Evolve Questions for Exam 2
The healthcare provider prescribes heparin 2500 units subcutaneous daily. The drug is available in 10,000 units per mL. How may milliliters will the nurse give? (Fill in the blank and record your answer using one decimal place.) __________________________
0.25 mL
The patient's heparin is infusing at 11 mL/hr. The bag of fluid is mixed 25,000 units of heparin in 250 mL D5W. What hourly dose is the patient receiving? (Fill in the blank and record your answer.) __________________________
1100 units/hr
The patient's heparin is infusing at 28 mL/hr. The bag of fluid is mixed 20,000 units of heparin in 500 mL D5W. What hourly dose is the patient receiving? (Fill in the blank and record your answer.) _________________________
1120 units/hr
The healthcare provider prescribes heparin 900 units/hr. The label on the IV bag reads Heparin 10,000 units in 500 mL D5W. How many mL/hr will deliver the correct dose? (Fill in the blank and record your answer.) _________________________
45 mL
A patient has been given instructions about levothyroxine [Synthroid]. Which statement by the patient indicates understanding of these instructions? A. "I'll take this medication in the morning so as not to interfere with sleep." B. "I'll plan to double my dose if I gain more than 1 pound per day." C. "It is best to take the medication with food so I don't have any nausea." D. "I'll be glad when I don't have to take this medication in a few months."
A
A patient is admitted to the emergency department with a diagnosis of ST-segment elevation myocardial infarction (STEMI). Which is the priority nursing action? A. Having the patient chew a 325-mg aspirin B. Administering meperidine [Demerol] for pain relief C. Giving verapamil [Calan] to lower blood pressure D. Preparing an insulin drip to manage complications
A
A patient is scheduled to start taking insulin glargine [Lantus]. On the care plan, a nurse should include which of these outcomes related to the therapeutic effects of the medication? A. Blood glucose control for 24 hours B. Mealtime coverage of blood glucose C. Less frequent blood glucose monitoring D. Peak effect achieved in 2 to 4 hours
A
A patient who has type 2 diabetes has a glycated hemoglobin A1c (HbA1c) of 10%. The nurse should make which change to the nursing care plan? A. Refer the patient to a diabetes educator because the result reflects poor glycemic control. B. Glycemic control is adequate; no changes are needed. C. Hypoglycemia is a risk; teach the patient the symptoms. D. Instruct the patient to limit activity and weekly exercise.
A
A patient with angina is being discharged with a prescription for nitroglycerin sublingual tablets. Which instruction should the nurse include? A. "Store the tablets in the original container and tightly close it after use." B. "The tablets are only good for 1 month after the container is opened." C. "Sublingual nitroglycerin tablets are also effective when swallowed whole." D. "Effects of sublingual nitroglycerin begin in 5 to 10 minutes."
A
A patient with nonvalvular atrial fibrillation is to be discharged on dabigatran etexilate [Pradaxa]. Which statement should the nurse include in the discharge teaching? A. "The medication must be stored in the manufacturer-supplied bottle." B. "Once a new bottle is opened, the capsules maintain efficacy for 90 days." C. "If you have difficulty swallowing the capsule, you can open it and mix it with food." D. "You will need to learn how to give yourself a subcutaneous injection in your abdomen."
A
A teaching plan for a patient who is taking lispro [Humalog] should include which instruction by the nurse? A. "Inject this insulin with your first bite of food, because it is very fast acting." B. "The duration of action for this insulin is about 8 to 10 hours, so you'll need a snack." C. "This insulin needs to be mixed with regular insulin to enhance the effects." D. "To achieve tight glycemic control, this is the only type of insulin you'll need."
A
Before administering metformin [Glucophage], the nurse should notify the prescriber about which laboratory value? A. Creatinine (Cr) level of 2.1 mg/dL B. Hemoglobin (Hgb) level of 9.5 gm/dL C. Sodium (Na) level of 131 mEq/dL D. Platelet count of 120,000/mm3
A
For which medication order should the nurse notify the healthcare provider? A. Cyanocobalamin 100 mcg intravenously (IV) every month B. Folic acid 1 mg orally daily × 2 weeks; then folic acid 400 mcg orally daily C. Iron dextran [INFeD] test dose 25 mg (IV) over 5 minutes D. Sodium-ferric gluconate complex [Ferrlecit] 125 mg in 100 mL NSS to run intravenously over 15 minutes
A
In the failing heart, arterial pressure falls, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. The nurse understands increased sympathetic activity will produce which response? A. Tachycardia B. Bradypnea C. Hypotension D. Hypoglycemia
A
The laboratory calls to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate? A. Notify the healthcare provider to discuss the reduction or withdrawal of heparin. B. Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level. C. Obtain vitamin K and prepare to administer it by intramuscular (IM) injection. D. Observe the patient and monitor the activated partial thromboplastin time (aPTT) as indicated.
A
The nurse has just administered the initial dose of enalapril [Vasotec] to a newly admitted patient with hypertension. What is the priority nursing intervention over the next several hours? A. Monitor blood pressure. B. Check the heart rate. C. Auscultate lung sounds. D. Draw a potassium level.
A
The nurse is administering epoetin alfa [Procrit] to a patient receiving chemotherapy. Which adverse effect is a potential risk with this drug? A. Accelerated tumor progression B. Hypotension C. Easy bruising D. Bone pain
A
The nurse is administering intravenous lidocaine [Xylocaine] to a patient with a ventricular dysrhythmia. What is the priority nursing intervention to prevent a potential complication with this drug? A. Monitor the electrocardiogram (ECG). B. Obtain a complete blood count. C. Instruct to report any chest pain. D. Keep naloxone [Narcan] at the bedside.
A
The nurse is administering iron dextran (INFeD) by intravenous (IV) infusion to a patient with iron deficiency. Which is the priority nursing action during the administration of this drug? A. Ensure that epinephrine is available as needed. B. Assess the lung sounds and respiratory rate. C. Monitor the blood urea nitrogen and creatinine levels. D. Use Y-connector tubing to connect to the primary line.
A
The nurse is caring for a patient who has been receiving intravenous sodium nitroprusside [Nitropress] for 3 days. Which assessment data indicate the patient may be experiencing thiocyanate toxicity? A. Sudden confusion B. Difficulty breathing C. Erythematous rash D. Gastrointestinal bleeding
A
The nurse is caring for a pregnant patient experiencing a new episode of hypertension. Which medication does the nurse anticipate will be prescribed for this patient? A. Methyldopa [Aldomet] B. Propranolol [Inderal] C. Captopril [Capoten] D. Valsartan [Diovan]
A
The nurse is evaluating the effectiveness of the drug oprelvekin [Neumega] in a patient undergoing cancer chemotherapy. Which finding is most indicative that this drug is having its intended effect? A. Platelet count of 150 × 103/mm3 B. Hemoglobin level of 13.2 g/dL C. White blood cell count of 5500/mm3 D. Total lymphocyte count of 1000/mm3
A
The nurse is preparing to administer a daily dose of digoxin [Lanoxin]. What is the priority nursing intervention? A. Analyze heart rate and rhythm. B. Assess for Homans' sign. C. Check blood pressure. D. Palpate the pedal pulses.
