The nurse is assessing the patient's knowledge regarding drug therapy prescribed for the treatment of hypertension. Which statement by the patient indicates the need for further teaching by the nurse?
"I will wear a medical alert bracelet."
"I will move slowly from a sitting to standing position."
"Blood pressure drugs can cause changes in sexual functioning."
"When my blood pressure is over 140/90, I will take my medication."
The nurse understands a patient who is treated for hypertension may be switched to an angiotensin receptor blocker (ARB) because of which angiotensin-converting enzyme (ACE) inhibitor adverse effect?
Fatigue
Hypokalemia
Orthostatic hypotension
Dry, nonproductive cough
Which medication should the nurse question if prescribed together with ACE inhibitors?
Furosemide (Lasix)
Morphine
Docusate sodium (Colace)
Potassium chloride (K-Dur)
Before administering eplerenone (Inspra) to a patient, what is the priority nursing action?
Auscultate heart sounds.
Check serum electrolytes.
Assess level of consciousness.
Obtain serum thiocyanate level.
To prevent cerebral artery spasms after a subarachnoid hemorrhage, the nurse anticipates administering which calcium channel blocker?
Verapamil (Calan)
Diltiazem (Cardizem)
Amlodipine (Norvasc)
Nimodipine (Nimotop)
The nurse should question a prescription for a calcium channel blocker in a patient with which condition?
Dysrhythmia
Hypotension
Angina pectoris
Increased intracranial pressure
During discharge teaching, which statement by the nurse would be MOST appropriate for a patient prescribed a transdermal clonidine (Catapres)?
“Occasional drooling is a common adverse effect of this medication.”
“Prolonged sitting or standing does not cause hypotension symptoms.”
“Your blood pressure should be checked by your health care provider two to three times a week.”
“The patch should be applied to a nonhairy site, and you should not suddenly stop using this drug.”
The nurse is conducting a community education program. When explaining different medication regimens to treat hypertension, it would be accurate to state that African Americans probably respond best to which combination of medications?
ACE inhibitors and diuretics
Diuretics and calcium channel blockers
Diuretics and beta blockers
ACE inhibitors and beta blockers
What is the classification of carvedilol (Coreg)?
Beta blocker
Alpha2 blocker
Dual-action alpha1 and beta receptor blocker
ACE inhibitor
When administering nitroprusside (Nipride) by continuous intravenous infusion, the nurse monitors for which symptom of drug toxicity?
Fever
Wheezing
Hyperglycemia
A patient who is prescribed tamsulosin (Flomax) does not have a history of hypertension. The nurse knows this medication is also used for what condition?
Migraine headache
Pulmonary emboli
Subarachnoid hemorrhage
Benign prostatic hyperplasia (BPH)
ACE inhibitors and ARBs both work to decrease blood pressure by which action?
Prevent aldosterone secretion
Increase the breakdown of bradykinin
Enhance sodium and water resorption
Prevent the formation of angiotensin II
When teaching a patient about a new prescription for carvedilol (Coreg), the nurse explains that this medication reduces blood pressure by which action? (Select all that apply.)
Relaxes muscle tone
Decreases heart rate
Peripheral vasodilation
Increases urine output
Promotes excretion of sodium
Which instruction should be included in the discharge teaching for a patient with a transdermal nitroglycerin (Nitro-Dur) patch?
“If you get chest pain, apply a second patch next to the first patch.”
“If you get a headache, remove the patch for 4 hours and then reapply.”
“Make sure to rub a lotion or cream on the skin before putting on a new patch.”
“Apply the patch to a hairless, nonirritated area of the chest, upper arm, back or shoulder.”
The patient states to the nurse, “My friend said nitroglycerin relieves angina pain by reducing preload. What is preload?” Which statement by the nurse explains preload to this patient?
“It is the blood return to the heart.”
“It is the oxygen demand of the heart.”
“It is the pressure against which the heart must pump.”
“It is dilation of arteries and veins throughout the body.”
Which statement by the patient demonstrates a need for further education regarding nitroglycerin (Nitrostat) sublingual tablets?
“I should keep my nitroglycerin in a cool, dry place.”
