Chapter 55, ATI Pharmacology Made Easy 4.0 Cardiovascular System, Chapter 54, Ch 53 Respiratory System - Pharm, Chapter 44 concepts, Chapter 45 questions, Chapter 43 questions, Ch. 42 Intro to the Cardiovascular System, Ch. 49 Drugs Used to Treat Ane...

Antiarrhythmic drugs alter the action potential of the cardiac cells. Because they alter the action potential, antiarrhythmic drugs often

cause new arrhythmias.

A patient who receiving an antiarrhythmic drug needs

constant cardiac monitoring until stabilized.

Ibutilide (Corvert) is a class III antiarrhythmic drug that is used for

conversion of recent onset AF and flutter

MC To ensure maximum absorption, a nurse instructs a patient receiving oral iron therapy to avoid taking the iron with a. protein b. antibiotics c. dairy products d. any other drugs

Answer: c. dairy products

MC Heparin reacts to prevent the conversion of prothrombin to thrombin. Heparin a. is available in oral and parenteral forms b. takes about 72 hours to have a therapeutic effect c. has its effects reversed with the administration of protamine sulfate d. has its effects reversed with the injection of Vitamin K

Answer: c. has its effects reversed with the administration of protamine sulfate

Antihemophilic agents are used to replace missing clotting factors to prevent severe blood loss. The most common side effect or side effects associated with the use of these drugs are. a. bleeding b. Dark stools and urine c. hepatitis and AIDS d. Constipation

Answer: c. hepatitis and AIDS

HCN blocker Therapeutic Actions

Blocking the HCNs slows the heart's pacemaker, the sinus node, in the repolarizing phase action potential- reduction in heart rate. Slowing heart rate improves cardiac output. There are no effects on ventricular repolarization. Can also affect channels in the retina, alter the retinal response bright light

Milrinone therapeutic action

Blocks the enzyme phosphodiesterase; increases myocardial cell cyclic adenosine monophasphate, increasing calcium levels. Increased calcium causes stronger contraction and prolongs sympathetic stimulation leading to vasodilation, increased o2 consumption and arrhythmias

Right-side heart failure

Blood backs up in venous system leading to right side of heart; liver congestion, edema of legs and feet

Left ventricle pumps ineffectively:

Blood backs up to lungs, causing congestion and fluid leakage into alveoli and tissues; pulmonary edema can occur

Adverse effects of ivabradine

Bradycardia, HTN, a-fib, luminous phenomena

Inhaled steroids

Budesonide Action: decrease the inflammatory response in the airway Indication: prevention and treatment of asthma. Treat chronic steroid-dependent bronchial asthma Contraindication: not used for emergency during an acute attack or status asthmaticus Adverse effects: Sore throat, hoarseness, coughing, dry mouth, pharyngeal and laryngeal fungal infection, rebound congestion

The stepped care approach to the treatment of hypertension includes

lifestyle modification, including exercise, diet, and decreased smoking and alcohol intake use of a diuretic, beta-blocker, or ACE inhibitor to supplement lifestyle changes. combination of antihypertensive drug classes to achieve desired control.

A patient with COPD would be expected to have

loss of protective respiratory mechanisms due to prolonged irritation or damage.

Hypertension is associated with

loss of vision. strokes. atherosclerosis.

A nurse is teaching a client with a prescription for quinidine. Which of the following statements should the nurse include?

" Monitor your pulse rate and report changes"

A nurse is caring for a client who will begin using transdermal nitroglycerin to treat angina pectoris. When speaking to the client about the drug, which of the following instructions should the nurse include? S.A.T.A

"Apply the patch to a hairless area and rotate sites." "Apply a new patch when you start of your day." "Remove patches 10 to 12 hours each day."

The nose performs which of the following functions in the respiratory system?

- Initiates the sneeze reflex - Serves as a passageway for air movement - Warms and humidifies the air - Cleanses the air using hair fibers

For gas exchange to occur in the lungs, oxygen must pass through which of the following?

- The conducting airways - The pleural fluid - The interstitial alveolar wall - The capillary basement membrane - The interstitial space

A nurse is teaching a client about taking ferrous sulfate to treat iron-deficiency anemia. Which of the following instructions should the nurse include?

-Eat iron-enriched foods -Spread the dosage across each day -Take the drug on an empty stomach -Increase dietary fiber

A nurse is teaching a client about the adverse effects of pseudoephedrine. Which of the following should the nurse include?

-Restlessness -Insomnia -Anxiety

A nurse is teaching a client about ipratropium. The nurse should include that this drug has which of the following adverse effects?

-Urinary retention -Dry mouth

During diastole

-opening of the atrioventricular valves -relaxation of the myocardial valves -flow of blood from the atria to the ventricles -closing of the semilunar valves -filling of the coronary arteries

The sympathetic nervous system would be expected to have which of the following effects?

-stimulate the heart to beat faster -speed conduction through the AV node -cause the heart muscle to contract harder -increase total peripheral resistance

A nurse is teaching a client who is beginning fluticasone propionate/salmeterol therapy. Which of the following instructions should the nurse include?

Increase weight-bearing activity

Cardiotonic drugs (inotropic)

2 types: cardiac glycosides, phosphodiesterase inhibitors

2. A child with repeated asthma attacks may be treated with which of the following drugs? A leukotriene receptor antagonist A beta-blocker An inhaled corticosteroid An inhaled beta-agonist A surfactant A mast cell stabilizer

A leukotriene receptor antagonist An inhaled corticosteroid An inhaled beta-agonist A mast cell stabilizer

After teaching a community group about the common cold the instructor determines that the teaching was successful when the group states which of the following as the cause?

A number of different viruses

Rebound congestion

A process that occurs when the nasal passages become congested as the effect of a decongestant drug wear off

Ivabradine caution

A-fib or moderate heart block. Fetal toxicity, not recommended during breastfeeding

Clinical manifestations of HF

A-fib; peripheral congestion, edema; hepatomegaly; splenomegaly; decreased BP to GI; decreased peripheral pulses; hypoxia; engorged vessels

Cheyne-Stokes respiration

Abnormal pattern of breathing characterized by apneic periods followed by periods of tachypnea

A nurse is caring for a client who is having difficulty mobilizing thick respiratory secretions. Which of the following drugs should the nurse expect to administer to the client?

