Pharmacology Exam 3 Practice Questions

7. The order reads, "Give metoprolol (Lopressor) 300 mg/day PO in 2 divided doses." The tablets are available in 50-mg strength. How many tablets will the patient receive per dose?

3 tablets per dose (150 mg per dose)

Which instruction should be included in the discharge teaching for a patient with a transdermal nitroglycerin patch? A. "Apply the patch to a nonhairy, nonirritated area of the upper torso or arms." B. "Apply the patch to the same site each day to maintain consistent drug absorption." C. "If you get a headache, remove the patch for 4 hours and then reapply." D. "If you get chest pain, apply a second patch right next to the first patch."

A. "Apply the patch to a nonhairy, nonirritated area of the upper torso or arms." Correct A nitroglycerin patch should be applied to a nonhairy, nonirritated area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and the drug should be continued if headache occurs because tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.

When titrating intravenous nitroglycerin, which assessment findings does the nurse monitor? (Select all that apply.) A. Blood pressure B. Heart rate C. Chest pain D. Respiratory rate

A. Blood pressure B. Heart rate C. Chest pain

Nitrates relieve angina pain by reducing preload. How would the nurse explain the term preload to a patient? A. It is the blood volume within the heart. B. It is the pressure within the superior vena cava. C. It is the pressure against which the heart must pump. D. It is the oxygen demand of the heart.

A. It is the blood volume within the heart. Preload is determined by the amount of blood in the ventricle just before contraction.

Which statement indicates that the patient understands discharge teaching about nitroglycerin? A. "I will need to refill my prescription once a year in order to maintain potency." B. "I will need to keep the nitroglycerin stored in the bottle it comes in." C. "I will take a nitroglycerin tablet every 15 minutes until my chest pain is gone." D. "I should take a nitroglycerin tablet 2 hours before I want to engage in activity that will cause chest pain."

B. "I will need to keep the nitroglycerin stored in the bottle it comes in." Nitroglycerin needs to be stored away from heat, humidity, and light, all of which can decrease its potency. Keeping it in the brown light-resistant bottle helps achieve this. It should be replaced every 3 to 6 months in order to maintain potency. Nitroglycerin is used every 5 minutes for pain relief or just before engaging in activity that is known to cause chest pain.

The patient asks how nitroglycerin should be stored while traveling. What is the nurse's best response? A. "You can protect it from heat by placing the bottle in an ice chest." B. "It's best to keep it in its original container away from heat and light." C. "You can put a few tablets in a resealable bag and carry in your pocket." D. "It's best to lock them in the glove compartment of your car to keep them away from heat and light."

B. "It's best to keep it in its original container away from heat and light." Although nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest where it could freeze. It should also not be locked up and needs to be kept away from light, not in a clear plastic bag.

When applying nitroglycerin ointment, the nurse should perform which action? A. Use the fingers to spread the ointment evenly over a 3-inch area. B. Apply the ointment to a nonhairy part of the upper torso. C. Massage the ointment into the skin. D. Apply two thick lines of ointment over the prescribed measured area on the nitroglycerin paper.

B. Apply the ointment to a nonhairy part of the upper torso. Absorption is best over a nonhairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves when applying to prevent transdermal absorption by the applier. The ointment is measured as one straight line on the nitroglycerin patch and is gently spread over paper and applied, but not rubbed, into the skin. Rubbing would increase absorption and risks of side effects.

A patient receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's best action? A. Assess the patient's lung sounds. B. Decrease the intravenous nitroglycerin by 10 mcg/min. C. Increase the intravenous nitroglycerin by 10 mcg/min. D. Recheck the patient's vital signs in 1 hour.

B. Decrease the intravenous nitroglycerin by 10 mcg/min. Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 minutes while changing the rate of the intravenous nitroglycerin infusion.

