The Point Pharm Exam 3

A 37 year old client presents with a blood pressure of 128/78mmHg. What lifestyle change should the nurse suggest related to this assessment finding?

"Be aware of your salt intake and limit hidden salt"

The nurse is providing education to a client who has been prescribed oral propranolol. What client statement indicates to the nurse that teaching was successful?

"I'll make sure not to stop taking my propanolol suddenly."

A client admitted with digitalis toxicity has been taking the same dose for more than 20 years. The family asks the nurse how someone can develop a toxic level while taking the usual dose. How would the nurse respond?

''Toxicity can occur even on low-dose therapy due to various factors including advanced age.''

A client's medication history includes a long-term prescription for modafinil. Which assessment question should the nurse ask the client to confirm why the medication was prescribed?

'Have you ever been diagnosed with narcolepsy?''

A client's angina pectoris is being successfully treated on an outclient basis with sublingual nitroglycerin. What teaching point should the nurse convey to the client when reporting concern about the headache that follows the use of the medication?

'This is a common adverse effect of nitroglycerin; try taking acetaminophen to treat your headache.''

Autoregulation of blood flow is directly connected to raising or lowering blood pressure via vasoactive substances. What are the examples of vasoconstrictive substances? Select all that apply.

-Endothelin-1 -Angiotensin II

A client has been prescribed metoprolol. The nurse should caution the client against abrupt cessation of treatment to avoid which undesired results? Select all that apply

-MI -Angina

The nurse is reviewing a prescription for chlorpromazine. The nurse would contact the prescribing health care provider regarding a contraindication for the client with what medical diagnosis? Select all that apply.

-Parkinson's -stroke -cirrhosis

Autoregulation of blood flow is directly connected to raising or lowering blood pressure via vasoactive substances. Which substances are examples of vasodilators? Select all that apply.

-Prostacyclin -Nitric oxide

Where can ectopic foci originate? Select all that apply.

-Right bundle branch -atrioventricular node -left bundle branch

Atomoxetine has been selected as the primary pharmacologic treatment for a young adult client diagnosed with attention deficit hyperactivity disorder (ADHD). What characteristics make this a good drug of choice for this population of clients? Select all that apply.

-a low risk for dependency -is administered orally -a lower potential for abuse

A client recently started on fluoxetine for the treatment of depression asks the nurse if there are any adverse effects to be aware of. The nurse should inform the client to be alert for what effects? Select all that apply.

-anxiety -insomnia -nervousness

The nurse is assessing an adolescent client diagnosed with attention deficit hyperactivity disorder (ADHD) for therapeutic effects of methylphenidate. The nurse should focus on improvement associated with what client functions? Select all that apply.

-behavior -motor task performance -cognitive task performance

The nurse is providing education on the safe use of caffeine. The nurse would strongly discourage use in clients with a history of what disorders? Select all that apply.

-bipolar disorder -cardiac dysrhythmias -history of stroke

A client has been prescribed a tricyclic antidepressant. What subsequent adverse effects of this drug should the nurse discuss with the client? Select all that apply.

-blurred vision -dry mouth -urinary retention

Initiation of the heart's electrical impulses depends predominantly on what electrolyte movements? Select all that apply.

-calcium ions into a myocardial cell -sodium ions into a myocardial cell -potassium ions out of a myocardial cell

The nurse is providing education to a client who has been prescribed monoamine oxidase inhibitor (MAOI) therapy following unsuccessful treatment with other agents. What foods should the nurse instruct the client to avoid? Select all that apply.

-chocolate -aged cheeses -coffee -bananas

Several forms of nitroglycerin have been developed to relieve acute angina pectoris, prevent exercise-induced angina, and decrease anginal episodes in frequency and severity. What characteristics of nitrate therapy can contribute to the ineffectiveness of the medication when prescribed via the oral route? Select all that apply.

-delayed pain relief -slow onset of action -rapid metabolism by the liver

The nurse is monitoring a client for possible neuroleptic malignant syndrome. What interventions will the nurse implement in client care? Select all that apply.

-document urinary output every 8 hours -monitor for signs of respiratory distress -assess temperature every 8 hours

The nurse is interviewing a client with a history of diabetes mellitus, obesity, and a recent myocardial infarction. What relevant assessment data should the nurse discuss with the client associated with coronary artery disease (CAD)? Select all that apply.

-experience of angina pain -cholesterol consumption -nicotine use -typical A1C results

The clinician has recommended that an adolescent take a ''drug holiday'' from the prescribed methylphenidate. What assessments should the nurse focus on to provide data to support the need for this intervention? Select all that apply.

