pharm week 5 textbook NCLEX questions
The nurse is teaching a patient with essential hypertension who has a new prescription for verapamil [Calan]. Which statements by the patient indicate that the teaching was effective? (Select all that apply.) A. "I will increase my intake of fluid and foods high in fiber." B. "I should stay out of direct sunlight to prevent exposing my skin to the sun." C. "I will call my healthcare provider if I notice swelling in my ankles." D. "I need to avoid salt substitutes and potassium supplements." E. "I may notice easy bruising and bleeding with this drug."
A. "I will increase my intake of fluid and foods high in fiber." Correct C. "I will call my healthcare provider if I notice swelling in my ankles." Correct Verapamil often causes constipation and can also cause peripheral edema. Patients should take measures to prevent constipation and should call about new symptoms of peripheral edema. Patients taking verapamil should not experience photosensitivity, hyperkalemia, or increased bruising and bleeding.
The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan? A. "When it is time to discontinue this drug, you will need to taper it off slowly." B. "Protect your skin from the sun to prevent rash and exaggerated sunburn." C. "Increase your intake of fluid and high-fiber food to prevent constipation." D. "Take this medication on an empty stomach at least 2 hours after meals."
A. "When it is time to discontinue this drug, you will need to taper it off slowly." Alprazolam [Xanax] is a benzodiazepine for which abrupt discontinuation can precipitate withdrawal symptoms. Patients should withdraw the drug gradually over several weeks. The other statements are not related to alprazolam [Xanax].
The nurse is caring for a patient with insomnia. The patient asks if there are medications for sleep that are not controlled substances. Which statement by the nurse is correct? A. "Yes, there is a medication that works with your body's melatonin and is not a controlled substance." B. "No, all of the sleep medications are controlled substances." C. "There are some over-the-counter medications, and you can take those without discussing them with your healthcare provider." D. "Yes, but it is not for chronic insomnia."
A. "Yes, there is a medication that works with your body's melatonin and is not a controlled substance." Ramelteon [Rozerem] is a relatively new hypnotic with a unique mechanism of action: activation of receptors for melatonin. The drug is approved for treating chronic insomnia characterized by difficulty with sleep onset, but not with sleep maintenance. Long-term use is permitted. Of the major drugs for insomnia, ramelteon is the only one not regulated as a controlled substance.
The healthcare provider ordered lorazepam [Ativan] 0.5 mg IV every 6 hours for anxiety. The medication available is lorazepam [Ativan] 2 mg/mL. How many mL will the nurse administer? A. 0.25 B. 0.5 C. 1 D. 4
A. 0.25 The available medication is 2 mg/mL. Divide 2 mg/mL by 4/4 to equal 0.5 mg/0.25 mL. This is the same as recognizing that 2 mg/mL equals 1 mg/0.5 mL, which equals 0.5 mg/0.25 mL. Continue dividing the top and bottom numbers in half.
Lithium is used in the treatment of bipolar disorder and what other psychiatric disorders? (Select all that apply.) A. Alcoholism B. Bulimia Correct C. Schizophrenia D. Hypertension E. Glucocorticoid-induced psychosis
A. Alcoholism Correct B. Bulimia Correct C. Schizophrenia Correct E. Glucocorticoid-induced psychosis Correct Although approved only for treatment of BPD, lithium has been used with varying degrees of success in other psychiatric disorders, including alcoholism, bulimia, schizophrenia, and glucocorticoid-induced psychosis. Nonpsychiatric uses include hyperthyroidism, cluster headache, and migraine. In addition, lithium can raise neutrophil counts in children with chronic neutropenia and in patients receiving anticancer drugs or zidovudine (AZT).
When comparing benzodiazepines to barbiturates, the nurse identifies which statements about benzodiazepines as true? (Select all that apply.) A. Benzodiazepines have a high safety profile. B. Benzodiazepines have a significant ability to depress central nervous system (CNS) function. C. Benzodiazepines are associated with a high suicide potential. D. Benzodiazepines have a low ability to cause tolerance. E. Benzodiazepines have a low abuse potential.
A. Benzodiazepines have a high safety profile. Correct D. Benzodiazepines have a low ability to cause tolerance. Correct E. Benzodiazepines have a low abuse potential. Correct Statements A, D, and E are true. Compared to barbiturates, benzodiazepines have a low suicide potential and low ability to cause CNS depression.