"I can take up to four tablets at 5-minute intervals for chest pain.”
“If I get a headache, I should keep taking my nitroglycerin and use Tylenol to relieve my headache.”
"I should change positions slowly to avoid getting dizzy from the drug’s effect on my blood pressure.”
Calcium channel blockers reduce myocardial oxygen demand by decreasing afterload. How would the nurse explain afterload to the patient?
It is the contractility of the heart muscle.
It is the total volume of blood in the heart.
It is the force against which the heart must pump.
It is the pressure within the four chambers of the heart.
Which dosage form of nitroglycerin has the longest duration of action?
Sublingual tablet
Transdermal patch
Intravenous (IV) infusion
Immediate-release tablet
To prevent the development of tolerance to nitroglycerin (Nitro-Bid) transdermal patch, the nurse instructs the patient to perform which action?
Apply a new nitroglycerin patch every other day.
Use the nitroglycerin patch for acute episodes of angina only.
Apply the nitroglycerin patch in the morning and remove it at night for 8 hours.
Switch to sublingual nitroglycerin when the systolic blood pressure is greater than 140 mm Hg.
Before administering isosorbide mononitrate (Imdur) sustained-release tablet to a patient, what is the priority nursing intervention?
Obtain a blood pressure reading.
Remind the patient to take the tablet before meals.
Emphasize that the patient should swallow the tablet whole.
Advise the patient that Tylenol is used to treat headache.
The patient asks the nurse, “How should sublingual nitroglycerin be stored when I travel?” What is the nurse’s best response?
“You can protect it from heat by placing the bottle in an ice chest.”
“It’s best to keep it in its original container away from heat and light.”
“You can put a few tablets in a resealable bag and carry it in your pocket.”
“Keep it in the glove compartment of your car to prevent exposure to heat.”
The nurse is teaching treatment of acute chest pain for a patient prescribed nitroglycerin (Nitrostat) sublingual tablets. Which instructions should the nurse include?
Take five tablets every 3 minutes for chest pain.
Sit or lie down before taking medication.
Chew or swallow the tablet for the quickest effect.
Keep the tablets locked in a safe place until you need them.
The nurse is providing discharge teaching for a patient with a new prescription for nitroglycerin (Nitrostat) sublingual tablets. Which statement by the patient indicates an understanding of the nurse’s discharge instructions about this medication?
“My nitroglycerin tablets are not affected by cold or heat.”
“I can take some aspirin if I get a headache related to nitroglycerin.”
“I will keep my nitroglycerin tablets in their original glass container.”
“I will need to refill my prescription when I feel burning under my tongue.”
A patient who is taking nitroglycerin (Nitrostat) sublingual tablets is complaining of flushing and headaches. What is the nurse’s best response?
“Put a cold wet washcloth or use an icepack on your forehead and lie down in a quiet place.”
“Stop taking the nitroglycerin because you are experiencing an allergic reaction to the medication.”
“These are the most common adverse effects of nitroglycerin. They should subside with continued use of nitroglycerin.”
“Immediately notify your health care provider because these symptoms are not related to the sublingual nitroglycerin.”
When applying nitroglycerin (Nitro-Bid) ointment, the nurse should perform which action?
Massage and then gently rub the ointment into the skin.
Apply the ointment to a nonhairy part of the upper torso.
Apply a thick layer of ointment on the nitroglycerin paper.
Use the fingers to spread the ointment evenly over a 3-inch area.
A patient receiving IV nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse’s best action?
Assess the patient’s lung sounds.
Decrease the IV nitroglycerin by 10 mcg/min.
Increase the IV nitroglycerin by 10 mcg/min.
Recheck the patient’s vital signs in 1 hour.
It is MOST important for the nurse to instruct a patient prescribed nitroglycerin to avoid which substance?
Antacids
Grapefruit juice
Erectile dysfunction drugs
Potassium-sparing diuretics
When caring for a patient with angina pectoris, the nurse would question a prescription for a noncardioselective beta blocker in a patient with which preexisting condition?