-height -appetite

The nurse is providing education to the parents of an adolescent who has been prescribed an antidepressant medication. What behaviors should the nurse indicate are associated with the increased risk of suicidal ideation? Select all that apply.

-impulsivity -panic attacks -mania -irritability

A direct thrombin inhibitor (DTI) has been added to a client's medication regimen to treat the onset of acute coronary syndrome. The nurse should anticipate administration by what route? Select all that apply.

-intravenous -oral

The nurse is caring for a client suspected of developing serotonin syndrome. What frequent assessments should the nurse include in the client's plan of care? Select all that apply.

-level of consciousness -temperature -blood pressure

A client with a history of unstable angina is being prepared for percutaneous transluminal coronary angioplasty (PTCA). The nurse assessing the client should focus on identifying a history of which conditions/situations that are considered contraindications to this procedure? Select all that apply.

-major trauma within the last 6 weeks -thrombocytopenia -uncontrolled hypertension

A client who has been prescribed long-term lithium therapy reports taking the medication only erratically since starting a new job. What assessments should the nurse prioritize? Select all that apply.

-manic behavior -mood swings

Phenothiazines such as chlorpromazine are occasionally used for clinical indications not associated with psychiatric illness. What indications would be included? Select all that apply.

-nausea and vomiting -preoperative restlessness

The nurse is monitoring a client who is receiving antipsychotic drug therapy. What behaviors would cause the nurse to suspect the client is demonstrating an extrapyramidal effect? Select all that apply.

-near-constant lip smacking -repeated, involuntary twisting of the arms -inability to stay seated for any length of time

The nurse is planning care for a client who is receiving treatment for acute psychosis. What goals would be appropriate during the first week of treatment? Select all that apply.

-normalizing the patterns of sleeping and eating -decreasing the client's symptoms

The nurse is developing a plan of care for a client who is obese and has been diagnosed with acute heart failure. What nonpharmacologic management techniques could be considered appropriate? Select all that apply.

-prepare the client and family for heart transplant, if indicated -restrict dietary sodium intake -encourage weight loss -provide oxygen, if prescribed, as needed

A client has been started on a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. The nurse should inform the client to watch for which adverse effect(s)? Select all that apply.

-sexual dysfunciton -GI bleeding -weight loss -nausea

The nurse is monitoring for adverse effects in a client who has been prescribed chlorpromazine. What interventions should the nurse incorporate into the plan of care? Select all that apply.

-take and record daily weight -monitor urinary output -monitor white blood cell count

The nurse is caring for a client who has been prescribed nitroglycerin for the treatment of angina. The nurse would alert the prescribing health care provider that therapy is contraindicated when observing what in the client record? Select all that apply.

-takes vardenafil -takes slidenafil

Methylphenidate has been prescribed to a child diagnosed with attention deficit hyperactivity disorder (ADHD). What information should the nurse provide both the child and the parents to ensure effective administration of the medication? Select all that apply.

-the last dose should be taken at least 6 hours before the child's bedtime -the child's first dose should be taken upon awakening

A client diagnosed with intermittent claudication has been prescribed cilostazol for its management. Medication education by the nurse should include informing the client that it may take a maximum of how long for symptom improvement to be achieved?

12 weeks

An adult client is being assessed for possible diagnosis of later attention deficit hyperactivity disorder (ADHD). A major criterion for diagnosing this disorder is previous diagnosis of ADHD by what age?

7 years

A client admitted for elective surgery reports regularly abusing illicit amphetamines. The nurse understands that the client must be assessed regularly for what clinical symptoms associated with this behavior?

Excessive CNS stimulation and sympathetic nervous system stimulation

A client diagnosed with narcolepsy expresses reluctance to rely on medication therapy. What recommendation should the nurse provide?

Maintaining regular sleeping and waking times to avoid periods of sleep deprivation

To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy is being discontinued?

The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks.

A client diagnosed with chronic renal failure is currently taking lithium for severe depression. How will this affect the plan of care?

The dose must be markedly reduced, and plasma lithium levels must be closely monitored.

