Pharm Reading Quizzes

Which of the following medication is the only adrenergic neuron-blocking agent available that causes depletion of norepinephrine from postganglionic sympathetic neurons. A. Clonidine B. Methyldopa C. Reserpine D. Guanabenz

C, reserpine (Rationale: On page 177 in Lehne, reserpine causes depletion of NE from postganglionic sympathetic neurons.)

Which of the following is NOT one of the four main goals of Stage C heart failure management? A. Improvement of functional status and quality of life. B. Prolongation of life. C. Speed up the progression of cardiac remodeling. D. Relief of pulmonary and peripheral congestion.

C, speed up the progression of cardiac remodeling

First generation antipsychotics have the ability to block which of the following receptor types? [Select all that apply] A. Dopamine. B. Serotonin. C. Acetylcholine. D. Histamine. E. Norepinephrine

A, C, D, E (Rationale: Lehne page 333: The FGAs block a variety receptors within and outside the CNS. To varying degrees, they block receptors for dopamine, acetylcholine, histamine, and norepinephrine. There is little question that blockade at these receptors is responsible for the major adverse effects of the antipsychotics. However, because the etiology of the psychotic illness is unclear, the relationship of receptor blockade to therapeutic effects can only be guessed.)

A nurse is teaching a patient about a medication that alters sympathetic nervous system functions. To evaluate understanding, the nurse asks the patient to describe which functions the sympathetic nervous system regulates. Which answer indicates the need for further teaching? A. "The digestive functions of the body." B. "The cardiovascular system." C. "The fight-or-flight response." D. "Body temperature."

A (The digestive functions of the body)

The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? A. "I will be sure to change positions slowly, especially from sitting to standing" B. "I must be sure to increase fiber in my diet" C. "This medication will help reduce my frequent urination" D. "This medication will cause my heart rate to slow down significantly"

A, "I will be sure to change positions slowly, especially from sitting to standing" (Rationale: Vasodilators may cause postural hypotension and reflex tachycardia.)

Mr. Dow works the evening shift and the physician orders that a medication must be taken three times a day on an empty stomach. He asks you if he can take his evening dose with supper due to convenience. How should you respond? A. "Food may slow the absorption of the drug." B. "Food may increase the effectiveness of the drug." C. "It does not matter if the drug is taken on a full or empty stomach." D. "If it is only one meal, food will not make a difference."

A, "food may slow the absorption of the drug" (Rationale: On page 31 within Lehne factors that can influence absorption include 1) solubility and stability of the drug, 2) gastric and intestinal pH, 3) gastric emptying time, 4) food in the gut, 5) co-administration of other drugs, and 6) special coatings on the drug preparation.)

A nurse is caring for an adolescent patient who asks about the cause of his frequent constipation. What is the best response from the nurse? A. "You may not be eating enough fiber for the stools to leave your intestine easily." B. "Your colon is not fully developed so constipation will be a frequent problem until you're an adult." C. "Excessive coffee consumption can lead to constipation." D. "You drink too many smoothies and they can make you constipated."

A, "you may not be eating enough fiber for the stools to leave your intestine easily"

What are the four phases of pharmacokinetics that a drug goes through? A. Absorption, distribution, metabolism, and excretion. B. Absorption, distribution, ionization, and metabolism. C. Diffusion, bioavailability, metabolism, and excretion. D. Active transport, ionization, diffusion, and excretion.

A, Absorption, distribution, metabolism, and excretion (Rationale: On page 24 within Lehne it states there are four basic pharmacokinetic processes: absorption, distribution, metabolism, and excretion.)

The patient has been taking aspirin long term after having a previous myocardial infarction 5 years ago. Which adverse effects should the nurse teach the patient to report? [Select all that apply]. A. Bleeding of the gums B. Black, tarry stools C. increased urinary output D. Diaphoresis

A, B

Muscarinic acetylcholinergic stimulation might have this effect(s) on organs if activated: [SELECT ALL THAT APPLY] A. Decreased heart rate B. Sweating C. Slowed GI motility D. Dilation of the eye

A, B (Rationale: Acetylcholine is the predominant neurotransmitter in the peripheral nervous system stimulating muscarinic receptors in both the sympathetic and parasympathetic nervous system. Activation of muscarinic receptors by ACh would result in sweating (sympathetic nervous system) and a decrease in heart rate (parasympathetic system). GI motility is also regulated by ACh acting on muscarinic receptors in the parasympathetic system, but when activated would result in increased motility/peristalsis.)

Neuroleptic Malignant Syndrome (NMS) is a rare, but potentially fatal condition associated with first generation antipsychotics. Fatalities from NMS have dramatically decreased from 30% to 4% due to early identification and treatment. Which of the following are signs/symptoms of NMS? [Select all that apply] A. High fever. B. "Lead pipe" rigidity. C. Fluctuating blood pressure. D. Opisthotonus.

A, B, C (Rationale: Opisthotonus is a hyperreflexive spasm associated with acute dystonia, an EPS that may result from use of first generation antipsychotics. High fever, "lead pipe" rigidity and labile blood pressures are signs of NMS that should be identified quickly and treated.)

Which should the nurse assess to determine whether a patient has metabolic effects from their second generation antipsychotic medication? [Select all that apply]. A. Weight B. Lipid profile C. Fasting Blood Glucose D. Complete Blood count

A, B, C (Rationale: Second generation antipsychotics can cause metabolic effects such as weight gain, diabetes, and dyslipidemia. The nurse should assess weight, blood glucose levels, and lipid levels.)

Laxatives are contraindicated for individuals with which following conditions: [SELECT ALL THAT APPLY] A. Acute surgical abdomen. B. Fecal Impaction. C. Nausea. D. Abdominal cramps. E. Abdominal pain.

A, B, C, D, E

Which of the following contributes to chronic endothelial injury? [SELECT ALL THAT APPLY] A. Hyperhomocystinemia B. Hypertension C. Smoking D. Beta blocker usage E. Immune reactions F. Hyperlipidemia G. Toxins

A, B, C, E, F, G

Which nursing interventions are important when caring for clients receiving IV digoxin? [Select all that apply] A. Monitor the heart rate closely B. Check the blood levels of digoxin C. Administer the dose over 1 minute D. Monitor the serum potassium level

A, B, D

Which side effects are common in second-generation antipsychotic drugs? [Select all that apply]. A. Agranulocytosis B. Anticholinergic effects C. Extrapyramidal symptoms D. Postural hypotension E. weight gain

A, B, D, E (rationale: Common adverse effects of first-generation antipsychotics include sedation and Metabolic Effects: Weight Gain, Diabetes, and Dyslipidemia, orthostatic hypotension (from blocking alpha-adrenergic receptors); and dry mouth, blurred vision, urinary retention, constipation, and tachycardia (from blocking muscarinic cholinergic receptors). (Lehne Ch 31, pg 326))

Which of the following are adverse effects associated with Clonidine (Catapres) [SELECT ALL THAT APPLY] A. Rebound hypertension B. Drowsiness C. Increased salivation D. Abuse E. Orthostatic hypotension F. Xerostomia

A, B, D, F (Rationale: Page 175 in Lehne it lists the possible effects of clonidine including drowsiness, xerostomia, rebound hypertension, possible abuse, and CNS effects.)

Calcium channel blockers work by reducing calcium influx into the cells of the heart and blood vessels. Calcium channels are coupled to which type of autonomic nervous system receptors? A. Beta1 B. Beta2 C. Alpha2 D. Alpha1

A, Beta1 (Rationale: Calcium channels are coupled to beta1-adrenergic receptors in the heart. For that reason, calcium channel blockers affect the heart in ways similar to the beta blockers. Both types of drugs cause a decrease in the force of contraction, heart rate, and cardiac impulse conduction.)

The following is a select all that apply question. Of the following drugs listed, which act to lower low density lipoprotein levels? A. Bile-acid sequestrants B. Calcium channel blockers C. Ezetimibe D. Niacin E. HMG-CoA reductase inhibitors (statins)

A, C, D, E

Which of the following are indications to administer a vasodilation medication? [SELECT ALL THAT APPLY] A. Hypertensive crisis B. Bradycardia C. Angina pectoris D. Heart failure E. Myocardial infarction F. Bradycardia G. Essential hypertension

A, C, D, E, G (Rationale: Vasodilators are used for essential hypertension, hypertensive crisis, angina pectoris, heart failure, and MI.)

What are the three approved applications of Clonidine? [Select all that apply] A. Hypertension B. Smoking cessation C. Relief of severe pain D. Managing opioid withdrawal E. Tourette's syndrome F. Management of ADHD

A, C, F (Rationale: According to the Lehne textbook, the approved uses of Clonidine. Investigational uses include managing opioid withdrawal, facilitating smoking cessation, and treating Tourette's syndrome.)

A patient who takes warfarin [Coumadin] is brought to the emergency department stating, "I think I accidentally took too much warfarin." The patient's heart rate is 78 beats per minute and the blood pressure is 120/80 mm Hg. The patient does not have any visible signs of hemorrhage and does not complain of pain. The nurse will anticipate a priority order for which of the following? A. a PT and an INR B. vitamin K (phytonadione). C. a PTT. D. protamine sulfate.

A, a PT and an INR (Rationale: This patient is unclear about whether he took and warfarin in excess. Because his vital signs are stable and there are no apparent signs/symptoms of hemorrhage or distress, labs (PT/INR) should be drawn to determine the current range. Once values are determined, treatment can be administered. If the patient showed signs of hemorrhage or overdose, administration of vitamin K would be warranted.)

A patient develops paroxysmal supraventricular tachycardia (SVT) and is hypotensive. Which medication should the nurse anticipate will be administered? A. Adenosine [Adenocard] B. Phenytoin [Dilantin] C. Amiodarone [Cordarone] D. Lidocaine [Xylocaine]

A, adenosine (adenocard) (Rationale: The drug of choice for terminating paroxysmal SVT is adenosine. Lidocaine is used for ventricular dysrhythmias; amiodarone is used for atrial and ventricular dysrhythmias; and phenytoin is used for digoxin-induced dysrhythmias.)