Acetylcysteine

A nurse should recognize that milrinone is contraindicated for a client who has which of the following conditions?

Acute myocardial infarction

Left-sided HF

Anxiety, tachypnea, dyspnea, orthopnea, hemoptysis, rales, cardiomegaly, S3 sounds, increased heart rate, GI upset, nausea, abdominal pain, decreased peripheral pulses, hypoxia

A nurse is teaching a client who is taking prednisone for chronic asthma. Which of the following instructions should the nurse include?

Avoid taking non steroidal anti-inflammatory drugs

A nurse would question an order for which of the following if the patient was also receiving verapamil?

Barbiturate anesthetics

Lung surfactants

Beractant Action: Replace the surfactant that is missing in the lungs of neonates with RDS Indication: Rescue treatment of infants who have developed RDS Contraindication: None Adverse effects: Patent ductus arteriosus, hypotnesion, intraventricular hemorrhage, pneumothorax, pulmonary air leak, hyperbilrubinemia, sepsis

How does HF occur?

CAD; cardiomyopathy; cardiomegaly, HTN, valvular disease

2 classes of drugs to treat heart failure

Cardiotonic agents and hyperpolarization-activated cyclic nucleotide-gated channel blockers (HCN channel blockers)

Treatments for HF

Cardiotonic, HCN Blockers, vasodilators (ACE inhibitors, nitrates), beta adrenergic agonists, diuretics, beta Blockers, human B-type natriuretic peptides

A nurse should recognize that using pseudoephedrine to treat allergic rhinitis requires cautious use with clients who have which of the following conditions?

Coronary artery disease

A nurse is caring for a client who is about to begin therapy with recombinant factor IX to treat hemophilia B. The client asks the nurse about the risk of disease transmission with recombinant factor IX as compared with plasma-derived factor IX. The nurse should explain that recombinant factor IX therapy practically eliminates the risk for which of the following?

Creutzfeldt-Jakob disease

Mast cell stabilizer

Cromolyn Action: works at the cellular level to inhibit the release of histamine and inhibits the release of SRSA Indication: treatment of chronic bronchial asthma, exercised induced asthma, allergic rhinitis Only available in an OTC form

A nurse is teaching a client about the use of beclomethasone to treat asthma. The nurse should explain that the drug has which of the following therapeutic effects?

Decreases inflammation

A nurse is caring for a client who is taking ferrous sulfate to treat iron deficiency anemia and develops toxicity. Which of the following drugs should the nurse expect to use to treat this complication?

Deferoxamine

Topical nasal decongestants

Ephedrine Action: Sympathomimetic (like SNS- vasoconstricting). Causing less inflammation of nasal membrane Indications: Relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis. Contraindication: lesion or erosion in the mucous membranes Adverse effects: Local stinging and burning, rebound congestion, restless, tremor, tachycardia, anorexia, nausea, vomiting, dyspnea Considerations: is bronchodilating

A nurse is caring for a client who is taking amiodarone to treat atrial fibrillation. Which of the following should the nurse instruct the client to avoid while taking this drug?

Grapefruit juice

Expectorants (Drug)

Guaifenesin Action: enhances output of the respiratory tract fluids. Result is a more productive cough and thus decreased cough frequency Indication: symptomatic relief of respiratory conditions characterized by a dry, nonproductive cough, including the common cold, acute bronchitis, and influenza Contraindication: persistent cough Adverse effects: nausea, vomiting, headache, dizziness, rash

Digoxin Indications

HF, atrial flutter, A-fib, paroxysmal atrial tachycardia

A nurse is reviewing the medication record of a client who is receiving alteplase following an acute myocardial infarction (MI). Which of the following medications should the nurse expect the client to be taking in addition to the alteplase?

Heparin

A nurse is caring for a client who is about to begin taking epoetin. An increase in which of the following laboratory values should indicate to the nurse that the therapy is effective?

Hgb

A nurse is caring for a client who is taking carvedilol in a prescription for oral antidiabetic to manage their new diagnosis of type 2 DM. By taking both drugs concurrently, The nurse should identify that the client is at an increased risk which of the following conditions?

Hypoglycemia

A nurse is monitoring a client who is taking a loop diuretic and is experiencing a thready, irregular pulse, orthostatic hypotension, and confusion. The nurse should identify that these manifestations indicate which of the following adverse effects?

Hypokalemia

A nurse is caring for a client with a new prescription for verapamil to treat atrial fibrillation. The nurse should instruct the client to avoid drinking grapefruit juice while taking verapamil because it can cause the client to experience which of the following?

Hypotension

Arrhythmias or dysrhythmias can be caused by which of the following?

Lack of oxygen to the heart muscle cells Acidosis near a cell Structural damage in the conduction pathway through the heart Thyroid hormone imbalance Electrolyte imbalances

1. Common adverse effects associated with the use of topical nasal steroids would include which of the following? Local burning and stinging Dryness of the mucosa Headache Constipation and urinary retention Fungal infections Osteonecrosis

Local burning and stinging Dryness of the mucosa Headache Osteonecrosis

A nurse is caring for a client with a new prescription for dobutamine. The nurse should clarify the prescription with the if the client is receiving which of the following types of drugs? S.A.T.A

MAOI General anesthetic Tricyclic antidepressant Beta blocker

Pulmonary edema

Manifested by rales, wheezes, blood-tinged sputum, low oxygenation and develop S3 sound

Digoxin

Most commonly used cardiotonic

The nurse is providing teaching to a client who is taking simvastatin. The nurse should instruct the client to report which of the following manifestations as an indication of serious adverse reaction that could require discontinuation of the drug therapy?

Muscle pain

A nurse is caring for a client who is taking atorvastatin and has a new prescription for gemfibrazil. The nurse should recognize that this drug combination places the client at risk for which of the following adverse affects?

Myopathy

A nurse is caring for a client with a new prescription for propranolol to treat tachydysrhythmia. The nurse should instruct the client to avoid taking which of the following types of overover-the-counter drugs while taking propranolol?

NSAIDs

Digoxin warnings

Narrow margin of safety, close monitoring needed

Xanthines (definition)

Naturally occurring substances Including caffeine and theophylline Have a direct effect on the smooth muscle of the respiratory tract

Pressure within the vascular system is determined by which of the following?