A
The nurse is preparing to administer an oral dose of digoxin [Lanoxin]. The apical pulse rate is 64. What nursing action is most appropriate? A. Give the medication. B. Obtain a serum digoxin level. C. Notify the healthcare provider. D. Assess for signs of digoxin toxicity.
A
The nurse is reviewing the home medication list with the patient. The nurse recognizes that hydrochlorothiazide is used primarily for which condition? A. Hypertension B. Edema C. Diabetes insipidus D. Protection against postmenopausal osteoporosis
A
The nurse is teaching a patient who has had an ST-segment elevation myocardial infarction (STEMI) about home medications. Which agent represents a drug category that should be taken by all post-MI patients? A. Metoprolol [Lopressor] B. Hydrochlorothiazide (HCTZ) C. Diltiazem [Cardizem] D. Lovastatin [Mevacor]
A
The nurse knows that diuretics mostly affect which function of the kidneys? A. Cleansing and maintenance of extracellular fluid volume B. Maintenance of acid-base balance C. Excretion of metabolic waste D. Elimination of foreign substances
A
The nurse reviews the medication treatment regimen for a patient with chronic hypertension. To promote optimal medication adherence, which frequency of drug dosing should the nurse advocate for this patient? A. Once a day B. Three times a day C. Four times a day D. Every 8 hours
A
The nurse should monitor for which adverse effect after administering hydrochlorothiazide [HydroDIURIL] and digoxin [Lanoxin] to a patient? A. Digoxin toxicity B. Decreased diuretic effect C. Dehydration D. Heart failure
A
The patient reports that she had to switch pharmacies to save money. She noticed that her "thyroid pill" looks different. The nurse anticipates that the healthcare provider will order what? A. Thyroid stimulating hormone (TSH) B. Electrocardiogram (ECG) C. Beta human chorionic gonadotropin (hCG) test D. Creatinine level
A
What is the most common sustained dysrhythmia among the U.S. population? A. Atrial fibrillation B. Atrial flutter C. Sustained supraventricular tachycardia (SVT) D. Ventricular premature beats (VPBs)
A
Which acid-base imbalance is caused by retention of CO2 secondary to hypoventilation? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
A
Which discharge instructions should the nurse include for a patient prescribed cholestyramine [Questran]? A. Mix the drug with water or juice. B. Take with all other morning medications. C. Take 325 mg of aspirin 30 minutes before each dose. D. Notify the healthcare provider if upper abdominal discomfort occurs.
A
Which drug is the most effective for lowering LDL cholesterol? A. Atorvastatin [Lipitor] B. Cholestyramine [Questran] C. Gemfibrozil [Lopid] D. Ezetimibe [Zetia]
A
Which instruction should the nurse provide when teaching a patient to mix regular insulin and NPH insulin in the same syringe? A. "Draw up the clear regular insulin first, followed by the cloudy NPH insulin." B. "It is not necessary to rotate the NPH insulin vial when it is mixed with regular insulin." C. "The order of drawing up insulin does not matter as long as the insulin is refrigerated." D. "Rotate subcutaneous injection sites each day among the arm, thigh, and abdomen."
A
Which intravenous (IV) fluid would be most appropriate for treating isotonic volume contraction? A. 0.9% sodium chloride B. 5% dextrose and water C. 0.225% sodium chloride D. 3% sodium chloride and water
A
Which manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine [Synthroid]? A. Tachycardia B. Tremors C. Insomnia D. Irritability
A
Which nursing action should prevent an adverse effect of a liquid iron preparation? A. Administer the iron preparation through a dropper. B. Administer the liquid iron preparation along with vitamin C. C. Administer the liquid buccally to delay absorption and lessen adverse effects. D. Mix the liquid iron preparation with an antacid for patients with underlying peptic ulcer disease.
A
Which organ regulates the body's iron stores? A. Intestines B. Kidneys C. Liver D. Bloodstream
A
Which statement is the most important for a nurse to make to a patient who is taking methimazole? A. "You need to notify your doctor if you have a sore throat and fever." B. "Another medication can be given if you experience any nausea." C. "You may experience some muscle soreness with this medicine." D. "Headache and dizziness may occur but not very frequently."
A
A patient is being discharged from the hospital on warfarin [Coumadin] for deep vein thrombosis prevention. Which instructions should the nurse include in the patient's discharge teaching plan? (Select all that apply.) A. Wear a medical alert bracelet. B. Check all urine and stool for discoloration. C. Do not start any new medication without first talking to your healthcare provider. D. Enteric-coated aspirin and any aspirin products can be used unless they cause a gastrointestinal ulcer. E. No laboratory or home monitoring of international normalized ratio (INR) is required after the first 6 months.
A,B,C
What are the primary regulatory systems of arterial pressure? (Select all that apply.) A. Autonomic nervous system B. Renin-angiotensin-aldosterone system C. Renal system D. Pulmonary system E. P450 enzyme system
A,B,C
Which are beneficial effects that can be derived from simvastatin [Zocor] and other drugs in this class? (Select all that apply.) A. Reduction of LDLs B. Elevation of HDLs C. Stabilization of the plaque in coronary arteries D. Reduction of risk of cardiovascular events E. Improvement of liver function
A,B,C,D
Which medications should be used with caution in a hypertensive diabetic patient? (Select all that apply.) A. Furosemide [Lasix] B. Metoprolol [Lopressor] C. Diltiazem [Cardizem] D. Hydrochlorothiazide [HCTZ] E. Enalapril [Vasotec]
A,B,D
Which of the following statements about mannitol [Osmitrol] are correct?(Select all that apply.) A. Mannitol cannot be given orally. B. Mannitol can cause edema. C. Mannitol can cause renal failure. D. Diuresis begins in 30 to 60 minutes after administration. E. Mannitol is a loop diuretic.
A,B,D
Which patient symptoms should cause the nurse to be concerned about digoxin [Lanoxin] toxicity? (Select all that apply.) A. Fatigue B. Vomiting C. Dizziness D. Blurred vision E. Muscle weakness
A,B,D
The nurse is caring for a patient receiving vitamin B12 because of a deficiency. What are common causes of this deficiency? (Select all that apply.) A. Regional enteritis and malabsorption B. Celiac disease C. Decreased intake of foods with vitamin B12 D. Advancing age E. Use of drugs that lower stomach acid
A,B,D,E
A patient in a hypertensive crisis is being started on a continuous sodium nitroprusside [Nipride] infusion. Which interventions are essential before the nurse administers nitroprusside [Nipride]? (Select all that apply.) A. Obtain a baseline weight and weigh daily. B. Prepare for arterial line insertion. C. Discontinue the infusion when blood pressure is controlled. D. Observe for signs of hypertrichosis during the infusion. E. Cover the solution with an opaque bag.
A,B,E
The healthcare provider prescribes lovastatin [Mevacor] for a patient discharged from the hospital post-myocardial infarction. Which instructions are most appropriate for the nurse to include in the patient's teaching plan? (Select all that apply.) A. "Do not start any new medications without first talking to your healthcare provider." B. "Before starting this medication a blood test will be done to check your total cholesterol level and to measure liver enzymes." C. "Take your medication in the morning, with a full glass of water for best results." D. "Take one 325-mg aspirin 30 minutes before your dose to lessen the problem of flushing and itching that can occur with this drug." E. "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains."
