pharmacology quiz 2

A client was admitted with head trauma. The family is concerned the client was not restarted on his transdermal nitroglycerin system. What is the best response of the nurse? "The head trauma is the priority at this point." "It is important that the nitroglycerin be restarted immediately to increase blood flow to the heart." "Nitroglycerin is contraindicated in head trauma as it diverts blood away from the brain and sends to the heart." "Nitroglycerin increases the amount of blood flow though the vessels and could cause increased damage."

"Nitroglycerin increases the amount of blood flow though the vessels and could cause increased damage." Nitroglycerin should not be used in clients with head trauma because it increases blood flow through the vessels and may increase pressure within the brain. Nitroglycerin affects all vessels of the body.

Which client statement demonstrates an accurate understanding of the action of a prescribed anticoagulant? "If a big clot starts to form, this medication will help break it up." "Anticoagulants thin the blood so clots can't get as big." "This medication will keep unnecessary clots from forming in my blood." "If I have another stroke, this medication will bust up the clot before too much damage is done."

"This medication will keep unnecessary clots from forming in my blood." An anticoagulant slows the body's normal blood-clotting processes to prevent harmful blood clots from forming. This type of drug is often called a "blood thinner"; however, it cannot dissolve any clots that have already formed and does not make your blood thin.

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

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

A nurse will use extreme caution when administering heparin to which patient? A 54-year-old female with accelerated heart rate A 56-year-old male who smokes and drinks alcohol occasionally A 38-year-old male with peptic ulcer disease A 22-year-old female with urticaria

A 38-year-old male with peptic ulcer disease Heparin should be administered with extreme caution to patients with peptic ulcer or liver disease or after surgery because those patients would have greater risk for hemorrhage or excessive blood loss. Urticaria is a listed adverse effect of taking heparin and would therefore be expected. A patient who takes heparin would be advised to not drink heavily or smoke, but neither would have the safety risk posed by a patient with peptic ulcer. A patient with an accelerated heart rate and on heparin therapy would be at no special risk.

Heparin therapy is prescribed to a client with deep vein thrombosis. Which client would be at greatest risk of bleeding from this therapy? A 25-year-old with a history of hypertension A 62-year-old with a history of prior cerebral vascular accident 5 years ago A 31-year-old with a history of DIC A 45-year-old corporate executive with peptic ulcer disease

A 45-year-old corporate executive with peptic ulcer disease Heparin is also contraindicated in clients with thrombocytopenia, bleeding disorders, and active bleeding other than DIC. This drug should be used with caution in clients with the potential for hemorrhage (e.g., immediately after surgery, with peptic ulcer disease, and with liver disease).

Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy? A 40-year-old male with a high white blood cell count A 62-year-old male with cancer A 30-year-old pregnant woman A 20-year-old female

A 62-year-old male with cancer Older adults who have cancer and are receiving chemotherapy are especially vulnerable to the adverse effects of anemia as a result of chemotherapy and would therefore be the most likely candidates for epoetin alfa therapy. Young adults over age 18, pregnant women, and patients with a high white blood cell count are not as vulnerable to anemia and would not require epoetin alfa therapy.

A client is receiving nitroprusside. The nurse suspects that the client is experiencing cyanide toxicity based on assessment of: Increased hair growth Chest pain Pupil constriction Absent reflexes

Absent reflexes Manifestations of cyanide toxicity include absent reflexes, dilated pupils, dyspnea, headache, vomiting, dizziness, ataxia, loss of consciousness, imperceptible pulse, pink color, distant heart sounds, and shallow breathing. Hair growth is an adverse effect of minoxidil. Chest pain is an adverse effect associated with vasodilator therapy related to changes in blood pressure.

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

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

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

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

After reviewing antiarrhythmic drugs, a group of nursing students demonstrate understanding of the drugs when they identify which as a class II antiarrhythmic? Select all that apply. Acebutolol Ibutilide Propranolol Amiodarone Verapamil

Acebutolol Propranolol Acebutolol and propranolol are class II antiarrhythmics. Amiodarone and ibutilide are class III antiarrhythmic drugs. Verapamil is a calcium channel blocker.

After teaching a group of students about anemias, the instructor determines that the teaching was effective when the students identify what as the critical issue? A defect in white blood cell function Altered red blood cell production or deficient functioning of red blood cells A deficiency of vitamin B12 Decreased levels of platelets

Altered red blood cell production or deficient functioning of red blood cells Anemias are disorders that involve too few or ineffective red blood cells that alter the ability of the blood to carry oxygen. They result from some alteration in erythropoiesis or the process of red blood cell production. White blood cells are associated with the immune response. Lack of vitamin B12 is associated with a specific type of anemia. Platelets are associated with blood clotting.

