Pharm Sem 4 Part 1
(Multiple Choice) Receptors that mediate most of epinephrine's cardiac effects: A) beta1 adrenergic B) beta2 adrenergic C) dopaminergic D) alpha-adrenergic
A.
(Multiple Choice) Concerning low-dose dopamine: interaction with this receptor causes renal, mesenteric, and coronary vasodilation: A) beta1 adrenergic receptors B) beta2 adrenergic receptors C) dopamine D1 receptors D) alpha-adrenergic E) prostaglandin receptors
C.
When assessing a patient who has been taking amiodarone for 6 months, which adverse reaction might the nurse identify? A. Glycosuria B. Dysphagia C. Photophobia D. Urticaria
C.
A client received lidocaine viscous before a gastroscopy was performed. Following the procedure, the nurse places priority on what assessment? A. Return of the gag reflex B. Abdominal pain C. Ability to stand D. Ability to urinate
A.
Which assessment indicates a therapeutic effect of mannitol (Osmitrol)? A) a. Decreased intracranial pressure B) b. Decreased potassium C) c. Increased urine osmolality D) d. Decreased serum osmolality
A. Mannitol (Osmitrol) is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This will decrease intracranial pressure, increase excretion of medications, decrease urine osmolality, and increase serum osmolality.
A client with subdural hematoma was given mannitol to decrease intracranial pressure (ICP). Which of the following results would best show the mannitol was effective? a. Urine output increases b. Pupils are 8 mm and nonreactive c. Systolic blood pressure remains at 150 mm Hg d. BUN and creatinine levels return to normal
A. Mannitol promotes osmotic diuresis by increasing the pressure gradient in the renal tubes. Fixed and dilated pupils are symptoms of increased ICP or cranial nerve damage. No information is given about abnormal BUN and creatinine levels or that mannitol is being given for renal dysfunction or blood pressure maintenance.
7. The client has been receiving spironolactone (Aldactone) 50 mg/day for heart failure. The nurse should closely monitor the client for which condition? a. Hypokalemia b. Hyperkalemia c. Hypoglycemia d. Hypermagnesemia
B
The nurse provides discharge instructions to a pt about the use of amiodarone. Which of the following statements indicates that the pt has the knowledge necessary to safely administer the drug? A. as soon as the physician says I can stop taking this medication, I will be able to enjoy the sun again B. the side effects of this med may not begin to show up for several weeks or even months after I start taking it C. If my pulse drops below 100 beats/minute, I should call the physician right away D. If I miss a dose of me, I should take it as soon as I remember it
B
A patient asks about taking potassium supplements while taking spironolactone (Aldactone). What is the nurse's best response? a. "You are correct about your concern. I will make sure that you get some right away." b. "I will call your doctor and let him know of your concern." c. "Potassium supplements are usually not necessary with this type of diuretic." d. "You are on a diuretic that is potassium-sparing, so there is no need for extra potassium."
B. Spironolactone is a potassium-sparing diuretic; furosemide causes potassium loss. Giving these together minimizes electrolyte imbalance.
A nurse is caring for a client who has been prescribed furosemide (Lasix) and is monitoring for adverse effects associated with this medication. Which of the following should the nurse recognize as a potential adverse effect Select all that apply. a. Nausea b. Tinnitus c. Hypotension d. Hypokalemia e. Photosensitivity f. Increased urinary frequency
B. C. D. Furosemide is a loop diuretic; therefore, an expected effect is increased urinary frequency. Nausea is a frequent side effect, not an adverse effect. Photosensitivity is an occasional side effect. Adverse effects include tinnitus (ototoxicity), hypotension, and hypokalemia and occur as a result of sudden volume depletion.
When assessing a pt who has been taking amiodarone for 6 months, which adverse reaction might the nurse identify? A. glycosuria B. dysphagia C. photophobia D. urticaria
C
A client with a subdural hematoma becomes restless and confused, with dilation of the ipsilateral pupil. The physician orders mannitol for which of the following reasons? a. To reduce intraocular pressure b. To prevent acute tubular necrosis c. To promote osmotic diuresis to decrease ICP d. To draw water into the vascular system to increase blood pressure
C. Mannitol promotes osmotic diuresis by increasing the pressure gradient, drawing fluid from intracellular to intravascular spaces. Although mannitol is used for all the reasons described, the reduction of ICP in this client is a concern.
The nurse identifies ventricular tachycardia on the heart monitor. Which action should the nurse prepare to take? A. Administer atropine sulfate. B. Check the potassium level C. Administer an anti arrhythmic medication such as lidocaine. D. Defibrillate at 360 joules
C. The treatment for ventricular tachycardia is lidocaine. A precordial thump is sometimes successful in slowing the rate, but this should be done only if a defibrillator is available. Atropine sulfate would speed the rate further. Checking the potassium is indicated but not the priority. Defibrillation is used for pulseless ventricular tachycardia or ventricular fibrillation. Also, defibrillation should begin at 200 joules and be increased to 360 joules.
A client with ventricular septal repair is receiving dopamine (inotropin) postoperatively. Which of the following responses is expected? A. Decreased heart rate B. Decreased urine output C. Increased cardiac output D. Decreased cardiac contractibility
C. Dopamine stimulates beta1 and beta2 receptors. Its a selective cardiac stimulant that will increase cardiac output, heart rate, and cardiac contractibility. Urine output increases in response to dilation of the blood vessels to the mesentery and kidneys.
Johanna has ventricular ectopy, which of the following drugs is the first line used to treat her condition? A. quinidine (Cardioquin) B. digoxin (Lanoxin) C. procainamide ( Pronestyl) D. lidocaine (Xylocaine)
D. Lidocaine is the only choice used to treat ventricular ectopy. A and C are class IA antiarrhythmics. Digoxin is a cardiac glycoside.
Which are the most effective antihyperlipidemics with few side effects? A. Niacin B. FIbric Acids C. Bile acid-binding resins D. Ezetimibe E. Statins
E.
When evaluating for therapeutic effects of mannitol, what does the nurse anticipate? a. Decreased intracranial pressure b. Decreased excretion of therapeutic medications c. Increased urine osmolality d. Decreased serum osmolality
a. Decreased intracranial pressure
A 68-year-old client with a history of mild CHF and glaucoma is receiving IV mannitol (Osmitrol) to decrease intraocular pressure. The nurse would monitor the client for signs and symptoms of: 1. Fluid volume excess 2. Fluid volume deficit 3. Hyperkalemia 4. Hypernatremia
1.
The nurse knows which of the following body systems is responsible for the production of erythropoietin? 1. Urinary system 2. Cardiovascular system 3. Lymphatic system 4. Endocrine system
1. The urinary system is responsible for the production of erythropoietin, which is the primary hormone regulator that promotes the development and differentiation of red blood cells in the bone marrow and initiates the production of hemoglobin. Ninety percent of erythropoietin is produced by renal peritubular cells, with the other 10% produced in the liver. The cells that produce erythropoietin are sensitive to levels of oxygen within the blood. If the level of oxygen is low, the kidney cells release erythropoietin to stimulate the bone marrow to produce more red blood cells to increase the oxygen-carrying capability of the blood.
The client has increased intracranial pressure with cerebral edema, and mannitol is administered. Which assessment should the nurse make to evaluate if a complication from the mannitol is occurring? 1. Auscultate breath sounds to assess for crackles 2. Monitor for >50 mL/hr urine output 3. Press over the tibia to assess for pitting edema 4. Monitor Glasgow Coma Scale increasing from 8/15 to 9/15
1. Mannitol (Osmitrol) is an osmotic diuretic used to treat cerebral edema (increased intracranial pressure) and acute glaucoma. When administered, mannitol causes an increase in plasma oncotic pressure (similar to excess glucose) that draws free water from the extravascular space into the intravascular space, creating a volume expansion. This fluid, along with the drug, is excreted through the kidneys, thereby reducing cerebral edema and intracranial pressure. However, if a higher dose of mannitol is given or it accumulates (as in kidney disease), fluid overload that may cause life-threatening pulmonary edema results. An early sensitive indicator of fluid overload is new onset of crackles auscultated in the lungs. To prevent these complications, clients require frequent monitoring of serum osmolarity, input and output, serum electrolytes, and kidney function.
A client with subdural hematoma was given mannitol to decrease intracranial pressure (ICP). Which of the following results would best show the mannitol was effective? Urine output increases Pupils are 8 mm and nonreactive Systolic blood pressure remains at 150 mm Hg BUN and creatinine levels return to normal
1. Mannitol promotes osmotic diuresis by increasing the pressure gradient in the renal tubes. Fixed and dilated pupils are symptoms of increased ICP or cranial nerve damage. No information is given about abnormal BUN and creatinine levels or that mannitol is being given for renal dysfunction or blood pressure maintenance.
