Quiz 3 (part 1)
A young female patient is being treated for hypertension. The nurse would be most concerned if the patient became pregnant while taking which drug? 1. Enalapril (Vasotec) 2. Potassium supplement 3. Doxazosin (Cardura) 4. Hydrochlorothiazide (HCTZ)
1
The nurse has completed medication education with the patient who is receiving nitroglycerine (Nitrostat) as therapy for angina. The nurse determines that additional teaching is necessary when the patient makes which statement? 1. "I can keep taking tablets until the pain is gone, but I should not use more than five tablets." 2. "If my pain is not reduced 5 minutes after taking one tablet I should call EMS." 3. "I should take a tablet as soon as chest pain occurs.." 4. "I can take three tablets, one every 5 minutes."
1
The nurse is planning to teach a class on antianginal drugs to a group of patients who have experienced myocardial infarctions (MIs). The nurse includes which information in this class? 1. "These medications decrease how much oxygen your heart needs." 2. "These medications thin your blood so your heart receives more oxygen." 3. "These medications increase the amount of oxygen your heart receives." 4. "These medications increase oxygen to your heart by increasing nitric oxide production."
1
The patient has hypertension and asks the nurse how this can lead to heart failure. What is the best response by the nurse? 1. "Hypertension causes resistance in your blood vessels, or afterload; your heart works harder, and weakens." 2. "Hypertension limits the ability of your heart to stretch before emptying, or afterload; your heart works harder, and weakens." 3. "Hypertension causes resistance in your aorta, or afterload; your heart works harder and weakens." 4. "Hypertension limits the amount of blood entering your left ventricle, or afterload; your heart works harder, and weakens."
1
The patient is receiving diltiazem (Cardizem) and wants to know why he developed a headache after taking the medication. What is the best response by the nurse? 1. "Diltiazem (Cardizem) causes the blood vessels in your brain to widen, giving you the headache." 2. "Diltiazem (Cardizem) increases prostaglandin synthesis, giving you the headache." 3. "Diltiazem (Cardizem) releases Substance P, activating pain receptors in your brain and giving you the headache." 4. "Diltiazem (Cardizem) causes the blood vessels in your brain to narrow, giving you the headache."
1
The patient is recovering from hypovolemic shock. The nurse hangs a bag of normal human serum albumin (Albutein) and educates the patient about this fluid. The nurse evaluates that learning has occurred when the patient makes which statement? 1. "It is a protein that pulls water into my blood vessels." 2. "It is a protein that causes my kidneys to conserve fluid." 3. "It is a super-concentrated salt solution that helps me conserve body fluid." 4. "It is a liquid that has electrolytes in it to pull water into my blood vessels."
1
The patient receives captopril (Capoten) as treatment for heart failure. Which adverse effect will the nurse plan to report to the physician? 1. The patient develops a cough. 2. The patient develops diarrhea. 3. The patient develops dehydration. 4. The patient develops facial flushing.
1
The patient takes nitroglycerine (Nitrostat) for relief of occasional stable angina. The nurse would be most concerned about which statement made by the patient? 1. "I'm getting married tomorrow; I hope my erectile dysfunction isn't a problem." 2. "I'm going water skiing tomorrow; I hope my angina isn't a problem." 3. "I really don't like those little pills. I've heard about patches: can I try them?" 4. "My angina has been a little more frequent. Do I need a painkiller too?"
1
The physician orders dopamine (Intropin) intravenous (IV) for the patient in shock. What is a priority plan of the nurse with regard to administration of this drug? 1. Have phentolamine (Regitine) available in the room. 2. Have naltrexone (Revia) available in the room. 3. Have epinephrine (Adrenalin) available in the room. 4. Have flumazenil (Romazicon) available in the room.
