Pharmacology Review
A client with hypertension is prescribed an angiotensin II receptor blocker (ARB). Which instruction will the nurse provide about this medication? Select all that apply. a.) "Monitor the blood pressure often." b.) "Discontinue treatment if a cough develops." c.) "Stop the medication if swelling of the mouth, lips, or face develops." d.) "Have blood drawn for potassium levels 2 weeks after starting the medication." e.) "Do not take nonsteroidal anti-inflammatory drugs (NSAIDs) concurrently with this medication." f.) "Notify other prescribers of new ARB prescription." g.) "Report lightheadedness or dizziness upon standing to the provider." h.) "Serum levels will be drawn at least once a month to ensure therapeutic levels."
a.) "Monitor the blood pressure often." c.) "Stop the medication if swelling of the mouth, lips, or face develops." d.) "Have blood drawn for potassium levels 2 weeks after starting the medication." f.) "Notify other prescribers of new ARB prescription." g.) "Report lightheadedness or dizziness upon standing to the provider." Rationale: The risk for hypertension is increased with ARB use, therefore the client should be educated on the signs and symptoms of a low blood pressure and the need to monitor blood pressure often. The medication should be stopped if angioedema occurs, and the health care provider should be notified. Electrolyte levels of potassium, sodium, and chloride should be obtained 2 weeks after the start of therapy and then periodically thereafter. ARBs may increase the effects of other medications such as antihypertensives and lithium, dosages may need to be adjusted accordingly.
Digoxin is prescribed for a client with heart failure. The nurse will assess for which clinical manifestations that indicate digoxin toxicity? Select all that apply. a.) Confusion b.) Headache c.) Nausea d.) Yellow vision e.) Dizziness f.) Irregular pulse g.) Increased urine output h.) Decreased respiratory rate
a.) Confusion b.) Headache c.) Nausea d.) Yellow vision e.) Dizziness f.) Irregular pulse
Several hours after administering insulin to a pediatric client, the nurse assesses the response to the insulin. Which client response is indicative of a hypoglycemic reaction? Select all that apply. a.) Confusion b.) Tremors c.) Anorexia d.) Anxiety e.) Hunger f.) Glycosuria g.) Diaphoresis h.) Paresthesia
a.) Confusion b.) Tremors d.) Anxiety e.) Hunger g.) Diaphoresis h.) Paresthesia Rationale: Confusion is typically the first sign of a hypoglycemic reaction. Tremors and anxiety are sympathetic nervous system responses that occur because circulating glucose in the brain decreases. Hunger, diaphoresis, and paresthesia are cholinergic responses to low blood glucose levels caused by too much insulin. Hypoglycemia causes hunger, not anorexia. Because blood glucose is low in hypoglycemia, the renal threshold is not exceeded and glycosuria does not occur.
A health care provider prescribes aspirin therapy for a client with arthritis. The nurse will advise the client to report which adverse effect immediately? Select all that apply. a.) Ongoing nausea b.) Diarrhea c.) Easy bruising d.) Decreased pulse e.) Sour stomach f.) Ringing in the ears g.) Trouble sleeping h.) Dry mouth
a.) Ongoing nausea b.) Diarrhea c.) Easy bruising g.) Trouble sleeping Rationale: Aspirin is a gastrointestinal irritant that can cause nausea, vomiting, and gastrointestinal bleeding. Salicylates can irritate gastric mucous membranes, leading to diarrhea. Salicylates decrease platelet aggregation, resulting in easy bruising and gastrointestinal bleeding. Tinnitus and hearing loss can occur as a result of the effects of the medication on the eighth cranial nerve. Salicylates may increase, not decrease, the heart rate. A sour stomach, trouble sleeping, and dry mouth are all known side effects of aspirin that do not require immediate medical attention.
A client receiving morphine is being monitored by the nurse for adverse effects of the medication. Which clinical finding warrants immediate action by the nurse? Select all that apply. a.) Polyuria b.) Unconsciousness c.) Bradycardia d.) Dilated pupils e.) Bradypnea f.) Hypertension g.) Yawning h.) Lacrimation
b.) Unconsciousness c.) Bradycardia e.) Bradypnea Rationale: The effect of morphine, if severe, can cause unconsciousness. The CNS depressant effect of morphine causes bradycardia and bradypnea. Morphine does not increase urine output. Morphine causes constriction of pupils. Along with bradycardia, morphine is associated with hypotension, not hypertension. Yawning, lacrimation, and rhinorrhea are symptoms associated with withdrawal from morphine or other opioids.
A client receiving chemotherapy develops bone marrow suppression. The nurse will monitor for which thrombocytopenic effect? Select all that apply. a.) Fatigue b.) Pale skin c.) Deep vein thrombosis d.) Dizziness e.) Melena f.) Purpura g.) Emboli h.) Hematuria
e.) Melena f.) Purpura h.) Hematuria Rationale: Bone marrow suppression results in a reduced number of circulating white and red blood cells, as well as platelets. Black tarry feces caused by the action of intestinal secretions on blood are associated with bleeding in the gastrointestinal tract; bleeding is related to a reduced number of thrombocytes, which are part of the coagulation process. Hemorrhages into the skin and mucous membranes (purpura) may occur with reduced numbers of thrombocytes, which are part of the coagulation process. Blood in the urine (hematuria) may occur with a reduced number of thrombocytes, which are part of the coagulation process.