The client with a head injury is experiencing signs of increased intracranial pressure (ICP), and mannitol (Osmitrol) is prescribed. The nurse administering this medication expects which as an intended effects of this medication? Select all that apply. 1. Increased diuresis 2. Reduced intracranial pressure 3. Increased osmotic pressure of glomerular filtrate 4. Reduced tubular reabsorption of water and solutes 5. Reabsorption of sodium and water in the loop of Henle
1. 2. 3. 4.
Atorvastatin (Lipitor) has been prescribed for a client. The nurse tells the client that which blood test will be done periodically while the client is taking this medication? 1. Neutrophil count 2. Liver function studies 3. White blood cell count 4. Complete blood cell (CBC) count
2.
The nurse is caring for a client receiving mannitol (Osmitrol) via intravenous (IV) infusion. A vial is sent from the pharmacy, and in preparing the medication the nurse notes that the vial contains crystals. What is the most appropriate nursing action? 1. Discard the vial. 2. Place the vial in warm water. 3. Send the vial back to the pharmacy. 4. Shake the vial to dissolve the crystals.
2.
The health care provider (HCP) has prescribed spironolactone to be given in addition to hydrochlorothiazide to a client with hypertension. Which finding by the nurse would indicate that the new medication is having the desired effect? 1. Blood glucose of 95 mg/dL 2. Potassium level of 4.2 mEq/L 3. Reduction in dizziness 4. Sodium level of 138 mEq/L
2. Spironolactone, amiloride. triamterene, and eplerenone are potassium-sparing diuretics. In general, these are very weak diuretics and antihypertensives and are used mainly in combination with thiazide diuretics to reduce potassium (K*) loss. The K+ level of 4.2 mEq/L would indicate that this medication has been effective in preventing hypokalemia in a client receiving a thiazide diuretic such as hydrochlorothiazide or chlorthalidone.
A client seen in the health care clinic for follow-up care is taking atorvastatin (Lipitor). The nurse should assess the client for which adverse effect of the medication? 1. Earache 2. Hearing loss 3. Photosensitivity 4. Lung congestion
3.
A client with a subdural hematoma becomes restless and confused, with dilation of the ipsilateral pupil. The physician orders mannitol for which of the following reasons? To reduce intraocular pressure To prevent acute tubular necrosis To promote osmotic diuresis to decrease ICP To draw water into the vascular system to increase blood pressure
3. Mannitol promotes osmotic diuresis by increasing the pressure gradient, drawing fluid from intracellular to intravascular spaces. Although mannitol is used for all the reasons described, the reduction of ICP in this client is a concern.
A nurse is viewing the cardiac monitor in a client's room and notes that the client has just gone into ventricular tachycardia. The client is awake and alert and has good skin color. The nurse would prepare to do which of the following? 1. Immediately defibrillate 2. Prepare for pacemaker insertion 3. Administer amiodarone (Cordarone) intravenously 4. Administer epinephrine (Adrenaline) intravenously
3. First-line treatment of ventricular tachycardia in a client who is hemodynamically stable is the use of anti-dysrhythmics such as amiodarone (Cordarone), lidocaine (Xylocaine), and procainamide (Pronestyl). Cardioversion also may be needed to correct the rhythm (cardioversion is recommended for stable ventricular tachycardia). Defibrillation is used with pulseless ventricular tachycardia. Epinephrine would stimulate and already excitable ventricle and is contraindicated.
A pt is on Spironolactone (Aldactone) and has a potassium level of 5.9. What should the nurse do? A. hold the med and contact the physician B. give the med as prescribed C. give the pt half the prescribed dose D. give the pt a banana
A
An elderly pt is prescribed spironolactone (Aldactone) with the addition of potassium chloride (Kaochlor). Which statement is a true statement regarding the use of these two meds together? A. spironolactone should not have potassium chloride added to the regimen b/c it is a potassium-sparing diuretic B. potassium is necessary when clients are placed on spironlocatone b/c it is a loop diuretic C. spironolactone and potassium chloride have no additive or antagonistic effects with each other D. potassium chloride added to spironolactone causes renal failure
A
A nurse cares for an elderly patient with hypertensive crisis. Which pharmaceutical intervention is considered as the most fast acting one in the treatment of hypertensive crisis? A. Sodiumnitroprusside B. Clonidine C. Captopril D. Amlodipine E. Indapamide
A Immediate treatment for hypertensive crisis is with intravenous sodium nitroprusside. This drug is considered as a fast acting drug. The other above-mentioned drugs are anti-hypertensives. If sodium nitroprusside is unavailable some other drugs are also used, but it will take several minutes for the other drugs to have onset of action. After initial treatment, with sodium nitroprusside the blood pressure is reduced to normal, slowly.
The nurse observes a co-worker preparing to administer a solution of lidocaine and epinephrine to a client with multiple premature ventricular contractions. The appropriate action by the nurse is to: A. Prevent the administration, and give a plain lidocaine solution. B. Offer to monitor the client's heart rhythm. C. Notify the supervisor of the error. D. Do nothing; the drug choice is correct.
A.
A 25-year-old has sustained a head injury from a motor vehicle accident. The nurse notes that his intracranial pressure (ICP) is elevating. Which of the following interventions should the nurse perform to decrease his ICP? Select all that apply: A. Administer mannitol as ordered. B. Assess pupil reactivity. C. Maintain neutral neck alignment and elevate the head of bed. D. Place the patient in Trendelenburg's position. E. Space out activities. F. Suction the patient.
A. A. Administering Mannitol, an osmotic diuretic, will decrease the cerebral edema in the brain, and therefore ICP. C. Positioning the patient's neck in a neutral alignment to avoid flexion and elevating the HOB will lower ICP by increasing venous return. E. Too much activity causes an increase in blood pressure, cerebral blood flow, and ICP. Elevations of an already high ICP can further elevate the ICP and lead to cerebral ischemia. It is prudent for the nurse to space out activities to allow the patient's ICP to return to a safe level.
A client with hyperaldosteronism is being treated with spironolactone (Aldactone)> Which of the following indicates to the nurse that the medication is effective? a) a decrease in blood pressure b) a decrease in sodium excretion c) a decrease in body metabolism d) a decrease in plasma potassium
A. Aldactone antagonizes the effect of aldosterone and decreases circulating volume by inhibiting tubular reabsorption of sodium and water. Thus, it produces a decrease in blood pressure. It increases the excretion of sodium and water and increases potassium retention. It has no effect on body metabolism.
A client with congestive heart failure and secondary hyperaldosteronism is started on spironolactone (Aldactone) to manage this disorder. The nurse informs the client that the need for dosage adjustment may be necessary if which of the following medications is also being taken? a) potassium chloride b) alprazolam (Xanax) c) warfarin sodium (Coumadin) d) verapamil hydrochloride (Calan)
A. Spironolactone (Aldactone) is a potassium-sparing diuretic. If the client is also taking potassium chloride or another potassium supplement, the risk for hyperkalemia exists. Potassium doses would need to be adjusted while the client is taking this medication. A dosage adjustment would not be necessary if the client was taking the medications identified in options B, C, and D.
A client is to be discharged home with a transdermal nitroglycerin patch. Which instruction will the nurse include in the client's teaching plan? A) a. "Apply the patch to a nonhairy area of the upper torso or arm." B) b. "Apply the patch to the same site each day." C) c. "If you have a headache, remove the patch for 4 hours and then reapply." D) d. "If you have chest pain, apply a second patch next to the first patch."
A. A nitroglycerin patch should be applied to a nonhairy area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation. The drug should be continued if headache occurs, as tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.
A client is taking spironolactone (Aldactone) to control her hypertension. Her serum potassium level is 6 mEq/L. For this client, the nurse's priority should be to assess her: a. electrocardiogram (ECG) results. b. neuromuscular function. c. bowel sounds. d. respiratory rate.
A. Although changes in all these findings are seen in hyperkalemia, ECG results should take priority because changes can indicate potentially lethal arrhythmias such as ventricular fibrillation. It wouldn't be appropriate to assess the client's neuromuscular function, bowel sounds, or respiratory rate for effects of hyperkalemia.
Your pt is currently taking Digoxin. What should you, as a nurse be prepared to administer in the even of digitalis toxicity? a. Potassium b. Digibind c. Protamine sulfate d. Heparin
Answer: b
Which is the most important action for the nurse to take before administering digoxin? a. Monitor potassium level b. Assess BP c. Evaluate urinary output d. Avoid giving with a thiazide diuretic
Answer: a Rationale: Monitoring potassium is especially important because hypokalemia potentiates digoxin toxicity. B and C are incorrect because these data reflect overall CV status but are not specific for digoxin. Choice d are drugs usually administered with digoxin.
