Cardiology Practice Questions

35) A client with acute myocardial infarction is admitted to the coronary care unit. Which medication should the nurse administer to lessen the workload of the heart by decreasing the cardiac preload and afterload? A. Nitroglycerin. B. Propranolol C. Morphine. D. Captopril

A Nitroglycerin is a nitrate that causes peripheral vasodilation and decreases contractility, thereby decreasing both preload and afterload.

1) Which vitamin deficiency may occur if cholestyramine, an anion exchange resin, to treat a client's persistent diarrhea is needed long-term? A. Retinol (Vitamin A) B. Riboflavin (Vitamin B 2) C. Thiamine (Vitamin B 12) D. Pyridoxine (Vitamin B 6)

A Rationale Cholestyramine is a fat-binding agent; it binds with and interferes with all the fat-soluble vitamins (A, D, E, and K). Riboflavin is not a fat-soluble vitamin and is unaffected. Thiamine is not a fat-soluble vitamin and is unaffected. Vitamin B 6 is not a fat-soluble vitamin and is unaffected.

2) The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker (ARB), for a client with hypertension and heart failure. The nurse reviews the client's laboratory results and notes that the client's serum potassium level is 5.9 mEq/L. Which action should the nurse take first? A. Withhold the scheduled dose. B. Check the client's apical pulse. C. Notify the healthcare provider. D. Repeat the serum potassium level.

A The nurse should first withhold the scheduled dose of Cozaar because the client is hyperkalemic (normal range 3.5 to 5 mEq/l). Although hypokalemia is usually associated with diuretic therapy in heart failure, hyperkalemia is associated with several heart failure medications, including ARBs. Because hyperkalemia may lead to cardiac dysrhythmias, the nurse should check the apical pulse for rate and rhythm, and blood pressure.

A health care provider prescribes digoxin for a client. The nurse teaches the client to be alert for which common early indication of acute digoxin toxicity? A. Vomiting B. Urticaria C. Photophobia D. Respiratory distress

Answer: A Rationale: Nausea, vomiting, anorexia, and abdominal pain are early indications of acute toxicity in approximately 50% of clients who take a cardiac glycoside, such as digoxin. Urticaria is a rare, not common, manifestation of digoxin toxicity. Photophobia is a later, not early, manifestation of digoxin toxicity. Respiratory distress is not directly associated with digoxin toxicity.

Which client statement indicates understanding of the side effects of nitroglycerin ointment? A. 'I may experience a headache.' B. 'Confusion is a common adverse effect.' C. 'A slow pulse rate in an expected side effect.' D. 'Increased blood pressure readings may occur initially.'

Answer: A Rationale: The most common side effect of nitroglycerin is a headache. Additional cardiovascular side effects are hypotension, not hypertension; tachycardia, not bradycardia; and dizziness, not confusion.

When teaching a client about digoxin, which symptom will the nurse include as a reason to withhold the digoxin? A. Fatigue B. Yellow vision C. Persistent hiccups D. Increased urinary output

Answer: B Rationale: Digoxin toxicity is a common and dangerous effect. Visual disturbances, most notably yellow vision, may be evidence of digoxin toxicity. Fatigue is not a toxic effect of digoxin. Persistent hiccups are not related to digoxin toxicity. An increased urinary output is not a sign of digoxin toxicity; it may be a sign of a therapeutic response to the medication and an improved cardiac output.

The nurse is monitoring a 6-year-old child for toxicity precipitated by digoxin. Which sign of digoxin toxicity would the nurse monitor for? A. Oliguria B. Vomiting C. Tachypnea D. Splenomegaly

Answer: B Rationale: Vomiting is a sign of digoxin toxicity in children. Oliguria is associated with renal failure, not toxicity. Tachypnea is associated with heart failure, not toxicity. Splenomegaly is associated with heart failure, specifically right ventricular failure.

15) The nurse administers a dose of metoprolol for a client. Which assessment is most important for the nurse to obtain? A. Temperature. B. Lung sounds. C. Blood pressure. D. Urinary output.

C It is most important to monitor the blood pressure of clients taking this medication because metoprolol is an antianginal, antiarrhythmic, antihypertensive agent.

3) A nurse is providing care to a client with diabetes insipidus. The client is on a prescribed vasopressin infusion with orders to titrate as needed. The nurse decreases the dose of vasopressin based on which clinical finding? A. Increased blood pressure B. Decreased urine osmolarity C. Reduced volume of urine output D. Elevated heart rate

C Rationale: Diabetes insipidus is an endocrine disorder that causes the excretion of large quantities of diluted urine. Vasopressin decreases urine output by allowing the reabsorption of water in the kidneys. A reduction in the volume of urine output indicates the medication is delivering the intended effect, and the dose can be decreased. Vasopressin can increase blood pressure and heart rate. However, these are not the intended effects of vasopressin for a client with diabetes insipidus. A decrease in the urine osmolarity indicates dilution is still present.

7) A nurse is assessing a client who started taking prescribed olmesartan 2 weeks ago. Which finding indicates an expected response to the medication? A. Heart rate of 85 beats/min B. Urinary output of 45 ml/hr C. Blood pressure of 125/79 mmHg D. Respiratory rate of 20 breaths/min

C Rationale: Olmesartan is an angiotensin II receptor antagonist used in the treatment of hypertension. The expected outcome is to maintain the blood pressure within normal limits. Although within normal limits, the heart rate, urinary output, and respiratory rate are not used to evaluate the efficacy of olmesartan.

A client is discharged with a prescription for sustained-release nitroglycerin. Which information will the nurse provide to the client? A. Swallow the capsule whole. B. Take the medication with milk. C. Place the capsule under the tongue. D. Crush the capsule and mix with soft food.

Answer: A Rationale: The sustained-release capsule should be swallowed whole on an empty stomach. The capsule should not be chewed or crushed because the 'beads' within the capsule are activated on a time-release schedule. Taking the capsule with milk isn't necessary; a full glass of water is sufficient. The sustained-release capsule is taken on an empty stomach. A sublingual tablet is held under the tongue, not swallowed; sustained-release nitroglycerin is a capsule that needs to be swallowed. A stinging feeling when the medication is under the tongue may occur with a sublingual nitroglycerin tablet; sustained-release nitroglycerin is a capsule that should be swallowed whole.

One week after being hospitalized for an acute myocardial infarction, a client reports nausea and loss of appetite. Which of the client's prescribed medications would be withheld and the health care provider notified? A. Digoxin B. Propranolol C. Furosemide D. Spironolactone

Answer: A Rationale: Toxic levels of digoxin stimulate the medullary chemoreceptor trigger zone, resulting in anorexia, nausea, and vomiting. Although anorexia, nausea, and vomiting may be side effects of furosemide, propranolol, and spironolactone, they do not indicate toxicity.

An infant with congenital heart disease is prescribed digoxin and furosemide upon discharge. Which sign would the nurse instruct the parents to be alert for? A. Difficulty feeding with vomiting B. Cyanosis during periods of crying C. Daily naps lasting more than 3 hours D. A pulse rate faster than 100 beats/min

Answer: A Rationale: Vomiting and feeding issues are early signs of digoxin toxicity. Cyanosis is expected in a crying infant with heart disease because the energy expenditure exceeds the body's ability to meet the oxygen demand. Long naps are expected; infants routinely require several naps, and an infant with heart disease requires long rest periods. The pulse rate of an infant receiving digoxin should remain faster than 100 beats/min.

The nurse is preparing to administer digoxin to a client with recurring atrial fibrillation. Which laboratory value should be of highest concern for the nurse? A. Hemoglobin 9.4 g/dL B. Serum potassium 3.1 mEq/L C. Serum creatinine 1.9 mg/dL D. B-type natriuretic peptide 140 pg/mL

Answer: B Rationale: Digoxin is a cardiac glycoside used to treat atrial dysrhythmias and heart failure. Because digoxin competes with potassium ions, digoxin should not be given when the client's potassium level is below the normal range. Giving digoxin to a client with hypokalemia can cause digoxin toxicity and life-threatening cardiac dysrhythmias. Although all of the lab values are outside of the normal range, the low potassium level (normal range 3.5-5.0 mEq/L) should be of highest concern for the client at this time. The nurse should hold the digoxin and notify the health care provider.

The nurse is reviewing medication instructions with a client who is taking digoxin. The nurse should reinforce to the client to report which of the following side effects? A. Rash, dyspnea, edema B. Nausea, vomiting, fatigue C. Hunger, dizziness, diaphoresis D. Polyuria, thirst, dry skin

Answer: B Rationale: Digoxin is considered an antidysrhythmic and inotrope, that is used to treat atrial dysrhythmias and congestive heart failure. The medication produces a positive inotropic effect, prolongs the refractory period and slows conduction through the sinoatrial (SA) and atrioventricular (AV) nodes. Overall, digoxin increases cardiac output and slows the heart rate. The effects of digoxin produce many side effects and clients who take digoxin are at risk for digoxin toxicity. Because digoxin improves cardiac output, side effects of the medication would not include dyspnea or edema. Rashes are also not considered a side effect of digoxin. Common manifestations of digoxin toxicity include nausea, vomiting and fatigue. Hunger, dizziness and diaphoresis, together, are not considered side effects of digoxin. Although dizziness could occur with another side effect of digoxin, such as bradycardia. Polyuria, thirst and dry skin are not considered side effects of digoxin.

A nurse has administered sublingual nitroglycerin to a client in the emergency department. Which clinical finding indicates an adverse response to the medication? A. Persistent chest pain B. Orthostatic hypotension C. Decreased heart rate D. Labored breathing

Answer: B Rationale: Decreased blood pressure when changing positions is an unexpected response to nitroglycerin. The nurse should instruct the client to lay down and elevate the feet to promote venous return. Persistent chest pain is not an unexpected response. Additional doses may be required to alleviate angina. A side effect of nitroglycerin is tachycardia, not a decreased heart rate. Nitroglycerin is not associated with respiratory effects.

A client with midsternal pain presents to the emergency department. Vital signs are stable. Which form of nitroglycerin would the nurse anticipate giving initially? A. Oral capsule B. Sublingual spray C. Intravenous solution D. Transdermal patch

Answer: B Rationale: Nitroglycerin spray provides prompt relief of symptoms. The nurse administers one to two sprays, up to a maximum of three sprays, onto or under the tongue every 5 minutes until pain is relieved. If unrelieved after three sprays, intravenous (IV) nitroglycerin may be considered. Both the transdermal and oral forms of nitroglycerin are used for prophylactic purposes, not management of acute pain.

Which medication is unsafe to administer as an intravenous (IV) bolus? A. Saline flush B. Potassium chloride C. Naloxone D. Adenosine

Answer: B Rationale: Potassium chloride given as an IV bolus can cause cardiac arrest. It must be diluted and infused slowly through an IV infusion pump. Saline flush, naloxone, and adenosine are appropriate to be given as an IV bolus undiluted.

Which instruction would the nurse include in a teaching plan for nitroglycerin patches? A. 'Apply the patch on a distal extremity.' B. 'Remove a previous patch before applying the next one.' C. 'Massage the area gently after applying the patch to the skin.' D. 'Apply a warm compress to the site before attaching the patch.'

Answer: B Rationale: Removing the previous patch before applying the next patch ensures that the client receives just the prescribed dose. Ideally, a patch should be removed after 12 to 14 hours to avoid the development of tolerance. The patch should be rotated among hair-free and scar-free sites; acceptable sites include the chest, upper abdomen, proximal anterior thigh, or upper arm. The patch should be gently pressed against the skin to ensure adherence; it should not be massaged. Applying a warm compress to the site before attaching the patch is unnecessary and can result in excessive absorption of the medication.

The nurse is discharging a client on oral potassium replacement. Which of the following statements requires further teaching by the nurse? A. "I can still take my nonsteroidal anti-inflammatory medications occasionally for my arthritis pain." B. "I will continue to use salt substitutes to flavor my food." C. "I will take my furosemide first thing in the morning." D. "I will read the food labels for added potassium."

Answer: B Rationale: Salt substitutes are made using potassium. As the client is taking potassium supplements, they should avoid salt substitutes to prevent hyperkalemia from occurring. NSAIDS can be used occasionally. The furosemide should be taken in the morning. Some low-sodium prepared foods may contain potassium, so reading the labels is important.

A client has a prescription for a sublingual nitroglycerin tablet. Which technique will the nurse teach the client to use? A. Place the pill inside the cheek and let it dissolve. B. Place the pill under the tongue and let it dissolve. C. Chew the pill thoroughly and then swallow it. D. Swallow the pill with a full glass of water.

Answer: B Rationale: Sublingual medication is placed under the tongue and is quickly absorbed through the mucous membranes into blood. The buccal route requires placing medication between the cheek and gums. Chewing the pill and then swallowing it may be done for oral administration of some large pills, but not with the sublingual route of administration. Taking the pill with water is required with the oral route of administration of medication, but not with sublingual. In addition, a full glass of water may be an excessive amount of fluid to swallow one pill.

A client presents to the emergency department with chest pain. A myocardial infarction is suspected, and 500 mL of 5% dextrose in water (D 5W) with 50 mg of nitroglycerin intravenously (IV) has been prescribed. The nurse will monitor the client for which common side effect of nitroglycerin? A. Bradycardia B. Hypotension C. Nausea and vomiting D. Leg cramps

Answer: B Rationale: The major action of intravenous nitroglycerin is venous and then arterial dilation, leading to a decrease in blood pressure; orthostatic hypotension can occur. Bradycardia is not an anticipated response. Nausea and vomiting may occur but are not the most common side effects of IV nitroglycerin. Leg cramps are not a side effect of this medication.

A client who takes furosemide and digoxin reports to the nurse that everything looks yellow. Which response by the nurse is most appropriate? A. 'This is related to your heart problems, not to the medication.' B. 'I will hold the medication until I consult with your health care provider.' C. 'It is a medication that is necessary, and that side effect is only temporary.' D. 'Take this dose, and when I see your health care provider, I will ask about it.'

Answer: B Rationale: The response 'I will hold the medication until I consult with your health care provider' is a safe practice because yellow vision indicates digitalis toxicity. The response 'This is related to your heart problems, not to the medication' is incorrect; yellow vision is not a symptom of heart disease. The response 'It is a medication that is necessary, and that side effect is only temporary' is incorrect; yellow vision is not a temporary side effect. The response 'Take this dose, and when I see your health care provider, I will ask about it' is unsafe.

When a client with type 1 diabetes develops heart failure, digoxin is prescribed. Which nursing action is important to include when planning care? A. Administer the digoxin 1 hour after the client's morning insulin. B. Monitor the client for cardiac dysrhythmias. C. Monitor for increased risk of hyperglycemia. D. Increase digoxin dosage if insulin requirements are increased.

Answer: B Rationale: The speed of conduction is decreased when digoxin is given, and this can result in a variety of cardiac dysrhythmias. The risk for hyperglycemia is not increased. Administration times for insulin and digoxin do not have to be coordinated. Dosage of digoxin is not dependent on insulin dosage.

The nurse administers a parenteral preparation of potassium slowly to avoid which complication? A. Metabolic acidosis B. Cardiac arrest C. Seizure activity D. Respiratory depression

Answer: B Rationale: Too rapid an administration can cause hyperkalemia, which contributes to a long refractory period in the cardiac cycle, resulting in cardiac dysrhythmias and arrest. Although acidosis can cause hyperkalemia, hyperkalemia will not lead to acidosis. Hyperkalemia causes muscle flaccidity and weakness, not seizures. Respiratory depression can occur with too rapid intravenous (IV) magnesium administration, not potassium administration.

A hospitalized 8-month-old infant is receiving digoxin to treat Tetralogy of Fallot. Prior to administering the next dose of the medication, the parent reports that the baby vomited one time, just after breakfast. The infant's heart rate is 92 bpm. What action should the nurse take? A. Give the scheduled dose after the client is done eating lunch. B. Hold the medication and notify the primary health care provider. C. Reduce the next dose by half and then resume the normal medication schedule. D. Double the next dose to make up for the medication lost from vomiting.

