120 terms

Pharmacology Unit 3 NCLEX Questions

Chapters 42-46. Questions came from the back of each chapter in the book and from the practice NCLEX questions for these chapters on the Evolve resources.
STUDY
PLAY

Terms in this set (...)

b. 0.5 to 2.0 ng/mL
A newly admitted client takes digoxin 0.25 mg/day. The nurse knows that which is the serum therapeutic range for digoxin?

a. 0.1 to 1.5 ng/mL
b. 0.5 to 2.0 ng/mL
c. 1.0 to 2.5 ng/mL
d. 2.0 to 4.0 ng/mL
a. It is in the high (elevated) range.
The client's serum digoxin level is 3.0 ng/mL. What does the nurse know about this serum digoxin level?

a. It is in the high (elevated) range.
b. It is in the low (decreased) range.
c. It is within the normal range.
d. It is in the low average range.
d. Pulse below 60 beats/min and irregular rate
The nurse is assessing the client for possible evidence of digitalis toxicity. The nurse acknowledges that which is included in the signs and symptoms for digitalis toxicity?

a. Pulse (heart) rate of 100 beats/min
b. Pulse of 72 with an irregular rate
c. Pulse greater than 60 beats/min and irregular rate
d. Pulse below 60 beats/min and irregular rate
a. Increase the serum digoxin sensitivity level
The client is also taking a diuretic that decreases her potassium level. The nurse expects that a low potassium level (hypokalemia) could have what effect on the digoxin?

a. Increase the serum digoxin sensitivity level
b. Decrease the serum digoxin sensitivity level
c. Not have any effect on the serum digoxin sensitivity level
d. Cause a low average serum digoxin sensitivity level
b. Headaches
When a client first takes a nitrate, the nurse expects which symptom that often occurs?

a. Nausea and vomiting
b. Headaches
c. Stomach cramps
d. Irregular pulse rate
c. Decrease heart rate and decrease myocardial contractility.
The nurse acknowledges that beta blockers are as effective as antianginals because they do what?

a. Increase oxygen to the systemic circulation.
b. Maintain heart rate and blood pressure.
c. Decrease heart rate and decrease myocardial contractility.
d. Decrease heart rate and increase myocardial contractility.
b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down.
The health care provider is planning to discontinue a client's beta blocker. What instruction should the nurse give the client regarding the beta blocker?

a. The beta blocker should be abruptly stopped when another cardiac drug is prescribed.
b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down.
c. The beta blocker dose should be maintained while taking another antianginal drug.
d. Half the beta blocker dose should be taken for the next several weeks.
c. To block the beta1-adrenergic receptors in the cardiac tissues
The beta blocker acebutolol (Sectral) is prescribed for dysrhythmias. The nurse knows that what is the primary purpose of the drug?

a. To increase the beta1 and beta2 receptors in the cardiac tissues
b. To increase the flow of oxygen to the cardiac tissues
c. To block the beta1-adrenergic receptors in the cardiac tissues
d. To block the beta2-adrenergic receptors in the cardiac tissues
a. "Apply the patch to a nonhairy area of the upper torso or arm."
A client is to be discharged home with a transdermal nitroglycerin patch. Which instruction will the nurse include in the client's teaching plan?

a. "Apply the patch to a nonhairy area of the upper torso or arm."
b. "Apply the patch to the same site each day."
c. "If you have a headache, remove the patch for 4 hours and then reapply."
d. "If you have chest pain, apply a second patch next to the first patch."
d. Client stating that pain is 0 out of 10
A nurse is monitoring a client with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective?

a. Blood pressure 120/80 mm Hg
b. Heart rate 70 beats per minute
c. ECG without evidence of ST changes
d. Client stating that pain is 0 out of 10
d. Chest pain
The nurse is monitoring a client during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action?

a. Blood pressure 110/90 mm Hg
b. Flushing
c. Headache
d. Chest pain
d. "I can take up to five tablets at 3-minute intervals for chest pain if necessary."
Which statement made by the client demonstrates a need for further instruction regarding the use of nitroglycerin?

a. "If I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief."
b. "I should keep my nitroglycerin in a cool, dry place."
c. "I should change positions slowly to avoid getting dizzy."
d. "I can take up to five tablets at 3-minute intervals for chest pain if necessary."
a. Client states that she has no chest pain.
Which client assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker?

a. Client states that she has no chest pain.
b. Client states that the swelling in her feet is reduced.
c. Client states the she does not feel dizzy.
d. Client states that she feels stronger.
d. "This medication will work for 24 hours and you will need to change the patch daily."
What statement is the most important for the nurse to include in the teaching plan for a client who has started on a transdermal nitroglycerin patch?

