Pharm Exam 2 PrepU

A client experiences nausea and visual disturbances when taking digoxin (Lanoxin). The nurse would anticipate the client's digitalis level to be: a. 2.7 nanograms/mL b. 1.3 nanograms/mL c. 0.2 nanograms/mL d. 1.7 nanograms/mL

a. 2.7 nanograms/mL Therapeutic drug levels of digoxin are between 0.8 and 2 nanograms/ mL. Plasma digoxin levels greater than 2 nanograms/mL are considered toxic and the client may experience signs and symptoms of toxicity.

Prior to the administration of nitroglycerin, the nurse would assess which of the following? a. Blood pressure b. Breath sounds c. EKG d. Pulse

a. Blood pressure It is important to assess the client's blood pressure prior to administering nitroglycerin because it can cause hypotension. Pulse, breath sounds, and EKG are not a priority before administration.

The nurse is administering an intravenous dose of amiodarone to a client in distress. What action should the nurse prioritize? a. Establish cardiac monitoring and maintain it until full recovery. b. Document resuscitation efforts in detail. c. Perform medication reconciliation. d. Provide reassurance and support to the client.

a. Establish cardiac monitoring and maintain it until full recovery. Cardiac monitoring is imperative for determining therapeutic effect and monitoring the client's status. Reassurance is likely a low priority, due to the client's reduced levels of consciousness. Documentation is important, but cardiac monitoring is an even higher priority. Medication reconciliation is not performed during an emergency situation.

The nurse knows that nitroglycerin can be administered in what ways? (Select all that apply.) a. IV b. Intrathecally c. Transdermal d. Transmucosal

a. IV c. Transdermal d. Transmucosal Nitroglycerin is administered in transdermal, and IV preparations. Nitroglycerin is not administered intrathecally.

A nurse is analyzing the chemistry profile of a client diagnosed with hyperlipidemia. Which measurement(s) will the nurse prioritize on the lipid profile? Select all that apply. a. LDL b. Triglycerides c. Total cholesterol d. ALT e. AST

a. LDL b. Triglycerides c. Total cholesterol A lipoprotein profile is a laboratory test that reports total cholesterol, LDL, HDL, and triglycerides. AST and ALT are values that would be reported from liver function tests.

A client is prescribed disopyramide. The nurse would expect to administer this drug by which route? a. Oral b. Subcutaneous c. Intravenous d. Intramuscular

a. Oral Disopyramide is administered orally.

The critical care nurse is caring for a client with bradycardia after cardiovascular surgery. The nurse knows that the heart rate is determined by myocardial cells with the fastest depolarizing rate. Under normal circumstances, where are these cells located? a. SA node b. Bundle of HIS c. AV node d. Purkinje cells

a. SA node Normally, the SA node sets the pace for the heart rate because it depolarizes faster than any cell in the heart.

A nurse is analyzing the chemistry profile of a client diagnosed with hyperlipidemia. Which measurement(s) will the nurse prioritize on the lipid profile? Select all that apply. a. Triglycerides b. LDL c. ALT d. AST e. Total cholesterol

a. Triglycerides b. LDL e. Total cholesterol A lipoprotein profile is a laboratory test that reports total cholesterol, LDL, HDL, and triglycerides. AST and ALT are values that would be reported from liver function tests.

Which category of blood lipids is involved in the formation of atherosclerotic plaques? a. cholesterol b. nitroglycerin c. triglycerides d. phospholipids

a. cholesterol Blood lipids are a category of fatty acids, which are substances used within the body to perform essential functions. Cholesterol is the portion of blood lipids involved in the formation of atherosclerotic plaques. Triglycerides and phospholipids are not involved in the formation of plaque. Nitroglycerin is not a blood lipid.

The nurse knows that superinfections are a concern for clients who have been taking oral penicillins. Which is one of the more common superinfections? a. pseudomembranous colitis b. meningococcal meningitis c. septicemia d. syphilis

a. pseudomembranous colitis A superinfection can develop rapidly and is potentially life-threatening. Pseudomembrananous colitis is a common bacterial superinfection. The others are infections typically treated with penicillin.

After teaching a group of students about conditions that can lead to heart failure, the instructor determines that additional teaching is needed when the students identify: a. renal failure. b. hypertension. c. valvular disease. d. coronary artery disease

a. renal failure. Renal failure would be least likely to contribute to the development of heart failure. Coronary artery disease, cardiomyopathy, valvular disease, and hypertension are commonly associated with heart failure.

A client diagnosed with heart disease is prescribed an antiarrhythmic drug. Further teaching is needed when the client makes which statement? a. "I can check the drug label about taking the medicine with food." b. "I know I must take my medication every day for my heartbeat to be fixed." c. "I need to call my primary care provider before taking any herbal supplements." d. "I will take my medication at the prescribed time."

b. "I know I must take my medication every day for my heartbeat to be fixed." Antiarrhythmic drugs do not cure disease. Along with lifestyle changes, they can improve the quality of life. Adherence to the drug regimen is important. Following the directions on drug labels is also important. The client should check with the primary care provider before taking any nonprescription drug, supplement, or herbal preparation.

After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states: a. "I can still use my salt substitute if I want to." b. "I need to make sure I don't eat too many high potassium foods." c. "I should take the medicine around dinnertime for the best effect." d. "I need to take the drug on an empty stomach."

b. "I need to make sure I don't eat too many high potassium foods." The drug is a potassium sparing diuretic placing the patient at risk for hyperkalemia, especially if the patient consumes foods high in potassium. The patient should take the medication in the morning to prevent interfering with sleep by having to get up at night to void. The patient can take the drug with meals if GI upset occurs. Many salt substitutes contain potassium, which could increase the patient's risk for hyperkalemia.

The client presents to the health care provider with a new onset of bradycardia. The nurse recognizes that which antihypertensive can cause bradycardia? a. Labetalol b. Diltiazem c. Enalapril d. Clonidine

b. Diltiazem Diltiazem is a calcium channel blocker that can cause atrioventricular block and bradycardia. Labetalol's adverse reactions include fatigue, drowsiness, insomnia, and hypotension. Clonidine's adverse reactions include drowsiness, dizziness, dry mouth, and constipation. Clients on enalapril can experience headache and dizziness.

A male client does not respond to traditional treatment for his chronic angina. The health care provider orders ranolazine (Ranexa) and orders a baseline ECG prior to medication administration. Three months later, the health care provider orders a repeat ECG. For what reason is the provider monitoring the client? a. Dose-dependent ectopic beats b. Dose-dependent QT prolongation c. Dose-dependent premature ventricular beats d. Dose-dependent ST elevation

b. Dose-dependent QT prolongation Ranolazine (Ranexa) represents a new classification of antianginal medication, metabolic modulators, used in people with chronic angina. The drug is labeled for use in combination with amlodipine, beta-blockers, or nitrates. After oral administration, peak plasma concentrations are reached within 2 to 5 hours. The drug is rapidly and extensively metabolized in the liver. Because of a risk of dose-dependent QT prolongation on electrocardiogram, ranolazine is reserved for the treatment of clients with chronic angina who have not achieved a satisfactory antianginal response with traditional drugs.

When describing the action of beta blockers to a client, the nurse would emphasize that the majority of drug actions involve stimulation of the receptors in which organ? a. Kidney b. Heart c. Brain d. Liver

b. Heart The majority of beta-adrenergic receptors are found in the heart. Blocking the nerve impulse of beta-adrenergic nerves decreases the heart rate and dilates the blood vessels. The majority are not found in kidney, brain, or liver.

A nurse is providing care to a client who has elevated levels of low-density lipoprotein (LDL). A review of the client's history reveals a sedentary lifestyle and a history of being overweight. The nurse understands that this combination of factors places the client at risk for which condition? a. Glaucoma b. Heart disease c. Diabetes d. Hypertension

b. Heart disease Increased levels of LDL in combination with other risk factors, such as increased weight, diet high in saturated fats, and lack of physical activity, can lead to the development of atherosclerotic heart disease. In diabetes high levels of blood glucose as well as HbA1c are seen. In clients with glaucoma, increased eye pressure causes damage to the optic nerve. Clients with hypertension left untreated can lead to kidney failure and stroke.

When describing cardiotonic drugs, the nurse would expect to include which condition as an indication for use? Select all that apply. a. Hyperlipidemia b. Heart failure c. Atrial fibrillation d. Hypertension e. Hypothyroidism

b. Heart failure c. Atrial fibrillation Cardiotonic drugs are used to treat heart failure if other treatments fail to improve client status and to treat atrial fibrillation. Thyroid hormones are used to treat hypothyroidism. Statin therapy is used in the treatment of hyperlipidemia. Thiazides and loop diuretics are used to treat hypertension along with other antihypertensives.

The pharmacology instructor is discussing cardiac glycosides with a class of pre-nursing students. According to the instructor, what physiologic effect do cardiac glycosides trigger? a. Decreased cardiac output b. Increased force of heart contraction c. Decreased afterload d. Increased ventricular rate

b. Increased force of heart contraction Cardiac glycosides increase the force of cardiac contraction, which increases cardiac output.

The health care provider has prescribed spironolactone for a client. The nurse is prepared to carefully monitor the client's potassium level if the client is also administered which drug? a. Diltiazem b. Lisinopril c. Terazosin d. Metoprolol

b. Lisinopril Spironolactone when given with ACE inhibitors (lisinopril) can lead to hyperkalemia. Hyperkalemia is not associated with the combination of spironolactone and metoprolol, terazosin, or diltiazem. The three drugs are all used to treat hypertension, which may include the use of a diuretic as well.

After teaching a group of students about drugs used as antianginal agents, the instructor determines that the teaching was successful when the students identify which as a beta-blocker antianginal agent? a. Amlodipine b. Nadolol c. Ranolazine d. Verapamil

b. Nadolol Nadolol is a beta-blocker used as an antianginal agent. Amlodipine and verapamil are calcium channel blocker antianginal agents. Ranolazine is classified as a piperazine acetamide.

The nurse has completed medication teaching for a client who has been prescribed aliskiren. What meal choice made by the client best demonstrates an understanding of dietary concerns related to the drug? a. grilled cheese sandwich, french fries, and a fruit salad b. baked white fish, rice, and a green salad c. pork chop, quinoa, and spinach salad d. 2 egg omelet, hash brown potatoes, toast

b. baked white fish, rice, and a green salad The client should be instructed to avoid taking aliskiren, a direct renin inhibitor, with a high-fat meal because this significantly decreases the amount of available drug. White fish, rice, and a green salad are all low fat foods. Eggs, cheese, french fries, and pork chops are high in fat and would affect absorption of the medication.

When describing the drugs classified as class IV antiarrhythmics, the nurse would identify these as: a. cardiac glycosides. b. calcium channel blockers. c. vasodilators. d. beta blockers.

b. calcium channel blockers. Class IV antiarrhythmics include calcium channel blockers. Beta blockers are class II antiarrhythmics. Cardiac glycosides, such as digoxin may be used as an antiarrhythmic, but are not classified as class I, II, III, or IV. Vasodilators are not used as antiarrhythmics.

The client has been started on nitroglycerin ointment for angina. The nurse identifies that the nitroglycerin ointment has been effective if the client reports: a. dizziness after each application. b. no episodes of angina since ointment was initiated. c. minimal episodes of angina. d. that he gets a headache each time the ointment is applied.

b. no episodes of angina since ointment was initiated. Topical nitroglycerin is used to manage angina. The treatment is effective if the client reports no episodes of angina. Headache and dizziness are adverse effects of the medication.

The nurse is providing health education to a client who has been newly diagnosed with hypertension. When explaining the need for vigilant blood pressure control, the nurse should describe what potential consequence of hypertension? Select all that apply. a. heart valve failure b. risk for damage to vessel walls c. impaired coronary circulation d. increased cardiac workload e. arrhythmias

b. risk for damage to vessel walls d. increased cardiac workload Hypertension creates a risk for damage to delicate vessel walls and increased cardiac workload. It does not normally lead to valve failure, conduction problems or disruptions to coronary circulation.

The nurse administers a bolus of lidocaine to a client with a life-threatening ventricular arrhythmia and follows it with a continuous infusion at what rate? a. 10 to 20 mg/min b. 0.25 to 0.75 mg/min c. 1 to 4 mg/min d. 6 to 8 mg/min

c. 1 to 4 mg/min Lidocaine may be delivered at 1 to 4 mg/min after a bolus. Therefore, the other options are incorrect.

Which would be classified as a bile acid sequestrant? a. Lovastatin b. Ezetimibe c. Cholestyramine d. Gemfibrozil

c. Cholestyramine Cholestyramine is classified as a bile acid sequestrant. Lovastatin is a HMG-CoA reductase inhibitor. Ezetimibe is a cholesterol absorption inhibitor. Gemfibrozil is classified as a fibrate.

A client diagnosed with hyperlipidemia is prescribed a statin. The nurse is reviewing the client's history and would notify the client's health care provider if which condition was noted in the client's history? a. Asthma b. Renal disease c. Liver disease d. Hypertension

c. Liver disease Statins are contraindicated in clients with liver disorders. They are used cautiously in clients with a history of hypotension, infection, and myopathy.

The health care provider indicates that a client experiencing renal failure is not a candidate for therapy with potassium-sparing diuretics. How will the nurse respond when the client's family member asks why this is the case? a. They are the strongest form of diuretics. b. They may cause rebound edema. c. They may cause hyperkalemia. d. They promote excretion of potassium.

c. They may cause hyperkalemia. Potassium-sparing diuretics accumulate in renal insufficiency and present the risk for hyperkalemia. For this reason, health care practitioners typically avoid the drug in this population. Potassium-sparing diuretics decrease potassium excretion, and, by themselves, they are weak diuretics. Rebound edema may be a concern when a diuretic is discontinued, but it is not the reason this client is a poor candidate for a potassium-sparing diuretic.

The nurse is preparing a teaching plan for a client who is receiving cephalosporins. Which of the following would the nurse identify as the most commonly occurring adverse effects? a. Phlebitis b. Headache and dizziness c. Vomiting and diarrhea d. Superinfections

c. Vomiting and diarrhea Although headache and dizziness, superinfections, and phlebitis (with intravenous administration) can occur, the most common adverse effects of cephalosporins involve the GI tract and include vomiting, diarrhea, nausea, anorexia, abdominal pain, and flatulence.

A nurse administers chlorothiazide to a client with renal compromise. Which action should the nurse prioritize after noting the BUN level is rising? a. Increase the fluid intake for the client. b. Administer the drug in a diluted form. c. Withhold the next dose of the drug. d. Give prescribed magnesium supplements.

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

In the rare instance in which penicillin is considered essential, hypersensitivity can be assessed by administering: a. the medication in a controlled environment. b. a loading dose of the medication. c. a skin test. d. the medication by the intravenous route only.

c. a skin test. In the rare instance in which penicillin is considered essential, a skin test may be helpful in assessing hypersensitivity.

A 37-year-old client presents with a blood pressure of 128/78 mm Hg. What lifestyle change should the nurse suggest related to this assessment finding? a. "Try to increase your intake of potassium-rich foods." b. "Explore the possible use of a calcium channel blocker with your health care provider." c. "Get 7 to 8 hours of sleep each night." d. "Be aware of your salt intake and limit hidden salt."

d. "Be aware of your salt intake and limit hidden salt." This client may reduce the likelihood of developing hypertension with a reduction in salt intake. There is no need for this client to be placed on a calcium channel blocker or to increase potassium intake. Adequate sleep is important, but this is not directly related to blood pressure control.

The nurse is taking a health history on a 58-year-old client who is taking atorvastatin for high cholesterol. What assessment question should the nurse prioritize related to the safe use of this drug? a. "How would you describe your caffeine intake?" b. "Do you do any physical exercise on a regular basis?" c. "Do you use any over-the-counter medications for headaches or colds?" d. "How many alcoholic drinks do you have in a typical day or week?"

d. "How many alcoholic drinks do you have in a typical day or week?" Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors are contraindicated with active liver disease or a history of alcohol-related liver disease, so it is important for the nurse to ask about the client's use of alcohol. For most clients, heavy alcohol use would be more dangerous than high caffeine intake or the use of OTC medications. Exercise has multiple benefits and should be encouraged by the nurse, but it is unrelated to safe medication use.

The nurse provides drug teaching to the client prescribed captopril. What statement made by the client does the nurse interpret to mean teaching has been effective? a. "I will monitor the effectiveness by watching for any symptoms of hypertension." b. "I'll take the drug in the morning so that I don't have to go to the bathroom often at night." c. "I will increase my intake of foods high in potassium, such as bananas." d. "I will call my doctor if I bruise easily or become extremely tired."

d. "I will call my doctor if I bruise easily or become extremely tired." Captopril has been associated with sometimes-fatal pancytopenia, cough, and unpleasant gastrointestinal (GI) distress, so the client should be alert to symptoms related to anemia, reduction in platelets, or infection. There is no need to increase potassium intake because a slight rise in potassium level is associated with this drug. Orthostatic hypotension is not a listed adverse effect. Effectiveness can only be gauged by blood pressure monitoring; most clients experience no symptoms of hypertension unless it is extreme.

A client with renal impairment has been receiving hydrochlorothiazide, and lately it has been less effective than usual. The nurse knows that thiazide drugs become ineffective when the GFR is less than what level? a. 60 mL/min b. 40 mL/min c. 50 mL/min d. 30 mL/min

d. 30 mL/min Thiazides may be useful in managing edema caused by renal disorders such as nephrotic syndrome and acute glomerulonephritis. However, their effectiveness decreases as the GFR decreases, and the drugs become ineffective when the GFR is less than 30 mL/min.

A health care provider prescribes a client 3.375 g piperacillin sodium and tazobactam (Zosyn) every six hours. After reconstitution, the concentration of the drug is 2.25 g/50 mL. Which quantity of the reconstituted solution should the nurse administer to the client? a. 60 mL b. 65 mL c. 70 mL d. 75 mL

d. 75 mL After reconstitution, the concentration of the drug is 2.25 g/50 mL. Concentration of drug per mL is 0.045 g (2.25/50). Therefore, to administer 3.375 mg piperacillin, 75 (3.375/0.045) mL of the reconstituted solution is required.

The nurse is teaching a client with angina who is prescribed sublingual tablets. The nurse would instruct the client to use a tablet at which frequency when experiencing an acute attack? a. Every 15 minutes b. Every 2 minutes c. Every 10 minutes d. Every 5 minutes

d. Every 5 minutes Sublingual nitroglycerin should be taken every 5 minutes up to a maximum number of 3 tablets in 15 minutes. The client should seek medical care if pain is not relieved after the 3 doses.

A nurse is caring for a client prescribed nicotinic acid for hyperlipidemia. The nurse would assess the client for which findings as a possibility? a. Dyspnea b. Tachycardia c. Weakness d. Flushing of the skin

d. Flushing of the skin The nurse should inform the client prescribed nicotinic acid that flushing of the skin is generally experienced by clients during this treatment. Weakness, tachycardia, and dyspnea are not adverse reactions associated with nicotinic acid.

A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment? a. Take a dietary history of the patient. b. Obtain reports of fasting blood sugar levels. c. Inspect skin and eyelids for evidence of xanthomas. d. Frequently monitor blood cholesterol.

d. Frequently monitor blood cholesterol. The nurse should frequently monitor blood cholesterol as part of the ongoing assessment for a patient receiving ezetimibe. Taking a dietary history of the patient and inspecting the skin and eyelids for evidence of xanthomas are the pre-administration assessments that a nurse should perform for a patient receiving ezetimibe. The nurse obtains the reports of fasting blood sugar for a diabetic patient.

A nurse is preparing to administer spironolactone to a client. The nurse would question this order if which disorder is noted in the client's history? a. Liver disease b. Diabetes c. Gout d. Hyperkalemia

d. Hyperkalemia The nurse should know that potassium-sparing diuretics are contraindicated in clients with hyperkalemia and are not recommended for children. Potassium-sparing diuretics should be used cautiously in clients with liver disease, diabetes, or gout.

There are four primary classes of antidysrhythmic drugs. What class consists primarily of potassium channel blockers? a. I b. II c. IV d. III

d. III The class III antiarrhythmics are primarily potassium channel blockers. Class I drugs are sodium channel blockers; class II drugs are beta-adrenergic blockers; and class IV drugs are calcium channel blockers.

A patient is prescribed esmolol for treatment of supraventricular tachycardia. The nurse would expect to administer this drug by which route? a. Intramuscular b. Oral c. Subcutaneous d. Intravenous

d. Intravenous Esmolol is available only for IV administration.

The nurse is caring for a client who is experiencing elevated intracranial pressure following neurosurgery. The health care provider orders an osmotic diuretic to reduce pressure. Which medication would the nurse expect to be ordered? a. Spironolactone b. Bumetanide c. Ethacrynic acid d. Mannitol

d. Mannitol Mannitol is an osmotic diuretic used frequently in cases of increased ICP. Bumetanide and ethacrynic acid are loop diuretics, and spironolactone is a potassium-sparing diuretic.

The nurse is providing teaching to a client who is at risk for hyperlipidemia. The nurse knows that which risk factors can be controlled or modified? a. Gender, obesity, family history, and smoking b. Stress, family history, and obesity c. Inactivity, stress, gender, and smoking d. Obesity, inactivity, diet, and smoking

d. Obesity, inactivity, diet, and smoking The risk factors for hyperlipidemia that can be controlled or modified include obesity, inactivity, diet, stress, and smoking. Gender and family history are risk factors that cannot be controlled.

A male client has cirrhosis and is receiving diuretic therapy. The nurse knows that what drug will help prevent metabolic alkalosis or hypokalemia in this client? a. Bumetanide b. Hydrochlorothiazide c. Dyazide d. Spironolactone

d. Spironolactone For clients with cirrhosis, diuretic therapy should be initiated in a hospital setting, with small doses and careful monitoring. To prevent hypokalemia and metabolic alkalosis, supplemental potassium or spironolactone may be needed.