Answer: B Rationale: Toxic side effects of digoxin include bradycardia, dysrhythmia, nausea, vomiting, anorexia, dizziness, headache, weakness and fatigue. It isn't typically necessary to hold the medication for infants and children if there is only one episode of vomiting. However, it is appropriate to hold the medication and notify the primary health care provider (HCP) of the vomiting episode and the lower than normal heart rate. A digoxin level may need to be drawn. The normal resting heart rate for infants 1 to 11 months old is 100 to 160 bpm.

When the nurse is administering intravenous potassium to a client with hypokalemia, which finding is most important to communicate to the health care provider? A. U waves on cardiac monitor B. QRS duration of 0.28 seconds C. Decreased bowel sounds D. Weakened grip strength

Answer: B Rationale: When administering intravenous potassium supplements, it is important to evaluate for clinical manifestations of hyperkalemia. Widening of the Q waves is a potentially fatal manifestation of hyperkalemia (because it may lead to cardiac arrest) and would be communicated rapidly to the health care provider so that the infusion can be stopped and the potassium level can be rechecked. The other findings would be reported to the health care provider but are expected with hypokalemia and are not an indication for a change in treatment. U waves are an expected manifestation of hypokalemia because of changes in ventricular repolarization. Decreased bowel sounds may occur because of decreased peristalsis caused by low potassium levels but should improve with potassium administration. Weakened grips may occur with hypokalemia because normal extracellular potassium levels are needed for skeletal muscle contraction.

The clinic nurse receives a call from the mother of an infant prescribed digoxin. The mother reports she forgot whether she gave the morning dose of digoxin. Which response by the nurse is most appropriate? A. 'Give the next dose immediately.' B. 'Wait 2 hours before giving the medication.' C. 'Skip this dose and give it at the next prescribed time.' D. 'Take the baby's pulse and give the medication if it's more than 90 beats/min.'

Answer: C Rationale: An additional dose may cause overdosage, leading to toxicity; it is better to skip the dose. Giving the dose without waiting may cause an overdose, which could result in toxicity. Even waiting 2 hours may cause an overdose, leading to toxicity. Taking the pulse is not a reliable method for determining a missed dose; 90 to 110 beats/min is within the expected range for this age.

Digoxin is prescribed for a client. Which therapeutic effect of digoxin would the nurse expect? A. Decreased cardiac output B. Decreased stroke volume of the heart C. Increased contractile force of the myocardium D. Increased electrical conduction through the atrioventricular (AV) node

Answer: C Rationale: Digoxin produces a positive inotropic effect that increases the strength of myocardial contractions and thus cardiac output. The positive inotropic effect of digoxin increases, not decreases, cardiac output. Digoxin increases the strength of myocardial contractions (positive inotropic effect) and slows the heart rate (negative chronotropic effect); these effects increase the stroke volume of the heart. Digoxin decreases the refractory period of the AV node and decreases conduction through the sinoatrial (SA) and AV nodes.

A nurse is teaching a client with stable angina about newly prescribed SL nitroglycerin. Which statement should the nurse include in the teaching? A. "Take this medication after each meal and at bedtime." B. "Take one tablet 30 minutes before any physical activity." C. "Take one tablet immediately when you experience chest pain." D. "Take this medication with 8 ounces of water."

Answer: C Rationale: Nitroglycerin is a vasodilator used to treat angina or ischemic chest pain. When teaching a client about SL nitroglycerin, the nurse should instruct the client to take one tab and place it under their tongue immediately when experiencing chest pain. The client only takes this medication when experiencing chest pain. The client should not eat or drink when taking this medication.

The nurse is reviewing medication instructions with parents of an infant receiving digoxin and spironolactone. Which parental response indicates instructions have been understood? A. Activity should be restricted. B. Orange juice should be given daily. C. Vomiting should be reported to the health care provider. D. Anti-inflammatory medications should be avoided.

Answer: C Rationale: Vomiting is a classic sign of digoxin toxicity, and the health care provider must be notified. Infants regulate their own activity according to their energy level. Orange juice is rarely needed because spironolactone spares potassium. There is no restriction on anti-inflammatory medications with spironolactone.

A client with heart failure is to receive digoxin. Which therapeutic effect is associated with this medication? A. Reduces edema B. Increases cardiac conduction C. Increases rate of ventricular contractions D. Slows and strengthens cardiac contractions

Answer: D Rationale: Digoxin improves cardiac function by increasing the strength of myocardial contractions (positive inotropic effect) and, by altering the electrophysiological properties of the heart, slows the heart rate (negative chronotropic effect). Digoxin increases the strength of the contractions but decreases the heart rate. Although a reduction in edema may result from the increased blood supply to the kidneys, it is not the reason for administering digoxin. Digoxin decreases, not increases, cardiac impulses through the conduction system of the heart.

3) A client with heart failure is being discharged with a new prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten). The nurse's discharge instructions should include reporting which problem to the healthcare provider? A. Weight loss. B. Dizziness. C. Muscle cramps. D. Dry mucous membranes

B Angiotensin-converting enzyme (ACE) inhibitors are used in heart failure to reduce afterload by reversing vasoconstriction common in heart failure. This vasodilation can cause hypotension and resultant dizziness. Weight loss is desired if fluid overload is present, and may occur as the result of effective combination drug therapy such as diuretics with ACE inhibitors. It does not require reporting to the healthcare provider. Unlike ACE inhibitors, diuretics may result in hypokalemia and excessive diuretic administration may result in fluid volume deficit manifested by symptoms of dehydration.

4) The nurse is reviewing prescribed medications with a client. Which information should the nurse reinforce about captopril? A. Take the medication with meals. B. Avoid using salt substitutes. C. Restrict fluids to 1000 mL/day. D. Avoid green leafy vegetables

B Rationale: Captopril is an angiotensin converting enzyme (ACE) inhibitor. It reduces aldosterone secretion, thereby reducing sodium and water retention. Captopril is used to treat hypertension and heart failure. Because it can cause an accumulation of serum potassium (i.e., hyperkalemia), clients should avoid the use of salt substitutes, which often contain potassium instead of sodium chloride. The other information does not apply to captopril.

10) The nurse is preparing to administer diltiazem to a client with heart disease. Which action should the nurse take first? A. Assess the client's lung sounds and monitor for wheezing B. Assess the client's blood pressure and apical pulse C. Assess the client's urine output and potassium level D. Auscultate the abdomen for bowel sounds

B Rationale: Diltiazem is a calcium channel blocker that is used to treat hypertension, angina and tachyarrhythmias. The medication works by causing systemic vasodilation and lowering the client's heart rate. Common side effects of diltiazem include hypotension, orthostatic hypotension, bradycardia, edema and headaches. It is not necessary to auscultate the client's lung sounds prior to administering the medication. Wheezing is not considered a side effect of diltiazem. Because the medication can lead to hypotension and bradycardia, it is essential to assess the client's blood pressure and apical pulse prior to administration. It is not necessary to check the client's urine output or potassium level prior to administering the medication. Diltiazem does not affect a client's renal status or potassium level. It is not necessary to check the client's bowel sounds prior to administering the medication. Diltiazem does not affect a client's gastrointestinal system.

5) The nurse is assisting a client who is taking amlodipine with meal planning. Which fluid selected by the client would require follow up by the nurse? A. Black coffee B. Grapefruit juice C. Green tea D. Chocolate Milk

B Question Explanation Rationale: Grapefruit juice affects the metabolism of certain medications, such as amlodipine, and may cause toxicity if taken together. Clients who are taking antibiotics, such as tetracycline, should avoid consuming milk products. Clients who are taking warfarin should avoid consuming green tea. Clients who are taking stimulants should avoid consuming black coffee.

6) A primary health care provider prescribes atenolol 20 mg by mouth four times a day. Which information is important for the nurse to include in the discharge teaching plan for this client? A. Drink alcoholic beverages in moderation. B. Avoid abruptly discontinuing the medication. C. Increase the medication if chest pain develops. D. Report a pulse rate less than 70 beats/minute.

B Rationale An abrupt discontinuation of atenolol may cause an acute myocardial infarction. Alcohol is contraindicated for clients taking atenolol because it can cause additive hypotension. Clients should never increase medications without a health care provider's direction. The pulse rate can go much lower as long as the client feels well and is not dizzy.

30) Hypertension develops in a school-age child with acute glomerulonephritis. Which medication would the nurse anticipate providing teaching for? A. Digoxin B. Furosemide C. Diazepam D. Phenytoin

B Rationale Furosemide inhibits the reabsorption of sodium and chloride from the loop of Henle and distal tubule, increasing urine output and thereby decreasing blood pressure. Digoxin increases the contractility and output of the heart; it is not an antihypertensive. Diazepam is inappropriate; it relaxes skeletal muscle, not the smooth muscle of the arterioles. Phenytoin is an anticonvulsant; it does not reduce blood pressure.

1) Valsartan, an angiotensin II receptor antagonist, is prescribed for a client. The nurse will monitor the client for which adverse effect? A. Constipation B. Hyperkalemia C. Hypertension D. Change in visual acuity

B Rationale Hyperkalemia may occur with valsartan. Angiotensin II receptor antagonists, such as valsartan, block vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites to decrease blood pressure. Hypotension, not hypertension, may occur. Diarrhea, not constipation, may occur with valsartan. Valsartan does not cause altered visual acuity.

15) A client is admitted to the hospital with a diagnosis of heart failure and acute pulmonary edema. The health care provider prescribes furosemide 40 mg intravenous (IV) stat to be repeated in 1 hour. Which nursing action will best evaluate the effectiveness of the furosemide in managing the client's condition? A. Performing daily weights B. Auscultating breath sounds C. Monitoring intake and output D. Assessing for dependent edema

B Rationale Maintaining adequate gas exchange and minimizing hypoxia with pulmonary edema are critical; therefore assessing the effectiveness of furosemide therapy as it relates to the respiratory system is most important. Furosemide inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule, causing diuresis; as diuresis occurs fluid moves out of the vascular compartment, thereby reducing pulmonary edema and the bilateral crackles. Although a liter of fluid weighs approximately 2.2 pounds (1 kg) and weight loss will reflect the amount of fluid lost, it will take time before a change in weight can be measured. Although identifying a greater output versus intake indicates the effectiveness of furosemide, it is the client's pulmonary status that is most important with acute pulmonary edema. Although the lessening of a client's dependent edema reflects effectiveness of furosemide therapy, it is the client's improving pulmonary status that is the best indicator of how furosemide improves the client's condition.

32) The nurse is administering 40 mg of furosemide intravenously. Which sensation reported by the client would the nurse consider when determining that it is being administered too quickly? A. Full bladder B. Buzzing ears C. Fast heartbeat D. Numb arms and legs

B Rationale Rapid administration of furosemide can cause tinnitus (a perceived ringing or buzzing in the ears), loss of hearing, and ear pain. Furosemide has a diuretic effect, so a full bladder with a need to urinate is an anticipated response unrelated to speed of administration. Furosemide does not affect the heart rate. Furosemide does not cause peripheral neuropathy.

4) A client with cirrhosis of the liver has been taking chlorothiazide. The provider adds spironolactone to the client's medication regimen to prevent which condition? A. Hyponatremia B. Hypokalemia C. Ascites D. Peripheral neuropathy

B Rationale Spironolactone is a potassium-sparing diuretic often used in conjunction with thiazide diuretics. The provider was prompted to add spironolactone to the chlorothiazide to prevent potassium loss. It stimulates sodium excretion so will not prevent hyponatremia. Spironolactone is a relatively weak diuretic that will not have a significant effect on ascites. Peripheral neuropathy is not a concern in this scenario and spironolactone would not have an effect on it if it was a concern.

11) Which clinical indicator would the nurse monitor to determine if the client's simvastatin is effective? A. Heart rate B. Triglycerides C. Blood pressure D. International normalized ratio (INR)

B Rationale Therapeutic effects of simvastatin include decreased levels of serum triglycerides, low-density lipoprotein (LDL), and cholesterol. INR is not related to simvastatin; it is a measure used to evaluate blood coagulation. Heart rate and blood pressure are not related to simvastatin.

3) Which sign of hypokalemia will the nurse monitor for in a client receiving furosemide? A. Chvostek sign B. Muscle weakness C. Anxious behavior D. Abdominal cramping

B Rationale With hypokalemia, failure occurs in myoneural conduction and smooth muscle functioning, resulting in fatigue and muscle weakness. Chvostek sign, the contraction of the facial muscles in response to a light tap over the facial nerve in front of the ear, is associated with hypocalcemia; low calcium levels allow sodium to move into excitable cells, increasing depolarization and nerve excitability. Anxiety and irritability are associated with hyperkalemia. Hyperkalemia affects the nervous and muscular systems; fatigue, weakness, and lethargy are associated with hypokalemia. Decreased gastrointestinal motility occurs with hypokalemia; abdominal cramping is associated with hyperkalemia and is caused by hyperactivity of smooth muscles.

12) The nurse is providing discharge education to a client who will be starting daily atenolol for the treatment of hypertension. Which side effect is most important for the client to notify their health care provider about? A. Decreased libido B. Slow, irregular heart rate C. Dizziness in the morning D. Decreased exercise tolerance

B Rationale: Atenolol is a Beta-1 selective adrenergic blocking agent or a "beta blocker." These medications are commonly used to treat hypertension or chronic angina. Due to their selectivity, they are the preferred medications for clients who have the comorbidities of Chronic Obstructive Pulmonary Disease (COPD). Common adverse effects often relate to the therapeutic action of the drug and include impotence, decreased libido, dizziness, decreased exercise tolerance, slowed heart rate, arrhythmias and heart failure. The client should be taught to assess their heart rate and to notify the health care provider of any changes to the heart rate or rhythm.

2) The nurse is providing education to the parents of a 10-year-old child who is diagnosed with diabetes insipidus (DI) and has been prescribed vasopressin. What important information should the nurse include regarding this medication? A. The child will need intravenous therapy for several weeks. B. The parents must closely monitor the child's fluid intake. C. The child may experience brief episodes of chest pain. D. The child should be observed for signs of dehydration.

B Rationale: Diabetes insipidus is characterized by a decreased secretion of antidiuretic hormone (ADH), resulting in excess diuresis and fluid volume deficit. Vasopressin, a synthetic form of ADH, is the drug of choice to treat DI. Vasopressin therapy can lead to excessive water retention and water intoxication. A major cause of intoxication is failure to reduce water intake once ADH therapy has begun. Because treatment prevents continued fluid loss, failure to decrease fluid intake will result in water buildup. Hence, at the onset of treatment, clients should be instructed to reduce their accustomed intake of fluid.

5) The nurse is providing information to a client about propranolol. Which statement by the client indicates the teaching has been effective? A. "I should expect to feel nervousness during the first few weeks." B. "I can have a heart attack if I stop this medication suddenly." C. "I could have an increase in my heart rate for a few weeks." D. "I may experience seizures if I stop the medication abruptly."

B Rationale: Propranolol is commonly used to treat hypertension, abnormal heart rhythms, heart disease and certain types of tremors. It is in a class of medications called beta blockers. Suddenly discontinuing a beta blocker can cause angina, hypertension, dysrhythmias, or even a myocardial infarction (i.e., heart attack).

2) The nurse is planning care for a pediatric client with a new prescription for adenosine to treat symptomatic supraventricular tachycardia (SVT). Which action should the nurse include in the plan of care? A. Monitor for ventricular dysrhythmias B. Monitor for shortness of breath C. Monitor for hypertension D. Monitor for nausea.

B Rationale: After giving adenosine, the nurse would monitor for shortness of breath, dyspnea, and a worsening of asthma, as they are expected effects/outcomes with this medication. Monitoring for ventricular dysrhythmias is necessary when giving dobutamine, dopamine, and epinephrine but not adenosine. Vomiting is not an expected outcome of adenosine. The nurse should include monitoring for hypotension, not hypertension, in the plan of care after administration of adenosine and instruct parents to change positions slowly to minimize orthostatic hypotension.

