33 Diuretics, 34 Antihyperlipidemic Drugs, 37 Anticoagulant and Thrombolytic Drugs, 38 Cardiotonic and Inotropic Drugs, 39 Antiarrhythmic Drugs

A nurse is preparing to administer an antiarrhythmic and identifies the drug as a class III potassium channel blocker. Which drug would the nurse be most likely to administer? A) Amiodarone B) Flecainide C) Mexiletine D) Propafenone

Ans: A Feedback: Amiodarone is a class III potassium channel blocker. Flecainide, mexiletine, and propafenone are class I sodium channel blockers.

When caring for a client who has been digitalized for his heart failure, the nurse observes that the client is experiencing bradycardia. Which of the following would the nurse expect the primary health care provider to prescribe for the client's bradycardia? A) Atropine B) Cholestyramine C) Furosemide D) Milrinone

Ans: A Feedback: Atropine should be administered to clients who develop bradycardia. Bradycardia may be seen in digitalis toxicity. Milrinone is a miscellaneous inotropic used in heart failure. Furosemide is a loop diuretic that can be used as part of the drug therapy regimen for heart failure. Cholestyramine is used to lower blood cholesterol levels. Milrinone, furosemide, and cholestyramine are not used in the treatment of bradycardia.

Quinidine is prescribed to a client with cardiac arrhythmia. When documenting the client's drug history, the nurse inquires about the concomitant use of any other drug. Which of the following drugs when given concomitantly may cause an increase in serum quinidine levels? A) Cimetidine B) Rifampin C) Hydantoins D) Nifedipine

Ans: A Feedback: Cimetidine, when given concurrently with quinidine, may cause an increase in serum quinidine levels. Hydantoins and nifedipine cause a decrease in serum quinidine levels. Rifampin does not interact with quinidine.

A client admitted to a health care facility with cardiac arrhythmia is prescribed propranolol. Which of the following would the nurse closely monitor as part of the ongoing assessment during the therapy? A) Pulse rate B) Tendon reflexes C) Hydration D) Visual acuity

Ans: A Feedback: During antiarrhythmic drug therapy, the nurse should closely monitor the client's pulse rate. A change in the pulse rate and rhythm will help the nurse assess a response to drug therapy, the development of signs of heart failure, the development of a new cardiac arrhythmia, or worsening of the arrhythmia being treated. It is not necessary to monitor the tendon reflexes, hydration, or visual acuity when administering an antiarrhythmic drug to the client.

A client with hypercholesterolemia is prescribed lovastatin. When instructing the client how to take the drug, which of the following would the nurse include? A) Taking the drug with his evening meal B) Combining the drug with the artificial sweetener aspartame C) Mixing the drug with highly fluid soups or pulpy fruits D) Taking the drug with grapefruit juice

Ans: A Feedback: For the self-administration of lovastatin, the nurse should suggest the client take the drug with his evening meal. Cholestyramine powder is mixed with highly fluid soups or pulpy fruits. Cholestyramine is available combined with the artificial sweetener aspartame. The client should not drink grapefruit juice when taking lovastatin.

A nurse is required to care for a child, age 4 years, who is being digitalized. Which of the following changes in the pulse rate indicates that the nurse should withhold the drug? A) Pulse rate less than 70 beats per minute B) Pulse rate less than 80 beats per minute C) Pulse rate less than 90 beats per minute D) Pulse rate more than 100 beats per minute

Ans: A Feedback: In a child, a pulse rate less than 70 beats per minute indicates toxicity. The nurse should withhold the drug when the pulse rate is less than 70 beats per minute and notify the health care provider. A pulse rate less than 60 or more than 100 beats per minute indicates toxicity in adults. A pulse rate less than 90 beats per minute indicates toxicity in infants.

A nurse is preparing to administer spironolactone to a client. When reviewing the client's medical record, the nurse would be alert for the development of hyperkalemia if the client was also receiving which of the following? A) Lisinopril (Prinivil) B) Metoprolol (Lopressor) C) Terazosin (Hytrin) D) Diltiazem (Cardizem)

Ans: A Feedback: Spironolactone when given with ACE inhibitors (lisinopril) can lead to hyperkalemia. Hyperkalemia is not associated with the combination of spironolactone and metoprolol, terazosin, or diltiazem.

When educating a group of nursing students on the signs of heart failure, the nurse mentions that the ejection fraction is altered in heart failure. The students demonstrate understanding of the information when they identify which ejection fraction as suggesting heart failure? A) 38% B) 48% C) 58% D) 68%

Ans: A Feedback: The ejection fraction is the amount of blood that is ejected from the ventricles per beat in relation to the amount of blood available to eject. An ejection fraction of less than 40% indicates heart failure. Normally the ejection fraction should be greater than 60%.

A nurse is caring for a client taking a cholestyramine drug. What instructions should the nurse give to this client to prevent constipation? A) Eat foods high in dietary fiber. B) Follow a complete liquid diet. C) Be sure to stay on complete bed rest. D) Take the water-soluble form of vitamin A.

Ans: A Feedback: The nurse should instruct the client taking a cholestyramine drug to eat foods high in dietary fiber to prevent constipation. The nurse need not instruct the client to have a complete liquid diet or complete bed rest; instead, the nurse should instruct the client to exercise to prevent constipation. Clients are asked to take a water-soluble form of vitamin A if they are experiencing impaired digestion of fats and absorption of the fat-soluble vitamins due to long-term therapy of bile acid sequestrants.

A nurse is preparing to administer spironolactone to a client. The nurse would contact the primary health care provider about the need to change the order if the client has a history of which of the following? A) Hyperkalemia B) Liver disease C) Gout D) Diabetes

Ans: A Feedback: The nurse should know that potassium-sparing diuretics are contraindicated in clients with hyperkalemia and are not recommended for children. Potassium-sparing diuretics should be used cautiously in clients with liver disease, diabetes, or gout, but these conditions do not contraindicate the use of potassium diuretics.

A client is prescribed warfarin. The client also takes a diuretic for the treatment of cardiac problems. The nurse would anticipate which of the following? A) Decreased effectiveness of the anticoagulant B) Increased effectiveness of the diuretic C) Increased absorption of the anticoagulant D) Increased absorption of the diuretic

Ans: A Feedback: The nurse should monitor for decreased effectiveness of warfarin as an effect of the interaction between the anticoagulant and the diuretic. The nurse need not monitor for the increased effectiveness of the diuretic, the increased absorption of the anticoagulant, or the increased absorption of the diuretic in the client.

A client with thrombotic stroke is administered ticlopidine. The nurse would assess the client for which of the following? A) Dyspepsia B) Dyspnea C) Hematoma D) Bradycardia

Ans: A Feedback: The nurse should monitor for dyspepsia in the client who has been administered ticlopidine. Hematoma is an adverse reaction to heparin. Dyspnea is an adverse reaction to protamine sulfate and treprostinil. Bradycardia is an adverse reaction to protamine sulfate.

A client with hyperlipidemia has been prescribed niacin by a physician. Which of the following adverse reactions should the nurse monitor for in the client? A) Tingling B) Constipation C) Diarrhea D) Cholelithiasis

Ans: A Feedback: The nurse should monitor for tingling in the client as an adverse reaction to the drug niacin. Constipation, diarrhea, and cholelithiasis are adverse reactions to the drug fenofibrate.

A nurse is caring for a client with increased intraocular pressure who is receiving urea. After administering the drug, the nurse would assess the client for which of the following? A) Syncope B) Cramping C) Photosensitivity D) Blurred vision

Ans: A Feedback: The nurse should observe the client for syncope after administering urea. Other adverse reactions associated with the administration of urea include headache, nausea, vomiting, and fluid and electrolyte imbalance. Cramping is an adverse reaction of the drug spironolactone. The nurse should observe the client for photosensitivity after administering triamterene. Blurred vision is an adverse reaction of mannitol.

A nurse is caring for a client receiving an oral antiarrhythmic drug. Which apical pulse rate would lead the nurse to withhold the drug and notify the health care provider immediately? A) 58 beats/min B) 68 beats/min C) 78 beats/min D) 88 beats/min

Ans: A Feedback: The nurse should withhold the drug and report to the primary health care provider whenever the client's pulse rate falls below 60 beats/min or rises to more than 120 beats/min. Pulse rates of 68 beats/min, 78 beats/min, and 88 beats/min fall within the normal range.

A client in a health care facility is receiving the thrombolytic drug reteplase. Which nursing diagnosis would be most likely? A) Anxiety B) Constipation C) Disturbed Sensory Perception D) Ineffective Tissue Perfusion

Ans: A Feedback: The nursing diagnoses for a client receiving the thrombolytic drug reteplase should include Anxiety. Constipation, disturbed sensory perception, and ineffective tissue perfusion would be unlikely for the client receiving reteplase.

1. When describing anticoagulants to a client, which of the following would the nurse expect to include? Select all that apply. A) Anticoagulants prevent formation of a thrombus. B) Anticoagulants prevent extension of a thrombus. C) Anticoagulants dissolve existing thrombi. D) Anticoagulants thin the blood. E) Anticoagulants can reverse the damage caused by a thrombus.

Ans: A, B Feedback: Anticoagulants can prevent the formation and extension of a thrombus but have no direct effect on an existing thrombus and do not reverse any of the damage from that thrombus. Although clients often refer to anticoagulants as blood thinners, they do not actually thin the blood.

When discussing class IB antiarrhythmics, which of the following would the nurse identify as an effect? Select all that apply. A) Shortening of the action potential duration B) Depression of cardiac conduction C) Prolongation of the action potential D) Slowing of repolarization E) Increase in cardiac conduction

Ans: A, B Feedback: Class IB antiarrhythmics shorten the action potential and selectively depress cardiac conduction.

A nurse is explaining how statin drugs help lower cholesterol, LDL, and triglycerides. Which of the following would the nurse include in the explanation? Select all that apply. A) Decreased absorption of cholesterol from the GI tract B) Promotion of cholesterol breakdown C) Formation of a substance that is excreted in the feces D) Decreased breakdown of fat to cholesterol E) Inhibition of cholesterol production

Ans: A, B Feedback: Statins inhibit the manufacture of cholesterol or promote the breakdown of cholesterol. The bile acid resins bind to bile acids to form an insoluble substance that cannot be absorbed by the intestine, so it is excreted in the feces.