Peripheral resistance Stroke volume Sodium load Total intravascular volume

An acute myocardial infarction is usually associated with which of the following?

Permanent injury to the heart muscle Potentially serious arrhythmias A feeling of anxiety Pain

Drug-Drug Interactions milrinone

Precipitates form when milrinone is given in solution with furosemide.

Adult Respiratory Distress Syndrome (ARDS)

Progressive loss of lung compliance and increasing hypoxia Caused by: cardiovascular collapse, major burns, severe trauma, rapid depressurization Treatment: reversal of the underlying cause combined with ventilatory support

Oral decongestants

Pseudoephedrine Action: Shrink the nasal mucous membranes by stimulating the alpha-adrenergic receptors in the nasal mucous membranes Indication: promotion of drainage in the sinuses and improving air flow Contraindication: glaucoma, hypertension, diabetes, thyroid disease, coronary disease, prostate problems Adverse effects: rebound congestion, sympathetic effects

A nurse is caring for a client who is taking a diuretic. The nurse should instruct the client to include which of the following foods in their diet to increase potassium intake?

Raisins

A nurse is caring for a client who has a depressive disorder and requires a prescription drug to treat hypertension. The nurse should recognize that which of the following hypertensive drugs are contraindicated for the client?

Reserpine

A nurse is caring for a client who is taking codeine. The nurse should identify that which of the following assessments is priority to make?

Respirations

When describing the action of antianginal drugs to patient, which of the following would the nurse include?

Restore the supply-and-demand balance of oxygen in the heart Decrease venous return to the heart Decrease the workload on the heart

A nurse is caring for a client who is about to begin taking folic acid to treat megaloblastic anemia. The nurse should monitor which of the following laboratory values to determine therapeutic effectiveness>

Reticulocyte count

The type II cells of the walls of the alveoli function to

Secrete Surfactant

A nurse is monitoring plasma drug levels in a client who is taking theophylline. Which of the following findings should the nurse expect to see if the client's drug level indicates toxicity?

Seizures

The baroreceptors are the most important factor in continual control of BP. The baroreceptors

Sense pressure and Immediately send that information to the Medulla in the brain

A nurse is teaching a client about montelukast. Which of the following instructions should the nurse include?

Take the drug once a day in the evening

The conduction system of the heart includes which of the following?

The SA node The atrial bundles The Purkinje fibers The bundle of His

When describing heart valves to a group of students, which of the following would the instructor include?

The aortic valve opens when the pressure in the left ventricle becomes greater than the aortic pressure

A nurse is teaching a client about the use of mucolytic to treat a cough. The nurse should include that a mucolytic has which of the following therapeutic effects?

Thins and loosens mucus

A nurse is caring for a client who is taking clopidogrel to prevent stent restenosis. The nurse should monitor the client for which of the following adverse reactions?

Thrombocytopenia

A nurse is caring for a client who is scheduled for an outpatient surgical procedure and reports taking aspirin 81 mg daily, including this morning. The nurse should identify that this places the client at risk for which of the following complications?

Uncontrolled bleeding

A nurse should assess a client who has megaloblastic anemia for indications of which of the following vitamin deficiencies?

Vitamin B12

A nurse is teaching a client about ipratropium. Which of the following instructions should the nurse include?

Wait 5 min between using the drug and another inhaled drug

1. A patient with sinus pressure and pain related to a seasonal rhinitis would benefit from taking...? an antitussive. an expectorant. a mucolytic. a decongestant.

a decongestant.

A patient who is hypertensive becomes pregnant. The drug of choice for this patient is

a diuretic.

5. Antihistamines should be used very cautiously in patients with...? a history of arrhythmias or prolonged QT intervals. COPD or bronchitis. asthma or seasonal rhinitis. angioedema or low blood pressure.

a history of arrhythmias or prolonged QT intervals.

Prinzmetal angina occurs as a result of

a spasm of a coronary vessel.

Calcium-channel blockers are effective in treating angina because they

block strong muscle contractions, causing vasodilation

Nitrates commonly used antianginal drugs that act to

decrease venous return to the heart, decreasing the myocardial workload.

2. The xanthines...? block the sympathetic nervous system. stimulate the sympathetic nervous system. directly affect the smooth muscles of the respiratory tract. act in the central nervous system to cause bronchodilation.

directly affect the smooth muscles of the respiratory tract.

Digoxin toxicity S&S

nausea, vomiting, dysrhythmias, vision changes, anorexia, malaise, depression

Diffusion of CO2 from the tissues into the capillary blood

occurs if the tissue concentration of CO2 is greater than that in the blood.

For which of the following reasons should a nurse instruct a client to avoid taking guaifenisin with combination over-the-counter cold products?

over-the-counter cold products can also contain guaifenisin

In the heart

spontaneous depolarization of the muscle membrane can occur in the absence of nerve stimulation

Cardiac contraction and relaxation are controlled by

spontaneous impulses arising within the heart.

A cliet is brought to the emergency room with a suspected myocardial infarction. The client is very upset b/c he had just had an ECG in his doctor's office and it was fine. The explanation of this common phenomenon would include the fact that

the ECG only measures the flow of electrical current through the heart

The activity of the heart depends on both the inherent properties of the cardiac muscle cells and the activity of the autonomic nerves to the heart. Therefore,

the heart rate will increase in cases of dehydration, which lead to low cardiac output

Cardiac cells differ from skeletal muscle cells in that

they posses automaticity and conductivity

Droxidopa, an antihypotensive drug, should be used

to treat orthostatic hypotension in patients whose lives are impaired by the disorder

Adverse Effects milrinone.

ventricular arrhythmias fibrillation), hypotension, and chest pain. GI effects include nausea, vomiting, anorexia, and abdominal pain. Thrombocytopenia can occur with milrinone. Hypersensitivity reactions associated with this drug include vasculitis, pericarditis, pleuritis, and ascites. Burning at the Ⅳ injection site is also a frequent adverse effect

Treating angina involves modifying factors that could decrease myocardial oxygen consumption. It could be expected that this might include

weight loss. use of nitrates. activity modification. use of a piperazine acetamide agent. use of a calcium-channel blocker

Acetylcysteine

Antidote for acetaminophen poisoning

Leukotriene receptor antagonists

Drugs that selectively and competitively block or antagonize receptors for the production of leukotrienes D4 and E4

A nurse is teaching a client who has a new prescription for gemfibrozil. Which of the following instruction should the nurse include? S. A. T. A

"Report any new intolerance to fried foods." "Report muscle tenderness" "Expect periodic liver function testing"

Ivabradine contraindications

Active HF, hypotension, sick sinus syndrome of AV block, resting heart rate <60, sever hepatic impairment, and concurrent use of strong CYP3A4 inhibitors

A nurse is administering epoetin intravenously to a client who has renal failure. Which of the following actions should the nurse take?