a. "This medication works faster than sublingual nitroglycerin works."
b. "This medication is the strongest of any nitroglycerin preparation available."
c. "This medication should be used only when you are experiencing chest pain."
d. "This medication will work for 24 hours and you will need to change the patch daily."
c. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night.
What will the nurse instruct the client to do to prevent the development of tolerance to nitroglycerin?

a. Apply the nitroglycerin patch every other day.
b. Switch to sublingual nitroglycerin when the client's systolic blood pressure elevates to more than 140 mm Hg.
c. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night.
d. Use the nitroglycerin patch for acute episodes of angina only.
c. Assess blood pressure.
Before the nurse administers isosorbide mononitrate (Imdur), what is a priority nursing assessment?

a. Assess serum electrolytes.
b. Measure blood urea nitrogen and creatinine.
c. Assess blood pressure.
d. Monitor level of consciousness.
b. "It's best to keep it in its original container away from heat and light."
The client asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response?

a. "You can protect it from heat by placing the bottle in an ice chest."
b. "It's best to keep it in its original container away from heat and light."
c. "You can put a few tablets in a resealable bag and carry it in your pocket."
d. "It's best to lock them in the glove compartment to keep them away from heat and light."
d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."
Which statement indicates to the nurse that the client understands sublingual nitroglycerin medication instructions?

a. "I will take up to five doses every 3 minutes for chest pain."
b. "I can chew the tablet for the quickest effect."
c. "I will keep the tablets locked in a safe place until I need them."
d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."
b. Apply the ointment to a nonhairy part of the upper torso.
What instruction should the nurse provide to the client who needs to apply nitroglycerin ointment?

a. Use the fingers to spread the ointment evenly over a 3-inch area.
b. Apply the ointment to a nonhairy part of the upper torso.
c. Massage the ointment into the skin.
d. Cover the application paper with ointment before use.
b. Decrease the intravenous nitroglycerin by 10 mcg/min.
A client receiving intravenous 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 priority action?

a. Assess the client's lung sounds.
b. Decrease the intravenous nitroglycerin by 10 mcg/min.
c. Stop the nitroglycerin infusion for 1 hour, and then restart.
d. Recheck the client's vital signs in 15 minutes but continue the infusion.
b. Heart rate 58 beats per minute
The nurse is monitoring a client taking digoxin (Lanoxin) for treatment of heart failure. Which assessment finding indicates a therapeutic effect of the drug?

a. Heart rate 110 beats per minute
b. Heart rate 58 beats per minute
c. Urinary output 40 mL/hr
d. Blood pressure 90/50 mm Hg
a. Administer ordered dose of digoxin.
A client's serum digoxin level is drawn, and it is 0.4 ng/mL. What is the nurse's priority action?

a. Administer ordered dose of digoxin.
b. Hold future digoxin doses.
c. Administer potassium.
d. Call the health care provider.
a. Evaluate digoxin levels.
A client is taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg. When the nurse enters the room, the client states, "There are yellow halos around the lights." Which action will the nurse take?

a. Evaluate digoxin levels.
b. Withhold the furosemide
c. Administer potassium.
d. Document the findings and reassess in 1 hour.
a. Loss of appetite with slight bradycardia
Which assessment finding will alert the nurse to suspect early digitalis toxicity?

a. Loss of appetite with slight bradycardia
b. Blood pressure 90/60 mm Hg
c. Heart rate 110 beats per minute
d. Confusion and diarrhea
b. To administer digoxin immune FAB
The nurse reviews a client's laboratory values and finds a digoxin level of 10 ng/mL and a serum potassium level of 5.9 mEq/L. What is the nurse's primary intervention?

a. To administer atropine
b. To administer digoxin immune FAB
c. To administer epinephrine
d. To administer Kayexalate
c. Monitor blood pressure continuously.
A client is to begin treatment for short-term management of heart failure with milrinone lactate (Primacor). What is the priority nursing action?

a. Administer digoxin via IV infusion with the Primacor.
b. Administer Lasix (furosemide) via IV infusion after the Primacor.
c. Monitor blood pressure continuously.
d. Maintain an infusion of lactated Ringers with Primacor infusion.
c. Continue to monitor the client.
A client's recently drawn serum lidocaine drug level is 3.0 mcg/mL. What is the nurse's priority intervention?

a. Increase the lidocaine infusion.
b. Decrease the lidocaine infusion.
c. Continue to monitor the client.
d. Stop the IV drip for 1 hour.
c. Rapid IV bolus of Adenosine (Adenocard)
A client is admitted to the emergency department with paroxysmal supraventricular tachycardia. What intervention is the nurse's priority?

a. Administration of digoxin IV push
b. Administration of oxygen, 2 lpm
c. Rapid IV bolus of Adenosine (Adenocard)
d. Instructing client to "bear down"
c. ECG
A nurse is caring for a client who has been started on ibutilide (Corvert). Which assessment is a priority for this client?