The nurse discusses the benefit of adding a statin drug to a client's medication regimen based on the understanding that this group of drugs can reduce the risk of death from which of the following? Select all that apply. A) Stroke B) Transient ischemic attack C) Kidney disease D) Hepatic disease E) Cancer

Ans: A, B Feedback: The use of statins in clients with hyperlipidemia with or without clinically evident coronary heart disease can reduce the risk of death from stroke and transient ischemic attacks.

A nurse is obtaining a lipoprotein profile for a client diagnosed with hyperlipidemia. Which of the following measurements would be obtained? Select all that apply. A) Total cholesterol B) Triglycerides C) LDL D) ALT E) AST

Ans: A, B, C Feedback: A lipoprotein profile is a laboratory test that reports total cholesterol, LDL, HDL, and triglycerides. AST and ALT are values that would be reported from liver function tests.

A client is prescribed nicotinic acid. When teaching the client about this drug, which of the following would the nurse include as a normal skin reaction that may occur? Select all that apply. A) Flushing B) Sensations of warmth C) Tingling D) Rash E) Pustule formation

Ans: A, B, C Feedback: Generalized skin flushing, a sensation of warmth, and severe itching and tingling can occur with the administration of nicotinic acid, especially at higher doses.

A client is receiving streptokinase. The nurse understands that which of the following would occur? Select all that apply. A) Breakdown of existing thrombi B) Reopening of occluded blood vessels C) Prevention of tissue necrosis D) Decreased risk of internal bleeding E) Prevention of formation of a thrombus

Ans: A, B, C Feedback: Streptokinase is a thrombolytic drug. Thrombolytic drugs break down existing thrombi, reopen blood vessels after occlusion, and prevent tissue necrosis.

A client is receiving a heparin infusion. The nurse should check the needle site for the heparin infusion for signs of which of the following? Select all that apply. A) Inflammation B) Pain C) Tenderness D) Clot formation E) Itching

Ans: A, B, C Feedback: The nurse inspects the needle site for signs of inflammation, pain, and tenderness along the pathway of the vein. If these occur the infusion is discontinued and restarted in another vein.

The nurse is assessing a client diagnosed with left ventricular dysfunction. Which of the following would the nurse most likely assess? Select all that apply. A) Dyspnea B) Moist cough C) Restlessness D) Peripheral edema E) Neck vein distention

Ans: A, B, C Feedback: The symptoms of left ventricular dysfunction include dyspnea; moist cough; production of frothy, pink sputum; orthopnea; restlessness; and anxiety. Right-sided failure (right ventricular dysfunction) can be seen with fluid backup in the body such as distended neck veins, peripheral edema, and hepatic engorgement.

The nurse instructs a client receiving warfarin about the importance of consistent intake of dietary vitamin K to decrease fluctuations in PT/INR. The nurse determines that the client understands the instructions when he identifies which foods as containing vitamin K? Select all that apply. A) Broccoli B) Cauliflower C) Fish D) Yogurt E) Chicken

Ans: A, B, C, D Feedback: Foods high in vitamin K include leafy green vegetables, beans, broccoli, cabbage, cauliflower, cheese, fish, and yogurt.

Before administering a cardiotonic drug, the nurse would expect which of the following laboratory tests to be completed? Select all that apply. A) Liver function tests B) Renal function tests C) Complete blood count D) Electrolyte levels E) Blood glucose

Ans: A, B, C, D Feedback: Liver function tests, renal function tests, complete blood count with the addition of serum electrolytes, and an electrocardiogram complete the lab workup prior to initiating therapy with a cardiotonic drug. It is not necessary to obtain serum blood glucose, but it might appear with other lab work that has been gathered.

When evaluating a client who is receiving antiarrhythmic therapy, which of the following would the nurse interpret as an expected outcome? Select all that apply. A) No evidence of injury is seen. B) No evidence of infection is seen. C) Client is free of nausea. D) Client urinates adequately. E) Oral mucous membranes are intact and moist.

Ans: A, B, C, D, E Feedback: Absence of injury, infection, and nausea; adequate renal function; and intact, moist oral mucous membranes are expected outcomes for antiarrhythmic therapy.

A client is being discharged on warfarin therapy. Which of the following would the nurse include in the teaching plan for the client? Select all that apply. A) Be consistent with your intake of foods containing vitamin K. B) Do not change brands of warfarin without consulting the physician. C) Take the drug at the same time every evening. D) Do not take or stop taking other medications except on the advice of the physician. E) Inform the dentist of therapy with warfarin prior to any treatment or procedure.

Ans: A, B, C, D, E Feedback: Instructions would include being consistent with intake of foods containing vitamin K, not changing brands of the drug, taking the drug at the same time each evening, not taking or stopping other medications, and informing the dentist about the use of warfarin.

After administering an antiarrhythmic drug, the nurse would report which of the following electrocardiogram (ECG) changes to the physician? Select all that apply. A) Tachycardia B) Prolongation of PR interval C) Prolongation of QT interval D) Widening of the QRS complex E) Bradycardia

Ans: A, B, C, D, E Feedback: The nurse reports to the physician any abnormalities or significant interval changes of the ECG, including tachycardia, prolongation of the PR interval or QT interval, widening of the QRS complex, or bradycardia.

Which of the following should be included in the nurse's ongoing assessment of a client receiving flecainide (Tambocor)? Select all that apply. A) Response to therapy B) Signs of heart failure C) Development of new cardiac arrhythmias D) Worsening of arrhythmia being treated E) Monitoring of serum flecainide levels

Ans: A, B, C, D, E Feedback: The nurse should closely monitor the client for a response to drug therapy, signs of heart failure, the development of new arrhythmias, worsening of the arrhythmia being treated, and serum flecainide levels.

The nurse is preparing a client for discharge. The client is prescribed antihyperlipidemic drug therapy. The nurse would include which of the following in the discharge teaching? Select all that apply. A) Reason for taking the prescribed drug B) Drug name C) Correct dose D) Frequency of administration E) Dosage form

Ans: A, B, C, D, E Feedback: The nurse should review the reasons for the drug and prescribed therapy, including drug name, form and method of preparation, correct dose, and frequency of administration, as part of a client's discharge counseling.

A client taking warfarin asks the nurse about using herbal remedies. Which of the following would the nurse instruct the client to avoid? Select all that apply. A) Chamomile B) St. John's wort C) Ginkgo biloba D) Ginger E) Ginseng

Ans: A, B, C, D, E Feedback: Warfarin, a drug with a narrow therapeutic index, has the potential to interact with many herbal remedies. For example, warfarin should not be combined with any of the following substances, because they may have additive or synergistic activity and increase the risk for bleeding: celery, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo biloba, ginseng, green tea, onion, passionflower, red clover, St. John's wort, and turmeric.

1. When describing arrhythmias to a group of nursing students, the instructor explains that arrhythmias may be triggered by which of the following? Select all that apply. A) Emotional stress B) Heart disease C) Electrolyte imbalance D) Diabetes E) Hypoxia

Ans: A, B, C, E Feedback: Arrhythmias may occur as a result of heart disease, a disorder that affects cardiovascular function, emotional stress, hypoxia, and electrolyte imbalances.

To help control the nausea and anorexia that may occur as an adverse reaction during digoxin therapy, the nurse should recommend which of the following? Select all that apply. A) Eating frequent smaller meals B) Restricting fluids at mealtime C) Maintaining good oral hygiene D) Eating more protein E) Avoiding fluid intake 1 hour before and after meals

Ans: A, B, C, E Feedback: If the nausea or anorexia is not a result of toxicity but an adverse reaction to the drug, use nursing measures to help control the reactions. Offer frequent small meals rather than three large meals. Restricting fluids at meals and avoiding fluids 1 hour before and after meals help to control nausea. Helping the patient to maintain good oral hygiene by brushing teeth or rinsing the mouth after ingesting food will also help with nausea.

Which assessment would the nurse obtain before administering an anticoagulant to a client with DVT? Select all that apply. A) Test for a positive Homans' sign. B) Examine extremity for skin temperature. C) Assess pain. D) Assess blood pressure. E) Check for pedal pulse.

Ans: A, B, C, E Feedback: Preadministration assessment for a client with a DVT should include checking for a pedal pulse, examining the extremity for color and skin temperature, assessing for pain, and checking for a positive Homans' sign.

A client is being discharged from the hospital with a prescription for clopidogrel. The nurse would instruct the client about which of the following as a possible adverse reaction? Select all that apply. A) Skin rash B) Bleeding C) Heart palpitations D) Nausea E) Constipation

Ans: A, B, C, E Feedback: The most common adverse reactions associated with clopidogrel are skin rash, dizziness, bleeding, palpitations, and constipation.

Prior to administering an antihyperlipidemic drug to a client, which of the following would the nurse assess? Select all that apply. A) Dietary history B) Vital signs C) Blood glucose D) Weight E) Input and output

Ans: A, B, D Feedback: Before administering an antihyperlipidemic drug, the nurse would assess a lipid profile, liver function tests, dietary history, vital signs, and weight and inspect for xanthomas.

The nurse understands that the use of diuretics is contraindicated in clients with which of the following? Select all that apply. A) Hyponatremia B) Hypokalemia C) Hypertension D) Anuria E) Asthma

Ans: A, B, D Feedback: Diuretics are contraindicated in clients with known hypersensitivity to the drugs, electrolyte imbalance (hyponatremia and hypokalemia), severe kidney or liver dysfunction, and anuria.

When teaching a class about parenterally administered heparin, which of the following would the nurse include? Select all that apply. A) Onset of action is almost immediate. B) Maximum effect occurs within 10 minutes. C) It is preferably given intramuscularly. D) Clotting time returns to normal within 4 hours. E) It causes fewer adverse reactions than the oral form.

Ans: A, B, D Feedback: Parenteral heparin results in an almost immediate onset of action with a maximum effect within 10 minutes, but clotting returns to normal within 4 hours unless subsequent doses are given. It is preferably given subcutaneously or intravenously.

The nurse is reviewing a client's medical record for predisposing factors for myopathy requiring that the client be started on low doses of statins and titrated as tolerated or until cholesterol goals are met. Which of the following would the nurse identify as one of these factors? Select all that apply. A) Asian descent B) Severe renal insufficiency C) Use of antihistamines D) Use of cyclosporine E) Cigarette smoking

Ans: A, B, D Feedback: Predisposing factors for myopathy with statin therapy include Asian descent, severe renal insufficiency, and use of cyclosporine.

