Pharm Exam 2
A 65-year-old patient is prescribed ipratropium (Atrovent) for the treatment of asthma. Which condition should be reported to the healthcare provider before giving this patient the ipratropium? A reported allergy to peanuts A history of intolerance to albuterol (Proventil) A history of bronchospasms A reported allergy to chocolate
A reported allergy to peanuts
The patient is receiving hydralazine with isosorbide (BiDil) for heart failure. The nurse should monitor this patient for: Dizziness and rapid heart rate Bleeding Tingling or cramping in the legs Confusion and agitation
Dizziness and rapid heartbeat
A patient with heart failure has an order for lisinopril (Prinivil, Zestril). Which condition in the patient's history would lead the nurse to confirm the order with the provider? A history of hypertension previously treated with diuretic therapy A history of seasonal allergies currently treated with antihistamines A history of angioedema after taking enalapril (Vasotec) A history of alcoholism, currently abstaining
A history of angioedema after taking enalapril
A patient with a history of heart failure will be started on spironolactone (Aldactone). Which drug group should not be used, or used with extreme caution in patients taking potassium-sparing diuretics? Nonsteroidal anti-inflammatory drugs Corticosteroids Loop diuretics Angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers
ACE inhibitors or ARBs
A patient is receiving cholestyramine (Questran) for elevated low-density lipoprotein (LDL) levels. As the nurse completes the nursing care plan, which adverse effects will be included for continued monitoring? Abdominal pain Orange-red urine and saliva Decreased capillary refill time Sore throat and fever
Abdominal Pain
The patient's serum sodium value is 152 mEq/L. Which nursing interventions are most appropriate for this patient? (Select all that apply.) Assess for inadequate water intake or diarrhea. Administer a 0.45% NaCl intravenous solution. Hold all doses of glucocorticoids. Notify the healthcare provider. Have the patient drink as much water as possible.
Assess for inadequate water intake or diarrhea Notify HCP
The nurse weighs the patient who is on an infusion of lactated Ringer's postoperatively and finds that there has been a weight gain of 1.5 kg since the previous day. What would be the nurse's next highest priority? Check with the patient to determine whether there have been any dietary changes in the last few days. Assess the patient for signs of edema and blood pressure for possible hypertension. Contact dietary to change the patient's diet to reduced sodium. Request a diuretic from the patient's provider.
Assess patient for signs of edema and blood pressure for possible HTN
Which action by the nurse is most important when caring for a patient with chronic kidney disease who has an order for furosemide (Lasix)? Assess urine output and renal laboratory values for signs of nephrotoxicity. Check the specific gravity of the urine daily. Eliminate potassium-rich foods from the diet. Encourage the patient to void every 4 hours.
Assess urine output and renal lab values for signs of nephrotoxicity
Which factor in the patient's history would cause the nurse to question a medication order for atropine? A 32-year-old man with a history of drug abuse A 65-year-old man with benign prostatic hyperplasia An 8-year-old boy with chronic tonsillitis A 22-year-old woman on the second day of her menstrual cycle
At 65 year old man with BPH
The nurse is teaching a patient about the use of dextromethorphan with guaifenesin (Robitussin-DM) syrup for a cough accompanied by thick mucus. Which instruction should be included in the patient's teaching? Lie supine for 30 minutes after taking the liquid. Drink minimal fluids to avoid stimulating the cough reflex. Take the drug with food for best results. Avoid drinking fluids immediately after the syrup but increase overall fluid intake throughout the day.
Avoid drinking fluids immediately after the syrup but increase overall fluid intake throughout the day
What health teaching should the nurse provide for a patient receiving diltiazem (Cardizem)? Select all that apply. Avoid driving or performing other activities requiring mental alertness until the effects of the drug are known. Maintain adequate fluid and fiber intake to facilitate stool passage. Report weight gain of 2 kg (5 lb) per week. Rise slowly from prolonged periods of sitting or lying down. Immediately stop taking the medication if sexual dysfunction is noted.