The nurse knows that diuretics mostly affect which function of the kidneys? A. Cleansing and maintenance of extracellular fluid volume B. Maintenance of acid-base balance C. Excretion of metabolic waste D. Elimination of foreign substances
A. Cleansing and maintenance of extracellular fluid volume Most diuretics block sodium and chloride reabsorption, thus affecting the maintenance of extracellular fluid volume.
The nurse should monitor for which adverse effect after administering hydrochlorothiazide [HydroDIURIL] and digoxin [Lanoxin] to a patient? A. Digoxin toxicity B. Decreased diuretic effect C. Dehydration D. Heart failure
A. Digoxin toxicity Digoxin levels have an inverse relationship with potassium levels. Because hydrochlorothiazide can lower potassium levels, combined use of hydrochlorothiazide and digoxin poses a risk for elevated digoxin levels and ensuing digoxin toxicity.
A patient with angina pectoris has been prescribed nifedipine [Procardia].Which possible adverse effects should the nurse expect with this medication? (Select all that apply.) A. Headache B. Constipation C. Nausea and vomiting D. Edema of ankles and feet E. Overgrowth of gum tissue
A. Headache Correct D. Edema of ankles and feet Correct E. Overgrowth of gum tissue Correct Some adverse effects of nifedipine are headache, edema of ankles and feet, and gingival hyperplasia (overgrowth of gum tissue). Nifedipine causes very little constipation. Nausea and vomiting are common side effects of clevidipine.
A family member of a patient who is experiencing a severe manic episode asks the nurse why the patient is receiving an antipsychotic medication. The nurse informs the family member that antipsychotics are used in the treatment of severe manic episodes to do what? A. Help control symptoms during the severe manic episode. B. Elevate mood during the severe manic episode. C. Produce sedating effects during the severe manic episode. D. Reduce the amount of physical pain the patient experiences during the severe manic episode.
A. Help control symptoms during the severe manic episode. Antipsychotic drugs are given to help control symptoms during severe manic episodes, even if psychotic symptoms are absent. Benzodiazepines are given for their sedating effects. Antidepressants help elevate mood during manic episodes.
The nurse is reviewing the home medication list with the patient. The nurse recognizes that hydrochlorothiazide is used primarily for which condition? A. Hypertension B. Edema C. Diabetes insipidus D. Protection against postmenopausal osteoporosis
A. Hypertension The primary indication for hydrochlorothiazide is hypertension, a condition for which thiazides are often the drugs of first choice. Hydrochlorothiazides are used for other conditions, but the primary indication is hypertension.
The nurse identifies which drugs as the principal mood stabilizers used in the treatment of bipolar disorder? (Select all that apply.) A. Lithium B. Risperidone C. Divalproex sodium [Depakote] D. Carbamazepine E. Venlafaxine [Effexor]
A. Lithium Correct C. Divalproex sodium [Depakote] Correct D. Carbamazepine Correct Lithium, divalproex sodium [Valproate], and carbamazepine are the principal mood stabilizers used in the treatment of bipolar disorder. Risperidone is an antipsychotic used in the management of bipolar disorder. Venlafaxine [Effexor] is an antidepressant used in the treatment of bipolar disorder.
Which of the following statements about mannitol [Osmitrol] are correct? (Select all that apply.) A. Mannitol cannot be given orally. B. Mannitol can cause edema. C. Mannitol can cause renal failure. D. Diuresis begins in 30 to 60 minutes after administration. E. Mannitol is a loop diuretic.
A. Mannitol cannot be given orally. Correct B. Mannitol can cause edema. Correct D. Diuresis begins in 30 to 60 minutes after administration. Correct Mannitol does not diffuse across the GI epithelium and cannot be transported by the uptake systems that absorb dietary sugars. Accordingly, to reach the circulation, the drug must be given parenterally. Diuresis begins in 30 to 60 minutes and persists 6 to 8 hours. Mannitol can leave the vascular system at all capillary beds except those of the brain. When the drug exits capillaries, it draws water along, causing edema. Mannitol is used in prophylaxis of renal failure. Mannitol is an osmotic diuretic, not a loop diuretic.
Which statements about the treatment of bipolar disorder does the nurse identify as true? (Select all that apply.) A. Mood stabilizers are used to prevent recurrent manic-depressive episodes. B. Antipsychotics are used to treat depressive episodes. C. Antidepressants should be used with mood stabilizers in the treatment of patients with bipolar depression. D. Lithium and valproate are the preferred mood stabilizers for BPD.