Which of the following should be included by the nurse during client teaching to improve client outcomes for a client receiving antihyperlipidemic drugs? Select all that apply. A) Measures to minimize gastrointestinal upset B) Consultation with a dietitian for assistance with diet teaching C) Emphasis on the fact that drug therapy alone will significantly lower blood cholesterol levels D) Focus on the importance of taking drug exactly as prescribed E) Instruction in possible adverse reactions and signs and symptoms to report to primary health care provider

Ans: A, B, D, E Feedback: Client teaching includes measures to minimize gastrointestinal upset, consultation with a dietician to assist with diet planning and teaching, focus on the need to take the drug exactly as prescribed, and information about possible adverse reactions including those that need to be reported to the primary health care provider. The nurse should emphasize that drug therapy alone will NOT significantly lower blood cholesterol levels.

A nurse is preparing to administer a cardiotonic drug via IM injection based on the understanding of which of the following about this route? Select all that apply. A) Appropriate when IV access is not available B) Site massage necessary after injection C) Not the recommended parenteral route D) Amount given no more than 2 mL E) Injection deep into the muscle

Ans: A, B, D, E Feedback: IM injection is not recommended for cardiotonic drugs yet, but they may be given as an IM injection when needed urgently and no IV access is available. When administering a cardiotonic drug IM, the nurse should give the injection deep in the muscle and follow with massage to the site. No more than 2 mL should be injected IM.

Before administering a cardiotonic drug to a client, which of the following would be most important for the nurse to assess? Select all that apply. A) Apical-radial pulse rate B) Respiratory rate C) Urinalysis D) Weight measurement E) Blood pressure

Ans: A, B, D, E Feedback: Preadministration physical assessment should include assessment of the apical-radial pulse rate, respiratory rate, weight, and blood pressure to establish a baseline for comparison. Assessing the client's urine is not required.

Which of the following would the nurse include in the client teaching about HMG-CoA reductase inhibitors (statins)? Select all that apply. A) Photosensitivity can occur. B) The drug should be continued even if the client feels better. C) Muscle pain and weakness are normal. D) Juices other than grapefruit juice are okay to use. E) Statins should be administered in the evening.

Ans: A, B, D, E Feedback: When teaching about statins, the nurse should include information about the possibility of photosensitivity, the need to continue the drug even if feeling better, juices other than grapefruit juice as appropriate, and administration in the evening. Muscle pain and weakness should be reported to the client's physician as soon as they occur.

A nurse may notice a decrease in diuretic effect when furosemide (Lasix) is given with which of the following drugs? Select all that apply. A) Phenytoin B) Naproxen C) Digoxin D) Lithium E) Ibuprofen

Ans: A, B, E Feedback: A nurse may notice a decrease in diuretic effect when furosemide (Lasix) is given with the following drugs: hydantoins (phenytoin) and NSAIDs (naproxen and ibuprofen). There is an increased risk of lithium toxicity if furosemide is given with lithium. An increased risk of cardiac arrhythmias occurs when digoxin is given with furosemide.

A client is prescribed a cardiotonic drug. The nurse would expect to administer which of the following in conjunction with this drug as part of the treatment for heart failure? Select all that apply. A) Loop diuretics B) Angiotensin-converting enzyme inhibitors (ACEIs) C) Thiazide diuretics D) Calcium channel blockers E) Beta blockers

Ans: A, B, E Feedback: Cardiotonic drugs are used in clients with persistent symptoms, with recurrent hospitalization, or as indicated in conjunction with ACEIs, loop diuretics, and beta blockers in clients with heart failure.

1. A nurse is preparing to administer a prescribed cardiotonic to a client. The nurse understands that the drug is being administered to achieve which of the following? Select all that apply. A) Improved myocardial contractility B) Increased myocardial efficiency C) Increased blood pressure D) Increased peripheral edema E) Improved profusion to all body tissues

Ans: A, B, E Feedback: Cardiotonics are drugs used to increase the efficiency and improve the contraction of the heart muscle, which leads to improved blood flow to all tissues of the body.

Which of the following is important for the nurse to remember when administering quinidine (Quinaglute) orally? Select all that apply. A) Quinidine can be administered with food to decrease GI upset. B) Quinidine can cause auditory adverse reactions. C) Quinidine can be crushed or chewed. D) Normal quinidine levels are between 7 and 10 mcg/mL. E) Quinidine levels must be monitored during therapy.

Ans: A, B, E Feedback: Quinidine can be administered with food to decrease GI upset and can cause ringing in the ears and hearing loss. Levels should be monitored during therapy to reduce the risk of quinidine toxicity. Quinidine should not be crushed or chewed, and normal quinidine levels are less than 6 mcg/mL.

A client comes to the clinic for a visit. The client has been taking digoxin for several months. While interviewing the client, the nurse suspects the client is experiencing digoxin toxicity based on which of the following? Select all that apply. A) Anorexia B) Weakness C) Inability to relax D) Photosensitivity E) Disorientation

Ans: A, B, E Feedback: Signs of digitalis toxicity include anorexia, weakness, lethargy, blurred vision, and disorientation. An inability to relax and photosensitivity are not associated with digitalis toxicity.

The nurse should educate the client to avoid which of the following nonprescription medications without permission from the physician, as they can interfere with the action of cardiotonic drugs? Select all that apply. A) Antacids B) Antidiarrheals C) Topical arthritis treatments D) Artificial tear products E) Allergy products

Ans: A, B, E Feedback: The nurse should teach the client to avoid antacids and nonprescription cough, cold, allergy, antidiarrheal, and diet drugs unless their use has been approved by the physician, as some of these drugs interfere with the action of cardiotonic drugs or cause other potentially serious problems.

A nurse is reviewing the medical record of several clients who are prescribed amiloride. The nurse would identify a client with which condition as being at highest risk for developing hyperkalemia? Select all that apply. A) Diabetes B) Hypertension C) Renal disease D) Epilepsy E) Asthma

Ans: A, C Feedback: Hyperkalemia is most likely to occur in clients with an inadequate fluid intake and urine output, those with diabetes or renal disease, the elderly, and those who are severely ill.

A nurse is providing care to a client who has an allergy to sulfamethoxazole/trimethoprim. The nurse understands that the client may have cross-sensitivity reactions with which of the following diuretics? Select all that apply. A) Chlorothiazide B) Furosemide C) Chlorthalidone D) Metolazone E) Spironolactone

Ans: A, C, D Feedback: A cross-sensitivity reaction may occur with the thiazides (chlorothiazide, chlorthalidone, and metolazone) and sulfonamides (sulfamethoxazole).

A nurse is administering acetazolamide to a client. The nurse understands that this drug leads to excretion of which of the following? Select all that apply. A) Sodium B) Magnesium C) Potassium D) Bicarbonate E) Chloride

Ans: A, C, D Feedback: Carbonic anhydrase inhibitors, like acetazolamide, result in the excretion of sodium, potassium, bicarbonate, and water.

A nurse would administer disopyramide cautiously to a client with which condition? Select all that apply. A) Myasthenia gravis B) Diabetes C) Glaucoma D) Urinary retention E) Hypothyroidism

Ans: A, C, D Feedback: Disopyramide is used cautiously in clients with myasthenia gravis, urinary retention, or glaucoma and in men with prostate enlargement.

Prior to the administration of furosemide (Lasix), a nurse would assess which of the following? Select all that apply. A) Weight B) Blood glucose C) Pulse D) Temperature E) Respiratory rate

Ans: A, C, D, E Feedback: Before administering furosemide (Lasix), the nurse takes the vital signs (blood pressure, pulse, temperature, respiratory rate, and weight) There is no need to assess the client's blood glucose.

The nurse is to administer bumetanide. The nurse reviews the client's medication history for possible interacting drugs. Which of the following, if found, would the nurse identify as having an increased risk for toxicity? Select all that apply. A) Lithium B) Phenytoin C) Gentamicin D) Warfarin E) Digoxin

Ans: A, C, D, E Feedback: Loop diuretics, like bumetanide, can increase toxicity of the following medications: lithium (Eskalith), gentamicin, warfarin (Coumadin), and digoxin (Lanoxin). A decrease in diuretic effect occurs when bumetanide is given with phenytoin.

A client is prescribed metolazone. As part of the client's teaching plan, the nurse instructs the client to increase his consumption of potassium-rich foods. The nurse determines that the teaching was successful when the client identifies which of the following as a good choice? Select all that apply. A) Bananas B) Shrimp C) Asparagus D) Salmon E) Peanuts

Ans: A, C, D, E Feedback: The top 10 foods with the highest amount of potassium per serving include white beans, dark leafy greens, baked potatoes with skin on, dried apricots, acorn squash, plain low-fat yogurt, salmon, avocado, mushrooms, and bananas. Fruits high in potassium include apricots, prunes, dried currants/raisins, dates, figs, dried coconut, avocado, bananas, oranges, nectarines, and peaches. Vegetables high in potassium include sun-dried tomatoes, spinach, Swiss chard, mushrooms, sweet potato, kale, brussels sprouts, zucchini, green beans, and asparagus. Other sources include chocolate, molasses, nuts, and nut butters.

1. A client is receiving atorvastatin. The nurse would be alert to client complaints of which of the following? Select all that apply. A) Headache B) Sedation C) Insomnia D) Diarrhea E) Constipation

Ans: A, C, E Feedback: Atorvastatin is an HMG-CoA reductase inhibitor (statin). Adverse reactions of statins include headache, dizziness, insomnia, flatulence, abdominal pain, cramping, constipation, and nausea.

After teaching a group of nursing students about heparins, the instructor determines that the teaching was successful when the students identify which of the following as an example of a low-molecular-weight heparin (LMWH)? Select all that apply. A) Dalteparin B) Streptokinase C) Enoxaparin D) Warfarin E) Tinzaparin

Ans: A, C, E Feedback: Dalteparin, enoxaparin, and tinzaparin are all examples of LMWHs. Streptokinase is a thrombolytic; warfarin is an oral anticoagulant.