1
Which interventions would be indicated and take highest priority for a 30-year-old female with a BMI of 20 who smokes and has a blood pressure of 137/88? 1. Smoking-cessation program 2. Diuretic therapy 3. Weight-loss program 4. Stress management
1
Which is the most serious adverse effect associated with milrinone (Primacor)? 1. Ventricular dysrhythmia 2. Nausea 3. Headache 4. Atrial dysrhythmia
1
Which medication would be of most help to increase myocardial contractility in a patient with heart failure? 1. Digoxin (Lanoxin) 2. Lisinopril (Prinivil) 3. Carvedilol (Coreg) 4. Furosemide (Lasix)
1
Which patient who has had a myocardial infarction would be a candidate for reteplase (Retavase) therapy? 1. 54-year-old female with type 2 diabetes 2. 45-year-old female with a 2-week-old cranial artery repair 3. 62-year-old with a recent hemorrhagic stroke 4. 70-year-old male with active GI bleed
1
Which symptom is most likely to be related to angina as opposed to a myocardial infarction? 1. Chest pain relieved by one sublingual nitroglycerin 2. Chest pain that radiates to the patient's back 3. Chest pain that occurred while the patient was eating breakfast 4. Chest pain accompanied by shortness of breath
1
Which vital sign is of greatest concern to the nurse prior to administering digoxin (Lanoxin)? 1. Heart rate 2. Temperature 3. Blood pressure 4. Respiratory rate
1
The nurse is caring for a patient recently diagnosed with hypertension. The patient asks what medications may be used to treat the condition. The nurse begins by discussing the primary antihypertensive agents, which include: 1. thiazide diuretics. 2. angiotensin-II receptor blockers (ARBs). 3. beta-adrenergic antagonists. 4. direct-acting vasodilators. 5. peripheral adrenergic antagonists.
1, 2
The nurse is caring for an African American male who has just been diagnosed with hypertension and mild heart failure. The nurse anticipates that this patient will be started on which medications? 1. A combination drug like hydralazine and isosorbide dinitrate 2. A calcium channel blocker like nifedipine (Adalat) 3. An ACE inhibitor like enalapril (Vasotec) 4. A beta-adrenergic antagonist like atenolol (Tenormin) 5. An angiotensin-II receptor blocker like clonidine (Catapres)
1, 2
The nurse is caring for a patient who is being treated pharmacologically for the symptoms of heart failure. What would be included in the nurse's role of pharmacologic management of this patient? 1. Teaching the patient how to space medications to decrease adverse effects 2. Teaching the patient the long-term benefits of beta blockers 3. Continually monitoring the patient during IV infusions 4. Decreasing medication dosages when the patient complains of adverse effects 5. Changing a medication that is no longer working to decrease the patient's symptoms
1, 2, 3
The nurse is concerned that a patient is developing right heart failure. What did the nurse assess in this patient? 1. Ankle edema 2. Enlarged liver 3. Displaced apical heart rate 4. Shortness of breath 5. Cough
1, 2, 3
The nurse is educating a patient diagnosed with heart failure (HF). The nurse knows that instruction regarding compensatory mechanisms has been effective when the patient states, 1. "My heart enlarged in order to compensate for the effects of heart failure." 2. "My nervous system kicks in to compensate for the effects of heart failure." 3. "My body will decrease blood flow to other organs in order to compensate for heart failure." 4. "My body will increase urine output in order to compensate for the effects of heart failure." 5. "My body will produce anti-inflammatory agents to compensate for heart failure."
1, 2, 3
The nurse is caring for a patient being treated pharmacologically for heart failure. Which laboratory values is the nurse careful to monitor during treatment? 1. Potassium levels 2. BUN 3. Creatinine 4. Liver function tests 5. Serum drug levels
1, 2, 3, 5
The nurse is caring for a patient who has been diagnosed with heart failure. The nurse knows that which conditions may have contributed to the development of heart failure in this patient? 1. Uncontrolled hypertension 2. Coronary artery disease (CAD) 3. Diabetes (DM) 4. HIV 5. Mitral stenosis
1, 2, 3, 5
The nurse is caring for a patient who is recovering from a myocardial infarction (MI). The nurse anticipates that the patient will be prescribed which medications in order to reduce post-MI mortality? 1. Aspirin 2. Beta blockers 3. Narcotic analgesics 4. ACE inhibitors 5. Antidysrhythmics
1, 2, 4
The nurse is caring for a patient with heart failure. Which assessment findings indicate the patient is currently experiencing class 2 heart failure? 1. Fatigue with physical activity 2. Palpitations with physical activity 3. No symptoms with physical activity 4. Dyspnea with physical activity 5. Angina at rest
1, 2, 4
The nurse works in a summer camp for children. One of the children says she was bitten by several wasps. The nurse plans to inject the child with epinephrine (EpiPen) if which symptoms are present? 1. The child's skin feels cold and clammy. 2. The child is thirsty. 3. The child's skin feels warm and dry. 4. The child is restless and confused. 5. The child is hyperactive and hyperverbal.