The nurse is caring for a client who is taking a sustained-release (SR) oral nitrate. How should the nurse instruct this client to take the medication? a. With milk or milk products b. 1 hour after eating c. Sublingually until absorbed d. With water

d. With water Give SR forms with water, and caution the client not to chew or crush them, because these preparations need to reach the gastrointestinal (GI) tract intact to avoid overdosage. They are not dissolved sublingually but swallowed whole. They are best taken on an empty stomach 1 hour before meals.

The nurse cares for a 10-year-old client who has been diagnosed with hypercholesterolemia. What is the most common cause of hypercholesterolemia in pediatric clients? a. sedentary lifestyle b. gender c. diet d. familial connection

d. familial connection Familial hypercholesterolemia may be seen in pediatric clients. Because of the importance of lipids in the developing nervous system, treatment is usually restricted to tight dietary restrictions to limit fats and calories. Gender, diet, or exercise-resistant hypercholesterolemia is possible in children, but they are not the most common causes.

A client's serum cholesterol is 286 mg/dL. Lovastatin (Mevacor) is prescribed. The nurse plans care based on the fact that the action of lovastatin: a. promotes the breakdown of HDL. b. promotes excretion of cholesterol in the feces. c. decreases absorption of cholesterol. d. inhibits the production of cholesterol.

d. inhibits the production of cholesterol. Statin drugs inhibit the production of cholesterol and promote the breakdown of cholesterol. Bile acid resins bind to bile acids to form insoluble substances that cannot be absorbed.

A client is prescribed sublingual nitroglycerin for treatment of angina. The nurse instructs the client to do what if chest pain occurs? a. "If the chest pain doesn't go away after three tablets are given 5 minutes apart, call 911." b. "Use the nitroglycerin if your chest pain doesn't subside on its own in 3 minutes." c. "If the medication burns or causes a headache, get a new prescription." d. "The pills are usually good for 12 to 18 months after the prescription is filled."

a. "If the chest pain doesn't go away after three tablets are given 5 minutes apart, call 911." The client should take 1 pill as soon as chest pain occurs. Burning indicates the medication is active, and it often causes a headache because of the vasodilation. The pills are only good for approximately 6 months. If chest pain is not relieved after the first pill, the client may take the second pill 5 minutes after the first and then may take a third pill 5 minutes later. At this point, if the client still has chest pain, the client should call 911.

A client, prescribed amlodipine, asks how this drug works. What is the nurse's best response? a. "It inhibits the influx of calcium ions across cardiac and smooth muscle, dilating the coronary arteries." b. "Blocks conversion of angiotensin I to angiotensin II." c. "Increases client's perception of pain and decreases the heart rate." d. "Decreases the cardiac output by diuresis of sodium and water."

a. "It inhibits the influx of calcium ions across cardiac and smooth muscle, dilating the coronary arteries." Amlodipine inhibits the influx of calcium ions across cardiac and smooth muscle during depolarization, resulting in relaxation and vasodilation. This leads to lowered blood pressure. Diuretics decrease the cardiac output by diuresis of sodium and water. This medication does not increase pain or affect the heart rate. ACE inhibitors block the conversion of angiotensin I to angiotensin II.

You are teaching a patient about his new prescription for oral propranolol. If the patient asks you how long it will take for the medication to relieve pain, what will you say in response? a. "It will start working in about a half hour." b. "It will start working in about fifteen minutes." c. "It will start working in about a minute." d. "It will start working in about ten minutes."

a. "It will start working in about a half hour." The onset of action is approximately thirty minutes for oral propranolol and one to two minutes for IV propranolol.

A nurse is providing education to a client who has been experiencing unstable angina. What is the nurse's best explanation of this condition? a. "There is serious narrowing of a coronary artery causing a reduction in oxygen to the heart." b. "The pain is caused by a spasm of a blood vessel, not just from the vessel narrowing." c. "A coronary vessel has become completely plugged and is unable to deliver blood to your heart." d. "Your body's response to a lack of oxygen in the heart muscle is causing the pain you are feeling."

a. "There is serious narrowing of a coronary artery causing a reduction in oxygen to the heart." Unstable angina is described as increased narrowing of coronary arteries with the heart experiencing episodes of ischemia even at rest. If a coronary vessel is completely occluded and unable to deliver blood to the cardiac muscle, a myocardial infarction has occurred. Prinzmetal angina is an unusual form of angina caused by spasm of the blood vessel and not just by vessel narrowing. Although pain is the body's response to ischemia in the heart muscle, this description could encompass angina or a myocardial infarction and is not specific enough to explain the condition.

Penicillins may trigger an anaphylactic reaction in some clients. Within what period following injection of a penicillin is anaphylaxis most likely to occur? a. 30 minutes b. 10 minutes c. 15 minutes d. 45 minutes

a. 30 minutes Anaphylaxis induced by injectable penicillins typically occurs within 30 minutes of administration.

A nurse is required to monitor the blood concentration levels of the drug in a client receiving IV lidocaine for cardiac arrhythmia. Which blood concentration level should the nurse to report to the health care provider immediately? a. 6 mcg/mL b. 2 mcg/mL c. 5 mcg/mL d. 3 mcg/mL

a. 6 mcg/mL The nurse should report to the health care provider immediately when the blood concentration level of lidocaine reaches 6 mcg/mL. Above a level of 6 mcg/mL, the risk of central nervous system and cardiac depression is significantly increased. Immediate reporting is needed as the dose of the drug may need to be changed.

A client is ordered to receive vancomycin IV. When administering the drug, the nurse would infuse the drug over which time frame? a. 60 minutes b. 15 minutes c. 45 minutes d. 30 minutes

a. 60 minutes Each IV dose of vancomycin is infused over 60 minutes. Too rapid an infusion may result in a sudden and profound fall in blood pressure and shock.

A client has been diagnosed with renal failure and is surprised to learn of the large volume of blood that is filtered by the kidneys. The client asks, "If that much blood gets filtered, why don't people produce more urine?" In response, the nurse should describe what phenomenon? a. A very large majority of filtrate is returned to circulation. b. Most urine is processed internally rather than excreted. c. Most of the substances that are removed from urine are recycled. d. Electrolytes draw the water from urine back into circulation.

a. A very large majority of filtrate is returned to circulation. Only 1% of filtrate is excreted as urine, since the majority of the filtrate is physiologically useful. Substances are removed from blood, not from urine. Urine is excreted, not processed internally.

A client receiving penicillin therapy reports mouth irritation and a sore throat to the nurse. Inspection reveals a red, swollen tongue with ulcerations. The nurse suspects a fungal superinfection and prioritizes which nursing diagnosis as most appropriate for this client? a. Altered Oral Mucous Membranes b. Deficient Knowledge c. Altered Comfort d. Inadequate Nutrition: Less Than Body Requirements

a. Altered Oral Mucous Membranes The assessment suggests a fungal superinfection, which would lead to the nursing diagnosis of Altered Oral Mucous Membranes. Although Altered Comfort may be appropriate, Altered Oral Mucous Membranes is more specific. There is no evidence of lack of knowledge or problems with nutrition. However, if the superinfection is not addressed, the client may experience difficulty eating due to the irritation and discomfort.

A 48-year-old client who experienced an MI 10 years ago is now reporting frequent episodes of angina. The physical assessment identifies the client as being tachycardic. What is the first drug of choice for the treatment of this client? a. Beta-blockers b. Calcium channel blockers c. Alpha-blockers d. Angiotensin II receptor blockers

a. Beta-blockers Beta adrenergic blockers are the drugs of first choice for clients younger than 50 years of age with high-renin hypertension, tachycardia, angina pectoris, myocardial infarction, or left ventricular hypertrophy.

When describing the action of class II antiarrhythmics, which would the nurse include? a. Blockage of beta receptors in the heart and kidneys b. Interference with calcium ion movement across the membrane c. Membrane stabilization with depression of phase 0 action potential d. Blockage of potassium channels during phase 3 action potential

a. Blockage of beta receptors in the heart and kidneys Class II antiarrhythmics are beta-adrenergic blockers that block the beta receptor sites in the heart and kidneys. Membrane stabilization and phase 0 depression occurs with class I antiarrhythmics. Blockage of potassium channels during phase 3 of the action potential occurs with class III antiarrhythmics. Blockage of calcium ion movement occurs with class IV antiarrhythmics.

A client is admitted to the emergency department with severe chest pain. The emergency department health care provider orders intravenous nitroglycerin 5 mcg/min, titrate dose by 5 mcg/min every 3 to 5 minutes per infusion pump as needed. Before administering the nitroglycerin, the nurse should prioritize which assessment? a. Blood pressure b. Urinary output c. Blood urea nitrogen (BUN) d. Heart rate

a. Blood pressure Before administering IV nitroglycerin, the nurse should first assess blood pressure to make sure that the client does not have hypotension and to establish a baseline blood pressure. It is also important to assess the heart rate and urinary function (urinary output and BUN). However, in the case of administering intravenous nitroglycerin, the nurse would first assess the blood pressure.

A breast-feeding woman is prescribed a Class 3 antiarrhythmic. What information should the nurse provide to the client regarding the safety of the breast-feeding while taking this medication? a. Breast-feeding must be discontinued and other forms of feeding should be introduced. b. The medication doesn't pass into the breast milk. c. The decision to continue breast-feeding should be based on the stress is creates for the woman d. The safety of this class of antiarrhythmic medications has not been established.

a. Breast-feeding must be discontinued and other forms of feeding should be introduced. The safety for the use of antiarrhythmic drugs during pregnancy has not been established. They should not be used in pregnancy unless the benefit to the mother clearly outweighs the potential risk to the fetus. The drugs enter breast milk, and some have been associated with adverse effects on the neonate. Class I, III, and IV agents should not be used during lactation; if they are needed, another method of feeding the baby should be used.

The nurse is preparing discharge teaching for a client prescribed chronic antiarrhythmic medication therapy. Which signs/symptoms should be reported to the health care provider immediately? (Select all that apply.) a. Chest pain b. Diarrhea c. Heart palpations d. Nausea e. Dyspnea

a. Chest pain c. Heart palpations e. Dyspnea Report any of the following to your health care provider: chest pain, difficulty breathing, palpitations, numbness, or tingling. The other options present the seriousness of the correct options.

A client is admitted to the emergency department with a severe headache, nausea, shortness of breath, and blood pressure of 200/120 mm Hg. Which response should the nurse prioritize? a. Continuously monitor the client's status. b. Alternate the arms for assessing the blood pressure and pulse. c. Take a blood pressure every 30 minutes. d. Measure the pulse rate every hour.

a. Continuously monitor the client's status. When the client has a severe hypertensive emergency (such as an extremely elevated blood pressure), does not have the expected response to drug therapy, or is critically ill, continuous monitoring is performed. The alarm should be set to alert the medical staff if the blood pressure continues to rise. The client is at risk of developing serious complications such as a stroke, kidney failure, or retinopathy if the blood pressure is not lowered quickly.

Ms. Quinn is admitted to the surgical intensive care unit after open heart surgery. The health care provider prescribes IV nitroglycerin, according to a hospital protocol for titration of the drug. Which factor would be most important when determining increases or decreases in the dose? a. Current blood pressure b. Current respiratory rate c. Susceptibility of the client to intracranial pressure d. Susceptibility of the client to renal insufficiency

a. Current blood pressure For a client receiving IV nitroglycerin, the nurse must monitor the blood pressure and presence of continued chest pain while the IV therapy continues. If chest pain continues, the IV dose can be increased; however, due to the vasodilation effects of the drug, if the blood pressure drops below a certain point, the dose cannot be further increased. It is important to assess for alcohol intoxication if giving high doses for a prolonged period. A client's susceptibility to renal insufficiency and intracranial pressure is not likely to be affected by the IV therapy and therefore need not be monitored closely. The GI tract is also not likely to be affected by the IV therapy.

A male client presents to the health care provider's office with symptoms of hyperglycemia. He is taking his oral antidiabetic medication and has not modified his diet or exercise program in any way. When the nurse interviews the client, he states that he now takes flax seed to reduce his cholesterol level. What may occur as a result of taking flax seed? a. Decreased absorption of his drugs b. the kidneys c. Increased liver metabolism d. Increased absorption of his drugs e. Decreased excretion of the drug through the kidneys

a. Decreased absorption of his drugs Flax or flax seed is used internally as a laxative and a dyslipidemic agent. Absorption of all medications may be decreased when taken with flax, resulting in a less than therapeutic effect.

A client being treated for cellulitis with a cephalosporin asks what the essential difference is between generations of this medication. The nurse should respond to the client's question based on what fact? a. Each successive generation is more effective against gram-negative microorganisms. b. Each generation of cephalosporins has a different mechanism of action. c. The generations of cephalosporins represent formulations that produce fewer side effects. d. The generations represent the order in which the drugs should be utilized clinically.

a. Each successive generation is more effective against gram-negative microorganisms. Cephalosporins are grouped into generations by their antimicrobial properties. Each newer generation of cephalosporins has significantly greater gram-negative antimicrobial properties than the preceding generation, with decreased activity against gram-positive organisms. None of the remaining options accurately describe the concept of generations associated with medications.

A client's hypertension has not responded to first-line therapies so the health care provider has added prazosin to the client's regimen. To ensure the client's safety and reduce adverse effects of this new medication, the nurse should perform what action? a. Encourage the client to take the medication at bedtime. b. Tell the client to avoid exercising for the first several days of treatment. c. Have the client abstain from dairy products for the first week of treatment. d. Encourage the client to void proactively to prevent bladder overdistention.

a. Encourage the client to take the medication at bedtime. One adverse effect associated with prazosin, called the first-dose phenomenon, results in orthostatic hypotension, with palpitations, dizziness, and perhaps syncope 1 to 3 hours after the first dose or an increased dose. To prevent this effect, first doses and first increased doses are taken at bedtime. There is no benefit to frequent voiding or abstaining from dairy and there is no reason to avoid exercise, provided the client remains safe doing so.

A client with a diagnosis of hypertension has been prescribed a regimen of ramipril and hydrochlorothiazide. In the nurse's most recent assessment, the client reports weakness and leg cramps. In addition to reporting this finding to the health care provider, the nurse will perform which action? a. Ensure the client's potassium level is promptly evaluated. b. Assess whether the client has been consuming high-sodium foods. c. Advocate for a referral to cardiology. d. Have the client begin to record daily intake and output.

a. Ensure the client's potassium level is promptly evaluated. Thiazide diuretics carry a risk for hypokalemia; weakness and confusion are among the symptoms of this electrolyte imbalance so the nurse should ensure that potassium levels are promptly assessed. This does not necessarily indicate a need for a cardiology referral if the health care provider is able to manage this adverse effect. Increased sodium intake would not produce these symptoms. Intake and output capture fluid balance but not potassium status.

A male client is diagnosed with severe hypertension. The health care provider prescribes minoxidil. Three months later, the client presents to the emergency department with angina. The nurse is concerned because minoxidil can have what effect? a. Exacerbate angina and precipitate effusion b. Exacerbate pancreatitis c. Cause rebound hypertension when a dose is missed d. Precipitate cardiovascular accidents

a. Exacerbate angina and precipitate effusion The FDA has issued a black box warning for minoxidil, because the drug can exacerbate angina and precipitate effusion (which can progress to cardiac tamponade).

A male client is excited because it is football season. He has season tickets and attends most games with his friends. At his latest appointment, the client's blood pressure is elevated. What does the nurse suspect is the cause? a. He is consuming excessive salty foods at the games. b. He is anxious about his team. c. He is developing comorbidities. d. He has become a vegetarian until his team wins the championship.

a. He is consuming excessive salty foods at the games. Excessive table salt and salty foods (e.g., ham, packaged sandwich meats, potato chips, dill pickles, most canned soups) may aggravate edema or hypertension.

Which of the following is true with headaches associated with nitrates? Select all that apply: a. Headaches may be a mark of the drug's effectiveness. b. Headaches may be relieved with the use of aspirin or acetaminophen. c. Headaches should decrease with continued therapy. d. Headaches should be avoided by altering the dosage schedule. e. Headaches are a serious adverse reaction and should be reported immediately.

a. Headaches may be a mark of the drug's effectiveness. b. Headaches may be relieved with the use of aspirin or acetaminophen. c. Headaches should decrease with continued therapy. Headaches are a common adverse reaction of nitrates but should decrease with continued therapy. Headache should be reported if they become severe or persist. Headaches may be a marker of the nitrate's effectiveness, and clients should not alter the dosing schedule to avoid headaches. Headaches may be treated with acetaminophen or aspirin.

What is the most common reason for an elevated cholesterol level in a client who does not have a genetic disorder of lipid metabolism? a. His dietary intake of saturated fat b. His alcohol intake c. His waist size d. His sedentary lifestyle

a. His dietary intake of saturated fat Unless a person has a genetic disorder of lipid metabolism, the amount of cholesterol in the blood is strongly related to dietary intake of saturated fat.

The client has been started on an ACE inhibitor for hypertension. The client also takes spironolactone (Aldactone) daily. The nurse would evaluate the client for which of the following? a. Hyperkalemia b. Hypokalemia c. Hypercalcemia d. Hypocalcemia

a. Hyperkalemia When ACE inhibitors are combined with potassium-sparing diuretics, the client is at risk for elevated potassium levels. Therefore, hyperkalemia, not hypokalemia, is the risk. Calcium levels are not affected.

A client who has been taking hydrochlorothiazide arrives at the clinic for his 1-month follow-up appointment. The client tells the nurse that he feels weaker since he began taking the drug. What should the nurse consider as a possible cause of these symptoms? a. Hypokalemia b. Hypercalcemia c. Hyperkalemia d. Hypocalcemia

a. Hypokalemia Thiazides, such as hydrochlorothiazide, are potassium-losing diuretics, and their use can lead to hypokalemia. Symptoms of hypokalemia include muscle weakness, arrhythmia, hypotension, anorexia, and shallow respirations.

The nurse is caring for a client experiencing an acute angina attack. Sublingual nitroglycerin has been administered. The nurse assesses the client's vital signs for which reason? a. Identify hypotension. b. Evaluate for recurrent pain. c. Reassure client that they are okay. d. Confirm report of headache.

a. Identify hypotension. When a client receives sublingual nitroglycerin, the nurse monitors vital signs to identify hypotension. The nurse does not monitor vital signs to identify headache, evaluate for recurrent pain, or to reassure the client that they are okay.

A nurse is caring for a client who is receiving penicillin. The nurse would assess for what common adverse reaction? a. Inflammation of the tongue and mouth b. Sudden loss of consciousness c. Altered oral mucous membranes d. Severe hypotension

a. Inflammation of the tongue and mouth Some of the common adverse effects of penicillin are glossitis (inflammation of the tongue), stomatitis (inflammation of the mouth), and gastritis (inflammation of the stomach). Unless the adverse effects are severe, the drug may be continued as prescribed and the nurse would intervene to help the client manage the common adverse reactions. Altered oral mucous membranes would suggest a possible fungal superinfection in the oral cavity, whereas severe hypotension and sudden loss of consciousness are signs of anaphylactic shock; these are not common adverse effects of penicillin and require immediate medical attention.

A male client who has undergone surgery of the urinary tract is administered cephalosporins to prevent infections. When assessing the client on the day after the surgery, the nurse notices that he has an elevated temperature. Which nursing intervention would be most appropriate in this case? a. Inform the primary health care provider. b. Discontinue use of the drug. c. Record the client's fluid intake. d. Administer a higher dosage of the drug.

a. Inform the primary health care provider. The nurse should immediately report an increase in the client's body temperature to the primary health care provider. The nurse should consult the provider before increasing, decreasing, or discontinuing the dosage. The nurse should measure and record the fluid intake if there is a decrease in the urine output.

After completing several days of penicillin therapy, a client presents with new reports of inflamed oral mucous membranes and tongue and gum swelling. What is a priority action in regards to this new finding? a. Inspect mouth and gums regularly. b. Instruct the client to gargle every 2 hours. c. Offer client a liquid diet. d. Instruct client to avoid brushing teeth.

a. Inspect mouth and gums regularly. The client is presenting with signs of a fungal superinfection. The nurse should regularly inspect the client's mouth and gums to assess the client's progress. The nurse should instruct the client to use a soft-bristled toothbrush. The client does not need to follow a liquid diet; a nonirritating soft diet can be recommended. Gargling every 2 hours may not help relieve the symptoms and may even aggravate the existing condition.

The nurse is preparing to teach a client about the antihyperlipidemic drug which the health care provider has prescribed. Which instruction(s) should the nurse point out during the teaching session? Select all that apply. a. Instruction in possible adverse reactions and signs and symptoms to report to primary health care provider b. Measures to minimize gastrointestinal upset c. Consultation with a dietitian for assistance with diet teaching d. Focus on the importance of taking drug exactly as prescribed e. Emphasis on the fact that drug therapy alone will significantly lower blood cholesterol levels

a. Instruction in possible adverse reactions and signs and symptoms to report to primary health care provider b. Measures to minimize gastrointestinal upset c. Consultation with a dietitian for assistance with diet teaching d. Focus on the importance of taking drug exactly as prescribed Client teaching includes measures to minimize gastrointestinal upset, consultation with a dietician to assist with diet planning and teaching, focus on the need to take the drug exactly as prescribed, and information about possible adverse reactions including those that need to be reported to the primary health care provider. The nurse should emphasize that drug therapy alone will NOT significantly lower blood cholesterol levels, but lifestyle changes may also be necessary such as diet and exercise.

The nurse is administering penicillin to a client who has strep throat. Which of the following statements accurately describe the action of penicillin? a. It is effective against gram-positive organisms b. It is metabolized in the liver c. It is not effective against gram-negative organisms d. It has many side effects, especially in large doses

a. It is effective against gram-positive organisms Penicillin is most effective against gram-positive organisms, such as streptococci, staphylococci, and pneumococci. It is also active against some gram-negative organisms, such as gonococci and meningococci, and against the organisms that cause syphilis. It is relatively free of side effects, even in larger doses, and is excreted rapidly in the urine.