A client is prescribed amiloride. The nurse would administer this drug cautiously if the client had a history of which of the following? Select all that apply. A) Gout B) Asthma C) Diabetes D) HIV E) Hepatic disease

Ans: A, C, E Feedback: Potassium-sparing diuretics, like amiloride, should be used cautiously in clients with gout, diabetes, and hepatic disease.

A nurse would administer the prescribed digoxin (Lanoxin) cautiously for a client with which electrolyte imbalances? Select all that apply. A) Hypokalemia B) Hypermagnesemia C) Hypocalcemia D) Hyperkalemia E) Hypomagnesemia

Ans: A, C, E Feedback: The cardiotonic drugs are given cautiously to clients with electrolyte imbalances (especially hypokalemia, hypocalcemia, and hypomagnesemia).

When reviewing the medical record of a client who is prescribed a cardiotonic, which condition would lead the nurse to contact the primary health care provider because the drug is contraindicated for use? Select all that apply. A) Digitalis toxicity B) Hypertension C) Cardiac tamponade D) Hypotension E) Ventricular tachycardia

Ans: A, C, E Feedback: The cardiotonics are contraindicated in the presence of digitalis toxicity and in clients with known drug hypersensitivity, ventricular tachycardia, cardiac tamponade, restrictive cardiomyopathy, or AV block.

A client is prescribed an anticoagulant. In which of the following situations would the nurse hold the drug and notify the physician? Select all that apply. A) PT exceeds 1.5 times the control value. B) PT is less than 1.5 times the control value. C) There is evidence of bleeding. D) INR is less than 3.0. E) INR is greater than 3.0.

Ans: A, C, E Feedback: The nurse should withhold the drug and contact the physician if any of the following occur: the PT exceeds 1.5 times the control value, there is evidence of bleeding, or the INR is greater than 3.0.

A nurse caring for a client with diabetes controlled with metformin recently began taking a drug for edema. The nurse notices that the client's blood glucose levels are increasing. Which of the following diuretics are likely to cause hyperglycemia? Select all that apply. A) Hydrochlorothiazide B) Furosemide C) Chlorthalidone D) Acetazolamide E) Metolazone

Ans: A, C, E Feedback: Thiazide diuretics, like hydrochlorothiazide, chlorthalidone, and metolazone, can result in hyperglycemia in clients receiving antidiabetic drugs, like metformin.

A nurse is assessing a client after administering a diuretic. Which of the following would lead the nurse to suspect that the client is experiencing a fluid and electrolyte imbalance? Select all that apply. A) Dry mouth B) Diaphoresis C) Muscle cramps D) Hypertension E) Tachycardia

Ans: A, C, E Feedback: Warning signs of a fluid and electrolyte imbalance include dry mouth, thirst, lethargy, weakness, drowsiness, restlessness, muscle pain or cramps, confusion, GI disturbances, hypotension, oliguria, tachycardia, and seizures.

After teaching a group of nursing students about antiarrhythmics, the instructor determines that the teaching was successful when the students identify which of the following as a class IA antiarrhythmic? Select all that apply. A) Quinidine (Quinaglute) B) Lidocaine (Xylocaine) C) Propafenone (Rythmol) D) Disopyramide (Norpace) E) Flecainide (Tambocor)

Ans: A, D Feedback: Class IA antiarrhythmics include disopyramide and quinidine. Lidocaine is a class IB drug. Propafenone and flecainide are class IC drugs.

A nurse is preparing to administer gemfibrozil to a client. The nurse understands that this drug lowers cholesterol via which of the following mechanisms? Select all that apply. A) Increases excretion of cholesterol B) Reduces very-low-density lipoproteins (VLDLs) C) Increases breakdown of VLDLs D) Reduces production of triglycerides E) Inhibits cholesterol formation

Ans: A, D Feedback: Gemfibrozil increases the excretions of cholesterol and reduces the production of triglycerides. The drug does not reduce VLDLs, increase VLDL breakdown, or inhibit cholesterol formation.

The nurse identifies a nursing diagnosis of Nausea secondary to the effects of antiarrhythmic therapy. Which of the following would the nurse include in the client's plan of care? Select all that apply. A) Administering the drug with food B) Having the client lie flat for 2 hours after eating C) Scanning the client's bladder for distention D) Offering small, frequent meals E) Encouraging gradual position changes

Ans: A, D Feedback: To combat nausea, the nurse would administer the drug with food and offer the client small, frequent meals. The nurse would encourage the client to keep his head at least 4 inches higher than his feet when resting or reclining. Scanning for bladder distention would be appropriate if the client experienced urinary retention. Encouraging gradual position changes would be appropriate for the client at risk for injury from dizziness or lightheadedness.

A nurse assesses the results of a client's complete blood count, observing for agranulocytosis for a client receiving which antiarrhythmic? Select all that apply. A) Verapamil (Calan) B) Lidocaine (Xylocaine) C) Sotalol (Betapace) D) Quinidine (Quinaglute) E) Mexiletine (Mexitil)

Ans: A, D, E Feedback: Agranulocytosis has been reported with the use of verapamil, quinidine, and mexiletine.

When reviewing the medical records of several clients, the nurse understands that the use of anticoagulants is contraindicated in clients with which of the following medical conditions? Select all that apply. A) Leukemia B) Hypotension C) Atrial fibrillation D) GI ulcers E) Tuberculosis

Ans: A, D, E Feedback: Anticoagulants are contraindicated in clients with known sensitivity to the drug, active bleeding, hemorrhagic disease, tuberculosis, leukemia, uncontrolled hypertension, GI ulcers, recent eye or CNS surgery, aneurysms, and severe renal and hepatic disease and during pregnancy and lactation.

Before administering any antiarrhythmic, the nurse would assess which of the following? Select all that apply. A) Skin color B) Blood glucose C) Input and output D) Orientation E) Level of consciousness

Ans: A, D, E Feedback: The preadministration assessment of the client's general condition should include observations such as skin color, orientation, level of consciousness, and the client's general status.

A client is receiving maintenance therapy with digoxin. The nurse understands that which form would be used? Select all that apply. A) Capsule B) Injection C) Ointment D) Patch E) Tablet

Ans: A, E Feedback: Capsules and tablets are used for maintenance therapy, injections are used for rapid digitalization, and digoxin patches and ointment do not exist.

A nurse is conducting an in-service presentation about hemostasis. The nurse determines that the teaching was successful when the class identifies a thrombus as which of the following? A) Damage to a blood vessel B) Formation of a blood clot C) Cessation of bleeding D) Coagulation cascade

Ans: B Feedback: A thrombus refers to the formation of a blood clot, sometimes from damage, in a vessel that impedes blood flow. Cessation of bleeding refers to hemostasis. The coagulation cascade is the series of events that occur in the formation of a blood clot to stop bleeding.

A client who is prescribed niacin comes to the clinic complaining of significant skin flushing and itching. The client states, It's really uncomfortable, so much so that I almost stopped taking the drug. The nurse informs the primary health care provider. Which of the following would the nurse anticipate that the primary health care provider may recommend? A) Prednisone B) Aspirin C) Ibuprofen D) Hydrocortisone

Ans: B Feedback: Aspirin may be recommended before taking niacin preparations to reduce adverse reactions when niacin causes skin reactions that are severe or cause extreme discomfort.

A client is diagnosed with an arrhythmia that involves irregular and rapid atrial contraction and an irregular and inefficient ventricular contraction. The nurse interprets this arrhythmia as which of the following? A) Atrial flutter B) Atrial fibrillation C) Ventricular tachycardia D) Ventricular fibrillation

Ans: B Feedback: Atrial fibrillation is characterized by irregular and rapid atrial contraction, resulting in a quivering of the atria and causing an irregular and inefficient ventricular contraction. Atrial flutter is the rapid contraction of the atria at a rate too rapid for the ventricle to pump efficiently. Ventricular tachycardia is a rapid heartbeat with a rate greater than 100 bpm. Ventricular fibrillation is rapid, disorganized contractions of the ventricles, resulting in the inability of the heart to pump any blood to the body.

A client who is receiving diuretic therapy comes to the clinic for a follow-up visit. The client states that his mouth is often dry and that he is urinating like there is no tomorrow. Assessment reveals dry mucous membranes and decreased skin turgor. Which nursing diagnosis would the nurse most likely identify? A) Risk for Injury B) Risk for Deficient Fluid Volume C) Impaired Urinary Elimination D) Deficient Knowledge

Ans: B Feedback: Based on the client's report and assessment findings, a nursing diagnosis of Risk for Deficient Fluid Volume would be most appropriate. Risk for Injury would be appropriate if the client was complaining of dizziness on changing positions or changes in heart rate and rhythm. Although the client is experiencing frequency, that is the intended effect of the drug. Although possible, there is no evidence provided to support a nursing diagnosis of Deficient Knowledge.

A client comes to the clinic complaining of weakness and drowsiness. He states, I just get so tired sometimes that I can't do what I want to do. The client is receiving digoxin as part of the treatment for heart failure. Which nursing diagnosis would the nurse most likely identify? A) Risk for Injury B) Activity Intolerance C) Decreased Cardiac Output D) Imbalanced Nutrition: Less Than Body Requirements

Ans: B Feedback: Based on the client's statement and complaints, the nurse would most likely identify a nursing diagnosis of Activity Intolerance. Risk for Injury might be appropriate if the client complained of dizziness or if his complaints affected his ambulation. There is no evidence to support a nursing diagnosis of Decreased Cardiac Output or Imbalanced Nutrition.

A client receives his prescribed daily digoxin at 9 a.m. today. The nurse would expect to obtain a serum drug level at which time? A) 12 noon today B) 4 p.m. today C) 9 p.m. tonight D) 12 midnight

Ans: B Feedback: Blood for plasma level measurements should be drawn immediately before the next dose or 6 to 8 hours after the last dose regardless of route. For this client, that would be between 3 p.m. and 5 p.m. today or immediately before his dose tomorrow.

A client is experiencing an overdosage of heparin. The nurse would expect to administer which of the following? A) Vitamin K1 B) Protamine C) Ticlopidine D) Tenecteplase

Ans: B Feedback: Heparin overdosage is treated with protamine. Vitamin K1 is used to treat overdoses of warfarin. Ticlopidine, an antiplatelet drug, and tenecteplase, a thrombolytic, would have no effect on counteracting the effects of warfarin.