You are caring for a patient who reports a mild fever, sore throat and nasal congestion. You review the chart and see that the patient is taking clozapine [Clozaril]. It is a priority that the patient is assessed for which condition? A. Agranulocytosis B. Anticholinergic reactions C. Allergy to clozapine D. Failed antipsychotic therapy

A, agranulocytosis (Rationale: Clozapine [Clozaril] can cause potentially fatal agranulocytosis. Regular blood tests are mandatory, and the drug should be reserved for patients who have not responded to other antipsychotics.)

The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising the blood pressure A. Angiotensin II B. Renin C. Angiotensin I D. Angiotensin III

A, angiotensin II (Rationale: Angiotensin II is a potent vasoconstrictor. It participates in all the pathways regulated by the renin-angiotensin-aldosterone system. Angiotensin I is a precursor to angiotensin II; angiotensin III is formed by degradation of angiotensin II and is less potent. Renin catalyzes the conversion of angiotensinogen to angiotensin I)

An antidepressant is prescribed for a depressed older adult client. After 1 week, the client's son expresses concern that there does not seem to be much improvement. How should the nurse respond? A. "Antidepressants require several weeks of therapy before it becomes effective." B. "Antidepressant therapy will be more effective as the physical condition improves." C. "Additional medications may be required before behavioral changes will be observed." D. "Additional time is needed for the medication to become effective because of the prolonged depression."

A, antidepressants require several weeks of therapy before it becomes effective (Rationale: Lehne page 354: with all antidepressants, symptoms resolve slowly. Initial responses develop in 1 to 3 weeks. Maximal responses may not be seen until 12-weeks.)

While heparin and warfarin are both anticoagulatnts, their mechanisms of action differ. The mechanism of heparin inhibits the activity of clotting factors by enhancing _______________________activity, while warfarin inhibits the biosynthesis of coagulation factors that are dependent on the conversion of _______________________. A. antithrombin; vitamin K B. antiplatelet; vitamin K C. prothrombin; vitamin K D. fibrinogen; vitamin K

A, antithrombin; vitamin K (Rationale: "antithrombin; vitamin K" is correct. The mechanism of action of heparin inhibits the activity of clotting factors by enhancing antithrombin activity, while warfarin acts to inhibits biosynthesis of coagulation factors VII, IX, and X and prothrombin which are VITAMIN K DEPENDENT CLOTTING FACTORS. Warfarin does this by inhibiting the enzyme needed to convert vitamin k to its active form.)

A patient is taking zolpidem [Ambien] for insomnia and tells the nurse that a recent telephone bill lists several calls to friends that the patient does not remember making. What is the nurse's next action? A. Ask the patient about any alcohol consumption in conjunction with the benzodiazepine. B. Reassure the patient that this is most likely caused by a paradoxical reaction to the benzodiazepine. C. Tell the patient that this is an example of anterograde amnesia that should be evaluated. D. Contact the prescriber to request an order for a benzodiazepine with a shorter duration.

A, ask the patient about any alcohol consumption in conjunction with the benzodiazepine (Rationale: Lehne pg 387-388: Ambien is a benzodiazepine-like drug that shares the same MOA as benzodiazepines, which can cause anterograde amnesia (impaired recall of events that take place after dosing). If patients complain of forgetfulness, the possibility of drug-induced amnesia should be evaluated.)

An agitated, extremely anxious patient is brought to the emergency department. The prescriber orders a benzodiazepine. The nurse understands that benzodiazepines are used in this clinical situation based on which principle? A. Benzodiazepines have a rapid onset of action. B. Benzodiazepines have a very short half-life. C. Physical dependence is not a risk when taking benzodiazepines. D. Benzodiazepines are known to cure generalized anxiety.

A, benzodiazepines have a rapid onset of action (Rationale: Lehne, pg 385-387: Benzodiazepines are drugs of first choice for acute anxiety. One of the 3 principle indications is for anxiety and anxiolytic effects result from depressing neurotransmission in the limbic system and cortical areas. Benzodiazepines treat acute anxiety and is not a drug that cures the disorder, they can cause physical dependence, and there is a poor correlation between the plasma half-life of the parent drug and the duration of pharmacologic effects.)

A nurse is administering an adrenergic agonist drug that acts on the adrenergic receptors of the sympathetic nervous system. Which response will the nurse expect to see? A. Bronchodilation B. Decreased sweating C. Pinpoint pupils D. Decreased cardiac output

A, bronchodilation (Rationale: Adrenergic agonist drug that acts on the adrenergic receptors of the sympathetic nervous system can lead to bronchodilation. Drugs that activate beta2 receptors in the lungs promote bronchodilation. (Lehne Ch 13))

A patient who has been taking an SSRI tells the nurse that the drug has caused reduced sexual performance, weight gain, and sedation. Based on these ADRs, the nurse will suggest that the patient ask the provider about switching to which drug? A. Bupropion [Wellbutrin] B. Imipramine [Tofranil] C. Isocarboxazid [Marplan] D. Trazodone [Oleptro]

A, bupropion (Wellbutrin) (rationale: Lehne page 368: bupropion does not affect serotonergic, cholinergic, or histaminergic transmission, and does not inhibit MAO. In contrast to SSRIs, bupropion does not cause weight gain or sexual dysfunction. In fact, it appears to increase sexual desire and pleasure, so bupropion has been used to counteract sexual dysfunction in patients taking SSRIs and to heighten sexual interest in women with hypoactive sexual desire disorder.)

A patient is receiving norepinephrine 30 mcg/min for treatment of shock. Which assessment finding suggest the patient is experiencing peripheral vasoconstriction from the medication? A. Decreased peripheral pulses. B. Increased cardiac output. C. Increase in body temperature. D. Drop in blood pressure.

A, decreased peripheral pulses

A nurse is planning care for a patient who has peptic ulcer disease and is taking amoxicillin [Amoxil]. The nurse is aware that the action of this medication is which of the following? A. Disruption of the bacterial cell wall, causing lysis and death B. Selective blockade of parietal cell histamine2 receptors C. Inhibition of an enzyme to block acid secretion D. Coating of the ulcer crater as a barrier to acid

A, disruption of the bacterial cell wall, causing lysis and death (Rationale: Amoxicillin disrupts the cell wall of H. pylori, which causes lysis and death. Inhibition of an enzyme to block acid secretion is a function of the proton pump inhibitors (PPIs). Coating of the ulcer crater as a barrier to acid is an action of sucralfate [Carafate]. Selective blockade of parietal cell histamine2 receptors is an action of the histamine2 receptor antagonists cimetidine, ranitidine, famotidine, and nizatidine.)

A primary healthcare provider prescribes 0.25 mg of diazepam [Valium] by mouth three times a day for a client with anxiety and physical symptoms related to work pressures. For what most common side effect of this drug will the nurse monitor the client? A. Drowsiness B. Bradycardia C. Agranulocytosis D. Tardive Dyskinesia

A, drowsiness (Rationale: Diazepam, a benzodiazepine, potentiates the actions of gamma-aminobutyric acid, enhances presympathetic inhibition, and inhibits spinal polysynaptic afferent pathways. Drowsiness, dizziness, and blurred vision are common side effects. Diazepam may cause tachycardia, not bradycardia. Agranulocytosis is usually a side effect of the antipsychotics in the phenothiazine, not the benzodiazepine, group. Tardive dyskinesia occurs after prolonged therapy with antipsychotic medications; diazepam is an antianxiety medication, not an antipsychotic.)

A nurse is caring for a client who has a prescription for bethanechol to treat urinary retention. The nurse should recognize that which of the following findings is a manifestation of muscarinic stimulation: A. Excessive perspiration. B. Hypertension. C. Dry mouth. D. Fecal impaction.

A, excessive perspiration (Rationale: Bethanechol is a muscarinic agonist and muscarinic stimulation can result in sweating. Lehne pg 119)

Which of the following is the MOST effective antiplatelet drug class? A. Glycoprotein IIb/IIIa receptor antagonists. B. Direct thrombin inhibitors C. P2Y12 ADP receptor antagonists. D. Aspirin.

A, glycoprotein Ilb/Illa receptor antagonists

The health care provider prescribes epinephrine (adrenalin) to a patient who was stung by several wasps 30 minutes ago. The nurse knows that the primary purpose of this medication for this patient is to: A. Increase a declining blood pressure and dilate constricting bronchi associated with anaphylaxis. B. Counteract the formation of antibodies in response to an invading antigen. C. Increase the number of WBCs produced to fight the primary invader. D. Stop the systemic release of histamine produced by the mast cells

A, increase a declining blood pressure and dilate constricting bronchi associated with anaphylaxis

The nurse is discussing the therapeutic effects of bethanechol (Urecholine) with a patient who is receiving this drug for urinary retention. The nurse understands that bethanechol: A. Increases the contractions of the bladder and structures that promote urination. B. Improves blood flow to the kidneys. C. Increases the amount of urine made in the kidneys. D. Changes in diameter of the urethral opening

A, increases the contractions of the bladder and structures that promote urination (Rationale: In the bladder, muscarinic activation causes contraction of the detrusor muscle and relaxation of the trigone and sphincter; the result is bladder emptying. Lehne pg 120.)

A patient takes a dose of albuterol prior to bedtime. Which effect would the nurse consider normal for this drug: A. Insomnia. B. Tinnitus. C. Sleepiness. D. Urticaria.

A, insomnia

What is the primary reason Lomotil, an antidiarrheal drug, contains atropine in addition to diphenoxylate? A. Its adverse effects limit the abuse of the drug. B. It antagonizes the opiate effects. C. It inhibits gastric acid secretion. D. It relieves pylorospasm.