a. Blood pressure measurement
b. BUN and creatinine
c. ECG
d. Lung sounds
b. Crackles in the lungs
Which assessment finding will alert the nurse to possible toxic effects of amiodarone?

a. Heart rate 100 beats per minute
b. Crackles in the lungs
c. Elevated blood urea nitrogen
d. Decreased hemoglobin
b. Continuous blood pressures
d. Presence of chest pain
What must the nurse monitor when titrating intravenous nitroglycerin for a client? (Select all that apply.)

a. Continuous oxygen saturation
b. Continuous blood pressures
c. Hourly ECGs
d. Presence of chest pain
e. Serum nitroglycerin levels
f. Visual acuity
b. Hypokalemia
A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. What type of electrolyte imbalance does the nurse expect to occur?

a. Hypocalcemia
b. Hypokalemia
c. Hyperkalemia
d. Hypermagnesemia
c. Hydrochlorothiazide
What would cause the same client's electrolyte imbalance?

a. High dose of digoxin
b. Digoxin taken daily
c. Hydrochlorothiazide
d. Low dose of hydrochlorothiaizde
d. Serum glucose (sugar)
A nurse teaching a client who has diabetes mellitus and is taking hydrochlorothiazide 50 mg/day. The teaching should include the importance of monitoring which levels?

a. Hemoglobin and hematocrit
b. Blood urea nitrogen (BUN)
c. Arterial blood gases
d. Serum glucose (sugar)
c. High-ceiling (loop) diuretic
A client has heart failure and is prescribed Lasix. The nurse is aware that furosemide (Lasix) is what kind of drug?

a. Thiazide diuretic
b. Osmotic diuretic
c. High-ceiling (loop) diuretic
d. Potassium-sparing diuretic
a. Hypokalemia
The nurse acknowledges that which condition could occur when taking furosemide?

a. Hypokalemia
b. Hyperkalemia
c. Hypoglycemia
d. Hypermagnesemia
b. To increase the serum potassium level
For the client taking a diuretic, a combination such as triamterene and hydrochlorothiazide may be prescribed. The nurse realizes that this combination is ordered for which purpose?

a. To decrease the serum potassium level
b. To increase the serum potassium level
c. To decrease the glucose level
d. To increase the glucose level
b. Hyperkalemia
The client has been receiving spironolactone (Aldactone) 50 mg/day for heart failure. The nurse should closely monitor the client for which condition?

a. Hypokalemia
b. Hyperkalemia
c. Hypoglycemia
d. Hypermagnesemia
a. Have the client lie down when taking a nitroglycerin sublingual tablet.
b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists.
e. Warn client against ingesting alcohol while taking nitroglycerin.
A client who has angina is prescribed nitroglycerin. The nurse reviews which appropriate nursing interventions for nitroglycerin (Select all that apply.)

a. Have the client lie down when taking a nitroglycerin sublingual tablet.
b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists.
c. Apply Transderm-Nitro patch to a hairy area to protect skin from burning.
d. Call the health care provider after taking 5 tablets if chest pain persists.
e. Warn client against ingesting alcohol while taking nitroglycerin.
b. Fasting blood glucose level of 140 mg/dL
Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide (HydroDIURIL)?

a. Sodium level of 140 mEq/L
b. Fasting blood glucose level of 140 mg/dL
c. Calcium level of 9 mg/dL
d. Chloride level of 100 mEq/L
b. "This combination promotes diuresis but decreases the risk of hypokalemia."
What is the best information for the nurse to provide to the client who is receiving spironolactone (Aldactone) and furosemide (Lasix) therapy?

a. "Moderate doses of two different diuretics are more effective than a large dose of one."
b. "This combination promotes diuresis but decreases the risk of hypokalemia."
c. "This combination prevents dehydration and hypovolemia."
d. "Using two drugs increases the osmolality of plasma and the glomerular filtration rate."
c. Administer 2 mEq potassium chloride per kilogram per day IV.
The nurse is assessing a client who is taking furosemide (Lasix). The client's potassium level is 3.4 mEq/L, chloride is 90 mmol/L, and sodium is 140 mEq/L. What is the nurse's primary intervention?

a. Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly.
b. Administer Kayexalate.
c. Administer 2 mEq potassium chloride per kilogram per day IV.
d. Administer PhosLo, two tablets three times per day.
c. The fact that Lasix has shown efficacy in treating persons with renal insufficiency.
A nurse admits a client diagnosed with pneumonia. The client has a history of chronic renal insufficiency, and the health care provider orders furosemide (Lasix) 40 mg twice a day. What is most important to include in the teaching plan for this client?