1, 2, 4
The patient has been recently diagnosed with hypertension with a sustained blood pressure of 144/90 mmHg. The patient is concerned about effects on the body. What effects of hypertension on the body will the nurse include in her education of this patient? 1. Kidney damage 2. Stroke 3. Liver failure 4. Heart failure 5. Blindness
1, 2, 4, 5
A patient has been prescribed nitroglycerin ointment for transdermal application. The nurse should teach the patient to hold the medication and contact the prescriber if which situations occur? 1. Dyspnea 2. Cough with frothy sputum 3. Headache 4. Fever 5. Confusion
1, 2, 5
A patient asks which conditions will cause his heart to need more oxygen. The nurse answers with which statements? 1. "Increasing physical activity." 2. "Watching a television show." 3. "Emotional stress." 4. "Eating a meal." 5. "Listening to music."
1, 3
A patient has had great difficulty controlling hypertension with standard drug therapy. She says, "My neighbor couldn't get her blood pressure down until the doctor started her on hydralazine (Apresoline). Which response, by the nurse, is indicated? 1. "Because you had rheumatic fever that damaged your heart, this is not a good drug for you." 2. "Your neighbor must be over age 70." 3. "Your lupus diagnosis keeps us from using that drug." 4. "You should not use that drug because you have rheumatoid arthritis." 5. "We try to avoid using hydralazine (Apresoline) because it causes constant coughing."
1, 3
A nurse has been assigned to provide care for a patient who has class IV heart failure. Which nursing interventions are indicated? 1. Assist nursing support personnel with the patient's bed bath. 2. Accompany the patient on a walk to the courtyard. 3. Monitor that the patient's position is changed every 2 hours. 4. Take vital signs before and after physical therapy weight-bearing exercises. 5. Assist the patient with meals as indicated.
1, 3, 5
A patient reports the following symptoms. Which symptoms would the nurse evaluate as probable unstable angina? 1. "My chest has started hurting even if I am just watching television." 2. "My chest starts hurting if I climb one set of stairs." 3. "My attacks of chest pain are coming more frequently now." 4. "The pain is intense and moves up into my neck." 5. "The pain is worse than it used to be."
1, 3, 5
A patient says, "Since I started taking metoprolol (Lopressor), I have been having problems having sex. I think I am going to stop taking it." What nursing responses are indicated? 1. "Sexual dysfunction is a common problem with this drug." 2. "Perhaps it would be better if you took atenolol (Tenormin)." 3. "I cannot stop you from discontinuing the drug." 4. "Stopping the drug all at once may make your blood pressure get higher." 5. "Try taking the drug early in the morning."
1, 4
A patient is brought to the emergency department in hypertensive crisis. The nurse plans care to protect which bodily systems that are most implicated in compensating for this crisis? 1. Cardiac 2. Respiratory 3. Integumentary 4. Gastrointestinal 5. Renal
1, 5
The nurse is conducting an education class about myocardial blood supply for patients with coronary artery disease (CAD). The nurse determines that learning has occurred when the patients make which statements. 1. "The heart has right and left arteries that arise from the aorta." 2. "The coronary arteries carry blood away from the heart to the right atrium." 3. "The heart receives its oxygen through the blood that fills it." 4. "Coronary arteries primarily carry blood to the left ventricle." 5. "The right and left arteries have smaller branches that go around the heart."
1, 5
Changes in which level would be sensed by baroreceptors and relayed to the vasomotor center? 1. Oxygenation 2. Blood pressure 3. Carbon dioxide 4. Blood pH
2
Following a myocardial infarction, elevations in which cardiac marker would be seen first and are cardiac tissue-specific? 1. White blood cells 2. Troponin I 3. Myoglobin 4. Creatine kinase
2
Lisinopril (Prinivil) is often used to treat heart failure because it lowers blood volume. Which statement best explains how lisinopril lowers blood volume? 1. It has an antagonistic effect on angiotensin-converting enzyme. 2. It lowers aldosterone secretion, a hormone that increases sodium reabsorption. 3. It causes hypernatremia and increased renal tubule permeability, resulting in a diuretic effect. 4. It causes a diuretic effect by lowering the amount of sodium lost in the urine.
2
The nurse has completed medication education with the patient who is receiving atenolol (Tenormin). The nurse determines that teaching is effective when the patient makes which statement? 1. "I must avoid grapefruit juice when I take this medicine." 2. "I must call my doctor if I want to stop this medicine." 3. "I must check my pulse before taking the medicine and call the doctor if it is less than 50." 4. "I must take this medicine with food so it will be properly absorbed."