Hypertension
Atrial fibrillation
Bronchial asthma
Myocardial infarction
The nurse understands that a patient receiving nitroglycerin should be monitored for which common adverse effects associated with this medication? (Select all that apply.)
Flushing
Headache
Dizziness
Blurred vision
For a patient receiving IV nitroglycerin (Tridil), what are the priority nursing interventions? (Select all that apply.)
Check the heart rate.
Monitor blood pressure.
Auscultate lung sounds.
Measure intake and output.
Assess for worsening chest pain.
The nurse is preparing to administer digoxin (Lanoxin) 0.25mg intravenous push to a patient. Which is an expected patient outcome related to the administration of digoxin?
Low serum potassium
Reduction in urine output
Decrease in the heart rate
Increase in blood pressure
The patient’s serum digoxin level is 0.4 ng/mL. How does the nurse interpret this laboratory value result for digoxin?
Normal therapeutic level
A toxic serum blood level
Above the therapeutic level
Below the therapeutic level
A patient prescribed digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg for the treatment of systolic heart failure states, “I am starting to see yellow halos around lights.” Which action will the nurse take?
Perform a visual acuity test on each eye.
Document the finding and reassess in 1 hour.
Assess for other symptoms of digoxin toxicity.
Prepare to administer digoxin immune fab (Digifab).
A patient weighing 44 lb is prescribed a digoxin (Lanoxin) loading dose of 0.03 mg/kg to be administered in three divided doses. How much will the nurse administer in each dose?
0.2 mg
0.3 mg
0.4 mg
0.6 mg
Which are therapeutic effects of digoxin (Lanoxin)?
Positive inotropic, positive chronotropic, and negative dromotropic
Positive inotropic, negative chronotropic, and positive dromotropic
Positive inotropic, negative chronotropic, and negative dromotropic
Negative inotropic, negative chronotropic, and negative dromotropic
Phosphodiesterase inhibitors (PDIs) have an added advantage in treating heart failure. These drugs cause a positive inotropic effect and what other effect?
Vasodilation
Bronchodilation
Vasoconstriction
Platelet inhibition
The nurse reviews an adult patient’s laboratory values and notes a digoxin level of 11 ng/mL and a serum potassium level of 6.2 mEq/L. The nurse would notify the health care provider and anticipate which medication will be prescribed to administer?
Sodium polystyrene sulfonate (Kayexalate)
Atropine
Epinephrine (Adrenalin)
Digoxin immune Fab
The nurse would question the use of milrinone (Primacor) in a patient with which condition?
Acute renal failure
Aortic regurgitation
Systolic heart failure
Mitral valve prolapse
When teaching a patient regarding the administration of digoxin (Lanoxin), the nurse instructs the patient not to take this medication with which food?
Bananas
Wheat bran
French toast
Scrambled eggs
For a patient receiving a positive inotropic drug, which nursing assessments should be performed? (Select all that apply.)
Check apical pulse.
Obtain daily weights.
Monitor serum electrolytes.
Review red blood cell count.
A patient is receiving lidocaine (Xylocaine) by continuous intravenous (IV) infusion. The nurse understands this medication is prescribed for what condition?
Sinus bradycardia
First-degree heart block
Ventricular dysrhythmias
The nurse is reviewing the protocol for administration of IV adenosine (Adenocard). What is the MOST important nursing intervention to remember when giving this medication?
Administer it as a fast IV push.
Assess for burning sensation at the IV site.
Monitor the infusion site for hematoma.
Flush the IV catheter with normal saline.
To prevent the occurrence of cinchonism in a patient prescribed quinidine (Quindex), which instruction is MOST important for the nurse to provide for this patient?
Avoid drinking grapefruit juice.
Remind the patient to change positions slowly.
Advise the patient to wear sunscreen every day.
Increase dietary intake of potassium.
The nurse understands adenosine (Adenocard) is used to treat which condition?
Atrial flutter
Second-degree atrioventricular block
Paroxysmal supraventricular tachycardia (PSVT)
Sodium channel blockers are considered which class of antidysrhythmic drugs?
Class I
Class II
Class III
Class IV
The patient is prescribed ibutilide (Corvert), a class III antiarrhythmic drug. The nurse understands this drug has been prescribed for which reason?