The nurse is caring for a client receiving a cardiotonic drug. The client has edema. Which assessment would be most important? A) Auscultation of bowel sounds B) Measurement of intake and output C) Observation of respiratory rate D) Observation of pulse rate

Ans: B Feedback: Measurement of intake and output would be most important for the client with edema who is receiving a cardiotonic drug. Auscultation of bowel sounds, observation of respiratory rate, and observation of pulse rate are interventions not related to edema in the client.

A client with very high serum triglyceride levels is prescribed the fibric acid derivative clofibrate. The nurse understands that this drug would be contraindicated if the client has which condition? A) Endocrine disorder B) Primary biliary cirrhosis C) Arterial bleeding D) Respiratory depression

Ans: B Feedback: The fibric acid derivative clofibrate is contraindicated in clients with primary biliary cirrhosis. The use of clofibrate is not contraindicated in clients with an endocrine disorder. The HMG-CoA reductase inhibitors are used with caution in clients with a history of endocrine disorders. Niacin is contraindicated in clients with arterial bleeding. The fibric acid derivative clofibrate is not contraindicated in clients with respiratory depression.

A client is admitted to the cardiology unit of a health care facility for ventricular arrhythmia. In which of the following conditions can an antiarrhythmic drug be safely administered? A) Aortic stenosis B) Premature ventricular contraction C) Third-degree heart block D) Severe heart failure

Ans: B Feedback: The nurse can safely administer an antiarrhythmic drug if the client has premature ventricular contractions. Aortic stenosis, third-degree heart block, and severe congestive heart failure are contraindications for the use of antiarrhythmic drugs.

A nurse is caring for a client receiving the anticoagulant drug warfarin. Which assessment would be most appropriate before administering the drug? A) Observe for signs of thrombus formation. B) Assess prothrombin time (PT) and INR. C) Assess for signs of bleeding. D) Monitor for hypersensitivity reaction.

Ans: B Feedback: The nurse should assess the prothrombin time (PT) and INR before administering the anticoagulant drug warfarin to the client. Observing for signs of thrombus formation, assessing for signs of bleeding, and monitoring for hypersensitivity reaction are the ongoing assessments performed in clients who are administered warfarin.

A client is prescribed a cardiotonic medication. Which of the following preadministration assessments should the nurse perform on this client? A) Inspect joints for swelling. B) Check for jugular vein distention. C) Inspect skin for rash. D) Obtain blood glucose levels.

Ans: B Feedback: The nurse should check for jugular vein distention as part of the preadministration assessment for the client prescribed a cardiotonic. The nurse need not inspect joints for swelling, inspect skin for rash, or obtain blood glucose levels as these interventions will not provide necessary information with regard to administration of a cardiotonic.

A client on antiarrhythmic drug therapy complains of nausea, vomiting, abdominal pain, diarrhea, and a ringing sensation in the ears. Which of the following drugs should the nurse consider as the possible cause? A) Lidocaine B) Quinidine C) Flecainide D) Procainamide

Ans: B Feedback: The nurse should consider the drug quinidine as the cause for these adverse reactions. Quinidine toxicity is called cinchonism. Some of its symptoms include ringing in the ears (tinnitus), hearing loss, headache, nausea, vomiting, abdominal pain, dizziness, vertigo, and lightheadedness. Lidocaine, flecainide, and procainamide do not cause tinnitus or hearing loss.

A physician has prescribed bumetanide for a client with high blood pressure who also has renal insufficiency. Which of the following instructions should the nurse include in the teaching plan for this client? A) Avoid salt substitutes containing potassium. B) Avoid over-the-counter drugs for cold symptoms. C) Always take the drug before meals. D) Omit the drug dose when feeling dizzy.

Ans: B Feedback: The nurse should instruct the hypertensive client to avoid medications that increase blood pressure, such as OTC drugs for appetite suppression and cold symptoms. The nurse should instruct clients taking potassium-sparing diuretics, not loop diuretics such as bumetanide, to refrain from using salt substitutes containing potassium. The nurse need not instruct the client to take the drug before meals since doing so will not decrease the client's blood pressure. The nurse should instruct the client to observe caution while driving or performing hazardous tasks when dizziness or weakness occurs. In such cases, the nurse instructs the client to rise slowly from a sitting or lying position and avoid standing in one place for an extended time.

A physician has prescribed furosemide to a client with pulmonary edema. The client informs the nurse that he is also taking phenytoin as treatment for seizures. The nurse would assess the client closely for which of the following? A) Increased risk of bleeding B) Decreased diuretic effectiveness C) Increased blood glucose levels D) Increased seizure episodes

Ans: B Feedback: The nurse should monitor for decreased diuretic effectiveness in the client as the effect of the interaction between furosemide and hydantoins. When the client is administered loop diuretics with anticoagulants or thrombolytics, there is an increased risk of bleeding. Increased blood glucose may occur when thiazide diuretics are given with antidiabetic drugs. Decreased effectiveness of hydantoins, such as manifested by increased seizure activity, is not known to occur as a result of the effect of the interaction between furosemide and hydantoins, and so the nurse need not monitor for the same in the client.

A primary health care provider has prescribed a loop diuretic for a client with hypertension. The client also has diabetes mellitus. The nurse would assess the client for which of the following after administering the drug? A) Sudden pain in the joints B) Increased blood glucose levels C) Occurrence of gout attacks D) Sudden increase in weight

Ans: B Feedback: The nurse should monitor for increased blood glucose levels in the diabetic client receiving a loop diuretic. The blood glucose levels may be elevated or urine may test positive for glucose. Thiazide diuretic agents may cause gout attacks and sudden joint pain. The nurse need not monitor for a sudden increase in weight as the administration of loop diuretics to a diabetic client will not cause this.

A nurse administers a thiazide diuretic to a client with renal compromise as prescribed by the primary health care provider. Which action by the nurse would be most appropriate if the client's blood urea nitrogen level increases? A) Give prescribed magnesium supplements. B) Withhold the next dose of the drug. C) Administer the drug in a diluted form. D) Increase the fluid intake for the client.

Ans: B Feedback: The nurse should withhold the drug or discontinue its use if the blood urea nitrogen (BUN) rises in the client with renal compromise who is receiving a thiazide diuretic. Magnesium supplements or add-ons may be provided to clients taking loop diuretics as they are prone to magnesium deficiency. The nurse should encourage fluid intake to prevent a fluid volume deficit in elderly clients who are particularly prone to fluid volume deficit and electrolyte imbalances when taking a diuretic. The nurse need not administer the drug in a diluted form since doing so will not have an effect on the blood urea nitrogen level.

A nurse is caring for a client with increased intracranial pressure caused by cerebral edema. The physician has prescribed mannitol. After administering the drug, the nurse should do which of the following? A) Monitor blood pressure every 4 hours. B) Check response of pupils to light. C) Monitor client for joint pain. D) Monitor serum uric acid concentrations.

Ans: B Feedback: When caring for a client who has been given mannitol for intracranial pressure, the nurse should perform neurologic assessments such as response of the pupils to light, level of consciousness, or response to a painful stimulus at the time intervals ordered by the primary health care provider. The nurse monitors the client for joint pain and other discomforts when the client is administered thiazide diuretics for renal impairment. When caring for clients taking thiazide diuretics, the nurse also monitors the serum uric acid concentrations because these drugs may precipitate an acute attack of gout. The nurse needs to monitor the client's blood pressure every 30 to 60 minutes when caring for a client receiving the osmotic diuretic mannitol or urea for the treatment of increased intracranial pressure caused by cerebral edema.

A nurse is monitoring a client who is prescribed milrinone for heart failure. The nurse determines that the client is experiencing an adverse reaction based on assessment of which of the following? A) Edema B) Hypotension C) Bradycardia D) Cyanosis

Ans: B Feedback: When caring for clients taking milrinone, the development of hypotension indicates an adverse reaction. Edema and cyanosis need to be assessed by the nurse as part of the preadministration assessment. Edema, bradycardia, and cyanosis are not adverse reactions associated with milrinone.

A nurse is caring for a client receiving gemfibrozil. Which of the following would the nurse include in the teaching plan for this client? A) Take the drug along with meals. B) Observe caution while driving. C) Take a single dose once daily in the evening. D) Be alert for mild to severe facial flushing.

Ans: B Feedback: When preparing a teaching plan for the client receiving the fibric acid derivative gemfibrozil, the nurse should instruct the client to observe caution while driving. Rosuvastatin calcium is taken as a single dose once daily in the evening. The nurse instructs a client prescribed nicotinic acid to take it along with meals; it may also cause mild to severe facial flushing.

After administering an antihyperlipidemic drug, the nurse continues to assess which of the following? Select all that apply. A) Blood glucose B) Vital signs C) Assessment of bowel function D) Input and output E) Stool sample

Ans: B, C Feedback: Clients on antihyperlipidemic medications should have vital signs checked and bowel function assessed because an adverse reaction to these drugs is constipation. Constipation may become serious if not treated early in the medication regimen.

A nurse is administering a diuretic that inhibits reabsorption of sodium and chloride ions in the distal and proximal tubules and in the loop of Henle. Which of the following might the nurse be administering? Select all that apply. A) Chlorothiazide B) Furosemide C) Bumetanide D) Mannitol E) Spironolactone

Ans: B, C Feedback: Loop diuretics, like furosemide (Lasix) and bumetanide (Bumex), cause dieresis by inhibiting reabsorption of sodium and chloride ions in the distal and proximal tubules and in the loop of Henle. Thiazide and related diuretics such as chlorothiazide inhibit the reabsorption of sodium and chloride ions in the ascending portion of the loop of Henle and the early distal tubule of the nephron. Osmotic diuretics such as mannitol increase the density of the filtrate in the glomerulus. Potassium-sparing diuretics such as spironolactone work by blocking the reabsorption of sodium in the kidney tubules, thereby increasing sodium and water in the urine.

Protamine is used to treat overdose of which of the following medications? Select all that apply. A) Clopidogrel (Plavix) B) Heparin C) Enoxaparin (Lovenox) D) Alteplase (Activase) E) Warfarin (Coumadin)

Ans: B, C Feedback: Protamine is used to treat overdose of heparin and low-molecular-weight heparins (LMWHs).