Based on knowledge of the guidelines, which drug combination therapy has been shown to decrease mortality from CHF? Digoxin and an ACE inhibitor Digoxin and a beta-blocker An ACE inhibitor, a beta-blocker, and a diuretic Digoxin, a beta-blocker, and a diuretic

An ACE inhibitor, a beta-blocker, and a diuretic The combination of an ACE inhibitor, a beta-blocker, and a diuretic has been shown to decrease mortality from CHF. This is the recommended therapy. Digoxin does not decrease mortality from CHF but it decreases symptoms and improves exercise tolerance, thereby improving the quality of life.

A nurse is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics. Treatment of high cholesterol using statins would be contraindicated in which client? A female client who had a laparoscopic cholecystectomy (gall bladder removal) earlier this year A resident of a long-term care facility whose Alzheimer disease is being treated with donepezil (Aricept) A 72-year-old man who has emphysema and a long history of cigarette smoking An obese male client who is a heavy alcohol user and who has cirrhosis of the liver

An obese male client who is a heavy alcohol user and who has cirrhosis of the liver Active liver disease is a contraindication to the use of statins. As well, heavy alcohol use increases the risk of liver dysfunction. Respiratory disease, recent surgery, and organic cognitive deficits do not preclude the use of statins for high cholesterol.

A nurse is caring for a patient receiving the anticoagulant drug warfarin. What pre-administration assessments should the nurse perform before administering the drug to the patient? Observe for signs of thrombus formation. Monitor for hypersensitivity reaction. Assess prothrombin time (PT) and INR. Assess for signs of bleeding.

Assess prothrombin time (PT) and INR. Nursing Implications

The nurse would instruct a client receiving acebutolol about which adverse effect? Increased libido Improved exercise tolerance Hypertension Bronchospasm

Bronchospasm Bronchospasm is a possible adverse effect of acebutolol, a class II antiarrhythmic. Other effects include hypotension, decreased libido, and decreased exercise tolerance.

A 60-year-old client experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The client has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect? By inhibiting platelet aggregation on vessel walls and promoting fibrinolysis By inhibiting the action of vitamin K at its sites of action By inactivating clotting factors and thus stopping the coagulation cascade By promoting the rapid excretion of vitamin K by the gastrointestinal mucosa

By inactivating clotting factors and thus stopping the coagulation cascade Heparin, along with antithrombin, rapidly promotes the inactivation of factor X, which, in turn, prevents the conversion of prothrombin to thrombin. Heparin does not achieve its therapeutic effect through the excretion or inhibition of vitamin K or by inhibiting platelet aggregation.

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

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

Beta-blockers have what advantage over nitrates in the management of angina? Clients do not develop tolerance to beta-blockers. Beta-blockers do not affect the client's heart rate or blood pressure. Beta-blockers can be administered on an outpatient basis. Clients can obtain beta-blockers on an over-the-counter basis.

Clients do not develop tolerance to beta-blockers. People taking beta-blockers do not develop tolerance during therapy as occurs with the organic nitrates. Both nitrates and beta-blockers can be safely taken in a home setting but are not available over the counter. Beta-blockers decrease heart rate and blood pressure.

A client is prescribed warfarin. The client also takes a diuretic for the treatment of cardiac problems. The nurse will monitor the client for which potential interaction? Increased effectiveness of the diuretic Increased absorption of the anticoagulant Decreased effectiveness of the anticoagulant Increased absorption of the diuretic

Decreased effectiveness of the anticoagulant The nurse should monitor for decreased effectiveness of warfarin as an effect of the interaction between the anticoagulant and the diuretic. The nurse need not monitor for the increased effectiveness of the diuretic, the increased absorption of the anticoagulant, or the increased absorption of the diuretic in the client.

The client is started on a transdermal nitroglycerin patch system. The nurse teaches the client that the system relieves pain by which action? Dilates arteries and veins Decreases the size of the artery Increases the workload of the heart Dilates the coronary arteries

Dilates arteries and veins Nitrates act by relaxing the smooth muscle of the blood vessels (arteries and veins) and increasing the amount of blood through the vessel. They also decrease the workload of the heart.

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

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

Which agent would a nurse identify as a cholesterol absorption inhibitor? Ezetimibe Colestipol Simvastatin Fenofibrate

Ezetimibe Ezetimibe is a cholesterol absorption inhibitor. Simvastatin is a HMG-CoA reductase inhibitor. Colestipol is a bile acid sequestrant. Fenofibrate is classified as a fibrate.

A nurse is caring for a client receiving warfarin therapy. The nurse instructs the client and family that certain foods must be ingested in moderation because of the possible interference with the effect of the therapy. Which foods must be taken in limited quantity? Foods rich in Vitamin D Foods rich in vitamin C Foods rich in vitamin A Foods rich in vitamin K

Foods rich in vitamin K The nurse should inform the client to limit the intake of foods rich in vitamin K as they interfere with warfarin therapy. Foods rich in vitamin A, C, or D need not be limited, as they do not affect the treatment.