2
The nurse is providing care to a patient who has experienced several episodes of angina. What is the primary desired outcome for this patient? 1. The patient will experience relief of chest pain with anticoagulant therapy. 2. The patient will experience relief of chest pain with nitrate therapy. 3. The patient will experience relief of chest pain with aspirin therapy. 4. The patient will experience relief of chest pain with therapeutic lifestyle changes.
2
The patient has a history of cardiac disease and receives digoxin (Lanoxin). The nurse determines that education about dietary needs with this medication has been effective when the patient makes which selection for lunch? 1. Cottage cheese, peach salad, and blueberry pie 2. Baked fish, sweet potatoes, and banana pudding 3. Green bean soup, whole-wheat bread, and an apple 4. Hamburger, French fries, and chocolate chip cookies
2
The patient has heart failure and receives digoxin (Lanoxin). Prior to discharge, what will the best teaching plan by the nurse include? 1. "Report development of a metallic taste in the mouth." 2. "Report mental changes such as depression." 3. "Stop the medication if your pulse is irregular." 4. "If you miss a dose, take two doses."
2
The patient in the emergency department experienced an acute myocardial infarction (MI) 8 hours ago. The nurse is administering reteplase (Retavase) intravenously (IV). The patient asks the nurse what is being done. What is the best response by the nurse? 1. "This medicine is widening the arteries in your heart so they can get more oxygen." 2. "This medication is dissolving the clot that is causing your heart attack." 3. "This medicine is thinning your blood so more clots will not develop." 4. No response is indicated; the patient is past the time frame where thrombolytic therapy is effective.
2
The patient is being treated for angina. He asks the nurse if angina is the same thing as having a heart attack. What is the best response by the nurse? 1. "They have some things in common, for example, severe emotional distress and panic can accompany both angina and myocardial infarction." 2. "Angina means heart muscle is not getting enough oxygen, while heart attack, or myocardial infarction, means part of your heart has died." 3. "Actually, it depends on what type of angina you mean; there are several types." 4. "They are basically the same."
2
The patient receives enalapril (Vasotec) as treatment for heart failure. What is the best nursing assessment following the initial administration of this drug? 1. Assess the patient for ototoxicity. 2. Assess the patient's blood pressure. 3. Assess the patient for an irregular pulse. 4. Assess the patient for a serious rash.
2
The patient receives hydrochlorothiazide (Microzide). He tells the nurse he is urinating a lot and questions how this drug affects his blood pressure. What is the best response by the nurse? 1. "Hydrochlorothiazide (Microzide) enhances kidney function causing you to urinate more and that decreases your blood pressure." 2. "Hydrochlorothiazide (Microzide) decreases the fluid in your bloodstream and this lowers your blood pressure." 3. "Hydrochlorothiazide (Microzide) dilates your blood vessels so you urinate more and your blood pressure decreases." 4. "Hydrochlorothiazide (Microzide) increases your heart rate; this pumps blood faster to your kidneys so you urinate more and your blood pressure decreases."
2
The patient receives reteplase (Retavase) intravenously (IV). The nurse assesses the patient for orientation and level of consciousness. The patient's wife asks the nurse why this is being done. What does the nurse indicate as the reason for the assessment? 1. The medication can alter fluid balance; this affects orientation and level of consciousness. 2. The medication can cause bleeding in the brain; this affects orientation and level of consciousness. 3. The medication causes hypoglycemia; this affects orientation and level of consciousness. 4. The medication decreases oxygen to the brain; this decreases orientation and level of consciousness.
2
The patient will receive an IV infusion of milrinone (Primacor) as treatment for acute heart failure. What is the priority plan by the nurse? 1. Plan to monitor for atrial fibrillation. 2. Plan to monitor the ECG continuously. 3. Plan to take vital signs every 15 minutes. 4. Plan to monitor for hypertension.
2
The patient with hypertension is receiving nifedipine (Procardia XL). The nurse determines that the patient needs additional medication education when the patient selects which menu for breakfast? 1. Whole-wheat pancakes with syrup, and bacon, oatmeal, and orange juice 2. Eggs, whole-wheat toast with butter, cereal, milk, and grapefruit juice 3. Eggs and sausage, a biscuit with margarine, coffee with cream, and cranberry juice 4. Egg and cheese omelet, tea with sugar and lemon, hash brown potatoes, and prune juice
2
The physician has prescribed epinephrine (Adrenalin) for an older adult patient. What is an important nursing assessment prior to administration of this drug? 1. A history of type 1 diabetes mellitus 2. A history of narrow angle glaucoma 3. A history of dizziness 4. A history of human immunodeficiency virus (HIV) infection
2
What is a priority nursing intervention for a patient who has just begun antihypertensive treatment with enalapril (Vasotec)? 1. Monitor the patient for headaches. 2. Take the patient's blood pressure. 3. Order a sodium-restricted diet for the patient. 4. Review the patient's lab results for hypokalemia.