A client has been prescribed intravenous heparin. What laboratory value will the nurse prioritize when providing care for this client?

aPTT

A client who began treatment with clozapine 2 weeks ago is now reporting worsening flulike symptoms, including a high fever. The nurse's assessment should be conducted with the goal of identifying signs and symptoms of what possible adverse medication rea

agranulocytosis

A client being treated for hypokalemia has a medication history that includes propranolol, digoxin, and warfarin. When the client reports nausea, abdominal discomfort, and visual changes, the nurse suspects what as the causative factor?

digitalis toxicity

A client's most recent digoxin level is reported to be 2.2 ng/mL. What conclusion should the nurse draw?

digitalis toxicity is a possibility

A client has been newly diagnosed with primary hypertension. Which medication classification represented in the client's current medication regimen should the nurse question when considering the treatment for this new diagnosis?

direct vasoconstrictors

The nurse is providing education to a client who has been prescribed captopril. What common adverse effect would the nurse mention in the teaching?

dry cough

What is the most likely reason a client has experienced a proliferation of atherosclerotic plaque in the coronary arteries?

elevated blood cholesterol levels

A client has been prescribed ramipril 5 mg PO daily with the scheduled dose due at 08:00. After reviewing the client's most recent blood work, the nurse should consider withholding the dose because of what laboratory finding?

elevated potassium levels

The nurse is assessing a client who has been prescribed lorazepam. Which of the client's current signs and symptoms should cause the nurse to suspect that the client is experiencing withdrawal?

severe insomnia for the past several nights

A nurse is providing care for a client diagnosed with attention deficit hyperactivity disorder (ADHD) who has been taking methylphenidate for several months. When monitoring for potential adverse effects, the nurse should include what assessment?

sleep patterns

An older adult client reports fatigue. Upon evaluation, the nurse notes decreased breath sounds, jugular vein distension, and 2+ pedal edema. The nurse suspects which complication?

systomatic decompensated heart failure

A client has been prescribed spironolactone therapy for the treatment of heart failure. What treatment goal related to the medication will the nurse include in the care plan?

the client will experience a decrease in edema

The nurse is providing health education to a client who has been newly diagnosed with schizophrenia. What subject should be the primary focus?

the importance of adherence to prescribed treatment

The nurse is providing education to a client who has been prescribed an antipsychotic drug. Which statement suggests that the client understands the typical length of medication therapy?

"I may always have to take this medication"

A client diagnosed with a cardiac dysrhythmia will not require medication therapy. The client expresses concern about the lack of proposed treatment. What response should the nurse provide to best address the client's concern?

"The dysrhythmia you have isn't interfering with getting oxygen to your body tissues so there is no need to treat it."

The nurse is providing education to a client who has been prescribed nitroglycerin transdermal spray. What instruction should the nurse provide the client concerning how to administer the spray?

''Administer the spray as soon as chest pain develops.''

A client admitted with digitalis toxicity has taking the same dose for more than 10 years. What question should the nurse ask the client to assess for the possible cause of an increased serum level of the medication?

''Do you take regular doses of antacids?''

The nurse is reviewing the care plan for a client who has been prescribed a central nervous system (CNS) stimulant. What nursing assessment question addresses the main goal of therapy?

''Has your quality of life improved since being prescribed this medication?''

A client reports that the selective serotonin reuptake inhibitor (SSRI) prescribed originally has been replaced with venlafaxine. What assessment question should the nurse ask the client to best determine the reason for the change?

''Have you been feeling anxious lately?''

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 rapidly brings your serum digoxin levels up to therapeutic levels.''

The nurse is providing education to a client who has been prescribed digoxin for symptomatic heart failure. What teaching point would the nurse convey to this client?

''Make sure to take your pulse for a minute before taking your digoxin.''

A client takes a nonsteroidal anti-inflammatory drug (NSAID) daily to manage the pain of arthritis. What response should the nurse make to the client's concern that another medication, like aspirin, should also be prescribed to minimize the risk for throm

''The antiplatelet effects of NSAIDs are effective in minimizing that risk.''

A client asks to have a year's worth of prescription refills for methylphenidate, explaining that it is very hard to leave work for clinic appointments. How should the nurse respond to that request to best assure client safety?

''The prescription dose is always started as low as possible, and the refills are monitored to prevent abuse.''

The psychiatric nurse is conducting health education addressing the adverse effects of clozapine. What teaching point should the nurse convey to the client?

''There's a possibility that this drug might cause you to gain weight and have high blood sugar levels.''

A client who is taking an ACE inhibitor informs the nurse that she is considering having a child. What information should the nurse provide to the client related to this new information?

ACE inhibitors are contraindicated during pregnancy

To compensate for clopidogrel's slow onset of action, the nurse should anticipate implementing which intervention?

Administering a one-time loading dose that is higher than the maintenance dose

For which client would the nurse question the use of antipsychotic medication therapy?

An older adult client whose delusions and psychosis are attributable to dementia

Antipsychotic drugs are contraindicated in clients with what medical issues?

Liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease

A client experiencing depression is reluctant to start on antidepressant medication. What information should be the basis for the nurse's best response?

Antidepressant therapy may be indicated if depressive symptoms impair social relationships or work performance and occur independently of life events.

The nurse is preparing to give prescribed haloperidol to an acutely dehydrated client. After administration, the nurse should prioritize what nursing assessment?

BP

The nurse notes that a client's current medications include both diltiazem for a dysrhythmia and atazanavir. The nurse should recognize the need to closely monitor which client assessment datum?

BP

A 48-year-old client who experienced an MI 10 years ago is now reporting frequent episodes of angina. The physical assessment identifies the client as being tachycardic. What is the first drug of choice for the treatment of this client?

Beta-blockers

A client has been prescribed a sodium channel blocker following cardioversion. How would the nurse explain the action by which the drug decreases the likelihood of dysrhythmias?

By prolonging the heart's refractory period

Beta-blockers have what advantage over nitrates in the management of angina?

Clients do not develop tolerance to beta-blockers.

An older adult client with a history of mild renal failure has experienced two different transient ischemic attacks (TIAs) and has been prescribed clopidogrel therapy. What statement should be the basis of the nurse's response when asked why aspirin (ASA)

Clopidogrel is believed to be more effective than aspirin in treating TIAs.

What is the prototype for the classification of drugs referred to as benzodiazepines?

Diazepam

A client with a history of severe renal failure has been placed on digoxin for atrial dysrhythmia. Based on the client's history, the nurse anticipates which action?

Digoxin dose will need to be reduced

The nurse, providing postprocedural care for a client scheduled for a cardiac catheterization, will plan to implement which intervention to manage the risk for a common adverse effect of the procedure?

Direct pressure to arterial access site

A client diagnosed with chronic atrial fibrillation is concerned about not being prescribed medication to manage the situation. Upon what information should the nurse base his or her response to the client's concern?

Drug treatment is believed to increase the risk of death in clients diagnosed with chronic atrial fibrillation

Which drug is specifically marketed for the treatment of insomnia?

Flurazepam

The nurse is caring for a client in long-term care who is receiving warfarin. Which assessment indicates a need to withhold the drug and consult with the client's primary health care provider?

INR exceeds 3

A client, an 80-year-old retired teacher, consistently has blood pressure readings of 146/76 mm Hg. What term would the nurse use in documenting the blood pressure?

Isolated systolic hypertension

During a cardiac catheterization and concurrent GP IIb/IIIa receptor antagonist administration, a client begins to bleed from the arterial access site of the catheterization. In what, if any, specific circumstance can the infusion continue?

It can continue if bleeding can be controlled by pressure application.

What is the rationale for administering adenosine as a bolus?

It has an exceptionally short half-life

The spouse of a client diagnosed with an anxiety disorder asks the nurse to explain the condition. The nurse's response should be based on what statement?

It is a common disorder in which the client perceives a situation as threatening to their well-being.

A client diagnosed with acute-onset pulmonary edema has not experienced a response to digitalization. The nurse should expect what drug to be prescribed for this client?

Milrinone

A nurse observing a client notices that the client has developed muscle rigidity, altered mental status, tachycardia, and sweating. The nurse interprets these findings as suggesting which disorder?

Neuroleptic malignant syndrome (NMS)

A client who presents with a blood pressure of 118/78 mm Hg reports exercising regularly, is weight-appropriate for height, and reports no use of tobacco or alcohol. According to current guidelines, what is the client's blood pressure classification?

Normal

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

By what means does warfarin achieve the desired anticoagulant effects?

Preventing synthesis of clotting factors in the liver

The nurse is caring for a client who has been diagnosed with chronic renal failure and has been prescribed a beta-blocker. Which beta-blocker would be a logical addition to existing therapy for renal failure?

Propranolol

The nurse is providing education to a client regarding healthy sleeping habits. What statement most accurately describes an aspect of rapid eye movement (REM) sleep?

REM deprivation can lead to serious psychological problems.

Which medication prescribed for insomnia is thought to play a role in maintenance of the circadian rhythm?

Ramelteon

The nurse is planning care for a client who has been prescribed a CNS stimulant. What should the nurse establish as the primary goal of therapy?

Relieve the symptoms for which they were prescribed.

A nurse is providing medication education to a client with a new prescription for digoxin. What herb should the nurse identify as having the tendency to decrease the effects of the medication?

St. John's wort

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 propanolol dose over a period of 2 weeks

A client reports taking kava for stress relief. What should the nurse teach the client about the supplement?

