pharm exam 4

a nurse is teaching a client who has a new prescription for nitroglycerin transdermal patch for angina pecotris. which fo the followning instructions shoul the nruse include? a. remove the patch each evening b. cut each patch in half if angina attacks are under control c. take off thenitroglycerin patch for 30 mins if a headache occurs. d. apply a new patch every 48 hrs.

a. to prevent tolderance to nitroglycerin the client should remove the patch 10-12 hrs during each 24-h4 period

a nurse is caring for a client who has increased intracranial pressure and is receiving mannitol. which of the following findings should the nurse report to the provider? a. blood glucose 150mg/dL b. urine output 40mL/hr c. dyspnea d. bilateral equal pupil size

c. dyspnea - manifestaion of heart failure, adv effect of mannitol, stop med and notify the provider

a nurse is monitoring a client who is receiving apironolactone. which of the following findings should the nurse report to the provider? a. blood sodium 144mEq/L b. urine output 120 mL in 4 hr c. blood potassium 5.2 mEq/L d. bp 140/90 mm Hg

c. indicates hyperkalemia, spirolactone causes potassium retention, withhold the med and notify the provider

a nurse is caring for a client who has a new prescription for captopril for htn. the nurse should monitor the client for which of the following as an adverse effect of this med? a. hypokalemia b. hypernatremia c. neutropenia d. bradycardia

c. neutropenia is a serious adv effect that can occur in clients taking an ace inhibitor. monitor the client's cbc and teach the client to report inidcations of infrection to the provider hyperkalemia, hyponatremia, and tachycardia are adv effects

a nurse in a provider's office is monitoring blood electrolytes for four clients who take digoxin. which fo the following electrolyte values increases a client's risk for digoxin toxicity? a. calcium 9.2 b. calcium 10.3 c. potassium 3.4 d. potassium 4.8

c. potassium 3.4 low potassium can cause fatal dysrhythmias, esp in older adults notify the provider might prescribe potassium supp or k sparing diuretciic

A patient with variant angina wants to know why a beta blocker cannot be used to treat the angina. Which response by the nurse is correct?

"Beta blockers do not help relax coronary artery spasm." Variant angina occurs when coronary arteries go into spasm, thus reducing the circulation and oxygen supply to the heart. CCBs help to reduce coronary artery spasm; beta blockers do not. Beta blockers do not constrict arterial smooth muscle. Beta1-selective beta blockers are used for stable angina for patients who also have asthma, because they do not activate beta2 receptors in the lungs to cause bronchoconstriction. Beta blockers help improve the oxygen supply in stable angina, but they do not relieve coronary artery spasm, so they are not useful in variant angina.

A prescriber has ordered clonidine for a patient who has hypertension. The nurse teaches the patient about the side effects of this drug. Which statement by the patient indicates understanding of the teaching?

"I should chew sugar-free gum or drink water to reduce my dry mouth." Xerostomia is a common side effect of clonidine and is often uncomfortable enough that patients stop using the drug. Counseling patients to chew sugar-free gum and take frequent sips of liquid can help alleviate this discomfort. Drowsiness is common, but this side effect becomes less intense over time. Patients should be counseled to avoid hazardous activities in the first weeks of therapy if they feel this effect. The drug should not be stopped abruptly because of the risk of rebound hypertension, so patients experiencing unpleasant central nervous system (CNS) effects should consult their provider about withdrawing the medication slowly. The hypertensive effects of clonidine are not posture dependent, as they are with the peripheral alpha-adrenergic blockers, so orthostatic hypotension is minimal with this drug. Clonidine causes euphoria, hallucinations, and sedation in high doses and can cause anxiety or depression, although the last two effects are less common.

A nurse is preparing to assist a nursing student to administer intravenous verapamil to a patient who also receives a beta blocker. The nurse asks the nursing student to discuss the plan of care for this patient. Which statement by the student indicates a need for further teaching?

"I will monitor the heart rate frequently to assess for reflex tachycardia." Reflex tachycardia is not an expected effect; the greater risks are cardiosuppression and bradycardia. Hypotension may occur and should be treated with IV norepinephrine. A CCB can cause hypotension. Because beta blockers and verapamil have the same effects on the heart, there is a risk of excessive cardiosuppression. To minimize this risk, the two drugs should be given several hours apart.

Lovastatin is prescribed for a patient for the first time. The nurse should provide the patient with which instruction?

"Take lovastatin with your evening meal." Patients should be instructed to take lovastatin with the evening meal because that's when they work best to lower cholesterol levels. Statins should be taken with the evening meal, not before breakfast. Statins should not be administered without regard to meals. Statins should not be taken on an empty stomach.

A patient arrives in the emergency department after becoming dehydrated. Based on the patient's history, the provider determines that isotonic dehydration has occurred. Which solution will the nurse expect to infuse to treat this patient?

