Pharm Test 3

Which of the following outcomes can be expected with administration of digoxin (Lanoxin)?

Decreased heart rate, slowed cardiac conduction speed, and strengthened cardiac contractions

The class I antidysrhythmic drugs block sodium channels. However, the nurse must realize that class I drugs have different actions. Which category of class I antidysrhythmic drugs accelerates repolarization?

Class IB

A nurse reviews these laboratory values: digoxin level, 3 ng/mL; serum potassium, 6.2 mEq/L. The nurse notifies the prescriber and anticipates administration of which drug?

Digoxin immune Fab (Digibind)

A nurse is teaching a class on hypertension to a group of African American patients. The nurse is correct to explain that African Americans with type I diabetes and proteinuria respond best to which combination of medications?

Angiotensin-converting enzyme (ACE) inhibitors and diuretics

A patient is admitted to the unit for vitamin B12 deficiency. Which clinical finding would the nurse monitor in a patient taking cyanocobalamin for the treatment of pernicious anemia?

Hypokalemia

The nurse is providing discharge instructions for a patient going home on warfarin (Coumadin). Which of the following statements made by the patient indicates a need for further teaching regarding warfarin?

"I will take aspirin if I get a headache."

A patient comments, "I don't understand why I have chest pain at times when I'm resting or exercising. How will metoprolol (Toprol XL) help?" Which of the following comments made by the nurse is correct?

"It increases exercise tolerance."

A pregnant patient complains that the iron she is taking makes her constipated. The patient asks the nurse, "Why can't I just supplement the iron solely through my diet?" The nurse's best response is

"Only 10% of dietary iron is absorbed by the body."

A patient who has recently started therapy on an HMG-COA reductase inhibitor asks the nurse, "How long will it take until I see an effect on my LDL cholesterol?" The nurse correctly states

"A reduction usually is seen within 2 weeks."

The nurse is providing patient education about colesevelam (Welchol), a bile acid sequestrant. Which statement made by the patient demonstrates a need for further teaching?

"I cannot take digoxin while on this medication."

The nurse is providing patient education about iron replacement therapy. Which statement made by the patient best indicates an accurate understanding of this therapy?

"I need to space the doses of iron evenly throughout the day."

The nurse is teaching a community education class on hypertension. Which statement about secondary hypertension compared with primary (essential) hypertension most accurately reflects these disease processes?

"Primary hypertension may lead to significant morbidity; secondary hypertension, which usually occurs as a consequence of a disease, also can lead to significant morbidity."

Lovastatin (Mevacor) is prescribed for a patient for the first time. The nurse should provide the patient with which of the following instructions?

"Take lovastatin with your evening meal."

The nurse is serving as a preceptor for a new nurse on the unit. The preceptor is assessing the new nurse's understanding of antidysrhythmic drugs. Which statement made by the new nurse about the use of antidysrhythmic drugs best demonstrates correct understanding?

"These drugs can actually worsen existing dysrhythmias or cause new dysrhythmias."

The nurse is providing patient education about digoxin (Lanoxin) to a 50-year-old woman. Which statement by the patient demonstrates a need for further teaching?

"This medication prolongs life in women."

A patient has begun taking an HMG-COA reductase inhibitor. Which of the following statements about this class of drugs made by the nurse during patient education would be inappropriate?

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

An elderly patient has hypertension, and the prescriber has ordered a combination of medications that have been shown to reduce mortality and morbidity in the elderly. Which combination of medications would the nurse anticipate being prescribed?

A beta blocker and a diuretic

A patient in heart failure shows a decrease in the glomerular filtration rate. The patient has been taking digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL). Considering the change in the patient's status, what change in the medication regimen would the nurse anticipate?

A change from hydrochlorothiazide (HydroDIURIL) to furosemide (Lasix)

In which of the following situations should the nurse prepare for administration of protamine sulfate?

A patient on a heparin drip with a PTT >120 seconds and active GI bleeding

To which of the following patients would the nurse expect to administer iron dextran?

