Pharm Test 3 NCLEX
The nurse teaches a patient about benazepril [Lotensin]. Which statement by the patient requires an intervention by the nurse? A."I use NoSalt instead of salt to season foods." B."I eat sweet potatoes once or twice a week." C."I drink 4 ounces of prune juice each morning." D."I like asparagus because it's high in vitamin K."
A. "I use NoSalt instead of salt to season foods." An adverse effect of angiotensin-converting enzyme (ACE) inhibitors (eg, benazepril) is hyperkalemia. Significant potassium accumulation is usually limited to patients taking potassium supplements, salt substitutes (which contain potassium), or a potassium-sparing diuretic. Patients should be instructed to avoid potassium supplements and potassium-containing salt substitutes unless they are prescribed. Sweet potatoes and prune juice are foods high in potassium; asparagus is high in vitamin K. Foods high in vitamin K are restricted for patients who are prescribed warfarin [Coumadin].
A patient with angina pectoris is prescribed sublingual nitroglycerin. Which statement made by the patient indicates understanding of the medication teaching? A. "I may experience a headache as a side effect." B. "The chest pain should be relieved within 20 minutes." C. "I should swallow the tablet and drink a glass of water." D. "I should take this medication in the morning before breakfast."
A. I may experience a headache as a side effect. •Rationale: Headache is a common adverse effect of nitroglycerin and is due to vasodilation. If chest pain is not relieved in 5 minutes, the person should dial 911. A sublingual tablet should be placed under the tongue and allowed to dissolve. Sublingual nitroglycerin is used to abort anginal attacks and is not a scheduled medication.
When providing discharge teaching for a patient who has been prescribed furosemide [Lasix], it is most important for the nurse to include which dietary items to prevent adverse effects of furosemide [Lasix] therapy? A.Oranges, spinach, and potatoes B.Baked fish, chicken, and cauliflower C.Tomato juice, skim milk, and cottage cheese D.Oatmeal, cabbage, and bran flakes
A. Oranges, spinach, and potatoes •Rationale: Furosemide may have the adverse effect of hypokalemia. Hypokalemia can be reduced by consuming foods that are high in potassium, such as nuts, dried fruits, spinach, citrus fruits, potatoes, and bananas.
The nurse cares for a patient receiving digoxin [Lanoxin]. What indicates to the nurse that treatment with this medication is effective? A.Improved cardiac output B.Reduced exercise tolerance C.Increased body weight Decreased cardiac contractility
A.Improved cardiac output •Rationale: Digoxin increases the cardiac output of patients with heart failure; it improves cardiac output, decreases the heart rate, decreases heart size, decreases constriction of arterioles and veins, reverses water retention, decreases blood volume, decreases peripheral and pulmonary edema, decreases weight (by water loss), and improves exercise tolerance.
The nurse cares for a patient with a digoxin level of 1.9 ng/mL. Which action would be most appropriate for the nurse to take initially? A.Start continuous heart monitoring. B.Check the patient's serum creatinine. C.Administer digoxin as prescribed. Give Fab antibody fragments [Digibind].
A.Start continuous heart monitoring. •Rationale: The optimal therapeutic range for digoxin is 0.5 to 0.8 ng/mL; levels higher than 2 ng/mL usually are associated with toxic symptoms. A priority action is to assess for dysrhythmias; the nurse should immediately initiate continuous heart monitoring. Serum creatinine indicates renal function, and digoxin is eliminated primarily by renal excretion. Renal impairment can lead to toxic accumulation, and the dosage must be reduced if kidney function declines. Digoxin should not be given to a patient suspected of having digoxin toxicity. If a severe digoxin overdose is responsible for dysrhythmias, digoxin levels can be lowered using Fab antibody fragments.