0.9% sodium chloride in sterile water Isotonic dehydration should be treated with an isotonic solution of 0.9% NaCl in sterile water.

a nurse is planning care for a client who is has a new prescription for torsemide. the nurse should plan to monitor for which of the following conditions as potential adverse reactions of this medications? a. respiratory acidosis b. hypokalemia c. hypotension d. ototoxicity e. ventricular dysrhythmias

b. c. d. e. & metabolic alkalosis

A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient?

ACE inhibitors ACE inhibitors slow the progression of kidney injury in diabetic patients with renal damage. Beta blockers can mask signs of hypoglycemia and must be used with caution in diabetics. Direct-acting vasodilators are third-line drugs for chronic hypertension. Thiazide diuretics promote hyperglycemia.

An ACE Inhibitor blocks the enzyme from the lungs that forms what?

Angiotensin II Renin is an enzyme from the kidney that reacts to form Angiotensin I. Angiotensin Converting Enzyme (ACE) is an enzyme from the lungs that reacts to form what Angiotensin II. Since Angiotensin II is a powerful vasoconstrictor, an ACE Inhibitor will block Angiotensin II from forming. This causes vasodilation and lowers blood pressure.

A patient has been admitted for a deep vein thrombosis in the left leg. The nurse will anticipate the provider to order which class of drug?

Anticoagulant The patient will be prescribed an anticoagulant such as heparin, enoxaparin, or warfarin. The principal indication for anticoagulants is prevention of thrombosis in veins. The principal indication for the antiplatelet drugs is prevention of thrombosis in arteries. Antiplatelet drugs include aspirin and clopidogrel.

a nurse is planning to administer a first does of captopril to a client who has htn. which of the following meds can intensify first does hypotension? a. simvastatin b. hydrochlorothiazide c. phenytoin d. clonidine e. aliskiren

b. diuretics c. clonidine - antihtn meds e. antihtn med

A patient is taking digoxin and furosemide. If the serum potassium level begin to decrease the nurse will observe the patient for:

Dysrhythmias Adverse effects of hypokalemia along with a rising level of digoxin due to the hypokalemia puts this patient at high risk for dysrhythmias.

A patient is receiving digoxin twice daily. When assessing the patient before giving a dose, the nurse counts a pulse of 60 beats/min and learns that the patient is experiencing nausea, headache, and visual changes. What should the nurse do?

Contact the prescriber to report the symptoms. The symptoms suggest possible toxicity, The nurse should contact the prescriber to discuss the next steps. Delaying a dose without a change in order is not within the scope of practice for a nurse. The nurse should not give a dose of a medication when toxicity is suspected, because additional drug will compound the symptoms. Antiemetics are useful for counteracting drug side effects, but they should not be used when the patient's symptoms indicate toxicity.

A patient with congestive heart failure is admitted to the hospital. During the admission assessment, the nurse learns that the patient is taking a thiazide diuretic. The nurse notes that the admission electrolyte levels include a sodium level of 142 mEq/L, a chloride level of 95 mEq/L, and a potassium level of 3 mEq/L. The prescriber has ordered digoxin to be given immediately. What will the nurse do initially?

Hold the digoxin and report the laboratory values to the provider The nurse needs to hold the digoxin and report the potassium level to the provider so it can be corrected before the digoxin is delivered. Holding the thiazide diuretic will not correct the potassium deficiency. Potassium depletion is common with thiazide diuretics, and hypokalemia is especially dangerous for patients receiving digoxin, because the drug can precipitate a fatal dysrhythmia and digoxin toxicity. Giving the digoxin could produce a fatal adverse effect, so this is not an appropriate course of action. An ECG is not the initial priority.

The nurse is administering the daily dose of warfarin to a patient being treated for atrial fibrillation. The INR is 3.5. What is the nurse's priority action?

Hold the dose and notify the provider A common therapeutic range for INR is 2.0 - 3.0. Since this result is slightly higher than desired, the nurse should hold the dose and notify the provider. The nurse should also monitor the patient for signs of bleeding, but this is not a priority action.

A provider has ordered captopril for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril in the past. Which action by the nurse is correct?

Hold the dose and notify the provider. Angioedema is a potentially life-threatening reaction to ACE inhibitors. If a patient has exhibited this reaction with any ACE inhibitor, he or she should not receive ACE inhibitors again. The nurse should hold the medication and notify the provider. Lisinopril is an ACE inhibitor and should not be given.

A nurse administers an ACE inhibitor to a patient who is taking the drug for the first time. What will the nurse do?

Instruct the patient not to get up without assistance. Severe hypotension can result with the first dose of an ACE inhibitor. The patient should be discouraged from getting up without assistance. Diuretics can exacerbate hypotension and should be discontinued temporarily when a patient starts an ACE inhibitor. Potassium supplements are contraindicated. A dry cough is an expected side effect that eventually may cause a patient to discontinue the drug; however, it is not a contraindication to treatment.