18) The nurse is preparing to administer metoprolol to a client with a history of hypertension. Which of the following data is the priority for the nurse to review prior to administration? A. Potassium level B. Most recent heart rate C. Creatinine level D. Respiratory rate

B Rationale: Beta-blockers, such as metoprolol, can decrease heart rate and blood pressure, so the nurse should review these specific vital signs prior to administering the medication. Most prescriptions will state to hold the medication if the heart rate or blood pressure is less than a designated value. Potassium and creatinine levels are monitored with clients who are taking lisinopril, an ACE inhibitor. Respiratory rate is an important part of assessment but is not the priority for the administration of a beta-

7) A nurse is providing education to a client about newly prescribed diltiazem. Which statement will the nurse include in the teaching? A. Skip the dose if your systolic blood pressure is less than 120 mmHg B. Hold the dose if your heart rate is less than 50 beats/min C. Call your healthcare provider if you experience any fever D. Notify your healthcare provider if you notice any weight loss

B Rationale: Diltiazem is a calcium channel blocker medication used in the treatment of hypertension and cardiac arrhythmias such as atrial flutter and fibrillation. Diltiazem can cause bradycardia. The nurse should instruct the client how to take their pulse and hold the dose if less than 50 beats/min. Diltiazem should be held if the systolic blood pressure is below 90 mmHg. Fever and weight loss are not effects associated with the use of diltiazem.

17) A client prescribed atenolol has a blood pressure of 120/68 mmHg, displaying a sinus bradycardia with a rate of 58 beats/minute, and a P-R interval of 0.24. Which action should the nurse take? A. Lower the head of the bed and assess the client for orthostatic vital sign changes. B. Give the medication as prescribed and continue to monitor the client. C. Prepare to administer atropine sulfate IV push. D. Hold the prescribed dose and contact the healthcare provider.

B Since the client's blood pressure is within normal limits, and the pulse is above 50 beats/min with a first degree block, the medication can be administered. Atenolol is a beta-blocker that slows the heart rate and lowers the blood pressure; this drug is generally held if the heart rate is less than 50 beats/min or the client exhibits dizziness related to hypotension.

1) A client with heart failure is prescribed spironolactone (Aldactone). Which information is most important for the nurse to provide to the client about diet modifications? A. Do not add salt to foods during preparation. B. Refrain for eating foods high in potassium. C. Restrict fluid intake to 1000 ml per day. D. Increase intake of milk and milk products.

B Spironolactone (Aldactone), an aldosterone antagonist, is a potassium-sparing diuretic, so a diet high in potassium should be avoided, along with table salt substitutes, which generally contain potassium chloride that can lead to hyperkalemia.

13) The nurse is providing care for a client prescribed propranolol. Which symptoms should the nurse report to the healthcare provider immediately? A. Headache, hypertension, and blurred vision. B. Wheezing, hypotension, and AV block. C. Vomiting, dilated pupils, and papilledema. D. Tinnitus, muscle weakness, and tachypnea.

B Wheezing, hypotension, and AV block represents the most serious adverse effects of beta-blocking agents. AV block is generally associated with bradycardia and results in potentially life-threatening decreases in cardiac output. Additionally, wheezing secondary to bronchospasm and hypotension represent life-threatening respiratory and cardiac disorders.

4) Which nursing diagnosis is important to include in the plan of care for a client receiving the angiotensin-2 receptor antagonist irbesartan (Avapro)? A. Fluid volume deficit. B. Risk for infection. C. Risk for injury. D. Impaired sleep patterns.

C Avapro is an antihypertensive agent, which acts by blocking vasoconstrictor effects at various receptor sites. This can cause hypotension and dizziness, placing the client at high risk for injury.

3) The healthcare provider prescribes a beta-1 agonist medication to be administered. The nurse should anticipate the medication to be prescribed for a client diagnosed with which condition? A. Glaucoma. B. Hypertension. C. Heart failure. D. Asthma.

C Beta-1 agonists improve cardiac output by increasing the heart rate and blood pressure. They are indicated in heart failure, shock, atrioventricular block dysrhythmias, and cardiac arrest.

14) A client who was prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs. Which statement reflects the correct drug-specific teaching the nurse should provide to this client? A. Increase consumption of potassium-rich foods since low potassium levels can cause muscle spasms. B. Have serum electrolytes checked at the next scheduled appointment to assess hyponatremia, a cause of cramping. C. Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. D. Be sure to consume a low-cholesterol diet while taking the drug to enhance the effectiveness of the drug.

C Myopathy, suggested by the leg pain and weakness, is a serious and potentially life-threatening complication of Lipitor, and should be evaluated immediately by the healthcare provider.

22) A beta blocker is prescribed for the client with persistent ventricular tachycardia. Which response indicates that the beta blocker is working effectively? A. Decreased anxiety B. Reduced chest pain C. Decreased heart rate D. Increased blood pressure

C Rationale A decreased heart rate is the expected response to a beta blocker. Beta blockers inhibit the activity of the sympathetic nervous system and of adrenergic hormones, decreasing the heart rate, conduction velocity, and workload of the heart. A beta blocker is not an anxiolytic and does not reduce anxiety. A beta blocker is not an analgesic and does not reduce chest pain. Beta blockers reduce blood pressure.

9) Which medication may be useful in managing hypertension in a child with acute glomerulonephritis? A. Digoxin B. Diazepam C. Captopril D. Phenytoin

C Rationale Captopril, an angiotensin-converting enzyme inhibitor antihypertensive, blocks the conversion of angiotensin I to the constrictor angiotensin II. Digoxin is not an antihypertensive; it increases the contractility and output of the heart. Diazepam is not an antihypertensive; it relaxes skeletal muscle. Phenytoin is not an antihypertensive; it is an anticonvulsant.

9) A client with supraventricular tachycardia (SVT) has a heart rate of 170 beats/minute. After treatment with diltiazem, which assessment indicates to the nurse that the diltiazem is effective? A. Increased urine output B. Blood pressure of 90/60 mm Hg C. Heart rate of 98 beats/minute D. No longer complaining of heart palpationS

C Rationale Diltiazem hydrochloride's purpose is to slow down the heart rate. SVT has a heart rate of 150 to 250 beats/minute. A heart rate of 110 beats/minute indicates that the diltiazem hydrochloride is having the desired effect. Hypotension is a side effect of diltiazem hydrochloride, not a desired effect. Heart palpations are experienced by some with various dysrhythmias. A decreased sensation of heart palpations is a positive finding but is not present in all clients. Increased urine output may occur over a period of time because of the increased ventricular filling time but would not occur until after the heart rate had stabilized.

27) A health care provider prescribes a diuretic for a client with hypertension. Which mechanism of action explains how diuretics reduce blood pressure? A. They facilitate vasodilation. B. They promotes smooth muscle relaxation. C. They reduce the circulating blood volume. D. They block the sympathetic nervous system.

C Rationale Diuretics decrease blood volume by blocking sodium reabsorption in the renal tubules, thus promoting fluid loss and reducing arterial pressure. Direct relaxation of arteriolar smooth muscle is accomplished by vasodilators, not diuretics. Vasodilators, not diuretics, act on vascular smooth muscle. Medications that act on the nervous system, not diuretics, inhibit sympathetic vasoconstriction.

2) Amlodipine is prescribed for a client with hypertension. Which response to the medication will the nurse instruct the client to report to the health care provider? A. Blurred vision B. Dizziness on rising C. Difficulty breathing D. Excessive urination

C Rationale Dyspnea may indicate development of pulmonary edema, which is a life-threatening condition. Blurred vision may occur in some people, but it is not life-threatening. Dizziness on rising and excessive urination are common side effects of this medication that are not life-threatening.

7) A health care provider prescribes enalapril for a client. Which nursing action is important? A. Assess the client for hypokalemia. B. Monitor for adverse effects on renal function. C. Monitor the client's blood pressure during therapy. D. Assess the client for hypoglycemia.

C Rationale Enalapril is an antihypertensive. A lowering of the client's blood pressure reflects a therapeutic response and needs to be monitored regularly. The client may be at risk for hyperkalemia, not hypokalemia. Enalapril has renal protective effects rather than adverse renal effects. Although an antihypertensive of choice for some clients with diabetes, it does not affect glucose levels.

4) A client is receiving furosemide to relieve edema. The nurse will monitor the client for which adverse effect? A. Hypernatremia B. Elevated blood urea nitrogen C. Hypokalemia D. Increase in the urine specific gravity

C Rationale Furosemide is a potent diuretic used to provide rapid diuresis; it acts in the loop of Henle and causes depletion of electrolytes, such as potassium and sodium. Furosemide inhibits the reabsorption, not retention, of sodium. Furosemide does not affect protein metabolism and will not elevate blood urea nitrogen. Because furosemide increases water excretion relative to solutes, the specific gravity of the fluid more likely will be low.

7) A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone. The nurse will monitor the client for which adverse medication effect? A. Bruising B. Tachycardia C. Hyperkalemia D. Hypoglycemia

C Rationale Spironolactone is a potassium-sparing diuretic that is used to treat clients with ascites; therefore the nurse would monitor the client for signs and symptoms of hyperkalemia. Bruising and purpura are associated with cirrhosis, not with the administration of spironolactone. Spironolactone does not cause tachycardia. Spironolactone does not cause hypoglycemia.

8) Which medication requires the nurse to monitor the client for signs of hyperkalemia? A. Furosemide B. Metolazone C. Spironolactone D. Hydrochlorothiazide

C Rationale Spironolactone is a potassium-sparing diuretic; hyperkalemia is an adverse effect. Furosemide, metolazone, and hydrochlorothiazide generally cause hypokalemia.

2) A health care provider in the emergency department identifies that a client is in cardiogenic shock. Which type of medication is indicated for management of this condition? A. Loop diuretic B. Cardiac glycoside C. Sympathomimetic D. Alpha-adrenergic blocker

C Rationale Sympathomimetics are vasopressors that induce arterial constriction, which increases venous return and cardiac output. Diuretics promote excretion of fluid, which is not indicated. Cardiac glycosides slow and strengthen the heartbeat; they do not increase the blood pressure and may decrease it. Alpha-adrenergic blockers decrease peripheral resistance, resulting in a decreased blood pressure.

20) A client who is receiving atenolol for hypertension frequently reports feeling dizzy. Which effect of atenolol is responsible for this response? A. Depleting acetylcholine B. Stimulating histamine release C. Blocking the adrenergic response D. Decreasing adrenal release of epinephrine

C Rationale The beta-adrenergic blocking effect of atenolol decreases the heart's rate and contractility; it may result in orthostatic hypotension and decreased cerebral perfusion, causing dizziness. Depleting acetylcholine is not an action of atenolol. Stimulating histamine release is not an action of atenolol. Decreasing adrenal release of epinephrine is not an action of atenolol.

9) A client hospitalized for uncontrolled hypertension and chest pain was started on a daily diuretic 2 days ago upon admission, with prescriptions for a daily basic metabolic panel. The client's potassium level this morning is 2.7 mEq/L (2.7 mmol/L). Which action will the nurse take next? A. Send another blood sample to the laboratory to retest the serum potassium level. B. Notify the health care provider that the potassium level is above normal. C. Notify the health care provider that the potassium level is below normal. D. No action is required because the potassium level is within normal limits.

C Rationale The health care provider should be notified immediately because the client's potassium is below normal. The normal potassium level range is 3.5 mEq/L to 5.0 mEq/L (3.5-5.0 mmol/L). Clients on diuretic therapy require close monitoring of their electrolytes because some can cause hypokalemia, whereas others spare potassium, which can cause hyperkalemia. Retesting the serum potassium level is unnecessary and will delay the treatment required by the client.

1) Which information is most important for the nurse to teach a client prescribed an antihypertensive medication to be taken once in the morning and a 2-gram sodium diet? A. "Avoid adding salt to cooked foods." B. "Use less salt when preparing foods." C. "Take your medicine exactly as prescribed." D. "Measure your blood pressure every morning."

C Rationale The most effective way to lower the blood pressure is to take the prescribed medication daily. Restricting salt in the diet will help limit fluid retention and thus reduce the blood pressure, but it is not as effective as an antihypertensive. Salt should not be added during food preparation. The natural sodium content of foods should be calculated in a 2-gram sodium diet. It is not necessary to take daily blood pressure measurements unless specifically prescribed to do so by the primary health care provider.

23) A client has primary open-angle glaucoma. Which ophthalmic preparation is indicated to manage this condition? A. Tetracaine B. Fluorescein C. Timolol maleate D. Atropine sulfate

C Rationale Timolol maleate is a beta-adrenergic antagonist that decreases aqueous humor production and increases outflow, thereby reducing intraocular pressure. Tetracaine is a topical anesthetic; it will not reduce the increased intraocular pressure associated with glaucoma. Fluorescein is a dye used to identify corneal abrasions and foreign bodies. Atropine sulfate, a mydriatic, is contraindicated because it dilates the pupil, obstructing drainage and increasing intraocular pressure.

14) The nurse incorrectly administers carvedilol (Coreg) to a client with an order for benztropine (Cogentin). What is the priority nursing intervention after making this medication error? A. Complete an incident report B. Notify the nurse manager C. Monitor the client's blood pressure D. Notify the health care provider

C Rationale: Because the nurse mistakenly administered a beta blocker medication, the priority intervention is to monitor the client for any adverse physiological response to the given drug. Carvedilol blocks alpha1 and beta receptors in blood vessels, causing dilation and a decrease in blood pressure.

10) The health care provider has written a new order to give metoprolol tartrate 25 mg twice a day by mouth. In assessing the client prior to administering the medications, which finding should the nurse report to the health care provider? A. Urine output of 50 mL/hour B. Respiratory rate of 16 C. Blood pressure of 94/60 D. Heart rate of 76 BPM

C Rationale: Both medications decrease the heart rate. Metoprolol (Lopressor)affects blood pressure. Therefore, the heart rate and blood pressure must be within normal range (HR 60 to 100 BPM and systolic BP greater than 100 mm Hg) in order to safely administer both medications.

10) The nurse is caring for a client who is being treated for heart failure. After completing the medication reconciliation process, the nurse notes that the prescriber has added lisinopril 5mg orally bid. Which medication from the list below should the nurse question due to possible drug-to-drug interaction with lisinopril? A. Metoprolol B. Glipizide C. Naproxen D. Enoxaparin

C Rationale: Nonsteroidal anti-inflammatory (NSAIDs) drugs, such as naproxen, reduce the antihypertensive effects of angiotensin converting enzyme (ACE) inhibitors such as lisinopril. The use of NSAIDs and ACE inhibitors may also predispose patients to develop acute renal failure. Additionally, naproxen increases the risk of heart attack or stroke with heart disease. The nurse should clarify the naproxen with the health care provider. The other medications are not known to interact with lisinopril.

19) The nurse is talking with a client who was admitted with an acute myocardial infarction due to coronary artery disease. The clients asks what the purpose for the prescribed carvedilol is. How should the nurse respond? A. "A beta blocker will prevent postural hypotension." B. "Most people develop hypertension after a heart attack." C. "This drug will decrease the workload on your heart." D. "Beta blockers will help to increase your heart rate."

C Rationale: One action of beta blockers is to decrease systemic vascular resistance by dilation of the arterioles. This is useful for clients with coronary artery disease and will reduce the risk of another MI or a sudden cardiac event. Some of the more commonly prescribed beta blockers include metoprolol and carvedilol (Coreg). The other responses are incorrect.

11) A 42-year-old male client diagnosed with hypertension tells the nurse he no longer wants to take the prescribed propranolol. Which client statement best explains the reason why he does not want to take this medication? A. "I have difficulty falling asleep." B. "I'm having problems with my stomach." C. "I'm experiencing decreased sex drive." D. "I feel so tired all the time."

C Rationale: Propranolol is a beta-blocker used to treat many conditions, such as essential tremors, angina, hypertension and heart rhythm disorders. Common side effects of this drug include nausea, diarrhea, constipation, stomach cramps, rash, tiredness, dizziness, sleep problems and vision changes. Additionally, propranolol may cause decreased sex drive, impotence or difficulty having an orgasm in men. The clients can be switched to an alternative antihypertensive, such as an angiotensin-converting enzyme (ACE) inhibitor or a calcium channel blocker.