A patient with intestinal disease who is unable to absorb iron taken orally

Which of the following patients is most likely to be receiving ticlopidine (Ticlid)?

A patient with multiple risk factors for thrombotic stroke, as prophylaxis

The nurse determines that which of the following patients would not be a candidate for beta-blocker therapy after a STEMI?

A patient with new onset of complete heart block

The neurohormonal systems, including the sympathetic nervous system (SNS) and the renin-angiotensin-aldosterone system (RAAS), greatly affect cardiac remodeling with declining cardiac performance. What is the ultimate effect of this pathology

A progressive decline in cardiac output

The only calcium channel blockers that have antidysrhythmic properties are verapamil and diltiazem. The nurse is especially cautious administering either of these drugs to a patient who takes digoxin because of the increased risk of

AV block

The nurse is teaching a group of cardiac care nurses about the various cardiac rhythms and drug management. Which of the following drugs, named by the group, best reflects accurate understanding of the management of paroxysmal supraventricular tachycardia (PSVT)?

Adenosine (Adenocard)

The patient with which of the following is most at risk for folic acid deficiency?

Alcoholism

The prescriber orders propranolol (Inderal) for a patient with a blood pressure reading of 200/106 mm Hg. An electrocardiogram taken shortly afterward shows an atrioventricular (AV) block. The nurse should immediately hold the propranolol and report this finding to the prescriber for which reason?

Beta blockers can intensify an AV block.

The prescriber has ordered filgrastim (granulocyte colony-stimulating factor) for a patient undergoing myelosuppressive chemotherapy. Which side effect should the nurse tell the patient that she may anticipate?

Bone pain

The nurse is caring for a patient in the emergency department who complain of chest pain. While watching the telemetry monitor, the nurse notes new S-T elevation in lead II. Which lab test should the nurse anticipate being ordered for this patient?

Cardiac troponin T

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 of the following actions based on this assessment?

Check the patient for other symptoms of digitalis toxicity.

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?

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

As people age, their systolic blood pressure tends to rise. What is the primary cause of this increase in the systolic measurement?

Decreased compliance in the large arteries

The nurse is reviewing medications for heart failure. The nurse is correct to assume that the front-line therapy for heart failure currently consists of which regimen?

Diuretic, ACE inhibitor, and beta blocker

A patient is brought to the emergency department for accidental warfarin (Coumadin) overdose. The nurse determines that the patient has no apparent signs of bleeding. Which action should the nurse take next?

Draw a stat blood level for PT and INR.

When providing education for a patient taking clonidine (Catapres), an alpha2 agonist, the nurse should inform the patient to anticipate which likely side effect?

Dry mouth

The nurse is caring for a patient recently admitted to the ICU with heart disease. Which symptom is a life-threatening adverse effect of digoxin toxicity?

Dysrhythmias

Assessment of a patient's right lower extremity reveals swelling and warmth, and the patient reports pain in the extremity. The nurse would anticipate the administration of which drug?

Enoxaparin (Lovenox)

A patient begins taking nitroglycerin for acute angina attacks and comes to the clinic for a follow-up appointment. The patient reports the development of a headache when taking a nitroglycerin tablet. What information should the nurse provide?

Headache is common because of the vasodilatory effects of the medication.

The nurse is reviewing laboratory values for a patient taking epoetin alfa. Which finding would be a cause for concern and put the patient at risk for a cardiovascular event?

Hemoglobin increased 2 g/dL in 2 weeks

The nurse is caring for a pregnant woman who has developed severe high blood pressure in her first trimester. What drug should the nurse prepare for immediate administration?

Hydralazine (Apresoline)

A patient with a history of angina and hypertension is being started on nicotinic acid (Niacin). The nurse is providing patient education. What statement made by the patient demonstrates a need for further teaching?

I will take Tylenol with my medication to reduce the inflammatory effects"

A patient diagnosed with intermittent claudication will be discharged to home on cilostazol (Pletal). Which of the following statements made by the patient indicates a need for further discharge instruction?