Which are common side effects of nitroglycerin? (Select all that apply.) A. Blurred vision B. Flushing C. Headache D. Hypotension

B. Flushing C. Headache D. Hypotension

A patient who is taking sublingual nitroglycerin is complaining of flushing and headaches. What is the nurse's best response? A. "This is a normal response to your chest pain." B. "Stop taking the nitroglycerin because you are probably allergic to it." C. "These are the most common side effects of nitroglycerin. They should subside with continued use of nitroglycerin." D. "These symptoms are not related to your sublingual nitroglycerin. You should notify your doctor for diagnostic testing."

C. "These are the most common side effects of nitroglycerin. They should subside with continued use of nitroglycerin." Headache and flushing are the most common side effects of nitroglycerin and will subside with continued use.

In order to prevent the development of tolerance, the nurse instructs the patient to perform which action? A. Apply the nitroglycerin patch every other day. B. Switch to sublingual nitroglycerin when the patient's systolic blood pressure elevates to >140 mm Hg. C. Apply the nitroglycerin patch for 16 hours each and remove for 8 hours at night. D. Use the nitroglycerin patch for acute episodes of angina only.

C. Apply the nitroglycerin patch for 16 hours each and remove for 8 hours at night. Tolerance can be prevented by maintaining an 8-hour nitrate-free period each day.

What is included in the priority assessment before administering isosorbide mononitrate (Imdur)? A. Serum electrolytes B. Blood urea nitrogen (BUN) and creatinine C. Blood pressure D. Level of consciousness

C. Blood pressure Mononitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.

When caring for a patient with angina, the nurse would question an order for a noncardioselective beta blocker in a patient with what coexisting medical diagnosis? A. Hypertension B. Atrial fibrillation C. Bronchial asthma D. Myocardial infarction

C. Bronchial asthma Noncardioselective beta blockers should be used with caution in patients with bronchial asthma since any level of blockade of beta2-receptors can promote bronchoconstriction through unopposed parasympathetic (vagal) tone.

Calcium channel blockers reduce myocardial oxygen demand by reducing afterload. How would the nurse explain afterload to the patient? A. It is the blood volume within the heart. B. It is the pressure within the heart. C. It is the pressure against which the heart must pump. D. It is the contractility of the heart muscle.

C. It is the pressure against which the heart must pump. Afterload is determined by the pressure in the aorta just before systole.

Which statement by the patient demonstrates a need for further education regarding nitroglycerin? A. "If I get a headache, I should keep taking my nitroglycerin and use Tylenol for pain relief." B. "I should keep my nitroglycerin in a cool, dry place." C. "I should change positions slowly to avoid getting dizzy from the nitroglycerin's effect on my blood pressure." D. "I can take up to four tablets at 5-minute intervals for chest pain."

D. "I can take up to four tablets at 5-minute intervals for chest pain." Patients are taught to take up to three tablets 5 minutes apart. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after one dose, the patient (or family member) must call 911 immediately.

Patient teaching regarding sublingual nitroglycerin should include which statement? A. "You can take up to five doses every 3 minutes for chest pain." B. "Chew the tablet for the quickest effect." C. "Keep the tablets locked in a safe place until you need them." D. "Sit or lie down after you take a nitroglycerin tablet to prevent dizziness."

D. "Sit or lie down after you take a nitroglycerin tablet to prevent dizziness." Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. It should be kept in a readily accessible location for immediate use should chest pain occur. Three tablets may be taken 5 minutes apart. It should be placed under the tongue and allowed to dissolve.

It is most important to instruct a patient prescribed nitroglycerin to avoid which substance(s)? A. Antacids B. Grapefruit juice C. Thiazide diuretics D. Erectile dysfunction medications

D. Erectile dysfunction medications Concurrent administration of erectile dysfunction medications such as sildenafil citrate (Viagra) can cause an acute exacerbation of nitrate-related hypotension.

Which nitrate preparation or dosage form has the longest duration of action? A. Sublingual nitroglycerin B. Sublingual isosorbide dinitrate C. Oral isosorbide dinitrate D. Transdermal nitroglycerin patch

D. Transdermal nitroglycerin patch The transdermal patch has an 8- to 12-hour duration of action, compared with 0.5 to 6 hours for the other choices.