A,B,E
The nurse is teaching a patient with essential hypertension who has a new prescription for verapamil [Calan]. Which statements by the patient indicate that the teaching was effective? (Select all that apply.) A. "I will increase my intake of fluid and foods high in fiber." B. "I should stay out of direct sunlight to prevent exposing my skin to the sun." C. "I will call my healthcare provider if I notice swelling in my ankles." D. "I need to avoid salt substitutes and potassium supplements." E. "I may notice easy bruising and bleeding with this drug."
A,C
The nurse understands patients receiving nitroglycerin are at risk for which adverse effects? (Select all that apply.) A. Headache B. Wheezing C. Dizziness D. Tachycardia E. Bradycardia
A,C,D
The nurse in the emergency department is receiving a report on a patient diagnosed with ST-elevation myocardial infarction (STEMI). What are the common biochemical markers and symptoms for an STEMI? (Select all that apply.) A. Chest pain and electrocardiographic (ECG) changes B. Decreased troponin I level C. Elevated troponin T level D. Elevated creatinine kinase level E. Weakness and diaphoresis
A,C,D,E
The nurse is caring for a group of patients taking warfarin [Coumadin]. Which patients are at moderate to high risk for harm as a result of warfarin therapy? (Select all that apply.) A. A patient with variant genes that code for VKORC1 and CYP2CP B. A patient with a current INR of 2.2 treated for deep vein thrombosis C. A woman with a new onset of symptoms of a pulmonary embolus D. A patient on day 4 after hip replacement with a new order for warfarin E. A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen
A,C,E
Which instructions should the nurse include when developing a teaching plan for a patient prescribed diltiazem [Cardizem] for atrial fibrillation? (Select all that apply.) A. Weigh yourself daily at the same time each day. B. The medication will not cause dizziness or headache. C. Notify the healthcare provider if a skin rash develops. D. Do not take daily oral calcium supplements. E. Rise slowly from a lying to a sitting position.
A,C,E
The nurse is assessing a patient with hemophilia for complications of clotting factor administration. Which assessment findings would indicate an adverse effect of this treatment? (Select all that apply.) A. Hives and urticaria B. Potassium level of 3.2 mEq/L C. Creatinine level of 2.5 mg/dL D. Bethesda titer of 40 units E. Alkaline phosphatase of 303 units/L
A,D
The nurse is teaching a patient with severe hemophilia A about the disease. Which statements by the nurse are appropriate to include in the teaching plan? (Select all that apply.) A. "You will need to be vaccinated for hepatitis A and B." B. "Take aspirin [Bayer] when you have mild pain." C. "You will receive prophylactic blood transfusions to manage your disease." D. "You will learn to reconstitute powdered medication with saline." E. "It will be important to get regular testing for HIV."
A,D,
A nurse caring for a patient who has diabetic ketoacidosis recognizes which characteristics in the patient? (Select all that apply.) A. Type 2 diabetes B. Altered fat metabolism leading to ketones C. Arterial blood pH of 7.35 to 7.45 D. Sudden onset, triggered by acute illness E. Plasma osmolality of 300 to 320 mOsm/L
A,D,E
A patient with angina pectoris has been prescribed nifedipine [Procardia].Which possible adverse effects should the nurse expect with this medication? (Select all that apply.) A. Headache B. Constipation C. Nausea and vomiting D. Edema of ankles and feet E. Overgrowth of gum tissue
A,D,E
The nurse should review which baseline data before starting epoetin alfa [Epogen] therapy in a patient with chronic renal failure (CRF)? (Select all that apply.) A. Ferritin level B. Temperature trends C. Blood glucose level D. Blood pressure trends E. Hemoglobin and hematocrit
A,D,E
A patient is receiving continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor? (Select all that apply.) A. Platelets B. Vitamin K C. Prothrombin time (PT) D. International normalized ratio (INR) E. Activated partial thromboplastin time (aPTT)
A,E
A maintenance dose of epoetin alfa [Epogen] is ordered for a dialysis patient. What is an appropriate dosage for administration? A. 100 units/kg IV 3 times/wk B. 75 units/kg IV 3 times/wk C. 40,000 units subQ weekly D. 150 units/kg subQ 3 times/wk
B
A nurse assesses a patient who is taking pramlintide [Symlin] with mealtime insulin. Which finding requires immediate follow-up by the nurse? A. Skin rash B. Sweating C. Itching D. Pedal edema
B
A nurse is caring for a patient with decreased triiodothyronine (T3) and thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from what? A. Thyrotoxicosis B. Hypothyroidism C. Hyperthyroidism D. Graves' disease
B
A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. What medication would be appropriate for this patient who has a history of heparin-induced thrombocytopenia (HIT)? A. Warfarin [Coumadin] B. Lepirudin [Refludan] C. Bivalirudin [Angiomax] D. Eptifibatide [Integrilin]
B
A patient develops supraventricular tachycardia (SVT) and is hypotensive. Which medication should the nurse anticipate will be administered? A. Lidocaine [Xylocaine] B. Adenosine [Adenocard] C. Amiodarone [Cordarone] D. Phenytoin [Dilantin]
B
A patient is admitted to the emergency department complaining of chest pain, and the electrocardiogram (ECG) shows an evolving ST-segment elevation myocardial infarction (STEMI). What intervention should the nurse anticipate? A. Administer 400 mg of ibuprofen. B. Have the patient chew a 325-mg aspirin. C. Administer an ACE inhibitor within 1 week of the onset of chest pain. D. Provide oxygen by nasal cannula to achieve an arterial oxygen saturation of 94%.
B
A patient is admitted to the unit in a hypertensive emergency and examination reveals papilledema. The nurse should expect which IV medications to be administered to achieve rapid, controlled reduction of the patient's blood pressure? A. Furosemide [Lasix] B. Sodium nitroprusside [Nitropress] C. Metoprolol [Lopressor] D. Diltiazem [Cardizem]
B
A patient is prescribed lisinopril [Prinivil] 40 mg by mouth once a day for hypertension. For which therapeutic effect will the nurse monitor? A. Slowing of the heart rate B. Decrease in blood pressure C. Symptoms such as dizziness and fainting D. Pulse oximetry oxygen saturation of 100%
B
A patient is receiving isosorbide dinitrate [Isordil] 20 mg 3 times/day for management of newly diagnosed stable angina. Which assessment finding would require an immediate nursing intervention? A. A change in blood pressure from 122/70 to 108/66 mm Hg B. An increase in the resting heart rate to 110 beats/min from baseline rates of 68 to 72 beats/min C. A headache the patient rates as a 5 on a pain scale of 0 to 10 D. Report of increased frequency of urination
B
A patient who has type 2 diabetes is taking nateglinide [Starlix]. Which response should a nurse expect the patient to have if the medication is achieving the desired therapeutic effect? A. Inhibition of carbohydrate digestion B. Promotion of insulin secretion C. Decreased insulin resistance D. Inhibition of ketone formation
B
A patient with deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response? A. Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting factors. B. Heparin suppresses coagulation by helping antithrombin perform its natural functions. C. Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot matrix. D. Heparin inhibits the enzyme responsible for platelet activation and aggregation within vessels.