A postsurgical client possesses numerous risk factors for venous thromboembolism, including a previous deep vein thrombosis. What drug would the nurse anticipate administering while this client recovers in the hospital? vitamin K clopidogrel cilostazol heparin

Heparin Heparin is frequently used to prevent postsurgical venous thromboembolism. Antiplatelet drugs do not have this indication, and vitamin K would increase the client's risks.

A client with hypertension has not responded adequately to treatment with losartan. What additional medication would the nurse expect the health care provider to prescribe? Hydralazine hydrochloride Atorvastatin calcium Digoxin Hydrochlorothiazide

Hydrochlorothiazide If losartan alone does not control blood pressure, a low dose of diuretic may be added. Hydrochlorothiazide is a diuretic agent. Atorvastatin calcium is not a diuretic agent but rather a statin medication. Hydralazine is not a diuretic agent but rather a vasodilator. Digoxin is not a diuretic agent but rather a digitalis glycoside.

Which adverse effect might occur in a client receiving milrinone? Hypoglycemia Confusion Hypotension Hyperkalemia

Hypotension Adverse effects of phosphodiesterase inhibitors such as milrinone include hypotension, ventricular arrhythmias, and headache.

A nurse is monitoring a patient who is prescribed milrinone for heart failure. Which sign in the patient indicates that the nurse should withhold the drug? Edema Cyanosis Bradycardia Hypotension

Hypotension When caring for patients taking milrinone, the development of hypotension would necessitate the nurse withholding the drug and notify the practitioner. Hypotension occurs as an adverse effect of milrinone. Edema and cyanosis need to be assessed by the nurse as part of the pre-administration assessment. Edema, bradycardia, and cyanosis are not adverse effects associated with milrinone.

A patient, aged 78 years, is receiving nitroprusside for hypertensive emergency. For which condition should the patient be assessed? Thromboembolism Hypotensive crisis Blindness Stroke

Hypotensive crisis Hypotensive crisis may be seen in older patients on nitroprusside. To prevent this, the dosage should be reduced during the initial period of therapy. Thromboembolism, stroke, and blindness will not occur during nitroprusside therapy.

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

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

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

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

A nurse is caring for a client receiving warfarin drug therapy. The client informs the nurse that they are also taking chamomile, which is an herbal remedy. The nurse would alert the client to which adverse effects? Increased risk for bleeding Decreased effectiveness of chamomile Increased absorption of warfarin Increased risk for hypertension

Increased risk for bleeding The nurse should inform the client about the increased risk for bleeding, which is an effect of the interaction between warfarin and the herb. Decreased effectiveness of chamomile, increased absorption of warfarin, and increased risk for hypertension are not effects of the interaction between warfarin and chamomile.

Which would a nurse identify as the primary issue associated with anemias? Defective white blood cells Lack of vitamin B12 Increased plasma proteins Ineffective red blood cells

Ineffective red blood cells Anemias are disorders that involve too few or ineffective RBCs that alter the ability of the blood to carry oxygen. White blood cells are associated with the immune response. Plasma proteins are important in the immune response and blood clotting. Lack of vitamin B12 is associated with a specific type of anemia.

A client who was diagnosed with iron deficiency anemia is worried because she does not know why she was prescribed iron supplements. The nurse teaches the client about which action of oral iron administration? Iron acts by elevating the serum iron concentration to replenish hemoglobin to treat anemia. Iron supplements prevent depletion of hemoglobin cells from anxiety to treat anemia. Iron supplements prevent bleeding to replenish hemoglobin cells faster to treat anemia. Iron supplements prevent infection so hemoglobin cells grow back faster to treat anemia.

Iron acts by elevating the serum iron concentration to replenish hemoglobin to treat anemia. Iron acts by elevating the serum iron concentration to replenish hemoglobin to treat anemia. Iron supplements do not treat anxiety, infection, or bleeding.

The nurse is caring for a client who is receiving epoetin alfa. What adjunct treatment will the nurse expect the health care provider to order for this client? Sodium restriction Potassium supplement Renal dialysis Iron supplement

Iron supplement Iron supplementation is used adjunctively with epoetin to increase RBCs. The nurse would not expect a potassium supplement, sodium restriction or renal dialysis to be ordered.

A nurse is preparing to administer an antihypertensive drug that lowers the blood pressure primarily via suppression of the renin-angiotensin-aldosterone system. Which drug might this be? Lisinopril Diltiazem Furosemide Verapamil

Lisinopril Angiotensin-converting enzyme inhibitors (ACEIs) act primarily for suppress the renin-angiotensin-aldosterone system, and lisinopril is an ACEI. Verapamil and diltiazem are calcium channel blockers and furosemide is a diuretic.

A nurse is preparing to administer colesevelam to a client with hyperlipidemia. The nurse determines cautious administration is warranted after noting which condition in the client's history? Hypotension Unstable angina Acute infection Liver disease

Liver disease Bile acid resins should be used cautiously in clients with diabetes, liver, peptic ulcer or kidney disease, and during pregnancy and lactation. Colesevelam is administered with caution in clients with liver disease. Niacin is used with caution in clients with unstable angina. Statins should be used cautiously in clients with hypotension and an acute infection.