When giving antihypertensive drugs, the nurse will consider giving the first dose at bedtime for which class of drugs? a. Alpha blockers such as doxazosin (Cardura) b. Diuretics such as furosemide (Lasix) c. ACE inhibitors such as captopril (Capoten) d. Vasodilators such as hydralazine (Apresoline)

a

3 Which statement by the patient reflects the need for additional patient education about the calcium channel blocker diltiazem (Cardizem)? a "I can take this drug to stop an attack of angina." b "I understand that food and antacids alter the absorption of this oral drug." c "When the long-acting forms are taken, the drug cannot be crushed." d "This drug may cause my blood pressure to drop, so I need to be careful when getting up."

a "I can take this drug to stop an attack of angina."

6 The nurse is reviewing drug interactions with a male patient who has a prescription for isosorbide dinitrate (Isordil) as treatment for angina symptoms. Which substances listed below could potentially result in a drug interaction? (Select all that apply.) a A glass of wine b Thyroid replacement hormone c tadalafil (Cialis), an erectile dysfunction drug d metformin (Glucophage), an antidiabetic drug e carvedilol (Coreg), a beta blocker

a, c, e a A glass of wine c tadalafil (Cialis), an erectile dysfunction drug e carvedilol (Coreg), a beta blocker

the nurse is assessing a patient who has new prescription for vorapaxar (Zontivity). Which of these conditions are considered contraindications to the use of vorapaxar? Select all that apply. a. impaired renal function b impaired liver function c. history of MI d. peripheral artery disease e. history of stroke

abe

A nurse administering niacin would implement which action to help to reduce adverse effects? a. give the medication with grapefruit juice b. administer a small dose of aspirin or an NSAID 30 minutes before the niacin dose. c. administer the medication on an empty stomache d. have the patient increase dietary fiber intake

b

a 46-year-old man started antihypertensive drug therapy 3 months earlier and is in the office for a follow-up visit. While the nurse is taking his blood pressure, he informs the nurse that he has had some problems with sexual intercourse. Which is the most appropriate response by the nurse a. not to worry. eventually tolerance will develop b. the physician can work with you on changing the dose and or drug c. sexual dysfunction happens with this therapy and you will learn to accept it. d. this is an unusual occurence but it is important to stay on your medication

b

a patient has received a double dose of heparin during surgery and is bleeding through the incision site. While the surgeons are working to stop the bleeding at the incision site the nurse will prepare to take what action at this time? a. give IV vitamin K as an antidote b. give IV protamine sulfate as an antidote c. call the blood bank for an immediate platelet transfusion. d. obtain an order for packed RBC

b

a patient is currently taking a statin. the nurse consider that the patient may have a higher risk for developing rhabdomyolysis when also taking which product? a. NSAID b. fibric acid derivative c. orange juice d fat soluble vitamins

b

the nurse is teaching a patient about self-administration of enoxaprin (Lovenox). Which statement will be included in this teaching session? a. "We will need to teach a family member how to give this drug in your arm" b. "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel." c. "this drug needs to be taken at the same time every day with a full glass of water." d. "Be sure to massage the injection site thoroughly after giving the drug"

b

5 A 68-year-old man has been taking the nitrate isosorbide dinitrate (Isordil) for 2 years for angina. He recently has been experiencing erectile dysfunction and wants a prescription for sildenafil (Viagra). Which response would the nurse most likely hear from the prescriber? a "He will have to be switched to isosorbide mononitrate if he wants to take sildenafil." b "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists." c "I'll write a prescription, but if he uses it, he needs to stop taking the isosorbide for one dose." d "These drugs are compatible with each other, and so I'll write a prescription."

b "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists."