Conversion of life-threatening ventricular dysrhythmias
Conversion of recent-onset atrial fibrillation and flutter
Treatment of dysrhythmias in patients with acute renal failure
Treatment of PSVT
Before administering a dose of an antidysrhythmic drug to a patient, what is the priority nursing assessment?
Check apical pulse and blood pressure.
Measure urine output and specific gravity.
Obtain temperature and pulse oximetry on room air.
Evaluate peripheral pulses and level of consciousness.
Which drug class is used to treat both hypertension and antidysrhythmias?
Sodium channel blockers
Calcium channel blockers
Direct-acting vasodilators
Alpha-adrenergic-blocking
Calcium channel blockers have which pharmacodynamic effect?
Positive inotropic
Positive chronotropic
Coronary vasodilation
Shortened refractory period
The nurse is caring for a patient prescribed amiodarone (Cordarone). The nurse knows the MOST serious adverse effect of this medication can occur in which body system?
Nervous
Immune
Respiratory
Gastrointestinal
For patients prescribed amiodarone (Cordarone), the nurse should monitor for which potential adverse effects of this drug? (Select all that apply.)
Diarrhea
Visual halos
Hypothyroidism
Photosensitivity
Overgrowth of gum tissue
Blue gray skin discoloration
Epinephrine, as an adrenergic (sympathomimetic) drug, produces which therapeutic effect?
Urinary retention
Bronchial constriction
Decreased intestinal motility
Increased heart rate and contractility
The health care provider has prescribed dopamine (Intropin) to treat the patient’s hypovolemic shock secondary to severe blood loss. For the medication to be effective, the health care provider must also prescribe which treatment?
Temporary pacing
Fluid replacement
Induced hypothermia
Beta-stimulating drugs
A patient weighing 176 lb is to receive a dopamine (Intropin) continuous intravenous (IV) infusion at 5 mcg/kg/min. The solution strength available is dopamine 400 mg in 500 mL D5W. The nurse will infuse the medication at which rate?
20 mL/hr
30 mL/hr
40 mL/hr
50 mL/hr
When assessing for cardiovascular effects of an adrenergic (sympathomimetic) drug, the nurse understands that these drugs produce which effect on the heart?
A positive inotropic, positive chronotropic, and positive dromotropic effect
A negative inotropic, positive chronotropic, and positive dromotropic effect
A positive inotropic, negative chronotropic, and negative dromotropic effect
A negative inotropic, negative chronotropic, and negative dromotropic effect
A hypertensive crisis may occur if adrenergic (sympathomimetic) drugs are given along with which of the following drug classes?
Beta blockers
Alpha1 blockers
Direct renin inhibitors
Monoamine oxidase inhibitors (MAOIs)
The nurse assesses the patient’s IV site, and it has infiltrated during the infusion of dopamine (Intropin). The nurse will prepare which medication to treat this infiltration?
Naloxone (Narcan)
Lidocaine (Xylocaine)
Nitroprusside (Nipride)
Phentolamine (Regitine)
A patient using Afrin nasal spray complains of worsening cold symptoms and tells the nurse, “I don’t understand why this is not working. I am using it almost every 3 hours.” The nurse’s response is based on knowledge of which drug information?
Afrin nasal spray may be minimally effective to relieve the nasal congestion.
The medication needs to be used every 30 minutes for maximum effectiveness.
The patient is experiencing rebound congestion related to excessive use of the medication.
Adrenergic decongestants should only be used prophylactically, not to treat acute congestion.
Nonselective beta blockers may be used to treat hypertension and what other condition?
Heart failure
Heart block
Supraventricular dysrhythmias
Chronic obstructive pulmonary disease (COPD)
The nurse knows which drug is an example of a cardioselective beta blocker?
Sotalol (Betapace)
Atenolol (Tenormin)
Propranolol (Inderal)
Labetalol (Normodyne)
When teaching a patient about beta blockers such as atenolol (Tenormin) and metoprolol (Lopressor), it is important for the nurse to instruct the patient about which drug information?
Alcohol intake is encouraged for its vasodilating effects.