The Food and Drug Administration (FDA) warns that kava may cause severe liver toxicity.

While reviewing a client record, the nurse sees that the client has a history of chronic insomnia. What assumption can the nurse have regarding the client?

The client has been experiencing dysfunctional sleep for more than 1 month.

The nurse is caring for a client who has been prescribed enalapril maleate for heart failure. The nurse would withhold the next scheduled dose upon assessing what change in the client's status?

The client is volume depleted following a bout of diarrhea

A client diagnosed with an anxiety disorder has expressed dissatisfaction with lorazepam therapy and wants to discontinue the drug. What is the most important information the nurse expects the health care provider to give the client?

The drug should be tapered gradually to prevent severe symptoms of withdrawal.

The nurse is providing education to a client who has been prescribed eszopiclone. What information should the nurse include?

The importance of taking the drug immediately before going to bed

What sequence describes the flow of electrical impulses in the heart?

The sinoatrial node, the atrioventricular node, the bundle of His, right and left bundle branches, and the Purkinje fibers

The nurse is providing educational instruction to a client who has been prescribed lithium. What statement is the priority?

There is a need for regularly scheduled blood work to monitor serum levels of lithium.

The nurse is providing education to a client who has been newly diagnosed with bipolar disorder type II. What information should the nurse share concerning the condition?

There will be episodes of both major depression and hypomania.

A client with a history of angina has been prescribed IV atenolol. When monitoring this client's health status, the nurse should recognize that there is a need to titrate the client's dose of atenolol with the goal of achieving what outcome?

a heart rate of 50 to 60 beats/min

The client reports using an over-the-counter (OTC) drug to treat insomnia. What classification of OTC medications is often used for this purpose?

antihistamines

What term is used to describe the heart's ability to independently generate an electrical impulse?

automaticity

The nurse is providing health education for a client who has been prescribed a benzodiazepine. What adverse effect should the nurse discuss in the teaching?

dependence

How does captopril contribute to a reduction of a client's blood pressure?

blocking the conversion of angiotensin I to angiotensin II

The nurse is providing education to a client who has been prescribed clozapine. During teaching, the nurse should inform the client of the need for regular monitoring of what laboratory test during the initial months of therapy and periodically thereafter

complete blood count

A current client, an overweight 61-year-old with a history of diabetes mellitus, is status post-MI 1 month and has returned for a cardiology follow-up. Along with dietary changes, the nurse will discuss which nonpharmacologic lifestyle modification to red

glucose control

The nurse is providing education to a client who has been prescribed sublingual nitroglycerin tablets. What action should the nurse instruct the client to take if the medication is not effective in relieving chest pain?

go to the emergency department

The nurse explains to a client that angina can be caused by a thrombus forming in which anatomical location?

heart

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?

heparin

When prescribed for angina, how does oral nifedipine achieve a therapeutic effect?

inhibiting the influx of calcium through slow channels

To monitor possible intermittent claudication, the nurse will assess for a thrombus lodging in what specific location?

legs

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?

lower blood pressure as quickly as possible

What is the primary goal of antidysrhythmic drug therapy for a client who has been successfully cardioverted?

maintenance of normal sinus rhythm (NSR)

What classification of medication, prescribed to manage myocardial ischemia, can preserve cardiac function without decreasing heart rate or blood pressure?

metabolic modulator

The client with a 10-year history of hypertension would like to know what effect the condition has on the heart. What is the nurse's best response?

myocardium hypertrophy

The risk for which outcome is increased when a client experiences a drug-to-drug interaction while on amiodarone therapy?

new dysrhythmias

The nurse is participating in a family meeting with the parents of a child diagnosed with attention deficit hyperactivity disorder (ADHD) and prescribed dextroamphetamine. The nurse should discuss what black box warning associated with this medication?

potential for abuse

A client prescribed fluoxetine 1 week ago presents for a scheduled follow-up appointment. What should be the focus of the client's nursing assessment to best assure client safety?

presence of suicidal ideation

The nurse is providing care for a client who is experiencing acute-onset heart failure (HF). The nurse would contact the health care provider to question a prescription for what medication?

propranolol hydrochlordie

A client with a history of diabetes and renal failure has been diagnosed with angina. What effect would the client's chronic renal failure have upon calcium channel blocker administration and dosing when compared with a person who has full kidney function

same route, same dosing

An older adult client has been admitted to the emergency department with severe chest pain. Onset of symptoms is within the last 60 minutes. What medication would the nurse expect the health care provider to prescribe for this acute disorder?

thrombolytic drugs