The rescue squad brought a 48-year-old client to the ED in the midst of a hypertensive emergency. Blood pressure is 188/112 mm Hg, and the client reports severe headache and drowsiness. The client is disoriented and vomits. What is the nurse's primary goal in this hypertensive emergency? Lower blood pressure as quickly as possible Assess for a cause of hypertension before proceeding Obtain complete medical history Lower blood pressure gradually

Lower blood pressure as quickly as possible Hypertensive emergencies require immediate blood pressure reduction with parenteral antihypertensive drugs to limit damage to target organs. The cause can be explored after the crisis has been resolved. A medical history, if necessary, can also be postponed.

The nurse is caring for a patient receiving cardiotonic drugs. The patient has edema. Which intervention should be taken to alleviate edema? Observation of pulse rate Measurement of intake and output Auscultation of the lungs Observation of respiratory rate

Measurement of intake and output Measurement of intake and output is a nursing intervention related to the edema in the patient receiving cardiotonic drugs. Auscultation of the lungs, observation of respiratory rate, and observation of pulse rate are interventions not related to edema in the patient.

Why do clients with impaired renal function require cautious use of epinephrine? Metabolites may accumulate and increase the risk of adverse effects. Epinephrine can cause lysis of Bowman's capsules, further reducing renal function. Epinephrine increases the pH of urine and constitutes a risk for urosepsis. Epinephrine is fully resorbed in the proximate tubules and can accumulate to toxic levels.

Metabolites may accumulate and increase the risk of adverse effects. The renal system eliminates many adrenergic drugs and their metabolites. In the presence of renal disease, these compounds may accumulate and cause increased adverse effects. None of the other options accurately describe the need for caution when administering epinephrine to a client diagnosed with renal impairment.

A client is experiencing orthostatic hypotension that is affecting his ability to function. Which medication would be most appropriate? Dopamine Methyldopa Midodrine Clonidine

Midodrine Midodrine is an alpha-specific adrenergic agent that is used to treat orthostatic hypotension. Dopamine is a sympathomimetic agent that is used to treat shock. Methyldopa and clonidine are alpha-2 blockers used to treat hypertension.

A 75-year-old client presents to the health care provider's office with bleeding gums and multiple bruises. When the nurse reviews the client's drug history, the nurse finds that the client is prescribed aspirin 81 mg/d. What drug may cause increased bleeding when used in conjunction with the aspirin? Antibiotics Antiarrhythmics Antihypertensives NSAIDs

NSAIDs NSAIDs, which are commonly used by older adults, also have antiplatelet effects. Clients who take an NSAID daily may not need low-dose aspirin for antithrombotic effects.

The nurse recognizes that which medication may be used to treat a hypertensive crisis? Nitroprusside Amlodipine Hydralazine Minoxidil

Nitroprusside Nitroprusside is administered during a hypertensive crisis intravenously. Hydralazine and minoxidil are used for severe hypertension, and amlodipine is also administered for hypertension.

A hospitalized client recently prescribed digoxin has reported beginning to experience a headache. What immediate action should the nurse take to best address the current situation? Notify the client's primary health care provider and obtain a serum digoxin level. Assess the client for cardiac arrhythmias and perform a bedside electrocardiogram (EKG). Dim the lights in the client's room and administer an oral dose of acetaminophen. Assess the client's heart rate and blood pressure and hold the next dose of digoxin.

Notify the client's primary health care provider and obtain a serum digoxin level. The adverse effects most frequently seen with cardiac glycosides include headache, weakness, drowsiness, and vision changes (a yellow halo around objects is often reported). Gastrointestinal (GI) upset and anorexia also commonly occur. It may be difficult to diagnose digoxin toxicity in adults with heart failure (HF) without drawing blood levels due to some of the signs and symptoms being similar to those of HF exacerbation and because of the varied causes of common headaches. It is initially important to determine the digoxin blood level to rule out digoxin toxicity. Dimming the lights and acetaminophen will help manage the headache but not determine if the headache is related to toxicity. While assessing the client's cardiac status is appropriate, the nurse should not hold the medication without first notifying the primary health care provider.

The nurse is to administer digoxin to a client with heart failure. The nurse auscultates an apical pulse rate of 52. What action should the nurse take? Assess the blood pressure Administer medication Notify the health care provider Administer half of the dose

Notify the health care provider Before administering each dose of digoxin, take the apical pulse rate for 60 seconds. If the apical rate is below 60 beats per minute, withhold the drug and notify the provider. Blood pressure is not affected by digoxin. Without prescriptive authority, the nurse cannot change medication dosages.