A. Mood stabilizers are used to prevent recurrent manic-depressive episodes. C. Antidepressants should be used with mood stabilizers in the treatment of patients with bipolar depression. D. Lithium and valproate are the preferred mood stabilizers for BPD. A lithium level of 2.0 mEq/L is considered therapeutic. The statements in options A, C, and D are true. Antipsychotics are used to treat manic episodes. A lithium level above 1.5 mEq/L is considered to be above the therapeutic index.
The nurse is caring for a patient with a seizure disorder who takes phenobarbital at bedtime each night to control seizures. Which symptom, if present, would most likely indicate an adverse effect of this drug? A. Morning sedation B. A respiratory rate of 30 breaths per minute C. Constipation Incorrect D. A blood pressure of 160/88 mm Hg
A. Morning sedation The adverse effects of the barbiturates include respiratory depression, risk of suicide, risk of abuse, and hangover (sedation, impaired judgment, and reduced motor skills).
A patient in a hypertensive crisis is being started on a continuous sodium nitroprusside [Nipride] infusion. Which interventions are essential before the nurse administers nitroprusside [Nipride]? (Select all that apply.) A. Obtain a baseline weight and weigh daily. B. Prepare for arterial line insertion. C. Discontinue the infusion when blood pressure is controlled. D. Observe for signs of hypertrichosis during the infusion. E. Cover the solution with an opaque bag.
A. Obtain a baseline weight and weigh daily. Correct B. Prepare for arterial line insertion. Correct E. Cover the solution with an opaque bag. Correct A Nipride infusion is ordered in micrograms/kilogram/minute. Knowing the patient's weight is essential for calculating the appropriate dose. Also, tracking daily weights and comparing them with the baseline values helps the nurse determine whether the adverse effect of fluid retention has developed. An arterial line allows for continuous and accurate measurement of blood pressure. Because light degrades nitroprusside, the infusion solution should be covered. The infusion should not be discontinued abruptly, because the blood pressure will return to the pretreatment levels within minutes. Hypertrichosis (excessive hair growth) is a side effect of minoxidil.
The nurse is caring for a patient with bipolar disorder (BPD) who is taking lithium [Lithobid]. Which abnormal laboratory value is most essential for the nurse to communicate to the healthcare provider because this patient is taking lithium? A. Sodium level of 128 mEq/L B. Prothrombin time of 8 seconds C. Blood urea nitrogen level of 25 mg/dL D. Potassium level of 5.6 mEq/L
A. Sodium level of 128 mEq/L The sodium level is well below the normal range of 135 to 145 mEq/L. When the serum sodium level is reduced, lithium excretion also is reduced, and lithium accumulates. Because lithium has a narrow therapeutic index, this is a dangerous situation, which can result in symptoms of toxicity and even death.
The nurse is caring for a patient who has been receiving intravenous sodium nitroprusside [Nitropress] for 3 days. Which assessment data indicate the patient may be experiencing thiocyanate toxicity? A. Sudden confusion B. Difficulty breathing C. Erythematous rash D. Gastrointestinal bleeding
A. Sudden confusion When nitroprusside is given for several days, thiocyanate may accumulate, which can cause adverse effects. These effects, which involve the central nervous system (CNS), include disorientation, psychotic behavior, and delirium. Difficulty breathing, erythematous rash, and gastrointestinal bleeding are not adverse effects related to thiocyanate toxicity.
Which instructions should the nurse include when developing a teaching plan for a patient prescribed diltiazem [Cardizem] for atrial fibrillation? (Select all that apply.) A. Weigh yourself daily at the same time each day. B. The medication will not cause dizziness or headache. C. Notify the healthcare provider if a skin rash develops. D. Do not take daily oral calcium supplements. E. Rise slowly from a lying to a sitting position.
A. Weigh yourself daily at the same time each day. Correct C. Notify the healthcare provider if a skin rash develops. Correct E. Rise slowly from a lying to a sitting position. Correct An adverse effect of diltiazem is heart failure. Daily weighing monitors for signs of fluid retention, which may indicate cardiac dysfunction. Chronic eczematous rash may occur, especially in older patients. Orthostatic hypotension is an adverse effect; patients must be taught to rise slowly from lying to sitting positions. Diltiazem causes vasodilation, which can cause dizziness or headache. Daily calcium supplements do not affect the action of diltiazem.