The nurse reviews lab studies of a pt receiving digoxin (Lanoxin). Intervention by the nurse is required if the results include which of the following laboratory results? a. Serum digoxin level of 1.2 ng/dL b. Serum potassium level of 3 mEq/L c. Hemoglobin of 14.4 g/dL d. Serum sodium level of 140 mEq/L
Answer: b
When a pt is experiencing digitalis toxicity, in which of the following situations would it be appropriate to treat with digoxin immune Fab (Digibind)? a. Hypokalemia b. Hyperkalemia c. Apical heart reate of 60 bpm d. Supraventricular dysrhythmias
Answer: b
When teaching the pt about signs and symptoms of cardiac glycoside toxicity, the nurse should alert the pt to watch for: a. Visual changes b. Flickering lights or halos c. Dizziness when standing up d. Increased urine output
Answer: b
The nurse is monitoring a pt taking digoxin (Lanoxin) for treatment of heart failure. Which assessment finding indicates a therapeutic effect of the drug? a. HR110 beats/min b. HR 58 beats/min c. Urinary output 40mL/hr d. BP 90/50 mm Hg
Answer: b Rationale: Digoxin has a negative inotropic effect (decreased heart rate). The heart rate should become slower and stronger.
Blurred vision or halos are signs of: a. Beta blocker toxicity b. Digoxin toxicity c. Diuretic toxicity d. Ace inhibitor toxicity
Answer: b Rationale: Halos is a hallmark sign of digoxin toxicity. A, c, and d are incorrect because subtherapeutic digoxin levels have no such effects.
A pt is taking digoxin and furosemide (Lasix) to manage congestive heart failure. The nurse determines that the pt understands diet therapy when the pt makes which meal choice? a. Veggie beef soup, mac and cheese, and a roll b. Beef ravioli w/bread c. Baked white fish, mashed potatoes, and carrot salad d. Roasted chicken, brown rice, and stewed tomatoes
Answer: c
A pt with congestive heart failure is receiving digoxin. What is the desired effect? a. Neck vein distention b. Decreased appetitie c. Increased urinary output d. Increased pedal edema
Answer: c
During assessment of a pt who is receiving digoxin, which finding would indicate an increased possibility of toxicity? a. Apical pulse rate of 60 bpm b. Digoxin level 1.5 c. Serum potassium level of 2.0 d. Serum potassium level of 4.8
Answer: c
Positive inotropic action does which of the following? a. Decreases heart rate b. Decreases cellular conduction c. Increases contractility
Answer: c
The therapeutic drug level for digoxin is: a. 0.1-2.0 b. 1.0-2.0 c. 0.1-0.5 d. 0.5-2.0
Answer: d
The nurse is scheduled to administer a does of digoxin to a adult pt with atrial fibrillation. The pt has a potassium level of 4.3 mEq/L. The nurse should perform which of the following activities nest? a. Withhold dose only for that day b. Obtain order for dose of potassium before giving digoxin c. Withhold dose and notify prescriber d. Administer dose as ordered
Answer: d Rationale: The normal reference range for potassium for an adult is 3.5-5.1 mEq/L. Hypokalemia can make the client more susceptible to digoxin toxicity. The nurse monitors the results of electrolytes for the potassium level. If low, the dose is withheld, and the healthcare provider notified. This client's result is within normal limits, so the dose should be administered.
You are caring for a patient who has an increased ICP and the physician just prescribed mannitol (Osmitrol). Which of the following adverse effects should you be aware to monitor for when administering mannitol? A. Hyperglycemia B. Hyponatremia C. Hypervolemia D. Oliguria
B Mannitol is a powerful osmotic diuretic & adverse effects include electrolyte imbalances such as hyponatremia. Hyperglycemia is not an adverse effect of mannitol. Hypovolemia is an adverse effect and should be monitored. Polyuria is also an adverse effect that should be monitored.
What must the nurse monitor when titrating intravenous nitroglycerin for a client? (Select all that apply.) A) a. Continuous oxygen saturation B) b. Continuous blood pressures C) c. Hourly ECGs D) d. Presence of chest pain E) e. Serum nitroglycerin levels F) f. Visual acuity
B, D. Intravenous nitroglycerin can cause hypotension and tachycardia. Relief of chest pain and systolic blood pressure <90 mm Hg are typical parameters used for titrating nitroglycerin. Pulse should also be monitored.
A patient has a potassium level of 2.0. Which of the following would you expect to be order for this patient? A. An oral supplement of potassium B. Infusion of Potassium intravenously C. Intramuscular injection of Potassium D. Potassium 30 meq IV push
B.
What instruction should the nurse provide to the client who needs to apply nitroglycerin ointment? A) a. Use the fingers to spread the ointment evenly over a 3-inch area. B) b. Apply the ointment to a nonhairy part of the upper torso. C) c. Massage the ointment into the skin. D) d. Cover the application paper with ointment before use.
B. Absorption is best over a nonhairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves and squeeze the ointment onto the application patch. Massaging in the ointment is not appropriate. The paper should not be covered with ointment. The ointment is measured as one straight line on the nitroglycerin paper and is then gently spread around and applied, but not rubbed, into the skin.
The client asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response? A) a. "You can protect it from heat by placing the bottle in an ice chest." B) b. "It's best to keep it in its original container away from heat and light." C) c. "You can put a few tablets in a resealable bag and carry it in your pocket." D) d. "It's best to lock them in the glove compartment to keep them away from heat and light."
B. Although nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest where it could freeze. It should also not be locked up and must be kept away from light, not in a clear plastic bag.
Lidocaine is a medication frequently ordered for the client experiencing: A. Atrial tachycardia B. Ventricular tachycardia C. Heart block D. Ventricular bradycardia
B. Lidocaine is used to treat ventricular tachycardia. The medication slowly exerts an antiarrhythmic effect by increasing the electric stimulation threshold of the ventricular contractions. It is not used for atrial arrhythmias. It slows the heart rate so it is not used for heart block or ventricular bradycardia.
A client receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's priority action? A) a. Assess the client's lung sounds. B) b. Decrease the intravenous nitroglycerin by 10 mcg/min. C) c. Stop the nitroglycerin infusion for 1 hour, and then restart. D) d. Recheck the client's vital signs in 15 minutes but continue the infusion.
B. Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The client should be monitored every 10 minutes while changing the rate of the intravenous nitroglycerin infusion.
The nurse administers mannitol (Osmitrol) to the client with increased intracranial pressure. Which parameter requires close monitoring? A. Muscle relaxation. B. Intake and output. C. Widening of the pulse pressure. D. Pupil dilation.
B. Reason: After administering mannitol, the nurse closely monitors intake and output because mannitol promotes diuresis and is given primarily to pull water from the extracellular fl uid of the edematous brain. Mannitol can cause hypokalemia and may lead to muscle contractions, not muscle relaxation. Signs and symptoms, such as widening pulse pressure and pupil dilation, should not occur because mannitol serves to decrease ICP.
The nurse is monitoring a client during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action? A) a. Blood pressure 110/90 mm Hg B) b. Flushing C) c. Headache D) d. Chest pain
D The client should not continue to have chest pain while on IV nitroglycerin. This would prompt the nurse to intervene. Blood pressure of 110/90 mm Hg is not cause for concern and is expected with nitroglycerin. Headache and flushing are common side effects of nitroglycerin.
which dietary change must a pt make when starting treatment with the med spironolactone? A. eat extra helpings of bananas B. increase intake of water C. avoid salt substitutes D. increase intake of green leafy veggies
C
Mannitol (Osmitrol) is administered intravenously to a client admitted to the hospital with loss of consciousness and a closed head injury. The nurse determines that the medication achieved its priority effect if which of the following outcomes was noted? a) weight loss of 1 kg and a serum creatinine of 0.8 mg/dL b) serum creatinine of 1.2 mg/dL and normal intracranial pressure c) improved level of consciousness and normal intracranial pressure d) diuresis of 500mL in 2 hours and a blood urea nitrogen (BUN) of 15 mg/dL
C - Mannitol (Osmitrol) is an osmotic diuretic that can be administered parenterally to treat cerebral edema. Lowering of intracranial pressure occurs within 15 minutes of administration, and diuresis occurs within 1 to 3 hours. Expected effects of the medication include rapid diuresis and fluid loss. For the client with cerebral edema (as in closed head injury), effectiveness is measured by assessing neurological status and intracranial pressure readings.
At the start of your shift you are receiving report on a patient who has sustained a head injury and is to receive mannitol due to an increased ICP. You should be aware that which of the following is an adverse effect of this medication that you should monitor the patient closely for? A. Hyperglycemia B. Oliguria C. Hyponatremia D. Hypervolemia
C Mannitol is a powerful osmotic diuretic to decrease the amount of excess fluid within the tissues; therefore its adverse effects include causing electrolyte imbalances, such as hyponatremia. Hyperglycemia would not be an adverse effect. This medication would cause polyuria, not oliguria, due to removing excess fluid from the body, which the nurse should monitor for. Finally, hypovolemia is an adverse effect of mannitol, not hypervolemia.
Mr. Davidson, a 39-year-old hypertensive client is on Carvedilol (Coreg) for 2 months. Which of the following is a sign that the client has developed a drug tolerance? a. Polyuria b. Weight loss c. Gradual rise in blood pressure d. Rapid decrease in blood pressure
C.
