Pharm Final

A patient who has just begun taking an angiotensin converting enzyme (ACE) inhibitor calls the nurse and reports feeling very dizzy when standing up and asks if the medication should be discontinued. What is the nurse's best response?

"Rise to a sitting or standing position slowly; your symptoms will resolve."

A patient who has recently been prescribed a beta-adrenergic blocking agent presents to the emergency department with a serious adverse effect. Which adverse effect is the patient likely exhibiting? 1. Hypertension 2. Angina pectoris 3. Bronchoconstriction 4. Cardiac dysrhythmias

3. Bronchoconstriction

Which accurately describes how centrally acting anticholinergics help control symptoms in Parkinson's disease? 1. By increasing the synthesis of dopamine 2. By activating dopaminergic receptors 3. By preventing the destruction of dopamine in the CNS 4. By blocking cholinergic receptors

4. By blocking cholinergic receptors

The nurse is providing instruction to a patient who was recently prescribed an ACE inhibitor for hypertension. Which is an adverse effect of this medication?

Chronic cough

What common adverse effect are adrenergic drugs known to cause?

Tremors

When patients use nasal decongestants such as pseudoephedrine, they must be aware of the possible resulting hypertension, because the sympathomimetic decongestants action is one of?

Vasoconstriction

The nurse is finished conducting nutritional education with a patient about the DASH (dietary approaches to stop hypertension) diet. The patient would like to complete the breakfast menu for tomorrow. Which foods offered for breakfast would be most appropriate for the patient to choose? (Select all that apply.)

Grapefruit Orange juice Oatmeal

A patient asks the nurse how amlodipine (Norvasc) works to reduce the blood pressure. Which response will the nurse provide?

"It causes blood vessel dilation."

A patient beginning levodopa (Larodopa) therapy for Parkinson's disease asks how long it will take for the medication to relieve symptoms. Which is the best response by the nurse? 1. "Maximum symptom control occurs when top dosage is reached in 14 to 21 days." 2. "Symptom relief is immediate but will vary with stress and fatigue level." 3. "Because a loading dose is given, the maximum effects of the drug are seen in 24 to 48 hours." 4. "The full therapeutic effect of the drug will not be apparent for up to 6 months."

4. The full therapeutic effect of the drug will not be apparent for up to 6 months. "Rationale: Levodopa must be taken for a full 6 months before it is completely effective. There is no loading dose of levodopa, and maximum effects do not occur in 24 to 48 hours. Symptom relief is not immediate with levodopa therapy. Maximum symptom control is not evident in 14 to 21 days with levodopa therapy.

Which statement(s) about diuretics is/are true? (Select all that apply.)

A mechanism of action for the antihypertensive effects of diuretics includes volume depletion. They have been shown to reduce cardiovascular morbidity associated with hypertension. Electrolytes must be evaluated periodically for patients on loop diuretics.

A pt is an urgent-care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment? A. An anticholinergic, such as ipratropium (Atrovent) B. An antileukotiene, such as montelukast (Singulair) C. A beta2 agonist, such as albuterol (Proventil) D. A corticosteroid, such as fluticasone (Flovent)

A. An anticholinergic, such as ipratropium (Atrovent)

A patient is being discharged on an adrenergic bronchodilator. Which common adverse effect(s) will the nurse include in discharge teaching? (Select all that apply.) a. Palpitations b. Dizziness c. Orthostatic hypotension d. Hypoglycemia e. Tremors f. Bradycardia

ANS: A, B, C, E

Which nerve endings liberate norepinephrine?

Adrenergic

Which category of medications is used for peripheral vascular diseases characterized by excessive vasoconstriction, such as Raynauds disease?

Alpha adrenergic blocking agents

Which medication is often administered with hydralazine to reduce reflex physiologic responses to the drug?

Beta blockers

which drug is the cornerstone of treatment for prophylaxis and treatment of tuberculosis (TB)?

Isoniazid (Nydrazid)(for non-active TB, just slight exposure... active TB would require multiple meds)

A patient presents with new onset symptoms of Parkinson's disease. Which category of drugs present in the patient's medication history would be cause for concern? 1. Succinimides 2. Anticholinergics 3. Benzodiazepines 4. Phenothiazines

Phenothiazines Rationale: Phenothiazines (as well as reserpine, methyldopa, and metoclopramide) deplete dopamine, thus causing secondary parkinsonism. Anticholinergic agents are used to reduce the severity of the tremors and drooling that occur with Parkinson's disease; they do not cause the symptoms. Benzodiazepines do not cause the symptoms similar to Parkinson's disease. Succinimides do not cause the symptoms similar to Parkinson's disease.