A patient with heart failure who takes furosemide [Lasix] is diagnosed with bacterial pneumonia. Which medication, if ordered by the physician, should the nurse question? A.Ciprofloxacin [Cipro] B.Gentamicin [Garamycin] C.Amoxicillin [Amoxcil] Erythromycin [E-Mycin]
B. Gentamicin (Garamycin) •Rationale: High-ceiling loop diuretics may cause hearing impairment; furosemide may result in deafness that is transient. Because of the risk of hearing loss, caution is needed when high-ceiling diuretics are used in combination with other ototoxic drugs (eg, aminoglycoside antibiotics). Gentamicin is an aminoglycoside. The other antibiotics are safe to administer with furosemide.
A patient's cardiac output is 8 L/min. Which hemodynamic effect would the nurse expect? A.Decreased contractility B.Increased stroke volume C.Decreased preload D.Increased arterial pressure
B. Increased stroke volume •Rationale: The average value for cardiac output is 4.9 L/min. An increase in stroke volume will increase cardiac output. Stroke volume is determined by contractility, preload, and afterload. A decrease in contractility or preload will decrease stroke volume and cardiac output. An increase in afterload (or arterial blood pressure) will decrease stroke volume and cardiac output.
A patient is prescribed a medication that causes venous dilation. It is most important for the nurse to teach the patient about what? A.B-natriuretic peptide B.Postural hypotension C.Increased urination D.Intermittent claudication
B. Postural Hypotension •Rationale: Postural hypotension may occur with drugs that promote the dilation of veins or that prevent the veins from constricting.
A nurse instructs a patient about signs and symptoms of digoxin toxicity. The nurse determines that teaching is successful if the patient makes which statement? A."If my heart is racing, the dose may be too high." B."I should report any muscle weakness or nausea." C."My doctor should be notified if diarrhea occurs." D."The dose will be reduced if I develop memory loss."
B."I should report any muscle weakness or nausea." •Rationale: Digoxin toxicity manifests with dysrhythmias, bradycardia, muscles weakness, anorexia, nausea, vomiting, fatigue, and visual disturbances.
A patient who is hospitalized for an infection takes eplerenone [Inspra] for heart failure. Which medication, if ordered by the physician, should the nurse question? A.Ciprofloxacin [Cipro] B.Itraconazole [Sporanox] C.Tetracycline [Sumycin] D.Ampicillin [Principen]
B.Itraconazole [Sporanox] •Rationale: Inhibitors of CYP3A4 can increase levels of eplerenone, thereby posing a risk of toxicity. Weak inhibitors (eg, erythromycin, saquinavir, verapamil, fluconazole) can double eplerenone levels. Strong inhibitors (eg, ketoconazole, itraconazole) can increase levels fivefold. If eplerenone is combined with a weak inhibitor, the eplerenone dosage should be reduced. Eplerenone should not be combined with a strong inhibitor.
The nurse teaches a patient diagnosed with chronic stable angina about the mechanism of action of nitroglycerin. The nurse should include which instruction? A. "Nitroglycerin reduces vasospasms of the heart's arteries, which improves blood supply." B. "Nitroglycerin opens the arteries to allow more oxygen to be delivered to the heart muscle." C. "Nitroglycerin dilates veins, which decreases the amount of oxygen needed by the heart." D. "Nitroglycerin improves blood flow to the heart muscle by increasing blood pressure."
C. "Nitroglycerin dilates veins, which decreases the amount of oxygen needed by the heart." Rationale: Nitroglycerin relieves the pain of stable angina by dilating veins; this decreases venous return, which decreases preload, which decreases oxygen demand.
A patient is prescribed a nitroglycerin transdermal patch. The nurse should include which statement when teaching the patient how to use this medication? A. "Apply the patch to the chest over the heart." B. "Change the patch each week." C. "Remove the patch at bedtime." D. "Put on the patch before exercising."
C. Remove the patch before bedtime •Rationale: A transdermal nitroglycerin patch is applied once daily to a hairless area of skin. The site should be rotated to avoid local irritation. Tolerance develops if patches are used continuously. A patch-free interval of 10 to 12 hours is recommended. Patches are suited for sustained prophylaxis and will not abort an ongoing attack.