A, its adverse effects limit the abuse of the drug (Rationale: Atropine, an anticholinergic, is purposefully added to diphenoxylate to deter the abuse of this opioid-based anti-diarrheal. The atropine is dose, dependent and when taken in large quantities, its anticholinergic effects significantly increase making the user very uncomfortable.)

Which cholinergic drug selectively mimics the effects of acetylcholine at muscarinic receptors: A. Muscarinic agonists. B. Ganglionic stimulating agents. C. Cholinesterase inhibitors. D. Muscarinic antagonists.

A, muscarinic agonists (Rationale: The muscarinic agonists, represented by bethanechol, selectively mimics the effects of acetycholine at muscarinic agonists (Lehne pg 118).)

A patient who has gastroesophageal reflux disease (GERD) is taking magnesium hydroxide (milk of magnesia). Which outcome should a nurse expect if the medication is achieving the desired therapeutic effect? A. Neutralized gastric acid B. Increased barrier to pepsin C. Reduced duodenal pH D. Reduced stomach motility

A, neutralized gastric acid (Rationale: Antacids work by neutralizing, absorbing, or buffering gastric acid, which raises the gastric pH above 5. For patients with GERD, antacids can produce symptomatic relief. Increased barrier to pepsin is an effect of sucralfate [Carafate]. Reduced stomach motility is not an effect of milk of magnesia.)

The student nurse is caring for a patient who takes spironolactone [Aldactone] and lisinopril for treatment of heart failure. What finding indicates a potential interaction between these two drugs? A. Potassium level of 5.7 mEq/L. B. Elevated serum lisinopril level. C. Heart rate of 58 beats/min. D. Glucose level of 180 mg/dL.

A, potassium level of 5.7 mEq/L (Rationale: Both spironolactone, a potassium-sparing diuretic, and lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, can increase potassium levels. These agents together do not increase lisinopril levels, lower the heart rate, or raise the blood glucose level.)

Which group of laxatives is the most widely "used and abused" laxatives? A. Stimulant laxatives B. Bulk forming laxatives C. Osmotic laxatives D. Surfactant laxatives

A, stimulant laxatives

What is the goal of pharmacologic therapy in the treatment of Parkinson's disease? A. To balance cholinergic and dopaminergic activity in the brain B. To increase the amount of acetylcholine at the presynaptic neurons C. To reduce the amount of dopamine available in the substantia nigra D. To block dopamine receptors in presynaptic and postsynaptic neurons

A, to balance cholinergic and dopaminergic activity in the brain (Rationale: Parkinson's disease results from a decrease in dopaminergic (inhibitory) activity, leaving an imbalance with too much cholinergic (excitatory) activity. With an increase in dopamine, the neurotransmitter activity becomes more balanced, and symptoms are controlled.)

The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? A. To prevent reflex tachycardia B. To reduce the risk of developing headaches C. To prevent heart failure D. To improve hypotensive effects

A, to prevent reflex tachycardia (Rationale: Hydralazine is a vasodilator that lowers blood pressure, but it also can trigger reflex tachycardia. Beta blockers, such as propranolol, are added to the regimen to normalize the heart rate.)

All patients with gastric or duodenal ulcers and confirmed infection with H. pylori should be treated with antibiotics in combination with an anti secretory agent. A. True B. False

A, true

Misoprostol is contraindicated for use during pregnancy as it is classified in FDA Pregnancy Risk Category X. A. True B. False

A, true

The blood-brain barrier can protect the CNS from toxic substances, but can also block entry of medicines into the CNS. A. True B. False

A, true

The goal of peptic ulcer disease therapy is to alleviate symptoms, promote healing, prevent complications, and prevent recurrence. A. True B. False

A, true

The principle indication for amphetamines is ADHD. A. True B. False

A, true

Through actions in the CNS, amphetamines can increase wakefulness and alertness, reduced fatigue, elevate mood, stimulate respiration, and suppress appetite. A. True B. False

A, true

Calcium channel blockers cause vasodilation that can cause dizziness, headaches, and peripheral edema. A. True B. False

A, true (Rationale: pg 491)

In blood vessels, calcium entry increases the heart rate, AV conduction, and myocardial contractility, so calcium channel blockade will have an opposite effect. A. True B. False

A, true (Rationale: pg 491)

The autonomic nervous system regulates arterial pressure by the ANS, the RAAS, the kidneys, and natriuretic peptides. A. True B. False

A, true (Rationale: pg. 469)

Starling's law of the heart states that force of ventricular contraction is proportional to muscle fiber length. A. True B. False

A, true (rationale: pg. 466)

Which condition do the natriuretic peptides serve to protect the cardiovascular system? A. Volume overload B. Hypotension C. Myocardial infarction D. Hypovolemia

A, volume overload

Match the following drug with the appropriate drug class. (Antibacterial drug, H2 receptor antagonist, proton pump inhibitors, mucosal protectant, anti-secretory agent to enhance mucosal defenses, antacids) A. Misoprostol [Cytotec] B. Famotidine [Pepcid] C. omeprazole [Prilosec] D. Bismuth [Pepto-Bismol] E. Sucralfate [Carafate] F. Aluminum hydroxide

Antibacterial drug: D H2 receptor antagonist: B Proton pump inhibitors: C Mucosal protectant: E Anti-secretory agent to enhance mucosal defenses: A Antacids: F

A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication? A. Heparin B. Clopidogrel [Plavix] C. Aspirin D. Enoxaparin [Lovenox]

D, enoxaparin (lovenox)

Match the following vessels with the corresponding function. (Arteries, Arterioles, Capillaries, Venules, Veins) A. Transport blood under high pressure to tissues B. Sites for the exchange of fluid, oxygen, carbon dioxide, nutrients, hormones, and waste. C. Transport blood back to the heart and serve as a major reservoir for blood D. Collect blood from capillaries E. Control valves that regulate local blood flow

Arteries: A Arterioles: E Capillaries: B Venules: D Veins: C

A client who is feeling lonely and who is extremely depressed has been prescribed a tricyclic antidepressant. The client asks the nurse, "how will this medication help me feel better?" What is the nurse's best response: A. "This drug will help you forget why you're lonely and depressed." B. "The medication could increase your appetite and elevate your mood." C. "You'll start to feel much better after taking this medication for 2 or 3 days." D. "You will feel less depressed when you take this with a monoamine oxidase inhibitor."

B, "The medication could increase your appetite and elevate your mood" (Rationale: Lehne page 363: TCAs are effective agents for major depression. These drugs can elevate mood, increase activity and alertness, decrease morbid preoccupation, improve appetite, and normalize sleep patterns.)

A female patient who takes a benzodiazepine, lorazepam [Ativan], for anxiety tells the nurse that she plans to become pregnant. What is the best instruction for the nurse to give the patient? A. "Eat a well-balanced diet that includes milk." B. "Discuss tapering the drug with the provider before conception." C. "Stop taking the drug and form another plan to manage anxiety." D. "Visit an obstetrician to determine the correct dose of lorazepam during pregnancy."

B, "discuss tapering the drug with the provider before conception" (Rationale: Lorazepam is Pregnancy Risk Category D, so the nurse instructs should instruct the patient to taper therapy as a means of avoiding the adverse effects of withdrawal and to prevent fetal harm. Therapy must be stopped before conception because benzodiazepines are lipid soluble and cross the placenta thereby, increasing the risk of fetal harm. To promote fetal development, the nurse instructs would instruct the patient to visit an obstetrician for folic acid and prenatal vitamin prescriptions and to eat a well-balanced diet. To help prevent a crisis, the nurse instructs would instruct the patient to develop an alternative plan for managing anxiety with the assistance of a primary health carehealthcare provider.)

A patient who uses over-the-counter phenylephrine nasal spray asks the nurse how the medication works. The nurse's response would be: A. "It coats the nasal passages to reduce swelling." B. "It helps to shrink the swelling in your nose by tightening the blood vessels there." C. "It works to locally destroy invading organisms that cause colds and flu." D. "It is absorbed after you swallow it to act as a decongestant."

B, "it helps to shrink the swelling in your nose by tightening the blood vessels there"

A patient with Type II DM is diagnosed with schizophrenia and the provider prescribes a first generation antipsychotic. The nursing student asks the nurse why the provider hasn't ordered a second generation antipsychotic like olanzapine [Zyprexa]. Which response by the nurse is the most important reason that this patient is not receiving olanzapine [Zyprexa]? A. "Thioridazine has a faster onset of action than olanzapine." B. "Olanzapine causes more metabolic side effects than thioridazine." C. "Olanzapine is more expensive than thioridazine." D. "Thioridazine has fewer side effects than olanzapine."

B, "olanzapine causes more metabolic side effects than thioridazine" (Rationale: Second generation antipsychotics can cause a group of closely linked metabolic effects—obesity, diabetes, and dyslipidemia—all of which increase the risk of cardiovascular events. Patients with documented diabetes at treatment onset should be monitored for worsening of glucose control due to the drug. (Lehne Ch 31, pg 326))

A nurse is teaching a patient about a medication that alters sympathetic nervous system functions. To evaluate understanding, the nurse asks the patient to describe which functions the sympathetic nervous system regulates. Which answer indicates the need for further teaching? A. "The fight-or-flight response." B. "The digestive functions of the body." C. "The cardiovascular system." D. "Body temperature."

B, "the digestive functions of the body" (Rationale: The sympathetic nervous system has three main functions: Regulating the cardiovascular system, Regulating body temperature and Implementing the acute stress response ("fight-or-flight" response). (Lehne Ch 13))

A nursing student who is preparing to care for a postoperative patient with deep vein thrombosis asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct? A. "Heparin has fewer adverse effects." B. "The onset of warfarin is delayed." C. "Heparin has a longer half-life." D. "Warfarin prevents platelet aggregation."