Which of the following may be ordered periodically during therapy with anticoagulants? Select all that apply. A) Urinalysis B) Platelet count C) Blood count D) Stool analysis E) Ultrasound

Ans: B, C, D Feedback: A complete blood count, platelet count, and stool analysis for occult blood may be ordered periodically throughout anticoagulant therapy.

A client is starting cholestyramine therapy for the treatment of hyperlipidemia. When teaching the client about possible adverse reactions, which of the following would the nurse include? Select all that apply. A) Diarrhea B) Malabsorption of vitamin K C) Aggravation of hemorrhoids D) Flatulence E) Myopathy

Ans: B, C, D Feedback: Adverse reactions reported with the use of bile acid resins, such as cholestyramine, include constipation (that can become severe), aggravation of hemorrhoids, abdominal cramps, flatulence, nausea, increased bleeding related to vitamin K malabsorption, and vitamin A and D deficiencies.

After teaching a group of nursing students about digoxin, the instructor determines that the teaching was successful when the students identify which of the following as true regarding the monitoring of plasma digoxin levels? Select all that apply. A) Levels should be drawn immediately after the dose. B) Levels should be drawn immediately before the next dose. C) Levels should be drawn 6 to 8 hours after the last dose. D) Levels of greater than 2 ng/mL are considered toxic. E) Levels are considered therapeutic between 0.5 and 1.5 ng/mL.

Ans: B, C, D Feedback: Digoxin blood plasma level measurements should be drawn immediately before the next dose or 6 to 8 hours after the last dose regardless of route. Therapeutic digoxin levels are between 0.8 and 2 ng/mL. Plasma digoxin levels greater than 2 ng/mL are considered toxic and are reported to the physician.

Which of the following is true with regard to oral administration of cardiotonic drugs? Select all that apply. A) Capsule doses are less absorbed. B) Alternating between oral dosage forms is avoided. C) Tablets can be crushed and mixed with food or fluids. D) Oral dosage forms can be administered without regard to meals. E) The recommended dosage of the capsules is 80% more than that of tablets.

Ans: B, C, D Feedback: Oral preparations can be given without regard to meals. Tablets can be crushed and mixed with food or fluids if the patient has difficulty swallowing. Do not alternate between the dosage forms (i.e., tablets and capsules); these dosages are not the same. Owing to better absorption, the recommended dosage of the capsules is 80% of the dosage for tablets and elixir.

When reviewing a client's history, the nurse notes that the client uses garlic to promote cardiovascular health. The nurse understands that which of the following is a benefit of its use? Select all that apply. A) Improved LDL-to-HDL ratio B) Lower serum triglyceride levels C) Lower blood pressure D) Prevention of atherosclerosis E) Reduced risk for blood clots

Ans: B, C, D Feedback: The benefits of garlic include lowering serum cholesterol and triglyceride levels, improving the ratio of HDL to LDL cholesterol, lowering blood pressure, and helping to prevent the development of atherosclerosis.

When explaining how verapamil (Calan) produces its effects on the cardiovascular system, which of the following would the nurse integrate into the explanation? Select all that apply. A) Reduction in the release of renin B) Dilation of coronary arteries C) Dilation of peripheral arteries D) Slowed conduction through the SA and AV nodes E) Membrane-stabilizing effects

Ans: B, C, D Feedback: Verapamil (Calan) is a calcium channel blocker. These drugs inhibit the movement of calcium through channels across the myocardial cell membranes and vascular smooth muscle. Cardiac and vascular smooth muscle depends on the movement of calcium ions into the muscle cells through specific ion channels. When this movement is inhibited, the coronary and peripheral arteries dilate, thereby decreasing the force of cardiac contraction. This drug also reduces heart rate by slowing conduction through the SA and AV nodes.

A client is experiencing constipation due to an antihyperlipidemic drug. The client asks the nurse how to manage this problem. Which suggestion would be most appropriate? Select all that apply. A) Stop taking the antihyperlipidemic medication. B) Increase your fluid intake. C) Eat foods rich in dietary fiber. D) Be sure to exercise every day. E) Use a stool softener.

Ans: B, C, D, E Feedback: Constipation resulting from an antihyperlipidemic drug can be treated by increasing fluid intake, consuming food rich in dietary fiber, exercising daily, and using a stool softener or laxative if needed.

A nursing instructor is conducting a class on heart failure and the events that occur. The instructor describes which of the following as a result of increases in neurohormonal activity that occur with heart failure? Select all that apply. A) Decreased secretion of catecholamines B) Remodeling of the cardiac muscle cells C) Hypertrophy of the heart D) Increased need for oxygen E) Cardiac necrosis

Ans: B, C, D, E Feedback: Increased catecholamines lead to increases in neurohormonal activity that cause remodeling of the cardiac muscle cells, leading to hypertrophy of the heart, increased need for oxygen, and cardiac necrosis, which worsen the heart failure.

A nurse checks the serum digoxin level of a client and finds it to be increased. Which of the following would the nurse identify as possibly associated with this increase? A) Colestipol (Colestid) B) Verapamil (Calan) C) Clarithromycin (Biaxin) D) Calcium carbonate (Maalox) E) Spironolactone (Aldactone)

Ans: B, C, E Feedback: Increased serum digoxin levels can occur with verapamil, clarithromycin, and spironolactone. Antacids, such as calcium carbonate, and colestipol cause a decrease in serum digoxin levels.

A client is receiving pravastatin. The nurse understands that which of the following should be avoided with this client to prevent the risk of myopathy? Select all that apply. A) Quinapril (Accupril) B) Niacin (Niaspan) C) Clarithromycin (Biaxin) D) Albuterol (Proventil E) Verapamil (Calan)

Ans: B, C, E Feedback: Niacin, clarithromycin, and verapamil when coadministered to a client taking a statin, like pravastatin, can result in increased myopathy.

A nurse is reading a journal article about propranolol. Which of the following would the nurse expect to find discussed? Select all that apply. A) Is a class III antiarrhythmic B) Acts by blocking beta-adrenergic receptors of the heart and kidney C) Reduces the release of renin D) Increases excitability of the heart E) Has membrane-stabilizing effects

Ans: B, C, E Feedback: Propranolol (Inderal) is a class II antiarrhythmic that acts by blocking beta-adrenergic receptors of the heart and kidney, reducing the influence of the sympathetic nervous system on these areas, decreasing the excitability of the heart and the release of renin. Propranolol also has membrane-stabilizing effects.

A nurse is reviewing the medical record of a client who is prescribed statin therapy. The nurse understands that this class of drugs is contraindicated in clients with which of the following conditions? Select all that apply. A) Kidney disease B) Pregnancy C) Serious hepatic disease D) Carcinoma of the breast E) Lactation

Ans: B, C, E Feedback: Statin drugs are contraindicated in individuals with known hypersensitivity to the drugs or serious liver disease and during pregnancy (category X) and lactation.

After administering metolazone to a client, the nurse monitors for signs of hypokalemia, including which of the following? Select all that apply. A) Diarrhea B) Anorexia C) Depression D) Hypoglycemia E) Drowsiness

Ans: B, C, E Feedback: The following are signs of hypokalemia: anorexia, nausea, vomiting, depression, confusion, cardiac arrhythmias, impaired thought process, and drowsiness.

The nurse should monitor a client receiving lidocaine (Xylocaine) IV closely for which of the following? Select all that apply. A) Heartburn B) Apprehension C) Hypotension D) Auditory changes E) Bradycardia

Ans: B, C, E Feedback: The nurse must observe the client closely for signs of apprehension, hypotension, and bradycardia. Auditory changes are seen with quinidine, not lidocaine. Heartburn is associated with mexiletine.

1. When describing the different classes of diuretics, the nursing instructor would include which of the following as sulfonamides, with nonbacteriostatic action, that inhibit the enzyme carbonic anhydrase? Select all that apply. A) Furosemide B) Acetazolamide C) Hydrochlorothiazide D) Methazolamide E) Torsemide

Ans: B, D Feedback: Acetazolamide and methazolamide are carbonic anhydrase inhibitors. Furosemide and torsemide are loop diuretics. Hydrochlorothiazide is a thiazide diuretic.

After receiving a loading dose of milrinone (Primacor), the nurse would assess the client for which of the following as most likely? Select all that apply. A) Hypertension B) Angina C) Hyperkalemia D) Headache E) Insomnia

Ans: B, D Feedback: The adverse reactions most likely to occur after the administration of milrinone (Primacor) to a client are ventricular arrhythmias, hypotension, angina, chest pain, headache, and hypokalemia.

When teaching a client how to inject heparin subcutaneously, which of the following would the nurse include? Select all that apply. A) Holding the needle at a 45-degree angle B) Pinching a fold of skin C) Aspirating before injecting the drug D) Applying firm pressure after injection E) Changing sites for each dose

Ans: B, D, E Feedback: When administering a subcutaneous dose of heparin, the nurse picks a site that has not been use previously, pinches a fold of skin, holds the needle at a 90-degree angle, does not aspirate before injecting, and then applies firm pressure to the area after injection.

A nurse is reviewing a client's laboratory test results after being on statin therapy for several months. Which of the following would the nurse interpret as indicating effectiveness of the drug? Select all that apply. A) Total cholesterol 220 mg/dL B) LDL cholesterol 80 mg/dL C) HDL cholesterol 30 mg/dL D) LDL cholesterol 165 mg/dL E) HDL cholesterol 60 mg/dL

Ans: B, E Feedback: Effectiveness of therapy would be indicated by values that are low or optimal. This would include a total cholesterol below 200 mg/dL, LDL less than 100 mg/dL, and HDL greater than 40 mg/dL.

Administration with which of the following would increase serum concentrations of disopyramide? Select all that apply. A) Amiodarone B) Quinidine C) Rifampin D) Cimetidine E) Erythromycin

Ans: B, E Feedback: Increased serum disopyramide levels occur when quinidine or erythromycin is given with disopyramide. Amiodarone and cimetidine increase serum flecainide levels. Rifampin decreases serum disopyramide levels.