B
About which patient should the nurse notify the healthcare provider immediately? A. A patient who takes digoxin [Lanoxin] 0.125 mg orally daily with a serum digoxin level of 0.8 ng/mL B. A patient who takes oral spironolactone [Aldactone] 25 mg daily and enalapril [Vasotec] 5 mg daily with a serum potassium level of 5.5 mEq/L C. A patient who takes digoxin [Lanoxin] 0.25 mg orally daily with a serum potassium level of 4.0 mEq/L D. A patient who takes oral lisinopril [Zestril] 5 mg daily and digoxin 0.125 mg daily with a serum digoxin level of 0.5 ng/mL
B
In which part of the conduction pathway in a healthy heart is the electrical impulse delayed to provide time for the blood to fill the ventricles? A. Bundle of His B. AV node C. Purkinje system D. Internodal pathways
B
The healthcare provider prescribes an intravenous dose of diltiazem [Cardizem] for treatment of a patient with atrial fibrillation. What is the priority nursing intervention? A. Assist with cardioversion. B. Monitor electrocardiogram. C. Obtain baseline coagulation studies. D. Assess for increased urinary output.
B
The healthcare provider prescribes hematopoietic growth factor for a patient. The nurse should notify the healthcare provider to question the prescription for which patient condition? A. A patient with chronic renal failure (CRF) B. A patient with uncontrolled hypertension C. A patient taking zidovudine for human immunodeficiency virus (HIV) D. A patient with nonmyeloid malignancy chemotherapy-induced anemia
B
The heart undergoes cardiac remodeling during the initial phase of heart failure. Which cardiac geometric change occurs during heart failure? A. Ventricular constriction B. Ventricular wall thickening C. Ventricular atrophy D. Ventricles become more cylindric
B
The nurse is caring for a patient prescribed a cholesterol-lowering drug. Which drug is least likely to cause systemic side effects? A. Simvastatin [Zocor] B. Colesevelam [Welchol] C. Nicotinic acid [Niaspan] D. Gemfibrozil [Lopid]
B
The nurse is caring for a patient receiving a nitroprusside [Nipride] intravenous infusion. The patient's wife asks why furosemide [Lasix] is being prescribed along with this drug. The nurse's response is based on which concept? A. Furosemide will help reduce reflex tachycardia. B. Many vasodilators cause retention of sodium and water. C. Thiocyanate may accumulate in patients receiving nitroprusside. D. Vasodilators can cause serious orthostatic hypotension.
B
The nurse is caring for a patient receiving amiodarone [Cordarone]. Which body system should the nurse assess for serious adverse effects of this medication? A. Musculoskeletal B. Respiratory C. Integumentary D. Gastrointestinal
B
The nurse is caring for a patient receiving clopidogrel [Plavix] to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel? A. Aspirin [Bayer] B. Omeprazole [Prilosec] C. Acetaminophen [Tylenol] D. Warfarin [Coumadin]
B
The nurse is caring for a patient undergoing cancer chemotherapy who presents with rash, bone pain, hypertension, and pedal edema. Which symptom is most likely an adverse reaction to the filgrastim [Neupogen] the patient is receiving? A. Rash B. Bone pain C. Headache D. Swelling in feet
B
The nurse is caring for a patient who has diabetes and hypertension. Which medication is most likely to be prescribed to treat this patient's hypertension? A. Hydrochlorothiazide [HCTZ] B. Enalapril [Vasotec] C. Propranolol [Inderal] D. Methyldopa [Aldomet]
B
The nurse is caring for a patient who is receiving enteral feedings because of dysphagia. The healthcare provider prescribes isosorbide mononitrate [Imdur] 60 mg SR daily via the enteral tube. What is the most appropriate action by the nurse? A. Have the patient swallow the pill, because it cannot be crushed. B. Call the healthcare provider about an alternate form of nitrate for administration. C. Crush the Imdur into a fine powder, dilute it with water, and administer it via the enteral tube. D. Place the nitrate under the patient's tongue and let it dissolve, because the person has dysphagia.
B
The nurse is caring for a patient with anemia. What is a common cause of iron deficiency in the United States? A. Decreased intestinal uptake of iron B. Chronic blood loss through the GI tract C. Vegetarian eating patterns D. Rapid growth during adolescence
B
The nurse is caring for a patient with bipolar disorder treated with lithium [Eskalith]. The patient has a new prescription for captopril [Capoten] for hypertension. The combination of these two drugs makes which assessment particularly important? A. Potassium level B. Lithium level C. Creatinine level D. Blood pressure
B
The nurse is explaining the use of romiplostim [Nplate] to treat idiopathic thrombocytopenic purpura (ITP). Which patient statement indicates understanding of the nurse's explanation? A. "I'll call my healthcare provider if I notice any swelling in my legs." B. "I'll let my healthcare provider know if I have any pain in my joints." C. "I will have my white blood cell count evaluated in 1 month." D. "I shouldn't take this medication with food, because that prevents absorption of the drug."
B
The nurse is interpreting an electrocardiogram (ECG). Which component represents the depolarization of the ventricles? A. P wave B. QRS complex C. ST segment D. T wave
B
The nurse is monitoring therapy for a patient with hemophilia B. Which evaluation criterion is most important to determine whether the medication dosage is effective? A. Clotting factor VIII levels B. Clinical response C. Clotting factor IX levels D. PT and INR
B
The nurse is providing discharge teaching for a patient with a new prescription for a nitroglycerin transdermal patch. Which statement by the patient indicates a need for further teaching? A. "I will remove my patch at bedtime each evening." B. "I will limit my alcohol to one drink per day." C. "I will not use Viagra as long as I am on nitroglycerin." D. "I will move slowly when changing positions."
B
The nurse is ready to begin a heparin infusion for a patient with evolving stroke. The baseline activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved? A. 50 B. 70 C. 90 D. 110
B
The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? A. "I can take this medication in the morning to reduce nighttime urination." B. "I will rise slowly when changing from a sitting to a standing position." C. "My heart rate may slow down with this drug. I will call if my pulse is below 60." D. "I need to increase my intake of fluids and foods that are high in fiber."
B
The nurse is teaching the parent of a young child about administering ferrous sulfate to the child at home. Which teaching point should receive the highest priority? A. "Give the liquid iron with a straw to reduce tooth staining." B. "Store the ferrous sulfate in a childproof container and keep it out of the child's reach." C. "This medicine may cause the child's stool to look dark green or black." D. "Do not give iron with any other medications or vitamins."
