds a new laboratory report showing a plasma digoxin level of 0.7 ng/mL. What action should the nurse take? Withhold the drug for an hour and reassess the level. Withhold the drug and notify the prescriber immediately. Check the patient's apical pulse, and if it is within a safe range, administer the digoxin. Administer Digibind to counteract the toxicity.
Check the pt's apical pulse, and if it is within a safe range, administer the digoxin
A patient with stable exertional angina has been receiving a beta blocker. Before giving the drug, the nurse notes a resting heart rate of 55 beats per minute. Which is an appropriate nursing action? Request an order to change to another antianginal medication. Request an order for a lower dose of the medication. Withhold the dose and notify the provider of the heart rate. Administer the drug as ordered, because this is a desired effect.
Administer the drug as ordered, because this is a desired effect
Which medications are included in first-line therapy for heart failure? Select all that apply. Aldosterone antagonists Cardiac glycosides Beta blockers Agents that inhibit the renin-angiotensin-aldosterone system (RAAS) Diuretics
Aldosterone antagoinists Beta blockers Agents that inhibit the renin-angiotensin-aldosterone system (RAAS) Diuretics
The potassium-sparing diuretic spironolactone [Aldactone] prolongs survival and improves heart failure symptoms by which mechanism? Blocking aldosterone receptors Reducing afterload Reducing venous pressure Increasing diuresis
Blocks aldosterone receptors
Which are conditions that may be treated using beta blockers? Select all that apply. Cardiac dysrhythmias Stage fright Heart failure Hypotension Hypothyroidism
Cardiac dysrhythmias HF Hypotension
A patient has been taking digoxin [Lanoxin] 0.25 mg, and furosemide [Lasix] 40 mg, daily. Upon routine assessment by the nurse, the patient states, "I see yellow halos around the lights." The nurse should perform which action based on this assessment? Check the patient for other symptoms of digitalis toxicity. Withhold the next dose of furosemide. Continue to monitor the patient for heart failure. Document the findings and reassess in 1 hour.
Check the pt for other symptoms of digitalis toxicity
An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide [HydroDIURIL]. Before administering this medication, the nurse reviews the patient's chart. Which laboratory value causes the nurse the most concern? Elevated creatinine clearance Elevated serum potassium level Normal blood glucose level Low levels of low-density lipoprotein (LDL) cholesterol
Elevated creatinine clearance
Which plasma lipoprotein level is most concerning when considering the risk of coronary atherosclerosis? Elevated very-low-density lipoprotein Elevated low-density lipoprotein Elevated cholesterol Elevated high-density lipoprotein
Elevated low-density lipoprotein (LDL)
A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication? Aspirin Warfarin [Coumadin] Clopidogrel [Plavix] Enoxaparin [Lovenox]
Enoxaparin [Lovenox] - Enoxaparin is a low-molecular-weight heparin and is used in situations requiring rapid onset of anticoagulant effects, such as massive DVT. Aspirin, clopidogrel, and warfarin are useful for primary prevention but are not used when rapid anticoagulation is required.
A patient who stops taking an ACE inhibitor because of its side effects will begin taking an angiotensin II receptor blocker (ARB) medication. Which side effect of ACE inhibitors will not occur with an ARB medication? Angioedema Cough Renal failure Hyperkalemia
Cough
A hospitalized patient complains of acute chest pain. The nurse administers a 0.3-mg sublingual nitroglycerin tablet, but the patient continues to complain of pain. Vital signs remain stable. What is the nurse's next step? Give a second dose of nitroglycerin in 5 minutes. Continue dosing at 10-minute intervals. Apply a nitroglycerin transdermal patch. Request an order for intravenous nitroglycerin.
Give a second dose of nitroglycerin in 5 minutes
A nurse is preparing to administer digoxin [Lanoxin] to a patient. The patient's heart rate is 62 beats per minute, and the blood pressure is 120/60 mm Hg. The last serum electrolyte value showed a potassium level of 5.2 mEq/L. What will the nurse do? Request an order for a diuretic. Withhold the dose and notify the provider of the heart rate. Contact the provider to request an increased dose of digoxin. Give the dose of digoxin and notify the provider of the potassium level.
Give the dose of digoxin and notify the provider of the potassium level
Besides having diuretic effects for patients with congestive heart failure, thiazides are also used to treat what? Select all that apply. Hepatic failure Intraocular pressure Diabetes insipidus Increased intracranial pressure Postmenopausal osteoporosis
Hepatic failure diabetes insipidus postmenopausal osteoporosis
A provider has ordered captopril [Capoten] for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nurse is correct? Administer the captopril and monitor for adverse effects. Request an order to administer fosinopril instead of captopril. Hold the dose and notify the provider. Reassure the patient that this is not a serious side effect.