5) The nurse is administering spironolactone for a client diagnosed with cirrhosis of the liver and ascites. Which electrolyte should the nurse anticipate to be spared when giving this medication? A. Sodium B. Phosphate C. Potassium D. Albumin

C Rationale: Spironolactone is a potassium-sparing diuretic. Indications for this medication include edema associated with heart failure, cirrhosis, and nephrotic syndrome. The nurse should anticipate that potassium is spared and should watch for signs of heart arrhythmias if the potassium is too elevated. This type of diuretic inhibits the action of aldosterone on the kidneys, which does not allow the body to reabsorb sodium. An adverse effect could be hyponatremia. This medication has no effects on phosphate and albumin is not an electrolyte.

6) The nurse is admitting a client to the hospital with findings of liver failure and ascites. A health care provider (HCP) orders spironolactone. The nurse understands that the pharmacological effects of the medication, are which of the following? A. Combines safely with antihypertensives B. Depletes potassium reserves C. Promotes sodium and chloride excretion D. Increases aldosterone levels

C Rationale: Spironolactone is considered a diuretic, that is indicated for individuals with hypertension, edema, congestive heart failure and potassium loss. Spironolactone promotes sodium and chloride excretion while sparing potassium and decreasing aldosterone levels. Spironolactone is often combined with other diuretics and anti-hypertensive agents. Kidney function and electrolytes should be monitored more closely when spironolactone is used in combination with other medications. The medication is considered a potassium-sparing diuretic, because as aldosterone levels decrease and sodium and water is excreted, potassium is spared. A major side effect of spironolactone is hyperkalemia.

4) A client has been prescribed cholestyramine (Questran) in addition to other medications for coronary artery disease and hyperlipidemia. When should the nurse instruct the client to take the cholestyramine? A. At least 1 to 2 hours after other medications B. At least 1 hour before meals C. Anytime is acceptable D. Early in the morning on an empty stomach

A Question Explanation Rationale: Cholestyramine is a bile acid sequestrant used to reduce LDL cholesterol levels. They are used primarily as adjuncts to statin therapy. Benefits derive from blocking cholesterol synthesis in the liver. The bile-acid sequestrants can form insoluble complexes with other drugs. Medications that undergo binding cannot be absorbed, and hence are not available for systemic effects. Drugs known to form complexes with the sequestrants include thiazide diuretics, digoxin, warfarin, and some antibiotics. To reduce the formation of sequestrant-drug complexes, oral medications that are known to interact should be administered either 1 to 2 hours before the sequestrant or 4 hours after. Cholestyramine works best when taken with meals.

1) A client with hyperlipidemia receives a prescription for niacin (Niaspan). Which client teaching is most important for the nurse to provide? A. Expected duration of flushing. B. Symptoms of hyperglycemia. C. Diets that minimize GI irritation. D. Comfort measures for pruritus.

A Flushing of the face and neck, lasting up to an hour, is a frequent reason for discontinuing niacin. Inclusion of this effect in client teaching may promote compliance in taking the medication. While nutrition tips and managing pruritus are worthwhile instructions to help clients minimize or cope with normal side effects associated with niacin (Niaspan), flushing is intense and causes the most concern for the client.

7) A client with hypertension has received a prescription for metoprolol. Which information will the nurse include when teaching this client about metoprolol? A. Do not abruptly discontinue the medication. B. Consume alcoholic beverages in moderation. C. Report a heart rate of less than 70 beats per minute. D. Increase the medication dosage if chest pain occurs.

A Rationale Abrupt discontinuation of metoprolol may cause rebound hypertension and an acute myocardial infarction. Alcohol is contraindicated for clients taking beta-adrenergic blockers such as metoprolol. Clients should never increase medications without medical direction. The pulse rate can go lower than 70 beats per minute as long as the client is asymptomatic.

9) A client who has type 1 diabetes and chronic bronchitis is prescribed atenolol for the management of angina pectoris. Which clinical manifestation will alert the nurse to the fact that the client may be developing a life-threatening response to the medication? A. Paroxysmal nocturnal dyspnea B. Supraventricular tachycardia C. Malignant hypertension D. Hyperglycemia

A Rationale Atenolol is associated with the adverse reactions of bradycardia, heart failure, and pulmonary edema; these are the most serious responses to atenolol and are often manifested by episodes of paroxysmal nocturnal dyspnea and orthopnea. A decreased, not increased, pulse rate is associated with atenolol so supraventricular tachycardia is not a response. Atenolol decreases, not increases, blood pressure so malignant hypertension is not a response. It also will not cause an increase in blood glucose. It may increase the hypoglycemic response to insulin, causing hypoglycemia. In addition, the medication may mask the clinical manifestations of hypoglycemia.

21) Which action describes a therapeutic effect of atenolol? A. Heart rate decreases B. Cardiac output increases C. Bronchospasm is relieved D. Pulse oximetry improves

A Rationale Atenolol, a beta-blocker, slows the rate of sinoatrial (SA) node discharge and atrioventricular (AV) node conduction, thus decreasing the heart rate; it prevents angina by decreasing the cardiac workload and myocardial oxygen consumption. Cardiac output is not increased and may be decreased. Atenolol may promote bronchospasm, not relieve it. Atenolol does not directly affect gas exchange in the lungs to promote improving oxygenation.

3) A client is receiving metoprolol. Which potential effect will the nurse teach the client to expect? A. Dizziness with strenuous activity B. Acceleration of the heart rate after eating a heavy meal C. Flushing sensations after taking the medication D. Pounding of the heart

A Rationale Because metoprolol competes with catecholamines at beta-adrenergic receptor sites, the expected increase in the heart's rate and contractility in response to exercise does not occur. This, combined with the medication's hypotensive effect, may lead to dizziness. Metoprolol decreases the heart rate. Flushing sensations and pounding of the heart do not represent side effects of metoprolol.

6) A client is given a prescription for bumetanide. The nurse will teach the client to watch for symptoms of which condition? A. Hypokalemia B. Hyperchloremia C. Hypernatremia D. Hypoglycemia

A Rationale Bumetanide is a loop diuretic. Diuretic therapy that affects the loop of Henle increases urinary excretion of sodium, chloride, and potassium. As a result, clients are at risk for hypokalemia, hyponatremia, and hypochloremia. Additionally, hyperglycemia can occur.

17) A client is receiving hydrochlorothiazide. Which physiological alteration will the nurse monitor to best determine the effectiveness of the client's hydrochlorothiazide therapy? A. Blood pressure B. Decreasing edema C. Serum potassium level D. Urine specific gravity

A Rationale Diuretics promote urinary excretion, which reduces the volume of fluid in the intravascular compartment, thus lowering blood pressure. The measure of blood pressure is the best determination of effectiveness because it is a direct measure of the desired outcome. A reduction in edema reflects effectiveness; however, multiple physiological processes, including venous competence, gravity, and disuse, maintain a significant degree of edema even when the diuretic is optimally effective. A lowered potassium level would indirectly indicate that the medication is working; however, this does not provide a good measure of effectiveness. Although specific gravity decreases with increased urinary output, and thus would demonstrate that the medication is working, it is not a direct measure of the desired outcome. A measure of the reduction in intravascular pressure is preferable.

1) Which is an appropriate nursing action when caring for a client taking benazepril for hypertension? A. Assess for dizziness. B. Assess for dark, tarry stools. C. Administer the medication after meals. D. Monitor the electroencephalogram (EEG).

A Rationale Dizziness may occur during the first few weeks of therapy until the client adapts physiologically to the medication. Dark, tarry stools are not a side effect of benazepril. Administering the medication after meals is unnecessary; however, if nausea occurs, the medication may be taken with food or at bedtime. The blood pressure should be monitored before and after administration. An EEG is unnecessary. Cardiac monitoring may be instituted because of possible dysrhythmias.

2) The nurse prepares discharge instructions for a client who will take enalapril for hypertension. Which instruction would the nurse include in the client's teaching? A. 'Change to a standing position slowly.' B. 'This may color your urine green.' C. 'The medication may cause a sore throat for the first few days.' D. 'Schedule blood tests weekly for the first 2 months.'

A Rationale Enalapril is classified as an angiotensin-converting enzyme (ACE) inhibitor. Like many antihypertensives, it can cause orthostatic hypotension. Clients should be advised to change positions slowly to minimize this effect. This medication does not alter the color of urine or cause a sore throat the first few days of treatment. Presently, there are no guidelines that suggest blood tests are required weekly for the first 2 months.

2) Which instructions will the nurse include in the teaching plan for a client with hyperlipidemia who is being discharged with a prescription for cholestyramine? A. 'Increase your intake of fiber and fluid.' B. 'Take the medication before you go to bed.' C. 'Check your pulse before taking the medication.' D. 'Contact your health care provider if your skin turns yellow.'

A Rationale Fiber and fluids help prevent the most common adverse effect of constipation and its complication, fecal impaction. The medication should be taken with meals. The pulse is not affected. Cholestyramine binds bile in the intestine; therefore it reduces the incidence of jaundice.

28) Which diuretic would the nurse anticipate administering to a client admitted with acute pulmonary edema? A. Furosemide B. Chlorothiazide C. Spironolactone D. Acetazolamide

A Rationale Furosemide acts on the loop of Henle by increasing the excretion of chloride and sodium; is available for intravenous administration; and is more effective than chlorothiazide, spironolactone, and acetazolamide. Although it is used in the treatment of edema and hypertension, chlorothiazide is not as efficacious as furosemide. Spironolactone is a potassium-sparing diuretic; it is less efficacious than thiazide diuretics. Acetazolamide is used in the treatment of glaucoma to lower intraocular pressure.

5) Furosemide has been prescribed as part of the medical regimen for a client with hypertension. Which client statement indicates a need for medication education? A. 'This can decrease my vitamin K level.' B. 'I will take the medication in the morning.' C. 'I will contact my health care provider if I notice muscle weakness.' D. 'I plan to take the medication even when my blood pressure is normal.'

A Rationale Furosemide can produce hypokalemia, not vitamin K deficiency. A well-balanced diet should provide all the necessary vitamins and nutrients. Further teaching is necessary. The morning is the desirable time to take furosemide; early administration prevents nocturia. The client's statement to call the health care provider at signs of muscle weakness is appropriate because muscle weakness may indicate hypokalemia. The client's response to take the medicine even when the blood pressure is normal demonstrates an understanding that the medication should be taken as prescribed, independent of how the client feels, because hypertension is often asymptomatic.

26) Which mechanism of action explains how hydrochlorothiazide increases urine output? A. Increases the excretion of sodium B. Increases the glomerular filtration rate C. Decreases the reabsorption of potassium D. Increases renal perfusion

A Rationale Hydrochlorothiazide inhibits sodium reabsorption in the nephrons, causing increased excretion of sodium, which increases urine excretion. The glomerular filtration rate is not affected. The loss of potassium is a side effect, not the mechanism of action. Renal perfusion is not affected.

25) Which principle explains how loop diuretics promote diuresis? A. Osmosis B. Filtration C. Diffusion D. Active transport

A Rationale Loop diuretics inhibit the reabsorption of sodium and water in the ascending loop of Henle. The increased sodium load in the distal tubule causes the passive transfer of water from the glomerular filtrate to urine through the process of osmosis. Filtration refers to solutes; solutes are not being passed into the urine. Diffusion is not specific to fluid; osmosis is. Active transport requires energy; water is passively moved from tubule cells to the urine.

33) Hydrochlorothiazide (HCTZ) has been prescribed for a client with hypertension. The client reports hearing that furosemide is more effective and requests a prescription change. How will the nurse respond? A. 'HCTZ has fewer side effects.' B. 'HCTZ does not cause dizziness.' C. 'HCTZ is only taken when needed.' D. 'HCTZ does not cause dehydration.'

A Rationale Side effects from thiazides generally are minor and rarely result in discontinuation of therapy. Dizziness is a side effect of all diuretics. There is a potential for dehydration with all diuretics. All diuretic medications are taken regularly as directed.

23) Which instruction regarding nutrition will the nurse give a client discharged after a short hospitalization for an episode of a transient ischemic attack (TIA) related to hypertension who is on a regimen that includes chlorothiazide? A. "Eat more dark green, leafy vegetables such as spinach." B. "Substitute a potassium-based salt substitute for table salt." C. "Return to previous eating habits." D. "Increase intake of dairy products."

A Rationale The client should increase the dietary intake of potassium because of potassium loss associated with chlorothiazide. Leafy green vegetables are high in potassium and should be encouraged. Salt substitutes should only be used if prescribed by the provider; otherwise, they should be discouraged because electrolyte abnormalities may occur without close monitoring. Returning to previous eating habits may be unsafe for those who do not consume a nutritional diet; the client should be taught about medication-induced deficiencies and how to try to prevent future TIAs. Dairy products should be limited, unless fat-free, because they are high in saturated fats.

16) The nurse provides instruction when the beta-blocker (BB) atenolol is prescribed for a client with moderate hypertension. Which client statement indicates to the nurse that further teaching is needed? A. 'I must take the medication before going to bed.' B. 'This medication will make me feel drowsy.' C. 'I need to count my pulse before taking the medication.' D. 'I will move slowly when changing positions from sitting to standing.'

A Rationale This medication should be taken early in the morning to maximize its therapeutic effect. Orthostatic hypotension is a side effect of BBs, and the client should change positions slowly from sitting to standing to prevent dizziness and falls. Drowsiness is a side effect of BBs, and the client should be taught precautions to prevent injury. The pulse rate should be taken before administration because ventricular dysrhythmias and heart block may occur with BBs.

1) Which medication is indicated for emergency treatment of bleeding esophageal varices? A. Vasopressin B. Neostigmine C. Lansoprazole D. Phytonadione

A Rationale Vasopressin is a vasoconstrictor that can be used to control gastrointestinal bleeding. Neostigmine inhibits cholinesterase, permitting acetylcholine to function; it is used primarily for myasthenia gravis. Lansoprazole is a proton pump inhibitor that is used for the treatment of gastric and duodenal ulcers. Phytonadione is vitamin K; it promotes formation of prothrombin in the liver. Although this medication may be helpful, its effects take too long to be of value in an emergency situation.

8) The nurse is assessing a client with hypertension who reports experiencing dizziness after taking prescribed diltiazem. It is most important that the nurse assesses for which client characteristic? A. Schedule for taking medication B. Appearance of feet and ankles C. Activity and rest patterns D. Daily intake of potassium

A Rationale: A critical focus is whether the client has complied with the prescribed medication schedule and dose. Although diltiazem (Cardizem, Cartia, Dilacor, Diltia, Taztia, Tiazac) can be taken either in the morning or evening, taking the medication in the evening might help with this common side effect.

7) The nurse is observing a new graduate nurse preparing to administer bumetanide 4 mg orally to a client with heart failure. Which client finding requires the nurse to intervene immediately? A. The client's most recent serum potassium level is 2.9 mEq or mmol/L. B. The client has crackles in both lung bases. C. The client has 4+ pitting edema in both lower legs. D. The client's most recent blood pressure is 96/60 mmHg.

A Rationale: Bumetanide is a powerful, potassium-wasting loop diuretic. It promotes diuresis in clients suffering from heart failure (HF) and fluid retention. Prior to administration, the nurse should verify that the client's potassium level is within normal range (3.5 to 5.0 mEq or mmol/L). A serum potassium level of 2.9 mEq or mmol/L is very low. The new graduate nurse should hold the bumetanide and notify the health care provider (HCP) immediately. Bibasilar crackles and pitting edema are expected findings for a client with HF and are indications for the use of diuretics. Although loop diuretics can cause hypotension related to diuresis, a BP of 96/60 is within acceptable limits for a client with HF.

16) The nurse is providing discharge instructions to an older adult client with heart failure. The client asks, "What is the purpose for taking the furosemide?" How should the nurse respond? A. It will help with decreasing fluid buildup in your lungs. B. It will help with reducing the risk for an irregular heart rhythm. C. It will protect your kidneys from chronic damage. D. It will reverse the damage to your heart muscle.