B
The nurse knows that which organ is primarily responsible for maintaining fluid volume and osmolality? A. Liver B. Kidneys C. Blood vessels D. Heart
B
The nurse reviews the prescribed medication for a patient with hemophilia who complains of bleeding-related pain. Which medication should the nurse question if ordered for this patient? A. Codeine B. Percodan C. MS Contin D. Tylenol
B
The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising the blood pressure? A. Angiotensin I B. Angiotensin II C. Angiotensin III D. Renin
B
What is the primary benefit of spironolactone [Aldactone] in patients with heart failure? A. Increase in diuresis and fluid loss B. Blockage of aldosterone receptors C. Inhibition of beta activation by norepinephrine D. Stimulation of the renin-angiotensin-aldosterone system
B
Which acid-base imbalance is caused by hyperventilation? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
B
Which adverse effect is the greatest concern with thrombolytic therapy? A. Anaphylaxis B. Intracranial hemorrhage C. Cerebral edema D. Hemophilia
B
Which classes of medications are prescribed as initial therapy for hypertension after a myocardial infarction (MI)? A. Diuretic and beta blocker B. Beta blocker and ACE inhibitor C. ACE inhibitor and calcium channel blocker D. Diuretic and calcium channel blocker
B
Which condition do the natriuretic peptides serve to protect the cardiovascular system? A. Hypovolemia B. Volume overload C. Myocardial infarction D. Hypotension
B
Which finding in a patient taking levothyroxine [Synthroid] and warfarin [Coumadin] would require follow-up by a nurse? A. Cardiac dysrhythmias B. Excessive bruising C. Weight loss of 5 kg D. Shortness of breath
B
Which finding indicates a positive outcome from treatment with filgrastim [Neupogen]? A. Bone pain is eliminated. B. The neutrophil count increases. C. Cancer goes into remission. D. The red blood cell count increases.
B
Which is the priority nursing intervention for a patient receiving parenteral iron dextran (INFeD) infusion? A. The medication must be administered by deep subcutaneous injection. B. An intravenous test dose of 25 mg over 5 minutes must be administered. C. Erythropoietin must also be given when a patient is receiving parenteral iron dextran. D. After administration of a test dose of intramuscular (IM) iron dextran, the patient must be observed for 15 minutes before the full therapeutic dose is given.
B
Which medication promotes hemostasis in hemophilia A and B by inhibition of fibrinolysis? A. Desmopressin [DDAVP] B. Aminocaproic acid [Amicar] C. Celecoxib [Celebrex] D. Diphenhydramine [Benadryl]
B
Which needle length and gauge should the nurse choose to administer subcutaneous heparin? A. ½ inch; 20 gauge B. ⅝ inch; 25 gauge C. 1½ inch; 18 gauge D. 1 inch; 26 gauge
B
Which physiologic mechanism helps to ensure venous return despite low pressure in the venules? A. Positive pressure in the right atrium B. Negative pressure in the right atrium C. Vasodilation in the periphery D. Cardiac muscle relaxation
B
A patient diagnosed with a pulmonary embolism is receiving a continuous heparin infusion at 1000 units/hr. Of which findings should the nurse immediately notify the healthcare provider? (Select all that apply.) A. aPTT of 65 seconds B. aPTT of 40 seconds C. Nosebleeds D. aPTT of 100 seconds E. Platelet count of 300,000/mcL
B,C,D
A patient is prescribed hydralazine [Apresoline] for the treatment of essential hypertension. Which expected adverse effects should the nurse discuss with the patient? (Select all that apply.) A. Nausea B. Fatigue C. Dizziness D. Headache E. Joint pain
B,C,D
Which are the main types of drugs used to prevent or relieve anginal pain? (Select all that apply.) A. Platelet inhibitors B. Beta blockers C. Nitrates D. Calcium channel blockers E. Statins
B,C,D
Which statements accurately reflect Starling's law as applied to a healthy heart? (Select all that apply.) A. When venous return increases, stroke volume decreases. B. The right and left ventricles pump the same amount of blood. C. Cardiac output is equal to the volume of blood delivered by the veins. D. When venous return increases, cardiac output increases. E. As cardiac muscle fibers increase in length, their contractile force decreases.
B,C,D
Which statements about levothyroxine [Synthroid] are correct? (Select all that apply.) A. Levothyroxine should be taken with food. B. Levothyroxine can be given by IV but is usually taken orally. C. Levothyroxine brands should not be changed if possible. D. Levothyroxine should be taken at night to avoid adverse effects. E. Levothyroxine can affect the metabolism of other medications.
B,C,E
A nurse should consider which diagnostic test a priority to obtain before a patient receives iodine-131? A. White blood cell (WBC) count B. Electrocardiogram (ECG) C. Beta human chorionic gonadotropin (hCG) test D. Creatinine level
C
A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug? A. + 2 edema of the lower extremities B. Potassium level of 3.5 mEq/L C. Crackles in the lungs are no longer heard D. Jugular vein distention
C
A patient is taking glipizide [Glucotrol] and a beta-adrenergic medication. A nurse is teaching hypoglycemia awareness and should warn the patient about the presence of which symptom? A. Vomiting B. Muscle cramps C. Tachycardia D. Chills
C
A patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which finding by the nurse most likely indicates an adverse reaction to this drug? A. Urticaria, itching, and flushing B. Blood pressure of 90/50 mm Hg C. Decreasing level of consciousness D. Potassium level of 5.5 mEq/L
C
A patient who took NPH insulin at 0800 reports feeling weak and tremulous at 1700. Which action should the nurse take? A. Take the patient's blood pressure. B. Give the patient's PRN dose of insulin. C. Check the patient's capillary blood sugar. D. Advise the patient to lie down with the legs elevated.
C
A patient with Graves' disease is treated with iodine-131 therapy. Which statement by the patient would indicate understanding of the treatment's effects? A. "I'll have to isolate myself from my family so I don't expose them to radiation." B. "I'm looking forward to feeling better immediately after this treatment." C. "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." D. "I'll need to take this drug on a daily basis for at least 1 year."
C
A patient with an acute myocardial infarction is prescribed an intravenous (IV) bolus of tenecteplase [TNKase]. The patient weighs 160 lb. The nurse will administer what dosage? A. 30 mg B. 35 mg C. 40 mg D. 45 mg
C
A patient with an elevated triglyceride level is prescribed a sustained-release form of nicotinic acid [Slo-Niacin]. Which laboratory value is most important for the nurse to monitor for in this patient? A. Blood urea nitrogen (BUN) B. Complete blood count (CBC) C. Alanine aminotransferase (ALT) D. Creatine kinase (CK)
C
A patient with hypertensive emergency is admitted to the hospital. Which medication should the nurse be prepared to administer to this patient? A. Minoxidil [Loniten] B. Hydralazine [Apresoline] C. Sodium nitroprusside [Nipride] D. Hydralazine and isosorbide dinitrate [BiDil]
C
After 3 weeks of therapy with oral ferrous sulfate, a patient calls the clinic nurse, complaining of continuous nausea and vomiting with this drug. Which is the most appropriate response to this patient? A. "This may indicate a serious adverse effect of this drug. You need to come into the clinic." B. "Try to take your medication with meals. This should reduce your nausea and vomiting." C. "You may need a lower dose, I will contact your primary healthcare provider and call you back." D. "Try taking an antacid just before taking your medication. This can help reduce stomach acid, which causes nausea."