2
Which lists include the three factors that make up blood pressure? 1. Blood volume, heart rate, and stroke volume 2. Cardiac output, blood volume, and peripheral vascular resistance 3. Age, weight, and race 4. Body mass index, diet, and genetics
2
Which statement is accurate in regard to secondary hypertension? 1. There is no known cause. 2. It can result from chronic renal impairment. 3. It is also known as idiopathic. 4. It accounts for 90% of all hypertensive cases.
2
A patient has been prescribed nifedipine (Adalat CC) as treatment for hypertension. The nurse would evaluate medication instruction as effective if the patient makes which statements? 1. "If I drink alcohol while taking this medication, I will get very sick to my stomach." 2. "I should stop taking my melatonin sleep medication." 3. "I should no longer drink grapefruit juice." 4. "I should no longer drink sports drinks with caffeine in them." 5. "I should stop taking my vitamin C supplement."
2, 3
A patient who is in hypertensive crisis will be given the calcium channel blocker clevidipine (Cleviprex). The nurse should prepare for which interventions? 1. Monitoring bowel sounds 2. Administering the drug intravenously 3. Continuous blood pressure monitoring 4. Crushing caplets for administration 5. Infusing normal saline at 125 mL/hr
2, 3
The nurse is conducting the initial group education session for patients who have hypertension. What is the most important information to include? 1. Blood pressures tend to decrease as people age, due to decreased blood volume. 2. The aorta has sensors that help regulate blood pressure. 3. Anger can result in hypertension. 4. The vasomotor center, located in the limbic system of the brain, helps regulate blood pressure. 5. Hypertension is diagnosed when the blood pressure is greater than 145/95 mmHg.
2, 3
The nurse is teaching a patient about the pharmacological management of angina. The nurse plans to include which points in the patient teaching? 1. The medications increase the heart rate. 2. The medications dilate the veins so that the heart receives less blood. 3. The medications cause the heart to contract with less force. 4. The medications increase blood pressure. 5. The medications increase the ability of the body to produce red blood cells
2, 3
The nurse is preparing to teach a patient therapeutic lifestyle changes that can decrease the risk of coronary artery disease. The nurse plans to include which topics in the teaching? 1. Eliminating the consumption of alcohol 2. Eliminating foods high in cholesterol and saturated fats 3. Maintaining blood pressure within normal levels 4. Exercising and maintaining a healthy weight 5. Decreasing the number of cigarettes smoked
2, 3, 4
The nurse is reviewing the health history for a patient who may be a candidate for thrombolytic therapy for the treatment of an MI. The nurse knows that therapy is contraindicated in which circumstances? 1. Menses 2. A history of intracranial hemorrhage 3. Hemophilia 4. Liver disease 5. Peptic ulcer disease
2, 3, 4, 5
A patient says, "Ever since I changed jobs I just don't feel as good. I think my heart medicine is not working." What nursing assessment questions are priority? 1. "How well are you sleeping?" 2. "How did your new job change your work schedule?" 3. "How did your new job change your insurance coverage?" 4. "How has your job change affected your home life?" 5. "In what way do you not feel as well?"
2, 3, 5
A patient has been prescribed transdermal nitroglycerin patches. What medication education should the nurse provide? 1. Place the patch on the upper arm or leg. 2. Rotate sites of application. 3. Remove the patch for an hour each day. 4. Cleanse the skin under the patch after removal. 5. Triple wrap the patch in plastic wrap for disposal.
2, 4
The nurse is educating a patient whose blood pressure is 140/90 mmHg on ways to lower blood pressure and avoid hypertension. Which lifestyle choices may eliminate the need for pharmacotherapy in this patient? 1. Increasing intake of wine 2. Restricting salt intake 3. Increasing intake of red meat 4. Increasing activity 5. Stopping smoking
2, 4, 5
For the last 3 months, the nurse has been working with a group of patients who have been using nonpharmacological methods to try to manage their hypertension. The nurse anticipates that which patients will require the addition of a pharmacological intervention? 1. A 30-year-old female whose blood pressure is 138/88 mmHg who is otherwise healthy. 2. A 61-year-old man whose blood pressure is 144/90 mmHg who also has type 2 diabetes. 3. A 56-year-old woman whose blood pressure is 135/84 who also has Cushing's disease. 4. A 65-year-old man whose blood pressure is 148/88 mmHg who is otherwise healthy. 5. A 61-year-old woman whose blood pressure is 153/92 mmHg who is otherwise healthy.