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

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

The nurse is teaching a client with arrhythmia about the prescribed verapamil. Which potential adverse reaction should the nurse point out to the client? Diarrhea Hyperactivity Peripheral edema Hypertension

Peripheral edema The nurse should inform the client that peripheral edema could be an adverse reaction to verapamil therapy. Other adverse reactions include constipation (not diarrhea), dizziness, lightheadedness, headache, asthenia, nausea, vomiting, hypotension (not hypertension), mental depression (not hyperactivity), agranulocytosis, and proarrhythmic effect.

The nurse is teaching a client with arrhythmia about the prescribed verapamil. Which potential adverse reaction should the nurse point out to the client? Peripheral edema Hyperactivity Hypertension Diarrhea

Peripheral edema The nurse should inform the client that peripheral edema could be an adverse reaction to verapamil therapy. Other adverse reactions include constipation (not diarrhea), dizziness, lightheadedness, headache, asthenia, nausea, vomiting, hypotension (not hypertension), mental depression (not hyperactivity), agranulocytosis, and proarrhythmic effect.

Which phase of the cardiac muscle action potential is affected by class I antiarrhythmics? Phase 2 Phase 0 Phase 3 Phase 1

Phase 0 Class I antiarrhythmics stabilize the cell membrane by binding to sodium channels, depressing phase 0 of the action potential.

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

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

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

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

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

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

A client arrives at the urgent care center reporting chest pain. After diagnosis, the health care provider prescribes amlodipine for the client's condition. The nurse understands that this drug is indicated for which condition? Prinzmetal angina Sick sinus syndrome Cardiogenic shock Atrioventricular (AV) block

Prinzmetal angina The nurse should identify Prinzmetal angina as the condition for which amlodipine is indicated. Prinzmetal angina is a vasospastic angina for which calcium channel blockers are used for treatment. Cardiogenic shock, sick sinus syndrome, and AV block are the conditions for which amlodipine is contraindicated.

A client has begun taking cholestyramine. Which action by the nurse best addresses likely adverse effects? Applying skin moisturizer after bathing or showering Promoting fiber and fluid intake Modifying routines to ensure adequate rest Home blood pressure and heart rate monitoring

Promoting fiber and fluid intake Cholestyramine is not absorbed systemically, so the main adverse effects are gastrointestinal (GI) ones (abdominal fullness, flatulence, diarrhea, and constipation). Constipation is especially common, and a bowel program may be necessary to control this problem. None of the other listed actions directly addresses these more common adverse effects.

The nurse is reviewing lab results where the client has elevated BUN and creatinine levels. The nurse would question the administration of which antihypertensive? Diltiazem Nifedipine Amlodipine Quinapril

Quinapril Quinapril is an ACE inhibitor and is contraindicated in clients with renal failure. Nifedipine, diltiazem, and amlodipine are calcium channel blockers and are not contraindicated in renal failure.

An instructor is teaching a class about vasodilators and their action for alleviating heart failure. The instructor determines that the class has understood the material when they identify what as being involved? Decreasing blood volume Increasing preload Reducing afterload Increasing myocardial oxygen use

Reducing afterload Vasodilators decrease cardiac workload, relax vascular smooth muscle to decrease afterload, and allow pooling in the veins thereby decreasing preload. Decreased blood volume results from the use of diuretics.

A nurse is caring for a client who is diabetic and has been diagnosed with hypertension. An angiotensin-converting enzyme inhibitor, captopril, has been prescribed. Which should the nurse assess before beginning drug therapy? Blood glucose levels Serum calcium levels Serum magnesium levels Serum potassium levels

Serum potassium levels Captopril inhibits the angiotensin-converting enzyme that is needed to change the inactive angiotensin I to the active form, angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, preventing sodium and water retention. This action decreases peripheral vascular resistance and lowers blood pressure. Serum potassium may increase as a result of decreased aldosterone levels. It would be helpful to have a baseline level at the beginning of the drug therapy to monitor the possible effect of hyperkalemia. There is no need to monitor calcium and magnesium levels. While it is important to always know a diabetic's blood glucose level, captopril does not alter the level during therapy.

A client diagnosed with a dysrhythmia has not responded appreciably to treatment with oral propranolol. When the medication is discontinued, what instruction should the nurse provide the client to maximize safety? Taper down the propranolol dose over a period of 2 weeks. Gradually replace the propranolol with newly prescribed metoprolol. Be prepared to substitute an intramuscular propranolol for several months. Monitor cardiac status at regularly after taking the final dose of propranolol.

Taper down the propranolol dose over a period of 2 weeks. It is essential that propranolol not be discontinued abruptly after long-term therapy; a hypersensitivity to catecholamines may have developed, exacerbating ventricular dysrhythmia. Gradual tapering over a 2-week period, with client monitoring, is necessary. Replacement with a different beta-blocker is not necessarily indicated. Propranolol is not administered by the IM route. Monitoring alone is not sufficient treatment in this situation.