C
Amiodarone [Cordarone] is prescribed for a patient with atrial fibrillation. What is the most important nursing intervention before administering this medication? A. Document an ophthalmic examination was performed. B. Explain a dermatologic evaluation is needed. C. Obtain baseline serum thyroid and liver function studies. D. Maintain NPO for transesophageal echocardiogram (TEE).
C
An adult male patient is taking medication for blood pressure management. The patient states to the nurse, "I'm not going to take these drugs anymore, because they are interfering with my sex life." What is the most appropriate response by the nurse? A. "It is unfortunate these drugs can cause erectile dysfunction but managing your blood pressure is more important than your sexual performance." B. "I understand how discouraging it must be to live with this adverse effect, but you could have a stroke if you do not take your blood pressure medications." C. "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect." D. "I am glad you told me about your experience with this common side effect. Sexual performance can be a difficult subject to discuss."
C
Hemophilia is a genetically based bleeding disorder seen almost exclusively in which patients? A. Caucasian B. Hispanic C. Male D. Female
C
The healthcare provider orders 150 mcg of levothyroxine [Synthroid] PO every morning. The medication available is levothyroxine [Synthroid] 75-mcg tablets. How many tablets will the nurse administer? A. 0.5 B. 1 C. 2 D. 4
C
The healthcare provider orders furosemide [Lasix] 20 mg IV twice daily. The medication available is furosemide [Lasix] 10 mg/mL. How many mL will the nurse administer with each dose? A. 0.5 mL B. 1 mL C. 2 mL D. 4 mL
C
The healthcare provider orders mannitol 72 gm infusion over 24 hours. The nurse plans to set the infusion pump for how many grams per hour? A. 1 gm B. 2 gm C. 3 gm D. 4 gm
C
The nurse is caring for a patient prescribed aliskiren [Tekturna]. How does this medication lower blood pressure? A. It blocks the conversion of angiotensin I to angiotensin II. B. It prevents angiotensin II from binding to its receptors. C. It inhibits the conversion of angiotensinogen into angiotensin I. D. It selectively blocks aldosterone receptors in the kidneys.
C
The nurse is caring for a patient prescribed digoxin [Lanoxin] for heart failure. Which finding would require immediate attention by the nurse? A. Potassium level of 3.7 mEq/L B. Digoxin level of 0.7 ng/mL C. Vomiting and diarrhea D. Heart rate of 68 beats/min
C
The nurse is caring for a patient prescribed quinidine [Quinaglute] for a supraventricular dysrhythmia. What is a common adverse effect of this drug? A. Constipation B. Urinary retention C. Diarrhea D. Blurred vision
C
The nurse is caring for a patient receiving IV therapy with a 3% sodium chloride infusion at 75 mL/hr. The nurse should closely monitor for which adverse effect of treatment? A. Blood urea nitrogen of 22 mg/dL B. Tenting of the skin and dry mucous membranes C. Distended neck veins and ankle edema D. Sodium level of 140 mEq/L
C
The nurse is caring for a patient receiving nitrates for relief of angina. What pharmacodynamic action is responsible for the relief of anginal pain with nitrates? A. Vasoconstriction leads to improved cardiac output. B. Decreased force of contraction leads to decreased oxygen demand. C. Vasodilation leads to decreased preload, which decreases oxygen demand. D. Influx of calcium ions leads to relaxation of vascular smooth muscle.
C
The nurse is caring for a patient receiving oral magnesium gluconate. Which symptom indicates a common adverse effect of this medication? A. Headache B. Wheezing C. Loose stools D. Urinary retention
C
The nurse is caring for a patient who takes spironolactone [Aldactone] and quinapril [Accupril] for treatment of heart failure. What finding indicates a potential interaction between these two drugs? A. Elevated serum quinapril level B. Heart rate of 58 beats/min C. Potassium level of 5.7 mEq/L D. Glucose level of 180 mg/dL
C
The nurse is caring for a patient with heart failure who needs a diuretic. Which agent is likely to be chosen, because it has been shown to greatly reduce mortality in patients with heart failure? A. Furosemide [Lasix] B. Hydrochlorothiazide [HydroDIURIL] C. Spironolactone [Aldactone] D. Mannitol [Osmitrol]
C
The nurse is caring for a patient with renal artery stenosis who has been prescribed benazepril [Lotensin]. Which laboratory result indicates an adverse effect of this drug? A. Potassium level of 3.2 mEq/L B. Blood glucose level of 180 mg/dL C. Serum creatinine level of 2.3 mg/dL D. Uric acid level of 10 mg/dL
C
The nurse is caring for several patients. For which patient diagnosis would a prescription for nifedipine [Adalat] be least appropriate? A. Angina pectoris B. Essential hypertension C. Atrial fibrillation D. Vasospastic angina
C
The nurse is evaluating the teaching done with a patient who has a new prescription for fosinopril [Monopril]. Which statement by the patient indicates a need for further teaching? A. "I can take this medicine with breakfast each morning." B. "I will call if I notice a rash or wheals on my skin." C. "I will use a salt substitute to lower my sodium intake." D. "I will call if I develop a bothersome cough."
C
The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin? A. Heart rate of 60 beats/min B. Blood pressure of 160/88 mm Hg C. Discolored urine D. Inspiratory wheezing
C
The nurse is monitoring a patient receiving ranolazine [Ranexa] for angina. Which assessment finding indicates an adverse effect of this drug? A. Blood pressure of 90/50 mm Hg B. Frequent bloody stools C. QT prolongation on the electrocardiogram D. Respiratory rate of 11 breaths per minute
C
The nurse is planning care for a patient at risk for dysrhythmias. The nurse understands that the Cardiac Arrhythmia Suppression Trial (CAST) confirmed which finding? A. Most atrial rhythm problems should be treated with medication. B. After a myocardial infarction, all dysrhythmias should be treated. C. Dysrhythmias should be treated only when they are symptomatically significant. D. Most rhythm problems result in bradydysrhythmias.
C
The nurse is preparing to administer IV potassium to a patient with hypokalemia. Which prescription is the most appropriate? A. Potassium chloride 30 mEq in 100 mL IV over 1 hour B. Potassium chloride 10 mEq in 100 mL IV over 30 minutes C. Potassium chloride 10 mEq in 100 mL IV over 1 hour D. Potassium chloride 10 mEq IV push over 1 minute
C
The nurse is preparing to administer an intravenous (IV) nitroglycerin infusion. For which patient should the nurse question the healthcare provider's prescription to administer IV nitroglycerin infusion? A. A patient with an inferior wall myocardial infarction (MI); blood pressure of 170/60 mm Hg B. A patient with an anterior wall MI who has pulmonary congestion; heart rate of 92 beats/min C. A patient with a right ventricular infarction, confirmed by right-sided ECG changes D. A patient with chest pain unrelieved to 3 sublingual nitroglycerin tablets; took tadalafil 4 days ago
C
The nurse is teaching a group of patients about dietary approaches to reduce cholesterol levels. Which statement is most important to include in the teaching? A. "Lower your cholesterol to 300 mg/day." B. "Eliminate red meat and pork from your diet." C. "Read food labels and reduce your intake of saturated fats." D. "Reduce salt consumption to keep your sodium intake to 2400 mg/day."