Administer via IV bolus over 1 to 3 min

COPD manifestations

Air is trapped in the lower respiratory tract The alveoli degenerate and fuse together The exchange of gases is greatly impaired

A nurse is teaching a client who has a prescription for albuterol via inhaler and fluticasone/salmeterol via inhaler who asthma management. For which of the following reasons should the nurse instruct the client to use the albuterol inhaler before using the fluticasone inhaler?

Albuterol will increase the absorption of fluticasone

A nurse is teaching a client about using intranasal glucocorticoids. Which of the following instructions should the nurse give?

Allow at least 2 weeks for the full therapeutic effect

A nurse is caring for a client who is experiencing an acute ischemic cerebrovascular event due to thrombus in cerebral vessel. Which of the following drugs should the nurse expect to administer?

Alteplase

Ivabradine Drug-Drug Interactions

Altered plasma concentrations occur with strong CYP3A4 inhibitors or inducers; this combination should be avoided. Severe bradycardia can occur if combined with other negatively chronotropic drugs

Xanthines (drug)

Aminophylline Action: Direct effect on the smooth muscles of the respiratory tract Indication: Symptomatic relief or prevention of bronchial asthma and for reversal of bronchospasm associated with COPD Contraindication: GI problems, coronary disease, respiratory dysfunction, renal & hepatic disease, alcoholism, hyperthyroidism Adverse effects: GI upset, nausea, irritability, tachycarida, seizure, brain damage, death

MC Which of the following would the nurse include in the teaching plan when describing anemia to a patient? a. A decreased number of or abnormal RBCs. b. A lack of iron in the body. c. A lack of vitamin B12 in the body d. An excessive number of platelets

Answer a. A decreased number of, or abnormal RBCs

Select all that apply A bile acid sequestrants is a drug of choice for clients who has which of the following? a. A high LDL concentration b. A high triglyceride concentration c. Biliary obstruction d. Vitamin K deficiency e. A high high-density lipoprotein (HDL) concentration f. Intolerance to statins

Answer: a. A high LDL concentration b. A high triglyceride concentration f. Intolerance to statins

Select all that apply In a healthy person, very little iron is needed on a daily basis. Loss of iron is associated with which of the following? a. Heavy menstrual flow b. Bile duct obstruction c. Internal bleeding d. Penetrating traumatic injury e. Bone marrow suppression f. Alcoholic cirrhosis

Answer: a. Heavy menstrual flow c. Internal bleeding d. Penetrating traumatic injury.

Select all that apply Antiplatelet drugs block the aggregation of the platelets and keep vessels open. These drugs would be useful in which of the following? a. Maintaining the patency of grafts b. Decreasing the risk of fatal MI c. Preventing reinfarction after MI d. Dissolving a pulmonary embolus and improving oxygenation e. Decreasing damage in a subarachnoid bleed f. Preventing thromboembolic strokes

Answer: a. Maintaining the patency of grafts b. decreasing the risk of fatal MI c. Preventing reinfarction after MI f. Preventing thromboembolic strokes

Select all that apply Hageman factor is know to activate which of the following? a. The clotting cascade b. The anticlotting process c. The inflammatory response d. Platelet aggregation e. Thromboxane A2 f. Troponin coupling

Answer: a. The clotting cascade b. The anticlotting process c. The inflammatory response

Select all that apply Teaching a client who is prescribed an HMG-CoA reductase inhibitor to treat high cholesterol and high lipid levels should include which of the following? a. The importance of exercise b. The need for dietary changes to alter cholesterol levels c. That taking a statin will allow a full, unrestricted diet. d. That drug therapy is always needed when these levels are elevated e. The importance of controlling blood pressure and blood glucose levels f. The stopping smoking may also help to lower lipid levels.

Answer: a. The importance of exercise b. The need for dietary changes to alter cholesterol levels e. The importance of controlling blood pressure and blood glucose levels f. That stopping smoking may also help to lower lipid levels.

Select all that apply Evaluating a client who is taking an anticoagulant for blood loss would usually include assessing for which of the following? a. the presence of petechiae b. Bleeding gums while brushing the teeth c. Dark-colored urine d. Yellow color to the sclera or skin e. the presence of ecchymotic areas f. Loss of hair

Answer: a. the presence of petechiae b. Bleeding gums while brushing teeth c. Dark-colored urine e. the presence of ecchymotic areas f. loss of hair

A nurse is caring for a client who has hemophilia A and is about to begin taking desmopressin to prevent bleeding. The nurse should monitor the client for which of the following adverse reactions?

Edema

Select all that apply Plasminogen is converted to plasmin, a clot-dissolving substance, by which of the following? a. Nicotine b. Hageman factor c. Tenecteplase d. Pyrogens e. Thrombins f. Christmas factor

Answer: b. Hageman factor c. Tenecteplase d. Pyrogens

MC RBCs must be continually produced by the body because a. the iron within the RBC wears out and must be replaced b. RBCs cannot maintain themselves and wear out c. RBCs are continuously entering and being lost from the GI tract d. RBCs are processed into bile salts and must be replaced

Answer: b. RBCs cannot maintain themselves and wear out

MC After describing to a community group the ways in which the body uses cholesterol, which of the following, if stated by the group as such as a way, indicates successful teaching? a. The production of water-soluble vitamins b. The formation of steroid hormones c. The mineralization of bones d. The development of dental plaques

Answer: b. The formation of steroid hormones

MC A thrombolytic agent could be safely used in a. cerebrovascular accident within the last 2 months b. acute myocardial infarction (MI) within the last 3 hours. c. recent, serious gastrointestinal bleeding d. obstetric delivery

Answer: b. acute myocardial infarction (MI) within the last 3 hours

MC The formation of atheromas in blood vessels precedes the signs and symptoms of a. hepatitis b. coronary artery disease (CAD) c. diabetes mellitus d. chronic obstructive pulmonary disease (COPD)

Answer: b. coronary artery disease (CAD)

MC Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors work in the a. process of bile secretion. b. process of cholesterol formation in the cell c. intestinal wall to block fat absorption. d. kidney to block fat excretion.