A patient begins taking an ACE inhibitor and complains of a dry cough. What does the nurse correctly tell the patient about this symptom?

It may be uncomfortable enough that the drug will need to be discontinued. A cough occurs in about 10% of patients taking ACE inhibitors and is the most common reason for discontinuing therapy. It does not indicate a serious condition. It occurs in about 10% of all patients and is more common in women, older adults, and those of Asian ancestry. It does not subside until the medication is discontinued.

Which order for potassium (KCl) would the nurse question?

Potassium chloride, 10 mEq rapid IV push OT now IV potassium should not be infused faster than 10 mEq/hr, so giving it as an IV push is never appropriate.

A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide. Which lab value causes the nurse the most concern?

Potassium level of 3.5 mEq/L This is on the low side of normal for a potassium level and since furosemide is potassium-wasting, the level is likely to get lower after administration. Although this is low level, generally SaO2 levels 90% and above are acceptable. A sodium level of 140 is normal. A blood glucose of 120 is normal.

A patient is admitted to the hospital after several days of vomiting and diarrhea. After an initial bolus of isotonic (0.9%) sodium chloride solution, the prescriber orders dextrose 5% in 1/2 normal saline (D5NS) with 20 mEq potassium chloride to infuse at a maintenance rate. What should the nurse review before implementing this order? (Select all that apply.)

Serum electrolyte levels Electrocardiogram Urine output Correct answers are serum electrolytes, electrocardiogram, and urine output. Serum electrolyte levels should be reviewed to make sure the patient is not already hyperkalemic. Patients receiving potassium should be monitored for cardiovascular toxicity; an ECG before and during administration can help monitor for this adverse effect. Because potassium is excreted via the kidneys, it is important to determine that renal function is intact. Intravenous potassium should never be given if the patient has not voided. Incorrect answers include ABGs and glucose level. Patients who are hyperkalemic can be treated with sodium bicarbonate to increase pH and insulin to promote uptake of potassium by cells, but it is not necessary to evaluate ABGs before administering potassium. Patients who are hyperkalemic can be treated with sodium bicarbonate to increase pH and insulin to promote uptake of potassium by cells, but it is not necessary to evaluate glucose level before administering potassium.

A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question?

Spironolactone Spironolactone is a potassium-sparing diuretic, which would cause this patient's potassium level to increase further. What would have been a better choice? (furosemide)

A patient who does not consume alcohol or nicotine products reports a strong family history of hypertension and cardiovascular disease. The patient has a blood pressure of 126/82 and a normal weight and body mass index for height and age. The nurse will expect to teach this patient about:

The DASH diet, sodium restriction, and exercise This patient has prehypertension without other risk factors. Lifestyle changes are indicated at this point. If blood pressure rises to hypertension levels, other measures, including drug therapy, will be initiated. Calcium and potassium supplements are not indicated.

A prescriber orders transdermal clonidine for a patient with hypertension. What will the nurse teach this patient?

To change the patch every week Transdermal patches are to be changed every 7 days. The patch should be applied to intact, hairless skin on the upper arm or torso. Medication administered by patch has the same therapeutic effect and adverse effects as that given by other routes, except that localized skin reactions may occur and are common with clonidine patches.

a nurse is caring for a client who has a new prescritption for digoxin and takes multiple other meds. the nurse recognize that concurrent use of which fo the following meds places the client at risk for digoxin toxicity? a. phytoin b. verapamil c. warfarin d. aluminum hydroxide

b. verapamil - ccb can cause inc digoxin levels, if given concurrently digoxin might be dec and nurse should monitor dig levls carefully

Which of the following is an antidote for a warfarin overdose?

Vitamin K Because warfarin is a vitamin K antagonist, any consumption of vitamin K from dietary sources can affect INR levels and reduce the anticoagulant effects of warfarin. Vitamin K can also be given IV if needed to treat an overdose. In case of aspirin overdose, sodium bicarb can help to eliminate aspirin through the urine (because high urine ph increases the excretion of aspirin). The antidote if heparin overdose occurs is protamine sulfate given IV.