When patients overuse topical decongestants, this can lead to rebound secretions caused by excessive vasoconstriction of the blood vessels in the nasal membranes called?

Rhinitis Medicamentosa

When a person uses a topical decongestant frequently, then stops taking the drug and notices even more congestion occurring, what is this phenomenon called?

Rebound Effect

A client has been diagnosed with Parkinson's disease and the nurse is providing health education. The client asks the nurse, "Why can't I take a dopamine pill if that's what is lacking?" When responding, the nurse should address what topic?

The structure and function of the blood-brain barrier

The nurse is explaining to a patient how ACE inhibitors affect blood pressure. Which statement accurately describes the action of these medications?

They inhibit vasoconstriction.

When displayed by the patient, which symptom would be most indicative to the nurse to withhold a recently prescribed beta-adrenergic blocker?

Wheezing

What can occur as a result of rapid withdrawal from long-term use of barbiturate therapy? (Select all that apply.) a. Anxiety b. Delirium c. Weakness d. Grand mal seizures e. Severe pain

a. Anxiety b. Delirium c. Weakness d. Grand mal seizures

A patient is receiving a vasodilator that has a high incidence of orthostatic hypotension. Before administering the medication and after the patient has rested supine for 10 minutes, the nurse assesses the BP and pulse. Results are BP 145/80 mm Hg, P 68 beats/min. The nurse assists the patient to stand, ensuring safety, and after 1 minute reassesses the BP and pulse. Which reading would be of most concern to the nurse? a. BP 110/70, pulse 92 b. BP 126/70, pulse 78 c. BP 134/70, pulse 72 d. BP 140/82, pulse 70

a. BP 110/70, pulse 92

When assessing the patient experiencing the onset of symptoms of type 1 diabetes, which question is most appropriate for the nurse to ask? a.Have you lost any weight lately? b.How long have you felt anorexic? c.Is your urine unusually dark colored? d.Do you crave fluids containing sugar?

a. Have you lost any weight lately?

Which medication is used in the treatment of hypothyroidism? a. Levothyroxine (Synthroid) b. Radioactive iodine c. Propylthiouracil (Propacil) d. Methimazole (Tapazole)

a. Levothyroxine (Synthroid) Levothyroxine (T4) is one of the two primary hormones secreted by the thyroid gland. This hormone is partially metabolized to liothyronine (T3), so therapy with levothyroxine (Synthroid) replaces both hormones. Levothyroxine is considered the drug of choice for hormone replacement in hypothyroidism. Radioactive iodine, propylthiouracil, and methimazole are used to treat hyperthyroidism.

A patient who is prescribed an ACE inhibitor complains of tongue swelling and is experiencing obvious dyspnea. What is the priority action by the nurse? a. administer prescribed PRN epinephrine b. assess BP c. Assess lung sounds d. Consult the prescriber

a. administer prescribed PRN epinephrine

A patient who has type 1 diabetes plans to take a swimming class daily at 1:00 PM. The clinic nurse will plan to teach the patient to a.check glucose level before, during, and after swimming. b.delay eating the noon meal until after the swimming class. c.increase the morning dose of neutral protamine Hagedorn (NPH) insulin. d.time the morning insulin injection so that the peak occurs while swimming.

a. check glucose level before, during, and after swimming.

A patient receives aspart (NovoLog) insulin at 8:00 AM. Which time will it be most important for the nurse to monitor for symptoms of hypoglycemia? a.9:00 AM b.11:30 AM c.4:00 PM d.8:00 PM

a.9:00 AM

Which nursing intervention(s) would be performed for a patient who is on diuretic therapy? (Select all that apply.)

a.Auscultation of lung sounds b.Assessment of skin turgor d.Positioning techniques e.Monitoring of intake and output ANS: A, B, D, E

Individuals with which disorder(s) are particularly susceptible to the development of electrolyte disturbances during diuretic therapy? (Select all that apply.)

a.History of cardiac disease b.History of renal disease c.History of hormonal disorders e.Massive trauma f.Serious burns ANS: A, B, C, E, F

The nurse administers insulin lispro (Humalog) to a patient. The nurse checks for effects of this medication within which time period? a. 5 to 10 minutes of administration b. 15 to 30 minutes of administration c. 45 to 60 minutes of administration d. 1 to 2 hours after administration

b. 15 to 30 minutes of administration Insulin lispro is a rapid-acting type of regular insulin. Effects begin within 15 to 30 minutes of subcutaneous injection and last for 3 to 6 hours.