Answer: b. process of cholesterol formation in the cell.

Select all that apply Clients are often given iron pills by their clinic. Instructions in giving these pills should include a. taking the drug with milk to avoid GI problems b. the potential for constipation c. keeping these potentially toxic pills away from children d. taking the drug with antacids to alleviate GI upset e. having periodic blood tests to evaluate the drug effect f. being aware that stools may be colored green

Answer: b. the potential for constipation c. keeping these potentially toxic pills away from children e. having periodic blood tests to evaluate the drug effect f. being aware the stools may be colored green

MC Warfarin, an oral anticoagulant acts a. to directly prevent the conversion of prothrombin to thrombin b. to decrease the production of vitamin K clotting factors in the liver c. as a catalyst in the conversion of plasminogen to plasmin d. immediately, so it is the drug of choice in emergency situations

Answer: b. to decrease the production of vitamin K clotting factors in the liver

MC After teaching a group of students about RBC production, the instructor determines that the teaching was effective when the grup states that the rate of RBC production is controlled by a. iron b. folic acid c. erythropoietin d. Vitamin B12

Answer: c. Erythropoietin

MC Which of the following would the nurse expect the health care provider to prescribe for a patient who has high lipid levels and cannot take fibrates or HMG-CoA reductase inhibitors? a. Nicotine b. Vitamin C c. Niacin d. Nitrates

Answer: c. Niacin

MC Megaloblastic anemia is a result of insufficient folic acid or vitamin B12, affecting which of the following? a. White blood cell production b. Vegetarians c. Rapidly turning over cells d. Slow-growing cells

Answer: c. Rapidly turning over cells

MC Which of the following would the nurse include when teaching a patient about HMG-CoA reductase inhibitors? a. The patient will not have a heart attack b. The patient will not develop CAD. c. The patient might develop cataracts as a result. d. The patient might stop absorbing fat-soluble vitamins

Answer: c. The patient might develop cataracts as a result

MC A patient with anemia who is given iron salts could expect to show a therapeutic increase in hematocrit a. within 72 hours b. within 2 to 3 weeks c. within 6 to 10 months d. within 1 to 2 weeks

Answer: c. Within 6 to 10 months

MC Hyperlipidemia is considered to be a. a normal finding in adult males. b. related to stress levels. c. a treatable CAD risk factor d. a side effect of cigarette smoking.

Answer: c. a treatable CAD risk factor.

After teaching a patient with pernicious anemia about vitamin B12, therapy, which patient statement would indicate that the teaching was successful? a. I can take this pill with breakfast b. I should take this pill at bedtime c. I need to inject this drug subQ every day d. I need to inject this drug intramuscularly every 5 to 10 days

Answer: d. I need to inject this drug intramuscularly every 5 to 10 days

MC Which of the following would alert the nurse to suspect that a patient receiving HMG-CoA reductase inhibitors is developing rhabdomyolysis? a. Flatulence and abdominal bloating b. Increased bleeding and bruising. c. The development of cataracts and blurred vision d. Muscle pain and weakness

Answer: d. Muscle pain and weakness

MC The low-molecular-weight heparin of choice for preventing deep venous thrombosis after hip replacement therapy is. a. tinzaparin b. dalteparin c. heparin d. enoxaparin

Answer: d. enoxaparin

MC The nurse would expect the physician to prescribe epoetin alfa (Epogen) as the drug of choice a. for acute blood loss during surgery b. to replace blood loss from traumatic injury c. for treatment of anemia during lactation d. for treatment of anemia associated with renal failure.

Answer: d. for treatment of anemia associated with renal failure

MC The bile acid sequestrants a. are absorbed into the liver b. take several weeks to show an effect. c. have no associated adverse effects. d. prevent bile salts from being reabsorbed.

Answer: d. prevents bile salts from being reabsorbed

MC Blood coagulation is a complex reaction that involves: a. vasoconstriction, platelet aggregation, and plasminogen action b. vasodilation, platelet aggregation, and activation of the clotting cascade c. vasoconstriction, platelet aggregation, and conversion of prothrombin to thrombin. d. vasodilation, platelet inhibition, and action of the intrinsic and extrinsic clotting cascades

Answer: c. vasoconstriction, platelet aggregation and conversion of prothronbin to thrombin

A nurse is caring for a client who is taking to digoxin and develops changes on the ECG tracing and other manifestations that indicates the client has severe digoxin toxicity. Which of the following drugs should the nurse expect to administer To treat this complication?

Antigen binding fragments

A nurse is preparing to administer a prescribed dose of desmopressin to a client who has hemophilia A. The client's laboratory results indicate that the client has a sodium level of 130 mEq/L. Which of the following actions should the nurse take?

Clarify the prescription with the provider

A nurse is caring for a client who has chronic stable angina. The nurse should identify that which of the following drugs inhibits the actions of adenosine diphosphate receptors (ADP) on platelets and can be prescribed to reduce the client's risk for myocardial infarction?

Clopidogrel

A nurse is monitoring a client following ferrous sulfate administration. The nurse should the client for which of the following adverse effects?

Constipation

Antitussives (drug)

Dextromethorphan (prototype) Codeine, hydrocodone Action: Act directly on the medullary cough center of the brain to depress cough reflex Indications: Control nonproductive cough Contraindications: Patients who need to maintain cough airway (cystic fibrosis), head injury, impaired CNS Adverse effects: Dry effect on the mucous membranes, respiratory depression, dry mouth, GI upset Considerations: do not give fluids immediately after administering to prevent fluid dilution of vehicle

A nurse is teaching a client who is starting treatment with warfarin. The nurse should plan to include information on which of the following topics to promote the effectiveness of the drug?

Dietary modifications

Digoxin antidote

Digoxin Immune Fab

Mucolytics (drug)

Dornase alfa Action: work to break down mucous in order to aid the high-risk respiratory patient in coughing up thick, tenacious secretions Indication: difficulty coughing up secretions, develop atelectasis, undergoing diagnostic bronchoscopy, postoperative ptx, tracheostomies Contraindication: acute bronchospasm, peptic ulcers, esophageal varices Adverse effects: nausea, stomatitis, urticaria (hives), bronchospasm, rhinorrhea Considerations: no data on effects in pregnancy or lactation

A nurse is teaching an adult client about diphenhydramine. The nurse should inform the client to expect which of the following adverse effects while taking this drug?