A patient has had blood pressures of 150/95 and 148/90 mm Hg on two separate office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient's diagnostic tests are all normal. The nurse will expect this patient's provider to order:

a thiazide diuretic This patient has primary, or essential, hypertension as evidenced by systolic pressure greater than 140 and diastolic pressure greater than 90, along with normal tests ruling out another primary cause. Thiazide diuretics are first-line drugs for hypertension. Loop diuretics cause greater diuresis than is usually needed and so are not first-line drugs. This patient should be counseled on lifestyle changes as an adjunct to drug therapy but should also begin drug therapy because hypertension already exists. Beta blockers are effective but are most often used to counter reflex tachycardia associated with reduced blood pressure caused by therapeutic agents.

a nurse is teaching a client who has a new prescription for digoxin to treat heart failure. which of the following instrucciones should the nruse include? a. contact provider if hr is less than 60 b. check pulse rate for 30s and multiply by 2 c. inc intake of sodium d. take w food if nausea occurs

a.

a nurse is providing teaching to a client who has a new prescription for digoxin. the nurse should instruct the client to monitor and report which of the following adv effects that is a manifestation of digoxin toxicity? a. fatigue b. constipation c. anorexia d. rash e. blurred vision

a. c. e.

a nursing is planning care for a client who is receiving furosemide iv for peripheral edema. which of the following interventions should the nurse include in the plan of care? a. assess for tinnitus. b. report urine output 50mL/hr c. monitor blood potassium levels d. elevate the head of the bed slowly before ambulation e. recommend eating a banana daily

a. an adverse effect of furosemide is ototoxicity. manifestiations of tinnitus should be reported to the provider. c. a decrease in blood postassium levels is an adv effect of furosemide, and the provider should be contacted. d. slowly elevating the hob will prevent the client from developing orthostatic hypotension, which is a manifestation of hypovolemia. e. a banana is high in potassium. encourage the client to eat foods high in potassium to prevent hypokalemia. a urine output of 50mL/hr is within the expected reference range. less than 30 indicated dehydration, notify the provider

a nurse is teaching a client who has angina pectoris and is learning how to treat acute anginal attacks. the clinets asks, what is my next step if i tak eone table, wait 5 mins, but still have anginal pain? which of the following responses should the nurse make? a. take two more sublingual tabs at the same time b. cal the emergency response team c. take a sustained-release nitroglycerin capsule d. wait another 5 mins then take a second sublingual tablet

a. if the first tab does not work, the client could be having an mi, the chlient can take a thrid tab if the scond one has not relieved the pin after waiting an additional 5 mins

a nurse is teaching a client who has an new prescription for verapamil to control ypertension. which of the following instructions should the nurse include? a. inc amt of fiber in diet b. drink grapefruit juice daily to inc vit c intake c. dec amt calcium in diet d. withhold food for 1 hr after med is taken

a. increasing dietary fiber intake can help prevent constipation, an adv effect avoid grapefruit juice causes toxicitiy, no calcium restriction or food

a nurse is reviewing the health record of a client who asks about using propranolol to treat hypertension. the nurse should recognize which of the following conditions is a contraindication for taking propranolol? a. asthma b. glaucoma c. hypertension d. tachycardia

a. it's a nonselective beta blocker that blocks both beta 1 & 2 receptors. blockade of beta 2 recpetors in the lungs causes bronchoconstricton can treat tachycardia, contraindicated in bradycardia

a nurse is providing information to a client who has a new prescription for hydrochlorothiazide. which of the following information whould the nurse include? a. take the med with food b. plan to take the med at bedtime c. expect inc swelling of the ankles d. fluid intake should be limited in the morning

a. the client should take hydrochlorothiazide with or after meals to prevent gi upset -take in morning or no later than 1400, to prevent nocturia, expect dec swelling of the ankles, maintain an adequate fluid intake (1500mL) throughout the day unless contraindicated

a nurse is an acute care facility is caring for a client who is receiving iv nitroprusside for htn crisis. which of the following conditions should the nurse monitor the client for as an adv effect of this med? a. intestinal ileus b. neutropenia c. delirium d. hyperthermia

c. delirium and other mental status changes can occur in thiocyanate toxicity when iv nitroprusside is infused at a high dosage . monitor thiocyanate level during therapy to remian below 10 mg/dL -headache, bradycardia, hypotension are also adv effects

A patient who has taken warfarin for a year begins taking carbamazepine. The nurse will anticipate an order to:

increase the dose of warfarin Carbamazepine is a powerful inducer of hepatic drug-metabolizing enzymes and can accelerate warfarin degradation. The warfarin dose should be increased if the patient begins taking carbamazepine. Not only is PTT the wrong lab for warfarin, It is not necessary to perform more frequent PTT monitoring. It not necessary to add extra vitamin K. It is not necessary to change to heparin, plus thi medication cannot be given as an outpatient.

A patient with heart failure who has been taking an ACE inhibitor, a thiazide diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the nurse will expect the provider to evaluate:

serum electrolyte levels Patients taking thiazide diuretics can develop hypokalemia, which can increase the risk for dysrhythmias; therefore, the serum electrolyte levels should be monitored closely. A complete blood count is not recommended. The patient's quality of life and ability to participate in activities should be monitored, routine measurement of the ejection fraction and maximal exercise capacity is not recommended.