Abrupt medication withdrawal may lead to a rebound hypertension.
Hot baths and showers will help increase the therapeutic effects of this drug.
These medications may be taken with antacids to minimize gastrointestinal distress.
Which is the pharmacological action of propranolol (Inderal)?
Beta1-adrenergic antagonist
Beta2-adrenergic antagonist
Selective alpha-adrenergic antagonist
Nonselective beta-adrenergic antagonist
During assessment of a patient diagnosed with pheochromocytoma, the nurse auscultates a blood pressure of 210/110 mm Hg. The nurse would expect to administer which medication?
Nadolol (Corgard)
Dobutamine (Dobutrex)
The nurse understands beta blockers produce which cardiovascular effects?
Positive inotropic, positive chronotropic, and positive dromotropic
Negative inotropic, positive chronotropic, and positive dromotropic
What is the priority nursing diagnosis for a patient prescribed metoprolol (Lopressor)?
Risk for injury related to possible adverse effects of the adrenergic blockers
Acute confusion related to adverse central nervous system effects of the drug
Risk for decreased cardiac tissue perfusion related to effects of medication
Deficient knowledge related to lack of information about the therapeutic regimen
When performing discharge instructions to a patient prescribed metoprolol (Lopressor), which statement by the nurse is correct?
“If you become dizzy, do not take your medication for 2 days and then restart on the third day.”
“This medication may make you fatigued; increasing caffeine in your diet may help alleviate this problem.”
“If you take your pulse and it is less than 60 beats/min, hold your medicine and call your health care provider for instructions.”
“Increase your intake of green leafy vegetables to prevent bleeding problems that can be caused by this medication.”
The nurse is caring for a patient with a history of angina and hypertension who is diagnosed with moderate heart failure. The patient’s current medication regimen includes digoxin (Lanoxin), furosemide (Lasix), and quinapril (Accupril). Which medication would be most beneficial for the health care provider to add to this patient’s treatment plan?
Carvedilol (Coreg)
Esmolol (Brevibloc)
Cholinergic (parasympathomimetic) drugs have which therapeutic effect?
Pupil dilation
Blood vessel vasoconstriction
Increased gastrointestinal (GI) motility
Cholinergic (parasympathomimetic) drugs are indicated for which situation?
To treat a postoperative patient who has bradycardia
To lower intraocular pressure in patients with glaucoma
To manage patients with excessive salivation and sweating
For conditions in which the patient has frequent urination
The nurse is performing postoperative teaching for a patient prescribed bethanechol (Urecholine). The patient is prescribed this drug for the treatment of which condition?
Urinary atony
Ischemic colitis
Respiratory atelectasis
What is an adverse effect of bethanechol (Urecholine)?
Tachypnea
Constipation
The nurse administering donepezil (Aricept) to a patient with Alzheimer’s disease understands this drug has which expected therapeutic action?
Relief of anxiety and restless behavior of the patient
Helps control associated urinary and fecal incontinence
Blocks the effect of norepinephrine at the presynaptic cell membrane
Increases levels of acetylcholine in the brain by blocking its breakdown
When providing teaching to a patient diagnosed with myasthenia gravis, which instruction regarding the administration of physostigmine (Antilirium) is MOST appropriate?
Instruct the patient to take the medication 30 minutes before meals.
Tell the patient to increase fluid and fiber in the diet to prevent constipation.
Inform the patient that common adverse effects include tachycardia and hypertension.
Explain that if a dose is missed, the patient should double the next dose to prevent withdrawal.
The health care provider prescribes donepezil (Aricept) for a patient. The patient states to the nurse, “I have no idea why I take this medication.” The nurse knows the administration of donepezil (Aricept) is MOST commonly associated with what condition?
Bladder retention
Parkinson’s disease
Alzheimer’s disease
The nurse caring for an adult patient with symptomatic bradycardia prepares to administer which recommended dose of intravenous (IV) atropine?
2 mg
0.5 mg
1.25 mg
An adult patient presents to the emergency department with insecticide poisoning. The nurse prepares to administer which dose of IV atropine?