B, "the onset of warfarin is delayed) (Rationale: Warfarin in some ways is similar to heparin. Like heparin, warfarin is used to prevent thrombosis. However, warfarin has a delayed onset, which makes it inappropriate for emergencies or situations where it is necessary to prevent thrombosis such as in post operative patients who are at an increased risk.)

The patient will be taking anticholinergic medications following discharge from the healthcare agency. Which statement, made by the patient, would indicate that additional teaching is needed? A. "I will avoid activities requiring mental alertness until I know the effects of this drug." B. "The use of lubricating eyedrops should be avoided. I should see an eye doctor for dry eyes." C. "To relieve dry mouth, I should drink plenty of water." D. "I will not breastfeed while taking this drug without consulting my healthcare provider."

B, "the use of lubricating eyedrops should be avoided. I should see an eye doctor for dry eyes" (Rationale: Anticholinergics typically cause dry eyes and the patient should be encouraged to use lubricating eyedrops. Lehne pg 118.)

Which is a normal lab range for digoxin? A. 0.1 - 5 ng/mL B. 0.5 to 0.8 ng/mL C. 0.7 - 3 ng/mL D. 0.5 - 4 ng/mL

B, 0.5-0.8 ng/mL

Which of the following are principal indications for administering a beta blocker? A. Hypotension B. Heart failure C. Bradycardia D. Angina E. Hypertension F. Cardiac dysrhythmias

B, C, D, E, F

Which of the following are considered defensive factors that serve to protect the stomach and duodenum from self-digestion? [SELECT ALL THAT APPLY] A. NSAIDs B. Mucus C. Blood flow D. Prostaglandins E. H. pylori F. Bicarbonate

B, C, D, F

Which of the following are major adverse effects of alpha blockers? [SECLET ALL THAT APPLY] A. Hypertension B. Inhibition of ejaculation C. Orthostatic hypotension D. Reflex bradycardia E. Nasal congestion

B, C, E (Rationale: Page 160-161 in Lehne states the adverse effects of alpha blockers.)

Which of the following are potential adverse effects of Reserpine? [SELECT ALL THAT APPLY] A. Lethargy B. Bradycardia C. Ulcer formation D. Hypertension E. Depression F. Euphoria

B, C, E (Rationale: Page 177 in Lehne lists the adverse effects of Reserpine.)

The nurse is administering digoxin (Lanoxin) to a client diagnosed with congestive heart failure. Which intervention should the nurse implement? (Select all that Apply) A. Assess the client's carotid pulse for 1 full minute. B. Check the client's current potassium level. C. Teach the client to stand up quickly from a sitting position. D. Have the client squeeze the nurse's fingers. E. Ask the client if he or she is having visual disturbances.

B, E

Complete the equation: Cardiac output = Volume of blood ejected at each heartbeat × ____. A. Stroke volume B. Heart rate C. Preload D. Afterload

B, Heart rate (Rationale: The amount of blood ejected with each heartbeat is known as the stroke volume. To determine the cardiac output, multiply the stroke volume by the number of beats per minute.)

When used in combination with certain foods and drugs, monoamine oxidase inhibitors (MAOIs) can cause serious side effects. Which condition could occur in clients treated with MAOIs for depression when taken in combination with certain drugs or when eating certain foods high in tyramine? A. A serious drop in blood pressure B. A serious increase in blood pressure C. A significant increase in liver enzymes D. A significant increase in cholesterol levels

B, a serious increase in blood pressure (Rationale: Hypertensive crisis can occur from dietary tyramine, indirect-acting sympathomimetic agents, and tricyclic antidepressants. MAOIs can interact with many drugs to cause potentially harmful results.)

The amount of active drug that reaches the systemic circulation from its site of administration: A. Distribution. B. Bioavailability. C. Maintenance Dose. D. Therapeutic Dose.

B, bioavailability (Rationale: On page 76 of Lehne it states the term bioavailability refers to the amount of active drug that reaches the systemic circulation from its site of administration.)

Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]? A. Peripheral pulses B. Blood pressure C. Respiratory rate D. Capillary refill

B, blood pressure (Rationale: Postural hypotension is a potential adverse effect for taking a vasodilator. If someone's blood pressure is low to begin with, the drug could lower it even further, potentially to dangerous levels, which can also lead to an increased risk of falls. Before giving any drug that vasodilates, you should always check blood pressure to be sure it is still an appropriate drug to give.)

A nurse is administering Digoxin to a heart failure patient and notes that the patient is also receiving furosemide [Lasix]. The nurse anticipates several possible adverse effects. Which is the most concerning potential adverse effect? A. Vomiting B. Cardiac dysrhythmias C. Bradycardia D. Fatigue

B, cardiac dysrhythmias

A patient is prescribed an ACE-inhibitor, lisinopril [Prinvil], as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug? A. Potassium level of 4.2 B. Crackles in bilateral lower lung fields are no longer appreciated C. Presence of jugular vein distention D. Edema in bilateral lower legs

B, crackles in bilateral lower lung fields are no longer appreciated (Rationale: Because ACE inhibitors promote venous dilation, they provide the therapeutic effect of reducing pulmonary congestion and peripheral edema. Absence of previously heard crackles would be an indicator of effectiveness. Edema and jugular vein distention are manifestations of heart failure. A potassium level of 3.5 mEq/L is a normal value.)

A patient is prescribed lisinopril [Prinivil] 40 mg by mouth once a day for hypertension. For which therapeutic effect will the nurse monitor? A. Slowing of the heart rate B. Decrease in blood pressure C. Dizziness and fainting D. Pulse oximetry of 100%

B, decrease in blood pressure (Rationale: The therapeutic effect of ACE inhibitors is to reduce blood pressure in patients with hypertension. ACE inhibitors do not affect patients' heart rate. Dizziness and fainting are symptoms of hypotension. ACE inhibitors do not affect oxygen saturation)

Combining levodopa with a nonelective MAO inhibitor can result in severe hypotension. A. True B. False

B, false

Hydralazine elects its therapeutic effect by causing selective dilation of veins. A. True B. False

B, false (Rationale: Hydralazine causes selective dilation of arterioles. Page 498)

H2 receptor antagonists are most effective inhibitors of acid secretion. A. True B. False

B, false (Rationale: PPIs are the most effective inhibitors of acid secretion and are considered first line drugs in the treatment of PUD..)

The nurse is caring for a patient with hepatitis and resulting hepatic impairment. The nurse would expect the duration of action for most medications to: A. Be unaffected. B. Increase. C. Improve. D. Decrease.

B, increase (Rationale: The length of time a drug concentration remains in the therapeutic range is its duration of action. Patients with hepatic impairment do not effectively metabolize drugs, which increases the duration of action. (see Lehne page 35).)

What is the primary therapeutic benefit of spironolactone [Aldactone] in a patient with heart failure? A. Stimulation of the renin-angiotensin-aldosterone system. B. Inhibition of potassium loss. C. Substantial increase in diuresis. D. Inhibition of beta activation by norepinephrine.

B, inhibition of potassium loss (Rationale: Spironolactone is a potassium-sparing diuretic that has been shown to prolong survival in patients with heart failure. It has only weak diuretic properties. The primary benefit of this drug is it's ability to prevent potassium loss in patients taking diuretics.)

A client has become increasingly depressed and is prescribed an antidepressant. After a few months of therapy, the client returns to the clinic and appears relaxed and smiles at the nurse. The most significant conclusion that the nurse can draw from this behavior is that the client: A. May be in denial of any problems. B. Is responding to the antidepressant therapy. C. Has resolved any conflicts. D. Wants to please the staff.

B, is responding to the antidepressant therapy (Rationale: Lehne page 354 & 356: with all antidepressants, symptoms resolve slowly. Initial responses develop in 1 to 3 weeks. Maximal responses may not be seen until 12-weeks. Once a drug has been selected for initial treatment, it should be used for 4 to 8 weeks to assess efficacy.)

The peak effect of warfarin (Coumadin) is not achieved for several days after treatment is initiated. This long delay occurs because warfarin has a very long half-life and: A. Loading doses are required to stimulate its effects. B. It has no effect on existing clotting factors. C. 99% of the drug is protein bound. D. It interacts with many other drugs.

B, it has no effect on existing clotting factors (Rationale: Although warfarin acts quickly to inhibit clotting factor synthesis, noticeable anticoagulant effects are delayed because warfarin has no effect on clotting factors already in circulation. Hence, until these clotting factors decay, coagulation remains unaffected.)

Which medication suppresses emesis and increases upper GI motility: A. Methotrexate. B. Metoclopramide (Reglan). C. Ondansetron (Zofran). D. Palifermin (Kepivance).

B, metoclopramide (Reglan) (Rationale: Metoclopramide has two beneficial actions: 1: suppresses emesis by blocking receptors for dopamine and serotonin in the CTZ and 2: increases upper GI motility by enhancing the actions of acetylcholine.)

Which of the following is a major adverse effect of HMG-CoA reductase inhibitors (statins)? A. Wheezing and shortness of breath B. Myopathy and rhabdomyolysis C. Chest pain D. Renal failure

B, myopathy and rhabdomyolysis (Rationale: the most severe adverse reactions that may occur with statin usage including myopathies and rhabdomyolysis, hepatotoxicity, new onset diabetes, and cataracts.)

A patient with myasthenia gravis has been receiving neostigmine, a cholinergic agonist, for the past 2 years. The nurse is ready to administer benztropine, a cholinergic antagonist. Which result will likely occur when these drugs are combined? A. Neostigmine will first exhibit a greater effect, followed by a lesser effect. B. Neostigmine will exhibit a lesser effect. C. Neostigmine will exhibit a greater effect. D. Neostigmine will not be affected by the administration of benztropine.