I will take the cilostazol with grapefruit juice

During discharge instruction, the nurse wants to assess the patient's understanding of treatment with cholestyramine (Questran). Which statement made by patient best demonstrates a need for additional teaching?

I will weigh myself weekly

A patient with atrial flutter is admitted to the unit and remains in atrial flutter for 24 hours. Which drug does the nurse anticipate will be given to attempt conversion to sinus rhythm?

Ibutilide (Covert)

A prescriber orders treatment with streptokinase for a patient admitted to the emergency department with an evolving myocardial infarction. Which of the following represents an appropriate action by the nurse?

If the patient develops urticaria and flushing, the nurse should prepare for administration of an antihistamine.

A 70-year-old patient without any medical history has a blood pressure of 160/88 mm Hg. What best describes this type of hypertension?

Isolated systolic hypertension

The nurse educator is providing patient education about the Cardiac Arrhythmia Suppression Trial (CAST). The nurse correctly explains that the trial demonstrated what effect from the pharmacological suppression of dysrhythmias?

It doubled the risk of a second myocardial infarction.

A patient has had hypertension for approximately 7 years and now is interested in becoming pregnant. What is the best antihypertensive drug for this woman, who is about to become pregnant?

Methyldopa (Aldomet)

The nurse checks the medication list of a patient experiencing an acute STEMI and determines that which of the following medications is given to reduce cardiac pain, infarct size, and short-term mortality?

Metoprolol (Lopressor)

A patient is being evaluated in the emergency department for complaints of severe chest pain. The ECG confirms an ST-elevation myocardial infarction (STEMI). Which drug would the nurse anticipate administering for the relief of chest pain?

Morphine

A patient is starting on antihypertensive medications, because two previous clinic visits showed a blood pressure reading of 166/92 mm Hg. Which of the following medications would interfere with the effects of the antihypertensive drugs prescribed?

NSAIDs

The nurse is caring for a patient who begins to complain of shortness of breath. Upon further assessment, the nurse notes 3+ pitting edema bilaterally in the lower extremities. Which medication taken by the patient would most concern the nurse with regard to these findings?

Oprelvekin (interleukin-11)

Which of the following INR results warrants a call to the prescriber by the nurse for adjustment of the daily warfarin (Coumadin) dosage?

Patient with DVT with an INR of 1.8

Most colony-stimulating factors are dosed according to the patient's body weight. Which medication would the nurse anticipate being dosed at 6 mg, regardless of the patient's size and weight?

Pegfilgrastim (Neulasta)

The prescriber has ordered rosuvastatin (Crestor) for a patient with non-alcoholic-related cirrhosis. Which intervention would be most appropriate for the nurse prior to administration?

Review the baseline liver function test results.

A patient is being discharged with a transdermal nitroglycerin patch. Which instruction should be included in the patient education?

Rotate the patches on nonhairy areas of your body

Which drug with a colony-stimulating factor would most likely be used to stimulate the production of neutrophils, eosinophils, monocytes, and macrophages?

Sargramostim (Leukine)

A newly admitted patient diagnosed with heart failure has just been started on an angiotensin-converting enzyme (ACE) inhibitor. He asks whether the drug will have a long-term effect on his general cardiovascular health. Which of the following responses from the nurse is most accurate?

Suppression of angiotensin II seems to diminish over time, but ACE inhibitors also increase kinin release, which has a favorable effect on cardiac remodeling."

The nurse is obtaining a health history on a patient admitted to the unit with a low hemoglobin and hematocrit. What antibiotic drug, taken concurrently with iron, would most concern the nurse?

Tetracycline

The nurse is caring for a 70-year-old patient taking clopidogrel (Plavix) 75 mg daily. What concerns should the nurse have regarding clopidogrel and the elderly?

The dose should be the same for all adults, regardless of age.

The nurse is providing care to a patient who has just undergone a procedure in which epidural anesthesia was used. When the patient returned from the procedure, the nurse administered enoxaparin (Lovenox) 30 mg as ordered. Which of the following findings would warrant an immediate call to the prescriber if it occurred after enoxaparin administration?