A patient with a history of heart failure has been diagnosed with hypothyroidism. The drug interaction with glycosides and thyroid replacement therapy will most likely require which change in therapy? a. Decrease in the daily digoxin dosage b. Gradual increase in the daily glycoside dosage c. Inability to begin thyroid replacement therapy because of the underlying heart condition d. Increased thyroid replacement dosage

b. Gradual increase in the daily glycoside dosage If thyroid replacement therapy is started while receiving digoxin, a gradual increase in the glycoside will also be necessary to maintain adequate therapeutic activity. Decreasing the digoxin would put the patient at risk for cardiovascular complications. The two treatments can be coordinated. The thyroid medication does not need to be increased.

A patient receiving diazepam (Valium) is complaining of nausea and vomiting and is becoming jaundiced. Which type of blood work will be performed? a. Renal function tests b. Liver function tests c. Clotting times d. Electrolyte panels

b. Liver function tests

A patient recently completed radiation treatment for throat cancer and presents to the healthcare provider's office with symptoms indicating possible hypothyroidism. Which symptom(s) would most likely be exhibited and/or reported? (Select all that apply.) a. Inability to sleep b. Weight gain c. Lethargy d. Nervousness e. Cold intolerance

b. Weight gain c. Lethargy e. Cold intolerance Symptoms associated with hypothyroidism include weight gain, lethargy, and cold intolerance. Inability to sleep and nervousness are not symptoms associated with hypothyroidism.

Which patient would be a candidate for radioactive iodine therapy? a. A 17-year-old woman with Graves' disease b. A 64-year-old woman with hypothyroidism c. A 46-year-old man with heart disease and thyroid cancer d. An 82-year-old man with myxedema crisis

c. A 46-year-old man with heart disease and thyroid cancer Patients typically treated with radioactive iodine therapy are those who are beyond childbearing years, those with severe complicating diseases (e.g., heart disease), those with recurrent hyperthyroidism after previous thyroid surgery, those who are poor surgical risks, and those who have unusually small thyroid glands. Women of childbearing age should not be treated with radioactive iodine. Hypothyroidism and myxedema are not treated with radioactive iodine.

Which nursing diagnosis may be identified for a patient with hyperthyroidism? a. Imbalanced nutrition: more than body requirements b. Constipation c. Disturbed sleep pattern d. Ineffective airway clearance

c. Disturbed sleep pattern

Which medication is used to treat hyperthyroidism? a. Levothyroxine (Synthroid) b. Liotrix (Thyrolar) c. Propylthiouracil (Propacil) d. Liothyronine (Cytomel)

c. Propylthiouracil (Propacil) Propylthiouracil is an antithyroid agent used in the treatment of hyperthyroidism. Levothyroxine, liotrix, and liothyronine are used to treat hypothyroidism.

The nurse transcribes a new order for liothyronine for a patient diagnosed with hypothyroidism. When educating the patient about this medication, the nurse will include that: a. the onset of action is slower than that of levothyroxine. b. it is safe for patients with cardiovascular disease to take. c. adverse effects may occur up to 3 weeks after changes in therapy have been initiated. d. symptoms of adverse effects include tachycardia and weight gain.

c. adverse effects may occur up to 3 weeks after changes in therapy have been initiated. Adverse effects may occur 1 to 3 weeks after changes in therapy have been initiated. Onset of action is more rapid than that of levothyroxine. It is not recommended for patients with cardiovascular disease. Symptoms of adverse effects include bradycardia and weight loss.

Peripheral adverse effects of levodopa, including nausea, hypotension, and cardiac arrhythmias, can be diminished by including which of the following drugs in the therapy? a. amantadine b. ropinirole c. carbidopa d. tolcapone e. pramipexole

c. carbidopa

Medications ordered on a patient with hypothyroidism include liotrix and cholestyramine. The nurse administers the dose of liotrix at 08:00. When is the best time for the nurse to administer the cholestyramine?a. 07:00 b. 08:00 c. 10:00 d. 12:00

d. 12:00 To prevent binding of thyroid hormones by cholestyramine, administer doses at least 4 hours apart.

Which condition can occur if congenital hypothyroidism is not treated? a. Diabetes b. Impaired vision c. Periorbital edema d. Cretinism

d. Cretinism Cretinism is a condition resulting from congenital hypothyroidism. Diabetes is not a complication of congenital hypothyroidism. Periorbital edema and impaired vision are complications of hyperthyroidism.

Which of these ECG findings would suggest hyperkalemia in a patient who is prescribed an ACE inhibitor and who was using a salt substitute? a. flat t waves b. prolonged QT interval c. shortened QT interval d. Tall, peaked T waves

d. tall, peaked T waves