B, neostigmine will exhibit a lesser effect (Rationale: Antagonist bind to receptors and block the effects of an endogenous chemical or another drug by competing with receptor binding sites or inhibiting the drug effect. As an antagonist, benztropine would block the effects of neostigmine and the neostigmine would exhibit a lesser effect - see Agonist, Antagonists, and Partial Agonist descriptions on page 49-50 within Lehne.)

The nurse knows that a drug with a high therapeutic index is: A. Most likely effective. B. Probably safe. C. Frequently risky. D. Often dangerous.

B, probably safe (Rationale: The therapeutic index is the ratio between the therapeutic dose of a drug and the toxic dose and is used as a measure of the relative safety of the drug. The higher the therapeutic index is, the safer the drug. (see page 53 within Lehne))

A patient brought to the emergency department requires sutures. The prescriber orders a local anesthetic with epinephrine. The nurse understands that epinephrine is ordered to: A. prevent hypertension induced by the anesthetic. B. prolong effects and allow a reduced dose of the anesthetic. C. reduce anesthetic-induced nausea. D. reduce the pain of an injection.

B, prolong effects and allow a reduced dose of the anesthetic

Which of the following neurotransmitters is not found in the peripheral nervous system? A. Norepinephrine B. Serotonin C. Epinephrine D. Acetylcholine

B, serotonin (Rationale: see Lehne page 108)

Ki is a 43 year-old baker at Harris Teeter. She has been followed by her primary care provider for depression for the past 4 months and has been doing well on a selective serotonin reuptake inhibitor called fluoxetine. However, one issue arises during her visit that provides a clue that she's experiencing a common side effect of fluoxetine. Which side effect do you suspect: A. She describes that she is uninterested in sex with her husband. B. She has gained about 7 pounds. C. She states that she has a pounding headache after she drinks red wine. D. She has a resting tremor.

B, she has gained about 7 pounds (Rationale: Lehne page 358: like many other antidepressants, fluoxetine and other SSRIs cause weight gain. During the 1st few weeks of therapy patients lose weight; however, with long-term treatment, the lost weight is regained.)

Activation of muscarinic receptors can produce the following: A. Vasoconstriction. B. Slowing of the heart rate. C. Slowing down of the GI tract. D. Rapid heart rate

B, slowing of the heart rate (Rationale: Activation of muscarinic receptors can produce the following: ocular effects (miosis and ciliary muscle contraction, slowing of the heart rate, bronchial constriction, urination, glandular secretion, stimulation of the GI tract, and vasodilation (Lehne pg 119).)

You are caring for a patient who reports taking an oral bisacodyl laxative [Dulcolax] for several years. The provider has suggested discontinuing the laxative, but the patient is unsure how to do this. You will plan on telling the patient to: A. "Stop taking the oral laxative and use a suppository until normal motility returns." B. "Stop taking the laxative immediately and expect no stool for several days." C. "Switch to a bulk-forming laxative instead." D. "Withdrawal from taking the laxative slowly to avoid rebound constipation."

B, stop taking the laxative immediately and expect no stool for several days (Rationale: The first step in breaking the laxative habit is abrupt cessation of laxative use. Bowel movements will be absent for several days after laxative withdrawal. Using a suppository, a bulk-forming laxative, or tapering the laxative only prolongs the habit and prevents normal function from returning.)

The student nurse is explaining the adverse effects of niacin including flushing of the face, neck, and ears. What advise can the student nurse give to reduce this adverse effect? A. Crush the tablet and dissolve in fruit juice B. Take 325 mg of aspirin 30 minutes prior to taking niacin C. Take the tablet with food D. Take 975mg of Tylenol prior to taking niacin

B, take 325 mg of aspirin 30 minutes prior to taking niacin (rationale: t instructing patients to take 325mg of aspirin prior to taking niacin can reduce flushing of hands, face, and ears in most patients.)

A patient has been prescribed an albuterol inhaler to take if needed for shortness of breath and wheezing. The patient informs the nurse that the medication causes feelings of nervousness after each use. What is the nurse's best response: A. You should stop taking the medication until we speak to your provider. B. This is a normal side effect of this medication. C. This is a severe side effect of the medication and you should stop taking it immediately. D. The nervousness side effect only happens when you start taking the medication and with continued use, you should not have these symptoms anymore.

B, this is a normal side effect of this medication

A patient is to receive a beta agonist. Before administration of this medication, which assessment finding would most concern the nurse? a. Pulse Oximetry reading of 88% b. heart rate of 110 bpm c. respiratory rate of 22 breaths/min d. blood pressure of 100/60 mmHg

B. Heart rate of 110 bpm (Rationale: A beta agonist will bind with the beta 1 receptors of the heart to further increase heart rate. This patient is already tachycardic and further increase could lead to a life-threatening, cardiac event)

The nurse is teaching a patient with attention-deficit/hyperactivity disorder (ADHD) about his prescription for methylphenidate [Ritalin LA]. Which statement by the patient indicates that the teaching was effective? A. "I will take this medication right before my evening meal." B. "I will chew this medication and take it with my ice cream." C. "I will take my medication once per day in the morning." D. "I will use an alarm to remind me to take this medicine 3 times daily."

C, "I will take my medication once per day in the morning" (Rationale: Ritalin LA is an extended-release formulation designed to be taken once daily. It should be taken in the morning and should not be crushed or chewed.)

A nurse is administering an adrenergic agonist drug that acts on the Beta 2 receptors of the sympathetic nervous system. Which response will the nurse expect to see? [Select all that apply] A. Tachycardia B. Decreased sweating C. Uterine relaxation D. Bronchodilation E. Increased blood glucose

C, D, E (Rationale: Bronchodilation, uterine relaxation and increased blood glucose are correct. Beta 2 receptors are part of the sympathetic nervous system and located on the lungs, uterus, liver and some blood vessels. These are only stimulated by epinephrine or drugs that mimic epinephrine, and when stimulated result is bronchodilator, uterine relaxation and glycogenolysis.)

What does the medical terminology enteral mean? A. Medication is given intravenously. B. Medication is given subcutaneously. C. Medication is given orally or through a gastric tube. D. Medication is given intramuscular.

C, Medication is given orally or through a gastric tube (Rationale: On pages 30 & 31 in Lehne is states that the enteral route refers to the oral (PO) route that also includes drugs that are absorbed from the stomach, intestine, or both.)

PR has been taking digoxin (Lanoxin) and two other medications for heart failure for several years. Recently, his primary physician increased his dose of furosemide. This morning PR is being seen in the clinic because, as he says, "The lights seem to have a funny yellow halo around them today and I'm really nauseous." What is your first suspicion? A. PR is experiencing an exacerbation of heart failure. B. Digoxin and furosemide interact to create vision changes and GI upset. C. PR is likely to be experiencing digoxin toxicity. D. The dose of furosemide is too high and PR is experiencing side effects of this drug.

C, PR is likely to be experiencing digoxin toxicity

Which of the following patients should the student nurse question administering a beta2 blockade to? A. A 32 year-old with chest pain B. A 44 year-old patient with hypertension C. A 74 year-old male with asthma D. A 69 year-old with atrial fibrillation

C, a 74 year-old male with asthma (Rationale: The student nurse should question administering a beta2 blockade medication to any patient with diabetes or asthma as beta2 blockade medications can cause broncoconstriction and glycogenolysis.)

Class III antiarrhythmic drug may be effective in treating ventricular arrhythmias; prolongs phase 3 (repolarization); potassium channel blocker: A. Metoprolol B. Diltizem C. Amiodarone D. Procainamide

C, amiodarone (Rationale: page 559)

Which statement will the nurse include when teaching a patient about atomoxetine [Strattera]? A. Atomoxetine is a central nervous system stimulant. B. Atomoxetine is not approved for the treatment of adults with attention-deficit/hyperactivity disorder. C. Atomoxetine has no potential for abuse. D. Atomoxetine exerts its therapeutic effect by increasing the release of dopamine.

C, atomoxetine has no potential for abuse (Rationale: Atomoxetine [Strattera] is a nonstimulant drug. It increases the release of norepinephrine, and it is approved for the treatment of adults with attention-deficit/hyperactivity disorder. It has no potential for abuse.)

A client in shock is prescribed a drug to act on dopamine, beta1, and at high doses, alpha1 receptors. The nurse will most likely be administering: A. Dobutamine. B. Milrione. C. Dopamine. D. Pavulon.

C, dopamine

A patient with Parkinson's disease is prescribed pramipexole [Mirapex] along with his levodopa/carbidopa [Sinemet]. Which symptom is most likely a manifestation of an adverse effect of these drugs when given together? A. Wheezing B. Diarrhea C. Dyskinesia D. Headache

C, dyskinesia (Rationale: When pramipexole is combined with the levodopa component in Sinemet, patients are most likely to experience symptoms of dyskinesias, such as dyskinesia (head bobbing) and orthostatic hypotension. The other effects are not common responses to these drugs.)

A nurse is administering an intravenous adrenergic agonist to a patient in the intensive care unit. Which assessment finding would cause the most concern? A. Blood pressure of 100/70 mm Hg B. Headache C. Edema and redness at the IV insertion site D. Increased urine output

C, edema and redness at the IV insertion site

An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide [HydroDIURIL]. Before administering this medication, the nurse reviews the patient's chart. Which laboratory value causes the nurse the most concern? A. Elevated serum potassium level B. Normal blood glucose level C. Elevated creatinine clearance D. Low levels of low-density lipoprotein (LDL) cholesterol

C, elevated creatinine clearance (Rationale: Elevated creatinine clearance is associated with impaired kidney function. For Thiazide diuretics to be effective, effective urine flow is needed since there will be increased excretion of sodium, chloride, potassium and water.)