A Rationale: Furosemide is a loop diuretic. Diuretics are the first-line drug of choice in older adults with heart failure (HF) and fluid overload. These drugs enhance the renal excretion of sodium and water by reducing circulating blood volume, decreasing preload, and reducing systemic and pulmonary congestion, i.e., decreased fluid buildup in the lungs. The other actions do not pertain to furosemide.

8) Propranolol is prescribed for a client with coronary artery disease (CAD). The nurse should consult with the health care provider (HCP) before giving this medication when the client reports a history of which condition? A. Asthma B. Deep vein thrombosis C. Myocardial infarction D. Peptic ulcer disease

A Rationale: Non-cardioselective beta-blockers such as propranolol block b1- and b2-adrenergic receptors and can cause bronchospasm, especially in clients with a history of asthma. Beta-blockers will have no effect on the client's peptic ulcer disease or risk for DVT. Beta-blocker therapy is recommended after an MI.'

3) A nurse is providing dietary instructions to a client who is taking prescribed amiloride. Which information will the nurse include in the teaching? A. Avoid eating foods that are rich in potassium such as bananas B. It is important to control high-sodium foods such as canned soups C. Eat plenty of foods that contain calcium such as milk D. Choose foods that are high in iron content such as shellfish

A Rationale: Amiloride is a potassium-sparing diuretic used in the treatment of edema, hypertension, and potassium loss caused by other diuretic medications. Amiloride may cause hyperkalemia, so the client should be informed to limit their potassium intake. Sodium, calcium, and iron are not affected by the use of amiloride.

8) A nurse is reviewing a client's medical history. The client has been newly diagnosed with hypertension and has been prescribed oral losartan as treatment. The nurse will clarify the use of losartan if which comorbidity is noted in the client's medical record? A. Renal stenosis B. Hyperlipidemia C. Atrial fibrillation D. Diabetes

A Rationale: Losartan is an angiotensin II receptor blocker used in the treatment of hypertension. Losartan is contraindicated in clients with renal stenosis due to the risk of kidney injury. Hyperlipidemia, atrial fibrillation, and diabetes are not known to be contraindicated in the use of losartan.

9) The nurse is transcribing a new prescription for spironolactone (Aldactone) for a client who receives an angiotensin-converting enzyme (ACE) inhibitor. Which action should the nurse implement? A. Verify both prescriptions with the healthcare provider. B. Report the medication interactions to the nurse manager. C. Hold the ACE inhibitor and give the new prescription. D. Transcribe and send the prescription to the pharmacy.

A The concomitant use of an angiotensin-converting enzyme (ACE) inhibitor and a potassium-sparing diuretic such as spironolactone, should be given with caution because the two drugs may interact to cause an elevation in serum potassium levels. Although the client is currently receiving an ACE inhibitor, verifying both prescriptions alerts the healthcare provider about the client's medication regimen and provides the safest action before administering the medication.

Sublingual nitroglycerin has been prescribed for a client with unstable angina. Which client response indicates that nitroglycerin is effective? A. Pain subsides as a result of arteriole and venous dilation. B. Pulse rate increases because the cardiac output has been stimulated. C. Blood pressure decreases because of the vasodilation effect. D. The client reports a headache because of the vasodilation effect.

Answer: A Rationale: Nitroglycerin is a vasodilator that decreases preload and afterload, which decreases myocardial oxygen demand. The client should experience relief of chest pain as a result of arteriole and venous dilation. Nitroglycerin does not increase the pulse rate or cardiac output. The blood pressure may decrease because of the vasodilation effect, but this is not the primary goal of nitroglycerin therapy. A headache is a common side effect of nitroglycerin, but it is not an indication of effectiveness.

Which food would the nurse encourage a client to eat while receiving treatment to prevent hypokalemia? A. Broccoli B. Oatmeal C. Fried rice D. Canned carrots

Answer: A Rationale: Potassium is plentiful in green leafy vegetables; broccoli provides 207 mg of potassium per half cup. Oatmeal provides 73 mg of potassium per half cup. Rice provides 29 mg of potassium per half cup. Cooked fresh carrots provide 172 mg of potassium per half cup; canned carrots provide only 93 mg of potassium per half cup.

1) A health care provider prescribes milrinone for a client with congestive heart failure. Which action would the nurse perform first? A. Administer the loading dose over 10 minutes. B. Monitor the electrocardiogram (ECG) continuously for dysrhythmias during infusion. C. Assess the heart rate and blood pressure continuously during infusion. D. Have the prescription, dosage calculations, and pump settings checked by a second nurse.

D Rationale Accidental overdose can cause death. Another nurse would verify accuracy of the prescription, dose, and pump settings to prevent harm to the client. Although administering the loading dose over 10 minutes is an appropriate intervention, it is not the first thing the nurse would do. Although monitoring for dysrhythmias is important because they are common with this medication and may be life threatening, it is not the first thing the nurse would do. Although taking the vital signs continuously during the infusion is important because the dose needs be slowed or discontinued if the blood pressure decreases excessively, it is not the first thing the nurse would do.

5) How would the nurse determine if a client is experiencing the therapeutic effect of valsartan? A. Check a lipid profile. B. Assess an apical pulse. C. Measure urinary output.11 D. Check the blood pressure.

D Rationale Angiotensin II receptor blockers (ARBs) are antihypertensive medications that lower the blood pressure. ARBs do not directly affect lipid profile, apical pulse, or urinary output.

8) Captopril is prescribed for a client. Which effect would the nurse anticipate? A. Increased urine output B. Decreased anxiety C. Improved sleep D. Decreased blood pressure

D Rationale Captopril is an angiotensin-converting enzyme (ACE) inhibitor antihypertensive. It does not have diuretic, sedative, or hypnotic properties. Diuretics promote fluid excretion. Sedatives reduce muscle tension and anxiety. Hypnotics promote sleep.

3) Which advice would the nurse include in a teaching plan to reduce the side effects of diltiazem? A. Lie down after meals. B. Avoid dairy products in diet. C. Take the medication with an antacid. D. Change slowly from sitting to standing.

D Rationale Changing positions slowly will help prevent the side effect of orthostatic hypotension. Diltiazem decreases esophageal tone, so lying down after meals can lead to acid reflux. Avoiding dairy products and taking the medication with an antacid are not necessary.

24) A health care provider prescribes furosemide for a client with hypervolemia. The nurse recalls that furosemide exerts its effects in which part of the renal system? A. Distal tubule B. Collecting duct C. Glomerulus of the nephron D. Loop of Henle

D Rationale Furosemide acts in the ascending limb of the loop of Henle in the kidney. Thiazides act in the distal tubule in the kidney. Potassium-sparing diuretics act in the collecting duct in the kidney. Plasma expanders, not diuretics, act in the glomerulus of the nephron in the kidney.

19) A client was prescribed furosemide. The nurse would instruct the client to include which food in the diet? A. Liver B. Apples C. Cabbage D. Bananas

D Rationale Furosemide is a loop diuretic that increases potassium excretion by preventing renal absorption. Bananas have a significant amount of potassium. Bananas: 450 mg; cabbage: 243 mg; liver: 73.6 mg; apples: 100 to 120 mg.

31) A school-age child is admitted with hypertensive acute glomerulonephritis. Which medication would the nurse anticipate being prescribed initially in addition to hydralazine? A. Digoxin B. Alprazolam C. Phenytoin D. Furosemide

D Rationale Furosemide is a loop diuretic that is recommended for the treatment of acute glomerulonephritis; it promotes the excretion of fluid and thus limits fluid retention. Digoxin is not used because there is no cardiac involvement. An anxiolytic is unnecessary. Phenytoin may be used only if hypertensive encephalopathy causes seizures.

8) After the nurse provides education about hydrochlorothiazide, the client will agree to notify the health care provider regarding the development of which symptom? A. Insomnia B. Nasal congestion C. Increased thirsT D. Generalized weakness

D Rationale Generalized weakness is a symptom of significant hypokalemia, which may be a sequela of diuretic therapy. Insomnia is not known to be related to hypokalemia or hydrochlorothiazide therapy. Although a stuffy nose is unrelated to hydrochlorothiazide therapy, it can occur with other antihypertensive medications. Increased thirst is associated with hypernatremia. Because this medication increases excretion of water and sodium in addition to potassium and chloride, hyponatremia, not hypernatremia, may occur.

29) A client with the diagnosis of primary hypertension is started on a regimen of hydrochlorothiazide. Which information will the nurse include when providing instructions regarding this medication? A. A common side effect is decreased sexual libido. B. One dose should be omitted if dizziness occurs when standing up. C. The client should adjust the dosage daily based on the client's blood pressure. D. An antihypertensive medication will likely be required for the remainder of life.

D Rationale If medication is necessary to control primary hypertension, usually it is a lifetime requirement. The client will not adjust the dosage without the health care provider's direction. Impotence may occur with some antihypertensive medications but not with hydrochlorothiazide. The medication will not be stopped; orthostatic hypotension can be controlled by a slow change of body position.

13) A health care provider prescribes simvastatin 20 mg daily for elevated cholesterol and triglyceride levels for a female client. Which advice is important for the nurse to teach when the client initially takes the medication? A. Take the medication with breakfast. B. Have liver function tests every 6 months. C. Wear sunscreen to prevent photosensitivity reactions. D. Inform the health care provider if you wish to become pregnant.

D Rationale Simvastatin is a teratogen that is contraindicated in pregnancy because it is capable of causing fetal damage. Simvastatin should be taken in the evening because most cholesterol is synthesized between midnight and 3:00 AM. Liver function tests should be done at 6 to 12 weeks initially and only then every 6 months. Although wearing sunscreen should be taught, sensitivity reactions are a rare occurrence, and this is not as important.

5) A client taking multiple medications for hypertension develops a persistent, hacking cough. Which antihypertensive medication class would the nurse identify as the likely cause of the cough? A. Thiazide diuretics B. Calcium channel blockers C. Direct renin inhibitors D. Angiotensin-converting enzyme (ACE) inhibitors

D Rationale The ACE breaks down kinins. When ACE is inhibited, the increase of kinins in the lung can cause bronchial irritation, leading to the common adverse effect sometimes referred to as an ACE cough. A cough is not a side effect of thiazide diuretics, calcium channel blockers, or direct renin inhibitors.

21) Which instruction would the nurse include when teaching about hydrochlorothiazide given to a client diagnosed with a transient ischemic attack (TIA) related to hypertension? A. "Resume regular eating habits." B. "Drink a protein supplement daily." C. "Avoid eating foods high in insoluble fiber." D. "Increase the intake of potassium-rich foods."

D Rationale The client must increase the dietary intake of potassium because of potassium loss associated with hydrochlorothiazide. The client should be taught about medication-induced deficiencies, which may necessitate a change in diet, and not just return to regular eating habits once home. Protein supplements are not necessary, and protein may be obtained from meat, fish, and dairy products in the diet or complementary vegetable and grain proteins. Foods high in insoluble fiber are part of the food pyramid and should be included in the diet.

22) A client diagnosed with a transient ischemic attack (TIA) related to hypertension is discharged with a prescription of hydrochlorothiazide. Which instruction would the nurse include when teaching about this medication? A. 'Resume regular eating habits.' B. 'Drink a protein supplement daily.' C. 'Avoid eating foods high in insoluble fiber.' D. 'Increase the intake of potassium-rich foods.'

D Rationale The client must increase the dietary intake of potassium because of potassium loss associated with hydrochlorothiazide. The client should be taught about medication-induced deficiencies, which may necessitate a change in diet, and not just return to regular eating habits once home. Protein supplements are not necessary, and protein may be obtained from meat, fish, and dairy products in the diet or complementary vegetable and grain proteins. Foods high in insoluble fiber are part of the food pyramid and should be included in the diet.

36) Sodium nitroprusside is prescribed for a client with a blood pressure of 260/120 mm Hg. The nurse recalls that sodium nitroprusside decreases blood pressure by which mechanism? A. Decreasing the heart rate B. Increasing cardiac output C. Increasing peripheral resistance D. Relaxing venous and arterial smooth muscles

D Rationale This medication decreases blood pressure by relaxing venous and arteriolar smooth muscles and is used for immediate reduction of blood pressure. This medication may increase the heart rate as a response to vasodilation. It decreases cardiac workload by decreasing preload and afterload. It decreases peripheral resistance by dilating peripheral blood vessels.

32) Which client response indicates to the nurse that a vasodilator medication is effective? A. Absence of adventitious breath sounds B. Increase in the daily amount of urine produced C. Pulse rate decreases from 110 to 75 beats/minute D. Blood pressure changes from 154/90 to 126/72 mm Hg

D Rationale Vasodilation will lower the blood pressure. The pulse rate is not decreased and may increase. Breath sounds are not directly affected by vasodilation, although vasodilator medications can decrease preload and afterload, which could indirectly affect breath sounds in heart failure. The urine output is not affected immediately, although control of blood pressure can help preserve renal function over time.

18) A client received 40 mg of furosemide by mouth at 10 am. Which information is most important for the nurse to provide to the next nurse in the change-of-shift report? A. The client lost two pounds in the last 24 hours. B. The client is to receive another dose of furosemide at 10 pm. C. The client's potassium level was 4.0 mEq/L prior to administration. D. The client's urine output was 1500 mL over nine hours.

D Rationale: Although all of the information is important to include, a diuresis of 1,500 mL is a very large amount and could cause hypokalemia, fluid volume deficit and hypotension. Therefore, it is the most important information to provide to the nurse on the next shift.

1) A client who has been diagnosed with Raynaud's disease and hypertension is prescribed nifedipine. For which side effect should the nurse monitor the client? A. Cyanosis of the lips B. Decreased urine output C. Increased pain in fingers D. Facial flushing

D Rationale: Nifedipine is a calcium channel blocker (CCB) used in the treatment of Raynaud's disease and hypertension by producing vasodilation. As a result of this vasodilating effect, facial flushing can occur. Cyanosis of the lips and decreased urinary output are not expected findings with nifedipine. Raynaud's disease causes vasoconstriction, resulting in pain in the fingers that should decrease when nifedipine is taken.

4) The nurse is monitoring the client who is taking newly prescribed antihypertensive medication. Which finding should indicate to the nurse that the client might be experiencing an allergic reaction to the medication? A. Mild decrease in blood pressure B. Increased urine output C. Left-sided weakness D. Development of a rash

D Rationale: Allergic reactions are often manifested by the presence of a rash, urticaria, gastrointestinal symptoms, and itching. A mild decrease in blood pressure is the intended effect of the medication. Increased urinary output and unilateral weakness are not indications of an allergic reaction.

14) A nurse is assessing a client with heart failure who is taking prescribed torsemide. Which clinical finding indicates effectiveness of the medication? A. Symmetrical pulses bilaterally B. Full strength to bilateral extremities C. Intact whisper test D. Absence of peripheral edema

D Rationale: Torsemide is a loop diuretic used in the treatment of hypertension and fluid overload. The expected therapeutic response of torsemide is a decrease in fluid retention evidenced by the absence of peripheral edema. Symmetrical pulses bilaterally and full strength to bilateral extremities do not evaluate the effectiveness of torsemide. An intact whisper test indicates the absence of ototoxicity, an adverse effect of torsemide. However, this does not evaluate medication effectiveness.

4) The nurse is caring for a client who has taken atenolol for 2 years. The healthcare provider recently changed the medication to enalapril to manage the client's blood pressure. Which instruction should the nurse provide the client regarding the new medication? A. Take the medication at bedtime. B. Report presence of increased bruising. C. Check pulse before taking medication. D. Rise slowly when getting out of bed or chair.

D The client's new medication is an angiotensin-converting enzyme (ACE) inhibitor, which has the side effect of orthostatic hypotension. Instructing the client to rise slowly from a sitting or lying down position is important to teach the client to avoid dizziness and potentially falling.