A client has come to the clinic for the past 7 months with elevated blood pressure. The client has now been prescribed three different antihypertensives as well as a diuretic. The nurse knows that what other factors may be contributing to the client's consistent hypertension? (Select all that apply.) a. OTC appetite suppressant b. Herbal supplement c. Walking program d. Nasal decongestant e. Meditation

a. OTC appetite suppressant b. Herbal supplement d. Nasal decongestant Other factors that may contribute to hypertension include the use of nasal decongestants, herbal supplements, and OTC appetite suppressants. Meditation and a walking program may help to decrease or control hypertension.

A nurse is caring for a 66-year-old female client who is receiving digoxin. When preparing to administer a dose, the nurse observes that the client's apical pulse rate is 55 bpm. What is the appropriate action to take? a. Omit the dose and contact the health care provider. b. Give the dose and contact the health care provider. c. Reduce the dose and contact the health care provider. d. Omit the dose and inform the oncoming nurse at the next shift change.

a. Omit the dose and contact the health care provider. Bradycardia is a potential adverse effect of digoxin. Nurses should assess the client's apical pulse before each dose. If the rate is lower than 60 bpm in an adult client, the nurse should omit the dose and notify the provider.

A nurse is conducting a community presentation on heart disease, cholesterol, and risk factors. The nurse determines that the class has been successful when the class correctly chooses which point as true? a. Physical activity raises HDL cholesterol levels. b. Low-fat diet raises LDL cholesterol levels. c. Excess body weight causes LDL cholesterol to go down. d. Being overweight causes HDL levels to go up.

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

A client with hypertension has been prescribed spironolactone. The client's previous diuretic, furosemide, has been discontinued. The nurse should explain what benefit of this change? a. Potassium losses are lower with spironolactone than with furosemide. b. Unlike furosemide, spironolactone can be taken on an outpatient basis. c. The diuretic effect is greater with spironolactone than with furosemide. d. Sodium losses are greater with spironolactone.

a. Potassium losses are lower with spironolactone than with furosemide. Spironolactone is a potassium-sparing diuretic; therefore, it promotes the retention of potassium. Furosemide promotes greater water, sodium, and potassium losses than spironolactone. Both medications can be safely taken on an outpatient basis with adequate follow-up.

A patient is admitted to the cardiology unit of a health care facility for ventricular arrhythmia. In which condition can an anti-arrhythmic drug be safely administered? a. Premature ventricular contraction b. Severe congestive heart failure c. Third-degree heart block d. Aortic stenosis

a. Premature ventricular contraction The patient can be safely administered an anti-arrhythmic drug if the patient has premature ventricular contractions. Aortic stenosis, third-degree heart block, and severe congestive heart failure are contraindications for the use of anti-arrhythmic drugs.

The nurse is leading an educational discussion on childhood hypertension at a local school board meeting. A particular focus of the discussion is the promotion of nonpharmacologic treatment measures. Which of the following is appropriate for managing hypertension in children? Select all that apply. a. Promoting exercise b. Preventing obesity c. Reducing dietary sodium d. Taking a daily multivitamin

a. Promoting exercise b. Preventing obesity c. Reducing dietary sodium Most principles for managing hypertension in adults also apply in children. Prevention of obesity, avoiding excessive sodium intake, and exercise are important nonpharmacologic measures. Multivitamin intake does not have a direct impact on hypertension management.

The nurse is preparing to administer nadolol. Which assessment(s) should the nurse investigate before administering the medication? Select all that apply. a. Pulse rate on both arms b. Pulse rate on one arm c. Blood pressure on one arm d. Blood pressure in the sitting position e. Blood pressure on both arms

a. Pulse rate on both arms d. Blood pressure in the sitting position e. Blood pressure on both arms Preadministration assessment for any antihypertensives should include blood pressure and pulse rate on both arms, not just one, with the client in lying, sitting, and standing positions.

A patient who is prescribed losartan for hypertension has stopped taking the drug immediately after experiencing adverse effects. Which of the following may result when antihypertensives are abruptly discontinued? a. Rebound hypertension b. Breathing difficulty c. Anginal attacks d. Orthostatic hypotension

a. Rebound hypertension Rebound hypertension will occur in patients when antihypertensives are abruptly discontinued. In rebound hypertension, there is a sudden rise in blood pressure when the antihypertensives are withheld. Orthostatic hypotension, anginal attacks, and breathing difficulty are the adverse effects of antihypertensive drug usage and may not occur on stopping the drug

A nurse is administering amiloride to several clients. The nurse should prioritize monitoring the serum potassium levels for clients with which noted disorder(s)? Select all that apply. a. Renal disease b. Diabetes c. Epilepsy d. Asthma e. Hypertension

a. Renal disease b. Diabetes Hyperkalemia may occur with the administration of potassium-sparing diuretics such as amiloride. It is most likely to occur in clients with an inadequate fluid intake and urine output, those with diabetes or renal disease, the elderly, and those who are severely ill. Many diuretics are used in the treatment of hypertension. Acetazolamide a carbonic anhydrase inhibitor can be used in the treatment of epilepsy. Some thiazide diuretics contain tartrazine that may cause an allergic-type reaction or bronchial asthma in clients who have a hypersensitivity to tartrazine.

The nurse is assessing a client with renal disease and discovers the client's blood pressure has increased since the last visit. The nurse suspects the client has developed which concern? a. Secondary hypertension b. Rebound hypertension c. Hypertensive emergency d. Essential hypertension

a. Secondary hypertension In secondary hypertension, there is usually a known cause for the development of hypertension. Renal disease is one of the causes of secondary hypertension. When there is no known cause of hypertension, it is called essential hypertension. Rebound hypertension occurs when a client abruptly stops taking antihypertensive medication. Hypertensive emergency is a high blood pressure state, which has to be lowered immediately.

The nurse is assessing a client and suspects that the client is experiencing a arrhythmia. What client assessments would support this condition? (Select all that apply.) a. Shortness of breath b. Polyuria c. Hypotension d. Mental confusion e. Leg pain

a. Shortness of breath c. Hypotension d. Mental confusion Clients who are experiencing a arrhythmia often experience oliguria, hypotension, mental confusion or syncope, or shortness of breath. Leg pain is not a symptom of arrhythmia.

An elderly client with hypertension is prescribed labetalol. Which instruction(s) should the nurse prioritize giving the client? Select all that apply. a. Sit on the bed for 1 or 2 minutes when rising from a lying position. b. Rise quickly from a chair when moving to a standing position. c. Take the antihypertensive less frequently if hypotension occurs. d. Have someone assist the client if dizziness or weakness occurs. e. Increase salt intake to counteract the hypotension.

a. Sit on the bed for 1 or 2 minutes when rising from a lying position. d. Have someone assist the client if dizziness or weakness occurs. Some antihypertensive medications can cause orthostatic hypotension which can lead to increased risk of falls. The nurse explains that when rising from a lying position, the client should sit on the edge of the bed for 1-2 minutes; the client should rise slowly from a chair and then stand for 1 to 2 minutes; and when symptoms of orthostatic hypotension occur, someone assisting the client in getting out of bed or a chair can decrease the risk of falls due to orthostatic hypotension. The client should not decrease or change the dose without consulting with the health care provider first, as this may cause rebound hypertension. Increased sodium intake will not counteract hypotension but could increase the blood pressure leading to more adverse reactions.

A nurse is caring for a client who has been diagnosed with primary hypertension. What nursing interventions should be included in the teaching plan? Select all that apply. a. Smoking cessation b. Focus on finding a different job c. Diet with more fruits and vegetables d. Decreased alcohol consumption e. Regular aerobic exercise

a. Smoking cessation c. Diet with more fruits and vegetables d. Decreased alcohol consumption e. Regular aerobic exercise Lifestyle management of a client diagnosed with primary hypertension should focus on aerobic exercise, improved diet, weight loss, decreased alcohol consumption, and decreased cigarette smoking. Client education should focus on stress management techniques, and finding a different job is not appropriate at this time.

The client has been prescribed amlodipine for hypertension. The client's blood pressure upon a revisit remains elevated. The nurse inquiries about the use of which alternative therapy? a. St. John's Wort b. Lavender c. Prune juice d. Hawthorn

a. St. John's Wort When taken with a calcium channel blocker, the herb St. John's wort can cause a decrease in serum levels of the calcium channel blocker. Neither hawthorn, lavender, nor prune juice is known to affect serum levels of calcium channel blockers.

What should the nurse tell the client about storage of oral nitroglycerin products? (Select all that apply.) a. Store oral nitroglycerin away from light exposure. b. Store oral nitroglycerin with the container lid tightly sealed. c. Store oral nitroglycerin in the original container. d. Store oral nitroglycerin and other medications in the container. e. Store oral nitroglycerin in a plastic pill box so doses are not missed.

a. Store oral nitroglycerin away from light exposure. b. Store oral nitroglycerin with the container lid tightly sealed. c. Store oral nitroglycerin in the original container. The proper storage of oral nitroglycerin includes keeping tablets and capsules in their original container, never mixing oral nitroglycerin with other drugs in a container, never storing oral nitroglycerin in a plastic container, and always replacing the container tightly and as soon as the drug is removed.

A 34-year-old female client is taking oral cephradine, a first-generation cephalosporin, at regular intervals with a 2-hour gap before meals. The client reports gastrointestinal distress. The nurse will encourage the client to do which? a. Take the drug with food. b. Avoid dairy products c. Change the drug dosage. d. Drink plenty of fluids.

a. Take the drug with food. Oral forms of cephradine are best taken with food to reduce GI distress. Drinking plenty of fluids will help maintain the fluid balance but will not deter cephradine absorption in the body. Altering the drug dosage would not have any effect if the client takes the medication on an empty stomach. The IV route is recommended only if the client cannot retain the oral form of the drug and could not be self-administered.

A 77-year-old man's chronic heart failure is being treated with a regimen of quinapril (Accupril) and furosemide (Lasix). Which of the following assessment findings would suggest that the loop diuretic is contributing to a therapeutic effect? a. The man's chest sounds are clear and his ankle edema is lessened. b. The man's potassium and sodium levels remain with reference ranges. c. The man's heart rate is between 60 and 70 beats per minute with a regular rhythm. d. The man's glomerular filtration rate and creatinine levels are within reference ranges.

a. The man's chest sounds are clear and his ankle edema is lessened. Appropriate diuretic therapy leads to the resolution of pulmonary and peripheral edema. Healthy kidney function, cardiac rhythm, and electrolyte levels are all desirable outcomes, but they are not directly indicative of the therapeutic action of diuretics in the treatment of CHF.

Which statement best reflects information about the renal system? a. The system includes the kidneys and urinary tract. b. Most of the fluid filtered by the kidneys is excreted. c. The system is primarily involved with regulating blood pressure. d. The kidneys consist of two protective layers.

a. The system includes the kidneys and urinary tract. The renal system consists of the kidneys and structures of the urinary tract: ureters, bladder, and urethra. The kidneys have three protective layers. The system has four major functions: maintaining the volume and composition of body fluids, regulating vitamin D activation, regulating blood pressure, and regulating red blood cell production. Most of the fluid that is filtered by the kidneys is returned to the body.

Anti-anginal drugs are used in the treatment of cardiac disease for what purposes? (Select all that apply.) a. Treatment chronic stable angina pectoris. b. Prevent angina attacks. c. Decrease serum triglyceride. d. Relieve the pain of acute anginal attacks. e. Increase high-density lipoproteins (HDL).

a. Treatment chronic stable angina pectoris. b. Prevent angina attacks. d. Relieve the pain of acute anginal attacks. Anti-anginal drugs are used to relieve pain of acute anginal attacks, prevent angina attacks, and treat chronic stable angina pectoris. Antianginals have no effect on HDL or triglycerides.

When a nurse is obtaining a history from a client regarding anginal pain, what information should be included? Select all that apply. a. Whether the pain radiates b. Events that relieve anginal pain c. Events that trigger anginal pain d. Duration of the pain e. Description of the pain

a. Whether the pain radiates b. Events that relieve anginal pain c. Events that trigger anginal pain d. Duration of the pain e. Description of the pain A client history regarding anginal pain should include a description of the pain including onset, duration, intensity, location, whether the pain radiates and to where it radiates, what events appear to trigger the pain, and what events appear to relieve the pain.

Which risk factors increase a client's risk for the development of hypertension? Select all that apply: a. advancing age b. family history c. Caucasian race d. cigarette smoking e. chronic alcohol consumption

a. advancing age b. family history d. cigarette smoking e. chronic alcohol consumption Advancing age, family history, smoking, and chronic alcohol consumption increase a client's risk of developing hypertension. Being Caucasian does not increase a client's risk of developing hypertension, however Black clients are at an increased risk.

A client has recently been prescribed a drug that treats hypertension by blocking the sympathetic receptors in the sympathetic nervous system. This action is characteristic of which? a. an adrenergic antagonist. b. a cardiotonic. c. an adrenergic agonist. d. a neurotransmitter.

a. an adrenergic antagonist. Those drugs that stimulate sympathetic receptors are referred to as adrenergic or dopaminergic agonists (stimulators), and those that block are referred to as adrenergic antagonists (blockers). Adrenergic antagonism is not synonymous with the action of a cardiotonic drug.

A client with a long-standing diagnosis of angina has been prescribed nitroglycerin and diltiazem. In addition to monitoring the client's heart rate, the nurse should prioritize what assessment? a. blood pressure b. daily weights c. respiratory status d. level of consciousness

a. blood pressure Concurrent use of nitrates and diltiazem creates a significant risk for hypotension, so the nurse should assess the client's blood pressure carefully. Changes to LOC, respiratory status, and fluid balance are less likely to result from this particular combination.

A client with a diagnosis of angina has been prescribed nifedipine sustained-release 30 mg orally once per day. Prior to administration, the nurse will perform which assessment? a. blood pressure b. chest auscultation c. oxygen saturation d. pain assessment

a. blood pressure Nifedipine is held if the client displays hypotension. For this reason, blood pressure assessment must be performed prior to administration. Sustained-release tablets are administered without regard to immediate symptoms of angina, so pain assessment is unnecessary. Chest auscultation does not need to be performed because the medication does not influence the respiratory system. The medication is administered without regard to oxygen saturation levels.

A client being treated for hypokalemia has a medication history that includes propranolol, digoxin, and warfarin. When the client reports nausea, abdominal discomfort, and visual changes, the nurse suspects what as the causative factor? a. digitalis toxicity b. myocardial infarction c. heart failure d. acute renal failure

a. digitalis toxicity People diagnosed with hypokalemia can develop digitalis toxicity even when digoxin levels are not considered elevated. Signs of toxicity include potentially life-threatening heart rhythm disturbances, ranging from very slow to rapid ventricular rhythms. Other side effects include nausea, vomiting, loss of appetite, abdominal discomfort, blurred vision, and mental changes. The client's level is unlikely to be considered therapeutic or untherapeutic or to have resulted from an appropriate loading dose.

What drug is a safe and effective calcium channel blocker only if the nurse administers it as a sustained-release or extended-release preparation to treat a client diagnosed with hypertension? a. diltiazem b. aliskiren c. metoprolol d. atenolol

a. diltiazem The calcium channel blockers available in immediate-release and sustained-release forms that are used in treating hypertension include amlodipine, felodipine, isradipine, and nicardipine. Other calcium channel blockers are safe and effective for this use only if they are given as sustained-release or extended-release preparations. These include diltiazem, nifedipine, nisoldipine, and verapamil. Aliskiren is a renin inhibitor. Atenolol and metoprolol are beta-blockers, not calcium channel blockers.

A 49-year-old client reports frequent muscle cramps while on hydrochlorothiazide therapy. The nurse would advise the client to do which? a. eat potassium-rich foods. b. take calcium supplements. c. include high-sodium foods in her diet. d. drink plenty of fluids

a. eat potassium-rich foods. The client is most likely experiencing muscle cramps due to potassium loss. Therefore, the nurse should advise the client to include potassium supplements in the diet. Drinking plenty of fluids or using calcium supplements will not reduce the occurrence of cramps. It is important to caution the client to avoid foods high in sodium because they could counteract the effects of drug therapy.

A client has been prescribed ramipril 5 mg PO daily with the scheduled dose due at 08:00. After reviewing the client's most recent blood work, the nurse should consider withholding the dose because of what laboratory finding? a. elevated potassium levels b. low hemoglobin levels c. elevated neutrophil levels d. low sodium levels

a. elevated potassium levels ACE inhibitors like ramipril carry a risk of hyperkalemia, and an elevated potassium level may warrant withholding the drug. Elevated neutrophils or low sodium and hemoglobin levels would not likely prompt this action.

A client has been prescribed ramipril 5 mg PO daily with the scheduled dose due at 08:00. After reviewing the client's most recent blood work, the nurse should consider withholding the dose because of what laboratory finding? a. elevated potassium levels b. low sodium levels c. low hemoglobin levels d. elevated neutrophil levels

a. elevated potassium levels ACE inhibitors like ramipril carry a risk of hyperkalemia, and an elevated potassium level may warrant withholding the drug. Elevated neutrophils or low sodium and hemoglobin levels would not likely prompt this action.

A client taking atorvastatin presents to the clinic reporting acute muscle pain not associated with exercise or injury. The nurse asks questions to determine if this client has been taking what contraindicated substance? a. grapefruit juice b. ginseng c. ibuprofen d. saw palmetto

a. grapefruit juice Grapefruit juice can decrease the breakdown of atorvastatin, leading to increased serum levels and toxic adverse effects, including rhabdomyolysis. Clients on this drug should be cautioned to avoid drinking grapefruit juice. Ibuprofen, ginseng, and saw palmetto are not associated with increased toxicity.

A health care provider prescribes spironolactone, a potassium-sparing diuretic, for a client with cirrhosis. For which category of clients is the use of potassium-sparing diuretics contraindicated? a. hyperkalemia b. gout c. diabetes d. liver disease

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

An expected outcome for a patient who has just taken sublingual nitroglycerin should be a. increased heart rate and decreased blood pressure. b. decreased heart rate and decreased blood pressure. c. increased heart rate and increased blood pressure. d. decreased heart rate and increased blood pressure.

a. increased heart rate and decreased blood pressure. Nitroglycerin relaxes vascular smooth muscle and dilates both arterial and venous vessels. Dilation of veins is more predominant than dilation of arteries, resulting in peripheral pooling of blood and decreased preload. Blood pressure will usually decrease as a result of the venous dilation. Reflex tachycardia usually follows the drop in blood pressure.

The nurse is preparing to teach a client about diet therapy when beginning bile sequestrant medication to lower lipid levels. What important point will the nurse include in the teaching plan? a. increasing fiber intake b. reducing fluid intake c. increasing carbohydrate intake d. reducing protein intake

a. increasing fiber intake The nurse would want to teach this client to increase fiber intake to avoid constipation that often occurs with this medication. Protein intake does not need to be reduced, but the client should be taught to avoid fatty protein and instead meet protein needs with vegetable proteins, fish, and lean poultry. Carbohydrate intake should be reduced if weight loss is needed, otherwise, no change is needed. Fluid intake should be maintained or increased if there are no diagnoses that would contraindicate fluid intake to help avoid constipation.

The nurse is justified in suspecting that a client who recently completed a course of ceftaroline may have been treated for what health problem? a. methicillin-resistant Staphylococcus aureus (MRSA) infection b. chlamydial infection c. endocarditis d. encephalitis

a. methicillin-resistant Staphylococcus aureus (MRSA) infection Ceftaroline is an IV cephalosporin for the treatment of community-acquired pneumonia and skin infections. It is the first cephalosporin to be considered active against resistant gram-positive organisms, such as MRSA. This drug is not indicated in the treatment of chlamydial infections, endocarditis, or encephalitis.

A client recently began taking lovastatin. The nurse should assess the client for what potential adverse effects? a. nausea, flatulence, and constipation b. hiccoughs, sinus congestion, and dizziness c. confusion and mental disorientation d. increased appetite and blood pressure

a. nausea, flatulence, and constipation GI problems such as nausea, vomiting, flatulence, constipation, or diarrhea can occur with lovastatin. Increased appetite is not associated with lovastatin, but clients may think that taking this drug means they can now eat anything they want and this would indicate the need for further teaching. Confusion and mental disorientation are not associated with this drug. Hiccoughs, sinus congestion, and dizziness would require exploration for cause because they are not normally associated with lovastatin therapy.

A 13-year-old male patient has been prescribed oral cefuroxime. The patient's parents should ensure that he takes the medication a. with food. b. immediately upon awakening. c. between meals. d. on an empty stomach.

a. with food. Oral cefuroxime should be taken with food to decrease nausea and vomiting.

The nurse is teaching a 62-year-old client about hydrochlorothiazide, which the health care provider has prescribed for treatment of hypertension. What statement, made by the client, suggests that the client understands the teaching? a. "I must take my medication on an empty stomach." b. "I will need to stand slowly." c. "I can jump right into action!" d. "I will need to make sure that I am consuming enough sodium."

b. "I will need to stand slowly." Diuretics, including hydrochlorothiazide, can cause orthostatic hypotension. Rising slowly to a standing position can reduce the risk of falls. Patients taking diuretics should restrict sodium intake to avoid the need for higher doses, which increase the likelihood of adverse effects. Taking diuretics with food can help avoid the GI irritation frequently associated with these drugs.

A nurse is giving discharge instructions to a client receiving nitroglycerin for angina. The nurse recognizes the client needs additional information when the client makes what statement? a. "Before I take my medication, I will lie down." b. "I will take a pill every 15 minutes until the pain subsides." c. "I may get a headache after I take this medication." d. "I will keep my medication in the original container."

b. "I will take a pill every 15 minutes until the pain subsides." When experiencing angina, the client may take one pill every five minutes times three doses. Nitroglycerin needs to be stored in its original dark container and may cause a headache. It is important the client lie down prior to taking nitroglycerin because it may cause hypotension.