a. That the medication will have to be monitored very carefully owing to the client's diagnosis of pneumonia.
b. The fact that Lasix has been proven to decrease symptoms with pneumonia.
c. The fact that Lasix has shown efficacy in treating persons with renal insufficiency.
d. That the medication will need to be given at a higher than normal dose owing to the client's medical problems.
c. Fish
A client taking spironolactone (Aldactone) has been taught about the therapy. Which menu selection indicates that the client understands teaching related to this medication?

a. Apricots
b. Bananas
c. Fish
d. Strawberries
c. A 47-year-old client with anuria
Which client would the nurse need to assess first if the client is receiving mannitol (Osmitrol)?

a. A 67-year-old client with type 1 diabetes mellitus
b. A 21-year-old client with a head injury
c. A 47-year-old client with anuria
d. A 55-year-old client receiving cisplatin to treat ovarian cancer
c. A decrease in arterial pH
A nurse is caring for a client receiving acetazolamide (Diamox). Which assessment finding will require immediate nursing intervention?

a. A decrease in bicarbonate level
b. An increase in urinary output
c. A decrease in arterial pH
d. An increase in PaO2
b. Assess lung sounds before and after administration.
c. Assess blood pressure before and after administration.
d. Maintain accurate intake and output record.
A client is ordered furosemide (Lasix) to be given via intravenous push. What interventions should the nurse perform? (Select all that apply.)

a. Administer at a rate no faster than 20 mg/min.
b. Assess lung sounds before and after administration.
c. Assess blood pressure before and after administration.
d. Maintain accurate intake and output record.
e. Monitor ECG continuously.
f. Insert an arterial line for continuous blood pressure monitoring.
d. "Wear protective clothing and sunscreen while on this medication."
A client is prescribed Thalitone (chlorthalidone). What is the most important information the nurse should teach the client?

a. "Do not drink more than 10 ounces of fluid a day while on this medication."
b. "Take this medication on an empty stomach."
c. "Take this medication before bed each night."
d. "Wear protective clothing and sunscreen while on this medication."
c. Decreased aldosterone
A client with hyperaldosteronism is prescribed spironolactone (Aldactone). What assessment finding would the nurse evaluate as a positive outcome?

a. Decreased potassium level
b. Decreased crackles in the lung bases
c. Decreased aldosterone
d. Decreased ankle edema
c. Lungs clear.
A client with acute pulmonary edema receives furosemide (Lasix). What assessment finding indicates that the intervention is working?

a. Potassium level decreased from 4.5 to 3.5 mEq/L.
b. Crackles auscultated in the bases.
c. Lungs clear.
d. Output 30 mL/hr.
a. Decreased intracranial pressure
Which assessment indicates a therapeutic effect of mannitol (Osmitrol)?

a. Decreased intracranial pressure
b. Decreased potassium
c. Increased urine osmolality
d. Decreased serum osmolality
c. Assess potassium levels.
Which intervention will the nurse perform when monitoring a client receiving triamterene (Dyrenium)?

a. Assess urinary output hourly.
b. Monitor for side effect of hypoglycemia.
c. Assess potassium levels.
d. Monitor for Hypernatremia.
a. It causes an alkaline urine, which facilitates the elimination of uric acid.
The client asks the nurse why the health care provider prescribed acetazolamide (Diamox), a diuretic, to treat gout. What is the nurse's best response?

a. It causes an alkaline urine, which facilitates the elimination of uric acid.
b. It increases alkalinity of urine, thus decreasing the formation of uric acid.
c. It causes an acid urine, which facilitates the elimination of uric acid.
d. It decreases alkalinity of urine, thus decreasing the formation of uric acid.
c. Stage 1 hypertension
A client's blood pressure (BP) is 145/90. According to the guidelines for determining hypertension, the nurse realizes that the client's BP is at which stage?

a. Normal
b. Prehypertension
c. Stage 1 hypertension
d. Stage 2 hypertension
a. Diuretic
The nurse acknowledges that the first-line drug for treating this client's blood pressure might be which drug?

a. Diuretic
b. Alpha blocker
c. ACE inhibitor
d. Alpha/beta blocker
c. Beta blockers and ACE inhibitors
The nurse is aware that which group(s) of antihypertensive drugs are less effective in African-American clients?

a. Diuretics
b. Calcium channel blockers and vasodilators
c. Beta blockers and ACE inhibitors
d. Alpha blockers
b. hydrochlorothiazide
The nurse knows that which diuretic is most frequently combined with an antihypertensive drug?

a. chlorthalidone
b. hydrochlorothiazide
c. bendroflumethiazide
d. potassium-sparing diuretic
a. Beta1 blocker
The nurse explains that which beta blocker category is preferred for treating hypertension?

a. Beta1 blocker
b. Beta2 blocker
c. Beta1 and beta2 blockers
d. Beta2 and beta3 blockers
d. Constant, irritating cough
Captopril (Capoten) has been ordered for a client. The nurse teaches the client that ACE inhibitors have which common side effects?