Avoid driving until effects of drug are known Maintain adequate fluid and fiber intake Report weight gain of more than 5lb per week Rise slowly
The patient has been given a prescription of hydro-chlorothiazide (Microzide) as an adjunct to treatment of hypertension and returns for a follow-up check. Which is the most objective data for determining the therapeutic effectiveness of the furosemide? Absence of edema in lower extremities Weight loss of 13 kg (6 lb) Blood pressure log notes blood pressure 120/70 mmHg to 134/88 mmHg since discharge Frequency of voiding of at least 6 times per day
BP log notes BP 120/70 to 134/88 since discharge
A patient is receiving PlasmaLyte for treatment of hypovolemic shock. When monitoring for therapeutic effects, which of the following will the nurse expect to occur? Breath sounds are clear. Potassium, glucose, and sodium levels remain within normal range. Blood pressure returns to within normal range and urine output increases. The pulse rate and ECG return to normal rate and pattern.
BP returns to within normal range and urine output increases
Propranolol (Inderal) has been ordered for a patient with hypertension. Because of adverse effects related to this drug, the nurse would carefully monitor for which adverse effect? Bronchodilation Tachycardia Edema Bradycardia
Bradycardia
Nursing assessment of a patient receiving normal serum albumin for treatment of shock should include which of the following? Breath sounds Serum glucose levels Potassium level Hemoglobin and hematocrit
Breath sounds
The nurse is caring for a patient with chronic hypertension. The patient is receiving losartan (Cozaar) daily. Which patient manifestations would the nurse conclude is an adverse effect of this medication? (Select all that apply.) Tremors Dizziness Drowsiness Hypoglycemia Angioedema
Dizziness Hypoglycemia Angioedema
A patient is starting to receive dobutamine by intravenous infusion for treatment of shock. This drug is particularly useful for which type of shock? Anaphylactic Septic Cardiogenic Hypovolemic
Cardiogenic
Lisinopril (Prinivil) is part of the treatment regimen for a patient with heart failure. The nurse monitors the patient for the development of which adverse effects of this drug? (Select all that apply.) Hyperkalemia Hypocalcemia Cough Dizziness Heartburn
Cough Dizziness Hyperkalemia
Older adult patients taking bethanechol (Urecholine) need to be assessed more frequently because of which adverse effect? Tachycardia Hypertension Dizziness Urinary retention
Dizziness
A patient is given a prescription for propranolol (Inderal) 40 mg bid. What is the most important instruction the nurse should give to this patient? Take this medication on an empty stomach, as food interferes with its absorption. Do not stop taking this medication abruptly; the dosage must be decreased gradually if it is discontinued. If the patient experiences any disturbances in hearing, the patient should notify the healthcare provider immediately. The patient may become very sleepy while taking this medication; do not drive.
Do not stop taking abruptly
The patient or caregiver of a patient taking neostigmine (Prostigmin) should be taught to be observant for which adverse effect that may signal a possible overdose has occurred? Excessive sweating, salivation, and drooling Extreme constipation Hypertension and tachycardia Excessively dry eyes and reddened sclera
Excessive sweating, salivation, and drooling
A patient who is experiencing shock is started on norepinephrine (Levophed) by intravenous drip. Why must the nurse conduct frequent inspections of the intravenous insertion site while the patient remains on this drug? The patient's blood pressure may rise if the site is occluded. Extravasation and leakage at the intravenous site may cause local tissue damage. Bleeding may occur from the site due to localized drug effects. The patient's blood pressure may drop precipitously if the intravenous runs too quickly.
