NCLEX Questions (Exam #3)

The nurse is educating a patient taking sublingual nitroglycerin 0.4 mg for anginal pain. Which of the following statements indicate that the patient understands the instructions? (Check all that apply.) a. "I should take one nitroglycerin tablet every 5 minutes for pain, up to a total of three tablets, as needed." b. "I should expect that the nitroglycerin will cause a stinging sensation when placed under my tongue." c. "I should store my nitroglycerin in the original dark bottle to protect the tablets from light." d. "I should replace my nitroglycerin tablets every month whether the bottle has been opened or not."

a. "I should take one nitroglycerin tablet every 5 minutes for pain, up to a total of three tablets, as needed." b. "I should expect that the nitroglycerin will cause a stinging sensation when placed under my tongue." c. "I should store my nitroglycerin in the original dark bottle to protect the tablets from light."

A patient taking nitroglycerin for angina reports developing a headache after taking more than one tablet. The nurse should inform him that a. Headache is a common side effect due to the vasodilating effects of the medication b. A headache indicates that a person is allergic to the nitroglycerin c. The experience of headache means that the levels of nitroglycerin are toxic d. The experience of a headache likely means that the tablets have passed their expiration date

a. Headache is a common side effect due to the vasodilating effects of the medication

A 57 year old man taking metoprolol presents to the cardiac clinic following a MI. He reports that continues to smoke. Smoking may contribute to what effect on beta-adrenergic blocking activity? a. Reduce the efficacy b. Potentiate an increase in intracranial pressure c. Precipitate ventricular fibrillation d. Increase the incidence of adverse effects

a. Reduce the efficacy

A 72 year old woman with angina pectoris, who is being discontinued from beta-adrenergic blockers, asks the nurse, "Why can't I just stop taking the drug today if it's not working anyway?" The nurse instructs the patient that failure to taper the drug slowly may lead to ... a. Worsening of her angina symptoms b. Significant bronchoconstriction c. Development of heart failure d. Drug fever

a. Worsening of her angina symptoms Explanation: The nurse needs to teach the client that when a beta blocker is being discontinued after prolonged use, it should be tapered in dosage and gradually discontinued, or rebound angina can occur

A 57-year-old man taking metoprolol presents to the cardiac clinic following a myocardial infarction. He reports that he continues to smoke. Smoking may contribute to what effect on beta-adrenergic blocking activity? a. reduce the efficacy b. potentiate an increase in intracranial pressure c. precipitate ventricular fibrillation d. increase the incidence of adverse effects

a. reduce the efficacy

The primary difference between shock and hypovolemic shock is that ... a. Hypovolemic shock results in decreased perfusion while distributive does not b. Blood volume remains constant in distributive shock * c. Distributive shock is most commonly caused by trauma d. Hypovolemic shock results in decreased vascular tone

b. Blood volume remains constant in distributive shock

A 72-year-old woman with angina pectoris, who is being discontinued from beta-adrenergic blockers, asks the nurse, "Why can't I just stop taking the drug today if it's not working anyway?" The nurse instructs the patient that failure to taper the drug slowly may lead to a. worsening of her angina symptoms b. significant bronchoconstriction c. development of heart failure d. drug fever

a. worsening of her angina symptoms

Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerves stimulation? a. Nitrates b. Beta-adrenergic blockers c. Adenosine diphosphate receptor antagonist d. Calcium channel blockers

b. Beta-adrenergic blockers Explanation- Beta-adrenergic blocks inhibit chronotropic, inotropic, and vasoconstrictor responses to catecholamines, epinephrine, and norepinephrine

A patient receiving norepinephrine for shock has an arterial line in place. The patient's blood pressure has been near 90/42 mm Hg for most of the morning. The blood pressure reading on the continuous monitor suddenly shows a blood pressure of 130/80 mm Hg. The nurse should ... a. Decrease the rate of norepinephrine b. Call the health care provider c. Stop the norepinephrine infusion d. Confirm the BP with a manual reading

b. Call the health care provider

Shock from anaphylaxis is a result of which type of shock? a. Hypovolemic b. Distributive c. Obstructive d. Cardiogenic

b. Distributive Explanation: Distributive or vasogenic shock develops from impaired utilization of oxygen and thus production of energy by the cell. It is characterized by massive vasodilation, which results in a relative hypovolemia. Distributive shock can be further divided, depending on the cause, into three subtypes. Anaphylactic shock, which is due to massive vasodilation caused by release of histamine in response to a severe allergic reaction. (pg.567)

Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulations a. Nitrates b. beta-adrenergic blockers c. adenosine diphosphate receptor antagonists d. calcium channel blockers

b. beta-adrenergic blockers

Mr. Smith, a 52-year-old African American man, is recovering from an acute non-ST-segment elevation myocardial infarction. His father died from an MI at age 44. He has smoked one pack of cigarettes a day for 30 years. Which of the following risk factors for heart disease does Mr. Smith have? (Check all that apply.) a. smoking b. genetics c. race d. age

b. genetics c. race d. age

When giving a drug with beta1 agonist activity, the nurse knows that which of the following would provide therapeutic benefit? (Check all that apply.) a. vasoconstriction and elevation of the blood pressure b. relaxation of bronchial smooth muscle and bronchodilation c. elevated heart rate and improved force of myocardial contraction d. uterine contraction and induction of labor

b. relaxation of bronchial smooth muscle and bronchodilation

The nurse teaches the patient with diabetes using adrenergic medications to anticipate ... a. No change in blood glucose levels b. A decrease in blood glucose levels c. An increase in blood glucose levels d. More fluctuation in blood glucose levels

c. An increase in blood glucose levels

During administration of dopamine, a patient complains of pain at the infusion site. The nurse should recognize that the... a. Patient is hypersensitive to the drug, and infusion should be stopped b. Infusion rate is too fast and should be slowed c. Medication should be stopped, phentolamine should be infused, and the infusion site should be changed d. Medication is probably not effective, therefore, patient response should be assessed once all the medication is infused

c. Medication should be stopped, phentolamine should be infused, and the infusion site should be changed