a. Nausea and vomiting
b. Dizziness and headaches
c. Upset stomach
d. Constant, irritating cough
b. Blocking angiotensin II from AT1 receptors
A client is prescribed losartan (Cozaar). The nurse teaches the client that an angiotensin II receptor blocker (ARB) acts by doing what?

a. Inhibiting angiotensin-converting enzyme
b. Blocking angiotensin II from AT1 receptors
c. Preventing the release of angiotensin I
d. Promoting the release of aldosterone
b. Dizziness
c. Headache
e. Ankle edema
During an admission assessment, the client states that she takes amlodipine (Norvasc). The nurse wishes to determine whether or not the client has any common side effects of a calcium channel blocker. The nurse asks the client if she has which signs and symptoms? (Select all that apply.)

a. Insomnia
b. Dizziness
c. Headache
d. Angioedema
e. Ankle edema
f. Hacking cough
a. "I will check my blood pressure daily and take my medication when it is over 140/90."
Which statement indicates that the client needs additional instruction about antihypertensive treatment?

a. "I will check my blood pressure daily and take my medication when it is over 140/90."
b. "I will include rest periods during the day to help me tolerate the fatigue my medicine may cause."
c. "I will change my position slowly to prevent feeling dizzy."
d. "I will not mow my lawn until I see how this medication makes me feel."
a. Call the health care provider to switch the medication.
A nurse is caring for a client who is taking an angiotensin-converting enzyme inhibitor and develops a dry, nonproductive cough. What is the nurse's priority action?

a. Call the health care provider to switch the medication.
b. Assess the client for other symptoms of upper respiratory infection.
c. Instruct the client to take antitussive medication until the symptoms subside.
d. Tell the client that the cough will subside in a few days.
d. spironolactone (Aldactone)
The nurse is reviewing a medication history on a client taking an ACE inhibitor. The nurse plans to contact the health care provider if the client is also taking which medication?

a. docusate sodium (Colace)
b. furosemide (Lasix)
c. morphine sulfate
d. spironolactone (Aldactone)
b. Respiratory assessment
A client is prescribed a noncardioselective beta1 blocker. What nursing intervention is a priority for this client?

a. Assessment of blood glucose levels
b. Respiratory assessment
c. Orthostatic blood pressure assessment
d. Teaching about potential tachycardia
c. The client who has stopped taking a beta blocker due to cost.
Which client will the nurse assess first?

a. The client who has been on beta blockers for 1 day.
b. The client who is on a beta blocker and a thiazide diuretic.
c. The client who has stopped taking a beta blocker due to cost.
d. The client who is taking a beta blocker and Lasix (furosemide).
d. Get up slowly from a sitting to a standing position.
The nurse is caring for a client with hypertension who is prescribed Clonidine transdermal preparation. What is the correct information to teach this client?

a. Change the patch daily at the same time.
b. Remove the patch before taking a shower or bath.
c. Do not take other antihypertensive medications while on this patch.
d. Get up slowly from a sitting to a standing position.
b. Notify the health care provider.
The client taking Methyldopa (Aldomet) has elevated liver function tests. What is the nurse's best action?

a. Document the finding and continue care.
b. Notify the health care provider.
c. Immediately stop the medication.
d. Change the client's diet.
c. Determine the client's history.
A client taking prazosin has a blood pressure of 140/90. The client is complaining of swollen feet. What is the nurse's best action?

a. Hold the medication.
b. Call the health care provider.
c. Determine the client's history.
d. Weigh the client.
c. Hypotension
A calcium channel blocker has been ordered for a client. Which condition in the client's history is a contraindication to this medication?

a. Hypokalemia
b. Dysrhythmias
c. Hypotension
d. Increased intracranial pressure
b. "Increasing fluid and fiber in your diet can help prevent the side effect of constipation."
A client who takes clonidine (Catapres) is to be discharged to home. Which instruction will the nurse include when teaching this client?

a. "Your blood pressure should be checked by a health care provider at least once a year."
b. "Increasing fluid and fiber in your diet can help prevent the side effect of constipation."
c. "Intense exercise or prolonged standing is not a problem with clonidine as it can be with other antihypertensive agents."
d. "If you are having difficulty with the common side effect of drooling, notify your health care provider so your dosage can be adjusted."
c. To administer phentolamine (Regitine)
During assessment of a client diagnosed with pheochromocytoma, the nurse auscultates a blood pressure of 210/110 mm Hg. What is the nurse's best action?

a. To ask the client to lie down and rest
b. To assess the client?s dietary intake of sodium and fluid
c. To administer phentolamine (Regitine)
d. To administer nitroprusside (Nipride)
a. Alteration in cardiac output related to effects on the sympathetic nervous system
Which is a priority nursing diagnosis for a client taking an antihypertensive medication?