When monitoring a patient with a dobutamine infusion, the nurse must be alert to the development of adverse effects. Which one may require slowing or discontinuing drug administration? A. Bradycardia B. Confusion C. Diaphoresis D. Myocardial ischemia
C.
Which client would the nurse need to assess first if the client is receiving mannitol (Osmitrol)? A) a. A 67-year-old client with type 1 diabetes mellitus B) b. A 21-year-old client with a head injury C) c. A 47-year-old client with anuria D) d. A 55-year-old client receiving cisplatin to treat ovarian cancer
C. Mannitol (Osmitrol) is not metabolized but excreted unchanged by the kidneys. Potential water intoxication could occur if mannitol is given to a client with anuria.
A physician order for additional mannitol (Osmitrol) has been written for a client with increased ICP. Which assessment finding would cause the nurse to question this order? A. Urine myoglobin is present. B. Osmotic gap less than 10 C. The client is hypovolemic. D. Serum albumin is low.
C. Mannitol should be given to euvolemic clients. Hypovolemia should be corrected prior to administration of mannitol.
A client with hyperaldosteronism is prescribed spironolactone (Aldactone). What assessment finding would the nurse evaluate as a positive outcome? A) a. Decreased potassium level B) b. Decreased crackles in the lung bases C) c. Decreased aldosterone D) d. Decreased ankle edema
C. Spironolactone (Aldactone) is the direct antagonist for aldosterone.
A client taking spironolactone (Aldactone) [potassium-sparing diuretic] has been taught about the therapy. Which menu selection indicates that the client understands teaching related to this medication? A) a. Apricots B) b. Bananas C) c. Fish D) d. Strawberries
C. Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Fish is an appropriate dietary choice, because it is low in potassium. The other foods are high in potassium.
What will the nurse instruct the client to do to prevent the development of tolerance to nitroglycerin? A) a. Apply the nitroglycerin patch every other day. B) b. Switch to sublingual nitroglycerin when the client's systolic blood pressure elevates to more than 140 mm Hg. C) c. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night. D) d. Use the nitroglycerin patch for acute episodes of angina only.
C. Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day.
A female client admitted to an acute care facility after a car accident develops signs and symptoms of increased intracranial pressure (ICP). The client is intubated and placed on mechanical ventilation to help reduce ICP. To prevent a further rise in ICP caused by suctioning, the nurse anticipates administering which drug endotracheally before suctioning? a. phenytoin (Dilantin) b. mannitol (Osmitrol) c. lidocaine (Xylocaine) d. furosemide (Lasix)
C. Administering lidocaine via an endotracheal tube may minimize elevations in ICP caused by suctioning. Although mannitol and furosemide may be given to reduce ICP, they're administered parenterally, not endotracheally. Phenytoin doesn't reduce ICP directly but may be used to abolish seizures, which can increase ICP. However, phenytoin isn't administered endotracheally.
A nurse is monitoring a client with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective? A) a. Blood pressure 120/80 mm Hg B) b. Heart rate 70 beats per minute C) c. ECG without evidence of ST changes D) d. Client stating that pain is 0 out of 10
D The client taking nitroglycerin should expect the therapeutic effect of absence of chest pain.
(Multiple Choice) This catecholamine simultaneously can increase myocardial contractility, glomerular filtration rates, sodium excretion, urinary output, and renal blood flow: A) phenylephrine B) isoproterenol C) dobutamine D) dopamine E) epinephrine
D.
During surgery, there is an increased potential for arrhythmias when catecholamines are given with: A. bupivacaine (Marcaine) B. digoxin (Lanoxin) C. lidocaine (Xylocaine) D. halothane (Fluothane)
D.
Furosemide (lasix) is order in combination with sodium nitroprusside in order to: (multiple choice) A. Decrease cardiac workload by decreasing after load B. Increase potassium excretion by the kidney to prevent hyperkalemia. C. Decrease systolic blood pressure by decreasing preload. D. Prevent sodium and water retention caused by sodium nitroprusside.
D.
Nitroprusside is available in which of the following formulations? A. Capsules B. Sublingual tablets C. Topical ointment D. Intravenous solution
D.
When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that: A. Moderate doses of two different types of diuretics are more effective than a large dose of one type B. This combination prevents dehydration and hypovolemia C. Using two drugs increases osmolality of plasma and the glomerular filtration rate D. This combination promotes diuresis but decreases the risk of hypokalemia
D.
Which of the following is indicative of an EKG change in a case of hypokalemia? A. Prolonged ST interval and Widened T-wave B. Widened QRS complex and prolonged PR interval C. Tall T-waves and depressed ST segment D. ST depression and inverted T-wave
D.
A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide? A. "Eat foods high in potassium" B. "Take daily potassium supplements" C. Discontinue sodium restrictions" D. "Avoid salt substitutes"
D. Because spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content. The client should also avoid potassium-rich foods and potassium-supplements. To reduce fluid volume overload, sodium restrictions should continue.
Which statement made by the client demonstrates a need for further instruction regarding the use of nitroglycerin? A) a. "If I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief." B) b. "I should keep my nitroglycerin in a cool, dry place." C) c. "I should change positions slowly to avoid getting dizzy." D) d. "I can take up to five tablets at 3-minute intervals for chest pain if necessary."
D. Clients are taught to take up to three tablets every 5 minutes. If no relief from chest pain is obtained after three tablets, they should seek medical assistance.
Which statement indicates to the nurse that the client understands sublingual nitroglycerin medication instructions? A) a. "I will take up to five doses every 3 minutes for chest pain." B) b. "I can chew the tablet for the quickest effect." C) c. "I will keep the tablets locked in a safe place until I need them." D) d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."
D. Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. Three doses can be taken 5 minutes apart. The tablet should be placed under the tongue to dissolve. The medication should be kept in a readily accessible location for immediate use should chest pain occur.
What statement is the most important for the nurse to include in the teaching plan for a client who has started on a transdermal nitroglycerin patch? A) a. "This medication works faster than sublingual nitroglycerin works." B) b. "This medication is the strongest of any nitroglycerin preparation available." C) c. "This medication should be used only when you are experiencing chest pain." D) d. "This medication will work for 24 hours and you will need to change the patch daily."
D. The transdermal patch has a duration of action of 24 hours. Sublingual nitroglycerin is more rapid acting than the transdermal patch. There are other preparations that may be considered stronger because they are higher in dosage. Sublingual and IV preparations are preferred during episodes of chest pain.
A 2-year-old child with bronchopulmanary dysplasia is placed on furosemide (Lasix) once per day. The parents are being educated on foods that are rich in potassium. Which of the following food should the nurse recommend? A. Apples B. Oranges C. Peaches D. Raisins
D. Raisins, dates, figs, and prunes are among the highest potassium-rich foods. They average 17-20 mEq of potassium. Apples, oranges, and peaches have very low amounts of potassium. They average 3-4 mEq of potassium.
A physician ordered nitroprusside I.V for a client in cardiogenic shock. Which of the following nursing interventions is needed to give this drug safely? A. Give only with other drugs. B. Mix the drug in an alkaline solution. C. Mix the drug only in normal saline solution. D. Cover the drug containing I.V. solution with an opaque wrapper.
D. The nurse should cover the drug containing I.V. solution with an opaque wrapper because the drug is light-sensitive. Only dilute the drug in dextrose 5% in water; no other fluid should be used. Nitroprusside cannot be mixed in alkaline solutions, and should not be given with other drugs.
A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess before giving the injection? A. Hematocrit B. Partial thromboplastin time C. Hemoglobin concentration D. Prothrombin time
Epogen is a recombinant DNA form of erythropoietin, which stimulates the production of RBCs and therefore causes the hematocrit to rise. The elevation in hematocrit causes an elevation in blood pressure; therefore, the blood pressure is a vital sign that should be checked. The PTT, hemoglobin level, and PT are not monitored for this drug.
The nurse preparing to administer a dose of calcium acetate (PhosLo) to a patient with CKD should know that this medication should have a beneficial effect on which lab value?
Phosphorus
Sodium nitroprusside is prescribed for a client with a diagnosis of cardiogenic shock. The nurse plans to do which of the following when preparing to administer this medication? a) protect the solution from light b) add potassium to the infusion bag c) obtain a baseline thiocyanate level d) administer only through a central venous line
a. Sodium nitroprusside becomes unstable when exposed to light and must be protected. No other medications are added to the infusion bag. It can be given through a peripheral line. The level of thiocyanate (a nitroprusside metabolite similar to cyanide) is usually drawn if the client is maintained on this therapy for several days.
Cyanosis and potential cyanide poisoning are possible with a. nitroglycerin b. nitroprusside (Nipride) c. nitrofurantoin (Macrodantin) d. nitrous oxide
b.