The patient complains of numbness and tingling in the lower extremities.

Prior to discharge, the nurse is reviewing the medications of a patient with diabetes. The nurse realizes that he will be going home on colesevelam, a bile acid sequestrant, and insulin. What patient education should the nurse provide in the discharge teaching for this patient?

The patient needs to monitor his blood sugar carefully, because colesevelam can cause hypoglycemia.

The nurse determines that a patient is experiencing the therapeutic effect of a continuous heparin drip if which of the following is noted?

The patient's PTT is 65 seconds.

The American College of Cardiology (ACC)/American Heart Association (AHA) published management guidelines for heart failure. They have defined stage A as including patients with no symptoms or functional cardiac anomalies who have which of the following behaviors or conditions that are strongly associated with the development of heart failure?

Treatment with cardiotoxic drugs, hypertension, and diabetes

The nurse is preparing to administer digoxin IV to treat a patient's heart failure. Which action is essential for the nurse to perform?

Use a cardiac monitor during administration of the drug and for at least 2 hours afterward.

A patient with essential hypertension has been placed on hydralazine (Apresoline). A week later, the patient complains that her heart rate goes up and down. To counteract this reflex tachycardia, the nurse anticipates that the prescriber will order

a beta blocker

A nurse prepares to administer a scheduled dose of verapamil (Calan) to a patient with atrial flutter. The nurse records a heart rate of 92/min and a BP 110/76 mm Hg. In light of these findings, the nurse should

administer the dose as prescribed.

The nurse is reviewing the patient's medication and realizes that gemfibrozil (Lopid) and warfarin (Coumadin) are to be administered concomitantly. This finding concerns the nurse, who is aware that the _______ will be _______.

anticoagulant effects; increased

A patient with stable angina uses a nitroglycerin transdermal patch, and efforts are being made to prevent drug tolerance. Which statement made by the patient best demonstrates an understanding of the transdermal patch? "I will apply my patch

at 8:00 AM and remove it at 8:00 PM."

The nurse in the cardiac catheterization laboratory administers an intravenous bolus of bivalirudin (Angiomax) just prior to the start of coronary angioplasty. For which of the following adverse effects should the nurse monitor the patient?

back and pelvic pain

The potassium-sparing diuretic spironolactone (Aldactone) has been demonstrated to prolong survival and improve heart failure (HF) symptoms by

blocking receptors for aldosterone.

The nurse has just received an order for tenecteplase (TNKase) for a patient experiencing an acute myocardial infarction. The nurse should administer this drug

by bolus injection.

A nurse is providing education about the various routes of administering nitroglycerin (NTG). The nurse correctly states that sublingual NTG can be used in lower dosages than drugs given by other routes, because it

bypasses the liver.

A patient is being treated for variant angina. She has been taking a long-acting nitrite and is still experiencing transient discomfort in her chest. The nurse anticipates that the patient will be trying a drug from which of the following categories and discontinuing the nitrite?

calcium channel blockers

The nurse practitioner is debating whether to prescribe darbepoetin alfa (ARAN esp) or epoetin alfa. The nurse practitioner decides to write the order for darbepoetin alfa (ARAM esp), because it has the advantage over erythropoietin that it

can be administered less frequently.

A patient is admitted to the cardiac care unit from the emergency department. He is receiving amiodarone (Cordarone), because his frequent runs of ventricular tachycardia have proved refractory to other drugs. The rationale for using this very toxic, potentially ventricular antidysrhythmic drug is that it

delays repolarization.

The nurse is caring for a patient in the cardiac care unit who is receiving lidocaine. The patient appears confused and drowsy and complains of numbness and tingling. During the physical assessment, the patient begins having convulsions. The nurse should prepare for immediate intravenous administration of

diazepam (Valium).