a. Alteration in cardiac output related to effects on the sympathetic nervous system
b. Knowledge deficit related to medication regimen
c. Fatigue related to side effects of medication
d. Alteration in comfort related to nonproductive cough
a. Coronary thrombosis
b. Acute myocardial infarction
c. Deep vein thrombosis (DVT)
d. Cerebrovascular accident (CVA) (stroke)
e. Venous disorders
When a newly admitted client is placed on heparin, the nurse acknowledges that heparin is effective for preventing new clot formation in clients who have which disorder(s)? (Select all that apply.)

a. Coronary thrombosis
b. Acute myocardial infarction
c. Deep vein thrombosis (DVT)
d. Cerebrovascular accident (CVA) (stroke)
e. Venous disorders
a. protamine sulfate
A client who received heparin begins to bleed, and the physician calls for the antidote. The nurse knows that which is the antidote for heparin?

a. protamine sulfate
b. vitamin K
c. aminocaproic acid
d. vitamin C
a. A longer half-life than heparin
A client is prescribed enoxaparin (Lovenox). The nurse knows that low-molecular-weight heparin (LMWH) has what kind of half-life?

a. A longer half-life than heparin
b. A shorter half-life than heparin
c. The same half-life as heparin
d. A four-times shorter half-life than heparin
c. Bleeding may increase when taken with aspirin.
The nurse is teaching a client about clopidogrel (Plavix). What is important information to include?

a. Constipation may occur.
b. Hypotension may occur.
c. Bleeding may increase when taken with aspirin.
d. Normal dose is 25 mg tablet per day.
d. Subcutaneously
A client is prescribed dalteparin (Fragmin). LMWH is administered via which route?

a. Intravenously
b. Intramuscularly
c. Intradermally
d. Subcutaneously
b. warfarin (Coumadin)
A client is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally?

a. enoxaparin sodium (Lovenox)
b. warfarin (Coumadin)
c. bivalirudin (Angiomax)
d. lepirudin (Refludan)
b. Elevated INR range
A client is taking warfarin 5 mg/day for atrial fibrillation. The client's international normalized ration (INR) is 3.8. The nurse would consider the INR to be what?

a. Within normal range
b. Elevated INR range
c. Low INR range
d. Low average INR range
d. To suppress platelet aggregation
Cilostazol (Pletal) is being prescribed for a client with coronary artery disease. The nurse knows that which is the major purpose for antiplatelet drug therapy?

a. To dissolve the blood clot
b. To decrease tissue necrosis
c. To inhibit hepatic synthesis of vitamin K
d. To suppress platelet aggregation
b. abciximab (ReoPro)
A client is to undergo a coronary angioplasty. The nurse acknowledges that which drug is used primarily for preventing reocclusion of coronary arteries following a coronary angioplasty?

a. clopidogrel (Plavix)
b. abciximab (ReoPro)
c. warfarin (Coumadin)
d. streptokinase
c. Thrombolytic agent
A client is admitted to the emergency department with an acute myocardial infarction. Which drug category does the nurse expect to be given to the client early for the prevention of tissue necrosis following blood clot blockage in a coronary or cerebral artery?

a. Anticoagulant agent
b. Antiplatelet agent
c. Thrombolytic agent
d. Low-molecular-weight heparin (LMWH)
b. Activated partial thromboplastin time (aPTT) of 120 seconds
A client is receiving an intravenous heparin drip. Which laboratory value will require immediate action by the nurse?

a. Platelet count of 150,000
b. Activated partial thromboplastin time (aPTT) of 120 seconds
c. INR of 1.0
d. Blood urea nitrogen (BUN) level of 12 mg/dL
b. Administer vitamin K.
A client who has been taking warfarin (Coumadin) is admitted with coffee-ground emesis. What is the nurse's primary action?

a. Administer vitamin E.
b. Administer vitamin K.
c. Administer protamine sulfate.
d. Administer calcium gluconate.
a. Administer an additional dose of warfarin (Coumadin).
The client has an international normalized ratio (INR) value of 1.5. What action will the nurse take?

a. Administer an additional dose of warfarin (Coumadin).
b. Hold the next dose of warfarin (Coumadin).
c. Increase the heparin drip rate.
d. Administer protamine sulfate.
c. "I will increase dark-green, leafy vegetables in my diet."
A client is receiving warfarin (Coumadin) for a chronic condition. Which client statement requires immediate action by the nurse?

a. "I will avoid contact sports."
b. "I will take my medication in the early evening each day."
c. "I will increase dark-green, leafy vegetables in my diet."
d. "I will contact my health care provider if I develop excessive bruising."
a. "I take aspirin daily for headaches."
A client is taking enoxaparin (Lovenox) daily. Which client statement requires additional monitoring?