Your patient is receiving dobutamine as a continuous infusion. Titration of this medication is based upon which factors? (Select all that apply.) a. Heart rate b. Blood pressure c. Urine output d. Liver enzymes e. Respiratory rate
a. Heart rate b. Blood pressure c. Urine output
The nurse is administering lidocaine and considers which condition, if present in the patient, a caution for the use of this drug? a. Tachycardia b. Hypertension c. Ventricular dysrhythmias d. Renal dysfunction
d. Renal dysfunction
When teaching a patient about carvedilol (Coreg), the nurse explains that this medication reduces blood pressure by which actions? (Select all that apply.) a. Reducing heart rate b. Vasodilation c. Decreasing stress d. Increasing urine output
a. Reducing heart rate b. Vasodilation
The nurse is admitting a patient with a history of angina and hypertension who is currently experiencing moderate heart failure. The patient's current medication regimen includes digoxin (Lanoxin), furosemide (Lasix), and quinapril (Accupril). Which medication would be most beneficial for the health care provider to add to this patient's treatment plan? a. carvedilol (Coreg) b. propranolol (Inderal) c. esmolol (Brevibloc) d. sotalol (Betapace)
a. carvedilol (Coreg)
The physician has ordered dopamine to treat the patient's hypovolemic shock secondary to severe blood loss. For the medication to be effective, the physician must also order a. fluid replacement b. beta-stimulating drugs c. antibodies d. fluid restriction
a. fluid replacement
Which statement needs to be included when the nurse provides patient education for a patient with heart failure who is taking daily doses of spironolactone (Aldactone)? a. "Be sure to eat foods that are high in potassium." b. "Avoid food that are high in potassium." c. "Avoid grapefruit juice while taking this medication." d. "A low-fiber diet will help prevent adverse effects of this medication."
b. "Avoid food that are high in potassium."
What is the best information for the nurse to provide to the client who is receiving spironolactone (Aldactone) and furosemide (Lasix) therapy? a. "Moderate doses of two different diuretics are more effective than a large dose of one." b. "This combination promotes diuresis but decreases the risk of hypokalemia." c. "This combination prevents dehydration and hypovolemia." d. "Using two drugs increases the osmolality of plasma and the glomerular filtration rate."
b. "This combination promotes diuresis but decreases the risk of hypokalemia."
When administering nitroprusside (Nipride) intravenously, the nurse would monitor for which sign of toxicity? a. Fever b. Hypotension c. Extreme fatigue d. Hyperglycemia
b. Hypotension
When a patient has experienced extravasation of a peripheral infusion of dopamine, the nurse will inject the alpha blocker phentolamine (Regitine) into the area of extravasation and expect which effect? a. Vasoconstriction b. Vasodilation c. Analgesia d. Hypotension
b. Vasodilation
A patient has been prescribed lidocaine (Xylocaine). What does the nurse understand as the reason for this medication order? a. Bradycardia b. Ventricular arrhythmias c. Atrial arrhythmias d. Heart block
b. Ventricular arrhythmias
Which laboratory value depicts a known side effect of furosemide (Lasix)? a. Hyperchloremia b. Hypernatremia c. Hypokalemia d. Hypophosphatemia
c.
The nurse would question the use of mannitol for which patient? a. A 67-year-old patient who ingested a poisonous substance b. A 21-year-old patient with a head injury c. A 47-year-old patient with anuria d. A 55-year-old patient who receives cisplatin to treat ovarian cancer
c. A 47-year-old patient with anuria
What is the best information for the nurse to provide to the client who is receiving spironolactone (Aldactone) [potassium-sparing diuretic]and furosemide (Lasix) [Loop (high-ceiling) diuretic] therapy? A) a. "Moderate doses of two different diuretics are more effective than a large dose of one." B) b. "This combination promotes diuresis but decreases the risk of hypokalemia." C) c. "This combination prevents dehydration and hypovolemia." D) d. "Using two drugs increases the osmolality of plasma and the glomerular filtration rate."
c. A 47-year-old patient with anuria
When the nurse is checking the laboratory data for a patient taking spironolactone (Aldactone), which result would be a potential concern? a. serum sodium level of 140 mEq/L b. serum calcium level of 10.2 mg/dL c. serum potassium level of 5.8 mEq/L d. serum magnesium level of 2.0 mg/dL
c. serum potassium level of 5.8 mEq/L
A patient asks about taking potassium supplements while taking spironolactone (Aldactone). What is the nurse's best response? a) "You are correct about your concern. I will make sure that you get some right away." b) "I will call your doctor and let him know of your concern." c) "Potassium supplements are usually not necessary with this type of diuretic." d) "You are on a diuretic that is potassium-sparing, so there is no need for extra potassium."
d Spironolactone is a potassium-sparing diuretic and thus the patient does not need potassium supplementation. Although it is true that potassium supplements are not necessary with this type of diuretic, providing the patient with an explanation of why the potassium is not needed is a better response
The nurse prepares to administer which diuretic to treat a patient with acute pulmonary edema? a. spironolactone (Aldactone) b. amiloride (Midamor) c. triamterene (Dyrenium) d. furosemide (Lasix)
d.
The drug of choice to control premature ventricular contractions, ventricular tachycardia, or ventricular fibrillation is a) quinidine b) procainamide c) bretylium d) lidocaine
d. lidocaine is the first line of drug to control PVC's, VT, VF. Lidocaine exerts anesthetic effect on the heart thus decreasing myocardial irritability.
A patient is receiving dobutamine for shock and is complaining of feeling more "skipping beats" than yesterday. What will the nurse do next? a. Monitor for other signs of a therapeutic response to the drug b. Titrate the drug to a higher dose to reduce the palpitations c. Discontinue the dobutamine immediately d. Assess the patient's vital signs and cardiac rhythm
d. Assess the patient's vital signs and cardiac rhythm
The nurse is reviewing a medication history on a client taking an ACE inhibitor. The nurse plans to contact the health care provider if the client is also taking which medication? a. docusate sodium (Colace) b. furosemide (Lasix) c. morphine sulfate d. spironolactone (Aldactone)
d. spironolactone (Aldactone)
Atorvastatin (Lipitor) has been prescribed for a client, and the client asks the nurse about the action of the medication. How should nurse respond about the action of this medication? 1. Increases plasma cholesterol 2. Increases plasma triglycerides 3. Decreases low-density lipoproteins (LDLs) 4. Decreases high-density lipoproteins (HDLs)
3.
Atorvastatin (Lipitor) has been prescribed for a client, and the client asks the nurse about the side effects of the medication. What should the nurse tell the client is a frequent side effect of this medication? 1. Tremors 2. Lethargy 3. Headache 4. Tiredness
3.
For which potential side effects would the nurse monitor patients prescribed amiodarone? (Select all that apply.) A. Bluish skin discoloration B. Hyperglycemia C. Hypothyroidism D. Photosensitivity
A. B. C. Potential side effects from amiodarone include photosensitivity, bluish skin discoloration, hyperthyroidism, hypothyroidism, and decreased libido.
A clinical situation in which the increased release of erythropoietin would be expected is: a. Hypoxemia b. Hypotension c. Hyperkalemia d. Fluid overload
A. Erythropoietin is released when the oxygen tension of the renal blood supply is low and stimulates production of red blood cells in the bone marrow. Hypotension causes activation of the renin-angiotensin-aldosterone system, as well as release of ADH. Hyperkalemia stimulates release of aldosterone from the adrenal cortex, and fluid overload does not directly stimulate factors affecting the kidney.
Before giving furosemide (Lasix) to an adult, the nurse checks the laboratory report for the last serum potassium level. Which finding would be of concern to the nurse? A. 3.2 mEq/L B. 3.7 mEq/L C. 4.1 mEq/L D. 4.9 mEq/L
A. The normal serum potassium level is 3.5 to 5.0 mEq/L. A finding of 3.2 mEq/L is of concern in a patient who is taking a potassium-depleting diuretic such as furosemide (Lasix).
The nurse is preparing to administer carvedilol (Coreg) to a patient. Which action should the nurse take first? A. Assess the patient's current pulse and BP B. Review the patient's urine output as recorded by nurses on the previous shift. C. Check the patency of the patient's IV line. D. Find the results of the patient's last BP measurement.
A. Carvedilol is a nonselective beta-adrenergic antagonist that blocks the action of Beta 1 in the heart and the action of Beta 2 receptors in the lung, smooth muscles, and skeletal muscles. Blocking the Beta 1 receptors leads to decreased HR, contractility, and velocity of impulse conduction in the atrioventricular node. Beta 2 receptor blockade can result in bronchoconstriction, vasoconstriction, and inhibition of glycogenolysis. Because of this drugs effect on the heart, the nurse should assess the patients current pulse and BP before administering. The prescriber should be contacted if bradycardia or hypotension is identified prior to the administration of the drug. Carvedilol is administered orally.
Drug therapy with atorvastatin (Lipitor) is initiated for a client with hyperlipidemia. The nurse develops a teaching plan and includes what information? A. Continues to make lifestyle changes toward lowering cholesterol levels. B. Always take the drug just before bedtime. C. Eliminate all cholesterol from the diet. D. Stop taking the drug when dietary changes are accomplished.