Extravasation and leakage at the IV site may cause local tissue damage
The nursing plan of care for a patient receiving oprelvekin (Neumega) should include careful monitoring for symptoms of which adverse effect? Fluid retention Severe hypotension Impaired liver function Severe diarrhea
Fluid retention
A patient has been on long-term therapy with colestipol (Colestid). To prevent adverse effects related to the length of therapy and lack of nutrients, which supplements may be required? (Select all that apply.) Folic acid Vitamins A, D, E, and K Potassium, iodine, and chloride Protein B vitamins
Folic Acid and Vitamin A, D, E, and K
When planning to teach the patient about the use of epoetin alfa (Epogen, Procrit), which instructions would the nurse give? Eating raw fruits and vegetables must be avoided. Frequent rest periods should be taken to avoid excessive fatigue. Skin and mucous membranes should be protected from traumatic injury. Exposure to direct sunlight must be minimized and sunscreen used when outdoors.
Frequent rest periods should be taken to avoid excessive fatigue
A patient is receiving treatment for asthma with albuterol (Proventil). The nurse teaches the patient that while serious adverse effects are uncommon, the following may occur. (Select all that apply.) Tachycardia Sedation Temporary dyspnea Nervousness Headache
Headache Nervousness Tachycardia
Verapamil (Calan, Covera-HS, Verelan) should be used with extra caution or is contraindicated in patients with which cardiovascular condition? Hypertension Tachycardia Heart failure Angina
Heart Failure
Which assessment findings in a patient who is receiving atenolol (Tenormin) for angina would be cause for the nurse to hold the drug and contact the provider? (Select all that apply.) Heart rate of 50 beats/minute Heart rate of 124 beats/minute Blood pressure 86/56 Blood pressure 156/88 Tinnitus and vertigo
Heart rate of 50 bpm BP 86/56
The patient receiving heparin therapy asks how the "blood thinner" works. What is the best response by the nurse? "Heparin makes the blood less thick." "Heparin does not thin the blood but prevents clots from forming as easily in the blood vessels." "Heparin decreases the number of platelets so that blood clots more slowly." "Heparin dissolves the clot."
Heparin does not thin the blood but prevents clots from forming as easily in the blood vessels
A man, age 67, reports taking diphenhydramine (Benadryl) for hay fever. Considering this patient's age, the nurse assesses for which findings? A history of prostatic or urinary conditions Any recent weight gain A history of allergic reactions A history of peptic ulcer disease
History of allergic reactions
A patient with significant hypertension unresponsive to other medications is given a prescription for hydralazine. An additional prescription of propranolol (Inderal) is also given to the patient. The patient inquires why two drugs are needed. What is the nurse's best response? Giving the two drugs together will lower the blood pressure even more than just one alone. The hydralazine may cause tachycardia and the propranolol will help keep the heart rate within normal limits. The propranolol is to prevent lupus erythematosus from developing. Direct-acting vasodilators such as hydralazine cause fluid retention, and the propranolol will prevent excessive fluid buildup.
Hydralazine may cause tachycardia and the propranolol will help keep the HR within normal limits
Common adverse effects of antidysrhythmic medications include which of the following? (Select all that apply.) Hypotension Hypertension Dizziness Weakness Panic attacks
Hypotension Dizziness Weakness
The nurse evaluates the effectiveness of dopamine therapy for a patient in shock. Which of the following may indicate treatment is successful? (Select all that apply.) Improved urine output Increased blood pressure Diminished breath sounds Slight hypotension Intact peripheral pulses
Improved urine output Increased blood pressure
A patient will be sent home on diuretic therapy and has a prescription for liquid potassium chloride (KCl). What teaching will the nurse provide before the patient goes home? Do not dilute the solution with water or juice; drink the solution straight. Increase the use of salt substitutes; they also contain potassium. Report any weakness, fatigue, or lethargy immediately. Take the medication immediately before bed to prevent heartburn.
Report any weakness, fatigue, or lethargy immediately
The healthcare provider prescribes epinephrine (Adrenalin) for a patient who was stung by several wasps 30 minutes ago and is experiencing an allergic reaction. The nurse knows that the primary purpose of this medication for this patient is to: Stop the systemic release of histamine produced by the mast cells. Counteract the formation of antibodies in response to an invading antigen. Increase the number of white blood cells produced to fight the primary invader. Increase a declining blood pressure and dilate constricting bronchi associated with anaphylaxis.