Drowsiness

Legal restrictions apply to the purchase of pseudoephedrine (Sudafed) because of which of the following risks?

Drug abuse

Mast cell stabilizer

Drug that works at the cellular level to inhibit the release of histamine and the release of slow-reacting substance of anaphylaxis

Antitussives (definition)

Drugs that block the cough reflex

Antihistamines (definition)

Drugs that block the release or action of histamine ( a chemical released during inflammation that increases secretions and narrows airways)

Decongestants

Drugs that decrease the blood flow to the upper respiratory tract and decrease the overproduction of secretions

Mucolytics (definition)

Drugs that increase or liquefy respiratory secretions to aid the clearing of the airways

Expectorants (definition)

Drugs that increase productive cough to clear airways

Sympathomimetics (definition)

Drugs that mimic the effects of the sympathetic nervous system

Right-sided HF characteristics

Elevated jugular venous pressure, splenomegaly, hepatomegaly, decreased renal perfusion when upright, increased renal perfusion when supine (nocturnal), pitting edema, weakness and fatigue

A nurse is caring for a client who is taking filgrastim to treat neutropenia. The nurse should assess the client for which of the following adverse effects?

Enlarged Spleen

Sympathomimetics (drug)

Epinephrine Action: Beta2 selective adrenergic agonists Indications: Acute asthma attack, bronchospasm with asthma , exercise induced asthma Contraindications: depends on the severity of the underlying condition Adverse effects: sympathomimetic stimulation, CNS stimulation, GI upset, arrhythmias, hypertension, bronchospasm, sweating, pallor, flushing, rebound congestion

A nurse is providing teaching to a client Who has a new prescription for losartan to treat hypertension. The nurse should instruct the client that which of the following findings could indicate an adverse reaction to the drug that needs to be reported?

Facial Edema

Topical nasal steroid decongestants

Flunisolide Actions: Locally acting. exact mechanism is unknown Indications: Seasonal allergic rhinitis. Inflammation after the removal of nasal polyps Contraindications: Acute infection Adverse effects: local burning, irritation, stinging, dryness of the mucosa, headache, increase risk of infection

A client stabilized on quinidine for the regulation of AF would be cautioned to avoid which of the following?

Foods that alkalinize the urine

Which of the following is most critical for respiration to occur?

Functioning inspiratory muscles

Nucleotide-Gated Channel Blockers Hyperpolarization-Activated Cyclic

HCN blocker introduced, ivabradine does not affect muscle contraction but does affect the pacemaker of the heart to rate.

A nurse is caring for a client who is about to begin factor VIII therapy to treat hemophilia A. When administering factor VIII, which of the following actions should the nurse take?

Have emergency equipment ready

A nurse is teaching a client who has a prescription for zileuton. Which of the following instructions should the nurse include?

Have laboratory tests performed at regular intervals

A nurse is caring for a client who recently started alteplase therapy. The nurse should monitor the client for which of the following adverse effects?

Headache

A nurse is preparing to administer phenylephrine to a client. The nurse should identify that which of the following manifestations is an adverse effect of this drug?

Headache

A nurse is teaching a client with a new prescription for nitroglycerin. The nurse should instruct the client that which of the following manifestations is a potential adverse effect of the drug?

Headache

Digoxin adverse effects

Headache, weakness, drowsiness, vision changes (yellow halo- indicative of toxicity) arrhythmia can develop,

Antihistamines (drug)

Hydroxyzine Action: Selectively block the effects of histamine at the histamine-1 receptor sites-- decreasing the allergic response. Anticholinergic and antipruritic effects Indication: Seasonal and perennial allergic rhinitis, allergic conjunctivitis, uncomplicated uticaria, and angioedema Contraindication: pregnancy and lactation Adverse effects: drowsiness, sedation, anticholinergic effects, dizziness, epigastric distress, rash, bradycardia

A nurse is caring for a client with a new prescription for aliskiren to treat hypertension. The nurse should monitor the client for which of the following adverse effects of the drug? S. A. T. A

Hyperkalemia Throat swelling. Cough

A nurse is caring for a client who has renal failure and is receiving epoetin. The nurse should monitor the client for which of the following adverse effects?

Hypertension

A nurse is administering hydrochlorothiazide to a client who has gouty arthritis. The nurse should monitor the client for which of the following findings that indicates an adverse effects of the drug?

Hyperuremia

Digoxin contraindications

In presence of allergy to any component of digitalis, ventricular tachycardia, or V-fib, heart block, sick sinus syndrome, idiopathic hypertrophic subaortic stenosis, acute MI, renal insufficiency, and electrolyte abnormalities. Avoid during pregnancy and lactation, children and elderly heed closely monitored for toxicity

Digoxin drug-drug effects

Increased effect:Verapamil, amiodarone, quinidine, erythromycin, tetracycline, or cyclosporine Decreased effect: thyroid hormones, metoclopramide or penicillamine Decreased oral absorption: cholestyramine, charcoal, colestipol, antacids, bleomycin, cyclophosphamide, methotrexate (administer 2-4 hours apart)

Effect of digoxin

Increased force of myocardial contraction, increased cardiac output, increased renal perfusion (diuretic effect), negative chronotropic effect (deacreased heart rate), decreased conduction velocity in AV node. Overall decreases myocardial workload

Therapeutic action of digoxin

Increases intracellular calcium and allows more calcium to enter myocardial cells during depolarization

A nurse is caring for a client who is about to begin taking aspirin to reduce the risk of a cardiovascular event. The nurse should identify that the drug inhibits platelet aggregation by which of the following mechanisms?

Inhibiting cyclooxygenase action in platelets

The renin-angiotensin system is associated with which of the following?