A client with kidney disease asks why there is blood in the urine. Which process will the nurse explain to the client? a. "Epithelial cells in the renal tubule are permitting blood to enter the urine." b. "The glomerulus in the kidney is scarred or damaged, permitting blood cells to escape in the urine." c. "Glands that sit on the kidneys are releasing hormones that promote blood to be in the urine." d. "The fluid transport system in the kidney is malfunctioning."

b. "The glomerulus in the kidney is scarred or damaged, permitting blood cells to escape in the urine." The glomerulus acts as an ultrafine filter for all of the blood that flows into it. The semipermeable membrane keeps blood cells, proteins, and lipids inside the vessel, while hydrostatic pressure from the blood pushes water and smaller components of the plasma into the tubule. Scarring or swelling of or damage to the semipermeable membrane leads to the escape of larger plasma components, such as blood cells, into the filtrate. The large size of these components prevents them from being reabsorbed by the tubule, and they are lost in the urine. Thus, a clinical sign of renal damage is the presence of blood cells or protein in the urine. Blood in the urine does not indicate a malfunction in the fluid transport system in the kidney. The epithelial cells in the renal tubule remove electrolytes, drugs and drug metabolites, and uric acid and secrete them into the filtrate. Hormones from the glands that sit on the kidneys do not promote blood to be in the urine.

The nurse is assessing a client with hypertension who was prescribed the calcium channel blocker diltiazem. Which question would the nurse ask when the client's blood pressure has not improved after 2 weeks of taking the medication? a. "Do you drink grapefruit juice with breakfast?" b. "When did you take the last dose of the medication?" c. "Are you having any problems driving?" d. "How many meals do you eat each day?"

b. "When did you take the last dose of the medication?" Diltiazem is a calcium channel blocker used to treat hypertension, cardiac workload, and myocardial oxygen consumption. There are side effects of this medication that may cause a client to stop taking it. Because the client was prescribed the medication and is having a follow-up 2 weeks later, a lack of change in the blood pressure could indicate that the client either stopped or decided to not take the medication. This is what the nurse needs to assess first. Problems with operating machinery might occur when first taking the medication. The medication may alter the taste and could affect the client's usual eating pattern. Ingesting grapefruit juice with a calcium channel blocker would cause toxic effects.

What is the nurse's priority assessment question before administering an angiotensin II-receptor blocker (ARB) to a female client? a. "Have you ever been pregnant?" b. "When was your last menstrual period (LMP)?" c. "Have you ever been diagnosed with a sexually transmitted infection (STI)?" d. "Do you have regular mammograms?"

b. "When was your last menstrual period (LMP)?" It would be important to know when the client's LMP occurred and that the client was not pregnant. These drugs can cause fetal abnormalities and fetal death. The other questions are appropriate and would help the nurse plan care for the client; however, it would not be as important as assessing for the possibility of pregnancy before beginning therapy. The nurse should teach the client the need to avoid pregnancy using a barrier contraceptive.

The amount of fluid excreted as urine each day averages approximately less than how many liters? a. 1 L b. 2 L c. 3 L d. 4 L

b. 2 L Approximately 1% of the filtrate or less than 2 L of fluid is excreted each day in the form of urine.

A nurse is assessing the serum digoxin level of a client who is receiving treatment for atrial fibrillation. Which result should the nurse prioritize and report to the primary health care provider? a. 1.6 ng/mL b. 2.2 ng/mL c. 2.0 ng/mL d. 1.8 ng/mL

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

You are monitoring serum electrolyte levels in a 55-year-old patient who has been prescribed digoxin and a potassium-sparing diuretic for treatment of heart failure. Which of the following potassium levels would you hope to see for this patient? a. 2.5 mEq/L b. 4.0 mEq/L c. 6.0 mEq/L d. 3.0 mEq/L

b. 4.0 mEq/L One goal of treatment is to maintain normal serum potassium levels, which are between 3.5 mEq/L and 5.0 mEq/L. Levels below or above that range are indicative of hypokalemia or hyperkalemia, respectively.

A client with hypertension has been started on losartan, an angiotensin II receptor blocker (ARB). After 6 weeks of therapy, the health care provider concludes that losartan alone is not controlling the hypertension. What would the health care provider likely add to the regimen to better control the client's hypertension? a. A vasopressor b. A diuretic c. Another ARB d. An ACE inhibitor

b. A diuretic When losartan therapy is started, maximal effects on blood pressure usually occur within 3 to 6 weeks. If losartan alone does not control blood pressure, a low dose of a diuretic may be added. A combination product of losartan and hydrochlorothiazide is available. The addition of an ACE inhibitor, a vasopressor or another ARB is not appropriate.

A 75-year-old client is being treated for type 2 diabetes, hypertension, gout, angina, coronary artery disease, and peptic ulcer disease. The nurse is concerned because the client is taking a traditional antianginal drug in combination with seven other medications. The nurse understands that what could be the consequence? a. Decreased effectiveness of the antihypertensive b. A greater incidence of adverse drug effects c. A greater incidence of hyperglycemic episodes d. Decreased effectiveness of the antianginal drug

b. A greater incidence of adverse drug effects Traditional antianginal drugs that act via hemodynamic mechanisms (e.g., beta-blockers, calcium antagonists, nitrates) can pose a problem in older adults because of the associated higher risk of drug interactions and greater incidence of adverse drug effects.

In a discussion of heart failure, the nursing instructor is explaining preload and afterload. Which of the following statements regarding preload and afterload is accurate? a. Preload is related to the ejection of blood from the ventricle, and afterload is related to the filling of the ventricle. b. Afterload is related to the ejection of blood from the ventricle, and preload is related to the filling of the ventricle. c. Preload is related to the filling of the right ventricle, and afterload is related to the filling of the left ventricle. d. Preload is related to the filling of the left ventricle, and afterload is related to the filling of the right ventricle.

b. Afterload is related to the ejection of blood from the ventricle, and preload is related to the filling of the ventricle. Preload is the filling pressure of the ventricle. Afterload is the pressure associated with the ejection of blood from the ventricle.

The nurse has administered torsemide to a client. Which finding(s) on the ongoing assessment should the nurse prioritize? Select all that apply. a. Hypoglycemia b. Anorexia c. Drowsiness d. Depression e. Diarrhea

b. Anorexia c. Drowsiness d. Depression The following are signs of hypokalemia: anorexia, nausea, vomiting, depression, confusion, cardiac arrhythmias, impaired thought process, and drowsiness. Diarrhea is a possible adverse reaction but not an indication of hypokalemia. Hyperglycemia is more of a concern with the use of diuretics than hypoglycemia.

A client diagnosed with angina has been prescribed nifedipine 15 mg PO three times a day. The client has received the first two doses of the medication and reports dizziness. What is the nurse's best action? a. Report this finding to the client's primary health care provider. b. Assess the client's blood pressure. c. Withhold the next scheduled dose and implement falls precautions. d. Reassure the client that this is an expected adverse effect.

b. Assess the client's blood pressure. If a client reports dizziness after beginning treatment with a calcium channel blocker, hypotension is a likely cause. The nurse should obtain objective data by assessing the client's blood pressure before taking further action. The nurse should not independently withhold the drug. The nurse should assess the client before providing reassurance. There may be no need to report this to the provider if it is transient.

What is the most accurate method for preventing adverse effects associated with the use of digoxin? a. Monitor therapeutic effects based on echocardiogram results. b. Assess the client's heart rate and hold administration if it is less than 60. c. Teach clients the signs and symptoms of heart failure. d. Teach clients to take their digoxin in divided doses with each meal.

b. Assess the client's heart rate and hold administration if it is less than 60. Clients should be taught to hold their digoxin if their heart rate is less than 60 (or some other defined heart rate). Divided doses are not normally used and an awareness of heart failure does not preclude adverse effects of digoxin.

Mr. Zee is being discharged home after treatment for a myocardial infarction. During the hospital stay he was also diagnosed with uncomplicated diabetes mellitus type 2 and hypertension. The health care provider has prescribed several new drugs, one of which is captopril. What instruction is important to include in the teaching plan regarding captopril administration? a. Avoid dairy products. b. Avoid potassium supplements. c. Discontinue drug if persistent dry cough occurs. d. Implement a low-carbohydrate diet as part of your weight loss program.

b. Avoid potassium supplements. The nurse needs to explain to the client that the drug may produce a persistent dry cough, but that it is not serious. Poor oral intake and decreased sodium intake may predispose the client to the adverse effects of captopril. If the client normally uses a salt substitute containing potassium or potassium supplements, these substances may need to be discontinued to avoid possible hyperkalemia. Also, the nurse needs to advise the client to explore lifestyle changes intended to decrease blood pressure, such as weight loss, smoking cessation, increased exercise, and limited salt intake. The client need not avoid dairy products because these have no implications on the therapy.

Where is the majority of potassium that is filtered at the glomerulus reabsorbed? a. Distal convoluted tubule b. Bowman's capsule c. Descending loop of Henle d. Ascending loop of Henle

b. Bowman's capsule About 65% of the potassium that is filtered at the glomerulus is reabsorbed at Bowman's capsule and the proximal convoluted tubule. Another 25% to 30% is reabsorbed in the ascending loop of Henle.

A client with asthma has been prescribed a beta-blocker for management of angina. For what adverse reaction should the nurse observe? a. Pleural effusion b. Bronchospasm c. Pneumonia d. Hypoglycemia

b. Bronchospasm When taking beta blockers, patients with asthma should be observed for bronchospasm from blockage of beta2 receptors in the lung.

The nurse is scheduled to administer the following medications at 0900: furosemide, carvedilol, and ivabradine. The morning laboratory values are: sodium 135 mEq/L; potassium 3.2 mEq/L; calcium 9 mg/dl (9 to 11 mg/dl). Which is the nurse's priority in this situation? a. Administer the ordered medications per policy. b. Call the primary care provider for further orders. c. Perform the morning assessment and chart findings. d. Teach the client about the current medications.

b. Call the primary care provider for further orders. The priority in the situation is to call the primary care provider (PCP) and report the abnormal lab, hypokalemia, 3.2 mEq/L (K+ 3.5 - 5.1 mEq/L) and receive further orders for potassium supplement since the client is taking furosemide, a loop diuretic that depletes potassium. When the potassium is low, it can lead to cardiotonic toxicity, and the client is taking ivabradine. The pharmacy may receive the order and fill it while the nurse assesses the client and charts the findings. The nurse receives the potassium supplement from pharmacy and may administer it with the rest of the medications following the policy for safe administration of meds. The potassium needs to be administered with the medications to keep from further decreasing the potassium level. The nurse could begin teaching about the medications during the administration process, instructing the client about the name of the med, the action, and adverse reactions to report to the PCP.

Beta-lactam antibiotics, such as penicillins and cephalosporins, fight infection by inhibiting development of the causative bacteria. What specific component development do these drugs affect? a. Cell division b. Cell wall synthesis c. Protein synthesis d. DNA replication

b. Cell wall synthesis Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. This binding produces a defective cell wall that allows intracellular contents to leak out. These do no affect DNA replication or cell division.

A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to help to promote compliance? a. Constipation b. Cough c. GI irritation d. Photosensitivity

b. Cough Fosinopril is associated with an unrelenting cough that can lead clients to discontinue the drug. Constipation is an adverse effect of ACE inhibitors, but would not necessarily lead a client to discontinue the drug. GI irritation is an adverse effect of ACE inhibitors, but would not necessarily lead a client to discontinue the drug. Photosensitivity is an adverse effect of ACE inhibitors, but would not necessarily lead a client to discontinue the drug.

While the nurse is obtaining a drug history from a client, the client states an allergy to penicillin and an experience of a rash after taking cephalosporin. The nurse interprets this information as indicating which situation? a. Hypersensitivity b. Cross-sensitivity c. Anaphylactoid reaction d. Anaphylaxis

b. Cross-sensitivity Once an individual is allergic to one penicillin, they are usually allergic to all of the penicillins. Those allergic to penicillin also have a higher incidence of allergy to the cephalosporins. Allergy to drugs in the same or related groups is called cross-sensitivity. Hypersensitivity is an allergic reaction to one substance. Anaphylactoid reaction is an unusual or exaggerated allergic reaction. Anaphylaxis or anaphylactic shock is a severe form of hypersensitivity that occurs immediately and can be fatal.

A male client takes cholesterol absorption inhibitors as a monotherapy without statins. He develops mild hepatic insufficiency. What would the nurse expect the health care provider to do? a. Maintain the current dosage of his medication b. Decrease the dosage of his medication c. Increase the dosage of his medication d. Discontinue his medication

b. Decrease the dosage of his medication Cholesterol absorption inhibitors as monotherapy (without statins) require dosage reduction in clients with mild hepatic impairment.

Which of the following best reflects the action of ezetimibe? a. Binds with bile acids to form an insoluble complex for excretion b. Decreases the absorption of dietary cholesterol from the small intestine c. Stimulates the breakdown of lipoproteins from tissues d. Blocks the enzyme involved in cholesterol synthesis

b. Decreases the absorption of dietary cholesterol from the small intestine Ezetimibe is a cholesterol absorption inhibitor that works in the brush border of the small intestine to decrease absorption of dietary cholesterol from the small intestine. HMG-CoA reductase inhibitors block the enzyme involved in cholesterol synthesis. Bile acid sequestrants block bile acids to form insoluble complexes for excretion in the feces. Fibrates stimulate the breakdown of lipoproteins from the tissues and their removal from the plasma.

A client has been prescribed an adrenergic blocking drug for glaucoma. Which nursing interventions should the nurse include when teaching the client? a. Inform the client about eye drop preservation. b. Demonstrate the technique of eye drop instillation. c. Demonstrate the method of cleaning eyes. d. Suggest the client protect their eyes from exposure to sunlight.

b. Demonstrate the technique of eye drop instillation. The nurse should demonstrate the technique of eye drop installation while educating the client with glaucoma. Demonstrating the method of cleaning eyes, suggesting the client protect their eyes from exposure to sunlight, and informing the client about eye drop preservation are not related nursing interventions when teaching the client about the use of an adrenergic blocker for glaucoma.

When sodium gates open along the cardiac cell membrane and sodium rushes into the cell it results in the membrane no longer having a positive or negative side but being electrically the same on both sides. The nurse recognizes this period of the cardiac cycle as what? a. Polarity b. Depolarization c. Action potential d. Repolarization

b. Depolarization Phase 0 occurs when the cell reaches a point of stimulation. The sodium gates open along the cell membrane, and sodium rushes into the cell, resulting in a positive flow of electrons into the cell—an electrical potential. This is called depolarization. The membrane no longer has a positive side or pole and a negative side; instead it is depolarized, or, in other words, electrically the same on both sides. During depolarization, the cells cannot be forced to contract. Repolarization is when the sodium returns to the outside of the cell and potassium returns to the inside of the cell and the muscle is ready to contract again. Action potential is the ability of the heart to respond to an electrical stimulus. Polarity is the electrical charge.

A client with heart failure has been prescribed sacubitril/valsartan. Before administering the first dose, the nurse will perform which action? a. Confirm the date of the client's most recent COVID-19 vaccination. b. Determine whether the client has recently taken an ACE inhibitor. c. Identify whether the client has had a bowel movement within the past 24 hours. d. Assess the client's blood glucose level.

b. Determine whether the client has recently taken an ACE inhibitor. When switching from an ACE inhibitor to sacubitril/valsartan, there should be a "washout" period of 36 hours between administration of the two drugs to reduce the risk of angioedema. For this reason, it is appropriate to confirm the client has not recently taken an ACE inhibitor. Assessments related to glucose levels, vaccinations, or bowel movements are not high priorities.

Diuretics increase the production and output of urine. Which statement helps explain how diuretics achieve these effects? a. Diuretics have no effect on reabsorption. b. Diuretics reduce the reabsorption of water in the kidneys. c. Diuretics increase production of nephrons. d. Diuretics increase the reabsorption of electrolytes in the kidneys.

b. Diuretics reduce the reabsorption of water in the kidneys. Diuretics increase urine production and output by reducing the reabsorption of water and electrolytes in the kidneys.

When explaining the underlying mechanisms associated with renal failure, which would be most important for the nurse to keep in mind? a. Renal failure typically involves some injury to the protective layers of the kidneys. b. Extensive kidney damage has usually occurred by the time the patient is symptomatic. c. Manifestations occur when a small number of nephrons become nonfunctional. d. Nephron damage is not associated with the development of signs and symptoms.

b. Extensive kidney damage has usually occurred by the time the patient is symptomatic. It is estimated that only about 25% of the total number of nephrons are necessary to maintain healthy renal function. That means that the renal system is well protected from failure with a large backup system. However, it also means that by the time a patient manifests signs and symptoms suggesting failure of the kidneys, extensive kidney damage has already occurred.

A patient has been advised to use a transdermal patch of clonidine for hypertension. For which of the following time periods should the nurse ensure that the patch is intact? a. For four weeks b. For one week c. For two weeks d. For three weeks

b. For one week The nurse should ensure that the transdermal patch is intact for a period of one week. A clonidine transdermal patch should be applied to a hairless area over the torso for one week. If the patch loosens before seven days, it has to be reinforced. The nurse has to mark the date of placement and the date of removal of the patch on the surface of the patch.

Penicillins are more effective when used on infections caused by what organism? a. Gram-negative bacteria b. Gram-positive bacteria c. Gram-negative viruses d. Fungi

b. Gram-positive bacteria Clinical indications for use of penicillins include bacterial infections caused by susceptible microorganisms. As a class, penicillins usually are more effective in infections caused by gram-positive bacteria than those caused by gram-negative bacteria. However, their clinical uses vary significantly according to the subgroup or individual drug and microbial patterns of resistance. Penicillins are not used to treat viral or fungal infections.

The nurse assesses the client for which of the following adverse reactions related to the use of digoxin? a. Hypermagnesemia b. Hypokalemia c. Angina d. Tachycardia

b. Hypokalemia Heart failure is caused by the heart's inability to adequately pump blood throughout the body. Digoxin increases the force of the contraction and slows the conduction, thereby increasing renal function. As renal function improves, diuresis occurs and the client may experience hypokalemia and hypomagnesemia.

A client has been prescribed IV amiodarone for emergency treatment of a serious ventricular arrhythmia. The nurse monitors the client's ECG anticipating a noted change how long after the medication is delivered? a. 2-3 days b. Immediately c. 90 minutes d. 10 minutes

b. Immediately The onset of IV amiodarone is immediate with the peak occurring in 20 minutes and a duration of 6-8 hours.

A nursing instructor is teaching a group of students about cardiotonics. The instructor determines the session is successful when the students correctly identify which as an action(s) of the cardiotonics? Select all that apply. a. Increases peripheral edema b. Improves myocardial contractility c. Increases blood pressure d. Improves profusion to all body tissues e. Increases myocardial efficiency

b. Improves myocardial contractility d. Improves profusion to all body tissues e. Increases myocardial efficiency Cardiotonics are drugs used to increase the efficiency and improve the contraction of the heart muscle, which leads to improved blood flow to all tissues of the body. An increased blood pressure and peripheral edema may be contributing causes for the need of cardiotonics.

The nurse understands that bacterial resistance can result when certain bacteria produce penicillinase. What does penicillinase do? a. Prevents the release of penicillin-binding proteins b. Inactivates penicillin c. Triggers the release of penicillin-binding proteins d. Activates penicillin

b. Inactivates penicillin One example of bacterial resistance is the ability of certain bacteria to produce penicillinase, an enzyme that inactivates penicillin. The penicillinase-resistant penicillins were developed to combat this problem. They have nothing to do with penicillin-binding proteins.

The nurse is administering quinidine to a client who is also taking digoxin. The nurse will assess this client for which important adverse effect? a. Decreased white blood cell count b. Increased digoxin level c. Increased anticoagulant effects d. Decreased red blood cell count

b. Increased digoxin level The nurse would assess this client for digoxin toxicity because quinidine and digoxin interact, leading to an increased digoxin level.

A client presents to the emergency department with signs and symptoms of acute congestive heart failure. Assessment findings and tests confirm the diagnosis. Which type of diuretic would be the drug of choice to treat the client? a. Calcium wasting b. Loop c. Potassium sparing d. Thiazide

b. Loop For acute HF, the first drugs of choice may include an IV loop diuretic, a cardiotonic-inotropic agent (e.g., digoxin, dobutamine, milrinone), and vasodilators (e.g., nitroglycerin and hydralazine or nitroprusside).

A group of students are reviewing the various antihypertensive agents. The students demonstrate understanding of the information when they identify what as an example of an angiotensin II receptor blocker? a. Moexipril b. Losartan c. Amlodipine d. Minoxidil

b. Losartan Losartan is an example of an angiotensin II receptor blocker. Moexipril is an ACE inhibitor. Minoxidil is a vasodilator. Amlodipine is a calcium channel blocker.

An older adult is to receive a low dose of a cephalosporin for an infection. When realizing that this client has age-related diminished renal function, what intervention should the nurse implement? a. Hold the drug for lab work. b. Monitor blood creatinine levels. c. Notify the prescribing provider. d. Initiate monitoring of intake and output.

b. Monitor blood creatinine levels. The older adult is more susceptible to the nephrotoxic effects of the cephalosporins, particularly if renal function is already diminished because of the aging process or a disease. With renal impairment, a lower dose can be given and monitoring creatinine levels is indicated. Refusing to give the drug is not necessary nor is immediately notifying the prescriber. Monitoring intake and output will not effectively monitor of nephrotoxicity.

The nurse is preparing to administer digoxin to a 9-month-old infant. What must the nurse do prior to administration of this medication? a. Monitor the infant's respiratory rate b. Monitor the infant's apical pulse c. Monitor the infant's blood pressure d. Monitor the infant's temperature

b. Monitor the infant's apical pulse The nurse must assess the client's apical pulse before administering digoxin because it has a narrow therapeutic index and can cause the heart rate to go too low, so the nurse takes the apical pulse and holds the medication if it is below a certain level (depending upon age of the client.)

Which of the following should a nurse carefully monitor in a patient who has been administered cephalosporin as well as aminoglycosides for a wound infection? a. Nausea b. Nephrotoxicity c. Respiratory difficulty d. Increased bleeding

b. Nephrotoxicity When cephalosporin is administered with aminoglycosides, it increases the risk for nephrotoxicity and should be closely monitored. Nausea is an adverse reaction of cephalosporins in patients with gastrointestinal tract infection. The risk of bleeding increases when cephalosporin is administered with oral anticoagulants. Risk for respiratory difficulty increases if alcohol is consumed within 72 hours after certain cephalosporin administration.