When the nurse responds to hypotension due to hypovolemic shock, which of the following should the nurse anticipate will be administered first? a. Epinephrine b. Dobutamine c. Normal saline (IV) d. Dopamine

c. Normal saline (IV)

When giving a drug with beta1 AGONIST activity, the nurse knows that which of the following would provide therapeutic benefit? (Check all that apply.) a. vasoconstriction and elevation of the blood pressure b. Relaxation of bronchial smooth muscle and bronchodilation c. Elevated HR and and improved force of myocardial contraction d. Uterine contraction and induction of labor

c. Relaxation of bronchial smooth muscle and bronchodilation

Which of the following are expected outcomes for a client on the second day of hospitalization after revascularization following an ST-segment elevation myocardial infarction? (Select all that apply) a. The client reports only minimal chest pain and diaphoresis with activity. b. Electrocardiogram (ECG) monitors shows sinus tachycardia with only occasional premature ventricular contractions. c. There is absence of bleeding complications. d. 12-Lead ECG shows a decrease of the ST-segment elevation by 50% of the initial height.

c. There is absence of bleeding complications.

Which of the following are expected outcomes for a client on the second day of hospitalization after revascularization following an ST-segment elevation myocardial infarction? (Check all that apply.) a. The client reports only minimal chest pain and diaphoresis with activity. b. Electrocardiogram (ECG) monitors shows sinus tachycardia with only occasional premature ventricular contractions. c. There is absence of bleeding complications. d. 12-Lead ECG shows a decrease of the ST-segment elevations by 50% of the initial height.

c. There is absence of bleeding complications. d. 12-Lead ECG shows a decrease of the ST-segment elevations by 50% of the initial height.

The nurse teaches the patient with diabetes using adrenergic medications to anticipate a. no change in blood glucose levels b. a decrease in blood glucose levels c. an increase in blood glucose levels d. more fluctuation in blood glucose levels

c. an increase in blood glucose levels

A patient in cardiogenic shock is started on dobutamine. The health care provider's order reads dobutamine 10 mcg/kg/min IV. What effect should the nurse expect after beginning drug therapy? a. enhanced cardiac contraction and contractility via stimulation of alpha1, beta1, and beta2 receptors b. dilated blood vessels via stimulation of dopamine receptors c. increased cardiac output through stimulation of beta1 receptors d. constricted blood vessels and increased cardiac output through stimulation of alpha1 receptors

c. increased cardiac output through stimulation of beta1 receptors

During administration of dopamine, a patient complains of pain at the infusion site. The nurse should recognize that the a. patient is hypersensitive to the drug, and infusion should be stopped b. infusion rate is too fast and should be slowed c. medication should be stopped, phentolamine should be infused, and the infusion site should be changed d. medication is probably not effective, and therefore, patient response should be assessed once all the medication is infused

c. medication should be stopped, phentolamine should be infused, and the infusion site should be changed

The health care provider prescribes nitroglycerin 2% ointment, 1.5-inch dose every 4 hours. To accurately apply the ointment, the patient should be instructed to a. rub the ointment into the skin to enhance absorption b. leave previous ointment on for 4 hours after applying a new dose c. rotate application sites to decrease skin irritation d. place the ointment on a distal part of the lower body to increase absorption

c. rotate application sites to decrease skin irritation

Concurrent use of nitrates in any form or route of administration with phosphodiesterase enzyme inhibitors produces a. enhanced erectile potential b. significant tachycardia c. severe hypotensive effects d. mild bronchodilation

c. severe hypotensive effects

A 63-year-old woman continues to complain of chest pain, although her cardiac catheterization showed no significant cardiac disease. She notes that the chest pain occurs at the same time each night and typically during the cold weather. What kind of angina is the patient likely experiencing? a. stable angina b. unstable angina c. variant angina d. acute coronary syndromes

c. variant angina

In caring for a patient with chronic angina who has been prescribed the new drug, ranolazine, the nurse is correct in counseling that this drug ... a. May be crushed if necessary b. Must not be taken with beta-adrenergic blockers c. Must be taken with meals d. Should not be taken with grapefruit juice

d. Should not be taken with grapefruit juice

The nurse removes a patient's transdermal nitroglycerin disk at bedtime as ordered to minimize nitrate tolerance. The patient awakens during the night and complains of anginal symptoms. The nurse's action is to a. notify the health care provider b. apply a new transdermal disk c. obtain further history of complaints d. administer a short-acting nitrate as ordered

d. administer a short-acting nitrate as ordered

In caring for a patient with chronic angina who has been prescribed the new drug, ranolazine, the nurse is correct in counseling that this drug a. may be crushed if necessary b. must not be taken with beta-adrenergic blockers c. must not be taken with meals d. should not be taken with grapefruit juice

d. should not be taken with grapefruit juice