A. Drug therapy should be used in conjunction with lifestyle changes. Lipitor is the only statin that can be administered at any time of day. Cholesterol intake should be reduced, but not totally eliminated.
A client with heart failure was experiencing difficulty breathing and increased pulmonary congestion. The physician prescribed furosemide (Lasix) 40 mg to be given intravenously and it was given an hour ago by the nurse. Which indicates the therapy has been effective? 1. The lungs are now clear to auscultation 2. The urine output has increased by 400 mL 3. The serum potassium has decreased from 4.7 mEq to 4.1 mEq 4. The blood pressure has decreased from 118/64 mm Hg to 106/62 mm Hg
A. Furosemide (Lasix) is a diuretic. In this situation, it was given to decrease preload and reduce the pulmonary congestion and associated difficulty in breathing. Although all options may occur, option 1 is the reason the furosemide was administered. Priority Nursing Tip: When administering a medication, knowing its purpose will assist in evaluating its effectiveness.
Digoxin (Lanoxin) and furosemide (Lasix) are ordered for client who has congestive heart failure. Which of the following would the nurse also expect to be ordered for this client? A. Potassium B. Calcium C. Aspirin D. Coumadin
A. Lasix is a potassium-depleting diuretic. Digoxin toxicity occurs more quickly in the presence of low serum potassium. Potassium supplements are usually ordered when the client is on a potassium-depleting diuretic. There is no indication for calcium supplementation. Aspirin and Coumadin are anticoagulants and are not indicated because the client is taking Lasix and digoxin.
The client is admitted with a BP of 210/100. Her doctor orders furosemide (Lasix) 40mg IV stat. How should the nurse administer the prescribed furosemide to this client? A. By giving it over 1-2 minutes B. By hanging it IV piggyback C. With normal saline only D. With a filter
A. Lasix should be given approximately 1mL per minute to prevent hypotension. Answers B, C, and D are incorrect because it is not necessary to be given in an IV piggyback, with saline, or through a filter.
The nurse is caring for a patient with chronic renal failure (CRF) that has developed decreased erythropoietin synthesis. The nurse assesses the patient for: (Select all that apply). A. Dyspnea. B. Nausea and dizziness. C. Weakness and fatigue. D. Low hemoglobin level and pallor. E. Intercostal retractions and wheezing. F. Cyanosis and hypercapnia.
A. C. D. -Erythropoietin is synthesized in the renal cortex. A decrease in production related to CRF leads to anemia, manifesting as weakness and fatigue. Dyspnea, pallor, malaise, and poor concentration are also common symptoms of anemia. -In a person with CRF, a low hemoglobin (Hgb) is most likely caused by low erythropoietin production. -Nausea is not associated with anemia. -Intercostal retractions, cyanosis, wheezing, and hypercapnia are generally related to problems with ventilation and perfusion. -Cyanosis is seen less in those with anemia because the bluish color of deoxyhemoglobin cannot be seen without a high enough hemoglobin count.
A pt has a potassium level of 6.0 and a digoxin level of 3.0. What medication would the nurse be giving? a. Digibind b. Sodium citrate c. Epinephrine d. Lidocaine
Answer: a
A client is discharged on Digoxin (Lanoxin) following hospitalization for Atrial Fibrillation. In preparing a Discharge Teaching Plan, the nurse would NOT include which of the following? a. Take pulse correctly and count for one full minute b. Report any signs and/or symptoms such as ocular disturbances, anorexia, etc., to MD promptly. c. Take another dose of medication if first dose is vomited. d. Withhold drug if heart rate falls below 60 bpm.
Answer: c Rationale: A client should NOT repeat a dose if first dose is vomited, as one would not know how much of the original dose was absorbed, and could possibly lead to excess Digoxin levels, which can cause arrhythmias, or slow heart rate below 60 bpm. Choices a, b, and d would be included in the teaching plan.
A patient in CCU (Coronary Care Unit) is receiving Digoxin (Lanoxin) and Furosemide (Lasix). In assessing the patient's lab values, which of the following might the nurse expect to see? a. Increase specific gravity of urine b. Hyperkalemia c. Hypokalemia d. Hypernatremia
Answer: c Rationale: Loop diuretics such as Lasix result in potent diuresis. The most common side effects are electrolyte imbalances such as hypokalemia hyponatremia making choices a, b, and d incorrect. In addition, Digoxin taken in combination with loop diuretics can result in digitalis toxicity, so the nurse should be alert to this and normal serum lab values for Digoxin. The nurse should be aware that there is a very small variance between therapeutic and toxic levels of this drug.
Which of the following is a contraindication for digoxin administration? a. BP 140/90 b. HR>80 c. HR<60 d. RR18
Answer: c Rationale: The apical heart rate must be monitored during therapy with digoxin, and the drug held for pulse below 60 and above 120. Remember that digoxin lowers the heart rate; therefore, the choice that reflects a low heart rate is the best selection
A nurse is caring for four clients who are each taking digoxin (Lanoxin). The client who is taking which of the following medications concurrently is at risk for digoxin toxicity? a. Procainamide (Pronestyl) for premature ventricular contractions. b. Ranitidine (Zantac) for peptic ulcer disease. c. Phenytoin (Dilantin) for a seizure disorder. d. Amiodarone (Cordarone) for ventricular dysrhythmias.
Answer: d
Which of the following pts is at greatest risk for digital toxicity? a. A 25-year old pt w/congestive heart disease b. A 50 year old pt w/CHF c. A 60 year old pt who had an MI d. An 80 year old pt with CHF
Answer: d Rationale: Extremely old clients are at greater risk for digitalis toxicity. Remember, when it comes to adversity, the very old and very young are always at highest risk.
One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect? A. Hypocalcemia B. Hypokalemia C. Hypermagnesemia D. Hypernatremia
B.
The physician orders lisinopril (Zestril) and furosemide (Lasix) to be administered concomitantly to the client with hypertension. The nurse should: A. Question the order. B. Administer the medications. C. Administer them separately. D. Contact the pharmacy.
B. Zestril is an ACE inhibitor and is frequently given with a diuretic such as Lasix. There is no need to question the order, give the drugs separately, or contact the pharmacy, so answers A, C, and D are incorrect.
A client with heart failure is given furosemide (Lasix) 40mg IV daily. The morning serum potassium level is 2.8mEq/L. Which of the following actions is the most appropriate? A. Question the physician about the dosage. B. Give 20mg of the ordered dose and recheck the laboratory test results. C. Notify the physician, repeat the potassium as ordered, then give the furosemide. D. Give the furosemide and get an order for sodium polystyrene sulfonate.
C. Furosemide is a diuretic. As water is lost, so is potassium. Diuresis is a treatment for heart failure. Notifying the physician of the low potassium level and getting an order for potassium chloride is the appropriate action before giving the furosemide. Furosemide, 40mg, is an appropriate dose for the treatment of heart failure. The nurse shouldn't give have the dose without an order. Giving furosemide and sodium polystyrene sulfonate together would further lower the potassium level.
A nurse is just starting her shift. She has four clients who should she assess first? A. A client who just started gentamycin with a temperature of 101 B. A client complaining of gastric upset who is taking clindamycin C. A client who has just started furosemide along with her vancomycin D. A client who is 19 years old and just prescribed telithromycin
C. Furosemide/Vanco is bad combo increase risk of nephrotoxicity
Mandy, a patient calls the clinic today because he is taking atorvastatin (Lipitor) to treat his high cholesterol and is having pain in both of his legs. You instruct him to: A. Stop taking the drug and make an appointment to be seen next week B. Continue taking the drug and make an appointment to be seen next week C. Stop taking the drug and come to the clinic to be seen today D. Walk for at least 30 minutes and call if symptoms continue
C. Muscle aches, soreness, and weakness may be early signs of myopathy such as rhabdomyolysis associated with the HMG-CoA reductase class of antilipemic agents. This patient will need an immediate evaluation to rule out myopathy. Additional doses may exacerbate the problem. Exercise will not reverse myopathy and delays diagnosis.
The nurse teaches the client taking atorvastatin to call the health care provider (HCP) if experiencing which symptom associated with a serious adverse effect of atorvastatin? A. Diarrhea B. Headache C. Muscle aches D. Numbness in the feet
C. Atorvastatin (Lipitor) is a statin drug, or HMG-CoA reductase inhibitor, prescribed to lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease. A serious adverse effect of statins, including atorvastatin and rosuvastatin (Crestor), is myopathy with ongoing generalized muscle aches and weakness. A client who develops muscle aches while on a statin drug should call the HCP who will then obtain a blood sample to assess the creatinine kinase (CK) level. If myopathy is present, CK will be significantly elevated (>10x normal), and the drug will then be discontinued.