4 mg
The nurse monitors a patient prescribed tolterodine (Detrol) for which therapeutic effect?
Absence of salivation
Increase in heart rate
Decrease in urinary frequency
Reduction in gastrointestinal (GI) motility
The nurse monitors a patient prescribed dicyclomine (Bentyl) for which therapeutic effect?
Decrease in sweating
Dilation of the pupils
Reduction in urinary frequency
Decrease in GI motility
What would be a priority nursing diagnosis for a patient receiving anticholinergic (parasympatholytic) drugs?
Risk for injury related to excessive central nervous system stimulation
Impaired gas exchange related to thickened respiratory secretions
Urinary retention related to loss of bladder tone
Deficient knowledge related to pharmacologic regimen
Which would be the most appropriate application time for a patient prescribed a scopolamine (Transderm Scop) transdermal medication patch for motion sickness?
Just before bedtime
Every 4 hours as needed
4 to 5 hours before travel
At the first sign of motion sickness
After administering oxybutynin (Ditropan) to a patient with spina bifida, the nurse is monitoring the patient for therapeutic effects. Which assessment finding indicates the therapeutic effect of this drug?
Absence of muscle rigidity and tremors
Sudden urge to have a bowel movement
The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin (Hemochron)?
Prothrombin time (PT)
Blood urea nitrogen
Complete blood count
Activated partial thromboplastin time (aPTT)
The nurse is caring for a patient admitted with gastrointestinal bleeding who is anticoagulated with warfarin (Coumadin). Which medication should the nurse anticipate administering?
Vitamin E
Vitamin K (Phytonadione)
Protamine (Protamine sulfate)
Calcium gluconate
The nurse notes a patient’s international normalized ratio (INR) value of 2.5. What is the meaning of this reported value?
The patient’s warfarin dose is within the therapeutic range.
The patient needs the subcutaneous heparin dose increased.
The patient is not receiving enough warfarin for a therapeutic effect.
The patient is receiving too much heparin and is at risk for bleeding.
The nurse is giving discharge instructions to a patient prescribed warfarin (Coumadin) for atrial fibrillation. Which statement by the patient indicates a need for further instruction from the nurse?
“I will take my medication in the early evening each day.”
“I will increase the dark green leafy vegetables in my diet.”
“I will contact my health care provider if I develop excessive bruising.”
“I will avoid activities that have a risk for injury such as contact sports.”
Which medication is an antiplatelet drug?
Clopidogrel (Plavix)
Alteplase (Activase)
Heparin (Hemochron)
Enoxaparin (Lovenox)
The nurse is preparing a patient with acute chest pain for an emergency angioplasty. The nurse would anticipate administering which medication to prevent platelet aggregation?
Warfarin (Coumadin)
Tirofiban (Aggrastat)
Aminocaproic acid (Amicar)
Enoxaparin sodium (Lovenox) is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This medication is in which drug class?
Thrombolytic drug
Oral anticoagulant
Glycoprotein IIb/IIIa inhibitor
Low-molecular-weight heparin
The patient asks the nurse, “What is the difference between dalteparin (Fragmin) and heparin?” What is the nurse’s best response?
“There is really no difference, but dalteparin is preferred because it is less expensive.”
“I’m not really sure why some health care providers choose dalteparin and some heparin.”
“The only difference is that the heparin dosage calculation is based on the patient’s weight.”
“Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect.”
Before emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin?
Phenytoin (Dilantin)
A patient who is prescribed an anticoagulant requests an aspirin (acetylsalicylic acid) for headache relief. What is the nurse’s best action?
Inform the patient of potential drug interactions with anticoagulants.
Explain that a common initial adverse effect is a headache for this drug.
Explain that acetylsalicylic acid is contraindicated and administer ibuprofen.
Administer 650 mg of acetylsalicylic acid and reassess pain in 30 minutes.
A patient is prescribed oral anticoagulant therapy while still receiving IV heparin infusion. The patient is concerned about risk for bleeding. What is the nurse’s best response?
“Bleeding is a common adverse effect of taking warfarin. If bleeding occurs, your health care provider will prescribe an injection of medication to stop the bleeding.”