Hold the dose and notify the provider
The nurse is caring for a pregnant patient who is in labor. The woman reports having had mild preeclampsia with a previous pregnancy. The nurse notes that the woman has a blood pressure of 168/102 mm Hg. The nurse will contact the provider to request an order for which drug? Sodium nitroprusside Angiotensin-converting enzyme (ACE) inhibitor Hydralazine (Apresoline) Magnesium sulfate
Hydralazine (Apresoline)
Which two-drug regimen would be appropriate for a patient with hypertension who does not have other compelling conditions? Hydralazine and minoxidil Hydrochlorothiazide and nadolol Trichlormethiazide and hydrochlorothiazide Spironolactone and amiloride
Hydrochlorothiazide and nadolol
A nurse is administering a vasodilator that dilates resistance vessels. The nurse understands that this drug will have which effect on the patient? Increased ventricular contraction Increased tissue perfusion Decreased cardiac preload Decreased cardiac output
Increase tissue perfusion
A patient with pheochromocytoma is admitted for surgery. The surgeon has ordered an alpha-blocking agent to be given preoperatively. What does the nurse understand about this agent? It reduces contraction of smooth muscles in the adrenal medulla. It is ordered to prevent perioperative hypertensive crisis. It is given chronically after the surgery to prevent hypertension. It prevents secretion of catecholamines by the adrenal tumor.
It is ordered to prevent perioperative hypertensive crisis.
A patient begins taking an ACE inhibitor and complains of a dry cough. What does the nurse correctly tell the patient about this symptom? It occurs frequently in patients taking the drug but will subside over time. It is a common side effect that occurs in almost all patients taking the drug. It indicates that a serious side effect has occurred. It may be uncomfortable enough that the drug will need to be discontinued.
It may be uncomfortable enough that the drug will need to be discontinued
A patient with hypertension will begin taking an alpha1 blocker. What will the nurse teach this patient? Move slowly from sitting to standing when taking this drug. Eat foods rich in potassium while taking this drug. A persistent cough is a known side effect of this drug. Report shortness of breath while taking this drug.
Move slowly from sitting to standing when taking this drug
A patient who is taking simvastatin [Zocor] develops an infection and the provider orders azithromycin [Zithromax] to treat the infection. The nurse should be concerned if the patient complains of: nausea. tiredness. headache. muscle pain.
Muscle pain
A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide [Lasix]. The nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern? Potassium level of 3.5 mEq/L Blood glucose level of 120 mg/dL Oxygen saturation of 90% Sodium level of 140 mEq/L
Potassium level of 3.5 mEq/L
A patient has three separate blood pressure (BP) readings of 120/100 mm Hg, 138/92 mm Hg, and 126/96 mm Hg. Which category describes this patient's BP? Prehypertension Isolated systolic hypertension Normal Hypertension
Prehypertension
A nurse checks a patient's vital signs in the hospital and notes a blood pressure of 146/98 mm Hg. What will the nurse do? Instruct the patient to consume a low-sodium diet. Recheck the patient's blood pressure in the other arm. Prepare the patient for an electrocardiogram and blood tests. Request an order for a thiazide diuretic.
Recheck the pt's blood pressure in the other arm
A patient who has been taking clonidine [Catapres] for several weeks complains of drowsiness and constipation. What will the nurse do? Suggest asking the provider for a transdermal preparation of the drug. Tell the patient to stop taking the drug and call the provider. Recommend that the patient take most of the daily dose at bedtime. Suspect that the patient is overusing the medication.
Recommend that the pt take most of the daily dose at bedtime
An Asian patient will begin taking rosuvastatin [Crestor] to treat hypercholesterolemia. What will the nurse include when teaching this patient about this medication? Higher than usual doses may be necessary for this patient. Serum drug levels must be monitored more frequently than with other patients. Yellow skin and sclera are more common side effects with Asian patients but are not concerning. Renal toxicity is a common adverse effect among Asian patients.
Serum drug levels must be monitored more frequently than with other pts
A patient with heart failure who has been taking an ACE inhibitor, a thiazide diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the nurse will expect the provider to evaluate: ejection fraction. serum electrolyte levels. complete blood count. maximal exercise capacity.
Serum electrolyte levels
A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question? Bumetanide [Bumex] Hydrochlorothiazide [HydroDIURIL] Furosemide [Lasix] Spironolactone [Aldactone]
Spironolactone [Aldactone]
A patient with hypertension is taking furosemide [Lasix] for congestive heart failure. The prescriber orders digoxin to help increase cardiac output. What other medication will the nurse expect to be ordered for this patient? Spironolactone [Aldactone] Chlorothiazide [Diuril] Hydrochlorothiazide [HydroDIURIL] Bumetanide [Bumex]
Spitonolactone [Aldactone]
A patient who does not consume alcohol or nicotine products reports a strong family history of hypertension and cardiovascular disease. The patient has a blood pressure of 126/82 and a normal weight and body mass index for height and age. The nurse will expect to teach this patient about: thiazide diuretics and lifestyle changes. the DASH diet, sodium restriction, and exercise. ACE inhibitors and calcium channel blocker medications. increased calcium and potassium supplements.