6) Which change in data indicates to the nurse that the desired effect of the angiotensin II receptor antagonist valsartan has been achieved? A. Dependent edema reduced from +3 to +1. B. Serum HDL increased from 35 to 55 mg/dL. C. Pulse rate reduced from 150 to 90 beats/minute. D. Blood pressure reduced from 160/90 mmHg to 130/80 mmHg.

D Valsartan is an angiotensin receptor blocker, prescribed for the treatment of hypertension. The desired effect is a decrease in blood pressure.

2) The health care provider prescribes atenolol for a client with angina. Which potential side effect will the nurse mention when instructing the client about this medication? A. Headache B. Tachycardia C. Constipation D. Hypotension

D Rationale Atenolol competitively blocks stimulation of beta-adrenergic receptors within vascular smooth muscles, which lowers the blood pressure. This medication does not cause headaches; this medication may be used to relieve vascular headaches. This medication may cause bradycardia, not tachycardia. This medication may cause diarrhea, not constipation.

1) The nurse is assessing a postpartum client who is taking labetalol. Which client report should the nurse identify as a potential adverse effect of the medication? A. Nausea B. Ankle edema C. Abdominal pain D. Dizziness

D Rationale: Labetalol is a beta-blocker that is used for blood pressure management in postpartum clients. The mechanism of action for labetalol is to vasodilate, which could lead to a decrease in blood pressure. A client with a sudden drop in blood pressure could report dizziness. Report of nausea or ankle edema is normal during pregnancy. Abdominal pain in pregnancy could be from active labor or constipation.

A client with a myocardial infarction receives intravenous nitroglycerin to relieve pain. The nurse will assess for which medication side effect? A. Nausea B. Delirium C. Bradycardia D. Hypotension

Answer: D Rationale: The major action of intravenous nitroglycerin is venous and then arterial dilation, leading to a decrease in blood pressure and resulting in decreased cardiac workload. Nausea is not a common side effect of intravenous nitroglycerin. Nitroglycerin does not cause delirium. Reflex tachycardia may occur with the decrease in blood pressure.

28) Following the administration of sublingual nitroglycerin to a client experiencing an acute anginal attack, which assessment finding indicates to the nurse that the desired effect has been achieved? A. Client states chest pain is relieved. B. Client's pulse decreases from 120 to 90. C. Client's systolic blood pressure decreases from 180 to 90. D. Client's SaO2 level increases from 92% to 96%.

A Nitroglycerin reduces myocardial oxygen consumption which decreases ischemia and reduces chest pain.

31) The nurse has administered sublingual nitroglycerin. Which outcome would the nurse use to determine the effectiveness of sublingual nitroglycerin? A. Relief of anginal pain B. Improved cardiac output C. Decreased blood pressure D. Ease in respiratory effort

A Rationale Cardiac nitrates relax smooth muscles of the coronary arteries; they dilate and deliver more blood to heart muscle, relieving ischemic pain. Although cardiac output may improve because of improved oxygenation of the myocardium, improved cardiac output is not a basis for evaluating the effectiveness of sublingual nitroglycerin. Although dilation of blood vessels and a subsequent drop in blood pressure is a reason why intravenous (IV) nitroglycerin may be administered, decreased blood pressure is not the basis for evaluating the effectiveness of sublingual nitroglycerin, which is indicated for pain relief. Although superficial vessels dilate, lowering the blood pressure and creating a flushed appearance, dilation of superficial blood vessels is not the basis for evaluating the medication's effectiveness.

30) Nitroglycerin sublingual tablets are prescribed for a client with the diagnosis of angina. The nurse advises the client to anticipate pain relief will begin within which period of time? A. 1 to 3 minutes B. 4 to 5 seconds C. 30 to 45 seconds D. 10 to 15 minutes

A Rationale The onset of action of sublingual nitroglycerin tablets is rapid (1-3 minutes); duration of action is 30 to 60 minutes. If nitroglycerin is administered intravenously, the onset of action is immediate, and the duration is 3 to 5 minutes. It takes longer than 30 to 45 seconds for sublingual nitroglycerin tablets to have a therapeutic effect. Sustained-release nitroglycerin tablets start to act in 20 to 45 minutes, and the duration of action is 3 to 8 hours.

A client with hypertensive heart disease who had an acute episode of heart failure is to be discharged on a regimen of metoprolol and digoxin. Which outcome would the nurse anticipate when metoprolol is administered with digoxin? A. Headaches B. Bradycardia C. Hypertension D. Junctional tachycardia

Answer: B Rationale: Metoprolol and digoxin both exert a negative chronotropic effect, resulting in a decreased heart rate. Metoprolol reduces, not produces, headaches. These medications may cause hypotension, not hypertension. These medications may depress nodal conduction; therefore junctional tachycardia would be less likely to occur.

Which criterion is an indicator that the nitroglycerin sublingual tablets have lost their potency? A. Sublingual tingling is experienced. B. The tablets are more than 3 months old. C. The headache is less severe. D. Onset of relief is delayed.

Answer: B Rationale: Nitroglycerin tablets are affected by light, heat, and moisture. Loss of potency can occur after 3 months, reducing the medication's effectiveness in relieving pain. A new supply should be obtained routinely. Experiencing sublingual tingling indicates the tablets have retained their potency. Headaches may decrease over time; this is not an indicator of medication potency. A delay in relief reflects the ischemia, not the medication.

A child being treated with cardiac medications developed vomiting, bradycardia, anorexia, and dysrhythmias. The nurse understands which medication toxicity is responsible for these symptoms? A. Digoxin B. Nesiritide C. Dobutamine D. Spironolactone

Answer: A Rationale Digoxin helps improve pumping efficacy of the heart, but an overdose can cause toxicity leading to nausea, vomiting, bradycardia, anorexia, and dysrhythmias. The side effects of nesiritide may include effects such as headache, insomnia, and hypotension. Dobutamine does not cause nausea or vomiting but may cause hypertension and hypotension. Spironolactone may cause edema.

A client who takes multiple medications complains of severe nausea, and the client's heartbeat is irregular and slow. The nurse determines that these signs and symptoms are toxic effects of which medication? A. Digoxin B. Captopril C. Furosemide D. Morphine sulfate

Answer: A Rationale Signs of digoxin toxicity include cardiac dysrhythmias, anorexia, nausea, vomiting, and visual disturbances. Although nausea and heart block may occur with captopril, these symptoms rarely are seen; drowsiness and central nervous system disturbances are more common. Toxic effects of morphine are slow, deep respirations, stupor, and constricted pupils; nausea is a side effect, not a toxic effect. Toxic effects of furosemide are renal failure, blood dyscrasias, and loss of hearing.

The client with hypokalemia reports nausea, vomiting, and seeing a yellow light around objects. Which of the client's medications is the likely cause of the client's symptoms? A. Digoxin B. Furosemide C. Propranolol D. Spironolactone

Answer: A Rationale These are signs of digitalis toxicity, which is more likely to occur in the presence of hypokalemia. Although furosemide most likely contributed to the hypokalemia, the client's symptoms are consistent with digitalis toxicity. Although propranolol can cause nausea, vomiting, and blurred vision, the presence of hypokalemia and yellow vision are more suggestive of digitalis toxicity. A side effect of spironolactone is hyperkalemia, not hypokalemia.

A client is admitted to the hospital for a new onset of supraventricular tachycardia (SVT) and is prescribed digoxin. For which laboratory finding should the nurse notify the healthcare provider immediately? A. Potassium level of 3.1 mEq/L. B. Sodium level of 132 mEq/L. C. Calcium level of 8.6 mg/dL. D. Magnesium level of 1.2 mEq/L.

Answer: A Rationale: Hypokalemia affects myocardial contractility and places this client at the greatest risk for dysrhythmias that may be unresponsive to drug therapy. Although an imbalance of serum sodium, calcium, and magnesium can affect cardiac rhythm, the greatest risk for a client receiving digoxin is low potassium.

An 80-year-old client who is taking digoxin reports nausea, vomiting, abdominal cramps, and halo vision. Which laboratory result should the nurse evaluate first? A. Potassium levels B. Blood pH C. Magnesium levels D. Blood urea nitrogen

Answer: A Rationale: Nausea, vomiting, abdominal cramps, and halo vision are classic signs of digitalis toxicity. The most common cause of digitalis toxicity is a low potassium level. Clients are to be taught that it is important to have adequate potassium intake, especially if taking loop or thiazide diuretics that enhance the loss of potassium.

A client takes furosemide and digoxin for heart failure. Why would the nurse advise the client to drink a glass of orange juice every day? A. Maintaining potassium levels B. Preventing increased sodium levels C. Limiting the medications' synergistic effects D. Correcting the associated dehydration

Answer: A Rationale: Orange juice is an excellent source of potassium. Furosemide promotes excretion of potassium, which can result in hypokalemia. Digoxin toxicity can occur in the presence of hypokalemia. Neither medication increases sodium levels. Digoxin does not potentiate the action of furosemide; therefore, the client should not experience dehydration. Orange juice will not prevent an interaction between digoxin and furosemide.

The nurse is providing care for a client admitted to the hospital with a diagnosis of digoxin toxicity. The client reports more than usual urine output over the previous 48 hours because of the prescribed diuretic. Which assessment finding does the nurse anticipate? A. Muscle weakness or cramping B. Blood in the urine C. Hypertension D. Tinnitus

Answer: A Rationale: The client with heart failure on digoxin and a diuretic is at risk for hypokalemia. The digoxin binds to the potassium receptor of the sodium/potassium ATPase pump. The increased urine output makes hypokalemia likely and thus it is more likely for digoxin toxicity to occur. Symptoms of hypokalemia include muscle weakness and cramping. Digoxin toxicity will not cause blood in the urine, or tinnitus or hypertension.

Which assessment will the nurse conduct before administering digoxin to a client? A. Apical heart rate B. Radial pulse C. Difference between carotid and radial pulses D. Difference between apical and radial pulses

Answer: A Rationale: Because digoxin slows the heart rate, the apical pulse should be counted for 1 minute before administration. If the apical rate is below a preset parameter (usually 60 beats/minute), digoxin should be withheld because its administration may further decrease the heart rate. Some protocols permit waiting for 1 hour and retaking the apical rate; the result determines if it is administered or if the health care provider is notified. Obtaining the radial pulse on the left side is not as accurate as an apical pulse; the client also may have an atrial dysrhythmia, which cannot be detected through a radial rate alone. Obtaining the radial pulse in both right and left arms is not as accurate as an apical pulse; the client also may have an atrial dysrhythmia, which cannot be detected through a radial rate alone. Obtaining the difference between apical and radial pulses is a pulse deficit, not a pulse rate.

A client is given a loading dose of digoxin and placed on a maintenance dose of digoxin 0.25 mg by mouth daily. Which responses would the nurse expect the client to exhibit when a therapeutic effect of digoxin is achieved? A. Resolution of heart failure B. Decreased anginal episodes C. Conversion of atrial fibrillation D. Decreased blood pressure

Answer: A Rationale: Digoxin improves cardiac output to improve heart failure. Digoxin is not an antianginal medication; if it decreases angina as a result of controlling heart failure, it is a secondary effect. Digoxin may be given to control a rapid ventricular response to atrial fibrillation, but it does not convert the rhythm. Digoxin has a negligible effect on blood pressure; therefore it is not an antihypertensive medication.

The nurse is caring for a client who received digoxin-specific immune fab. Which finding indicates the treatment is having the intended effect? A. Increased heart rate B. Decreased potassium levels C. Decreased blood pressure D. Increased serum digoxin levels

Answer: A Rationale: Digoxin-specific immune fab is an antidote that binds molecules of digoxin, making them unavailable for binding at their usual sites of action in the body. After administration of the medication, serum digoxin levels may be misleading, as they will be elevated until the drug is excreted by the kidneys. The goal of treatment is to lower digoxin levels and treat symptomatic digoxin toxicity, specifically cardiac dysrhythmias including bradycardia. Potassium levels may be low, triggering digoxin toxicity, and then elevated due to shifts caused by digoxin toxicity, so fluctuating levels are not a sign of effective treatment. Effective treatment of dysrhythmia should raise blood pressure.

The nurse is preparing a teaching plan for a client prescribed nitroglycerin sublingual. Which would the nurse include in the teaching? A. 'Place the tablet under the tongue or between the cheek and gums.' B. 'It takes 30 to 45 minutes for the nitroglycerin to achieve its effect.' C. 'If dizziness occurs, take a few deep breaths and lean the head back.' D. 'To facilitate absorption, drink a large glass of water after taking the medication.'

Answer: A Rationale: Nitroglycerin sublingual tablets should not be chewed, crushed, or swallowed. They work much faster when absorbed through the lining of the mouth. Clients are instructed to place the tablet under the tongue or between the cheek and gums and let it dissolve. The client should not eat, drink, smoke, or use chewing tobacco while a tablet is dissolving; this will decrease the effectiveness of the medication. If taken with water, the tablet is washed away from the site of absorption or may be swallowed. Nitroglycerin sublingual tablets usually give relief in 1 to 5 minutes. If a client experiences dizziness or lightheadedness, the client is instructed to take several deep breaths and bend forward with the head between the knees. This position promotes blood flow to the head.

Which information would the nurse include when preparing a teaching plan for a client prescribed sublingual nitroglycerin? A. "Place the tablet under the tongue or between the cheek and gums." B. "It takes 30 to 45 minutes for the nitroglycerin to achieve its effect." C. "If dizziness occurs, take a few deep breaths and lean the head back." D. "To facilitate absorption, drink a large glass of water after taking the medication."

Answer: A Rationale: Nitroglycerin sublingual tablets should not be chewed, crushed, or swallowed. They work much faster when absorbed through the lining of the mouth. Clients are instructed to place the tablet under the tongue or between the cheek and gums and let it dissolve. The client should not eat, drink, smoke, or use chewing tobacco while a tablet is dissolving; this will decrease the effectiveness of the medication. Nitroglycerin sublingual tablets usually give relief in 1 to 5 minutes. If a client experiences dizziness or lightheadedness, the client is instructed to take several deep breaths and bend forward with the head between the knees. This position promotes blood flow to the head. If taken with water, the tablet is washed away from the site of absorption or may be swallowed.

The nurse is providing discharge education to a client diagnosed with coronary artery disease. The client is prescribed to use a nitroglycerin transdermal patch at home. Which statement by the client indicates a correct understanding of safe medication administration? A. "I will remove the old patch and cleanse the area before applying a new patch." B. "This drug can lead to hypertension. So, I will monitor my blood pressure at home." C. "I will keep a record of chest pain occurrences now that I have this patch." D. "I can place this patch on broken skin. It will absorb better."

Answer: A Rationale: Numerous administration errors have been reported with nitroglycerin paste and patches. The errors include improper storage and basic administration. The client should be taught to remove the previous patch before applying the new patch and to properly label the tube of nitroglycerin paste and keep it out of the reach of children. When selecting an area to place the patch, the skin should be intact and show no signs of irritation. Nitroglycerin paste has been used erroneously as lotion and caused toxic effects. Nitroglycerin causes vasodilation, which increases the blood supply through the coronary arteries. This may cause hypotension in clients. Some other common side effects include lightheadedness, nausea, dizziness, headache and redness or irritation of the skin covered by the patch.

The nurse administers sodium polystyrene sulfonate to a client with chronic renal failure. Which finding provides evidence that the intervention is effective? A. Pruritus decreases. B. Mental status improves. C. Sodium decreases to 137 mEq/L (137 mmol/L). D. Potassium decreases to 4.2 mEq/L (4.2 mmol/L).

Answer: D Rationale: Sodium polystyrene sulfonate (Kayexalate) is a medication used to treat hyperkalemia by exchanging sodium ions for potassium in the large intestine. A decrease in potassium levels is the expected therapeutic effect of this medication. The other options are not directly related to the action of sodium polystyrene sulfonate.

Intravenous (IV) potassium is prescribed for a client with a diagnosis of hypokalemia. Which statement about administration of IV potassium is accurate? A. Oliguria is an indication for withholding IV potassium. B. Rapid infusion of potassium prevents burning at the IV site. C. Clients with severe deficits should be given IV push potassium. D. Average IV dosage of potassium should not exceed 60 mEq in 1 hour.