Increasing a declining blood pressure and dilate constricting bronchi associated with anaphylaxis
The patient is to begin taking atorvastatin (Lipitor) and the nurse is providing education about the drug. Which symptom related to this drug should be reported to the healthcare provider? Constipation Increasing muscle or joint pain Hemorrhoids Flushing or "hot flash"
Increasing muscle or joint pain
The nurse is instructing a patient on home use of niacin and will include important instructions on how to take the drug and about its possible adverse effects. Which of the following may be expected adverse effects of this drug? (Select all that apply.) Fever and chills Intense flushing and hot flashes Tingling of the fingers and toes Hypoglycemia Dry mucous membranes
Intense flushing and hot flashes Tingling of the fingers and toes
The use of procainamide (Pronestyl) is limited to the treatment of life-threatening dysrhythmias because of what potential adverse effect? It can cause rebound hypertension in patients with heart failure. It increases the risk of ketoacidosis in patients with diabetes. It has significant cholinergic effects, causing diarrhea and electrolyte depletion. It causes antinuclear antibodies (ANA) when given long-term, resulting in blood dyscrasias.
It causes ANA when given long term resulting in blood dycrasias
The patient has been prescribed oxymetazoline (Afrin) nasal spray for seasonal rhinitis. Which instructions will the nurse provide? Limit use of this spray to 5 days or less. The drug may be sedating so be cautious with activities requiring alertness. This drug should not be used in conjunction with antihistamines. This is an over-the-counter drug and may be used as needed for congestion.
Limit use to 5 days or less
The patient is taking atenolol (Tenormin) and doxazosin (Cardura). What is the rationale for combining two antihypertensive drugs? The blood pressure will decrease faster. Lower doses of both drugs may be given with fewer adverse effects. There is less daily medication dosing. Combination therapy will treat the patient's other medical conditions.
Lower doses of both drugs may be given with fewer adverse effects
A patient is started on atenolol (Tenormin). Which is the most important action to be included in the plan of care for this patient related to this medication? Monitor apical pulse and blood pressure. Elevate the head of the bed during meals. Take the medication after meals. Consume foods high in potassium.
Monitor apical pulse and blood pressure
A patient who is taking an adrenergic-blocker for hypertension reports being dizzy when first getting out of bed in the morning. The nurse should advise the patient to: Move slowly from the recumbent to the upright position. Drink a full glass of water before rising to increase vascular circulatory volume. Avoid sleeping in a prone position. Stop taking the medication.
Move slowly from recumbent to the upright position
Anticholinergics may be ordered for which conditions? (Select all that apply.) Peptic ulcer disease Bradycardia Decreased sexual function Irritable bowel syndrome Urine retention
Peptic Ulcer disease bradycardia IBS
The patient admitted for heart failure has been receiving hydrochlorothiazide (Microzide). Which laboratory levels should the nurse carefully monitor? (Select all that apply.) Platelet count White blood cell count Potassium Sodium Uric acid
Potassium, sodium, uric acid
A patient has a prescription for fluticasone (Flonase) for allergic rhinitis. Place the following instructions in the order in which the nurse will instruct the patient to use the drug. Instill one spray directed high into the nasal cavity. Clear the nose by blowing. Prime the inhaler prior to first use. Spit out any excess liquid that drains into the mouth.
Prime, clear, spray, spit
When monitoring for therapeutic effect of any anti-dysrhythmic drug, the nurse would be sure to assess which essential parameter? Pulse Blood pressure Drug level Hourly urine output
Pulse
The patient is being discharged with nitroglycerin (Nitrostat) for sublingual use. While planning patient education, what instruction will the nurse include? "Swallow three tablets immediately for pain and call 911." "Put one tablet under your tongue for chest pain. If pain does not subside, call 911." "Call your healthcare provider when you have chest pain. She will tell you how many tablets to take." "Place three tablets under your tongue and call 911."