C
The nurse is teaching a patient who has a new prescription for spironolactone [Aldactone]. Which statement by the patient indicates that the teaching was effective? A. "I will use salt substitutes to lower my sodium intake." B. "I will increase my intake of foods that are high in potassium." C. "I will call my doctor if I begin having menstrual irregularities." D. "I will take this medication at bedtime each evening."
C
The nurse is teaching a patient with vitamin B12 deficiency caused by a previous gastrectomy and lack of intrinsic factor. Which statement by the nurse is the most appropriate to include in the teaching plan? A. "Because your body does not have intrinsic factor, vitamin B12injections will be required." B. "If you increase your intake of animal protein foods, you may be able to avoid injections." C. "You may be prescribed a high dose of oral vitamin B12." D. "You will need to return to the clinic each month for your vitamin B12injections."
C
The nurse knows that which statement is accurate for enoxaparin [Lovenox]? A. It equally reduces the activity of thrombin and factor Xa. B. It has selective inhibition of factor Xa and no effect on thrombin. C. It reduces the activity of factor Xa more than the activity of thrombin. D. It has a lower bioavailability and shorter half-life than unfractionated heparin.
C
The nurse plans to closely monitor for which clinical manifestation after administering furosemide [Lasix]? A. Decreased pulse B. Decreased temperature C. Decreased blood pressure D. Decreased respiratory rate
C
The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? A. Very-low-density lipoprotein (VLDL) B. Apolipoprotein B-100 C. Low-density lipoprotein (LDL) D. High-density lipoprotein (HDL)
C
What condition increases the patient's risk for the development of myocardial infarction (MI) and disseminated intravascular coagulation (DIC) when receiving anti-inhibitor coagulant complex (AICC)? A. Diabetes B. Chronic renal disease C. Liver disease D. Hypothyroidism
C
What is the most appropriate nursing consideration for a patient who is prescribed verapamil [Calan] and digoxin [Lanoxin]? A. Restrict intake of oral fluids and high-fiber food. B. Take an apical pulse for 30 seconds before administration. C. Notify the healthcare provider of nausea, vomiting, and visual changes. D. Hold the medications if the heart rate is greater than 110 beats/min.
C
Which acid-base imbalance is caused by chronic renal failure, loss of bicarbonate during severe diarrhea, or metabolic disorders that result in overproduction of lactic acid? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
C
Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]? A. Peripheral pulses B. Homans' sign C. Blood pressure D. Capillary refill
C
Which drug would not be included in the treatment plan for a patient who will undergo a primary percutaneous coronary intervention (PCI)? A. Aspirin B. Heparin C. Diltiazem [Cardizem] D. Clopidogrel [Plavix]
C
Which instruction about clopidogrel [Plavix] should the nurse include in the discharge teaching for a patient who has received a drug-eluting coronary stent? A. "Constipation is a common side effect of clopidogrel, so take a stool softener daily." B. "If you see blood in your urine or black stools, stop the clopidogrel immediately." C. "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." D. "Keep the amount of food containing vitamin K, such as mayonnaise, canola and soybean oil, and green, leafy vegetables, consistent in your diet."
C
Which is the most beneficial treatment for patients experiencing an ST-segment elevation myocardial infarction (STEMI)? A. Oxygen administration B. Metoprolol [Lopressor] C. Reperfusion therapy D. Lidocaine [Xylocaine]
C
Which medication combination is useful in the treatment of variant angina? A. Metoprolol [Lopressor] and ranolazine [Ranexa] B. Isosorbide dinitrate [Isordil] and metoprolol [Lopressor] C. Diltiazem [Cardizem] and isosorbide mononitrate [Imdur] D. Propranolol [Inderal] and diltiazem [Cardizem]
C
Which medication is not associated with prolongation of the QT interval? A. Dofetilide [Tikosyn] B. Sotalol [Betapace] C. Diltiazem [Cardizem] D. Dronedarone [Multaq]
C
Which medication is the treatment of choice for ST-segment elevation myocardial infarction (STEMI)-associated pain? A. Aspirin B. Lorazepam [Ativan] C. Morphine D. Hydromorphone hydrochloride [Dilaudid]
C
A patient with nonmyeloid cancer is receiving oprelvekin [Neumega]. Which adverse effects are most likely associated with this drug? (Select all that apply.) A. Hypertension B. Accelerated tumor progression C. Fluid retention D. Atrial fibrillation E. Anaphylactic reactions
C,D,E
The nurse is teaching a patient prescribed captopril [Capoten] for the treatment of hypertension. Which instructions should the nurse include? (Select all that apply.) A. Take the medication with food. B. Expect a sore throat and fever. C. Avoid potassium salt substitutes. D. A persistent dry cough may occur. E. Report difficulty in breathing immediately.
C,D,E
What should the nurse include in the discharge teaching for a patient prescribed amiodarone [Cordarone]? (Select all that apply.) A. "Take amiodarone with grapefruit juice." B. "Take the medication on an empty stomach." C. "Wear sunblock and protective clothing when you are outdoors." D. "Check your pulse daily and report excessive slowing to your healthcare provider immediately." E. "Immediately notify your healthcare provider of shortness of breath, cough, or chest pain."
C,D,E
A nurse is caring for a patient receiving dronedarone [Multaq] for treatment of atrial fibrillation. What electrocardiogram (ECG) change indicates an adverse effect of this medication? A. Previously upright T waves now are inverted. B. Previously rounded, upright P waves now are notched. C. ST segments previously on the baseline now are depressed. D. The QT-interval measurement changes from 400 to 520 msec.
D
A patient being treated for pernicious anemia with cyanocobalamin reports new onset of muscle weakness and states, "My heart is skipping beats." Which laboratory value most likely is contributing to these new symptoms? A. Serum chloride level of 98 mEq/L B. Serum sodium level of 133 mEq/L C. Serum glucose level of 185 mg/dL D. Serum potassium level of 2.3 mEq/L
D
A patient has vitamin B12 deficiency following a subtotal gastrectomy. The nurse understands the patient has which type of anemia? A. Microcytic B. Iron deficiency C. Hemolytic D. Megaloblastic
D
A patient is admitted to the hospital with a diagnosis of hypertension. The nurse understands that which medication works by preventing angiotensin II from binding with its receptor sites? A. Quinapril [Accupril] B. Aliskiren [Tekturna] C. Eplerenone [Inspra] D. Candesartan [Atacand]
D
A patient is receiving cyanocobalamin for the treatment of pernicious anemia. Which electrolyte should the nurse monitor as a result of this treatment? A. Sodium B. Calcium C. Chloride D. Potassium
D
A patient newly diagnosed with type 1 diabetes asks a nurse, "How does insulin normally work in my body?" The nurse explains that normal insulin has which action in the body? A. It stimulates the pancreas to reabsorb glucose. B. It promotes the synthesis of amino acids into glucose. C. It stimulates the liver to convert glycogen to glucose. D. It promotes the passage of glucose into cells for energy.