“Because you are now getting out of bed and walking around, you have a higher risk of blood clot formation and therefore need to be on both medications.”
“Because of your mechanical valve replacement, it is especially important for you to be fully anticoagulated, and the heparin and warfarin together are more effective than one alone.”
“It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin infusion is continued to help prevent blood clots until the warfarin reaches its therapeutic effect.”
The nurse determines the patient has a good understanding of the discharge instructions regarding warfarin (Coumadin) with which patient statement?
“I should keep taking ibuprofen for my arthritis.”
“I should use a soft toothbrush for dental hygiene.”
“I should decrease the dose if I start bruising easily.”
“I will double my dose if I forget to take it the day before.”
While observing a patient self-administer enoxaparin (Lovenox), the nurse identifies the need for further teaching when the patient performs which self-injection action?
Does not aspirate before injecting the medication
Massages the site after administration of the medication
Administers the medication into subcutaneous (fatty) tissue
Injects the medication greater than 2 inches away from the umbilicus
The nurse recognizes that the patient understands the teaching about warfarin (Coumadin) when the patient verbalizes an increased risk of bleeding with concurrent use of which herbal product? (Select all that apply.)
Garlic
Ginkgo
Dong quai
Glucosamine
St. John’s wort
The nurse provides discharge instructions to a patient prescribed cholestyramine (Questran). Which statement by the patient indicates teaching was effective for this drug?
“I will increase fiber in my diet and drink more fluids.”
“I will notify my health care provider if I have muscle pain.”
“I will take Questran 1 hour before my other medications.”
“This drug can cause flushing, itching and gastrointestinal upset.”
To decrease the skin flushing adverse effect reaction of niacin (nicotinic acid), which action should the nurse take?
Administer niacin with a liquid antacid.
Give niacin with all other morning medications.
Apply cold compresses to the head and neck.
Administer aspirin 30 minutes before each dose.
Hydroxymethylglutaryl–coenzyme A (HMG–CoA) reductase inhibitors (statins) are generally administered at which time of day?
Morning
Evening
Afternoon
12:00 noon
Which discharge instruction should the nurse include for a patient prescribed an antilipemic medication?
“Stop taking the medication if it causes nausea and vomiting.”
“Continue your exercise program and maintain a low-fat diet.”
“It is important to take a double dose to make up for a missed dose.”
“Lifestyle changes are no longer necessary when taking this medication.”
What is the mechanism of action of ezetimibe (Zetia)?
Inhibits the biosynthesis of cholesterol in the liver.
Decreases the adhesion of cholesterol in the arteries.
Inhibits absorption of dietary and biliary cholesterol in the small intestine.
Binds to bile acids in the intestine, inhibiting its reabsorption into the blood.
Which statement by the nurse explains to the patient the action of cholestyramine (Questran) to decrease blood lipid levels?
Inhibits absorption of dietary cholesterol in the small and large intestine.
Stimulates the biliary system to increase excretion of dietary cholesterol.
Binds to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces.
Inhibits lipolysis in adipose tissue and decreases the hepatic synthesis of triglycerides in the liver.
Which statement by the patient indicates a need for further instruction about colestipol (Colestid) from the nurse?
“The potential adverse effects of this drug are rash and itching.”
“I might need to take fat-soluble vitamins to supplement my diet.”
“I will mix and stir the powder thoroughly with at least 1 to 2 oz of fluid.”
“I should take this medication 1 hour after or 4 hours before my other medications.”
By which action does atorvastatin (Lipitor) decrease lipid levels?
Stimulating the gallbladder and biliary system to increase excretion of dietary cholesterol
Binding to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces
Inhibiting HMG-CoA reductase, the enzyme responsible for the biosynthesis of cholesterol in the liver
Decreasing the amount of triglycerides produced by the liver and increasing the removal of triglycerides by the liver
To assess for a potentially serious adverse effect to HMG-CoA reductase inhibitors, the nurse should monitor which laboratory results?
Serum electrolytes
Urine specific gravity
Liver function studies
The nurse is providing discharge teaching for a patient about potential serious adverse effects to simvastatin (Zocor). Which symptom may indicate the patient is experiencing a serious adverse effect to this medication?