2, 5
A newly licensed nurse abruptly discontinues the intravenous (IV) norepinephrine (Levophed) once it has infused into the patient. What is the priority action of the more experienced nurse? 1. Obtain an oxygen saturation reading with a pulse oximeter. 2. Notify the physician. 3. Assess the patient's blood pressure. 4. Administer oxygen via a rebreather mask.
3
The nurse completed medication education with the patient who receives hydrochlorothiazide (Microzide). The nurse determines that teaching has been effective when the patient makes which statement? 1. "I really need to avoid grapefruit juice when I take this medication." 2. "I need to avoid salt substitutes and potassium-rich foods." 3. "I take my medication early in the morning." 4. "If I develop a cough, I should call my doctor."
3
The nurse is preparing to administer nitroglycerine via the intravenous route. What must the nurse plan to do prior to administering this medication? 1. Use gloves to prevent self-administration. 2. Instruct the patient to avoid moving the arm in which the medication is infusing. 3. Cover the intravenous (IV) bottle to decrease light exposure. 4. Darken the room to decrease light exposure.
3
The nurse is teaching the patient about lifestyle modifications to help manage the patient's hypertension. The nurse determines that teaching has been effective when the patient makes which statement? 1. "I need to get started on my medications right away." 2. "My father had hypertension, did nothing, and lived to be 90-years-old." 3. "I know I need to give up my cigarettes and alcohol." 4. "I won't be able to run in the marathon race anymore."
3
The nurse volunteers at a senior citizen center. The nurse assesses which senior citizen as having the greatest risk of developing heart failure? 1. A 50-year-old African American female who smokes 2. A 75-year-old Caucasian male who is overweight 3. A 69-year-old African American male with hypertension 4. A 52-year-old Caucasian female with asthma
3
The patient comes to the emergency department after suffering a bilateral traumatic amputation of his lower extremities. The physician orders normal serum albumin (Albuminar). The patient goes into shock. What will the best nursing assessment of this patient reveal? 1. B/P: 140/90 mmHg, P: 46, weak and irregular, R: 24, and shallow. 2. B/P: 50/0 mmHg, P: 126, weak and thready, R: 14, and shallow. 3. B/P: 80/20 mmHg, P: 122, weak and thready, R: 28, and shallow. 4. B/P: 130/88 mmHg, P: 90, bounding, R: 32, and shallow.
3
The patient comes to the emergency department with a blood pressure of 200/120 mmHg. The physician orders hydralazine (Apresoline) IV. What will the nurse's priority assessment include? 1. Hypotension and bradycardia 2. Hypotension and hyperthermia 3. Hypotension and tachycardia 4. Hypotension and tachypnea
3
The patient has experienced hypovolemic shock as a result of severe burns. The physician orders a low dose of dopamine (Intropin). What is the best evaluation by the nurse? 1. Vasoconstriction and increased blood pressure 2. Stabilization of fluid loss 3. Urinary output of at least 50 mL/hour 4. Increased cardiac output
3
The patient is in shock with a blood pressure of 60/20 mmHg. The physician orders dobutamine intravenously (IV). The family is quite anxious and asks what "that liquid" is for. What is the best response of the nurse? 1. "This drug is a vasopressor and helps the heart beat more effectively, which will increase blood pressure." 2. "Vasopressor drugs act on the renin-angiotension system and thus increase blood pressure." 3. "This drug is a vasopressor and will help stabilize blood pressure by making the blood vessels smaller." 4. "It is called a vasopressor and will help increase blood flow to peripheral muscles."
3
The patient is receiving doxazosin (Cardura) for hypertension. He asks the nurse how the medication works. What is the nurse's best response? 1. "It works by causing your kidneys to excrete more urine." 2. "It works by making your heart work more efficiently." 3. "It works by making your blood vessels expand." 4. "It works by decreasing the release of your stress hormones."
3
The patient is receiving hydrochlorothiazide (Microzide) as well as digoxin (Lanoxin). Which lab result would the nurse recognize as most significant? 1. ALT level of 35 units/L 2. Sodium level of 140 mEq/L 3. Potassium level of 2.9 mEq/L 4. BUN level of 20 mg/dl
3
The patient is receiving normal serum albumin (Albuminar). What will be a priority outcome with this patient? 1. The patient will be afebrile. 2. The patient will be free of a rash. 3. The patient will experience adequate breathing patterns. 4. The patient will remain alert and oriented.