The patient is being prescribed epoetin alfa for the treatment of anemia related to the renal failure. The patient also has a history of diabetes mellitus, uncontrolled hypertension, osteoarthritis, and hypothyroidism. Which of these conditions should the nurse bring to the physician's attention prior to administering the medication? Osteoarthritis Hypothyroidism Uncontrolled hypertension Diabetes mellitus

Uncontrolled hypertension The nurse should determine whether the patient has pre-existing uncontrolled hypertension, which is a contraindication for the use of epoetin alfa.

A client experiences pain in the chest that radiates to the jaw, occurring when the client is at rest. The nurse would interpret this as: Prinzmetal angina Unstable angina Stable angina Myocardial infarction

Unstable angina Unstable angina is chest pain that occurs when the client is at rest. Stable angina is chest pain that occurs with activity and is relieved by rest. Prinzmetal angina is chest pain due to vessel spasm. Myocardial infarction indicates ischemia and subsequent necrosis of the heart muscle.

A client is receiving antihemophilic factor. The nurse understands that this drug is which factor? VIII X IX VIIa

VIII Antihemophilic factor is factor VIII, which is the factor missing in classic hemophilia. Coagulation factors VIIa and IX are separate clotting factors. Factor IX complex contains plasma fractions of many of the clotting factors and increases blood levels of factors II, VII, IX, and X.

A client, diagnosed with chronic renal failure, has begun experiencing increasing shortness of breath. The nurse suspects that the client is experiencing symptoms associated with which resulting condition? thrombocytopenia hypoglycemia anemia hypertension

anemia A common condition associated with chronic renal failure is anemia. Shortness of breath in a client with chronic renal failure (without obvious fluid balance issues) is likely due to anemia and its effect on the body's ability to transport oxygen. None of the other options would cause the client's symptoms.

The chest pain and pressure a client experiences during an anginal attack is caused by which of the following? decreased oxygen supply to the heart. vasodilation of the arteries around the heart. decreased workload on the heart. increased oxygen supply to the heart.

decreased oxygen supply to the heart. Chest pain and pressure during an anginal attack are the result of decreased oxygen supply to the heart. Vasodilation would allow more oxygen to the heart and a decreased workload would be oxygen promoting to the heart.

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

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

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

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

A client has been prescribed lovastatin for high cholesterol. The nurse's teaching plan will include a basic explanation of how the drug produces its therapeutic effect. The nurse will explain that lovastatin lowers cholesterol levels in which manner? consists of a fibric acid derivative. inhibits cholesterol syntheses. is a bile-acid resin. is a hormone.

inhibits cholesterol syntheses. Lovastatin belongs to a group of drugs classified as statins. These drugs work by inhibiting cholesterol synthesis in the liver. Fibric acid derivatives and bile-acid resins also decrease cholesterol levels but they work at different sites. Fibric acid derivatives work on lipoproteins and triglycerides to reduce cholesterol, and bile-acid resins work in the gastrointestinal tract and bind bile salts in the intestine. Lovastatin is not a hormone.

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

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

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

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

After teaching a patient who is receiving ferrous sulfate about the drug therapy regimen, which patient statement indicates that the teaching was successful? "I need to eat three large meals every day." "I must take the drug on an empty stomach." "I need to watch the amount of fiber I eat." "My stools might turn dark or green."

"My stools might turn dark or green." The patient needs to know that his stools may become dark or green. Small frequent meals with snacks can help minimize nausea and GI upset associated with this drug. The patient may take the drug with meals as long as those meals do not include eggs, milk, coffee, and tea. Constipation is possible, so the patient needs to increase the fiber in his diet.

What would the nurse teach the client about the safe and effective use of nitroglycerin? Select all that apply. "Nitroglycerin does not lose its potency easily." "Protect the drug from heat and light." "Always replace when past the expiration date." "Older tablets may require you to use two tablets at one time." "The tablet should fizzle or burn when placed under the tongue."

"The tablet should fizzle or burn when placed under the tongue." "Protect the drug from heat and light." "Always replace when past the expiration date."

A client reports seeing halos around lights. The client takes digoxin by mouth every day. The health care provider orders the client to have serum digoxin level drawn. Which of the digoxin levels indicate the client is experiencing toxicity? 1.0 ng/mL 2.0 ng/mL 0.5 ng/mL 4.0 ng/mL

4.0 ng/mL Therapeutic serum levels of digoxin are 0.8 to 2 ng/mL. Levels above that would indicate toxicity, and those below would not yet be therapeutic.

Which substance would a group of students identify as being responsible for breaking up dietary fats into smaller units? Bile acids Cholesterol Chylomicrons Micelles

Bile acids Bile acids act like a detergent in the small intestine and break up fats into small units. These small units are called micelles. High levels of cholesterol are part of bile acids. Chylomicrons are carriers for micelles.

When educating a group of nursing students on the mechanism of action of angiotensin converting enzyme inhibitor (ACEI) drugs, the nurse identifies what as the action brought about by aldosterone? Causes sodium and water retention. Promotes angiotensin I conversion. Inhibits renin secretion. Causes excess potassium retention.