A nurse is caring for a patient receiving heparin therapy and notes that the patient has a heart rate of 98 beats per minute and a blood pressure of 110/72 mm Hg. A stat CBC shows a platelet count of less than 100,000 mm3 [normal platelet count: 150,000 - 450,000]. The nurse suspects_______________________and will prioritize which action? A. Heparin toxicity; request an order for protamine sulfate. B. Heparin-induced thrombocytopenia; order a repeat stat CBC. C. Heparin-induced thrombocytopenia; discontinue the heparin and notify the provider. D. Heparin toxicity; request an order for vitamin K.

C, heparin-induced thrombocytopenia; discontinue the heparin and notify the provider. (Rationale: Heparin-Induced Thrombocytopenia (HIT): reduced platelet counts and increased thrombotic events, poses a risk of DVT, PE, cerebral thrombosis, MI, and ischemic injury to the arms and legs. Severe thrombocytopenia develops when platelet count falls below 100,000/mm3. Protamine sulfate will not reverse this as it is not related to heparin toxicity. Heparin therapy should be discontinued and the provider should be notified.)

A young adult patient has been taking an antidepressant medication for several weeks and reports having increased thoughts of suicide and a concrete plan for committing suicide. The nurse questions the client and learns that the patient has attempted suicide more than once in the past. The nurse contacts the provider to discuss: A. changing the medication to another drug class. B. discontinuing the medication immediately. C. hospitalizing the patient for closer monitoring. D. requiring more frequent clinic visits for this patient.

C, hospitalizing the patient for closer monitoring (Rationale: Lehne page 356: if the risk of suicide appears high, temporary hospitalization may be the best option. In this case, the client has a concrete plan to carry out the suicide attempt, which puts this client at high risk and further monitoring is imperative.)

A patient is prescribed a sustained-release capsule and asks the nurse if she can open the capsule and pour the medication on her food. What is the nurse's best response: A. "Crushing the capsule versus sprinkling the medication on your food is the best option." B. "Yes, this is completely fine to sprinkle the medication on your food." C. "It is best to swallow the capsule as prescribed because the drug is designed to be released steadily throughout the day." D. "Let me check with your provider and verify if you can sprinkle the capsules on your food."

C, it is best to swallow the capsule as prescribed because the drug is designed to be released steadily throughout the day" (Rationale: On page 33 within Lehne sustained-release formulations are capsules filled with tiny spheres that contain the actual drug; the individual spheres have coatings that dissolve at variable rates. Because some spheres dissolve more slowly than others, the drug is released steadily throughout the day. These formulations have the additional advantage of producing relatively steady drug levels over an extended time.)

The nurse is preparing to administer a dose of clonidine (Catapres). Which is the best description of the action of this drug? A. It depletes sympathetic neurons of norepinephrine B. It causes peripheral activation of alpha1 and alpha2 receptors C. It selectively activates alpha2 receptors in the central nervous system D. It directly blocks alpha and beta receptors in the periphery

C, it selectively activates alpha2 receptors in the central nervous system (Rationale: Clonidine is an alpha2-adrenergic agonist that causes selective activation of alpha2 receptors in the CNS. This in turn reduces sympathetic outflow to the blood vessels and the heart. Although the body's responses are similar to those from a peripheral adrenergic blocker, clonidine's action occurs in the CNS.)

The nurse is caring for a patient with bipolar disorder treated with lithium [Eskalith]. The patient has a new prescription for captopril [Capoten] for hypertension. The combination of these two drugs makes which assessment particularly important? A. Creatinine level B. Potassium level C. Lithium level D. Blood pressure

C, lithium level (Rationale: ACE inhibitors, such as captopril, can cause lithium accumulation. Lithium levels should be monitored on a regular basis. ACE inhibitors can cause hyperkalemia, renal insufficiency in some patients, and hypotension. However, the combination of lithium and captopril would not increase the risk of these effects)

An 80-year-old patient with a history of renal insufficiency recently was started on cimetidine. Which assessment finding indicates that the patient may be experiencing an adverse effect of the medication? A. 3+ pitting edema to bilateral lower extremities B. Painful urination C. New onset altered mental status D. Tachypnea

C, new onset altered mental status (Rationale: Effects on the central nervous system are most likely to occur in elderly patients who have renal or hepatic impairment. Patients may experience confusion, hallucinations, lethargy, restlessness, and seizures.)

The nurse instructs a young adult patient about treatment options for post traumatic stress disorder (PTSD) symptoms. Which drug does the nurse anticipate administering to the patient: A. Bupropion. B. Buspirone. C. Paroxetine. D. Trazodone.

C, paroxetine (Rationale: Lehne pg 404: The SSRIs paroxetine (Paxil) and sertraline (Zoloft) are FDA approved for PTSD. Current evidence does not support the use of mono therapy with bupropion, buspirone, trazodone, or a benzodiazepine.)

SC is a 75-year old white male who has heart failure. He is seen in clinic today, reporting shortness of breath, increased pitting edema, and a 5 pound weight gain over the last two days. His current medications include: losartan and metoprolol. SC has no chest pain and is deemed stable for outpatient treatment. Which of the following actions would you anticipate the provider will do? A. Increase the metoprolol. B. Start hydrochlorothiazide. C. Start furosemide. D. Discontinue losartan.

C, start furosemide (Rationale: SC is having a heart failure exacerbation and increasing a beta blocker would potentially make this worse. Losartan (ARB) is a primary medication in treating HF and there is no reason to change that at this time. Loop diuretics like furosemide are designed to move large volumes of fluid quickly and are preferred in this case given that SC has substantial fluid retention and we would like to prevent/reduce the occurrence of pulmonary edema.)

A patient has been taking high doses of clorazepate, a benzodiazepine, for several months for an anxiety disorder. The nurse assessing the patient observes that the patient is agitated, euphoric, and anxious. What will the nurse do? A. Request an order for a longer-acting benzodiazepine. B. Withhold the next dose until a drug level can be drawn. C. Suspect a possible paradoxical reaction to the clorazepate. D. Double-check the chart to make sure the last dose was given.

C, suspect a possible paradoxical reaction to the clorazepate (Rationale: Lehne pg 387: Benzodiazepines sometimes cause paradoxical responses including insomnia, excitation, euphoria, heightened anxiety, and rage. If these occur, the benzodiazepines should be withdrawn.)

In the failing heart, arterial pressure falls, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. The student nurse understands increased sympathetic activity will produce which response? A. Hypotension B. Hypoglycemia C. Tachycardia D. Bradypnea

C, tachycardia

A client with the diagnosis of schizophrenia is given one of the antipsychotic drugs. The nurse understands that antipsychotic drugs can cause extrapyramidal side effects. Which effect is cause for the greatest concern? A. Acute dystonic reaction B. Parkinsonian syndrome C. Tardive dyskinesia D. Akathisia

C, tardive dyskinesia (Rationale: Tardive dyskinesia, an extrapyramidal response characterized by vermicular movements and protrusion of the tongue, chewing and puckering movements of the mouth, and puffing of the cheeks, is often irreversible, even when the antipsychotic medication is withdrawn. Akathisia, motor restlessness, usually can be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued. Parkinsonian syndrome (a disorder featuring signs and symptoms of Parkinson disease such as resting tremors, muscle weakness, reduced movement, and festinating gait) can usually be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued. Dystonia, impairment of muscle tonus, can usually be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued.)

A selective beta-blocker is prescribed for a patient who is diagnosed with dysrhythmias. The nurse knows that the primary purpose of the drug is? A. To increase the beta1 and beta2 receptors in the cardiac tissues. B. To block the beta 1 & beta 2-adrenergic receptors in the cardiac tissues. C. To block the beta1-adrenergic receptors in the cardiac tissues. D. To increase the flow of oxygen to the cardiac tissues.

C, to block the beta1-adrenergic receptors in the cardiac tissues (Rationale: Lehne page 558: Blockade of cardiac beta1 receptors attenuates sympathetic stimulation of the heart.)

The nurse is caring for a patient receiving propranolol [Inderal]. Which clinical finding is most indicative of an adverse effect of this drug? A. Urinary urgency B. A glucose level of 180 mg/dL C. Wheezing D. A heart rate of 100 beats/min

C, wheezing (Rationale: Beta blockers, such as propranolol, are known to cause bronchoconstriction, which could manifest as wheezing. Other adverse effects could include bradycardia, atrioventricular heart block, heart failure, rebound cardiac excitation, inhibition of glycogenolysis, and potential central nervous system effects.)

Which term defines the time required for the serum concentration of a drug to decrease by 50%? A. Mechanism of action. B. Bioavailability. C. Half-life. D. Therapeutic index.

C. Half-life (Rationale: On page 40 within Lehne it states that a drug half-life is defined as the time required for the amount of drug in the body to decrease by 50%.)

The first-pass effect or pre-systemic metabolism, a drug is extensively metabolized in the liver, with only part of the drug dose reaching the systemic circulation for distribution to sites of action. The first-pass effect occurs when some drugs are given by which following route? A. Intramuscular. B. Parenteral. C. Oral. D. Subcutaneous.

C. Oral (Rationale: On page 37 within Lehne it states that the term first-pass refers to the rapid hepatic inactivation of certain oral drugs.)

Match the following antidysrhythmic drug to its corresponding class in the Vaughan Williams Classification system. (Class I, Class II, Class III, Class IV) A. These drugs block calcium channels and reduce SA automaticity, slow AV conduction, and reduce myocardial contractility. B. These drugs block potassium channels and delay repolarization of fast potentials. C. These drugs are beta-adrenergic blocking agents and reduce calcium entry; thus, reduce automaticity, slow conduction velocity, and reduce contractility. D. These drugs block cardiac sodium channels and thus slow impulse conduction in the atria, ventricles, and His-Purkinje system.