3
The patient receives digoxin (Lanoxin). Which assessment findings would indicate adverse effects to this medication? 1. Tachycardia and hypotension 2. Blurred vision and tachycardia 3. Anorexia and nausea 4. Anorexia and constipation
3
The patient takes insulin for diabetes mellitus. The physician orders metoprolol (Lopressor) for hypertension. After medication teaching, the nurse determines that learning has occurred when the patient makes which statement? 1. "I might not need to check my blood sugars as often with metoprolol (Lopressor)." 2. "I might be able to change from insulin to a pill with metoprolol (Lopressor)." 3. "I might need less insulin when I take metoprolol (Lopressor)." 4. "I might need more insulin when I take metoprolol (Lopressor)."
3
The physician orders metoprolol (Toprol-XL) for several patients. The nurse will most closely monitor the effects of this drug on which patient? 1. The patient with an apical pulse rate of 100 2. The patient with compensated heart failure 3. The patient with chronic bronchitis 4. The patient with a history of migraines
3
The young patient has a history of multiple allergies, and the physician prescribed epinephrine (EpiPen) for prevention of anaphylactic shock. The patient's mother says to the nurse, "I thought shock was about heart failure." What is the best response by the nurse? 1. "There are many kinds of shock: heart failure, nervous system damage, loss of blood, and respiratory failure." 2. "Allergic response is the most fatal type of shock; other types involve loss of blood, heart failure, and liver failure." 3. "There are many kinds of shock that also include infection, nervous system damage, and loss of blood." 4. "Heart failure is the most serious kind of shock; others include infection, kidney failure, and loss of blood."
3
Which adverse effect is common for patients taking topical nitroglycerin paste? 1. Rash 2. Shortness of breath 3. Headache 4. Ventricular tachycardia
3
Which statement is accurate regarding the physiological changes associated with heart failure? 1. Blood backs up into the lungs due to right ventricular hypertrophy. 2. The walls of the heart shrink, leading to lower cardiac output. 3. Cardiac remodeling occurs after prolonged ventricular hypertrophy. 4. Blood pressure increases, resulting in lowered afterload.
3
A hospitalized patient has been started on enalapril (Vasotec). The nurse would hold this drug and discuss which findings with the prescriber? 1. Cough 2. Light-headedness on ambulation 3. Swelling around the eyes 4. Sneezing 5. Difficulty swallowing
3, 5
The patient comes to the emergency department complaining of coughing and difficulty breathing. The patient's diagnosis is heart failure. He asks the nurse how difficulty breathing could be a heart problem. What is the best response by the nurse? 1. "The right side of your heart has weakened and blood has entered your lungs." 2. "The right side of your heart has enlarged and cannot effectively pump blood." 3. "What you have is called congestive heart failure." 4. "The left side of your heart is weak and pumps blood too quickly." 5. "The left side of your heart has weakened and blood has entered your lungs."
3, 5
The myocardium receives blood via coronary arteries that attach to: 1. the aortic arch. 2. the superior vena cava. 3. the pulmonary vein. 4. the base of the aorta.
4
The nurse is taking the initial history of a patient admitted to the hospital for hypertension. The physician has ordered a beta-adrenergic blocker. Which statement by the patient does the nurse recognize as most significant? 1. "I don't handle stress well; I have a lot of diarrhea." 2. "When I have a migraine headache, I need to have the room darkened." 3. "My father died of a heart attack when he was 48-years-old." 4. "I have always had problems with my asthma."
4
The nurse teaches the patient about lisinopril (Prinivil) and evaluates that additional teaching is required when the patient makes which statement? 1. "I will monitor my blood pressure until my next appointment." 2. "I will avoid using salt substitutes for seasoning." 3. "It takes a while for this medication to take effect." 4. "I don't need to worry about having blood tests done."
4
The patient has been recently diagnosed with hypertension. Assessment data include: Wt: 200 pounds Ht: 5' 4" Diet: Mostly starches Alcohol intake: 3 beers/week Stressors: Works 60 hours/week In planning care with this patient, what is the priority outcome? 1. Patient will eliminate alcohol from the diet. 2. Patient will decrease stress by limiting work to 40 hours/week. 3. Patient will balance diet according to the food pyramid. 4. Patient will achieve and maintain optimum weight.