Question # 9 (Multiple Choice) Antiarrhythmic drug: may cause hypothyroidism or hyperthyroidism (frequency -- 2%-4%): approved for use only in the treatment of serious ventricular arrhythmias (USA); also use for refractory supraventricular arrhythmias A) mexiletine (Mexitil) B) tocainide (Tonocard) C) adenosine (Adenocard) D) amiodarone (Cordarone) E) procainamide (Procan SR, Pronestyl-SR)
D.
The nurse provides teaching to a patient who will take atorvastatin (Lipitor) at home. Which patient teaching is most likely to help maintain the antilipemic medication dosage at the lowest level possible? A. Take atorvastatin (Lipitor) at bedtime. B. Adhere to the blood test schedule C. Avoid all alcoholic beverages. D. Engage in moderate exercise.
D.
The patient is taking Atorvastatin (Lipitor) 80mg/day. The patient's partner calls to report that the patient is feeling weak and complaining of muscle pain. What severe side effect of statins does the nurse suspect? A. Stevens-Johnson Syndrome B. Pseudomembranous colitis C. Gastric ulcers D. Rhabdomyolysis
D.
What intervention is essential prior to starting a client on atorvastatin therapy? A. Assessing for muscle strength B. Assessing the client's dietary intake C. Determining if the client is on digoxin therapy D. Monitoring liver function tests
D.
The nurse preparing to administer a dose of calciumacetate (PhosLo) to a patient with chronic kidneydisease (CKD) should know that this medication shouldhave a beneficial effect on which laboratory value? A.Sodium B.Potassium C. Magnesium D. Phosphorus
D. Phosphorus and calcium have inverse or reciprocalrelationships, meaning that when phosphorus levels arehigh, calcium levels tend to be low. Thereforeadministration of calcium should help to reduce apatient's abnormally high phosphorus level, as seen withCKD. PhosLo will not have an effect on sodium,potassium, or magnesium levels.
Bronchopulmonary dysplasia can cause increased fluid in the lungs due to disruption of the alveolar-capillary membrane, and the client may begin receiving furosemide (Lasix). Which of the following adverse effects is possible? A. Hypercalcemia B. Hyperkalemia C. Hypernatremia D. Irregular heart rhythm
D. An irregular heart rhythm and muscle cramps are adverse effects related to hypokalemia and hypocalcemia. Diuretics cause volume depletion by inhibiting reabsorption of sodium and chloride. Hypokalemia can occur with excessive fluid loss or as part of contraction alkalosis. Hypocalcemia is related to the urinary excretion of calcium.
The doctor has ordered 80mg of furosemide (Lasix) two times per day. The nurse notes the patient's potassium level to be 2.5meq/L. The nurse should: A. Administer the Lasix as ordered B. Administer half the dose C. Offer the patient a potassium-rich food D. Withhold the drug and call the doctor
D. The potassium level of 2.5meq/L is extremely low. The normal is 3.5-5.5meq/L. Lasix (furosemide) is a nonpotassium sparing diuretic, so answer A is incorrect. The nurse cannot alter the doctor's order, as stated in answer B, and answer C will not help with this situation.
The nurse reviews the history for a client taking atorvastatin (Lipitor). What will the nurse act on immediately? A. Client takes medications with grape juice. B. Client takes herbal therapy including kava kava. C. Client is on oral contraceptives. D. Client was started on penicillin for a respiratory infection.
D. Client is on oral contraceptives.
The nurse is providing education to a patient on why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together. What information does the nurse provide to the patient? a. Moderate doses of two different types of diuretics are more effective than a large dose of one type. b. This combination promotes diuresis but decreases the risk of hypokalemia. c. This combination prevents dehydration and hypovolemia. d. Using two drugs increases osmolality of plasma and the glomerular filtration rate.
b. This combination promotes diuresis but decreases the risk of hypokalemia.
The client is diagnosed with uric acid stone. Which foods should the client eliminate from their diet? a. Beer and colas b. Asparagus and cabbage c. Venison and sardines d. Cheese and eggs
c. Venison and sardines Venison, sardines, goose, organ meats, and herring are high-purine foods which should be eliminated from the diet to prevent uric acid stones. Beer, cola, asparagus, and cabbage are foods high in oxalate which can cause calcium oxalate stones. Cheese and eggs are foods that help acidify the urine and do not cause the development of uric acid stones.
The nurse is preparing to begin a dopamine (Intropin) infusion on a client. Before beginning the infusion the nurse should 1. evaluate the urine output. 2. obtain the client's weight. 3. determine the patency of the IV line. 4. measure pulmonary artery pressures.
(1) not a critical assessment at this time (2) contains correct information, but is not a priority (3) correct-if extravasation occurs, there is sloughing of the surrounding skin and tissue; patent IV line is essential to prevent serious side effects (4) not a critical assessment at this time
A client suffering from chronic kidney disease is scheduled to receive recombinant human erythropoietin and iron sucrose. An assessment of lab work shows hemoglobin of 9.7 g/dL and hematocrit of 29%. What is the best nursing action? 1. Administer the erythropoietin in the client's abdominal area 2. Check the client's blood pressure prior to administering the erythropoietin 3. Hold the client's next scheduled iron sucrose dose 4. Hold the erythropoietin dose and inform the health care provider
2. Anemia associated with chronic kidney disease is treated with recombinant human erythropoietin (Epogen/Procrit. epoetin). Therapy is initiated to achieve a target hemoglobin of 10-11.5 g/dL and to alleviate the symptoms of anemia (eg. fatigue) and the need for blood transfusions. However, higher hemoglobin concentrations, especially >13 g/dL, are associated with venous thromboembolism and adverse cardiovascular outcomes. Hypertension is a major adverse effect of erythropoietin administration. Therefore, uncontrolled hypertension is a contraindication to recombinant erythropoietin therapy. Blood pressure should be well controlled prior to administration of erythropoietin.
Atorvastatin (Lipitor) has been prescribed for a client, and the nurse provides instructions to the client about the medication. Which statement by the client indicates the need for further teaching? 1. "This medication will lower my cholesterol level." 2. "I will need to have blood tests drawn while I am taking this medication." 3. "I won't need to adhere to a low-fat diet as long as I take this medication faithfully." 4. "I need to talk to the health care provider (HCP) before taking any over-the-counter medications."
3.
The health care provider (HCP) writes a prescription for atorvastatin (Lipitor) for a client who was admitted to the hospital. The nurse contacts the HCP to verify the prescription if which finding is noted in the assessment data? 1. Renal calculi 2. Chronic heart failure 3. Cirrhosis of the liver 4. Coronary artery disease
3.
A nurse is collecting subjective and objective data from a client and notes that the client is taking atorvastatin (Lipitor). What should the nurse determine that this medication has been prescribed to specifically treat? 1. Heart failure 2. Hypertension 3. Angina pectoris 4. Hypercholesterolemia
4.
A patient is presenting with an orthostatic blood pressure of 80/40 when she stands up, thready and weak pulse of 58, and shallow respirations. In addition, the patient has been having frequent episodes of vomiting and nausea and is taking hydrochlorothiazide. Which of the following findings would explain the patient's condition? A. Potassium level of 2.4 B. Potassium level of 3.5 C. Potassium level of 7.0 D. None of the options are correct
A.
A patient with nasogastric suctioning is experiencing diarrhea. The patient is ordered a morning dose of Lasix 20mg IV. Patient's potassium level is 3.0. Which of the following options is correct? A. No intervention is need the potassium level is within normal range B. Turn off the nasogastric suctioning and administered a laxative C. Hold the dose of Lasix and notify the doctor for further orders D. Administered the Lasix and notify the doctor for further orders
A.
When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that: A. This combination promotes diuresis but decreases the risk of hypokalemia B. Using two drugs increases osmolality of plasma and the glomerular filtration rate C. Moderate doses of two different types of diuretics are more effective than a large dose of one type D. This combination prevents dehydration and hypovolemia
A.
Which drugs are competitive inhibitors of hepatic HMG CoA reductase, the rate-limiting enzyme in cholesterol biosynthesis? A. Statins B. Ezetimibe C. Fibric Acids D. Bile acid-binding resins E. Niacin
A.
Which patient is at a potential risk for Digoxin toxicity? A. A patient with Cushing's syndrome taking Laxis 20 mg IV twice a day B. A patient presenting with painful muscle spasms and positive Trousseau's sign C. A patient with a potassium level of 3.8 D. A patient with a calcium level of 8.9
A.
The nurse makes which of the following recommendations to assist a client in reducing lipid levels? A. Reducing cholesterol and saturated fats B. Increasing complex carbohydrate intake C. Reducing sodium intake and exercise D. Increasing intake of antioxidants
A. Although exercise and substituting complex carbohydrates for simple carbohydrates will help to improve the lipid profile overall, the best choice is reduction of both cholesterol and fats. When saturated fats are present in the blood, cholesterol excretion is inhibited.