Put one tablet under your tongue for chest pain. If pain does not subside call 911
Nifedipine (Procardia XL) has been ordered for a patient with hypertension. In the care plan, the nurse includes the need to monitor for which adverse effect? Rash and chills Reflex tachycardia Increased urinary output Weight loss
Reflex Tachycardia
Nitroglycerin patches have been ordered for a patient with a history of angina. What teaching will the nurse give to this patient? Keep the patches in the refrigerator. Use the patches only if the chest pain is severe. Remove the old patch and wait 6-12 hours before applying a new one. Apply the patch only to the upper arm or thigh areas.
Remove the old patch and wait 6-12 hours before applying a new one
While planning for a patient's discharge from the hospital, which teaching points would be included for a patient going home with a prescription for chlorothiazide (Diuril)? Increase fluid and salt intake to make up for the losses caused by the drug. Increase intake of vitamin-C rich foods, such as grapefruit and oranges. Report muscle cramping or weakness to the healthcare provider. Take the drug at night because it may cause drowsiness.
Report muscle cramping or weakness to the healthcare provider
What health teaching should the nurse provide for the patient receiving nadolol (Corgard)? Increase fluids and fiber to prevent constipation. Report a weight gain of 1 kg per month or more. Immediately stop taking the medication if sexual dysfunction occurs. Rise slowly after prolonged periods of sitting or lying down.
Rise slowly after prolonged periods of sitting or lying down
The nurse is providing teaching to a patient who has been prescribed furosemide (Lasix). Which of the following should the nurse teach the patient? Avoid consuming large amounts of kale, cauliflower, or cabbage. Rise slowly from a lying or sitting position to standing. Count the pulse for one full minute before taking this medication. Restrict fluid intake to no more than 1 L per 24-hour period.
Rise slowly from lying or sitting position to standing
The teaching plan for a patient receiving hydralazine (Apresoline) should include which point? Returning for monthly urinalysis testing Including citrus fruits, melons, and vegetables in the diet Decreasing potassium-rich food in the diet Rising slowly to standing from a lying or sitting position
Rise slowly to standing from a lying or sitting position
A patient is receiving 5% dextrose in water (D5W). Which statements is correct? The solution may cause hypoglycemia in the patient who has diabetes. The solution may be used to dilute mixed intravenous drugs. The solution is considered a colloid solution. The solution is used to provide adequate calories for metabolic needs.
Solution may be used to dilute mixed IV drugs
An older adult patient diagnosed with iron-deficiency anemia will be taking ferrous sulfate (Feosol). The nurse will teach which of the required administration guidelines to the patient? (Select all that apply.) Take the tablets on an empty stomach if possible. Increase fluid intake and increase dietary fiber while taking this medication. If liquid preparations are used, dilute with water or juice and sip through a straw placed in the back of the mouth. Crush or dissolve sustained-release tablets in water if they are too big to swallow. Take the drug at bedtime for best results.
Take on empty stomach Increase fluid intake and increase dietary fiber while taking this med If liquid, dilute with water or juice and sip through straw placed in back of throat
What patient education should be included for a patient receiving enoxaparin (Lovenox)? (Select all that apply.) Teach the patient or caregiver to give subcutaneous injections at home. Teach the patient or caregiver not to take any over-the-counter drugs without first consulting with the healthcare provider. Teach the patient to observe for unexplained bleeding, such as pink, red, or dark brown urine or bloody gums. Teach the patient to monitor for the development of deep vein thrombosis. Teach the patient about the importance of drinking grapefruit juice daily.