Class I: D Class II: C Class III: B Class IV: A

A client is prescribed doxepin, a tricyclic antidepressant, for severe depression. Which most dangerous side effect of tricyclic antidepressants will the nurse monitor the client for? A. Breast hypertrophy B. Dry mouth C. Constipation D. Dysrhythmias

D, dysrhythmias (rationale: Lehne page 363: tricyclics can adversely affect cardiac function. TCAs affect the heart by: decreasing vagal influence on the heart and by acting directly on the bundle of His to slow conduction. Both effects increase the risk of dysrhythmias.)

The nurse is providing discharge teaching for a patient with a new prescription for a nitroglycerin transdermal patch. Which statement by the patient indicates an understanding of the teaching? A. "I can wear my patch for 7 days without interruption." B. "I will limit my alcohol to one drink per day." C. "I won't experience any dizziness when changing positions." D. "I will not use Viagra as long as I am on the nitroglycerin."

D, "I will not use Viagra as long as I am on the nitroglycerin" (Rationale: Alcohol can intensify the hypotensive effects of nitrates, so the patient should avoid alcohol. Patients develop tolerance to nitrates rather quickly so it is recommended that patients using transdermal nitrates have 10 to 12 hours of patch-free time each evening. Sildenafil [Viagra] and other drugs for erectile dysfunction also can cause significant hypotension with nitroglycerin and are contraindicated. Nitroglycerin causes orthostatic hypotension; therefore, patients should change positions slowly.)

Your patient complains of having recent episodes of insomnia and would like a prescription for a hypnotic drug such as zolpidem (Ambien). Which statement made by the patient would concern the nurse? A. "I'm on birth control and plan on notifying my provider if I plan on getting pregnant." B. "I have stopped drinking wine while taking this medication." C. "I was recently diagnosed with sleep apnea and just started using a CPAP machine at night." D. "I work full-time and in the past, I've experienced some day-time drowsiness when taking zolpidem (Ambien)."

D, "I work full-time and in the past, I've experienced some day-time drowsiness when taking zolpidem (Ambien). (Rationale: Lehne pg 389: zolpidem has a side effect of daytime drowsiness and dizziness, has been associated with sleep driving and other sleep-related complex behaviors, at therapeutic doses causes little or no respiratory depression, and safety in pregnancy has not been established. Based on daytime drowsiness side effects, the patient should be evaluated with the use of the medication due to safety concerns.)

A nurse is interviewing a client in the mental health clinic. Which statement by the client indicates an irreversible adverse response to long-term therapy with an antipsychotic medication? A. "My mouth is always dry." B. "I don't have much of an appetite." C. "I can't seem to sleep at night." D. "My tongue seems to move by itself."

D, "My tongue seems to move by itself" (Rationale: : The tongue's moving by itself is characteristic of tardive dyskinesia, an irreversible, antipsychotic, drug-induced neurological disorder. Dry mouth is an anticholinergic-type side effect that is not considered serious. This drug will cause sedation, not insomnia. Lack of an appetite is unrelated to antipsychotic medications.)

A patient receiving clozapine [Clozaril] is complaining of increased urination and thirst. What nursing intervention is essential for this patient? A. Holding the medication. B. Assessing blood pressure. C. Measuring potassium levels. D. Assessing blood glucose levels.

D, Assessing blood glucose levels (Rationale: "Assessing blood glucose levels. " Is correct. Clozapine and all other SGAs can cause new-onset diabetes. Patients taking these drugs have developed typical diabetes symptoms, including hyperglycemia, polyuria, polydipsia, polyphagia, and dehydration. In extreme cases, hyperglycemia has led to ketoacidosis, hyperosmolar coma, and even death. Because of diabetes risk, fasting blood sugar should be measured before starting clozapine. (Lehne Ch 31, pg 327))

Digoxin (Lanoxin, Lanoxicaps) is useful in treating high ventricular rates in patients with atrial fibrillation because: A. Digoxin (Lanoxin, Lanoxicaps) is a good drug for stopping atrial fibrillation. B. Digoxin (Lanoxin, Lanoxicaps) is metabolized in the liver. C. Digoxin (Lanoxin, Lanoxicaps) increases cardiac contractility. D. Digoxin (Lanoxin, Lanoxicaps) suppresses dysrhythmias by decreasing conduction through the AV node and by decreasing automaticity in the SA node.

D, Digoxin (Lanoxin, Lanoxicaps) suppresses dysrhythmias by decreasing conduction through the AV node and by decreasing automaticity in the SA node.

The nurse is preparing to administer an epinephrine auto-injector to a family member who is having an anaphylactic reaction after eating peanuts on his salad. How will the nurse administer the drug: A. Take the cap off, swing the epinephrine auto-injector into the deltoid muscle, and hold the injection in place for a full minute before removing the needle. B. Take the cap off, have the family member remove any clothing, swing the epinephrine auto-injector into the inner thigh muscle, and hold the injection in place for 3-10 seconds before removing the needle. C. Take the cap off, have the family member remove any clothing, swing the epinephrine auto-injector into the subcutaneous abdominal space, and hold the injection in place for 3-10 seconds before removing the needle. D. Take the cap off, swing the epinephrine auto-injector into the vastus lateralis muscle through any clothing material, and hold the injection in place for 3-10 seconds before removing the needle.

D, Take the cap off, swing the epinephrine auto-injector into the vastus lateralis muscle through any clothing material, and hold the injection in place for 3-10 seconds before removing the needle.

Which factor in the patient's history would cause the nurse to question a medication order for atropine? A. A 22-year-old woman on the second day of her menstrual cycle. B. A 42-year-old woman with a history of drug abuse. C. An 18-year-old man with irritable bowel syndrome. D. An 85-year-old man with benign prostatic hyperplasia.

D, an 85-year-old man with benign prostatic hyperplasia (Rationale: Atropine causes urinary retention to worsen in patients with benign prostatic hyperplasia (BPH). Lehne pg. 122)

A patient who has been taking alprazolam [Xanax] to treat generalized anxiety disorder (GAD) reports recently stopping the medication after symptoms have improved, but reports having feelings of panic and paranoia. Which initial action by the nurse is correct? A. Instruct the patient to resume taking full doses of the alprazolam (Xanax). B. Suggest that the patient discuss taking buspirone [Buspar] with the provider. C. Notify the provider that the patient is experiencing abuse symptoms from taking too much of the medication. D. Ask the patient if the medication was stopped abruptly.

D, ask the patient if the medication was stopped abruptly (rationale: Lehne pg 401: withdrawal symptoms from benzodiazepines include panic, paranoia, and delirium. Benzodiazepines should be tapered gradually over a period of several months to reduce withdrawal symptoms.)

The nurse should be prepared to administer which of the following drugs as an antidote to cholinergic drug overdose? A. Propranolol. B. Neostigmine. C. Diphenhydramine. D. Atropine.

D, atropine (Rationale: At therapeutic doses, atropine produces selective blockade of muscarinic cholinergic receptors and the effects are opposite to those caused by muscarinic activation. Lehne pg 122.)

A patient is admitted with lower abdominal pain and nausea. The nurse performing the initial assessment notes that the patient's abdomen is distended and firm, and hypoactive bowel sounds are present. The patient has not had a stool for 3 days. The nurse will contact the provider and anticipate an order for: A. Extra fluids and fiber. B. A cathartic laxative. C. A bulk-forming laxative. D. Diagnostic testing.

D, diagnostic testing

What is the preferred initial method to lowering LDL cholesterol? A. A combonation of a beta blocker and a statin B. A low dose beta blocker C. A high dose statin D. Diet modification and increasing exercise

D, diet modification and increasing exercise (rationale: the preferred (initial) method in lowering LDL cholesterol is modification of diet combined with exercise and that drugs, such as statins, are employed only when diet modification and exercise are insufficient.)

Dopamine is administered to a patient who has been experiencing hypotensive episodes. Other than an increase in blood pressure, which indicator would the nurse use to evaluate a successful response? A. Weight gain B. Improved gastric motility C. Decrease in pulse D. Increase in urine output

D, increase in urine output

Muscarinic antagonists are most often contraindicated in glaucoma because these drugs can: A. Cause miosis, which leads to blindness. B. Promote ocular infections. C. Detach the retina. D. Increase intraocular pressure.

D, increase intraocular pressure (Rationale: Muscarinic antagonist drugs affect the intraocular pressure by causing mydriasis and paralysis of the ciliary muscle (opposite of muscarinic agonists). Lehne pg 119.)

A client is prescribed a monoamine oxidase inhibitor (MAOI). Which of the following should the nurse teach the client: A. It is necessary to avoid the sun. B. Drowsiness is an expected side effect of this medication. C. The therapeutic and toxic levels of the drug are very close. D. Many prescribed and over-the-counter drugs cannot be taken with this medication.

D, many prescribed and over-the counter drugs cannot be taken with this medication (Rationale: Lehne page 367: the MAOIs can interact with many drugs to cause potentially harmful results. Patients should be instructed to avoid all medications, prescription and over-the-counter, that have not been specifically approved by the prescriber.)

A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer? A. Misoprostol [Cytotec] B. Ranitidine [Zantac] C. Famotidine [Pepcid] D. Omeprazole [Prilosec]

D, omeprazole (Prilosec) (Rationale: Omeprazole causes irreversible inhibition of the proton pump, the enzyme that generates gastric acid. It is a powerful suppressant of acid secretion. Famotidine and ranitidine block histamine2 receptors on parietal cells. Misoprostol protects against ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) by stimulating the secretion of mucus and bicarbonate to maintain submucosal blood flow.)

Which following medication can be used to cleanse the bowl in preparation for a colonoscopy? A. Fleet enema B. Bisacodyl (Ducolax) C. Docusate sodium (Colace) D. Polyethylene Glycol-Electrolyte

D, polyethylene glycol-electrolyte

The nurse instructs a nursing student about phenobarbital, a barbiturate, for suppression of seizures. Which statement, if made by the student, indicates an understanding of barbiturates: A. "It's safe to use this drug when drinking alcohol." B. "There is minimal risk for respiratory depression." C. "Barbiturates have little to no abuse potential." D. "Prolong use can result in physical dependence."