Answer: A Rationale: Potassium chloride should not be given unless renal flow is adequate; otherwise, the potassium chloride will accumulate in the body, causing hyperkalemia. Rapid infusion may cause severe pain at the infusion site and precipitate cardiac arrest. Potassium chloride must be well diluted or it will precipitate cardiac arrest. A dose of 60 mEq per hour of potassium chloride is too high.

Which teaching would a nurse give to a client with a prescription for potassium supplements? A. To report any abdominal distress B. To use salt substitutes to season food C. To take the medication on an empty stomach D. To increase the dosage if muscle cramps occur

Answer: A Rationale: Potassium supplements can cause gastrointestinal ulceration and bleeding. Most salt substitutes contain potassium, and their use with potassium supplements can cause hyperkalemia. Because they can be irritating to the stomach, potassium supplements should not be taken on an empty stomach. Although muscle cramps may indicate hypokalemia, clients should not adjust their own dosage.

Potassium supplements are prescribed for a client receiving diuretic therapy. Which client statement indicates that the teaching about potassium supplements is understood? A. 'I will report any abdominal distress.' B. 'I should use salt substitutes with my food.' C. 'The medication must be taken on an empty stomach.' D. 'The dosage is correct if my urine output increases.'

Answer: A Rationale: Potassium supplements can cause gastrointestinal ulceration and bleeding. Most salt substitutes contain potassium, and their use with potassium supplements can cause hyperkalemia. Because they can be irritating to the stomach, potassium supplements should not be taken on an empty stomach. An increase in urine output is the therapeutic effect of diuretic therapy, not potassium supplements. An adverse effect of potassium supplements is oliguria.

The nurse is caring for a client diagnosed with diabetic ketoacidosis who is receiving 50 mEq of sodium bicarbonate in 1 L of dextrose 5% in water via a central venous access device. The client has three new prescriptions for continuously infused medications. Which action is appropriate? A. Refer to an IV compatibility chart B. Request that an additional IV access be inserted C. Use a Y-site connector to infuse two medications in the same port D. Insert a peripheral intravenous access

Answer: A Rationale: Sodium bicarbonate is incompatible with many other drugs and solutions. The nurse should consult a drug compatibility reference for more information on which drugs can be administered via connection at the most distal IV tubing port. Y tubing should not be added to an IV until compatibility is determined. Y tubing does not prevent the mixing of infusions. Adding an additional access may be unnecessary if compatibility is determined and may pose an unnecessary infection risk to the client. A central line is the preferred access for drugs that have a pH less than 5 and greater than 9. Certain drugs are venous irritants regardless of pH or concentration; therefore, a PIV would be inappropriate.

According to developmental norms for a 5-year-old child, the nurse would hold digoxin if an apical heart rate falls below which number? A. 70 beats/min B. 80 beats/min C. 90 beats/min D. 100 beats/min

Answer: A Rationale: The purpose of digoxin is to slow and strengthen the apical rate. The apical rate for a healthy child of 5 years is 70 to 110 beats/min. If the apical rate is slow, administration of the medication may lower the apical rate to an unsafe level.

The nitrate isosorbide dinitrate is prescribed for a client with angina. Which instruction should the nurse include in this client's discharge teaching plan? A. Quit taking the medication if dizziness occurs. B. Do not get up quickly. Always rise slowly. C. Take the medication with food only. D. Increase your intake of potassium-rich foods.

Answer: B Rationale: An expected side effect of nitrates is orthostatic hypotension and the nurse should instruct the client to prevent it by rising slowly.

The client diagnosed with heart failure is prescribed oral digoxin. What is the priority nursing assessment for this medication? A. Monitor serum electrolytes and creatinine B. Measure apical pulse prior to administration C. Maintain accurate intake and output ratios D. Monitor blood pressure every 4 hours

Answer: B Rationale: Digoxin is an antiarrhythmic and an inotropic drug. It works to increase cardiac output and slow the heart rate. The priority assessment is to measure the apical pulse for one minute prior to administering the drug. The nurse will withhold the dose and notify the healthcare provider if the apical rate is less than 60 beats per minute. Intake and output ratios and daily weights should be monitored for a client in heart failure, but this is not the priority assessment. Impaired renal function may contribute to drug toxicity, which is why the nurse will monitor serum electrolytes, creatinine and BUN; the nurse should also monitor serum digoxin levels.

Which information will the nurse include when teaching a client about potassium chloride effervescent tablets? A. Chew the tablet completely. B. Take the medication with food. C. Take the medication at bedtime. D. Use warm water to dissolve the tablet.

Answer: B Rationale: Eating food when taking the medication will decrease gastrointestinal irritation. Side effects of this medication include abdominal cramps, diarrhea, and ulceration of the small intestine. Chewing the tablet completely will cause oral mucosal irritation and is not the way the medication should be administered. Taking the medication at bedtime increases the possibility of mucosal irritation because the gastrointestinal tract is empty during the night. The tablet should be dissolved in cold water or juice to make it more palatable.

The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with heart failure. Which intervention should the nurse implement prior to administering the digoxin? A. Observe respiratory rate and depth. B. Assess the serum potassium level. C. Obtain the client's blood pressure. D. Monitor the serum glucose level.

Answer: B Rationale: Hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in persons receiving digoxin. The nurse should monitor the client's serum potassium levels. Blood pressure and respiratory rate will not inform the nurse about potential safety issues with digitalis.

Which response would a nurse give to a client who takes furosemide and digoxin and reports that everything looks yellow? A. "This is related to your heart problems, not to the medication." B. "I will hold the medication until I consult with your health care provider." C. "It is a medication that is necessary, and that side effect is only temporary." D. "Take this dose, and when I see your health care provider, I will ask about it."

Answer: B Rationale: The response "I will hold the medication until I consult with your health care provider" is a safe practice because yellow vision indicates digitalis toxicity. The response "This is related to your heart problems, not to the medication" is incorrect; yellow vision is not a symptom of heart disease. The response "It is a medication that is necessary, and that side effect is only temporary" is incorrect; yellow vision is not a temporary side effect. The response "Take this dose, and when I see your health care provider, I will ask about it" is unsafe.

The nurse is providing discharge medication teaching to a client who will be taking furosemide and digoxin after discharge from the hospital. Which information is important for the nurse to include in the teaching plan? A. Maintenance of a low-potassium diet B. Avoidance of foods high in cholesterol C. Signs and symptoms of digoxin toxicity D. Importance of monitoring output

Answer: C Rationale The risk of digoxin toxicity increases when the client is receiving digoxin and furosemide, a loop diuretic; loop diuretics can cause hypokalemia, which potentiates the effects of digoxin, leading to toxicity. Digoxin toxicity can result in dysrhythmias and death. When a client is receiving a loop diuretic, the diet should be high in potassium. Although teaching the need to avoid foods high in cholesterol may be included in the teaching plan, it is not the priority. It is not necessary to monitor output.

A nurse is preparing to administer morning medications to a client with heart failure. The morning lab values are: sodium 142 mEq/L (142 mmol/L), potassium 2.9 mEq/L (2.9 mmol/L), digoxin level 1.4 ng/mL. Which of the following medications should the nurse not administer until after speaking with the health care provider? A. Spironolactone B. Carvedilol (Coreg) C. Digoxin (Lanoxin) D. Ferrous sulfate

Answer: C Rationale: Because the potassium levels are low (normal is 3.5 to 5 mEq/L or 3.5 to 5 mmol/L), the nurse should not give the digoxin; hypokalemia can predispose a person to digoxin toxicity. The other medications can be administered. Although carvedilol can increase plasma digoxin concentration, the digoxin level is normal. Spironolactone is a potassium-sparing diuretic and because the potassium level is low, this too can be given. Ferrous sulfate does not affect the given lab values.

The nurse is caring for a client prescribed furosemide and digoxin for the treatment of heart failure. The client reports seeing halos and bright lights. Which laboratory result would be anticipated? A. Low sodium level B. Low digitalis level C. Low potassium level D. Low serum osmolality

Answer: C Rationale: Digitalis toxicity is an accumulation of digitalis (digoxin) in the body that leads to nausea, vomiting, visual disturbances, atrial or ventricular tachydysrhythmias, ventricular fibrillation, sinoatrial block, and atrioventricular block. Clients with heart failure who take digoxin are commonly given diuretics. Hypokalemia can increase the risk of digitalis toxicity. Digitalis toxicity may also develop in the presence of hypomagnesemia. Clients with dig toxicity would have elevated digoxin levels. Sodium would likely be normal. The serum osmolality would likely be normal or high in a client on a diuretic.

Which instructions about the use of nitroglycerin to prevent angina will the nurse provide to a client? A. 'At the point when pain first occurs, place two tablets under the tongue.' B. 'Place one tablet under the tongue before activity, and swallow another if pain occurs.' C. 'Before physical activity, place one tablet under the tongue, and repeat the dose in 5 minutes if pain occurs.' D. 'Place one tablet under the tongue when pain occurs and use an additional tablet after the attack to prevent recurrence.'

Answer: C Rationale: Anginal pain, which can be anticipated during certain activities, may be prevented by dilating the coronary arteries immediately before engaging in the activity. Generally, one tablet is administered at a time; doubling the dosage may produce severe hypotension and headache. The sublingual form of nitroglycerin is absorbed directly through the mucous membranes and should not be swallowed. When the pain is relieved, rest generally will prevent its recurrence by reducing oxygen consumption of the myocardium.

Which assessment would be brought to the health care provider's attention before administration of intravenous potassium chloride? A. Progressively worsening muscle weakness B. Poor tissue turgor with tenting C. Urinary output of 200 mL during the previous 8 hours D. Oral fluid intake of 300 mL during the previous 12 hours

Answer: C Rationale: Decreased urinary output may result in the retention of potassium, causing hyperkalemia. Progressively worsening muscle weakness is a manifestation of hypokalemia, which is the reason for prescribing the potassium. Reporting poor tissue turgor with tenting is unnecessary; this may indicate dehydration, which is probably the rationale for the fluid prescribed. Reporting an oral fluid intake of 300 mL during the previous 12 hours is unnecessary; this can precipitate dehydration or can compound an existing dehydration, which can be treated with appropriate hydration.

The nurse is caring for a client diagnosed with heart failure who will begin treatment with digoxin. Which therapeutic effect would the nurse expect to find after administering this medication? A. Decreased chest pain with decreased blood pressure B. Increased heart rate with increased respirations C. Improved respiratory status with increased urinary output D. Diaphoresis with decreased urinary output

Answer: C Rationale: Digoxin (Lanoxin), a cardiac glycoside, is used in clients with heart failure to slow and strengthen the heartbeat. As cardiac output is improved, renal perfusion is improved and urinary output increases. The other findings are related to adverse, not therapeutic, effects related to digoxin or are not typically seen at all with digoxin.

A client's dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily. When the client reports the onset of a headache prior to the next scheduled dose, which action should the nurse implement? A. Hold the next scheduled dose of Imdur 60 mg and administer a PRN dose of acetaminophen (Tylenol). B. Administer the 40 mg of Imdur and then contact the healthcare provider. C. Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol). D. Do not administer the next dose of Imdur or any acetaminophen until notifying the healthcare provider.

Answer: C Rationale: Imdur is a nitrate which causes vasodilation. This vasodilation can result in headaches, which can generally be controlled with acetaminophen until the client develops a tolerance to this adverse effect.

The inpatient hospital nurse is caring for a client with hypokalemia. The health care provider prescribed a potassium intravenous (IV) infusion of 40 mEq potassium chloride in 250 mL normal saline to be infused over 4 hours. The nurse receives the infusion from the pharmacy. Which action should the nurse take next? A. Confirm patency of the peripheral venous access device and start the infusion B. Notify the health care provider of the inappropriate dose of the prescribed IV potassium C. Ask another nurse to verify the prescription, IV solution and serum potassium level D. Ask another nurse to witness the addition of the prescribed potassium to the IV solution

Answer: C Rationale: Since potassium chloride is considered a high alert medication, especially when given IV, having two nurses verify the order and IV bag is recommended. The nurses should compare the supplied IV bag to the prescriber's order. If potassium IV is infused too rapidly or in too high a dose, it can cause dysrhythmias and cardiac arrest. In addition, the second nurse should also verify the client's most recent serum potassium level to ensure that the prescription is appropriate. The prescribed dose and amount of IV solution is within normal range for IV potassium replacement therapy. Potassium should never be added by a nurse to an IV bag.

Which clinical finding indicates that a client taking digoxin may have developed digoxin toxicity? A. Constipation B. Decreased urination C. Cardiac dysrhythmias D. Metallic taste in the mouth

Answer: C Rationale: The development of cardiac dysrhythmias is often a sign of digoxin toxicity. Constipation is not a sign of toxicity; gastrointestinal signs and symptoms of toxicity include anorexia, nausea, vomiting, and diarrhea. Decreased urination is not a sign of toxicity. Digoxin does not cause a metallic taste in the mouth.

The nurse is teaching a client who has a new prescription for sublingual nitroglycerin. Which point should the nurse emphasize? A. 'Take the medication at the same time each day' B. 'Rest in bed for an hour after taking medication' C. 'Carry the nitroglycerine with you at all times' D. 'Keep the medication bottle in the refrigerator'

Answer: C Rationale: The medication should be kept in its original dark-colored glass container. Nitroglycerin should be carried by the client at all times so it can be used when anginal pain occurs. When needed, the client should sit and place tablet under his or her tongue. Sitting is safe because the drug can cause lightheadedness or dizziness, but it's not necessary to rest in bed. The client should never pack this and any other medications in a checked a bag when traveling.

The nurse is monitoring a 4-month-old infant who is prescribed digoxin. The infant's blood pressure is 92/78 mm Hg; resting pulse is 78 beats per minute; respirations are 28 breaths per minute; and serum potassium level is 4.8 mEq/L. The infant is irritable and has vomited twice since receiving the morning dose of digoxin. Which finding is most indicative of digoxin toxicity? A. Irritability B. Vomiting C. Bradycardia D. Dyspnea

Answer: C Rationale: The most common sign of digoxin toxicity in children is bradycardia which is a heart rate below 100 beats per minute in an infant. Normal resting heart rate for infants 1-11 months-old is 100-160 beats per minute.

Which instruction would the nurse include when teaching the client about sublingual nitroglycerin? A. 'Once the tablet is dissolved, spit out the saliva.' B. 'Take tablets 3 minutes apart up to a maximum of five tablets.' C. 'Common side effects include headache and low blood pressure.' D. 'Once opened, the tablets should be refrigerated to prevent deterioration.'

Answer: C Rationale: The primary side effects of nitroglycerin are headache and hypotension. It is not necessary to spit out saliva into which nitroglycerin has dissolved. For pain that is not relieved, additional tablets may be taken every 5 minutes up to a total of three tablets. It should be stored at room temperature.

A client recently diagnosed with heart failure has been prescribed digoxin and furosemide. Which of the following foods should the nurse teach the client to eat at least one serving a day? A. Blueberries B. Wheat cereal C. Tomato juice D. Pear nectar

Answer: D Rationale: Digoxin, an antiarrhythmic, and furosemide, a diuretic, are commonly prescribed for clients with heart failure. A common side effect for furosemide is depletion of potassium. Of the food choices, tomato juice is the highest in potassium. To reduce the risk of potassium depletion, the client should be encouraged to drink at least 1/2 cup of tomato juice every day which is about 400 mg of potassium. The other choices are low in potassium which would be recommended for clients diagnosed with chronic renal failure.

A client has been given a prescription for furosemide 40 mg every day in conjunction with digoxin. Which concern would prompt the nurse to ask the health care provider about potassium supplements? A. Digoxin causes significant potassium depletion. B. The liver destroys potassium as digoxin is detoxified. C. Lasix requires adequate serum potassium to promote diuresis. D. Digoxin toxicity occurs rapidly in the presence of hypokalemia.