Causes sodium and water retention. Aldosterone causes retention of sodium and water. This in turn causes a rise in blood pressure. ACEIs act by inhibiting the conversion of angiotensin I to angiotensin II. Aldosterone does not inhibit the release of renin and is not involved in the retention of potassium. Angiotensin converting enzyme, and not aldosterone, is involved in the conversion of angiotensin I to angiotensin II

Which best describes the action of class II antiarrhythmics? Block the movement of calcium ions across the cell membrane Block potassium channels slowing the outward movement of potassium Block sodium channels in the cell membrane during an action potential Competitive block beta receptor sites in the heart and kidneys

Competitive block beta receptor sites in the heart and kidneys Class II antiarrhythmics are beta blockers that block beta receptors in the heart and kidneys causing a depression of phase 4 of the action potential. Class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, prolonging it. Class IV antiarrhythmics block the movement of calcium ions across the cell membrane depressing the generation of action potentials delaying phases 1 and 2 of repolarization. Class I antiarrhythmics block sodium channels in the cell membrane during an action potential.

A female client has been started on labetalol. Which effect can occur as a result of the beta blocking? Orthostatic hypotension Elevations in blood pressure Decrease in the plasma renin level Reflex tachycardia

Decrease in the plasma renin level The beta-blocking effect of labetalol results in a decrease in the plasma renin level. The alpha-blocking action causes orthostatic hypotension. The beta-blocking action prevents reflex tachycardia and elevations in blood pressure.

A client is admitted with thrombophlebitis and sent home on enoxaparin therapy. Which statement indicates a good understanding of why enoxaparin is being administered? Enoxaparin will dissolve the clots. Enoxaparin decreases the viscosity of blood. Enoxaparin inhibits the formation of additional clots. Enoxaparin eliminates certain clotting factors.

Enoxaparin inhibits the formation of additional clots. Low-molecular-weight heparins (LMWH) prevent the development of additional clots. They do not eliminate clotting factors. LMWHs do not prevent the blood from clotting. LMWHs do not dissolve the clot.

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

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

After teaching a group of students about fats and biotransformation, the instructor determines that the teaching was successful when the students identify what as the storage location of bile acids? Gallbladder Small intestine Stomach Liver

Gallbladder The presence of fatty acids, lipids, and cholesterol in the duodenum stimulates contraction of the gallbladder and the release of bile, which contains bile acids. Once their action is completed, they are reabsorbed and recycled to the gallbladder, where they remain until the gallbladder is stimulated again.

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

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

An ED patient presents with dyspnea, tachycardia, and chest pain. The patient has a history of cardiomyopathy. The nursing assessment reveals hypotension with an apical pulse of 134 bpm. What would the nurse conclude might be causing the symptoms? Adequate cardiac output Asthma attack Inadequate cardiac output Hypokalemia

Inadequate cardiac output Symptoms presenting suggest a cardiac condition. A diseased heart may not be able to maintain an adequate cardiac output with heart rates below 60 bpm above 120 bpm.

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

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

A nurse is required to monitor a client for right ventricular dysfunction. Which would the nurse commonly assess? Dyspnea Pitting edema Hacking cough Orthopnea

Pitting edema One of the most common symptoms associated with right ventricular dysfunction is pitting edema. The other symptoms of right ventricular dysfunction are nocturia, anorexia, weight gain, and weakness. Dyspnea, orthopnea, and hacking cough are the symptoms associated with left ventricular dysfunction, and not right ventricular dysfunction.

A client admitted to a health care facility with cardiac arrhythmia is prescribed propranolol. Which signs should the nurse prioritize on the ongoing assessment? Pulse rate Tendon reflexes Visual acuity Hydration

Pulse rate During antiarrhythmic drug therapy, the nurse should closely monitor the client's pulse rate. A change in the pulse rate and rhythm will help the nurse assess a response to drug therapy, the development of signs of heart failure, the development of a new cardiac arrhythmia, or worsening of the arrhythmia being treated. It is not necessary to monitor the tendon reflexes, hydration, or visual acuity when administering an antiarrhythmic drug to the client.

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

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

A client is receiving candesartan. The nurse understands that this drug acts in which manner? Prevents angiotensin converting enzyme from converting angiotensin I to angiotensin II Increases the excretion of sodium and water from the kidney Selectively binds with angiotensin II receptors in the vascular smooth muscle Inhibits the movement of calcium ions across the heart and arterial muscle cell membranes

Selectively binds with angiotensin II receptors in the vascular smooth muscle Candesartan is an angiotensin II receptor blocker. ACE inhibitors prevent ACE from converting angiotensin I to angiotensin II. Calcium channel blockers inhibit calcium ion movement across muscle cells of the heart and arterial muscle cells. Diuretics increase the excretion of sodium and water from the kidney.