a. "I take aspirin daily for headaches."
b. "I take ibuprofen (Motrin) at least once a week for joint pain."
c. "Whenever I have a fever, I take acetaminophen (Tylenol)."
d. "I take my medicine first thing in the morning."
b. Weigh the client before administration.
The client is receiving tirofiban (Aggrastat). What is an essential nursing intervention for this client?

a. Have protamine sulfate available in case of an overdose.
b. Weigh the client before administration.
c. Have vitamin K available in case of an overdose.
d. Assess intake and output.
c. Administer the medication into subcutaneous tissue.
A nurse is preparing to administer enoxaparin sodium (Lovenox) to a client for prevention of deep vein thrombosis. What is an essential nursing intervention?

a. Draw up the medication in a syringe with a 22-gauge, 1-½ inch needle.
b. Utilize the Z-track method to inject the medication.
c. Administer the medication into subcutaneous tissue.
d. Rub the administration site after injecting.
b. "Dalteparin is a low-molecular-weight heparin that is more predictable in its effect and has a lower risk of bleeding."
The client asks what the difference is between dalteparin (Fragmin) and heparin. What is the nurse's best response?

a. "There is no real difference. Dalteparin is preferred because it is less expensive."
b. "Dalteparin is a low-molecular-weight heparin that is more predictable in its effect and has a lower risk of bleeding."
c. "I'm not sure why some health care providers choose dalteparin and some heparin. You should ask your doctor."
d. "The only difference is that heparin dosing is based on the client's weight."
b. Administer protamine sulfate.
A client has been admitted through the emergency department and requires emergency surgery. The client has been receiving heparin. What nursing intervention is essential?

a. Teach the client about the phenytoin.
b. Administer protamine sulfate.
c. Assess the INR before surgery.
d. Administer vitamin K.
a. Assess for reperfusion dysrhythmias.
What nursing intervention is essential for the client receiving alteplase?

a. Assess for reperfusion dysrhythmias.
b. Monitor liver enzymes.
c. Administer vitamin K if bruising is observed.
d. Monitor blood pressure and stop the medication if blood pressure drops below 110 systolic.
b. Teach the client of potential drug interactions with anticoagulants.
A client who is taking warfarin (Coumadin) requests an aspirin for headache relief. What is the nurse's best response?

a. Administer 650 mg of acetylsalicylic acid (ASA) and reassess pain in 30 minutes.
b. Teach the client of potential drug interactions with anticoagulants.
c. Explain to the client that ASA is contraindicated and administer ibuprofen as ordered.
d. Explain that the headache is an expected side effect and will subside shortly.
b. "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic."
A client is started on warfarin (Coumadin) therapy while still receiving intravenous heparin. The client questions the nurse about the risk for bleeding. How should the nurse respond?

a. "Your concern is valid. I will call the doctor to discontinue the heparin."
b. "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic."
c. "Because of your valve replacement, it is especially important for you to be anticoagulated. The heparin and warfarin together are more effective than one alone."
d. "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications."
d. "I should use a soft toothbrush for dental hygiene."
The nurse evaluates that the client understood discharge teaching regarding warfarin (Coumadin) based on which statement?

a. "I will double my dose if I forget to take it the day before."
b. "I should keep taking ibuprofen for my arthritis."
c. "I should decrease the dose if I start bruising easily."
d. "I should use a soft toothbrush for dental hygiene."
a. Perform all necessary venipunctures.
What intervention is essential before the nurse administers tenecteplase (TNKase)?

a. Perform all necessary venipunctures.
b. Administer aminocaproic acid (Amicar).
c. Have the client void.
d. Assess for allergies to iodine.
c. Risk for injury
Which nursing diagnosis would be possible for a client receiving intravenous heparin therapy?

a. Potential for fluid volume excess
b. Potential for pain
c. Risk for injury
d. Potential for body image disturbance
c. Hyperlipidemia
A client has a serum cholesterol level of 265 mg/dL, triglyceride level of 235 mg/dL, and LDL of 180 mg/dL. What do these serum levels indicate?

a. Hypolipidemia
b. Normolipidemia
c. Hyperlipidemia
d. Alipidemia
a. 150 to 200 mg/dL
The nurse knows that the client's cholesterol level should be within which range?

a. 150 to 200 mg/dL
b. 200 to 225 mg/dL
c. 225 to 250 mg/dL
d. Greater than 250 mg/dL
b. It is the desired level of HDL.
A client's high-density lipoprotein (HDL) is 60 mg/dL. What does the nurse acknowledge concerning this level?