Answer: D Rationale: Furosemide promotes potassium excretion, and low potassium (hypokalemia) increases cardiac excitability. Digoxin is more likely to cause dysrhythmias when potassium is low. Digoxin does not affect potassium excretion. Furosemide causes potassium excretion. Potassium is excreted by the kidneys, not destroyed by the liver. Furosemide causes diuresis and consequent potassium loss regardless of the serum potassium level.

A client receives a cardiac glycoside, a diuretic, an angiotensin-converting enzyme (ACE) inhibitor, and a vasodilator. The client's apical pulse rate is 44 beats/minute. The nurse concludes that the decreased heart rate is caused by which medication? A. Diuretic/furosemide B. Vasodilator/nitroglycerin C. ACE inhibitor/ "ace" to -pril D. Cardiac glycoside/digoxin

Answer: D Rationale: A cardiac glycoside such as digoxin decreases the conduction speed within the myocardium and slows the heart rate. The primary effect of a diuretic is on the kidneys, not the heart; it may reduce the blood pressure, not the heart rate. A vasodilator can cause tachycardia, not bradycardia, which is an adverse effect. ACE inhibitors act on the renin-angiotensin system and are not associated with decreased heart rates.

A nurse is preparing to administer prescribed maintenance dose of digoxin to a client who has heart failure. Which action should the nurse to take? A. Withhold the medication if the heart rate is above 100/min B. Instruct the client to eat foods that are low in potassium C. Measure apical pulse rate for 30 seconds before administration D. Evaluate the client for nausea, vomiting, and anorexia

Answer: D Rationale: A client with heart failure who is prescribed digoxin should be assessed for digoxin toxicity. Manifestations of digoxin toxicity include nausea, vomiting, and anorexia. Digoxin is used to decrease heart rate and should be held if the heart rate is less than 60 beats per minute. Digoxin toxicity can occur when the client has low potassium. When administering digoxin, the nurse should measure the client's apical pulse for a full minute.

The nurse provides medication discharge instructions to a client who received a prescription for digoxin. Which statement by the client leads the nurse to conclude that the teaching was effective? A. 'I will avoid foods high in potassium.' B. 'I must increase my intake of vitamin K.' C. 'I should adjust the dosage according to my activities.' D. 'It will be important to check my pulse rate daily.'

Answer: D Rationale: Checking the pulse rate daily is necessary for monitoring cardiac function; digoxin slows and strengthens the heart rate. Digoxin should be withheld, and the health care provider notified, if the pulse rate falls below a predetermined rate (e.g., 60 beats per minute). Hypokalemia increases the potential for digoxin toxicity; potassium intake may need to be increased, not decreased. An increase in the intake of foods rich in vitamin K is unnecessary; digoxin does not affect vitamin K or vitamin K clotting factors. Adjusting the dosage according to activities is not an appropriate decision for the client; the health care provider should make this decision.

A client with angina has been instructed about the use of sublingual nitroglycerin. Which statement by the client indicates the need for additional teaching? A. "I'll call the health care provider if pain continues after three tablets five minutes apart." B. "I will rest briefly right after taking one tablet." C. "I understand that the medication should be kept in the dark bottle." D. "I can swallow two or three tablets at once if I have severe pain."

Answer: D Rationale: Clients must understand that just one sublingual tablet should be taken at a time. Clients must also understand that they should rest when experiencing angina. Two or three tablets should not be used at once, even in the setting of severe pain, as this can lead to significant hypotension. The client should notify their primary healthcare provider should they not have a relief of symptoms with nitroglycerin use.

A client is prescribed furosemide and digoxin for heart failure. The nurse should monitor the client for which potential adverse drug effect? A. Pulmonary hypertension B. Acute arterial occlusion C. Acute kidney injury D. Cardiac dysrhythmias

Answer: D Rationale: Digoxin is a cardiac glycoside, or positive inotrope that increases myocardial contractility. By increasing contractile force, digoxin can increase cardiac output in clients with heart failure (HF). Furosemide is a potassium-wasting (loop) diuretic, prescribed to prevent fluid overload in clients with HF. Clients who take furosemide are at risk for developing hypokalemia. Potassium ions compete with digoxin and a low potassium level can cause digoxin toxicity, leading to lethal cardiac dysrhythmias. Therefore, it is imperative that potassium levels be kept within normal range (3.5 to 5 mEq/L) while taking digoxin.

The nurse is preparing to administer digoxin to a client admitted for acute decompensated heart failure. Which action is the priority before giving this drug? A. Monitor oxygen saturation on room air B. Assess the client's weight and compare to the baseline C. Auscultate the lungs for crackles in the bases D. Assess the apical pulse for a full minute

Answer: D Rationale: Digoxin, a cardiac glycoside, is used to slow the heart rate and increase the force of contraction. The priority for the nurse is to count the client's apical pulse for one full minute, even if the heart rhythm is regular. Typically, when the pulse is less than 60, digoxin should not be given. The other actions are also appropriate assessments for a client with heart failure. However, they are not the priority when administering digoxin.

The nurse working in an intensive care unit is caring for a client diagnosed with acute angina. The client is receiving an intravenous infusion of nitroglycerin. What is the priority assessment for this client? A. Heart rate B. Neurologic status C. Urine output D. Blood pressure

Answer: D Rationale: Nitroglycerin (NTG) is a vasodilator used to promote myocardial tissue perfusion and relieve chest pain associated with coronary artery occlusion. The systemic vasodilation that occurs as a result of this medication can cause profound hypotension. The client's blood pressure should be evaluated every 15 minutes until stable, and then every 30 minutes to every hour thereafter. Clients receiving IV nitroglycerin should also be placed on continuous ECG monitoring. NTG is not known to affect neurologic status, urine output or heart rate.

The nurse on a cardiac unit is caring for a client who is receiving nitroglycerin intravenously for unstable angina. During administration of the medication, which assessment is the priority? A. Respiratory rate B. Cardiac enzymes C. Cardiac rhythm D. Blood pressure

Answer: D Rationale: Nitroglycerin is a drug that is used to provide relief from myocardial chest pain and treat hypertensive emergencies. Nitroglycerin causes vasodilation. Common adverse effects of nitroglycerin include hypotension, headache and dizziness; therefore, monitoring the client's blood pressure is the priority. Nitroglycerin does not affect respirations, cardiac enzyme levels or heart rhythm.

Which instructions will the nurse give a client for whom nitroglycerin tablets are prescribed? A. Limit the number of tablets to four per day. B. Discontinue the medication if a headache develops. C. Increase the number of tablets if dizziness is experienced. D. Ensure that the medication is stored in its original dark container.

Answer: D Rationale: Nitroglycerin is sensitive to light and moisture, so it must be stored in a dark, airtight container. Limit the number of tablets to four per day, taken as needed. If more than three tablets are necessary in a 15-minute period, emergency medical attention should be received. A headache may be an expected side effect, and the medication should not be discontinued. Dizziness indicates the dosage may need to be decreased by the health care provider.

Which pain characteristic would the nurse expect to observe when a client is experiencing anginal pain? A. Unchanged by rest B. Precipitated by light activity C. Described as a knifelike sharpness D. Relieved by sublingual nitroglycerin

Answer: D Rationale: Relief by sublingual nitroglycerin is a classic reaction because it causes vasodilation of peripheral veins and arteries, thereby decreasing oxygen demand by decreasing preload. To a lesser extent, sublingual nitroglycerin dilates coronary arteries, which increases oxygen to the myocardium, thereby decreasing pain. Immediate rest frequently relieves anginal pain. Angina usually is precipitated by exertion, emotion, or a heavy meal. Angina usually is described as tightness, indigestion, or heaviness.

When a client's cells are deprived of oxygen during a cardiac arrest, which medication corrects for deleterious effects of anaerobic energy production? A. Regular insulin B. Calcium gluconate C. Potassium chloride D. Sodium bicarbonate

Answer: D Rationale: Sodium bicarbonate is used to correct the acidosis that occurs during anaerobic metabolism. It helps to buffer the excess hydrogen ions produced during anaerobic respiration. Regular insulin, calcium gluconate, and potassium chloride are not used specifically to correct the effects of anaerobic energy production during cardiac arrest.

A nurse is assessing a client receiving intravenous potassium chloride. The client verbalizes pain to the IV site. The site appears swollen and is warm to touch. Which action does the nurse perform? A. Decrease the rate of the infusion B. Apply ice to the IV access site C. Inform the client that this is an expected finding

Answer: D Rationale: The nurse should discontinue the IV catheter. The client's symptoms are indicative of phlebitis, inflammation of the vein. Decreasing the rate of the infusion will not treat the swelling or injury to the vein. Applying ice to the access site does not address the possible vein injury caused by the medication. Pain, swelling, and warmth are not expected findings for a patent IV access site.

The nurse is preparing to apply nitroglycerin ointment. Before applying the ointment, which action will the nurse take? A. Assess the client's pulse rate. B. Prepare the site with an alcohol swab. C. Shave the client's chest in the area for application. D. Use the dose measuring application paper and spread the ointment in a thin layer to the prescribed amount.

Answer: D Rationale: The nurse would use the dose measuring application paper supplied with the ointment and spread in a thin layer to the prescribed amount and place side down on the desired skin. The nurse would assess blood pressure reading, not pulse rate. There is no need to clean the site with alcohol before administration. Shaving is not recommended; a hairless site on the chest, back, abdomen, or anterior thigh should be selected.

Sublingual nitroglycerin is prescribed for a client with a history of a myocardial infarction and atrial tachycardia. The nurse instructs the client about the prophylactic use of these tablets. Which statement by the client indicates the teaching was effective? A. 'I should take the medicine three times a day.' B. 'I will be sure to take my pulse after I have exercised.' C. 'It will be important to avoid activities that can cause angina.' D. 'I should take one tablet before attempting activity that has caused angina.'

Answer: D Rationale: The response about taking one tablet before activity that has caused angina indicates that the client understands the nurse's teaching. Taking a nitroglycerin tablet before such an activity probably will prevent an episode of angina, which is an example of prophylactic use of a medication. Taking the medicine three times a day is an example of scheduled administration of a nitrate medication for prophylaxis, but the client is being prescribed sublingual nitrate. The statement to avoid activities that can cause angina indicates avoidance of activity rather than taking medication to prevent angina during the activity. Blood pressure, not pulse, is the parameter most affected by nitroglycerin.

Which advice will the nurse include when teaching a client about digoxin for left ventricular failure? A. Sleep flat in bed. B. Follow a low-potassium diet. C. Take the pulse three times a day. D. Report increasing fatigue.

Answer: D Rationale: Treatment with digoxin should improve fatigue associated with heart failure; if fatigue increases, it may reflect complications of therapy. Sleeping with the head slightly elevated facilitates respiration. The client needs potassium. A low-potassium diet when the client is taking digoxin predisposes the client to toxicity and dangerous dysrhythmias. To avoid becoming obsessed with the pulse rate, the client should take the pulse less often; once daily is adequate.

A client with coronary artery disease who is taking digoxin (Lanoxin) receives a new prescription for atorvastatin (Lipitor). Two weeks after initiation of the Lipitor prescription, the nurse assesses the client. Which finding requires the most immediate intervention? A. Heartburn. B. Headache. C. Constipation. D. Vomiting.

Answer: D Rationale: Vomiting, anorexia, and abdominal pain are early indications of digitalis toxicity. Since Lipitor increases the risk for digitalis toxicity, this finding requires the most immediate intervention by the nurse.

Which reason would an intravenous infusion of 5% dextrose with 0.45% sodium chloride and 20 mEq of potassium be prescribed for a client with a nasogastric (NG) tube set to low intermittent suction? A. Prevent constipation B. Prevent dehydration C. Prevent vomiting D. Prevent Electrolyte imbalance

Answer: D Rationale: When clients do not receive nutrients or fluids by mouth and have a loss of electrolytes through the removal of gastric secretions via an NG tube, electrolyte imbalance is a primary concern. Constipation is usually not a concern in this situation. Although dehydration is a possible effect of an NG tube that removes gastric secretions and fluid, electrolyte balance is still the priority. An NG tube set to low intermittent suction usually relieves nausea and vomiting.

A client has been receiving digoxin. The client calls the clinic and complains of 'yellow vision.' Which response would the nurse provide? A. 'This is related to your illness rather than to your medication.' B. 'This is an expected side effect; you will become accustomed to it over time.' C. 'This side effect is only temporary. You should continue the medication.' D. 'The medication may need to be discontinued. Come to the clinic this afternoon.'

Answer: D Rationale: Yellow vision indicates digoxin toxicity; the medication should be withheld until the health care provider can assess the client and check the digoxin blood level. Yellow vision is related to digoxin therapy, not the client's underlying medical condition. Yellow vision is a sign of digoxin toxicity; taking more digoxin will escalate the digoxin toxicity.

1) The client is discharged from the hospital with a new prescription for furosemide. During a follow-up visit one week later, the nurse notes the following findings. Which finding is most important to report to the health care provider? A. Constipation B. Muscle cramps C. Occasional lightheadedness D. Increased urine production

B Rationale: Furosemide is a loop (potassium-wasting) diuretic. It can cause dehydration and hypokalemia, which can result in muscle cramps. This is the most important finding. Dizziness or lightheadedness may occur as the body adjusts to the medication. The nurse should reinforce to the client that they should get up slowly when rising from a sitting or lying position. The client should tell the HCP if these findings persist or become worse. Increased urine production is an expected action of the medication. Some people experience constipation when taking this medication, but it is not as important to report that finding as the possibility of hypokalemia.

29) The nurse is monitoring a client who is taking prescribed nitroglycerin for angina. Which finding indicates the medication has a therapeutic effect? A. The client blood pressure is 150/80 mm/Hg. B. The client heart rate is 110. C. The client reports a decrease in chest pressure. D. The client reports a headache.

C Rationale: Nitroglycerin acts to decrease myocardial oxygen consumption. Dilatation of the veins reduces the amount of blood returning to the heart (preload), so the chambers have a smaller volume to pump resulting in decreased oxygen needs. Decreased oxygen demand reduces pain caused by dilating coronary blood flow. While blood pressure may decrease slightly due to the vasodilatory effects of nitroglycerin, it is a secondary effect and not the desired therapeutic effect of this drug. Increased blood pressure and increased preload would mean the heart would work harder, increasing oxygen demand and thus angina. Decreased heart rate is not an effect of nitroglycerin.

34) The health care provider prescribes isosorbide dinitrate 10 mg for a client with chronic angina pectoris. The client asks the nurse why the isosorbide dinitrate is prescribed. How will the nurse respond? A. 'It prevents excessive blood clotting.' B. 'It suppresses irritability in the ventricles.' C. 'It decreases cardiac oxygen demand.' D. 'The inotropic action increases the force of contraction of the heart.'

C Rationale Isosorbide dinitrate dilates peripheral veins and arteries thus decreasing preload and decreasing oxygen demand. Preventing blood from clotting is the action of anticoagulants. Suppressing irritability in the ventricles is the action of antidysrhythmics. Increasing the force of contraction of the heart is the action of cardiac glycosides.

33) A client who had a myocardial infarction receives a prescription for a nitroglycerin patch. Which statement would the nurse identify as the purpose of the nitroglycerin patch? A. Decreased heart rate lowers cardiac output. B. Increased cardiac output increases oxygen demand. C. Decreased cardiac preload reduces cardiac workload. D. Peripheral venous and arterial constriction increases peripheral resistance

C Rationale Nitroglycerin reduces cardiac workload by decreasing the preload of the heart by its vasodilating effect. It decreases blood pressure, not heart rate (which may increase to compensate for the decreased blood pressure). It decreases, not increases, oxygen demand. Nitroglycerin dilates, not constricts, peripheral veins and arteries.

2) The nurse is caring for a client who has been taking furosemide for the past week. Which manifestation would indicate that the client may be experiencing a negative side effect? A. Edema of the ankles B. Gastric irritability C. Weight gain of five pounds D. Decreased appetite.

D Rationale: Furosemide (Lasix) causes a loss of potassium if a supplement is not taken. Findings of hypokalemia include anorexia, fatigue, nausea, decreased gastrointestinal motility, muscle weakness and dysrhythmias.