The nurse is caring for a patient on the cardiac unit with a history of atrial flutter the nurse understands that the patient may be treated with which drug?

digoxin (Lanoxin)

A patient presents with stable angina. The patient's spouse begins asking questions about the calcium channel blockers (CCBs). The spouse asks how CCBs relieve pain, and the nurse explains, "CCBs

dilate arterioles and reduce afterload."

A patient is taking carvedilol (Coreg) for heart failure. The nurse should monitor the patient carefully for which of the following, which would indicate an adverse effect?

dizziness

The prescriber has ordered clonidine (Catapres) for a patient newly diagnosed with hypertension. The nurse should educate the patient on the most likely side effect of _______ and monitor the patient for _______.

dry mouth; rebound hypertension

The nurse has received an order for mexiletine (Mexitil) for a patient with severe diabetes who is experiencing dysrhythmias. This drug helps alleviate discomfort from peripheral neuropathy; however, its principal indication is use as a(n)

dysrhythmic agent for symptomatic ventricular dysrhythmias.

A patient at a family planning clinic says that she is considering getting pregnant, and she wants to know what she can do to help prepare her body for pregnancy. The nurse would be correct to provide information on and recommend that the patient take

folic acid.

The nurse understands that the primary indications for use of glycoprotein IIb/IIIa-receptor antagonists are

for acute coronary syndromes and percutaneous coronary interventions.

The nurse is trying to evaluate understanding among a group of nursing students. The nurse asks, "Which statement is accurate about the effects of lidocaine on the heart?" the students' best answer is that lidocaine

has no significant impact on the ECG

A 17-year-old young woman is brought to the hospital by her mother, who is concerned about her daughter's fatigue. Upon assessment, the patient displays listlessness, pallor, and fatigue. The patient is diagnosed with iron deficiency anemia. During the discharge instructions, the patient's mother asks the nurse how her daughter acquired this problem. The nurse correctly explains that the most likely cause of her daughter's iron deficiency is

heavy menstruation.

A patient whose status is post-STEMI with reduced LV function is placed on lisinopril 10 mg daily. The patient asks the nurse about the rationale for the drug. Which of the following statements made by the nurse would be an accurate reply? "This drug will

help you get rid of excess fluids."

A patient is 2 days postoperative for a hip replacement, and her mobility is limited. The patient complains of pleuritic chest pain, shortness of breath, and hemoptysis, and her oxygen saturation level is 82% to 84%. The nurse should anticipate administration of ___________, for the signs and symptoms of ____________.

heparin; pulmonary embolus

A patient is taking enalapril (Vasotec). The nurse understands that patients taking this type of drug for heart failure need to be monitored carefully for

hyperkalemia

A patient arrives in the emergency department with complaints of pain, cramping, and weakness of the calf muscles while walking. The nurse would be correct to suspect ___________ and anticipate the administration of ___________.

intermittent claudication; cilostazol (Pletal)

A patient with a history of angina is admitted for outpatient cataract surgery. When asked, "What medication do you take for the angina?" she replies, "It is similar to nitroglycerin, and I take it under my tongue. See, I brought it with me." The nurse is not surprised to see

isosorbide (Isordil).

The nurse in acute care is reviewing a patient's medications and notes that a prescriber's order for the patient has been changed to nesiritide (Natrecor). The nurse understands that the advantage of nesiritide (Natrecor), the synthetic form of natriuretic peptide, in treating heart failure is that

it reduces both preload and afterload.

A patient is admitted with essential hypertension. Which concurrent health problem is an example of target organ damage that increases the risk of cardiovascular event?

left ventricular hypertrophy

The nurse reviews the medications of a patient taking folic acid. The nurse notes that the patient is concurrently taking vitamin B12. This concerns the nurse because of the fact that folic acid may

mask the signs of vitamin B12 deficiency.

A patient with malaise has been taking daptomycin (Cubicin) for an infection and is concurrently taking simvastatin (Zocor). The nurse should be concerned if the patient complains of

muscle pain.

Which of the following statements made by the nurse during patient education is incorrect regarding the goals of antianginal therapy? "Antianginal drug therapy

must be used in conjunction with antihypertensive agents."