The DASH diet, sodium restriction, and exercise
A 50-year-old female patient asks a nurse about taking aspirin to prevent heart disease. The patient does not have a history of myocardial infarction. Her cholesterol and blood pressure are normal, and she does not smoke. What will the nurse tell the patient? There is most likely no protective benefit for patients her age. Aspirin is useful only for preventing a second myocardial infarction. She should ask her provider about using a P2Y12 ADP receptor antagonist. She should take one 81-mg tablet per day to prevent myocardial infarction.
There is most likely no protective benefit for pts her age
A prescriber orders transdermal clonidine [Catapres TTS] for a patient with hypertension. What will the nurse teach this patient? That medication given by transdermal patch has fewer systemic side effects To apply the patch to intact skin on the forearm or leg That localized skin reactions are uncommon To change the patch every week
To change the patch every week
A patient who has begun using transdermal nitroglycerin for angina reports occasional periods of tachycardia. The nurse will expect the prescriber to order: verapamil as an adjunct to nitroglycerin therapy. immediate discontinuation of the nitroglycerin. digoxin [Lanoxin] to slow the heart rate. periods of rest when the heart rate increases.
Verapamil as an adjunct to nitroglycerin therapy
A nurse prepares to administer propranolol [Inderal] to a patient recovering from acute myocardial infarction. The patient's heart rate is 52 beats per minute, and the rhythm is regular. What action should the nurse take next? Request an order for atropine. Withhold the dose and document the pulse rate. Withhold the dose and notify the prescriber. Administer the drug as prescribed.
Withhold the dose and notify the prescriber
A female patient with essential hypertension is being treated with hydralazine 25 mg twice daily. The nurse assesses the patient and notes a heart rate of 96 beats per minute and a blood pressure of 110/72 mm Hg. The nurse will request an order to: give the patient a diuretic. administer a beta blocker. administer a drug that dilates veins. reduce the dose of hydralazine.
administer a beta blocker
A patient who took an overdose of verapamil has been treated with gastric lavage and a cathartic. The emergency department nurse assesses the patient and notes a heart rate of 50 beats per minute and a blood pressure of 90/50 mm Hg. The nurse will anticipate: placing the patient in an upright position. preparing to administer a beta blocker. administering intravenous norepinephrine (NE) and atropine and glucagon. assisting with direct-current (DC) cardioversion
administering intravenous norepinephrine (NE) and atropine and glucagon
A patient with heart failure who has been given digoxin [Lanoxin] daily for a week complains of nausea. Before giving the next dose, the nurse will: request an order for a decreased dose of digoxin. review the serum electrolyte values and withhold the dose if the potassium level is greater than 3.5 mEq/L. contact the provider to report digoxin toxicity. assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per minute.
assess the heart rate (HR) and give the dose if the HF is greater than 60 beats per minute
The nurse is caring for a patient who is taking a vasodilator that dilates capacitance vessels. The nurse will expect which effect in this patient? Decrease in cardiac work Increase in cardiac output Increase in venous return Increase in tissue perfusion
decrease in cardiac work
A nursing student asks a nurse how beta blockers increase the oxygen supply to the heart in the treatment of anginal pain. The nurse tells the student that beta blockers: improve cardiac contractility, which makes the heart more efficient. dilate arterioles to improve myocardial circulation. increase the time the heart is in diastole. increase arterial pressure to improve cardiac afterload.
improve cardiac contractility, which makes the heart more efficient
A patient taking a beta blocker complains of shortness of breath. The patient has respirations of 28 breaths per minute, a blood pressure of 162/90 mm Hg, and a pulse of 88 beats per minute. The nurse auscultates crackles in all lung fields. The nurse understands that these assessments are consistent with: rebound cardiac excitation. sinus bradycardia. left-sided heart failure. bronchoconstriction
left-sided heart failure
A patient begins taking nifedipine [Procardia], along with metoprolol, to treat hypertension. The nurse understands that metoprolol is used to: reduce flushing. prevent constipation. minimize gingival hyperplasia. prevent reflex tachycardia.
prevent reflex tachycardia
A patient is taking gentamicin [Garamycin] and furosemide [Lasix]. The nurse should counsel this patient to report which symptom? Urinary retention Ringing in the ears Headaches Frequent nocturia
ringing in the ears
A 60-year-old African American patient has a blood pressure of 120/80 mm Hg and reports a family history of hypertension. The patient has a body mass index of 22.3. The patient reports consuming alcohol occasionally. Which therapeutic lifestyle change will the nurse expect to teach this patient? Weight loss Sodium restriction Alcohol cessation Potassium supplementation
sodium restriction