Itching
Muscle pain
Weight loss
The nurse would question a prescription for simvastatin (Zocor) in a patient with which condition?
Diabetes
Leukemia
Hepatic disease
A patient with elevated triglyceride levels unresponsive to HMG-CoA reductase inhibitors will most likely be prescribed which drug?
Gemfibrozil (Lopid)
Cholestyramine (Questran)
Colestipol (Colestid)
Simvastatin (Zocor)
The nurse would question a prescription for colesevelam (Welchol) in a patient with which condition?
Glaucoma
Renal disease
Bowel obstruction
The nurse will assess a patient receiving gemfibrozil (Lopid) and warfarin (Coumadin) for the increased risk of which adverse effect?
Clotting
Bleeding
Vitamin K toxicity
Deep vein thrombosis
For a patient prescribed hydrochlorothiazide (HydroDIURIL), the nurse should closely monitor which laboratory test value?
Sodium
Glucose
Calcium
Chloride
The nurse is providing education to a patient prescribed spironolactone (Aldactone) and furosemide (Lasix). What information does the nurse explain to the patient?
Using two drugs increases blood osmolality and the glomerular filtration rate.
This combination promotes diuresis but decreases the risk of low levels of potassium.
The lowest dose of two different types of diuretics are more effective than a large dose of one type.
This combination maintains water balance to protect against dehydration and electrolyte imbalance.
Which laboratory test result is a common adverse effect of furosemide (Lasix)?
Hypernatremia
Hyperchloremia
Hypophosphatemia
Why does the health care provider prescribe furosemide (Lasix) 40 mg twice a day by mouth for a patient with a history of renal insufficiency?
Furosemide is effective in treating patients with hypoaldosteronism.
Furosemide helps the kidney with reabsorption of sodium and water.
Furosemide has an antagonist effect to prevent respiratory alkalosis.
Furosemide is effective in treating patients with impaired kidney function
The nurse would question the use of mannitol (Osmitrol) for which patient condition?
Increased intraocular pressure
Oliguria from acute renal failure
Cerebral edema from head trauma
Anuria related to end-stage kidney disease
When preparing to administer intravenous furosemide (Lasix) to a patient with renal dysfunction, the nurse will administer the medication no faster than which rate?
2 mg/min
4 mg/min
6 mg/min
8 mg/min
A patient asks the nurse about using potassium supplements while taking spironolactone (Aldactone). What is the nurse’s best response?
“I will call your health care provider and discuss your concern.”
I would recommend that you take two multivitamins every day.”
“This diuretic is potassium sparing, so there is no need for extra potassium.”
“You will need to take potassium supplements for the medication to be effective.”
To treat a patient diagnosed with primary hyperaldosteronism, the nurse would expect to administer which diuretic?
Acetazolamide (Diamox)
Spironolactone (Aldactone)
Hydrochlorothiazide (HydroDIURIL)
To treat a patient with pulmonary edema, the nurse prepares to administer which diuretic to this patient?
Amiloride (Midamor)
Triamterene (Dyrenium)
To evaluate the therapeutic effects of mannitol (Osmitrol), the nurse should monitor the patient for which clinical finding?
Increase in urine osmolality
Decrease in serum osmolality
Decrease in intracranial pressure
Increase in cerebral blood volume
When assessing a patient taking triamterene (Dyrenium), the nurse would monitor for which possible adverse effect?
Hyperkalemia
Hypoglycemia
When teaching a patient about symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which symptom occurs?
Diaphoresis
Muscle weakness
A patient prescribed spironolactone (Aldactone) asks the nurse to assist with food choices that are low in potassium. The nurse would recommend which food choices? (Select all that apply.)
Apples
Pineapple
Lean meat
Winter squash
Acetazolamide (Diamox) is used to treat which conditions? (Select all that apply.)
Dry eye syndrome
Cardiac dysrhythmias
High-altitude sickness
Open-angle glaucoma
Edema associated with heart failure
Potassium-sparing diuretics may cause which common adverse reactions? (Select all that apply.)
Mental confusion