A nurse is caring for a client who is prescribed mexiletine for the treatment of a cardiac arrhythmia. Which adverse reaction would lead the nurse to identify a nursing diagnosis of Risk for Infection? A) Lightheadedness B) Dry mouth C) Agranulocytosis D) Nausea

Ans: C Feedback: A nursing diagnosis of Risk for Infection related to the adverse reaction of the drug may be made in the case of agranulocytosis. Lightheadedness would lead to a nursing diagnosis of Risk for Injury related to the adverse effect of the drug. Dry mouth leads to a nursing diagnosis of Impaired Oral Mucous Membranes related to the adverse effect of the drug. Nausea does not indicate the implementation of the nursing diagnosis of Risk for Infection.

A nurse is caring for a client with edema due to congestive heart failure (CHF). The primary health care provider has prescribed indapamide. The client is also receiving digoxin. Which intervention would be most appropriate for the nurse to implement? A) Encourage oral fluids at frequent intervals during waking hours. B) Encourage the client to eat or drink between meals and in the evening. C) Frequently monitor the client's pulse rate and rhythm. D) Closely monitor the client for signs of hyperkalemia.

Ans: C Feedback: Clients receiving a diuretic, particularly a loop or thiazide diuretic such as indapamide, and a digitalis glycoside concurrently require frequent monitoring of the pulse rate and rhythm because of the possibility of cardiac arrhythmias. Any significant changes in the pulse rate and rhythm are immediately reported to the primary health care provider. The nurse should encourage oral fluids at frequent intervals during waking hours when caring for older clients to prevent a fluid volume deficit. In such cases the nurse should also encourage elderly clients to eat or drink between meals and in the evening. The nurse must closely observe clients receiving a potassium-sparing diuretic for signs of hyperkalemia, a serious and potentially fatal electrolyte imbalance.

A nurse in a health care facility is caring for a client receiving colesevelam. The nurse would anticipate administering this drug cautiously to a client with which condition? A) Diabetes B) Peptic ulcer disease C) Liver disease D) Unstable angina

Ans: C Feedback: Colesevelam is administered with caution in clients with liver disease. Fibric acid derivatives are administered with caution in clients with peptic ulcer disease and diabetes. Niacin is used with caution in clients with unstable angina.

A nurse is reviewing a journal article about class IA antiarrhythmics. The article describes a drug that decreases depolarization and prolongs the refractory period. The nurse is most likely reading an article about which drug? A) Quinidine B) Lidocaine C) Disopyramide D) Flecainide

Ans: C Feedback: Disopyramide (Norpace) decreases depolarization of myocardial fibers, prolongs the refractory period, and increases the action potential duration of cardiac cells. Lidocaine (Xylocaine) decreases diastolic depolarization, decreases automaticity of ventricular cells, and raises the threshold of the ventricular myocardium. Quinidine depresses myocardial excitability or the ability of the myocardium to respond to an electrical stimulus. Flecainide (Tambocor) depresses fast sodium channels, decreases the height and rate of rise of action potentials, and slows conduction of all areas of the heart.

A client with cardiac arrhythmia is prescribed ibutilide IV. The client weighs 63 kg. The nurse would expect to administer the drug over which time frame? A) 1 minute B) 5 minutes C) 10 minutes D) 30 minutes

Ans: C Feedback: Ibutilide is administered IV over 10 minutes.

A client is receiving mannitol as treatment to promote diuresis in acute renal failure. The nurse would expect to administer the drug by which route? A) Intramuscularly B) Subcutaneously C) Intravenously D) Orally

Ans: C Feedback: Mannitol is administered intravenously. It is not given intramuscularly, subcutaneously, or orally.

A nurse is conducting a community presentation on heart disease, cholesterol, and risk factors. The nurse determines that the class has been successful when the class identifies which of the following as true? A) Low-fat diet raises LDL cholesterol levels. B) Being overweight causes HDL levels to go up. C) Physical activity raises HDL cholesterol levels. D) Excess body weight causes LDL cholesterol to go down.

Ans: C Feedback: Saturated fat and cholesterol in the food raises total and LDL cholesterol levels. Being overweight can make LDL cholesterol levels go up and HDL levels go down. Increased physical activity helps to lower LDL cholesterol and raise HDL cholesterol levels.

After teaching a client about his prescribed cardiotonic drug therapy, the nurse determines that additional teaching is needed when the client states which of the following? A) I will take the drug at the same time each day. B) I can crush the tablet and mix it with food. C) I should call if my pulse rate is below 80 beats per minute. D) I need to notify my doctor if I have blurred vision.

Ans: C Feedback: The client should call the primary health care provider if his pulse rate is below 60 beats per minute or above 100 beats per minute. The client should take the drug at the same time each day, crush the tablet and mix with food, and notify the primary health care provider if blurred vision occurs.

A client receiving antiarrhythmic therapy develops a new arrhythmia due to the administration of the drug. The nurse documents this as which of the following? A) Cinchonism B) Refractory period C) Proarrhythmic effect D) Action potential

Ans: C Feedback: The development of a new arrhythmia due to drug administration is referred to as a proarrhythmic effect. Cinchonism refers to quinidine toxicity. Refractory period refers to the quiet period between the transmission of nerve impulses along a nerve fiber. Action potential refers to the electrical impulse that passes from cell to cell in the myocardium of the heart and stimulates the fibers to shorten, causing heart muscles to contract.

A nurse is caring for a client with edema. The physician has prescribed diuretic therapy for the client. Which of the following would be most appropriate for the nurse to do? A) Ask the client to decrease fluid intake. B) Gradually increase the drug dosage. C) Administer the drug early in the day. D) Encourage the client to exercise.

Ans: C Feedback: The nurse should administer the drug early in the day to prevent any nighttime sleep disturbance caused by increased urination when caring for a client receiving diuretic therapy for acute renal failure. The nurse need not ask the client to decrease fluid intake, gradually increase the drug dosage, or encourage the client to exercise as these are not appropriate interventions and will not help in reducing the discomfort caused by increased urination.

A nurse is caring for a client prescribed warfarin. The nurse would instruct the client that which of the following foods are high in vitamin K? A) Dairy products B) Root vegetables C) Green leafy vegetables D) Fruits and cereals

Ans: C Feedback: The nurse should inform the client that green leafy vegetables are high in vitamin K. Increased amounts of vitamin K could decrease the PT/INR and increase the risk of clot formation. Dairy products, root vegetables, fruits, and cereals are generally low in vitamin K. A diet that is very low in vitamin K may prolong the PT/INR and increase the risk of hemorrhage. The key to vitamin K management for clients receiving warfarin is maintaining a consistent daily intake of vitamin K. To avoid large fluctuations in vitamin K intake, clients receiving warfarin should be aware of the vitamin K content of food.

A client with cardiac arrhythmia is prescribed verapamil. The nurse would instruct the client about which of the following as a possible adverse reaction? A) Diarrhea B) Hyperactivity C) Peripheral edema D) Hypertension

Ans: C Feedback: The nurse should inform the client that peripheral edema could be an adverse reaction to verapamil therapy. Diarrhea, hyperactivity, and hypertension are not adverse reactions associated with verapamil therapy. Other adverse reactions associated with verapamil are constipation, mental depression, and hypotension.

A client has been prescribed an antiarrhythmic. Which of the following points should the nurse include in the client teaching plan? A) Decrease the dose if adverse effects occur. B) Chew the tablets well before swallowing. C) Take frequent sips of water or chew gum. D) Take the drug only on an empty stomach.

Ans: C Feedback: The nurse should instruct the client to take frequent sips of water or chew gum to avoid dryness of the mouth. The nurse should instruct the client not to stop the medication or change the dose and schedule without consulting the health care provider. The tablets should not be chewed or crushed. They should be swallowed whole. Taking the drug on an empty stomach may cause gastric upset. The drug should be taken with food.

A female client is receiving an anticoagulant to prevent the formation and extension of blood clots. What instruction should the nurse include in the teaching plan for the client? A) Avoid caffeinated drinks. B) Take the drug on an empty stomach. C) Use a reliable contraceptive. D) Take the drug with a glass of milk.

Ans: C Feedback: The nurse should instruct the female client to use a reliable contraceptive to prevent pregnancy. The nurse need not instruct the client to avoid caffeinated drinks, take the drug on an empty stomach, or take the drug with a glass of milk.

A nurse is conducting a seminar on thrombosis. What information would the nurse include about the cause of arterial thrombosis? A) Decreased blood flow B) Injury to the vessel wall C) Arrhythmias D) Altered blood coagulation

Ans: C Feedback: The nurse should mention that arterial thrombosis is caused by atherosclerosis and arrhythmias. Decreased blood flow, injury to the vessel wall, and altered blood flow are causes of venous thrombosis.

A client is prescribed a diuretic that is to be taken twice a day. When instructing the client about the schedule for administration, the nurse would suggest that the client take the drug at which times? A) In the early morning and at bedtime B) After lunch and dinner C) At breakfast and midafternoon D) Midmorning and before dinner

Ans: C Feedback: Twice-a-day dosing should be administered early in the morning (e.g., 7 a.m.) and early afternoon (e.g., 2 p.m.) to prevent the drug from interfering with the client's sleep.

A client is prescribed digoxin IV as a loading dose. The nurse would expect to administer the drug over which time frame? A) 30 seconds B) 2 minutes C) 5 minutes D) 30 minutes

Ans: C Feedback: When a cardiotonic drug is given IV, it is administered slowly (over at least 5 minutes), and the administration site is assessed for redness or infiltration.

A client is receiving pravastatin to reduce the risk of coronary heart disease due to hyperlipidemia. The client is also receiving amiodarone for an arrhythmia. The nurse understands that the client is at risk for which of the following based on these two drugs? A) Increased anticoagulant effect B) Increased hypoglycemic effect C) Increased risk of myopathy D) Decreased effects of pravastatin

Ans: C Feedback: When the HMG-CoA reductase inhibitor pravastatin is administered with amiodarone, the nurse should monitor the client for increased risk of myopathy as an effect of the interaction between the two drugs. Increased anticoagulant effect is observed in clients receiving warfarin along with pravastatin. Increased hypoglycemic effects are observed in clients receiving sulfonylureas with fibric acid derivatives. The interaction of pravastatin with amiodarone does not decrease the effect of pravastatin.

After teaching a group of nursing students about bile acids, the instructor determines that the teaching was successful when the students identify which of the following as true about bile? Select all that apply. A) Bile is manufactured by the gallbladder. B) Bile is stored in the liver. C) Bile emulsifies fat and lipids. D) Bile is secreted by the liver. E) Bile is classified as a hormone.