D, prolonged use can result in physical dependence (Rationale: Lehne pg 391: barbiturates cause tolerance and dependence, have a high abuse potential, are subject to multiple drug interactions, and are powerful respiratory depressants that can be fatal in overdose.)

A patient is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes that the patient has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats per minute. The nurse reviews labs and sees that the patient's most recent aPTT is greater than the therapeutic range. As a priority action, the nurse will request an order for: A. a repeat aPTT to be drawn immediately. B. analgesic medication. C. changing heparin to aspirin. D. protamine sulfate

D, protamine sulfate (Rationale: When aPTT is above the therapeutic range the patient is at risk for hemorrhage as a result of Heparin overdose. Signs of bleeding/hemorrhage includes reduced blood pressure, elevated heart rate, discolored urine or stool, and bruises.If bleeding occurs, heparin should be discontinued and severe overdose treated with protamine sulfate administered by slow IV injection.)

A patient in the emergency department is given intravenous diazepam [Valium] for seizures. When the seizures stop, the nurse notes that the patient is lethargic and confused and has a respiratory rate of 10 breaths per minute. The nurse will expect to administer which of the following? A. Flumazenil [Romazicon] B. Toxicology testing C. Gastric lavage D. Respiratory support

D, respiratory support (rationale: Lehne pg 387-388: Although respiratory depression with oral therapy is rare, benzodiazepines can cause severe respiratory depression when administered intravenously. Benzodiazepine-induced toxicity is managed with supportive care. Respiration should be monitored and the airway kept patent. Flumazenil can reverse sedative effects, but may not reverse respiratory depression.)

The nurse is caring for a patient taking dextroamphetamine [Dexedrine]. Which symptom, if present, is most likely an adverse effect of this drug? A. Heart rate of 60 beats/min B. Weight gain C. Respiratory rate of 10 breaths per minute D. Restlessness

D, restlessness (Rationale: The adverse effects of amphetamines include central nervous system (CNS) stimulation (insomnia, restlessness, talkativeness), weight loss, cardiac stimulation (dysrhythmias, angina, hypertension), and psychosis (paranoia).)

A health care provider prescribes antipsychotic medication, and the nurse teaches the client about the possible side effects of the drug. The nurse concludes that the client needs further teaching about these side effects when he states that he should call the clinic if he experiences: A. Tremors B. Constipation C. Blurred vision D. Ringing in the ears

D, ringing in the ears (Rationale: Ototoxicity is not a side effect of antipsychotics; this side effect occurs with aspirin. Signs of pseudoparkinsonism (e.g., tremors, rigidity, and bradykinesia) are common side effects of antipsychotics. The anticholinergic effect of antipsychotic medications can cause constipation, and it is a common gastrointestinal side effect. Vision changes and photosensitivity are common side effects of antipsychotic medications.)

A client is prescribed imipramine (Tofranil), a tricyclic antidepressant, for depression. The nurse assesses the client for adverse effects. Which adverse effect requires further assessment and possible medical intervention? A. Salivation. B. Weight gain. C. Diaphoresis. D. Urinary hesitancy.

D, urinary hesitancy (rationale: Lehne page 363: the TCAs block muscarinic cholinergic receptors and can thereby cause an array of anticholinergic effects (dry mouth, blurred vision, photophobia, constipation, urinary hesitancy, and tachycardia).)

A patient is preparing to travel to perform missionary work in a region with poor drinking water. The provider gives the patient a prescription for the antibiotic ciprofloxacin [Cipro] to take on the trip. What will the nurse instruct this patient to do? A. Combine the antibiotic with an antidiarrheal medication, such as loperamide. B. Take 1 tablet of ciprofloxacin with each meal for best results. C. Start taking the ciprofloxacin 1 week before traveling. D. Use the drug if symptoms are severe or do not improve in a few days.

D, use the drug if symptoms are severe or do not improve in a few days

Match the following drug with its appropriate drug class. (Dopamine replacement, nonergot derivatives, ergot derivatives, COMT inhibitors, MAO-B inhibitors) A. Entacapone B. Levodopa/carbidopa C. Cabergoline D. Apomorphine E. Rasagiline

Dopamine replacement: B Nonergot derivatives: D Ergot derivatives: C COMT inhibitors: A MAO-B inhibitors: E

Potassium sparing diuretics can cause hypokalemia. True False

False

Digoxin has a wide therapeutic index. True False

False (Rationale: Digoxin has a narrow therapeutic index and has the potential to cause significant adverse effects.)

Nitroglycerin causes vasoconstriction which can cause headaches, orthostatic hypotension, and reflex tachycardia. True False

False (Rationale: Nitroglycerin causes vasodilation to elicit these signs and symptoms. (Lehne, pg 594))

Statin use is recommended for lowering LDL cholesterol in pregnancy. True False

False (Rationale: statins are contraindicated during pregnancy and health care professionals should inform women of child-bearing age about the potential for fetal har and warm them against becoming pregnant.)

The lipid abnormality that contributes most to cardiovascular disease is high levels of high density lipoproteins. True False

False (Rationale: the lipid abnormality that contributes most to cardiovascular disease is high low density lipoproteins.)

Match the following components of cardiac output regulation with the corresponding function. (Heart rate, Stroke volume, myocardial contractility, preload, afterload) A. The force with which the ventricles contracted determined by the degree of cardiac dilation and venous return. B. Defined as the amount of stretch (determined by ventricular filling) applied to a muscle before contraction. C. The atrial pressure that the left ventricle must overcome to eject blood. D. Primarily controlled by the ANS and is increased by the sympathetic branch acting through beta1 adrenergic receptors in the SA node. E. determined largely by three factors including myocardial contractility, cardiac after load, and cardiac preload

Heart rate: D Stroke volume: E Myocardial contractility: A Preload: B Afterload: C

Match the following mechanism of action with the appropriate laxative: [This question is worth 4 points--one point will be given for each correct match] (Psyllium (Metamucil), Docusate sodium (Colace), Biscodyl (Dulcolax), Milk of Magnesia (MOM)) A. lowers surface tension to promote penetration of water into the stool B. swells with water to form a gel to soften and increase fecal mass. C. stimulates peristalsis and increases water in the intestine D. salts that draws water into the intestine to soften stool and stimulate peristalsis

Psyllium: B Docusate sodium: A Biscodyl: C Milk of Magnesia: D

Nitroglycerin causes vasoconstriction which can cause headaches, orthostatic hypotension, and reflex tachycardia. True False

false (Rationale: Nitroglycerin causes vasodilation to elicit these signs and symptoms. (Lehne, pg 594))

Match the following stage of heart failure with its corresponding description. (Stage A, Stage B, Stage C) A. These patients have no signs or symptoms of heart failure, but they do have structural heart disease that is associated with development of heart failure. B. These patients have no symptoms of heart failure and no structural or functional cardiac abnormalities, but they do have behaviors or conditions strongly associated with developing heart failure. C. These patients have symptoms of heart failure with occupying structural heart disease.

Stage A: B Stage B: A Stage C: C

Match the following diuretic with its defining characteristic. (Thiazide diuretics, loop diuretics, potassium-sparing diuretics) A. These diuretics produce moderate diuresis and are ineffective when GFR is low. A possible adverse effects includes hypokalemia which can increase the risk of digoxin-induced dysrhythmias. B. These diuretics promote scant diuretic and are employed to counteract potassium loss. The mechanism of action lowers the risk of digoxin-induced dysrhythmias, but can cause hyperkalemia. C. These diuretics can promote fluid loss even when GFR is low and are capable of mobilizing large volumes of water. These drugs are used in patients with severe heart failure, but can produce hypokalemia and hypotension.

Thiazide diuretics: A Loop diuretics: C Potassium-sparing diuretics: B

Digoxin is eliminated by renal excretion. True False

True

Heart failure is characterized by ventricular dysfunction, reduced cardiac output, signs of inadequate tissue perfusion, and fluid overload. True False

True (Rationale: Lehne pages 529-530)

Methyldopa is an oral antihypertensive agent that lowers blood pressure by acting at sites within the CNS and can cause severe hemolytic anemia and hepatic necrosis. True False

True (Rationale: On page 169 in Lehne, lists two side effects of Methyldopa are hemolytic anemia and hepatic necrosis.)

Therapy with cholesterol-lowering drugs must continue lifelong. If these drugs are withdrawn, cholesterol levels will return to pretreatment values. True False

True (rationale: drug therapy must be continued or cholesterol levels will return to pretreatment values.)

Atherosclerosis is plaque that can develop in any artery and thereby compromise circulation to any tissue. True False

True (rationale: it is important to appreciate that atherosclerosis is not limited to arteries of the heart and brain: atherosclerotic plaque can develop in any artery, and can thereby compromise circulation to any tissue.)

Match the following class of lipoprotein with the appropriate function (Very-low density lipoproteins, low density lipoproteins, high density lipoproteins) A. promote cholesterol removal and carry cholesterol from peripheral tissues back to the liver B. deliver cholesterol to nonhepatic tissues C. deliver triglycerides from the liver to adipose tissue and muscle

Very-low density lipoproteins: C low density lipoproteins: B high density lipoproteins: A

The nurse is caring for a patient receiving warfarin therapy. The patient complains of persistent bleeding gums when brushing his teeth for the last 2 days. The nurse anticipates that she/he will administer _________ to counteract this effect.

Vitamin K (Rationale: The effects of warfarin overdose can be overcome with vitamin K1 (phytonadione). Vitamin K1 antagonizes warfarin's actions and can thereby reverse warfarin-induced inhibition of clotting factor synthesis. Like medicinal vitamin K, dietary vitamin K can reduce the anticoagulant effects of warfarin.)