The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? A. "I can take this medication in the morning to reduce nighttime urination." B. "I will rise slowly when changing from a sitting to a standing position." C. "My heart rate may slow down with this drug. I will call if my pulse is below 60." D. "I need to increase my intake of fluids and foods that are high in fiber."
B. "I will rise slowly when changing from a sitting to a standing position." Vasodilators may cause postural hypotension and reflex tachycardia. Patients should be taught to move slowly when changing positions to prevent dizziness.
The nurse is seeing several patients in the outpatient clinic today. Which patient most requires the nurse's immediate attention? A. A female patient with BPD who takes valproic acid [Depakene] and who reports nausea and vomiting B. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L C. A male patient with depression who takes fluoxetine [Prozac] and who reports sexual dysfunction D. A female patient with schizophrenia who takes haloperidol [Haldol] and who has a blood pressure of 102/72 mm Hg
B. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L Lithium levels above 1.5 mEq/L should be reported, because this level may indicate impending serious toxicity. The other findings may be side effects of the drugs the patients are taking, but they are not priority problems.
A patient is prescribed hydralazine [Apresoline] for the treatment of essential hypertension. Which expected adverse effects should the nurse discuss with the patient? (Select all that apply.) A. Nausea B. Fatigue C. Dizziness D. Headache E. Joint pain
B. Fatigue Correct C. Dizziness Correct D. Headache Correct Some of the common adverse effects of hydralazine include fatigue, dizziness, and headache. Nausea is associated with minoxidil. Joint pain is not a common adverse effect of hydralazine.
The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam [Valium]. Which agent is most likely to be administered to reverse the effects of diazepam? A. Naloxone [Narcan] B. Flumazenil [Romazicon] C. Acetylcysteine [Mucomyst] D. Vitamin K
B. Flumazenil [Romazicon] Flumazenil [Romazicon], a benzodiazepine receptor antagonist, is the treatment of choice for overdose of the benzodiazepine diazepam [Valium]. Naloxone [Narcan] is used to reverse opioid overdose. Acetylcysteine [Mucomyst] is used to reverse acetaminophen [Tylenol] overdose. Vitamin K is used to reverse warfarin toxicity.
The nurse is caring for a patient receiving a nitroprusside [Nipride] intravenous infusion. The patient's wife asks why furosemide [Lasix] is being prescribed along with this drug. The nurse's response is based on which concept? A. Furosemide will help reduce reflex tachycardia. B. Many vasodilators cause retention of sodium and water. C. Thiocyanate may accumulate in patients receiving nitroprusside. D. Vasodilators can cause serious orthostatic hypotension.
B. Many vasodilators cause retention of sodium and water. Nitroprusside is a potent vasodilator that can cause retention of sodium and water. Furosemide, a diuretic, often is combined with nitroprusside to reduce the risk of edema and fluid retention. Furosemide does not reduce reflex tachycardia. Thiocyanate can accumulate in patients receiving nitroprusside, but furosemide does not help prevent or treat that. Vasodilators can cause serious orthostatic hypotension, but that is not the rationale for adding furosemide to the regimen.
The healthcare provider prescribes an intravenous dose of diltiazem [Cardizem] for treatment of a patient with atrial fibrillation. What is the priority nursing intervention? A. Assist with cardioversion. B. Monitor electrocardiogram. C. Obtain baseline coagulation studies. D. Assess for increased urinary output.
B. Monitor electrocardiogram. Monitor the electrocardiogram (ECG) continuously during IV administration of diltiazem for AV block, sudden reduction in heart rate, and prolongation of the PR or QT interval. Cardioversion is not necessary; however, have equipment for cardioversion available. Baseline laboratory studies are needed for liver and kidney function. Increased urinary output is not an adverse effect of diltiazem.
The healthcare provider ordered lamotrigine [Lamictal] for long-term maintenance therapy of BPD. The nurse anticipates which dosing schedule? A. Starting at a high dose to quickly control mania B. Starting at a low dose and titrating up C. Starting at a high dose and titrating down D. Starting with a loading dose and then a low maintenance dose
B. Starting at a low dose and titrating up Lamotrigine [Lamictal] is indicated for long-term maintenance therapy of BPD. The goal is to prevent affective relapses into mania or depression. To minimize the risk of serious rash, dosage should be low initially (25 to 50 mg/day) and then gradually increased.