A nurse in a health care facility is caring for patients receiving the bile acid sequestrant colesevelam. In which category of patients is colesevelam administered with caution? a. Patients with diabetes b. Patients with liver disease c. Patients with unstable angina d. Patients with peptic ulcer disease

b. Patients with liver disease Colesevelam is administered with caution in patients with liver disease. Fibric acid derivatives are administered with caution in patients with peptic ulcer disease and diabetes. Niacin is used with caution in patients with unstable angina.

Which would a nurse expect to assess if a client is experiencing right-sided heart failure? a. Wheezing b. Peripheral edema c. Hemoptysis d. Dyspnea

b. Peripheral edema Peripheral edema would be noted in clients with right-sided heart failure. Wheezing, hemoptysis, and dyspnea would suggest left-sided heart failure.

A client is prescribed aliskiren. The nurse would monitor the laboratory test results of which electrolyte closely? a. Magnesium b. Potassium c. Sodium d. Chloride

b. Potassium Aliskiren is associated with hyperkalemia. Therefore, the nurse would need to closely monitor potassium levels. Diuretics can lead to hyponatremia, hypomagnesemia, and hypokalemia.

The health care provider has prescribed fenofibrate for a client discovered to have very high serum triglyceride levels. The nurse should question this order if the client has a history of which additional disorder? a. Endocrine disorder b. Primary biliary cirrhosis c. Respiratory depression d. Arterial bleeding

b. Primary biliary cirrhosis The fibric acid derivative fenofibrate is contraindicated in clients with primary biliary cirrhosis. The HMG-CoA reductase inhibitors are used with caution in clients with a history of endocrine disorders. Niacin is contraindicated in clients with arterial bleeding. Respiratory depression is a potential adverse reaction to fenofibrate.

A client on antiarrhythmic drug therapy reports nausea, vomiting, abdominal pain, diarrhea, and a ringing sensation in the ears. Which drug should the nurse investigate first to determine possible cause? a. Lidocaine b. Quinidine c. Flecainide d. Procainamide

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

Which condition would least likely contribute to the development of heart failure? a. Coronary artery disease b. Renal failure c. Hypertension d. Valvular disease

b. Renal failure Renal failure would be least likely to contribute to the development of heart failure. Coronary artery disease, valvular disease, hypertension, and cardiomyopathy are commonly associated with heart failure.

The client presents for a routine clink visit to evaluate the long-term use of cholestyramine. The health care provider determines vitamin A and D should be prescribed at this time. The nurse determines which nursing diagnose is most appropriate at this time? a. Constipation b. Risk for imbalanced nutrition: less than body requirements c. Risk for impaired skin integrity d. Risk for injury

b. Risk for imbalanced nutrition: less than body requirements Bile acid resins may interfere with the digestion of fats and prevent the absorption of the fat-soluble vitamins (vitamins A, D, E, and K) and folic acid. Therefore, the nursing diagnosis of risk for imbalanced nutrition: less than body requirements would be most appropriate. Adverse reactions associated with nicotinic acid such as flushing would suggest a risk for impaired skin integrity. Constipation would be associated with statin therapy. Risk for injury may be appropriate for clients taking fibrates or statins.

A client with chronic alcoholism has been admitted to the health care center for acute angina management and is started on nitrates. The nurse emphasizes the need for the client to avoid alcohol use to prevent which reaction? a. Decreased effectiveness of nitrates b. Severe hypotension c. Increased hypersensitivity reactions d. Increased risk of hypoglycemia

b. Severe hypotension The nurse should inform the client that severe hypotension and cardiovascular collapse may occur due to the drug interaction between alcohol and nitrates. Nitrates given for treating angina interact with alcohol and cause severe hypotension. Increased risk of hypoglycemia, increased hypersensitivity reactions, and decreased effectiveness of nitrates do not result from the interaction of nitrates and alcohol.

The nurse administering a Class I antiarrhythmic drug understands that the action of this drug is to: a. Indirectly block calcium channels b. Stabilize or anesthetize the membranes of cardiac cells c. Depress depolarization and lengthen repolarization d. Prolong repolarization

b. Stabilize or anesthetize the membranes of cardiac cells Class I antiarrhythmics (sodium channel blockers) stabilize or anesthetize the membranes of cardiac cells. Class II antiarrhythmics (beta-adrenergic blockers) indirectly block calcium channels. Class III antiarrhythmics (potassium channel blockers) prolong repolarization. Class IV antiarrhythmics (calcium channel blockers) depress depolarization and lengthen repolarization.

The client with hypertension, who has been prescribed aliskiren, reports to the clinic not feeling well. Which assessment(s) finding should the nurse prioritize? Select all that apply. a. Fever greater than 100°F b. Swelling of the face c. Heart rate above 100 beats per minute d. Blood pressure above 170/100 mm Hg e. Swelling of the throat

b. Swelling of the face e. Swelling of the throat An adverse reaction to aliskiren is angiedema. Angiedema presents with swelling of the face, lips, throat, or extremities. The client should immediately call the health care provider to report the symptoms and get instructions regarding treatment. The increased heart rate, fever, and elevated blood pressure would be related to other sources and would also need to be investigated and treated appropriately; however, they are not indications of angiedema.

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

b. Take the drug regularly without skipping a dose. The nurse should instruct the patient to take the drug regularly without skipping a dose. The patient should consult the provider before discontinuing the drug. Taking the drug with high-fiber meals will decrease the absorption of the drug. The patient should be advised to report to the center if the pulse is less than 60 bpm. Antacids should not be taken as it alters the plasma digoxin levels.

What sequence describes the flow of electrical impulses in the heart? a. The atrioventricular node, sinoatrial (SA) node, bundle of His, right and left bundle branches, and Purkinje fibers. b. The Sinoatrial node, the atrioventricular node, bundle of His, right and left bundle branches, and the Purkinje fibers. c. The Sinoatrial node, the Purkinje fibers, bundle of His, right and left bundle branches, and the atrioventricular node. d. The bundle of His, atrioventricular node, sinoatrial (SA) node, right and left bundle branches, and Purkinje fibers.

b. The Sinoatrial node, the atrioventricular node, bundle of His, right and left bundle branches, and the Purkinje fibers. The heart contains special cells that can carry electrical impulses much more rapidly than ordinary muscle fibers. This special conduction system consists of the sinoatrial (SA) node, the atrioventricular node, bundle of His, right and left bundle branches, and Purkinje fibers. The electrical current flows over the heart in an orderly way to produce contraction of both atria, then both ventricles.

Mrs. Houston is a 78-year-old woman who resides in an assisted living facility. Her provider prescribed digoxin at her last visit to the clinic and she has approached the nurse about this new drug. What teaching point should the nurse emphasize to Mrs. Houston? a. The correct technique for using a home blood pressure cuff b. The importance of having required laboratory work performed on time c. The need to take the medication at the same time each day regardless of her heart rate d. Timing household activities to coincide with the administration times of her digoxin

b. The importance of having required laboratory work performed on time Clients taking digoxin need to know the importance of having all laboratory work (serum drug levels; electrolytes) performed on time. Digoxin is not taken if the client is bradycardic, and it does not provide an immediate or short-term increase in exercise tolerance. Blood pressure monitoring is not normally required for clients who are taking digoxin.

A client is questioning the new prescription for a statin. The nurse should point out the statin will reduce the risk of which disorder(s) for the client? Select all that apply. a. Cancer b. Transient ischemic attack c. Kidney disease d. Hepatic disease e. Stroke

b. Transient ischemic attack e. Stroke The use of statins in clients with hyperlipidemia with or without clinically evident coronary heart disease can reduce the risk of death from stroke and transient ischemic attacks. Individuals with kidney disease should use bile acid resin antihyperlipidemic drugs cautiously. Statins are contraindicated in individuals with severe hepatic disease. Whether a client with cancer could use a statin would depend on the location of the cancer and would be decided on a case-by-case manner.

After teaching a group of students about metabolic syndrome, the instructor determines that the teaching was successful when the students identify which characteristic? a. Fasting blood glucose below 110 mg/dL b. Triglyceride level above 150 mg/dL c. Blood pressure below 130/85 mm Hg d. Waist measurement over 35 inches in men

b. Triglyceride level above 150 mg/dL Characteristics of metabolic syndrome include fasting blood glucose levels greater than 110 mg/dL, waist measurement over 40 inches in men and over 35 inches in women, triglyceride levels greater than 150 mg/dL or HDL levels less than 40 mg/dL in men or less than 50 mg/dL in women, blood pressure greater than 130/85 mm Hg, increased macrophages, levels of interleukin-6 and TNF, and increased plasminogen activator levels.

The nurse evaluates an improvement in the client's heart failure (HF) status based on what assessment finding a. Heart rate regular b. Using fewer pillows to sleep c. Improved mental status d. Increased skin turgor

b. Using fewer pillows to sleep The degree of HF is often calculated by the number of pillows required to get relief (e.g., one-pillow, two-pillow, or three-pillow orthopnea). Fluid overload is associated with HF so skin turgor is not an indicator of improvement. Regular heart rate and normal cognition can be found with acute flare-ups of HF so these findings would not indicate improvement.

The nurse is reviewing the medication regimen of a newly admitted client. The client currently takes dofetilide 250 mcg PO twice a day. This client's health history likely includes what diagnosis? a. ischemic heart disease b. atrial fibrillation c. hypertensive crisis d. ventricular tachycardia

b. atrial fibrillation Dofetilide is indicated for conversion of atrial fibrillation or flutter to normal sinus rhythm and for maintenance of normal sinus rhythm after conversion for adults. It is not used for long-term treatment after ventricular tachycardia, hypertensive crisis, or ischemic heart disease.

A client is receiving digoxin and experiences severe bradycardia. Which medication would the nurse anticipate administering if prescribed? a. activated charcoal b. atropine c. milrinone (Primacor) d. propafenone

b. atropine If severe bradycardia occurs, atropine may be ordered. Milrinone is a miscellaneous inotropic drug used to treat heart failure. Activated charcoal is an antidote for poisoning with certain toxic substances, but not digoxin. It also decreases serum digitalis levels. Propafenone increases serum digitalis levels and would not be used.

The health care provider is selecting an antibiotic for a client with a known penicillin allergy. The provider knows that cephalosporins are a poor choice for this client because cephalosporins: a. can cause kidney damage in clients who are allergic to penicillins. b. can cause allergic reactions in clients who are allergic to penicillins. c. are ineffective in clients who are allergic to penicillins. d. are derived from penicillin.

b. can cause allergic reactions in clients who are allergic to penicillins. Clients who are allergic to penicillins may also be allergic to cephalosporins. Although this cross-allergenicity (allergy to a drug of another class with similar chemical structure) is rare, cephalosporins are not typically administered to clients who have had life-threatening allergic reactions to a penicillin.

What class of antiarrhythmic agents does the nurse administer to slow the outward movement of potassium during phase 3 of the action potential? a. class Ic b. class III c. class Ib d. class II

b. class III The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, prolonging it. Class Ib drugs depress phase 0 somewhat and actually shorten the duration of the action potential. Class Ic drugs markedly depress phase 0, with a resultant extreme slowing of conduction, but have little effect on the duration of the action potential. The class II antiarrhythmics are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential.

A client with hypertension has been taking propranolol as prescribed. Which assessment findings indicate to the nurse that the client is experiencing an adverse effect of this medication? Select all that apply. a. tachycardia b. dizziness c. fatigue d. hypotension e. claudication

b. dizziness c. fatigue d. hypotension e. claudication Propranolol is a Class II beta-adrenergic blocker used to treat cardiovascular conditions including hypertension. Adverse effects of this medication include fatigue, dizziness, bradycardia (not tachycardia), claudication, and hypotension.

A client diagnosed with coronary artery disease has been prescribed a medication that inhibits peripheral breakdown of lipids, reduces low-density lipoproteins (LDLs), and increases high-density lipoprotein (HDL) concentrations. What is this client most likely taking? a. atorvastatin b. gemfibrozil c. fenofibrate d. niacin

b. gemfibrozil Gemfibrozil inhibits peripheral breakdown of lipids, reduces production of triglycerides and LDLs, and increases HDL concentrations. It is associated with gastrointestinal (GI) and muscle discomfort. Fenofibrate, niacin, and atorvastatin do not increase HDL concentrations.

The nurse is caring for a client diagnosed with angina who is taking a calcium-channel blocker. What adverse effects would the nurse caution this client about? a. hypertension and tachycardia b. headache and dizziness c. nausea and diarrhea d. itching and rash

b. headache and dizziness The adverse effects associated with these drugs are related to their effects on cardiac output and on smooth muscle. Central nervous system (CNS) effects include dizziness, light-headedness, headache, and fatigue. Gastrointestinal (GI) effects can include nausea and hepatic injury related to direct toxic effects on hepatic cells. Cardiovascular effects include hypotension, bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. The adverse effects do not, however, include diarrhea, hypertension, tachycardia, or itching.

The client is diagnosed with hyperlipidemia and prescribed lovastatin. Which is the most common adverse effects of lovastatin? a. fatigue and mental disorientation. b. headache and flatulence. c. increased appetite and blood pressure. d. hiccups, sinus congestion, and dizziness.

b. headache and flatulence. The most common adverse effects of statins include GI symptoms (including nausea, constipation, flatulence, and abdominal pain), headache, and muscle aches. These effects are usually mild and transient. Hiccups, sinus congestion, dizziness, fatigue, mental disorientation, increased appetite or hypertension are not common adverse effects of statin drugs.

A 66-year-old woman has a complex medical history that includes poorly-controlled type 1 diabetes, renal failure as a result of diabetic nephropathy and chronic heart failure (CHF). Her care provider has recently added spironolactone (Aldactone) to the woman's medication regimen. The nurse should consequently assess for signs and symptoms of a. leukocytosis. b. hyperkalemia. c. thrombophlebitis. d. atrial fibrillation.

b. hyperkalemia. Spironolactone (Aldactone) and eplerenone (Inspra) are potassium-sparing diuretics, so their use increases serum potassium levels. Spironolactone is not known to contribute to arrhythmias, leukocytosis, or thrombophlebitis.

Propranolol is ordered for a client who has a cardiac arrhythmia. It will be important for the nurse to determine if the person has a history of: a. hypersensitivity to sulfonylureas. b. hypersensitivity to beta blockers. c. chronic heart failure secondary to a tachyarrhythmia. d. idiosyncratic reaction to cinchona derivatives.

b. hypersensitivity to beta blockers. Propranolol would be contraindicated in a patient with hypersensitivity to beta blockers since it blocks the beta-adrenergic receptor sites. For the same reason, it would not be contraindicated in chronic heart failure secondary to a tachyarrhythmia, treatable with beta blockers. It would also not be contraindicated in a client with an idiosyncratic reaction to cinchona derivatives or in a client with hypersensitivity to sulfonylureas because it is not a cinchona derivative and does not contain sulfonylurea.

A 49-year-old client is admitted with uncontrolled chest pain. The client is currently taking nitroglycerin. The primary health care provider adds nifedipine to the client's regimen. The nurse should observe the client for what adverse effect? a. renal insufficiency b. hypotension c. hypokalemia d. hypoglycemia

b. hypotension Both nitroglycerin and nifedipine have hypotension as a potential adverse effect, so frequent assessment of blood pressure is important. Other cardiovascular effects include bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. Adverse effects do not include renal insufficiency, hypokalemia, or hypoglycemia.

The nurse is administering lidocaine to a client with ventricular tachycardia. The nurse will need to observe for adverse effects, including a. dysphagia. b. hypotension. c. hypertension. d. hyperthermia.

b. hypotension. Possible adverse effects of lidocaine include hypotension, aggravation of existing arrhythmia, bradycardia, drowsiness, agitation, and muscle twitching.

The nurse prepares to administer a phosphodiesterase inhibitor to a client. Which route will the nurse use to administer the medication? a. oral b. intravenous c. subcutaneous d. intramuscular

b. intravenous Phosphodiesterase inhibitors are only given intravenously (IV). They cannot be given orally, intramuscularly, or subcutaneously.

A client newly diagnosed with heart failure questions why the therapy with digoxin will begin with four doses of digoxin rather than the usual one dose, in a 24-hour period. How would the nurse respond? a. it more accurately gauges the effect of digoxin on your cardiac function b. it rapidly brings your serum digoxin levels up to therapeutic levels c. it helps mitigate the potential for adverse effects d. it helps confirm that you don't have a hypersensitivity to digoxin

b. it rapidly brings your serum digoxin levels up to therapeutic levels Digitalization is the administration of a loading dose (a dose larger than the regularly prescribed daily dosage) of digoxin to reach the therapeutic index rapidly. None of the options accurately describe the reasoning behind this practice of dose loading.

The primary health care provider prescribes a class I sodium channel blocker to be given intravenously. Which drug would the nurse most likely administer? a. mexiletine b. lidocaine c. flecainide d. disopyramide

b. lidocaine The nurse should administer lidocaine intravenously; disopyramide, flecainide, and mexiletine are administered orally.

The nurse is teaching the client how to reduce the risk of coronary artery disease (CAD). What should the nurse recommend? Select all that apply. a. increase intake of foods high in antioxidants b. lose weight c. eat a high-protein, low-carbohydrate diet d. manage hypertension e. reduce stress levels whenever possible

b. lose weight d. manage hypertension e. reduce stress levels whenever possible Successful treatment in reducing risk for CAD involves reducing risk factors including decreasing dietary fats (decreasing total fat intake and limiting saturated fats seems to have the most impact on serum lipid levels); losing weight, which helps to decrease insulin resistance and the development of type 2 diabetes; eliminating smoking; increasing exercise levels; decreasing stress; and treating hypertension, diabetes, and gout. Increased protein intake is not recommended; many high-protein foods are also high in fat, and there is no benefit to increased protein. Similarly, foods considered to be high in antioxidants are not of any proven benefit.

What event triggers the development of a superinfection? a. bone marrow suppression triggered by antibiotic treatment b. proliferation of antibiotic-resistant microorganisms c. complete establishment of the infection prior to initiation of antibiotic therapy d. unforeseen interactions between the antibiotic and other prescribed medications

b. proliferation of antibiotic-resistant microorganisms Superinfection is an infection after the occurrence of a previous infection, typically caused by microorganisms that are resistant to the antibiotics used earlier. None of the other options accurately describe this condition as it is associated with antibiotic-resistant microorganisms.

A nurse is assessing a client who is receiving vancomycin intravenously. While the drug is being administered, the client reports a throbbing sensation in their neck and back and paresthesias. The client's blood pressure has dropped and their neck and back are erythematous. The nurse suspects which adverse finding? a. Stevens-Johnson syndrome (SJS) b. red man syndrome c. toxic epidermal necrosis d. pseudomembranous colitis

b. red man syndrome Red man syndrome is manifested by a drop in blood pressure and reports of throbbing neck or back pain. Additionally, the client develops fever, chills, paresthesia, and erythema (redness) of the neck and back. SJS is manifested by fever, cough, muscular aches and pains, headache, and lesions of the skin, mucous membranes, and eyes; the lesions appear as red wheals or blisters, often starting on the face, in the mouth, or on the lips, neck, and extremities. Toxic epidermal necrosis is manifested by skin lesions resulting from the death of the epidermal layer of the skin. Pseudomembranous colitis is a bacterial superinfection that is manifested by severe bloody diarrhea.

While teaching a patient about sublingual nitroglycerin, the nurse explains proper use and storage. When the patient asks whether the medication ever expires, the nurse should respond that it: a. should be replaced monthly. b. should be replaced every six months. c. should be replaced annually. d. has an indefinite shelf life.

b. should be replaced every six months. Sublingual nitroglycerin tablets should be replaced every 6 months because they become ineffective over time.

What substance is reabsorbed in the ascending limb of the loop of Henle? a. amino acids b. sodium c. glucose d. water

b. sodium In the ascending limb of the loop of Henle, sodium is reabsorbed. Glucose and amino acids are reabsorbed by the proximal tubule, while water is reabsorbed by the descending limb of the loop of Henle.

To which client should the nurse anticipate administering mannitol? a. the postpartum client with dependent edema 3+ b. the client with increased intracranial pressure secondary to a subarachnoid hemorrhage c. the client with ascites secondary to liver cirrhosis d. the client in a hypertensive crisis with blood pressure 222/141 mm Hg

b. the client with increased intracranial pressure secondary to a subarachnoid hemorrhage Mannitol is a drug of choice to treat increased ICP. Other diuretics are preferred in the treatment of hypertensive crisis, edema, or ascites.

A patient with a longstanding diagnosis of chronic renal failure has experienced a significant decline in urine output in recent days, prompting him to seek care at a local clinic. A nurse at the clinic has suggested to a colleague that the administration of a diuretic such as hydrochlorothiazide may improve the patient's urine output. How should the colleague best respond to this suggestion? a. "Maybe, but hydrochlorothiazide affects the bladder more than the kidneys." b. "That would only work if he could come in twice a day to get it intravenously." c. "Actually, patients with renal failure usually can't take hydrochlorothiazide." d. "That would probably help, but we'd have to do blood work first."

c. "Actually, patients with renal failure usually can't take hydrochlorothiazide." Renal disease and severe renal impairment contraindicate the use of hydrochlorothiazide. HCTZ affects the kidneys, not the bladder, and is not administered intravenously.

The nurse is preparing to teach a client with hyperlipidemia about the prescribed cholestyramine. Which instruction should the nurse prioritize for the client? a. "Take the water-soluble form of vitamin D." b. "Follow a complete liquid diet." c. "Eat foods high in dietary fiber." d. "Be sure to stay on complete bed rest."

c. "Eat foods high in dietary fiber." The nurse should instruct the client taking cholestyramine to eat foods high in dietary fiber to prevent constipation. The nurse should instruct the client to exercise to prevent constipation. Clients are asked to take a water-soluble form of vitamin A (not vitamin D) if they are experiencing impaired digestion of fats and absorption of the fat-soluble vitamins due to long-term therapy of bile acid sequestrants.