Teach about subQ injections at home Teach not to take OTC Teach patient to observe for signs of bleeding Teach patient to monitor for the development of DVT
A patient who received a prescription for montelukast (Singulair) returns to his provider's office after 3 days, complaining that "the drug is not working." She reports mild but continued dyspnea and has had to maintain consistent use of her bronchodilator inhaler, albuterol (Proventil). What does the nurse suspect is the cause of the failure of the montelukast? The patient is not taking the drug correctly. The patient is not responding to the drug and will need to be switched to another formulation. The drug has not had sufficient time of use to have full effects. The albuterol inhaler is interacting with the montelukast.
The drug has not had sufficient time of use to have full effects
The patient in hypovolemic shock is prescribed an infusion of lactated Ringer's. What is the purpose for infusing this solution in shock? (Select all that apply.) The solution will help to replace fluid and promote urine output. The solution will draw water into cells. The solution will draw water from cells to blood vessels. The solution will help to maintain vascular volume. The solution is used to provide adequate calories for metabolic needs.
The solution with help to replace fluid and promote urine output The solution will help maintain vascular volume
Erectile dysfunction drugs such as sildenafil (Viagra) are contraindicated in patients taking nitrates for angina. What is the primary concern with concurrent administration of these drugs? They contain nitrates, resulting in an overdose. They also decrease blood pressure through vasodilation and may result in prolonged and severe hypotension when combined with nitrates. They will adequately treat the patient's angina as well as erectile dysfunction. They will increase the possibility of nitrate tolerance developing and should be avoided unless other drugs can be used.
They also decrease BP through vasodilation and may result in prolonged and severe hypotension when combined with nitrates
The patient is prescribed digoxin (Lanoxin) for treatment of heart failure. Which statement by the patient indicates the need for further teaching? "I may notice my heart rate decrease." "I may feel tired during early treatment." "This drug should cure my heart failure." "My energy level should gradually improve."
This drug should cure my HF
A patient has started clopidogrel (Plavix) after experiencing a transient ischemic attack. What is the desired therapeutic effect of this drug? Anti-inflammatory and antipyretic effects To reduce the risk of a stroke from a blood clot Analgesic as well as clot-dissolving effects To stop clots from becoming emboli
To reduce risk of stroke from a blood clot
A patient with asthma has a prescription for two inhalers, albuterol (Proventil) and beclomethasone (Qvar). How should the nurse instruct this patient on the proper use of the inhalers? Use the albuterol inhaler, and use the beclomethasone only if symptoms are not relieved. Use the beclomethasone inhaler, and use the albuterol only if symptoms are not relieved. Use the albuterol inhaler, wait 5-10 minutes, then use the beclomethasone inhaler. Use the beclomethasone inhaler, wait 5-10 minutes, then use the albuterol inhaler.
Use albuterol, wait 5-10 minutes, then use beclomethasone
To avoid the first-dose phenomenon, the nurse knows that the initial dose of prazosin (Minipress) should be: Very low and given at bedtime. Doubled and given before breakfast. The usual dose and given before breakfast. The usual dose and given immediately after breakfast.
Very low and given at bedtime
A patient was admitted from the emergency department after receiving treatment for dysrhythmias. He will be started on amiodarone (Pacerone) due to the lack of therapeutic effects from his other antidysrhythmic therapy. When the nurse checks with him in the afternoon, he complains of feeling lightheaded and dizzy. What will the nurse assess first? Whether there is the possibility of sleep deprivation from the stress of admission to the hospital Whether an allergic reaction is occurring with anticholinergic-like symptoms Whether the amiodarone level is not yet therapeutic enough to treat the dysrhythmias Whether the patient's pulse and blood pressure are within normal limits
Whether the patient's pulse and BP are WNL
A patient with deep vein thrombosis is receiving an infusion of heparin and will be started on warfarin (Coumadin) soon. While the patient is receiving heparin, what laboratory test will provide the nurse with information about its therapeutic effects? Antithrombin III International normalized ratio (INR) Activated partial thromboplastin time (aPTT) Platelet count
aPTT