the nurse is administering drugs to older adult patients. The nurse knows that which adverse effect is the most concern for these patients? a. dry mouth b. hypotension c. restlessness d. constipation

b. hypotension

a patient is starting wafarin (Coumadin) therapy as part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy? a. teach proper subcutaneous administration b. administer the oral dose at the same time every day c. assess carefully for excessive bruising or unusual bleeding. d. monitor lab results for a target INR of 2 to 3. e. monitor lab results for a therapeutic aPTT value of 1.5 to 2.5 times the control values

bcd

a patient has been taking simvastatin (Zocor) for 6 months. Today he received a call that he needs to come to the office for a laboratory check. the nurse expects which labs studies to be order at this time?

bcdf

the nurse is administering cholestyramine (Questran), a bile acid sequestrant which nursing intervention (s) is appropriate. a. administering the drug on an empty stomach b. administering the drug with meals c. instructing the patient to follow a low-fiber diet while taking this drug d. instructing the patient to take a fiber supplement while taking this drug e. increase fluid intake f. not administering this drug at the same time as other drugs?

bdef

a patient has a new prescription for an ACE inhibitor. During a review of the patient's list of current medications which would cause concern for a possible interaction with the new prescription? (select all that apply) a. a benzodiazepine taken as needed for allergies b. a potassium supplement taken daily c. an oral anticoagulant taken daily d. an opioid used for occasional severe e. An NSAID taken as needed for headaches

be

A patient is receiving instructions regarding warfarin therapy and asks the nurse about what medications she can take for headaches. The nurse will tell her to avoid which type of medication? a. Opioids b. acetaminophen (Tylenol) c. NSAIDs d. There are no restrictions while taking warfarin.

c

Which point will the nurse emphasize to a patient who is taking an antilipemic medication in the "statin" class? a) The drug needs to be taken on an empty stomach before meals. b) A low-fat diet is not necessary while taking these medications. c) It is important to report muscle pain immediately. d) Improved cholesterol levels will be evident within 2 weeks.

c

a patient is being assessed before a newly ordered antilipemic medication is given. Which condition would be a potential contraindication? a. diabetes insipidus b. pulmonary fibrosis c. liver cirrhosis d. MI

c

a patient is receiving dabigatran (Pradaxa), 150 mg twice daily, as part of treatment for atrial fibrillation. which condition if present would be a concern if the patient were to receive this dose? a. asthma b. elevated liver enzymes c. renal impairment d. history of myocardial infarction

c

when a patient in being taught about the potential adverse effects of an ACE inhibitor, which of these effects should the nurse mention as possibly occurring when this drug is taken to treat HTN? a. diarrhea b. nausea c. dry, nonproductive cough d. sedation

c

2 A nurse with adequate knowledge about the administration of intravenous nitroglycerin will recognize that which statement is correct? a The intravenous form is given by IV push injection. b Because the intravenous forms are short-lived, the dosing must be every 2 hours. c Intravenous nitroglycerin must be protected from exposure to light through use of special tubing. d Intravenous nitroglycerin can be given via gravity drip infusions.

c Intravenous nitroglycerin must be protected from exposure to light through use of special tubing.

1 A patient has a new prescription for transdermal nitroglycerin patches. The nurse teaches the patient that these patches are most appropriately used for which reason? a To relieve exertional angina b To prevent palpitations c To prevent the occurrence of angina d To stop an episode of angina

c To prevent the occurrence of angina

when administering niacin, the nurse needs to monitor for which adverse effect? a. cutaneous flushing b. muscle pain c. headache d. constipation

cutaneous flushing

The nurse is assessing a patient who will be starting antihypertensive therapy with an ACE inhibitor. Which condition if present in the patient, would be a reason for cautious use? a. asthma b. rheumatoid arthritis c. hyperthyroidism d. renal insufficency

d

4 While assessing a patient with angina who is to start beta blocker therapy, the nurse is aware that the presence of which condition may be a problem if these drugs are used? a Hypertension b Essential tremors c Exertional angina d Asthma

d Asthma

the nurse is monitoring a patient who is receiving antithrombolytic therapy in an emergency department because of a possible MI. Which adverse effect would be of the greatest concern at this time? a. dizziness b. BP 130/98 c. slight bloody oozing from the IV insertion site d. irregular heart rhythm

d.