A patient presents to the clinic with complaints of muscle aches, muscle pain, and weakness. Upon review of the individual's medications, the nurse notes that the patient is concurrently taking gemfibrozil (Lopid) and atorvastatin (Lipitor). The nurse should assess the patient for the development of

myopathy

The nurse is teaching a class to cardiac rehabilitation patients. To test their knowledge, the nurse poses the question, "Which class of drugs is considered one of the treatments of choice for acute anginal attacks?" The correct response should be

organic nitrates.

A patient taking digoxin (Lanoxin) is admitted to the unit and develops digoxin-induced dysrhythmias. The nurse anticipates the administration of

phenytoin (Dilantin).

During patient education, the nurse discusses the major side effects of thiazide diuretics, because the patient has just begun therapy. The nurse should review the laboratory results for the patient and should be concerned about a finding of a

potassium level of 3 mEq/L.

A hospitalized patient complains of acute chest pain, which he rates as a 9 on a scale of 0 to 10. The nurse administers a 0.4 mg sublingual nitroglycerin tablet, but the patient continues to complain of pain, although his vital signs are stable. The nurse's next step is to

provide a second dose of nitroglycerin in 5 minutes.

An Asian comes to the clinic. Upon assessment, the nurse notes a slight yellow tint to the skin and sclera, edema, and hepatomegaly. The drug history reveals that the patient has been taking rosuvastatin (Crestor) for 6 months. The nurse is concerned, because rosuvastatin (Crestor) has been shown to

reach levels twice as high in Asians as in Caucasians, resulting in a greater chance of hepatotoxicity.

A patient comes to the clinic for a follow-up appointment after being treated in the hospital for angina and released. The nurse is discussing his medication, nitroglycerin. The nurse is correct to state that the principal way this medication relieves the pain of stable angina is by

reducing cardiac oxygen demand.

A patient applies a transdermal nitroglycerin patch at 0900. What additional instruction should be provided by the nurse regarding the patch?

remove patch at 9 pm

The nurse understands that the most effective way to preserve myocardial function and limit the size of an infarct is to implement/administer

reperfusion therapy.

A patient with increasing renal insufficiency and nephrosclerosis is admitted to the unit and is started on oral antihypertensive therapy. Given the patient's medical history, the nurse would question a prescription for

spironolactone (Aldactone).

To assess the patient's knowledge of hypertension, the nurse asks, "Into which category would an adult with consistent blood pressures at or above 160/97 mm Hg be placed?" The patient would be correct to respond

stage 2 hypertension

A patient is brought to the emergency department with complaints of chest pressure for 1 hour and ECG changes significant for an evolving myocardial infarction. The nurse understands that the best response from thrombolytic therapy with tissue plasminogen activator (tPA) occurs when it is

started within 4 to 6 hours of the onset of symptoms.

A patient who comes to the emergency department is anxious, short of breath, diaphoretic, and has a history of heart disease. The patient states that the doctor instructed him to chew an aspirin on the way to the emergency department. The nurse understands that the rationale for this instruction is that aspirin

suppresses platelet aggregation, producing an immediate antithrombotic effect.

The nurse understands that to reduce tolerance to nitrates in a patient with stable angina, the patient should be dosed with

sustained-release oral tablets on an intermittent schedule.

The nurse is providing patient education to a patient who has just been given a new prescription for sublingual nitroglycerin tablets. Which statement by the patient would indicate a need for additional teaching? "I should

take the nitro every 2 to 3 minutes until my pain goes away

The nurse is evaluating a patient admitted to the emergency department with an evolving STEMI for possible administration of thrombolytic therapy. Which of the following, identified during history taking, would contraindicate this type of therapy?

the patient has a history of a small cerebral aneurysm

A patient taking gemfibrozil (Lopid) and rosuvastatin (Crestor) concurrently begins to complain of muscle aches, fatigue, and weakness. The nurse should monitor

the patient's creatinine kinase levels.