Which single class drug is known to be most effective in reducing the major types of dyslipidemia? Bile acid sequestrants Fibrates Statins Niacin

Statins For single-drug therapy, a statin is preferred for the treatment of dyslipidemia. To lower cholesterol and triglycerides, a statin, a cholesterol absorption inhibitor, gemfibrozil, a fibrate, or the vitamin niacin may be used. To lower triglycerides, gemfibrozil, ezetimibe, a cholesterol absorption inhibitor, or niacin may be given.

A client is being sent home with subcutaneous heparin after a total hip replacement. The nurse understands what symptom would indicate a serious drug reaction? Stomach pain Headache Hypotension Tarry stools

Tarry stools Tarry stools would be an indication of gastrointestinal bleeds. The most common adverse effect of heparin is bleeding.

The clinic nurse assesses a client taking benazepril to control hypertension. What change in the client's health status may require a change in drug therapy? The client's creatinine clearance is steadily declining. The client is treated for hepatitis A. The client is diagnosed with gastroesophageal reflux disease. The client takes a selective serotonin reuptake inhibitor (SSRI) for depression.

The client's creatinine clearance is steadily declining. Benazepril is an angiotensin-converting enzyme inhibitor; drugs in this class are contraindicated in the presence of impaired renal function. Mental illness, hepatic disease, or GERD are not contraindications with this drug.

A group of nursing students are reviewing cardiotonic drugs. The students demonstrate understanding of the information when they identify which adverse reaction associated with cardiotonic medications? Visual disturbances Diarrhea Constipation Restlessness

Visual disturbances Adverse reactions associated with cardiotonic medications include headache, weakness, drowsiness, visual disturbances, nausea, anorexia, and arrhythmias. Diarrhea, constipation, and restlessness are not adverse reactions of cardiotonic medications.

After successful treatment for a myocardial infarction, a 69-year-old man has developed a ventricular arrhythmia. His care team has opted for treatment with a Class II antiarrhythmic. The nurse would understand that this client is likely to be prescribed: amiodarone. verapamil. lidocaine. acebutolol.

acebutolol. Class II antiarrhythmics are the beta blockers. Of the other numerous drugs in this class, only acebutolol and esmolol are approved as Class II antiarrhythmics, though other beta blockers are used off label. Lidocaine is a Class IB drug; amiodarone is a Class III antiarrhythmic, and verapamil is a Class IV drug.

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

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

The nurse teaches a client receiving propranolol at home for the management of ventricular dysrhythmia to monitor what parameter? daily fluid intake weekly pulse daily blood pressure weekly weight

daily blood pressure Hypotension can occur with propranolol, which is a beta-blocker, so clients should check their blood pressure and pulse every day. Propranolol does not require that fluid intake be measured. Propranolol also will not require daily weight taking, but it may be necessary with a diagnosis of propranolol.

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

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

The nurse is caring for a client recovering from cardiac bypass surgery. For which prescribed medication would the nurse question giving the client aminocaproic acid as prescribed? metoprolol heparin acetaminophen cimetidine

heparin Aminocaproic acid is a systemic hemostatic agent used to prevent body-wide or systemic clot breakdown and prevent blood loss. It inhibits plasminogen-activating substances and has some antiplasmin activity. The risk of bleeding increases if it is given with heparin. The use of aminocaproic acid is not contraindicated for cimetidine, metoprolol, or acetaminophen.

A client presents to the ED with wheezing and blood-tinged sputum. The nurse suspects the client is experiencing pulmonary edema. The nurse should suspect the cause of the pulmonary edema is most likely: left ventricular failure. cardiomyopathy. valvular heart disease. right ventricular failure.

left ventricular failure. Pulmonary edema occurs when left ventricular failure (or dysfunction) results in accumulation of blood and fluid in pulmonary veins and tissues.

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

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

A client is taking lovastatin. The nurse will teach the client about which potential adverse effects? nausea and constipation pruritis and bruising fatigue and mental disorientation muscle pain on exertion, and muscle stiffness

nausea and constipation The most common adverse effects of statins are nausea, constipation, diarrhea, abdominal cramps or pain, headache, and skin rash. None of the other listed adverse effects are common in clients taking statins. Muscle pain can be a sign of a serious adverse effect but this is less common.

A client comes to the clinic asking what erythropoiesis means. The nurse would state that erythropoiesis is the process of making: stem cells. red blood cells. platelets. white blood cells.

red blood cells. Erythropoiesis means the process of making red blood cells. The production of white blood cells, stem cells, and platelets do not fit the definition of erythropoiesis.

A client diagnosed with iron deficiency has been taking oral ferrous sulfate for the past several days. When the nurse is assessing for therapeutic effects, what question is most warranted? "Do you feel like you're able to see a bit more clearly now?" "Is your skin feeling itchy when you're at rest?" "Are you having any leg spasms or restless legs at night?" "How is your energy level compared with a few days ago?"

"How is your energy level compared with a few days ago?" The nurse should assess for increased energy, vigor, and feeling of well-being. Pruritus, visual changes, and restless legs do not accompany iron deficiency and would not be addressed in follow-up assessments.