The nurse is teaching a patient who has a new prescription for spironolactone [Aldactone]. Which statement by the patient indicates that the teaching was effective? A. "I will use salt substitutes to lower my sodium intake." B. "I will increase my intake of foods that are high in potassium." Incorrect C. "I will call my doctor if I begin having menstrual irregularities." D. "I will take this medication at bedtime each evening."
C. "I will call my doctor if I begin having menstrual irregularities." Spironolactone is a potassium-sparing, aldosterone-blocking diuretic. As such, it can cause endocrine effects, such as gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of the voice. Patients taking spironolactone should avoid salt substitutes because they contain potassium, and high-potassium foods should be avoided with this drug. Ideally, all diuretics should be taken in the morning to prevent nocturia.
The healthcare provider orders furosemide [Lasix] 20 mg IV twice daily. The medication available is furosemide [Lasix] 10 mg/mL. How many mL will the nurse administer with each dose? A. 0.5 mL B. 1 mL C. 2 mL D. 4 mL
C. 2 mL The healthcare provider has ordered 20 mg of furosemide [Lasix], which is available in 10 mg/mL. Multiply 10 mg/mL by 2 to equal 20 mg/2 mL. The nurse will administer 2 mL of furosemide to equal 20 mg with each dose.
The healthcare provider orders mannitol 72 gm infusion over 24 hours. The nurse plans to set the infusion pump for how many grams per hour? A. 1 gm B. 2 gm C. 3 gm D. 4 gm
C. 3 gm To infuse 72 gm over 24 hours, divide 72 by 24 for the total per hour. 72 divided by 24 equals 3 gm per hour.
The healthcare provider ordered lithium 250 mg PO every 8 hours for a patient experiencing acute mania. What will the patient's total dose be in 24 hours? A. 250 mg B. 500 mg C. 750 mg D. 1000 mg
C. 750 mg The patient taking a medication every 8 hours will take it 3 times in a 24-hour period: 250 mg times 3 equals 750 mg for a 24-hour period.
The nurse is caring for a patient taking lithium [Lithobid]. The nurse understands that many drugs interact with lithium. Which agent is safe to administer with lithium? A. Ibuprofen [Motrin] for muscle pain B. Hydrochlorothiazide (HCTZ) for edema C. Aspirin (ASA) for mild headache D. Diphenhydramine [Benadryl] for cold symptoms
C. Aspirin (ASA) for mild headache Aspirin is safe to use as an analgesic with lithium. Other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can increase lithium levels by as much as 60%. Diuretics increase lithium levels by reducing the serum sodium level. Diphenhydramine has anticholinergic properties and can aggravate lithium-induced polyuria by causing urinary hesitancy.
The nurse is caring for several patients. For which patient diagnosis would a prescription for nifedipine [Adalat] be least appropriate? A. Angina pectoris B. Essential hypertension C. Atrial fibrillation D. Vasospastic angina
C. Atrial fibrillation Nifedipine produces very little blockade of the calcium channels of the heart; therefore, it is ineffective for treating dysrhythmias, such as atrial fibrillation. Therapeutic uses for nifedipine include the treatment of angina pectoris, essential hypertension, and vasospastic angina.
Calcium channel blockers work by reducing calcium influx into the cells of the heart and blood vessels. Calcium channels are coupled to which type of autonomic nervous system receptors? A. Alpha1 B. Alpha2 C. Beta1 D. Beta2
C. Beta1 Calcium channels are coupled to beta1-adrenergic receptors in the heart. For that reason, calcium channel blockers affect the heart in ways similar to the beta blockers. Both types of drugs cause a decrease in the force of contraction, heart rate, and cardiac impulse conduction.
Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]? A. Peripheral pulses B. Homans' sign C. Blood pressure D. Capillary refill
C. Blood pressure Hydralazine is a vasodilator that causes arteriolar dilation, decreased resistance, and decreased blood pressure. Monitoring of the blood pressure and heart rate is the highest assessment priority.