Ans: C, D Feedback: Bile is manufactured and secreted by the liver and stored in the gallbladder; it emulsifies fat and lipids, and these products pass through the intestine.

A nurse is reviewing a journal article about antiplatelet agents. Which of the following would the nurse expect to be discussed? Select all that apply. A) Heparin B) Warfarin C) Abciximab D) Anagrelide E) Dipyridamole

Ans: C, D, E Feedback: Abciximab, anagrelide, and dipyridamole are antiplatelet agents. Heparin and warfarin are anticoagulants.

A client is receiving warfarin therapy as part of the treatment plan for atrial fibrillation. The client is also to begin therapy with cholestyramine. When assessing the client, the nurse would be alert for which of the following? Select all that apply. A) Bruising B) Blood in the stool C) Subtherapeutic INR D) Supratherapeutic INR E) Calf pain and warmth

Ans: C, E Feedback: Coadministration of warfarin and cholestyramine can result in a decreased anticoagulant effect, leading to subtherapeutic INR and increased chance of clotting (signs and symptoms of DVT or PE).

A female client is prescribed warfarin. The client also uses oral contraceptives. The nurse would assess the client closely for which of the following? Select all that apply. A) Bruising B) Blood in the stool C) Subtherapeutic INR D) Supratherapeutic INR E) Calf pain and warmth

Ans: C, E Feedback: Coadministration of warfarin and oral contraceptives can result in a decreased anticoagulant effect, leading to subtherapeutic INR and increased chance of clotting (signs and symptoms of DVT or PE).

A nurse suspects that a client who is receiving acetazolamide is developing hyponatremia based on assessment of which of the following? Select all that apply. A) Bradycardia B) Anorexia C) Hypotension D) Hypoglycemia E) Decreased skin turgor

Ans: C, E Feedback: The following are signs of hyponatremia: cold, clammy skin; decreased skin turgor; confusion; hypotension; irritability; and tachycardia.

A client is currently taking propranolol (Inderal) for hypertension, glipizide (Glucotrol) for diabetes, and acetaminophen (Tylenol) for osteoarthritis. If cholestyramine was given to this client, which of the following would likely result? Select all that apply. A) The client would experience hypoglycemia from increased absorption of glipizide. B) The client would experience decreased analgesia from decreased absorption of acetaminophen. C) The client would experience an increase in blood pressure due to decreased absorption of propranolol. D) The client would experience hypotension from increased absorption of propranolol. E) The client would experience hyperglycemia from decreased absorption of glipizide.

Ans: C, E Feedback: The use of bile acid resins, like cholestyramine, decreases the absorption of some medications including glipizide and propranolol. This decreased absorption could result in hyperglycemia and an increase in blood pressure for this particular client.

A nurse caring for a client with atrial fibrillation who is started on digoxin therapy is required to monitor plasma drug levels. The nurse would report which level to the primary health care provider? A) 1.6 ng/mL B) 1.8 ng/mL C) 2.0 ng/mL D) 2.2 ng/mL

Ans: D Feedback: A plasma digoxin level of more than 2 ng/mL would require the nurse to report to the primary health care provider; therefore, plasma digitalis levels of 2.2 ng/mL indicate digoxin toxicity. The therapeutic levels range from 0.5 to 2 ng/mL.

A client is prescribed a bile acid resin and has been taking this therapy long term. The primary health care provider has prescribed vitamins A and D in water-soluble form. Which nursing diagnosis would be most likely? A) Risk for Impaired Skin Integrity B) Constipation C) Risk for Injury D) Risk for Imbalanced Nutrition: Less Than Body Requirements

Ans: D Feedback: Bile acid resins may interfere with the digestion of fats and prevent the absorption of the fat-soluble vitamins (vitamins A, D, E, and K) and folic acid. Therefore, the nursing diagnosis of Risk for Imbalanced Nutrition: Less Than Body Requirements would be most appropriate. Adverse reactions associated with nicotinic acid such as flushing would suggest a risk for impaired skin integrity. Constipation would be associated with statin therapy. Risk for Injury may be appropriate for clients taking fibrates or statins.

A client with intermittent claudication is prescribed cilostazol by the primary health care provider. The nurse would expect to administer this drug cautiously if the client's history reveals which of the following? A) Intermittent claudication B) Pulmonary emboli C) Myocardial infarction D) Pancytopenia

Ans: D Feedback: The nurse should administer cilostazol with caution to clients with pancytopenia. Anticoagulants are used for the prevention and treatment of pulmonary emboli, the adjuvant treatment of myocardial infarction, and the treatment of intermittent claudication.

A client has been admitted to a health care center with complaints of dyspnea. The nurse suspects left-sided heart failure based on assessment of which of the following? A) Nocturia B) Pitting edema C) Weight gain D) Orthopnea

Ans: D Feedback: The nurse should assess for orthopnea in clients with left-sided heart failure. Orthopnea is a condition where the client experiences difficulty in breathing on lying down. The other features of left ventricular failure include a hacking cough or wheezing, restlessness, and anxiety. Nocturia, pitting edema, and weight gain are associated with right-sided heart failure.

A client with hyperlipidemia is prescribed ezetimibe. Which of the following assessments should the nurse perform during treatment? A) Taking a dietary history of the client B) Inspecting skin and eyelids for evidence of xanthomas C) Obtaining reports of fasting blood sugar levels D) Frequently monitoring blood cholesterol

Ans: D Feedback: The nurse should frequently monitor blood cholesterol as part of the ongoing assessment for a client receiving ezetimibe. Taking a dietary history of the client and inspecting the skin and eyelids for evidence of xanthomas are the preadministration assessments that a nurse should perform for a client receiving ezetimibe. The nurse obtains the reports of fasting blood sugar for a client with diabetes.

When educating a group of nursing students on the mechanism of action of various antiarrhythmic drugs, the nurse identifies which of the following drugs as inhibiting the beta-adrenergic receptors of the heart and kidney? A) Propafenone B) Amiodarone C) Disopyramide D) Acebutolol

Ans: D Feedback: The nurse should inform the nursing students that acebutolol acts by inhibiting the beta-adrenergic receptors of the heart and kidney. Propafenone and amiodarone appear to act directly on the cardiac cell membrane, and not on the beta-adrenergic receptors of the heart and kidney. Disopyramide acts by decreasing the depolarization of the myocardial fibers, and not the beta-adrenergic receptors of the heart and kidney.

A client with heart failure has been digitalized. The client requires long-term digoxin therapy. Which of the following instructions should the nurse provide the client on discharge? A) Take the drug with high-fiber meals. B) Report to the center if the pulse is less than 70 bpm. C) Take antacids promptly to avoid gastric problems. D) Take the drug regularly without skipping a dose.

Ans: D Feedback: The nurse should instruct the client to take the drug regularly without skipping a dose. The client should consult the provider before discontinuing the drug. Taking the drug with high-fiber meals will decrease the absorption of the drug. The client should be advised to report to the center if the pulse is less than 60 bpm. Antacids should not be taken as they alter the plasma digoxin levels.

A nurse is caring for a client who has been prescribed colestipol granules. Which of the following would the nurse do when administering the drug to the client? A) Mix the granules in 2 to 6 fluid ounces of water. B) Take care not to crush the granules. C) Give the granules once or twice daily with meals. D) Mix the drug in 90 mL of liquid.

Ans: D Feedback: The nurse should mix the drug in 90 mL of liquid, soups, cereals, carbonated drinks, or pulpy fruits when administering the colestipol granules to the client. Cholestyramine powder is mixed in 2 to 6 fluid ounces of water. Colestipol tablets are not crushed. Colesevelam tablets are taken once or twice daily with meals.

A physician prescribes diuretic therapy to a client with nephrotic syndrome. The nurse suspects that the client is hyponatremic based on assessment of which of the following? A) Paresthesias B) Tremors C) Visual hallucination D) Tachycardia

Ans: D Feedback: The nurse should monitor for tachycardia, cold and clammy skin, confusion, and hypotension in the client experiencing hyponatremia. Hyponatremia is excessive loss of sodium and is a common fluid and electrolyte imbalance associated with diuretic therapy. Tremors, visual hallucinations, and paresthesias are the symptoms of hypomagnesemia and not hyponatremia.

A client is receiving heparin by continuous IV infusion. Which of the following would be most appropriate for the nurse to do? A) Perform a complete blood count. B) Perform baseline PT/INR. C) Perform APTT test 4 to 6 hours after injection. D) Perform blood coagulation tests every 4 hours.

Ans: D Feedback: The nurse should perform blood coagulation tests every 4 hours for the client receiving heparin by continuous IV infusion. A blood count test or the baseline PT/INR test is not the right intervention for this client. When administering heparin by the subcutaneous route, an APTT test is performed 4 to 6 hours after the injection.

After teaching a group of nursing students about diuretics, the instructor determines that the teaching was successful when the students identify which of the following as causing diuresis by increasing the density of filtrate in the glomerulus? Select all that apply. A) Amiloride B) Torsemide C) Ethacrynic acid D) Mannitol E) Urea

Ans: D, E Feedback: Osmotic diuretics, like mannitol and urea, cause diuresis by increasing the density of the filtrate in the glomerulus. Amiloride is a potassium-sparing diuretic that acts to block the reabsorption of sodium in the kidney tubules, thereby increasing sodium and water in the urine. Torsemide and ethacrynic acid are loop diuretics that inhibit reabsorption of sodium and chloride in the distal and proximal tubules of the kidney and in the loop of Henle.

A nurse is reviewing the laboratory test results of a client who is receiving diuretic therapy. The nurse determines that the client is at risk for electrolyte imbalance based on which results? Select all that apply. A) Potassium 4.5 mEq/L B) Sodium 139 mEq/L C) Magnesium 2.0 mEq/L D) Sodium 124 mEq/L E) Potassium 2.9 mEq/L

Ans: D, E Feedback: Sodium levels below 132 mEq/L, such as 124 mEq/L, or above 145 mEq/L would indicate an imbalance. Potassium imbalances would occur with levels below 3.0 mEq/L, such as 2.9 mEq/L, or above 5 mEq/L. A magnesium level of 2.0 mEq/L is within the normal range of 1.5 to 2.5 mEq/L.