4
The patient is receiving human serum albumin (Albuminar) as treatment for shock. What is a priority assessment by the nurse? 1. Auscultate breath sounds for hyper-resonance. 2. Auscultate for an absence of breath sounds in the lower lobes. 3. Auscultate breath sounds for inspiratory stridor. 4. Auscultate breath sounds for crackles.
4
The patient says to the nurse, "My doctor said I can't have fried chicken anymore because I have heart disease. I've eaten it all my life and am fine except for some indigestion lately." What is the best response by the nurse? 1. "Did your doctor mention exercise? That is the most important lifestyle change to slow the progression of your heart disease." 2. "Your indigestion is an indication that your body cannot tolerate fatty foods; this causes an increased workload for your heart." 3. "Fried chicken is actually okay, but you must be very careful with the type of fat that you fry the chicken in." 4. "Your indigestion could actually be chest pain caused by narrowed coronary arteries; you will need a low-fat diet."
4
The patient who is prescribed furosemide (Lasix) and digoxin (Lanoxin) reports using an over-the-counter antacid for recurrent heartburn. The nurse would assess for which result? 1. Hyponatremia 2. Hypermagnesemia 3. Increased effectiveness of furosemide (Lanoxin) 4. Decreased effectiveness of digoxin (Lanoxin)
4
The patient with hypertension has experienced heart failure. The nurse notes that the patient is receiving nifedipine (Procardia). What is a priority assessment for the nurse? 1. Review recent lab results for hypokalemia. 2. Assess urinary output. 3. Assess level of orientation. 4. Auscultate breath sounds for crackles.
4
The primary pharmacologic goal in treating patients experiencing stable angina is to: 1. increase venous blood flow to the right atrium. 2. eliminate blockages by using thrombolytics. 3. establish a regular exercise program and diet plan. 4. increase cardiac oxygen supply and reduce cardiac oxygen demand.
4
What is the most likely reason that atherosclerotic plaque would be responsible for producing a myocardial infarction? 1. Atherosclerotic plaque builds up on the endocardium, preventing blood from leaving the atriums. 2. Atherosclerotic plaque results in a narrowing of 50% of the coronary arteries. 3. Atherosclerotic plaque impairs the ability of coronary arteries to constrict and dilate. 4. Atherosclerotic plaque causes a blockage that prevents blood from reaching the myocardium.
4
Which drug is indicated for the prevention of blood clots? 1. Captopril (Capoten) 2. Reteplase (Retavase) 3. Morphine 4. Abciximab (ReoPro)
4
Which drugs reduce the heart's demand for oxygen by lowering heart rate? 1. Anticoagulants and beta-adrenergic blockers 2. Calcium channel blockers and anticoagulants 3. Organic nitrates and calcium channel blockers 4. Beta-adrenergic blockers and calcium channel blockers
4
Which individual listed below would be at the greatest risk for developing heart disease? 1. 35-year-old with diabetes mellitus and prehypertension 2. 75-year-old with Parkinson's disease and normal blood pressure 3. 52-year-old with osteoporosis and stage 1 hypertension 4. 68-year-old with stage 2 hypertension and recent myocardial infarction
4
Which laboratory test would be the priority for a patient with hypertension who takes a thiazide diuretic? 1. Magnesium 2. Calcium 3. Chloride 4. Potassium
4
Which situation would lead to an increase in cardiac output? 1. Reduced cardiac contractility 2. Hypovolemia 3. Peripheral vascular resistance 4. Increase in preload
4
Which statement is accurate regarding the use of beta-adrenergic blockers for use in patients with heart failure? 1. Higher doses are used initially until optimal vital signs are achieved. 2. Dosage changes are done on a daily basis for the first 2 weeks. 3. This drug class does not have an effect on the bronchioles of the lungs. 4. They are generally used in combination with other heart-failure drugs.
4
The nurse knows that the basic strategies of antianginal therapy are: 1. decreased oxygen consumption of the brain. 2. increased myocardial contractility. 3. increased blood flow to the peripheral blood vessels. 4. increased blood flow to the myocardium. 5. decreased myocardial oxygen demand.
4, 5
The nurse teaches the patient about digoxin (Lanoxin) toxicity and determines that learning has occurred when the patient makes which statements? 1. "I should limit my fluids while taking this medication." 2. "It is okay to keep taking my ginseng." 3. "If I have nausea, it means I must stop the medication." 4. "I can drink orange juice every morning." 5. "I must check my pulse and not take the medication if it is less than 60."
4, 5