After teaching a client about prescribed statin therapy, the nurse determines that additional teaching is needed when the client makes which statement? a. "I should take the dose around bedtime." b. "I should report any problems with muscle pain or weakness." c. "I can take the drug with grapefruit juice." d. "I need to be careful when I'm out in the sun."

c. "I can take the drug with grapefruit juice." The client needs additional teaching when stating that they can take the drug with grapefruit juice. Instead, the client should choose juices other than grapefruit juice because of the risk for an enzyme reaction. The client should take the dose in the evening or at bedtime, use sunscreen and protective clothing to reduce the risk of photosensitivity reactions, and report any muscle pain, tenderness, or weakness to the primary health care provider.

The nurse is assessing a client taking a beta blocker as treatment for angina. Which statement by the client indicates to the nurse that the client is experiencing an adverse effect of the medication? a. "My heart doesn't race anymore." b. "I sleep through the night better." c. "I feel so down about my life." d. "I have not changed by diet."

c. "I feel so down about my life." Beta blockers are used to block the stimulatory effects of the sympathetic nervous system. This decreases the excitability of the heart, decreases cardiac output, decreases cardiac oxygen consumption, and lowers blood pressure. Even though the dose to prevent angina is lower than doses to treat hypertension, adverse effects can still occur. One adverse effect is emotional depression. The statement about feeling down about life indicates an adverse effect. Statements about diet, sleep, and heart rate do not indicate adverse effects of the medication.

A client with heart failure is prescribed a loop diuretic. Which client statement indicates that teaching provided by the nurse about this medication was effective? a. "I am to take this medication on an empty stomach." b. "I will weigh myself once a week." c. "I will change positions slowly if I feel dizzy." d. "I should reduce my fluid intake every day."

c. "I will change positions slowly if I feel dizzy." Loop diuretics can cause a sudden and dramatic increase in urine output and a drop in total body fluid. Because of the loss of fluid, blood pressure may drop causing feelings of dizziness. Because of this, the client should change positions slowly if dizziness occurs. The client should measure weight every day. Fluid intake should not be reduced because this could cause fluid rebound. The medication can be taken with food, which will eliminate any stomach upset.

A client who is receiving cholestyramine also takes digoxin. The nurse teaches the client about the drug and administration. The client demonstrates understanding of the teaching when stating: a. "I need to take both drugs at the same time of the day." b. "I'll take the digoxin about 15 minutes before the cholestyramine." c. "I will take the digoxin about an hour before the cholestyramine." d. "I'll take the cholestyramine at 8 AM and the digoxin at 9 AM."

c. "I will take the digoxin about an hour before the cholestyramine." The absorption of digoxin can be decreased or delayed with cholestyramine, a bile acid sequestrant. Therefore, the digoxin should be taken 1 hour before for 4 to 6 hours after the cholestyramine.

A 52-year-old client who experienced a myocardial infarction has an order for discharge. Part of the discharge teaching includes prior administration of nitroglycerin for chest pain. Which statement by the client indicates understanding of the teaching provided? a. "I will take one tablet and lay down for an hour." b. "I will take three tables every 5 minutes until the chest pain subsides." c. "I will take three nitroglycerin tablets 5 minutes apart, and if I do not have any relief I will seek emergency care immediately." d. "I will take two nitroglycerin tablets 15 minutes apart, and if I do not have any relief I will contact my health care provider."

c. "I will take three nitroglycerin tablets 5 minutes apart, and if I do not have any relief I will seek emergency care immediately." The client with stable or unstable angina will be prescribed sublingual nitroglycerin to relieve chest pain symptoms. The client may take up to three tablets of sublingual nitroglycerin 5 minutes apart. If the chest pain is unrelieved, the client needs to seek emergency medical care immediately.

The client receives a prescription for niacin. The nurse is providing education about the medication and possible adverse effects. Which adverse affect would the nurse include? a. "You're likely to have some nausea when you begin taking the drug, but this will dissipate with time." b. "It's important to avoid eating shellfish and to tell your care provider before having any diagnostic imaging tests." c. "Some people get very flushed skin when they take this medication." d. "Sometimes this causes a full body rash when you first take it, but that doesn't necessarily mean you're allergic to it."

c. "Some people get very flushed skin when they take this medication." Niacin is associated with intense cutaneous flushing, nausea, and abdominal pain, making its use somewhat limited. A full body rash should always be reported and self-limiting nausea is not expected. There is no need to avoid shellfish or contrast solution when taking niacin.

The client wants information about triglycerides and cholesterol. Which response by the nurse would be correct? a. "Triglycerides are found in your blood. Cholesterol is found in the gallbladder." b. "Triglycerides are found in your blood. Cholesterol is how the fat is transported." c. "Triglycerides and cholesterol are fatlike substances found in your blood." d. "Triglycerides transport cholesterol throughout the body."

c. "Triglycerides and cholesterol are fatlike substances found in your blood." Triglycerides and cholesterol are lipids that are found in blood. Cholesterol is produced mostly by the liver.

The nurse identifies the therapeutic range for digoxin as: a. 3 to 4 ng/mL. b. 0.1 to 0.9 ng/mL. c. 0.8 to 2 ng/mL. d. 2 to 3 ng/mL.

c. 0.8 to 2 ng/mL. Therapeutic digoxin levels are between 0.8 and 2 nanograms/mL. Plasma digoxin levels greater than 2 nanograms/mL are considered toxic.

After administering an intravenous (IV) dose of digoxin to a client, the nurse would expect to see effects within what period of time? a. 30 to 120 minutes b. 60 to 90 minutes c. 5 to 30 minutes d. 90 to 120 minutes

c. 5 to 30 minutes The drug has a rapid onset of action and rapid absorption (30 to 120 minutes when taken orally, 5 to 30 minutes when given IV).

A 75-year-old client is being treated for type 2 diabetes, hypertension, gout, angina, coronary artery disease, and peptic ulcer disease. The nurse is concerned because the client is taking a traditional antianginal drug in combination with seven other medications. The nurse understands that what could be the consequence? a. Decreased effectiveness of the antianginal drug b. A greater incidence of hyperglycemic episodes c. A greater incidence of adverse drug effects d. Decreased effectiveness of the antihypertensive

c. A greater incidence of adverse drug effects Traditional antianginal drugs that act via hemodynamic mechanisms (e.g., beta-blockers, calcium antagonists, nitrates) can pose a problem in older adults because of the associated higher risk of drug interactions and greater incidence of adverse drug effects.

When educating a group of nursing students on the mechanism of the action of various anti-arrhythmic drugs, the nurse identifies which drugs as inhibiting the beta-adrenergic receptors of the heart and the kidney? a. Disopyramide b. Propafenone c. Acebutolol d. Amiodarone

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

A client with hypertension is prescribed clonidine. The nurse should question this order if which disorder is noted in the client's history? a. Mental depression b. Active peptic ulcer c. Active hepatic disease d. Ulcerative colitis

c. Active hepatic disease The use of a centrally acting antiadrenergic drug is contraindicated in clients with active hepatic disease. The use of a centrally acting antiadrenergic drug is not contraindicated in clients with active peptic ulcer or ulcerative colitis. In clients with active peptic ulcer, ulcerative colitis, or mental depression, the use of peripherally acting antiadrenergic drug is contraindicated. It is also contraindicated if the client is using MAOIs.

A client presents to the emergency department with dizziness, shortness of breath, and palpitations. This is the third episode of A-Fib for this client in 1 month. A low dose of what drug is the pharmacologic choice for preventing recurrent A-Fib after electrical or pharmacologic conversion? a. Diltiazem b. Amlodipine c. Amiodarone d. Nifedipine

c. Amiodarone Low-dose amiodarone is a pharmacologic choice for preventing recurrent A-Fib after electrical or pharmacologic conversion. The low doses cause fewer adverse effects than the higher ones used for life-threatening ventricular arrhythmias.

A 26-year-old female client with a skin infection has been prescribed 400 mg ampicillin to be taken orally. Which instruction should the nurse include in the client teaching plan? a. Avoid use of skin care products, like moisturizers, when on penicillin therapy. b. If a dosage is missed, increase the next dosage to meet the daily quota. c. Ampicillin will reduce the effectiveness of birth control pills. d. Take drug on an empty stomach, an hour before or 2 hours after meals.

c. Ampicillin will reduce the effectiveness of birth control pills. Ampicillin (also penicillin V) reduces the effectiveness of birth control pills. Increasing a dosage to compensate for a missed dosage should not be done. The client should adhere to the prescribed regimen as strictly as possible. Ampicillin and penicillin V may be taken without regard to meals. The client need not avoid use of skin care products when on penicillin therapy.

The nurse has finished a teaching session with a client who is prescribed a diuretic to be taken twice a day. The nurse determines the session is successful when the client correctly chooses which times to take the drug? a. After lunch and dinner b. Midmorning and before dinner c. At breakfast and midafternoon d. In the early morning and at bedtime

c. At breakfast and midafternoon Twice-a-day dosing should be administered early in the morning (e.g., 0700) and early afternoon (e.g., 1400) to prevent the drug from interfering with the client's sleep.

When caring for a client with angina, the nurse instructs the client to place the nitroglycerin tablet between the cheek and the gums. Which form of nitroglycerin is the nurse administering? a. Translingual b. Transdermal c. Buccal d. Sublingual

c. Buccal The nurse is administering the buccal route of administration. When administering buccal nitroglycerin, the nurse should instruct the client to place the tablet between the cheek and gums or the lips and gums above the incisors. The nurse should instruct the client to allow the tablet to dissolve and not to chew the tablet. Nitrates can also be given by the sublingual, transdermal, and translingual routes. When administering nitroglycerin sublingually, it should be placed under the tongue. In the transdermal route, the patch is applied directly onto the skin. In the translingual route, a spray is directed under or onto the tongue.

A 46-year-old client with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension after serial blood pressure readings. The clinician has opted to begin the client on captopril (Capoten). The nurse should recognize that the therapeutic effect of this drug is achieved in what way? a. By blocking the movement of calcium ions into arterial smooth muscles b. By directly relaxing vascular smooth muscle c. By inhibiting the transformation of angiotensin I to angiotensin II d. By blocking aldosterone from binding to mineralocorticoid receptors

c. By inhibiting the transformation of angiotensin I to angiotensin II Captopril inhibits the ACE needed to change the inactive angiotensin I to the active form, angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, thus preventing sodium and water retention. Captopril therefore decreases peripheral vascular resistance and lowers blood pressure. Calcium channel blockers such as verapamil block the movement of calcium ions into arterial smooth muscles and aldosterone blockers such as Eplerenone (Inspra) inhibit aldosterone from binding to mineralocorticoid receptors. ACE inhibitors do not have a direct effect on vascular smooth muscle.

A nurse is caring for a client receiving cholestyramine to improve his blood lipid profile at a home care setting. What adverse reactions to cholestyramine should the nurse monitor in the client? a. Cholelithiasis b. Rash c. Constipation d. Vertigo

c. Constipation The nurse should monitor for constipation in the client receiving cholestyramine. Rash, vertigo, and cholelithiasis should be monitored by the nurse when caring for a client receiving gemfibrozil.The nurse should monitor for constipation in the client receiving cholestyramine. Rash, vertigo, and cholelithiasis should be monitored by the nurse when caring for a client receiving gemfibrozil.

The nurse is preparing a teaching plan for a client who is prescribed ceftriaxone. What should the nurse identify as common adverse effects associated with this drug? a. Superinfections and phlebitis b. Lethargy and paresthesias c. Diarrhea and nausea d. Headache and dizziness

c. Diarrhea and nausea The most common adverse effects associated with ceftriaxone, a cephalosporin, include those affecting the GI tract, such as nausea, vomiting, diarrhea, abdominal pain, and flatulence. Headache, dizziness, lethargy, and paresthesias can occur as well as superinfections and phlebitis (with IV administration), but these are not the most common.

A client's most recent digoxin level is reported to be 2.2 ng/mL. What conclusion should the nurse draw? a. The medication is at a subtherapeutic drug level. b. A loading dose of digoxin has been given. c. Digoxin toxicity is a possibility. d. A therapeutic drug level has been achieved.

c. Digoxin toxicity is a possibility. The normal digoxin level is 0.5 to 2.0 ng/mL. Toxic serum levels are greater than 2 ng/mL; however, toxicity may occur at any serum level. None of the other options would result in a digoxin level above normal serum levels.

A male client is diagnosed with heart failure. The health care provider orders a loading dose of digoxin. Loading doses are necessary for what reason? a. Digoxin's short half-life increases the risk for toxicity. b. Oral digoxin is ineffective for the treatment of heart failure. c. Digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading. d. The client is at risk for dysthymia with titrated doses.

c. Digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading. Digoxin dosages must be interpreted with consideration of specific client characteristics, including age, weight, gender, renal function, general health state, and concurrent drug therapy. Loading or digitalizing doses are necessary for initiating therapy, because digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading. Loading doses should be used cautiously in clients who have taken digoxin within the previous 2 or 3 weeks.

A client with hypertension has recently been prescribed spironolactone. The client states that they take the medication at the same time each morning, on an empty stomach, and that they measure their blood pressure once per day. Which is the nurse's best action? a. Instruct the client to perform more frequent blood pressure monitoring. b. Encourage the client to vary the times that the medication is taken. c. Encourage the client to take the medication with food. d. Instruct the client to take the medication near midday or early afternoon.

c. Encourage the client to take the medication with food. Taking spironolactone with food increases absorption, and this may decrease gastrointestinal irritation. Morning administration is preferred and the medication should be taken at a consistent time each day. For most clients, daily blood pressure monitoring is sufficient, and thus more frequent assessment is unnecessary.

After teaching a group of students about drugs used to treat hyperlipidemia, the instructor determines that the teaching was successful when the students identify which of the following? Select all that apply. a. Calcium channel blockers b. Angiotensin II receptor blockers c. Fibric acid derivatives d. HMG-CoA reductase inhibitors e. Bile acid resins

c. Fibric acid derivatives d. HMG-CoA reductase inhibitors e. Bile acid resins HMG-CoA reductase inhibitors, fibric acid derivatives, and bile acid resins are classes of medications used to treat hyperlipidemia. Calcium channel blockers and angiotensin II receptor blockers are used to treat hypertension.

A client with congestive heart failure and currently administered digoxin is now prescribed indapamide for edema. Which intervention should the nurse prioritize? a. Closely monitor the client for signs of hyperkalemia. b. Encourage oral fluids at frequent intervals during waking hours. c. Frequently monitor the client's pulse rate and rhythm. d. Encourage the client to eat or drink between meals and in the evening.

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

A male client is admitted to the unit for a total hip replacement. The surgeon orders a first-generation cephalosporin as a surgical prophylaxis because of what type of bacteria commonly associated with this type of procedure? a. Gram-negative b. Aerobic c. Gram-positive d. Anaerobic

c. Gram-positive Some cephalosporins are used in surgical prophylaxis. The particular drug depends largely on the type of organism likely to be encountered in the operative area. First-generation drugs, mainly cefazolin, are used for procedures associated with gram-positive postoperative infections, such as prosthetic implant surgery.

The pharmacology instructor is discussing medications used in the treatment of dyslipidemia. Which drug class would the instructor identify as the most widely used dyslipidemia drugs? a. Bile acid sequestrants b. Niacin c. HMG-CoA reductase inhibitors d. Fibrates

c. HMG-CoA reductase inhibitors HMG-CoA reductase inhibitors (or statins) are the most widely used dyslipidemia drugs. They are useful in treating most of the major types of dyslipidemia.

A 65-year-old client presents to the health care provider's office with reports of shortness of breath on exertion, edema in the ankles, and waking up in the middle of the night unable to breathe. The nurse suspects that the symptoms are indicative of which condition? a. Asthmatic bronchitis b. Pulmonary edema c. Heart failure d. Myocardial infarction

c. Heart failure Cardinal manifestations of HF are dyspnea and fatigue, which can lead to exercise intolerance and fluid retention resulting in pulmonary congestion and peripheral edema.

A 54-year-old client has a cholesterol level of 240 mg/dL (6.2064 mmol/L). What serum concentration of cholesterol would this client have? a. Optimal b. Very high c. High d. Desirable

c. High High is rated at >240 mg/dL (6.2064 mmol/L). The other options are incorrect.

Milrinone is a miscellaneous inotropic drug used in the short-term management of heart failure. What is the only way this drug is approved to be administered? a. Intramuscularly b. Subcutaneously c. Intravenously d. Orally

c. Intravenously Milrinone is only to be given intravenously. The other routes are not used.

A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered? a. Bumetanide b. Furosemide c. Mannitol d. Amiloride

c. Mannitol Mannitol is a powerful osmotic diuretic that is used to treat increased intracranial pressure. It is given intravenously and begins to work in 30 to 60 minutes. Furosemide, amiloride, and bumetanide are not indicated for the treatment of increased intracranial pressure.

A critical care nurse is caring for a client after open-heart surgery. What nursing intervention would the nurse initiate to help detect life-threatening arrhythmias and manage and minimize any that occur? a. Provide supplemental oxygen. b. Palpate the client's pulse and observe the client's response. c. Monitor cardiac rhythm continuously. d. Monitor blood pressure continuously.

c. Monitor cardiac rhythm continuously. The nurse should monitor cardiac rhythm continuously. Cardiac monitors display real-time heart rate and rhythm and alert the nurse to potentially life-threatening arrhythmias. Monitoring blood pressure continuously and palpating the client's pulse do not help detect life-threatening arrhythmias. Providing supplemental oxygen helps maintain adequate cardiac output and does not help detect life-threatening arrhythmias.

The nurse is providing care to a client who is receiving an aminoglycoside and cephalosporin. Which assessment is a priority of care? a. Increased bleeding b. Respiratory difficulty c. Nephrotoxicity d. Nausea

c. Nephrotoxicity When cephalosporin is administered with aminoglycosides, it increases the risk for nephrotoxicity and should be closely monitored. Nausea is an adverse reaction of cephalosporins in clients with gastrointestinal tract infection. The risk of bleeding increases when cephalosporin is administered with oral anticoagulants. The risk for respiratory difficulty and a disulfiram-like reaction increases if alcohol is consumed within 72 hours after administration of certain cephalosporins.

Losartan is frequently prescribed for hypertension management. For which client would the health care provider write a smaller starting dose of the medication, based on medical history and age? a. Luke, age 28, who is suffering from hypertension b. Judy, age 36, who is pregnant c. Nick, age 35, who is suffering from hepatic impairment d. Cole, age 88, who is suffering from hypertension

c. Nick, age 35, who is suffering from hepatic impairment Clients who have impaired liver function have increased bioavailability of losartan because metabolism is impaired. They should be given a lower starting dose of the drug and be monitored for therapeutic and adverse effects. No dosage adjustments seem to be necessary for older adults because losartan is just as safe and effective in this group as it is in younger adults. Because losartan has essentially no contraindications, older adults with hypertension and other comorbidities can still be prescribed losartan. The drug should not be used during pregnancy because of adverse effects on the fetus.

A patient with very high serum triglyceride levels is prescribed the fibric acid derivative clofibrate. In which of the following categories of patients is the use of clofibrate contraindicated? a. Patients with endocrine disorder b. Patients with arterial bleeding c. Patients with primary biliary cirrhosis d. Patients with respiratory depression

c. Patients with primary biliary cirrhosis The fibric acid derivative clofibrate is contraindicated in patients with primary biliary cirrhosis. The use of clofibrate is not contraindicated in patients with endocrine disorder. The HMG-CoA reductase inhibitors are used with caution in patients with a history of endocrine disorders. Niacin is contraindicated in patients with arterial bleeding. The fibric acid derivative clofibrate is not contraindicated in patients with respiratory depression.

The pharmacology instructor is describing medications that increase the contractile force of the heart. Which term describes this effect? a. Positive chronotropic b. Negative dromotropic c. Positive inotropic d. Negative inotropic

c. Positive inotropic A positive inotropic effect improves the contractility and pumping ability of the heart.

A client is receiving a cephalosporin and an aminoglycoside as combination therapy. What assessment should the nurse prioritize? a. Complete blood count b. Coagulation studies c. Serum BUN and creatinine levels d. Signs of disulfiram-like reaction

c. Serum BUN and creatinine levels The nurse would need to assess renal function indicated by serum BUN and creatinine levels because combining cephalosporins with aminoglycosides increases the client's risk for renal toxicity. Coagulation studies would be important if the client was receiving a cephalosporin with an oral anticoagulant because there is an increased risk for bleeding. Combining cephalosporins with alcohol could result in a disulfiram-like reaction. Assessing the client's complete blood count would not be directly indicated by the combination of cephalosporins and aminoglycosides.

It is determined that a client's cardiac rhythm is being originated in the sinoatrial (SA) node. What mechanism is responsible for the triggering of this node? a. Chemical neurotransmissions from the adrenal cortex. b. Interpretation of pressure sensors in the aorta c. Specialized cells within the node itself d. Impulses from the brain

c. Specialized cells within the node itself Each cycle of cardiac contraction and relaxation is controlled by impulses that arise spontaneously in the sinoatrial (SA) node of the heart. These continuous, rhythmic contractions are controlled by the heart itself; the brain does not stimulate the heart to beat. None of the other mechanisms described are involved in SA node function.

A nurse is preparing to administer a diuretic that antagonizes the action of aldosterone. Which drug would the nurse likely administer? a. Hydrochlorothiazide b. Furosemide c. Spironolactone d. Acetazolamide

c. Spironolactone Spironolactone is a potassium-sparing diuretic that exerts its diuretic effect by antagonizing the action of aldosterone. Furosemide is a loop diuretic when given with lithium increases the risk for lithium toxicity. Hydrochlorothiazide given with anesthetics increases the anesthetic effectiveness. Acetazolamide when given with primidone for seizures, decreases the primidone effectiveness.

A 34-year-old female client is taking oral cephradine, a first-generation cephalosporin, at regular intervals with a 2-hour gap before meals. The client reports gastrointestinal distress. The nurse will encourage the client to do which? a. Avoid dairy products b. Change the drug dosage. c. Take the drug with food. d. Drink plenty of fluids.

c. Take the drug with food. Oral forms of cephradine are best taken with food to reduce GI distress. Drinking plenty of fluids will help maintain the fluid balance but will not deter cephradine absorption in the body. Altering the drug dosage would not have any effect if the client takes the medication on an empty stomach. The IV route is recommended only if the client cannot retain the oral form of the drug and could not be self-administered.