The nurse plans to closely monitor for which clinical manifestation after administering furosemide [Lasix]? A. Decreased pulse B. Decreased temperature C. Decreased blood pressure D. Decreased respiratory rate
C. Decreased blood pressure High-ceiling loop diuretics, such as furosemide, are the most effective diuretic agents. They produce more loss of fluid and electrolytes than any others. A sudden loss of fluid can result in decreased blood pressure. When blood pressure drops, the pulse probably will increase rather than decrease. Lasix should not affect respiration or temperature. The nurse should also closely monitor the patient's potassium level.
What is the most appropriate nursing consideration for a patient who is prescribed verapamil [Calan] and digoxin [Lanoxin]? A. Restrict intake of oral fluids and high-fiber food. B. Take an apical pulse for 30 seconds before administration. C. Notify the healthcare provider of nausea, vomiting, and visual changes. D. Hold the medications if the heart rate is greater than 110 beats/min.
C. Notify the healthcare provider of nausea, vomiting, and visual changes. Verapamil can raise digoxin blood serum levels, increasing the risk of digoxin toxicity. Symptoms of digoxin toxicity may include nausea, vomiting, and visual changes. Increase intake of oral fluids and high-fiber food to decrease the adverse effect of constipation. An apical pulse should be taken for a full minute prior to administering digoxin. Verapamil and digoxin can cause bradycardia not tachycardia.
A patient with hypertensive emergency is admitted to the hospital. Which medication should the nurse be prepared to administer to this patient? A. Minoxidil [Loniten] B. Hydralazine [Apresoline] C. Sodium nitroprusside [Nipride] D. Hydralazine and isosorbide dinitrate [BiDil]
C. Sodium nitroprusside [Nipride] Intravenous sodium nitroprusside has an immediate effect and is the drug of choice for hypertensive emergencies. Minoxidil and hydralazine are used for blood pressure control.
The nurse is caring for a patient with heart failure who needs a diuretic. Which agent is likely to be chosen, because it has been shown to greatly reduce mortality in patients with heart failure? A. Furosemide [Lasix] B. Hydrochlorothiazide [HydroDIURIL] C. Spironolactone [Aldactone] D. Mannitol [Osmitrol]
C. Spironolactone [Aldactone] Spironolactone is a potassium-sparing diuretic used to treat both hypertension and edema. It is a preferred drug in heart failure, because it has been shown to have a cardioprotective effect, reducing mortality in patients with heart failure.
Which agent is most likely to be prescribed today for short-term management of insomnia? A. Secobarbital [Seconal Sodium] B. Meprobamate [Miltown] C. Zolpidem [Ambien] D. Flumazenil [Romazicon]
C. Zolpidem [Ambien] Zolpidem is a benzodiazepine-like drug that is widely used in the treatment of insomnia. It is safer than the barbiturates (secobarbital) or miscellaneous sedative-hypnotics (meprobamate). Flumazenil is a reversal agent for the benzodiazepines.
The nurse provides discharge instructions to a patient prescribed verapamil [Calan] SR 120 mg PO daily for essential hypertension. Which statement by the patient indicates understanding of the medication? A. "I will take the medication with grapefruit juice each morning." B. "I should expect occasional loose stools from this medication." C. "I'll need to reduce the amount of fiber in my diet." D. "I must make sure I swallow the pill whole."
D. "I must make sure I swallow the pill whole." "SR" indicates that the drug is sustained release; therefore, the patient must swallow the pill intact, without chewing or crushing, which would result in a bolus effect. Grapefruit juice should be avoided, because it can inhibit intestinal and hepatic metabolism of the drug, thereby raising the drug level. Constipation, not loose stools, is a common side effect of Calan; increasing fluids and dietary fiber can help prevent this adverse effect.
The patient is admitted for the management of a hypertensive emergency. The healthcare provider prescribes sodium nitroprusside [Nipride] drug therapy. What is the priority nursing action during this treatment? A. Observe for respiratory depression. B. Monitor the electrocardiogram for tachycardia. C. Initiate oxygen therapy via nasal cannula at 2 L/min. D. Adjust the intravenous infusion rate to the blood pressure response.
D. Adjust the intravenous infusion rate to the blood pressure response. The nurse will adjust the rate of infusion based on the patient's blood pressure. Respiratory depression is not associated with administration of this drug. Oxygen therapy is not necessary and nitroprusside causes very little tachycardia.