A mother calls the clinic and asks to speak to the nurse regarding her 6 month old daughter who has been vomiting for the past 24 hours. The mother states that the baby is on Digoxin for a congenital heart defect and she is concerned that this may be a serious problem. What instructions should the nurse give to the mother over the phone? a. Check the infant's pulse for a HR <100bpm b. Increase the infant's fluid intake c. Check the infant for a wet diaper d. Redose the digoxin
Answer: a Rationale: Signs of Digoxin Toxicity in infants often presents with vomiting since increased drug levels stimulate the emetic control center in the medulla. Digoxin toxic levels significantly suppress the SA node and cause slowing of the heart rate, therefore having the mother assess the child's pulse will help to determine if the child is exhibiting a toxic reaction to Digoxin. Increasing fluid intake is inappropriate until it is determined whether or not the child is toxic. Checking for wet diapers would indicate renal response to digoxin, not toxicity. Redosing the digoxin is inappropriate until toxicity is ruled out.
Hypokalemia is a potential side effect of Digoxin. You need to educate your pt on consuming potassium-rich foods. Which of the following will you include in your list of potassium-rich foods? a. Eggs b. Strawberries c. Whole grain bread
Answer: b
The nurse is reviewing the classes of antidysrhythmic drugs. Amiodarone is classified on the Vaughan Williams classification as a class III drug, which means it works by A. blocking slow calcium channels. B. prolonging action potential duration. C. blocking sodium channels and affecting phase D. decreasing spontaneous depolarization and affecting phase 4.
B.
What is the most important information for the nurse to communicate to the parents of a child receiving amiodarone? A. Amiodarone can be used with antiviral medication B. Amiodarone can cause pulmonary toxicity C. Amiodarone doses should not exceed 300mg/day D. Amiodarone should be given rapidly by IV means
B.
A female patient is receiving furosemide (Lasix), 40 mg P.O. b.i.d. in the plan of care, the nurse should emphasize teaching the patient about the importance of consuming: a. Fresh, green vegetables b. Bananas and oranges c. Lean red meat d. Creamed corn
B. Because furosemide is a potassium-wasting diuretic, the nurse should plan to teach the patient to increase intake of potassium-rich foods, such as bananas and oranges. Fresh, green vegetables; lean red meat; and creamed corn are not good sources of potassium.
A client with hypertension has and order for furosemide. Which lab finding should be reported to the physician? A. Phosphorus 2.5 mEq/L B. Potassium 1.8 mEq/L C. Calcium 9.4 mg/dL D. Magnesium 2.4 mEq/L
B. The client taking furosemide is at risk for developing hypokalemia (decreased potassium) because this drugs is a non-potassium-sparing diuretic. A potassium level of 1.8 is extremely low and might result in cardiac dysrhythmias. Answers A, C, and D are incorrect because the levels because the levels are within the normal levels.
A patient who has received chemotherapy for cancer treatment is given an injection of Epoetin. Which of the following should reflect the findings in a complete blood count (CBC) drawn several days later? A. An increase in neutrophil count. B. An increase in hematocrit. C. An increase in platelet count. D. An increase in serum iron.
B. Epoetin is a form of erythropoietin, which stimulates the production of red blood cells, causing an increase in hematocrit. Epoetin is given to patients who are anemic, often as a result of chemotherapy treatment. Epoetin has no effect on neutrophils, platelets, or serum iron.
Question # 26 (Multiple Choice) Most serious adverse effect with long-term treatment: rapidly progressive pulmonary fibrosis:frequency: 5%-15% A) lidocaine (Xylocaine) B) propranolol (Inderal) C) amiodarone (Cordarone) D) procainamide (Procan SR, Pronestyl-SR)
C.
The nurse administers furosemide (Lasix) to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully? A. Increase in blood pressure B. Increase in blood volume C. Low serum potassium level D. High serum sodium level
C. Furosemide is a potassium-wasting diuretic. The nurse must monitor the serum potassium level and assess for signs of low potassium. As water and sodium are lost in the urine, blood pressure decreases, blood volume decreases, and urine output increases.
Which of the following data obtained by the nurse during the history and physical of a client receiving atorvastatin (Lipitor) requires immediate attention? A. History of diabetes mellitus B. History of glaucoma C. Possibility of pregnancy D. Coronary artery disease
C. Lipitor is a pregnancy Category X drug, and should not be used by clients who are planning to become pregnant, are pregnant, or are breastfeeding. The drug should be stopped if the client becomes pregnant while taking it.
A nurse is viewing the cardiac monitor in a client's room and notes that the client has just gone into ventricular tachycardia. The client is awake and alert and has good skin color. The nurse would prepare to do which of the following? A. Immediately defibrillate B. Prepare for pacemaker insertion C. Administer amiodarone (Cordarone) intravenously D. Administer epinephrine (Adrenaline) intravenously
C. First-line treatment of ventricular tachycardia in a client who is hemodynamically stable is the use of anti-dysrhythmics such as amiodarone (Cordarone), lidocaine (Xylocaine), and procainamide (Pronestyl). Cardioversion also may be needed to correct the rhythm (cardioversion is recommended for stable ventricular tachycardia). Defibrillation is used with pulseless ventricular tachycardia. Epinephrine would stimulate and already excitable ventricle and is contraindicated.
A nurse is administering IV furosemide to a patient admitted with congestive heart failure. After the infusion, which of the following symptoms is NOT expected? A. Increased urinary output. B. Decreased edema. C. Decreased pain. D. Decreased blood pressure.
C. Furosemide, a loop diuretic, does not alter pain. Furosemide acts on the kidneys to increase urinary output. Fluid may move from the periphery, decreasing edema. Fluid load is reduced, lowering blood pressure.
Amiodarone toxicity is evidenced in which body system? A. Renal B. Hepatic C. Pulmonary D. Hematologic
C. Patients taking amiodarone must have baseline and serial pulmonary function tests in order to monitor for potential pulmonary toxicity.
A client in shock is receiving dopamine hydrochloride by intravenous (IV) infusion. The nurse should have which of the following medications available for local injection if IV infiltration and medication extravasation occur? A. Vitamin K B. Phentolamine C. Atropine Sulfate D. Protamine Sulfate
Correct Answer: B Rationale: Phentolamine is an a-adrenergic blocking agent that prevents dermal necrosis and sloughing after infiltration of norepinephrine or dopamine. Vitamin K is the antidote for warfarin (coumadin). Atropine sulfate is the antidote for cholinergic crisis. Protamine sulfate is the antidote for heparin
A patient's potassium level is 3.0. Which foods would you encourage the patient to consume? A. Raisins, yogurt, and cauliflower B. Cheese, collard greens, and fish C. Tofu, oatmeal, and peas D. Avocados, strawberries, and potatoes
D.
The nurse assesses the intravenous infusion site of a patient receiving dopamine and finds it is infiltrated. The nurse will prepare which medication to treat this infiltration? a. lidocaine (Xylocaine) b. phentolamine (Regitine) c. nitroprusside (Nipride) d. naloxone (Narcan)
b. phentolamine (Regitine)
A patient is admitted to the hospital with pneumonia and has a history of chronic renal insufficiency. Why does the physician order furosemide (Lasix) 40 mg twice a day? a. Furosemide will not cause potassium loss. b. Furosemide is effective in treating patients with pulmonary congestion. c. Furosemide is effective in treating patients with renal insufficiency. d. Furosemide will increase PO2 levels.
c. Furosemide is effective in treating patients with renal insufficiency.
For a patient receiving a vasoactive drug such as intravenous dopamine, which action by the nurse is most appropriate? a. Monitor the gravity drip infusion closely, and adjust as needed. b. Assess the patient's cardiac function by checking the radial pulse c. Assess the intravenous site hourly for possible infiltration d. Administer the drug by intravenous boluses according to the patient's blood pressure
c. Assess the intravenous site hourly for possible infiltration
Carvedilol (Coreg) is classified as a a. beta blocker. b. alpha1 blocker. c. Dual-action alpha1 and beta receptor blocker. d. Calcium channel blocker.
c. Dual-action alpha1 and beta receptor blocker.
When administering beta blockers, the nurse will follow which guideline for administration and monitoring? a. The drug may be discontinued at any time b. Postural hypertension rarely occurs with this drug c. Tapering off the medication is necessary to prevent rebound hypertension d. The patient needs to stop taking the medication at once if he or she gains 3 to 4 pounds in a week.
c. Tapering off the medication is necessary to prevent rebound hypertension
A client is prescribed digoxin (Lanoxin) 0.125mg PO daily and furosemide (Lasix) 20mg PO daily. Which of the following statements by the client should demonstrate to the nurse that the client has an accurate understanding regarding these medications? a) "I will take my Lasix with my supper meal" b) "I will measure my urine output and document it in my diary" c) "I will skip a dose of my Lanoxin if my resting HR is below 72bpm" d) "I will eat fruits and vegetables every day that have high-potassium content in them"
d. Hypokalemia is an adverse effect of Lasix therapy. Since the client is on Lanoxin, it is important to maintain the K+ level between 3.5 to 5.0 mg/dl to avoid Lanoxin toxicity.