Intense vasoconstriction and BP elevation Blood flow through the kidneys Release of aldosterone from the adrenal cortex Retention of sodium and water in the kidneys

Anticholinergic (drug)

Ipratropium Action: blocks vagally mediated reflexes by antagonizing the action of acetylcholine Indication: maintenance treatment of bronchospasm associated with COPD Contraindication: any condition that would be aggravated by the anticholinergic effects of the drug Adverse effects: dizziness, headache, fatigue, nervousness, dry mouth, sore throat, palpitations, urinary retention

A patient who coughs is experiencing a reflex caused by

Irritation to receptors in the trachea and conducting airway

2. An antihistamine would be the drug of choice for treating which of the following? Itchy eyes Irritating cough Nasal congestion Drippy nose Idiopathic urticaria Thick, tenacious secretions

Itchy eyes Nasal congestion Drippy nose Idiopathic urticaria

Bronchodilator

Medication used to facilitate respirations by dilating the airways Helpful in symptomatic relief or prevention of bronchial asthma and bronchospasms associated with COPD

Phosphodiesterase inhibitors (inotropic)

Milrinone

Pharmacokinetics Milrinone

Milrinone is available only for IV use. It is widely distributed after injection. It is metabolized in the liver and excreted primarily in the urine.

CV system is a closed system

One side failure will lead to the other side failing leading to signs and symptoms of total HF

Digoxin pharmakinetcs

Oral and parental, rapid onset and rapid absorption, widely distributed, excreted mostly unchanged in urine, caution in presence of renal impairment

HF cell changes

Overstretched due to increased workload-cardiomegaly; cardiac cells lack ability to produce energy needed for effective contractions

A nurse is teaching a client about albuterol. The nurse should instruct the client to monitor for and report which of the following as an adverse effect of this drug?

Palpitations

A nurse should identify that clopidogrel is contraindicated for clients who have which of the following conditions?

Peptic Ulcer Disease

A nurse is caring for a client who is taking spironolactone to treat hypertension. The nurse should recognize that which of the following of the clients laboratory values require immediate intervention?

Potassium 5.2 mEq/L

A nurse should identify that dextromethorphan can have which of the following effects when combined with morphine?

Potentiation of depression of CNS actions

A nurse is teaching a client about the use of antihistamines to treat allergic rhinitis. The nurse should explain that these drugs are effective because they perform which of the following actions?

Prevent histamine from binding to receptors

A nurse should identify that which of the following drugs is used only for short term treatment cardiac dysrhythmia because of serious adverse affects associated with long term use?

Procainamide

A nurse is monitoring a client who is undergoing anticoagulant therapy with heparin. Which of the following findings should nurse identify as a possible indication of hemorrhage?

Rapid Pulse

Ivabradine pharmacokinetics

Rapidly absorbed in the GI tract, reaches peak in 1 hr. Metabolized in the liver and intestines and excreted in feces and bile.

A nurse is caring for a client who is about to begin captopril therapy. Which of the following adverse effects should the nurse instructed client to report because it could indicate a need to discontinue therapy? S. A. T. A

Rash Distorted Taste Swelling of the tongue Dry cough

Prevention and treatment of COPD

Reduce environmental exposure to irritants Smoking cessation Filter allergens from the air Avoid exposure to know allergens and irritants Open airways through muscular bronchodilation Decrease inflammation effects

A nurse is teaching a client about the use of cromolyn sodium to prevent bronchospasm. The nurse should explain that the drug has which of the following therapeutic effects?

Reduces inflammation

A nurse is teaching a client about the use of an expectorant to treat a cough. The nurse should include that an expectorant has which of the following therapeutic effects?

Reduces surface tension

Rhinitis medicamentosa

Reflex reaction to vasoconstriction caused by decongestants

Which of the following would a nurse expect to assess if a patient has inflammation of the upper respiratory tract?

Running nose Laryngitis Sneezing

A nurse is caring for a client who has a prescription for verapamil. The nurse should clarify the prescription with the provider if the client has a history of which of the following conditions?

Second degree AV block

Troponin

Separates actin and myosin in sarcomere; calcium inactivated and allows for actin and myosin to react and form actomyosin bridges that allows for contraction

A nurse is reviewing new prescriptions for a client with heart failure. The nurse should instruct the client that which of the following drugs is prescribed to treat Hypercholesteremia?

Simvastatin

Decreased cardiac output

Stimulates baroreceptors in aortic arch and carotid- sympathetic response is to stimulate increased heart rate, blood pressure and rate and depth of respirations; also positive inotropic effect; stimulates the release of renin in kidneys and activates the RAAS system which increases BP and volume

1. Clients who are using inhalers require careful teaching about which of the following? Avoiding food 1 hour before and 2 hours after dosing Storage of the drug Administration techniques to promote therapeutic effects and avoid adverse effects Lying flat for as long as 2 hours after dosing Timing of administration The difference between rescue treatment and prophylaxis

Storage of the drug Administration techniques to promote therapeutic effects and avoid adverse effects Timing of administration The difference between rescue treatment and prophylaxis

A nurse is caring for a client with a glomerular filtration rate of 10 mL/min and a reduced urine output. The nurse should clarify a prescription for hydrochlorothiazide for this client because of which of the following characteristics of the drug?

The drug does not promote diuresis for clients who have renal insufficiency.

For which of the following reasons should a client attach a spacer to a metered-dose inhaler?

To increase the amount of drug delivered to the lungs

3. Additional nursing interventions for clients receiving antihistamines probably would include which of the following? Using a humidifier Advising client to suck sugarless lozenges to help to relieve the dry mouth Limiting fluid intake to decrease swelling Providing safety measures to prevent falls or injury Encouraging pushing fluids, if allowed Leaving bowls of water around the house to increase humidity

Using a humidifier Advising client to suck sugarless lozenges to help to relieve the dry mouth Providing safety measures to prevent falls or injury Encouraging pushing fluids, if allowed Leaving bowls of water around the house to increase humidity

A nurse in an emergency department is assessing a client who has been taking warfarin and is experiencing rectal bleeding. Which of the following drugs should the nurse expect to administer to the client?

Vitamin K

A nurse is caring for a client who is about alteplase therapy to treat pulmonary embolism. Which of the following drugs should the nurse have available in the event of a severe adverse reaction?

Vitamin K

Leukotriene receptor antagonists

Zafirlukast Action: selectively and competitively block or antagonize receptors for the production of leukotreines Indication: prophylaxis and chronic treatment of bronchial asthma Contraindication: hepatic & renal impairment Adverse effects: headache, dizziness, myalgia, nausea, diarrhea, abdominal pain, elevated liver enzyme concentrations, vomiting, generalized pain

The drug of choice for the treatment of a supraventricular tachycardia associated with Wolff- Parkinson-White syndrome is

adenosine.