A nurse assesses a patient who takes a maintenance dose of lithium carbonate [Lithobid] for bipolar disorder. The patient complains of hand tremor, nausea, vomiting, and diarrhea. The patient's gait is unsteady. The patient most likely has done what? A. Consumed some foods high in tyramine B. Not taken the lithium as directed C. Developed tolerance to the lithium D. Developed lithium toxicity
D. Developed lithium toxicity Early lithium toxicity is evidenced by diarrhea, anorexia, muscle weakness, nausea, vomiting, tremors, slurred speech, and drowsiness. Later signs include blurred vision, seizures, trembling, confusion, and ataxia.
Which medication is most likely to cause the side effect of constipation? A. Nifedipine [Adalat] B. Amlodipine [Norvasc] C. Isradipine [DynaCirc] D. Diltiazem [Cardizem]
D. Diltiazem [Cardizem] Nifedipine, amlodipine, and isradipine, which are dihydropyridine calcium channel blockers, cause less risk of constipation than diltiazem and verapamil.
Alprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter? A. Norepinephrine B. Acetylcholine C. Serotonin (5-HT) D. Gamma-aminobutyric acid (GABA)
D. Gamma-aminobutyric acid (GABA) Alprazolam is a benzodiazepine; this class of drugs reduces anxiety by potentiating the action of GABA.
The nurse caring for a patient taking furosemide [Lasix] is reviewing the patient's most recent laboratory results, which are: sodium, 136 mEq/L; potassium, 3.2 mEq/L; chloride, 100 mEq/L; blood urea nitrogen, 15 mg/dL. What is the nurse's best action? A. Administer Lasix as ordered. B. Place the patient on a cardiac monitor. C. Begin a 24-hour urine collection. D. Hold the Lasix and notify the physician.
D. Hold the Lasix and notify the physician. The nurse's best action is to hold the Lasix and notify the physician. Loop diuretics, such as furosemide, can cause significant potassium loss. The normal potassium level is 3.5 to 5 mEq/L. The remaining electrolyte levels are normal. Administering the Lasix could result in a critically low potassium level. Effects of low potassium include cardiac dysrhythmias. Placing a patient on a cardiac monitor requires a physician's order and would warrant further assessment first, such as taking vital signs and asking the patient whether he or she is having any cardiac-related symptoms. Collecting a 24-hour urine specimen is not appropriate in this case.
The nurse is caring for a group of patients who have been prescribed sedative-hypnotic agents. Which agent has the greatest abuse potential? A. Diazepam [Valium] B. Triazolam [Halcion] C. Zolpidem [Ambien] D. Phenobarbital [Luminal Sodium]
D. Phenobarbital [Luminal Sodium] Phenobarbital is a barbiturate drug that carries a higher abuse potential than the benzodiazepine or benzodiazepine-like drugs.
The nurse is preparing to administer minoxidil [Loniten] 5 mg orally. What is the only cardiovascular indication for this medication? A. Heart failure B. Myocardial infarction C. Angina pectoris D. Severe hypertension
D. Severe hypertension Because of its serious adverse effects, minoxidil is reserved for patients who have failed to respond to safer drugs. The only cardiovascular indication for minoxidil is severe hypertension.
The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? A. To reduce the risk of headache B. To improve hypotensive effects C. To prevent heart failure D. To protect against reflex tachycardia
D. To protect against reflex tachycardia Hydralazine is a vasodilator that lowers blood pressure, but it also can trigger reflex tachycardia. Beta blockers, such as propranolol, are added to the regimen to normalize the heart rate.
Which statements about zaleplon [Sonata] does the nurse identify as true? (Select all that apply.) A. Zaleplon [Sonata] is a benzodiazepine. B. Zaleplon [Sonata] is indicated for long-term management of insomnia. C. Zaleplon [Sonata] is used to maintain sleep throughout the night. D. Zaleplon [Sonata] should not be administered with cimetidine [Tagamet]. E. Zaleplon [Sonata] interacts with the neurotransmitter GABA.
D. Zaleplon [Sonata] should not be administered with cimetidine [Tagamet]. Correct E. Zaleplon [Sonata] interacts with the neurotransmitter GABA. Correct Zaleplon [Sonata] belongs to a new class of drugs called the pyrazolopyrimidines. It is indicated for short-term management of insomnia. Zaleplon has a rapid onset and short duration of action and therefore is beneficial for initiating sleep but not for maintaining it throughout the night. Zaleplon and cimetidine should not be administered together. Zaleplon interacts with the neurotransmitter GABA.