D
A patient received desmopressin preoperatively to maintain hemostasis during a surgical procedure. Which postoperative assessment finding indicates the patient has experienced an adverse effect of the drug? A. Serum sodium level of 150 mEq/L B. Blood glucose level of 220 mg/dL C. Serum potassium level of 5.5 mEq/L D. +2 edema of the extremities
D
A patient with cardiovascular disease is taking rosuvastatin [Crestor]. The nurse is monitoring for potential adverse effects. Which finding indicates a potential adverse effect of this drug? A. Blood pressure of 140/90 mm Hg B. Wheezing and shortness of breath C. Platelet count of 100 × 103/mm3 D. Muscle pain and tenderness
D
A patient with heart failure has developed a cough while taking an angiotensin-converting enzyme (ACE) inhibitor. The health care provider discontinued the ACE inhibitor and prescribed an angiotensin II receptor blocker (ARB) as an alternative to the ACE inhibitor. The patient continues to have symptoms of heart failure despite using an ARB. Which medication should the nurse anticipate will be prescribed? A. Eplerenone [Inspra] B. Triamterene [Dyrenium] C. Hydrochlorothiazide [Microzide] D. BiDil [Isosorbide Dinitrate and Hydralazine]
D
Complete the equation: Cardiac output = Volume of blood ejected at each heartbeat × ____. A. Stroke volume B. Preload C. Afterload D. Heart rate
D
Fondaparinux [Arixtra] is not approved for use in which circumstance? A. Prevention of deep vein thrombosis (DVT) after knee replacement B. Treatment of acute pulmonary embolism (PE) (in conjunction with warfarin) C. Prevention of deep vein thrombosis (DVT) after abdominal surgery D. Prevention of ischemic complications in patients with unstable angina
D
For all patients undergoing percutaneous coronary intervention (PCI), which drug is recommended to be combined with clopidogrel [Plavix]? A. Heparin B. ACE inhibitor C. Alteplase [Activase] D. Aspirin
D
In which situation is dronedarone [Multaq] contraindicated? A. PR intervals of 240 msec B. QT intervals of less than 500 msec C. Resting heart rate of 55 beats/min D. Concomitant administration of amitriptyline [Elavil]
D
On-demand therapy is indicated for which type of patient? A. Patient with mild hemophilia B. Patient with severe hemophilia C. Patient who is allergic to factor VIII (Bioclate) D. Patient who is bleeding or about to undergo surgery
D
The home health nurse observes the patient for proper use of topical nitroglycerin ointment. Which action by the patient indicates the need for further teaching? A. Rotates the application sites to minimize skin irritation. B. Uses the applicator paper to measure the prescribed dose. C. Removes ointment from a previous dose before applying the next dose. D. Applies the prescribed ribbon of ointment to the applicator paper and places it on the chest.
D
The nurse caring for a patient taking furosemide [Lasix] is reviewing the patient's most recent laboratory results, which are: sodium, 136 mEq/L; potassium, 3.2 mEq/L; chloride, 100 mEq/L; blood urea nitrogen, 15 mg/dL. What is the nurse's best action? A. Administer Lasix as ordered. B. Place the patient on a cardiac monitor. C. Begin a 24-hour urine collection. D. Hold the Lasix and notify the physician.
D
The nurse is caring for a patient prescribed gemfibrozil [Lopid]. For which patient should the nurse question the use of this drug? A. A patient with cardiovascular disease and elevated triglycerides B. A patient with elevated very-low-density lipoprotein (VLDL) levels C. A patient with elevated triglycerides who has not responded to dietary changes D. A patient with history of gallstones and elevated triglycerides
D
The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? A. To reduce the risk of headache B. To improve hypotensive effects C. To prevent heart failure D. To protect against reflex tachycardia
D
The nurse is caring for a patient who takes warfarin [Coumadin] for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate? A. Administer intravenous (IV) push protamine sulfate. B. Continue with the current prescription. C. Prepare to administer vitamin K. D. Call the healthcare provider to increase the dose.
D
The nurse is caring for a patient with anemia related to chronic renal failure. Which agent might be used to treat the anemia? A. Filgrastim [Neupogen] B. Sargramostim [Leukine] C. Oprelvekin [Neumega] D. Epoetin alfa [Procrit]
D
The nurse is preparing to administer minoxidil [Loniten] 5 mg orally. What is the only cardiovascular indication for this medication? A. Heart failure B. Myocardial infarction C. Angina pectoris D. Severe hypertension
D
The nurse is teaching a patient about the side effects associated with doxazosin [Cardura]. Which statement by the patient indicates an understanding of the nurse's instructions? A. "I may experience an increase in hair growth as a side effect." B. "I'll notify the healthcare provider if I develop a persistent cough." C. "I'll make sure I include extra sources of potassium in my diet, such as bananas and baked potatoes." D. "When getting out of bed in the morning, I will sit on the side of the bed for several minutes before standing."
D
The nurse knows that which statement is most accurate? A. Individuals with severe hemophilia A have less of a risk of developing inhibitors than those with the mild form. B. The risk of inhibitor development is higher in Caucasians than in Hispanics. C. Antibodies to factor VIII develop after 20 to 30 treatments. D. Immune tolerance therapy is more successful in eliminating inhibitor production in hemophilia A than in hemophilia B.
D
The nurse provides discharge instructions to a patient prescribed verapamil [Calan] SR 120 mg PO daily for essential hypertension. Which statement by the patient indicates understanding of the medication? A. "I will take the medication with grapefruit juice each morning." B. "I should expect occasional loose stools from this medication." C. "I'll need to reduce the amount of fiber in my diet." D. "I must make sure I swallow the pill whole."
D
The nurse understands that ventricular fibrillation is a common cause of death after myocardial infarction (MI). Which drug should be readily available to treat ventricular fibrillation? A. Propranolol [Inderal] B. Dobutamine C. Valsartan [Diovan] D. Amiodarone [Cordarone]
D
The patient is admitted for the management of a hypertensive emergency. The healthcare provider prescribes sodium nitroprusside [Nipride] drug therapy. What is the priority nursing action during this treatment? A. Observe for respiratory depression. B. Monitor the electrocardiogram for tachycardia. C. Initiate oxygen therapy via nasal cannula at 2 L/min. D. Adjust the intravenous infusion rate to the blood pressure response.
D
Which acid-base imbalance is characterized by increases in both the pH and bicarbonate content of plasma? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
D
Which hemodynamic system serves as a reservoir for circulating blood? A. Heart B. Lungs C. Arteries D. Veins
D
Which laboratory result may be a consequence of therapy with a thiazide diuretic? A. Serum glucose level of 58 mg/dL B. Serum potassium level of 5.3 mEq/L C. Serum sodium level of 135 mEq/L D. Serum uric acid level of 10.4 mg/dL
D
Which medication is most likely to cause the side effect of constipation? A. Nifedipine [Adalat] B. Amlodipine [Norvasc] C. Isradipine [DynaCirc] D. Diltiazem [Cardizem]
D
Calcium channel blockers work by reducing calcium influx into the cells of the heart and blood vessels. Calcium channels are coupled to which type of autonomic nervous system receptors? A. Alpha1 B. Alpha2 C. Beta1 D. Beta2
c