A patient is prescribed spironolactone [Aldactone] for treatment of hypertension. Which foods should the nurse teach the patient to avoid? A. Baked fish B. Low-fat milk C. Salt substitutes D. Green beans
C. Salt substitutes •Rationale: Spironolactone is a potassium-sparing diuretic. Medications that are potassium sparing, potassium supplements, and salt substitutes should be avoided. High-potassium foods should also be avoided.
A patient is prescribed digoxin [Lanoxin] and furosemide [Lasix]. It is most important for the nurse to assess which value before administering these medications? A.Serum sodium B.Blood urea nitrogen C.Serum potassium Plasma B-natriuretic peptide
C. Serum K •Rationale: Furosemide is a loop diuretic that promotes loss of potassium and thereby increases the risk of digoxin-induced dysrhythmias. When digoxin and furosemide are used concurrently, serum potassium levels must be monitored and maintained within a normal range (3.5 to 5 mEq/L).
A patient who is taking spironolactone [Aldactone] is prescribed losartan [Cozaar]. The nurse should take which action? A.Assess for symptoms of hyperkalemia. B.Observe for a hypertensive crisis. C.Administer the medications as scheduled. D.Evaluate for first-dose hypotension.
C.Administer the medications as scheduled. •Rationale: These medications may be administered together without serious drug interactions. Spironolactone is a potassium-sparing diuretic, and losartan is an angiotensin II receptor blocker (ARB). The hypotensive effects of ARBs are additive with those of other antihypertensive drugs. When an ARB is added to an antihypertensive regimen, dosages of the other drugs may require reduction. The patient would be observed for hypotension (not first-dose hypotension).
A patient is prescribed sustained-release oral nitroglycerin capsules for chronic stable angina. The nurse should include which instruction? A. "Avoid exercising to help prevent chest pain." B. "Place the capsule under the tongue if chest pain occurs." C. "Take the capsule as needed before exercise or exertion." D. "Sit or lie down if dizziness or lightheadedness occurs."
D. "Sit or lie down if dizziness or lightheadedness occurs." •Rationale: Patients taking nitroglycerin should be instructed about symptoms of hypotension (eg, dizziness, lightheadedness) and advised to sit or lie down if these occur. Patients should be advised to avoid overexertion but should be encouraged to establish a regular program of aerobic exercise. Sustained-release nitroglycerin should be swallowed, not placed under the tongue. Sustained-release nitroglycerin is prescribed 1 to 4 times daily, not as needed.
The nurse cares for a patient who is prescribed oral bumetanide twice daily. It is most important for the nurse to take which action? A.Monitor the patient for signs and symptoms of hyperkalemia. B.Insert a urinary catheter and assess the hourly urine output. C.Weigh the patient before administering each dose. D.Schedule the medication to be given at 0800 and 1400.
D. schedule the medication to be given at 0800 and 1400 •Rationale: The nurse should administer oral bumetanide with twice-a-day dosing at 0800 and 1400 to minimize nocturia. Daily weights should be obtained in the morning before eating. Patients receiving IVbumetanide are more likely to need hourly monitoring of urine output with a urinary catheter. Bumetanide may cause hypokalemia; signs and symptoms of hypokalemia include irregular heartbeat, muscle weakness, cramping, flaccid paralysis, leg discomfort, extreme thirst, and confusion.
Which patient would the nurse expect to have the highest risk for postural hypotension? A.A patient who is prescribed a drug that acts primarily on the arterioles B.A patient who is prescribed a drug that blocks the renin-angiotensin-aldosterone system C.A patient who is prescribed a drug that triggers the baroreceptor reflex D.A patient who is prescribed a drug that promotes venous vasodilation
D.A patient who is prescribed a drug that promotes venous vasodilation •Rationale: Postural (orthostatic) hypotension is caused by decreased venous return as a result of the pooling of blood in the veins, which can occur when a person assumes an erect posture. Drugs that dilate the veins intensify and prolong postural hypotension.
A patient is prescribed a medication that lowers the arterial blood pressure. The nurse should assess for which response by the body to restore the blood pressure? ???
•C •Rationale: Drugs that lower the arterial pressure will trigger the baroreceptor reflex with the response of reflex tachycardia.