A client taking ACE inhibitor is scheduled for surgery, the nurse should

alert the surgeon and mark the client's chart prominently

Clinically, dysrhythmias or arrhythmias cause

altered cardiac output that could affect all cells

Coronary artery disease results in

an imbalance in cardiac muscle oxygen supply and demand

A heart transplantation patient has no nerve connections to the transplanted heart. In such an individual, one would expect to find

an increase in heart rate during emotional stress

4. A person with hypertension and known heart disease has frequent bronchospasms and asthma attacks that are most responsive to sympathomimetic drugs. This patient might be best treated with...? an inhaled sympathomimetic to decrease systemic effects. a xanthine. no sympathomimetics because they would be contraindicated. an anticholinergic.

an inhaled sympathomimetic to decrease systemic effects.

Because of the results of the CAST study,

antiarrhythmics are reserved for use in cases of life-threatening arrhythmias.

The baroreceptors in the carotid sinus and aortic arch

are in appropriate position to protect the brain

Essential hypertension is the most commonly diagnosed form of high BP. Essential hypertension is

associated with no known cause.

6. Leukotriene receptor antagonists act to block production of a component of slow-reacting substance of anaphylaxis. They are most beneficial in treating...? seasonal rhinitis. pneumonia. chronic obstructive pulmonary disease. asthma.

asthma.

Blood flow to the myocardium differs from blood flow to the rest of the body in that

blood perfuses the myocardium during diastole

A patient is brought into the emergency room with a potentially life-threatening ventricular arrhythmia. Immediate might include

bolus and titrated doses of lidocaine.

Contraindications Phosphodiesterase

contraindicated for allergy to either of these drugs or to bisulfites presence to avoid hypersensitivity; contraindicated in the following conditions: Severe aortic or pulmonic valvular disease, which could be exacerbated by increased contraction; acute MI, fluid volume deficit, and ventricular arrhythmias, which could be exacerbated by this drug. Avoid during pregnancy and breastfeeding. Caution should be exercised in the elderly

5. A patient with many adverse reactions to drugs is tried on an inhaled steroid for treatment of bronchospasm. For the first 3 days, the patient does not notice any improvement. You should...? switch the patient to a xanthine. encourage the patient to continue the drug for 2 to 3 weeks. switch the patient to a sympathomimetic. try the patient on surfactant.

encourage the patient to continue the drug for 2 to 3 weeks.

3. Your patient has been maintained on theophylline for many years and has recently taken up smoking. The theophylline levels in this patient would be expected to...? rise, because nicotine prevents the breakdown of theophylline. stay the same, because smoking has no effect on theophylline. fall, because the nicotine stimulates liver metabolism of theophylline. rapidly reach toxic levels.

fall, because the nicotine stimulates liver metabolism of theophylline.

The nurse emphasizes the need to take sinusitis very seriously because

if it is left untreated, microorganisms can travel to brain tissue.

heart failure (HF)

inability of the heart to circulate blood effectively enough to meet the body's metabolic needs

cardiotonic drugs

increase the force of cardiac muscle contraction, treats congestive heart failure

8. Lung surfactants used therapeutically are...? injected into a developed muscle. instilled via a nasogastric tube. injected into the umbilical artery. instilled into an endotracheal tube properly placed in the baby's lungs.

instilled into an endotracheal tube properly placed in the baby's lungs.

1. Treatment of obstructive pulmonary disorders is aimed at...? opening the conducting airways or decreasing the effects of inflammation. b blocking the autonomic reflexes that alter respiration's. blocking the effects of the immune and inflammatory systems. altering the respiratory membrane to increase the flow of oxygen and carbon dioxide.

opening the conducting airways or decreasing the effects of inflammation.

Angina is

pain due to lack of oxygen to myocardial cells.

2. Antitussives are useful in blocking the cough reflex and preserving the energy associated with prolonged, nonproductive coughing. Antitussives are best used with...? postoperative patients. asthma patients. patients with a dry, irritating cough. chronic obstructive pulmonary disease (COPD) patients who tire easily.

patients with a dry, irritating cough.

7. Respiratory distress syndrome occurs in...? babies with frequent colds. babies with genetic allergies. premature and low-birth-weight babies. babies stressed during the pregnancy.

premature and low-birth-weight babies.

7. Dornase alfa (Pulmozyme), because of its mechanism of action, is reserved for use in...? clearing secretions before diagnostic tests. facilitating the removal of secretions postoperatively. protecting the liver from acetaminophen toxicity. relieving the buildup of secretions in cystic fibrosis.

relieving the buildup of secretions in cystic fibrosis.

4. A patient taking an over-the-counter (OTC) cold medication and an OTC allergy medicine is found to be taking double doses of pseudoephedrine. As a result, the patient might exhibit...? ear pain and eye redness. restlessness and palpitations. sinus pressure and ear pain. an irritating cough and nasal drainage.

restlessness and palpitations.

Milrinone is indicated for

short-term treatment of HF that has not responded to digoxin or diuretics alone or that has had a poor response to digoxin, diuretics, and vasodilators. Because this drug has been associated with the development of potentaly fatal ventricular arrhythmias, its use is limited severe situations.

A client who has nitroglycerin to avert an acute anginal attack would need to be taught

to protect tablets from light and humidity. to use the nitroglycerin before an event or activ ity that will most likely precipitate an anginal attack to discard them if they do not fizzle when placed under the tongue.

3. Patients with seasonal rhinitis experience irritation and inflammation of the nasal passages and passages of the upper airways. Treatment for these patients might include...? systemic corticosteroids. mucolytic agents. an expectorant. topical nasal steroids.

topical nasal steroids.

6. A patient is not getting a response to the antihistamine that was prescribed. Appropriate action might include...? switching to a decongestant. stopping the drug and increasing fluids. trying a different antihistamine. switching to a corticosteroid.

trying a different antihistamine.

ACE inhibitors work the renin-angiotensin system prevent the conversion of angiotensin I to angiotensin II. Because this blocking occurs in the cells in the lung, which is usually the site of this conversion, the use of ACE inhibitors often results in

unrelenting cough.