The nurse is conducting an admission assessment for a client who has been prescribed hydrochlorothiazide. What information suggests that the nurse should contact the primary health care provider to discuss safety risks for this client? a. a blood glucose level of 130 mg/dL b. a blood pressure of 140/96 mm Hg c. The client is allergic to sulfa drugs. d. The client's mother is allergic to codeine.

c. The client is allergic to sulfa drugs. Thiazide and thiazidelike diuretics are contraindicated with an allergy to thiazides or sulfonamides in order to prevent hypersensitivity reactions. None of the other listed assessment findings pose a safety risk. Having a parent allergic to a medication does not indicate that the client shares the same allergy. An allergy to codeine also does not pose a concern for the client prescribed hydrochlorothiazide. The client's blood pressure and glucose levels should not be adversely affected by the administration of the medication.

A client has been declared "brain dead". The family asks the nurse to explain why their loved one's heart continues to beat in spite of the damage to the brain. The nurse should provide what explanation to the family? a. When the brain is unable to trigger the heart to beat, the sinoatrial (SA) node in the heart assumes that role. b. The inability to control the heart is not among the losses associated with "brain death". c. The heart beats in response to impulses that are generated by specialized cells located in the heart not the brain. d. The heart will eventually stop beating as the losses associated with "brain death" become more extensive.

c. The heart beats in response to impulses that are generated by specialized cells located in the heart not the brain. Each cycle of cardiac contraction and relaxation is controlled by impulses that arise spontaneously in certain pacemaker cells of the sinoatrial (SA) node of the heart. This property allows the heart to continue functioning in a patient who is "brain dead." None of the other options accurately describe the relationship between "brain death" and cardiac functioning.

What is the basis for a nurse's recommendation of a period of intensive diet therapy and lifestyle modification before initiation of drug therapy for a client newly diagnosed with dyslipidemia? a. Continued therapeutic lifestyle changes during drug therapy will guarantee success. b. Therapeutic lifestyle changes are easier to comply with than medication therapies. c. Therapeutic lifestyle changes are the preferred method for lowering blood lipids. d. Nonpharmacologic interventions are cheaper than using medications.

c. Therapeutic lifestyle changes are the preferred method for lowering blood lipids. Nonpharmacologic interventions are always preferred to pharmacologic ones if there is potential for success. Appropriate lifestyle changes should be maintained, but there will not assure guaranteed success. Medications are to be used only when nonpharmacologic efforts have proven unsuccessful. While nonpharmacologic interventions may be less expensive, that is not the basis for the recommendation.

The teaching plan for a client taking amiodarone should include which instruction? a. Urinary retention is common and no need for concern. b. Take this medication with grapefruit juice for optimal absorption. c. Use a reliable form of birth control while taking this medication. d. Drowsiness is common but will not interfere with any of your usual activities.

c. Use a reliable form of birth control while taking this medication. Amiodarone is a pregnancy category D drug. Because of a specific enzyme reaction, grapefruit or its juice should not be taken with amiodarone or calcium channel blockers. Urinary retention is an adverse reaction and should be reported to the health care provider. Drowsiness may occur, and the client should be instructed not to drive and to avoid hazardous tasks if drowsy.

Which substances are moved from the glomerulus into the tubule due to hydrostatic pressure? a. Blood cells b. Proteins c. Water d. Lipids

c. Water The glomerulus acts as an ultrafine filter for all of the blood that flows into it. The semipermeable membrane keeps lipids, proteins, and blood cells inside the vessel, whereas the hydrostatic pressure from the blood pushes water and smaller components of the plasma into the tubule.

The health care provider prescribes a small dose of antianginal medication to a client newly diagnosed with coronary artery disease. Small doses are given initially to minimize: a. oxygenation to the myocardium. b. myocardial enervation. c. adverse effects. d. angina.

c. adverse effects. Starting with relatively small doses of antianginal drugs and increasing them at appropriate intervals as necessary should achieve optimal benefit and minimal adverse effects.

A client has recently been prescribed a drug that treats hypertension by blocking the sympathetic receptors in the sympathetic nervous system. This action is characteristic of which? a. a cardiotonic. b. a neurotransmitter. c. an adrenergic antagonist. d. an adrenergic agonist.

c. an adrenergic antagonist. Those drugs that stimulate sympathetic receptors are referred to as adrenergic or dopaminergic agonists (stimulators), and those that block are referred to as adrenergic antagonists (blockers). Adrenergic antagonism is not synonymous with the action of a cardiotonic drug.

The nurse explains to a client the action of a hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor. What enzyme does the nurse state this drug inhibits? a. an enzyme used immediately for energy b. an enzyme that combines with proteins to become chylomicrons c. an enzyme that controls the production of cellular cholesterol d. an enzyme used to make bile acids

c. an enzyme that controls the production of cellular cholesterol HMG-CoA reductase is an enzyme that controls the final step in production of cellular cholesterol. Some fats are used immediately for energy. Bile acids act like detergents to break down or metabolize fats into small molecules called micelles, which are absorbed into the intestinal wall and combined with proteins to become chylomicrons, to allow transport throughout the circulatory system. Cholesterol is a fat that is used make bile acids.

After teaching a group of nursing students about the action of penicillins, the instructor determines that the teaching was effective when the students identify natural penicillins as exerting which type of effect on microorganisms? a. fungistatic b. fungicidal c. bactericidal d. bacteriostatic

c. bactericidal Natural penicillins exert a bactericidal effect on bacteria. Because penicillin targets bacterial cells, it is of no value to treat fungal infections as it is neither fungicidal nor fungistatic. Since it targets the bacterial cell wall to destroy the bacteria, it does not inhibit growth as in bacteriostatic.

A patient with class-IV CHF has a medication regimen consisting of metoprolol (Lopressor), enalapril (Vasotec), and furosemide (Lasix). In addition to regularly assessing the patient's heart rate, the nurse should prioritize assessment of the patient's a. intake and output. b. exercise tolerance. c. blood pressure. d. cognition

c. blood pressure. Fluid balance, cognition, and exercise tolerance are all affected by CHF and should be regularly assessed as part of thorough nursing care. However, the combination of an ACE inhibitor, a beta blocker, and a diuretic constitutes a significant risk for hypotension and indicates a need for frequent blood pressure monitoring.

Recommended treatments for clients with dyslipidemia are made according to their blood levels of total and low-density lipoproteins (LDL) cholesterol and risk factors for cardiovascular disease. What does the impact of existing cardiovascular disease have on recommendations? a. has no effect on either LDL or HDL levels b. decreases target serum triglyceride level c. decreases target serum LDL level d. increases target serum high-density lipoproteins (HDL) level

c. decreases target serum LDL level Existing cardiovascular disease entails a lower target LDL serum level in these clients. Such existing conditions are not considered in treating abnormal triglyceride or HDL levels.

A client with a complex medical history is scheduled to begin with an IV cephalosporin. After the initiation of therapy, the nurse should monitor the client for which potential adverse effect of intravenous cephalosporin therapy? Select all that apply. a. oliguria b. itching c. diarrhea d. nausea and vomiting e. abdominal pain

c. diarrhea d. nausea and vomiting e. abdominal pain Adverse effects to cefazolin and the other cephalosporins are like those of most other antibiotics: abdominal pain, diarrhea, gastritis, nausea, and vomiting. Neither oliguria nor itching is associated with adverse reactions to cephalosporin therapy.

In addition to being synthesized in the liver and intestine, from where are blood lipids derived? a. exercise b. medications c. diet d. kidneys

c. diet Blood lipids, which include cholesterol, phospholipids, and triglycerides, are derived from the diet or synthesized by the liver and intestine. None of the remaining options are capable of synthesizing or even stimulating the synthesis of blood lipids.

An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for: a. constipation. b. depression. c. falls. d. xerostomia (dry mouth).

c. falls. Angiotensin II receptor blockers such as losartan are associated with a risk of dizziness and a consequent risk for falls. This risk is more pronounced among older adults. Losartan is not associated with constipation, xerostomia, or depression.

Which diuretic will most likely be the initial drug of choice when a client demonstrates dyspnea related to pulmonary edema? a. spironolactone b. hydrochlorothiazide c. furosemide d. mannitol

c. furosemide Loop diuretics, like furosemide, are the diuretics of choice when rapid effects are required since they produce extensive diuresis for short periods, after which the kidney tubules regain their ability to reabsorb sodium. Thiazide diuretics, like hydrochlorothiazide, are the drugs of choice for most clients who require diuretic therapy, especially for long-term management of heart failure and hypertension. In clients with heart failure and inadequate renal function, the addition of spironolactone, a potassium-sparing diuretic, allows smaller doses of loop diuretics and potassium supplements to be administered as spironolactone reduces urinary potassium loss. Mannitol, an osmotic diuretic, is useful in managing oliguria or anuria, and it may prevent acute renal failure (ARF) during prolonged surgery, trauma, or infusion of cisplatin, an antineoplastic agent.

What assessment finding indicates to the nurse that a client's left-sided heart failure is worsening? a. liver enlargement b. increased jugular venous pressure c. increased crackles in lung fields d. increased pulse rate

c. increased crackles in lung fields Fluid may accumulate in the lungs due to left-sided heart failure. Clients may evidence dyspnea, tachypnea, and orthopnea. Right-sided failure would include increased jugular venous pressure and liver enlargement. Pulse rate could increase or decrease depending on medications administered.

When prescribed for angina, how does oral nifedipine achieve a therapeutic effect? a. binding extracellular sodium ions with chloride ions b. preventing the outflow of intracellular potassium c. inhibiting the influx of calcium through slow channels. d. potentiating the effect of B-type natriuretic peptide

c. inhibiting the influx of calcium through slow channels. Nifedipine inhibits the influx of calcium entering through slow channels, producing vasodilation of the peripheral blood vessels and coronary arteries. None of the other options accurately describes the action of nifedipine.

A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by: a. decreasing sodium and potassium conduction. b. blocking adrenergic receptors and producing antisympathetic effects. c. inhibiting the movement of calcium ions across the cardiac muscle cell membrane. d. weakening diastolic depolarization and the action potential duration.

c. inhibiting the movement of calcium ions across the cardiac muscle cell membrane. Verapamil acts by inhibiting the movement of calcium ions across the cardiac and arterial muscle cell membrane. It works preferentially in "slow response" myocardial tissue, such as the SA and AV nodes. Beta blockers inhibit adrenergic receptors and Class IB antiarrhythmics are among the drugs that decrease sodium and potassium conduction. Lidocaine weakens phase 4 diastolic depolarization and decreases the action potential duration and the effective refractory period of Purkinje fibers and ventricular muscle.

The nurse is caring for a client with a severe head injury. An osmotic diuretic is prescribed. The nurse understands which drug is an osmotic diuretic? a. bumetanide b. ethacrynic c. mannitol d. spironolactone

c. mannitol Mannitol is an osmotic diuretic. Spironolactone is a potassium-sparing diuretic. Bumetanide and ethacrynic are loop diuretics.

The nurse is caring for a client with increased intracranial pressure. Which diuretic would the nurse anticipate being prescribed for this client? a. furosemide b. spironolactone c. mannitol d. hydrochlorothiazide

c. mannitol Osmotic diuretics pull water into the renal tubule without sodium loss. Mannitol is a sugar that is not well reabsorbed by the tubules; it acts to pull large amounts of fluid into the urine due to the osmotic pull exerted by the large sugar molecule. Because the tubule is not able to reabsorb all of the sugar pulled into it, large amounts of fluid are lost in the urine. Because of this, it is the diuretic of choice in increased intracranial pressure. Neither furosemide, spironolactone, nor hydrochlorothiazide are identified as being the diuretic of choice for increased intracranial pressure.

The nurse is caring for a client who is experiencing pulmonary edema. The client is treated with furosemide. What will the nurse monitor most closely? a. calcium levels b. bone narrow function c. potassium levels d. sodium levels

c. potassium levels Furosemide is associated with a loss of potassium, so the client will need to be monitored carefully for low potassium levels, which could cause cardiac arrhythmias and further aggravate pulmonary edema. The nurse would not monitor sodium or calcium levels or bone marrow function because of the effects of the drug during the acute treatment of pulmonary edema.

The students are studying the male reproductive system. The instructor tells the students that in the male, the urethra leaves the urinary bladder and passes through the: a. vas deferens. b. renal calyx. c. prostate gland. d. renal cortex.

c. prostate gland. In the male, the urethra leaves the urinary bladder and passes through the prostate gland. The renal calyx and cortex are located in the kidney and the urethra does not pass through the kidney. The vas deferens delivers the sperm from the testicles to the urethra.

The client is admitted to the acute care facility with acute septicemia and has orders to receive gentamicin and ampicillin IV. The nurse is performing an admission assessment that includes a complete nursing history. What information provided by the client would indicate the need to consult the health care provider (HCP) before administering the ordered medication? a. history of hypothyroidism b. had prostate surgery 3 months ago c. takes high-dose furosemide daily d. allergy to peanuts and peanut products

c. takes high-dose furosemide daily Aminoglycosides should be avoided if the client takes a potent diuretic because of the increased risk of ototoxicity, nephrotoxicity, and neurotoxicity. Learning the client takes a potent diuretic would indicate the need to consult with the health care provider (HCP) before administering gentamicin. Prostate surgery, hypothyroidism, and an allergy to peanuts would not preclude the administration of these medications and would not indicate a need to consult with the health care provider.

The parent of an 8-year-old asks the nurse why it seems amoxicillin is so often prescribed when the child needs an antibiotic. What is the nurse's best response? a. "Amoxicillin is an inexpensive antibiotic, so clients are more likely to follow through with treatment." b. "Amoxicillin is effective and has a less offensive taste than many antibiotics." c. "Amoxicillin has the benefit of once-daily dosing, which is easier for both parents and children." d. "Amoxicillin is better absorbed than many other antibiotics and it's highly effective."

d. "Amoxicillin is better absorbed than many other antibiotics and it's highly effective." Most penicillins are rapidly absorbed from the GI tract, reaching peak levels in 1 hour. Although amoxicillin is less expensive, that fact has far less impact on choosing the proper antibiotic than the effectiveness of the drug. Most oral antibiotics for children are available in pleasant tasting syrups so taste would not be a factor. Amoxicillin must be given q8h.

A female client's drugs include a furosemide, digoxin, and hydralazine. She is unable to afford all of her medications, so she takes them intermittently to make them last longer. In addition to making a referral to social service, what should the home care nurse tell this client? a. "Changes in doses may be better than alternating medications." b. "Your plan is acceptable if the health care provider is aware and laboratory studies are done more frequently." c. "Over-the-counter drugs may be viable substitutes for the more expensive medications." d. "Different types of drugs have different actions and produce different responses."

d. "Different types of drugs have different actions and produce different responses." When clients are receiving a combination of drugs for management of HF, the nurse needs to assist them in understanding that the different types of drugs have different actions and produce different responses. As a result, they work together to be more effective and maintain a more balanced state of cardiovascular function. Changing drugs or dosages can upset the balance and lead to acute and severe symptoms that may require hospitalization or may even cause death from HF. Therefore, it is extremely important that clients take all their medications as prescribed. If they are unable to take the medications for any reason, clients or caregivers should notify the prescribing health care provider. They should be instructed not to wait until symptoms become severe before seeking care.

A 58-year-old man has recently been prescribed atorvastatin (Lipitor) in an effort to reduce his cholesterol levels. The man has acknowledged the potentially harmful effects of hyperlipidemia and is motivated to make changes to resolve this health problem. What advice should the nurse give to this client? a. "I'll give you the names of some salt substitutes that you can start using to season your food." b. "Try to get most of your food energy from protein sources rather than carbohydrates." c. "A low-fat diet is a good idea, and the animal sources of fat are always preferable to plant sources." d. "It's a good idea to keep your intake of saturated fat to a bare minimum."

d. "It's a good idea to keep your intake of saturated fat to a bare minimum." Statins should be accompanied by a low-cholesterol diet that is also low in saturated fats. Reduction of sodium intake is a useful health-promotion measure but is not particular to treatment with statins. Plant sources of fat are typically lower in saturated fat than animal sources and it is unnecessary to prioritize protein intake over carbohydrates.

The nurse is providing education to an older adult client who has been prescribed atorvastatin. How should the nurse describe the common adverse effects of the drug? a. "Some clients experience mild chest pain initially." b. "Most people who experience side effects from atorvastatin report stiffness in their joints." c. "The more serious side effects of atorvastatin involve a risk of bleeding." d. "The most common side effects of atorvastatin include some mild gastrointestinal upset."

d. "The most common side effects of atorvastatin include some mild gastrointestinal upset." Statins like atorvastatin are usually well tolerated. The most common adverse effects (nausea, constipation, diarrhea, abdominal cramps or pain, headache, skin rash) are usually mild and transient. Chest pain, joint stiffness, and bleeding are not common adverse effects.

Your client receives IV vancomycin every 12 hours. You know that this infusion should run over: a. 3 to 4 hours. b. 30 minutes. c. 2 to 4 hours. d. 1 to 2 hours.

d. 1 to 2 hours. For systemic infections, vancomycin is given IV and reaches therapeutic plasma levels within 1 hour after infusion. It is very important to give IV infusions slowly, over 1 to 2 hours, to avoid an adverse reaction characterized by hypotension, flushing, and skin rash. This reaction, sometimes called "red man syndrome," is attributed to histamine release.

A nurse is analyzing the medical records of several clients who have come to the clinic for a visit. The nurse determines that a client with which blood pressure readings would be identified as prehypertensive? a. 144/92 mm Hg b. 164/102 mm Hg c. 112/72 mm Hg d. 128/86 mm Hg

d. 128/86 mm Hg Prehypertension is classified as a systolic blood pressure ranging between 120 and 139 mm Hg or a diastolic pressure ranging between 80 and 89 mm Hg. A systolic pressure below 120 mm Hg and a diastolic pressure below 80 mm Hg are considered normal. Stage 1 hypertension would be characterized by a systolic pressure between 140 and 159 mm Hg or a diastolic pressure between 90 and 99 mm Hg. Stage 2 hypertension would be characterized by a systolic pressure of 160 mm Hg or greater or a diastolic pressure of 100 mm Hg or greater.

A client with diabetes also has hypertension. The nurse would expect that the blood pressure goal for the client would be which of the following? a. 140/90 mm Hg b. 150/100 mm Hg c. 100/70 mm Hg d. 130/80 mm Hg

d. 130/80 mm Hg The blood pressure goal for a client with diabetes or kidney disease is 130/80 mm Hg. Values of 140/90 mm Hg and 150/100 mm Hg indicate the blood pressure is not under good control. Blood pressure of 100/70 mm Hg can increase the risk or orthostatic hypotension.

A clinic nurse is caring for a 66-pound child who has acute otitis media. The health care provider has ordered ceftibuten 9mg/kg per day PO for 10 days. The drug comes in an oral suspension of 90 mg/5 mL. Which dose will the nurse administer? a. 5 mL b. 10 mL c. 20 mL d. 15 mL

d. 15 mL First, using the formula: 2.2 lb/1kg = 66 lb/x kg, determine the child's weight in kg (66/2.2 = 30 kg). Next, determine the desired dose by using the formula: amount of prescribed drug times weight in kg (9 mg/kg times 30 kg = 270 mg). In order to determine the volume of medication to administer, use the formula amount of drug available/volume available = amount of drug prescribed/volume to administer (90 mg/5 mL = 270 mg/x mL; 90x = 1350; x = 15 mL).

A clinic nurse has been assigned to follow up with a group of patients on hydrochlorothiazide therapy. Which patient will the nurse most closely monitor for hyponatremia? a. A 23-year-old male who has diabetes b. A 36-year-old female who has diabetes c. A 42-year-old male who has advanced arteriosclerosis d. A 71-year-old female who has advanced arteriosclerosis

d. A 71-year-old female who has advanced arteriosclerosis While patients with diabetes or advanced arteriosclerosis should be monitored closely during hydrochlorothiazide therapy, older patients (over 65 years), especially women, are more at risk for hyponatremia. Older adults and their family members must be advised to report symptoms of hyponatremia such as weakness, nerve disorders, weight loss, salt hunger, cramps, and digestive problems.

When learning about the different classes of cephalosporins, the nurse correctly identifies which of the following statements? a. Cephalosporins are completely different chemically from penicillin. b. Cephalosporins are divided into three different groups. c. Cephalosporins are limited in treating many types of bacteria. d. A first-generation cephalosporin is more useful than a third-generation cephalosporin against gram-positive microorganisms.

d. A first-generation cephalosporin is more useful than a third-generation cephalosporin against gram-positive microorganisms. Cephalosporins are valuable and effective in treating infections with almost all strains of bacteria also affected by penicillins, as well as some strains that have become resistant to penicillin. Cephalosporins are structurally and chemically related to penicillin. They are divided into four groups: first, second-, third-, and fourth-generation drugs. It is true that progression from first to fourth generation shows an increase in the sensitivity of gram-negative microorganisms and a decrease in the sensitivity of gram-positive microorganisms. For instance, a first-generation cephalosporin would be more useful against gram-positive microorganisms than would a third-generation cephalosporin.

A 42-year-old client is seen by the health care provider for follow-up for diabetic nephropathy. The provider prescribed losartan for the treatment of this condition because the medication has been shown to reduce the rate of end-stage renal disease. Which drug class does this drug belong to? a. Selective aldosterone blockers b. Antihyperlipidemic drugs c. Calcium channel blockers d. Angiotensin II receptor blockers

d. Angiotensin II receptor blockers Losartan is an angiotensin II receptor blocker (ARB) and is recommended for clients with diabetic renal disease because ARBs have been shown to reduce the rate of end-stage renal disease. Antihyperlipidemic drugs help to reduce cholesterol. Calcium channel blockers relax and widen blood vessels by affecting the muscle cells in the arterial walls, these are recommended with caution in pregnant women. Selective aldosterone blockers do not show reduction of end-stage renal disease but are effective in treating severe CHF.

A client receiving warfarin is prescribed disopyramide. The nurse would monitor for signs and symptoms of what as most important? a. Arrhythmia b. Disopyramide toxicity c. Renal dysfunction d. Bleeding

d. Bleeding The combination of disopyramide with warfarin increases the client's risk for bleeding. The combination of disopyramide with warfarin does not promote renal dysfunction. The combination of disopyramide with digoxin or beta blockers increases the client's risk for the development of arrhythmias.

Which statement would be true about the mechanism of action of class II antiarrhythmic agents? a. Block the influx of sodium into the cells b. Cause depression in phase 2 of repolarization c. Stimulate the uptake of potassium in the tissues d. Block the stimulation of the adrenergic receptors

d. Block the stimulation of the adrenergic receptors Class II antiarrhythmic drugs block adrenergic receptors (beta-blockers), producing antisympathetic effects that slow the heart rate, lengthen the time needed for conduction, and increase the force of contraction. The effect seen with class II antiarrhythmic drugs is depression of phase 4 of depolarization.

A breast-feeding woman is prescribed a Class 3 antiarrhythmic. What information should the nurse provide to the client regarding the safety of the breast-feeding while taking this medication a. The decision to continue breast-feeding should be based on the stress is creates for the woman b. The safety of this class of antiarrhythmic medications has not been established. c. The medication doesn't pass into the breast milk. d. Breast-feeding must be discontinued and other forms of feeding should be introduced.

d. Breast-feeding must be discontinued and other forms of feeding should be introduced. The safety for the use of antiarrhythmic drugs during pregnancy has not been established. They should not be used in pregnancy unless the benefit to the mother clearly outweighs the potential risk to the fetus. The drugs enter breast milk, and some have been associated with adverse effects on the neonate. Class I, III, and IV agents should not be used during lactation; if they are needed, another method of feeding the baby should be used.

A nurse is preparing to administer ivabradine to a client with heart failure. Which preadministration assessment should the nurse prioritize for this client? a. Inspect joints for swelling. b. Obtain blood glucose levels. c. Inspect skin for rash. d. Check for jugular vein distention.

d. Check for jugular vein distention. The nurse should check for jugular vein distention as part of the preadministration assessment for the client prescribed a cardiotonic. Inspecting the joints for swelling should occur on the ongoing assessment to evaluate for possible adverse reactions, especially if the client is also receiving a diuretic. Inspecting the skin would be necessary if there were any indications of a possible adverse reaction, but this would also occur after the drug's administration. Obtaining blood glucose levels is not necessary for heart failure but would be indicated if the client also had diabetes.

The 96-year-old client is receiving digoxin and furosemide. In the morning, the client reports having a headache and feeling nauseated. What should the nurse do first? a. Administer acetaminophen and aluminum hydroxide/magnesium hydroxide. b. Contact the client's primary health care provider immediately. c. Give the client clear liquids and have the client lie down. d. Check the client's laboratory values and vital signs.

d. Check the client's laboratory values and vital signs. The nurse will check the client's digoxin level and electrolytes. Assessing vital signs is important because the risk of cardiac arrhythmias could increase due to the client's receiving furosemide, which is a potassium-wasting diuretic. The adverse effects most frequently seen with the cardiac glycosides include headache, weakness, drowsiness, and vision changes (a yellow halo around objects is often reported). Gastrointestinal (GI) upset and anorexia also commonly occur. Only after checking lab values and assessing vital signs might the nurse call the health care provider. Acetaminophen and aluminum hydroxide/magnesium hydroxide (antacid) would not be indicated. Having the client lie down and restricting the diet to clear liquids would be appropriate but not the first actions.

After teaching a group of students about angina, the instructor determines that the teaching was successful when the students describe stable angina as: a. Chest pain that occurs at rest b. Chest pain that occurs due to vasospasm c. Chest pain that occurs with coronary artery disease d. Chest pain that is relieved by rest

d. Chest pain that is relieved by rest Stable angina is characterized as chest pain that is relieved with rest. Unstable angina is chest pain that occurs at rest. Prinzmetal angina is chest pain that results from vasospasm. Chest pain is associated with coronary artery disease due to a supply and demand problem.

Unless hemodialysis is started within 48 hours, imipenem is contraindicated for clients with severe renal impairment. What laboratory measurement would indicate renal impairment? a. Serum albumin b. Hematocrit c. White blood count d. Creatinine clearance

d. Creatinine clearance Dosage of imipenem should be reduced in most clients with renal impairment, and the drug is contraindicated in clients with severe renal impairment (CrCl of 5 mL/min or less) unless hemodialysis is started within 48 hours. For clients already on hemodialysis, the drug may cause seizures and should be used very cautiously, if at all.

A client is diagnosed with atherosclerosis. What would the nurse say is the most likely cause of his angina? a. Hypertension of the myocardium b. A reduction in plaque secondary to atherosclerosis c. Decreased musculature of the myocardium related to plaque d. Decreased oxygenation to the myocardium

d. Decreased oxygenation to the myocardium Angina pectoris results from deficit in myocardial oxygen supply (myocardial ischemia) in relation to myocardial oxygen demand, most often caused by atherosclerotic plaque in the coronary arteries.

A client with hypertension is prescribed atenolol. Which assessment finding(s) on the ongoing assessment should the nurse evaluate first? Select all that apply. a. Cough b. Constipation c. Hyperkalemia d. Dizziness e. Bradycardia

d. Dizziness e. Bradycardia Common adverse reactions seen with atenolol, a beta-adrenergic blocker, include bradycardia, dizziness, fatigue, weakness, hypotension, nausea, vomiting, diarrhea (not constipation), and nervousness. Cough is associated with ACE inhibitors. Hyperkalemia is associated with eplerenone and aliskiren. Constipation is not a common adverse reaction with atenolol.

The health care provider has prescribed ezetimibe for a client diagnosed with hyperlipidemia. The nurse is prepared to prioritize which assessment to evaluate the drug's effectiveness? a. Taking a dietary history of the client b. Obtaining reports of fasting blood sugar levels c. Inspecting skin and eyelids for evidence of xanthomas d. Frequently monitoring blood cholesterol

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

The nurse should instruct the client to take what action if nitroglycerin tablets taken sublingually are not effective in eliminating chest pain? a. Lie down after taking an aspirin. b. Take more tablets until pain subsides, to a maximum of six tablets. c. Call the primary health care provider. d. Go to the emergency department.

d. Go to the emergency department. A sublingual dose may be repeated in 5 minutes if relief is not felt, for a total of three doses. If pain persists, the client should go to the emergency department. The client should not waste time by calling the primary health care provider or lying down. It would be unsafe to take more tablets.

The nurse is providing education to clients on antiarrhythmic drug classes. What class of antiarrhythmics drug will the nurse indicate blocks potassium channels, prolonging phase 3 of the action potential and slowing the rate and conduction of the heart? a. IV b. II c. I d. III

d. III The class III antiarrhythmics block potassium, prolonging phase 3 of the action potential, which prolongs repolarization and slows the rate and conduction of the heart. Class I drugs block the sodium channels in the cell membrane during an action potential. Class II drugs are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. Class IV drugs block calcium channels in the cell membrane, leading to a depression of depolarization and a prolongation of phases I and II of repolarization, which slows automaticity.

A group of students are reviewing the various antianginal agents. The students demonstrate a need for additional review when they identify what as a beta blocker? a. Metoprolol b. Nadolol c. Propranolol d. Isosorbide

d. Isosorbide Isosorbide is a nitrate. Metoprolol is a beta blocker. Nadolol is a beta blocker. Propranolol is a beta blocker.

When discussing cephalosporins with the nursing class, the pharmacology instructor explains that this classification of drug is primarily excreted through which organ? a. Liver b. Lung c. Skin d. Kidney

d. Kidney The cephalosporins are primarily metabolized in the liver and excreted in the urine. These drugs cross the placenta and enter breast milk. They are not excreted through the lungs, the liver, or the skin.

Which lipid level would the nurse interpret as being high? a. Total cholesterol of 200 mg/dL b. HDL cholesterol of 48 mg/dL c. Triglyceride level of 160 mg/dL d. LDL cholesterol of 190 mg/dL

d. LDL cholesterol of 190 mg/dL LDL level of 190 mg/dL would be considered high. A total cholesterol level of 200 mg/dL would be considered borderline high. A triglyceride level of 160 would be borderline high. HDL level of 48 would be considered low to optimal. Levels about 60 mg/dL would be considered high.

A client develops primary hypertension and asks the nurse, "How long will I need to receive therapy?" The nurse responds based on the understanding that therapy would be required for how long? a. 5 years b. Until blood pressure is 120/80 mmHg c. One year d. Lifelong

d. Lifelong Once primary hypertension develops, management of the disorder becomes a lifetime task. Diet and exercise with weight loss can help to lower blood pressure; however, there are many factors even genetics that contribute to hypertension.

A group of students are reviewing the drugs used to treat heart failure. The students demonstrate understanding of the information when they identify which agent as a phosphodiesterase inhibitor? a. Hydrochlorothiazide b. Digoxin c. Captopril d. Milrinone

d. Milrinone Milrinone is a phosphodiesterase inhibitor. Captopril is an ACE inhibitor. Digoxin is a cardiac glycoside. Hydrochlorothiazide is a diuretic.

A 75-year-old patient with a history of renal impairment is admitted to the primary health care center with a UTI and has been prescribed a cephalosporin. Which of the following interventions is most important for the nurse to perform when caring for this patient? a. Monitoring fluid intake. b. Testing for occult blood. c. Testing for increased glucose levels. d. Monitoring blood creatinine levels.

d. Monitoring blood creatinine levels. An elderly patient is more susceptible to the nephrotoxic effects of the cephalosporins. Since renal impairment is present, it is important for the nurse to closely monitor the patient's blood creatinine levels. The nurse should conduct a test for occult blood if blood and mucus occur in the stool and monitor the fluid intake if there is a decrease in urine output. The nurse does not need to monitor for increased glucose levels unless the patient has a history of diabetes.

A 40-year-old is being treated for an ear infection with a cephalosporin. Which adverse reactions should the nurse monitor for in the client? a. Excessive tearing b. Hypotension c. Chest pain d. Nausea

d. Nausea The most common adverse reactions that are caused due to cephalosporin administration include nausea, vomiting, and diarrhea. Cephalosporin does not cause hypotension, chest pain, or excessive tearing; hypotension and chest pain are some of the adverse reactions of disulfiram.

A female client presents to the health care provider's office with recurrence of her "hot flashes." The nurse understands that the client is taking what drug to treat her dyslipidemia? a. Atorvastatin b. Cholestyramine c. Fenofibrate d. Niacin

d. Niacin Skin flushing may occur with niacin.

A patient arrives at the community health care center reporting chest pain and is diagnosed with angina pectoris. Which drug is administered for treating angina? a. Papaverine b. Isospin c. Cilostazol d. Nicardipine

d. Nicardipine Nicardipine is the drug used in the treatment of angina. Nicardipine is a calcium channel blocker used as an anti-anginal drug. Isospin, papaverine, and cilostazol are peripheral vasodilating drugs used in the treatment of peripheral vascular diseases.

A client has been admitted to a health care center with reports of dyspnea. The nurse suspects left-sided heart failure based on which assessment finding? a. Pitting edema b. Weight gain c. Nocturia d. Orthopnea

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

A patient has been admitted to a health care center with reports of dyspnea. Which signs should the nurse monitor for when assessing the patient for left ventricular dysfunction? a. Nocturia b. Weight gain c. Pitting edema d. Orthopnea

d. Orthopnea The nurse should assess for orthopnea in patients with left ventricular dysfunction. Orthopnea is a condition where the patient experiences difficulty in breathing on lying down. The other features of left ventricular failure include a hacking cough or wheezing, restlessness, or anxiety. Nocturia, pitting edema, and weight gain are associated with right ventricular dysfunction, and not left ventricular dysfunction.

A nurse is presenting a class for patients newly diagnosed with hypertension. What factor would the nurse tell the class has the greatest effect on diastolic blood pressure? a. Force of myocardial contraction b. Renal function c. Pulse pressure d. Peripheral vascular resistance

d. Peripheral vascular resistance Arterial blood pressure reflects the force exerted on arterial walls by blood flow. It does not reflect pulse pressure, renal function, or force of myocardial contraction.

After a cardiac muscle contracts, what chemical reaction is needed to prepare the muscle cells for the next contraction? a. Sodium ions return to the intracellular space. b. Potassium ions return to the extracellular space. c. Calcium ions return to the extracellular space. d. Potassium ions return to the intracellular space.

d. Potassium ions return to the intracellular space. Sodium is a primary extracellular ion and potassium is the primary intracellular ion. At the start of the contraction, the sodium and calcium ions move into the cells, while potassium moves out. This movement of the ions changes the membrane from its resting state to an activated state of electrical energy buildup. After this electrical energy is discharged, muscle contraction occurs. The sodium and calcium ions then move back to the extracellular fluid, while the potassium returns to the intracellular fluid to prepare for the next contraction.

HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category? a. Pregnancy Category A b. Pregnancy Category B c. Pregnancy Category C d. Pregnancy Category X

d. Pregnancy Category X HMG-CoA reductase inhibitors (statins) are in pregnancy category X and contraindicated during any stage of pregnancy. Medications in pregnancy category A are considered safe. Medications classified as pregnancy category B, studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. For pregnancy category C, studies have shown adverse effects to the fetus; however, benefit may outweigh the potential harm—the risk has not been ruled out.

A client presents to the urgent care clinic reporting severe dizziness. On assessment, the nurse learns the client was recently prescribed losartan and quit taking it thinking it was responsible for the dizziness. Which assessment should the nurse prioritize? a. Anginal attacks b. Breathing difficulty c. Orthostatic hypotension d. Rebound hypertension

d. Rebound hypertension Rebound hypertension will occur in clients when antihypertensives are abruptly discontinued. In rebound hypertension, there is a sudden rise in blood pressure when the antihypertensives are withheld. Orthostatic hypotension, anginal attacks, and breathing difficulty are the adverse reactions associated with antihypertensive drug usage and may not occur on stopping the drug.

A client has a complex cardiac history that includes recurrent ventricular fibrillation. After the failure of more conservative treatments, the care team has introduced oral amiodarone. What assessments should be prioritized by the nurse who is providing care for this client? a. Neurological assessment b. Orientation and cognition c. Active and passive range of motion d. Respiratory assessment

d. Respiratory assessment Amiodarone has several adverse effects that are potentially fatal. Pulmonary toxicity is the most important of these serious adverse effects. Consequently, the nurse should prioritize respiratory assessments over musculoskeletal or neurological assessments.

A nurse is required to administer a parenteral form of penicillin to a client. Which intervention would be most appropriate for the nurse to do when preparing penicillin in parenteral form? a. Extract penicillin from vial and then reconstitute. b. Save excess antibiotic after reconstitution for later use. c. Use any available diluent for reconstitution. d. Shake the vial well to distribute the drug evenly.

d. Shake the vial well to distribute the drug evenly. When preparing a parenteral form of penicillin, the nurse should shake the vial thoroughly before withdrawing the drug to ensure its even distribution in the solution. Penicillins in powder or crystalline form must be reconstituted before being withdrawn from the vial. Excess antibiotic after reconstitution should never be saved, as the drug loses its potency when stored. Reconstitution should be done only with the diluent prescribed on the manufacturer's label.

A nurse is required to administer a parenteral form of penicillin to a patient. Which of the following interventions should a nurse perform when preparing penicillin in parenteral form? a. Use any available diluent for reconstitution. b. Extract penicillin from vial and then reconstitute. c. Save excess antibiotic after reconstitution for later use. d. Shake the vial well to distribute the drug evenly.

d. Shake the vial well to distribute the drug evenly. When preparing a parenteral form of penicillin, the nurse should shake the vial thoroughly before withdrawing the drug to ensure its even distribution in the solution. Penicillins in powder or crystalline form must be reconstituted before being withdrawn from the vial. Excess antibiotic after reconstitution should never be saved, as the drug loses its potency when stored. Reconstitution should be done only with the diluent prescribed on the manufacturer's label.

The nurse is teaching a 63-year-old client about sustained-release oral nitrates which has been prescribed for treatment of angina. Which instructions would the nurse offer to the client when teaching how to properly self-administer the medication? a. Crush the medication and dissolve it in water. b. Take the medication immediately following a meal. c. Crush the medication and mix it with food. d. Take the medication on an empty stomach.

d. Take the medication on an empty stomach. Oral nitrates should be taken on an empty stomach with a glass of water. Clients should not crush or chew sustained-release tablets.

The nurse monitors which client for an increased risk of digoxin toxicity? a. The client with an integumentary dysfunction b. The client with liver dysfunction c. The client with a peripheral vascular dysfunction d. The client with renal dysfunction

d. The client with renal dysfunction The client with renal dysfunction is at an increased risk for digoxin toxicity.

What is the expected outcome when the glomerular membrane is damaged? a. The kidney's ability to regulate the concentration of urine is impaired b. The chemical reaction that results in the formation of sodium bicarbonate is impaired c. The reabsorption of substances from the renal tubule back into the vascular system is altered d. The filtration of fluid from the blood into the kidney's nephron tubule is impaired

d. The filtration of fluid from the blood into the kidney's nephron tubule is impaired The fenestrated membrane of the glomerulus allows filtration of fluid from the blood into the nephron tubule. None of the remaining options describe the result of a damaged glomerular membrane.

Frequent episodes of exercise-related chest pain have caused a 79-year-old woman to use her prescribed nitroglycerin spray several times in recent weeks. This patient's age will have what effect on her use of nitroglycerin? a. The woman will need to allow more time between doses in order to facilitate absorption. b. The woman may experience paradoxical vasoconstriction when taking nitroglycerin. c. Decreased saliva production will inhibit the absorption of the drug in her mucosa. d. The woman will be more susceptible to hypotension than a younger patient.

d. The woman will be more susceptible to hypotension than a younger patient. Older adults may have a more pronounced venous dilation from nitroglycerin than younger adults and may experience more hypotension from the drug. Xerostomia does not inhibit the absorption of nitroglycerin spray and it is unnecessary to adjust the timing of nitroglycerin doses based on age.

The nurse would anticipate which client to most likely to be diagnosed with secondary hypertension? a. a client with type 1 diabetes who has developed nephropathy b. a client whose body mass index is 31 c. a client whose most recent blood pressure readings were 143/92, 147/94, and 144/94 mmHg d. a client who is being treated for pheochromocytoma

d. a client who is being treated for pheochromocytoma The majority of clients with hypertension have the primary (essential) form, in which there is no obvious cause. A client with a pheochromocytoma would have secondary hypertension, because the cause is identifiable. Obesity and diabetes are associated with hypertension but are not the direct causes of it. A client with blood pressures of 143/92, 147/94, and 144/94 mmHg would be likely diagnosed with hypertension, but not likely the secondary type.

Recommended treatments for clients with dyslipidemia are made according to their blood levels of total and low-density lipoproteins (LDL) cholesterol and risk factors for cardiovascular disease. What does the impact of existing cardiovascular disease have on recommendations? a. has no effect on either LDL or HDL levels b. decreases target serum triglyceride level c. increases target serum high-density lipoproteins (HDL) level d. decreases target serum LDL level

d. decreases target serum LDL level Existing cardiovascular disease entails a lower target LDL serum level in these clients. Such existing conditions are not considered in treating abnormal triglyceride or HDL levels.

An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for: a. xerostomia (dry mouth). b. constipation. c. depression. d. falls.

d. falls. Angiotensin II receptor blockers such as losartan are associated with a risk of dizziness and a consequent risk for falls. This risk is more pronounced among older adults. Losartan is not associated with constipation, xerostomia, or depression.

A physician has prescribed triamterene to a client with renal disease. The client informs the nurse that they are taking potassium supplements to address some heart problems. The nurse would be alert for which of the following? a. increased risk of arrhythmias. b. decreased diuretic effectiveness. c. increased risk of bleeding. d. increased risk of hyperkalemia.

d. increased risk of hyperkalemia. The nurse should inform the client about the increased risk of hyperkalemia as the effect of the interaction between triamterene, which is a potassium-sparing diuretic, and potassium supplements. When the client is administered loop diuretics with anticoagulants or thrombolytics, there will be increased risk of bleeding. When the client is administered digitalis with loop diuretics, there is an increased risk of arrhythmias. Decreased diuretic effect, in this case decreased effect of triamterene, will occur when a potassium-sparing diuretic such as triamterene is administered with NSAIDs, salicylates, and anticoagulants.

Losartan focuses on what aspect of the cardiac process to address the pathophysiology of heart failure? a. reducing preload b. increasing stroke volume c. increasing heart rate d. lowering blood pressure

d. lowering blood pressure Losartan potassium selectively blocks the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal glands. This, in turn, blocks the vasoconstrictive effect of the renin-angiotensin system and the release of aldosterone, leading to a decrease in the client's blood pressure. Losartan is not focused on reducing preload or increasing either stroke volume or heart rate.

What is the primary goal of antidysrhythmic drug therapy for a client who has been successfully cardioverted? a. proof of increased cardiac contractility b. increase in blood pressure c. suppression of original dysrhythmia d. maintenance of normal sinus rhythm (NSR)

d. maintenance of normal sinus rhythm (NSR) Maintaining NSR after conversion from atrial fibrillation or atrial flutter is one of the indications for antidysrhythmic drug therapy. This is not achieved solely by increasing contractility. Increased tissue perfusion is a valid goal, but increased blood pressure may or may not be desirable. Clinicians use drugs not just to suppress dysrhythmia but to prevent or relieve symptoms or prolong survival.

For what condition would the nurse expect to administer lidocaine intravenously to a client? a. increase in intracranial pressure (ICP) b. decrease in arterial oxygen saturation (SaO2) c. precipitous increase in blood pressure d. multiple premature ventricular contractions (PVCs)

d. multiple premature ventricular contractions (PVCs) Lidocaine drips are indicated for the treatment of life-threatening ventricular arrhythmias such as long or frequent runs of PVCs. Lidocaine would not be indicated for the treatment of hypoxia, hypertension, or increased ICP.