a. It is lower than the desired level of HDL.
b. It is the desired level of HDL.
c. It is higher than the desired level of HDL.
d. It is a much lower HDL level than desired.
b. homocysteine
The nurse realizes that which is the laboratory test ordered to determine the presence of the amino acid that can contribute to cardiovascular disease and stroke?

a. antidiuretic hormone
b. homocysteine
c. ceruloplasmin
d. cryoglobulin
d. Liver enzymes
A client is taking lovastatin (Mevacor). Which serum level is most important for the nurse to monitor?

a. Blood urea nitrogen
b. Complete blood count
c. Cardiac enzymes
d. Liver enzymes
b. Rhabdomyolysis
The client is taking rosuvastatin (Crestor). What severe skeletal muscle adverse reaction should the nurse observe for?

a. Myasthenia gravis
b. Rhabdomyolysis
c. Dyskinesia
d. Agranulocytosis
a. Inhibits absorption of dietary cholesterol in the intestines.
When a client is taking ezetimibe (Zetia), she asks the nurse how it works. The nurse should explain that Zetia does what?

a. Inhibits absorption of dietary cholesterol in the intestines.
b. Binds with bile acids in the intestines to reduce LDL levels.
c. Inhibits HMG-CoA reductase, which is necessary for cholesterol production in the liver.
d. Forms insoluble complexes and reduces circulating cholesterol in blood.
a. Relaxes the arterial walls within the skeletal muscles
b. May cause hypotension, chest pain, and palpitations
A client is diagnosed with peripheral arterial disease (PAD). He is prescribed isoxsuprine (Vasodilan). The nurse acknowledges that isoxsuprine does what? (Select all that apply.)

a. Relaxes the arterial walls within the skeletal muscles
b. May cause hypotension, chest pain, and palpitations
c. Increases the rigidity of arteriosclerotic blood vessels
d. May increase intermittent claudication
e. May lead to hypertension and bradycardia
f. Commonly causes an adverse effect of rhabdomyolysis
b. "I will increase fiber in my diet."
Which statement indicates the client understands discharge instructions regarding cholestyramine (Questran)?

a. "I will take Questran 1 hour before my other medications."
b. "I will increase fiber in my diet."
c. "I will weigh myself weekly."
d. "I will have my blood pressure checked weekly."
b. Administer aspirin 30 minutes before nicotinic acid.
The nurse plans which intervention to decrease the flushing reaction of niacin?

a. Administer niacin with an antacid.
b. Administer aspirin 30 minutes before nicotinic acid.
c. Administer diphenhydramine hydrochloride (Benadryl) with niacin.
d. Apply cold compresses to the head and neck.
b. "Take this medication at the same time each day."
The nurse is reviewing instructions for a client taking an HMG-CoA reductase inhibitor (statin). What information is essential for the nurse to include?

a. "Take this medication on an empty stomach."
b. "Take this medication at the same time each day."
c. "Take this medication with breakfast."
d. "Take this medication with an antacid."
b. "You may experience headaches with this medication."
A client is prescribed gemfibrozil (Lopid) for treatment of hyperlipidemia type IV. What is important for the nurse to teach the client?

a. "Take aspirin before the medication if you experience facial flushing."
b. "You may experience headaches with this medication."
c. "You will need to have weekly blood drawn to assess for hyperkalemia."
d. "Cholesterol levels will need to be assessed daily for one week."
d. "I will continue my exercise program to help increase my high-density lipoprotein serum levels."
Which statement made by the client indicates understanding about discharge instructions on antihyperlipidemic medications?

a. "Antihyperlipidemic medications will replace the other interventions I have been doing to try to decrease my cholesterol."
b. "It is important to double my dose if I miss one in order to maintain therapeutic blood levels."
c. "I will stop taking the medication if it causes nausea and vomiting."
d. "I will continue my exercise program to help increase my high-density lipoprotein serum levels."
c. Muscle pain.
A client is prescribed ezetimibe (Zetia). Which assessment finding will require immediate action by the nurse?

a. Headache.
b. Slight nausea.
c. Muscle pain.
d. Fatigue.
c. Have the client increase fluids and fiber in his diet.
A nurse is caring for a client taking cholestyramine (Questran). The client is complaining of constipation. What will the nurse do?

a. Call the health care provider to change the medication.
b. Tell the client to skip a dose of the medication.
c. Have the client increase fluids and fiber in his diet.
d. Administer an enema to the client.
d. "I should stir the powder in as small an amount of fluid as possible to maintain potency of the medication."
Which statement indicates to the nurse that the client needs further medication instruction about colestipol (Colestid)?

a. "The medication may cause constipation, so I will increase fluid and fiber in my diet."
b. "I should take this medication 1 hour after or 4 hours before my other medications."
c. "I might need to take fat-soluble vitamins to supplement my diet."
d. "I should stir the powder in as small an amount of fluid as possible to maintain potency of the medication."
b. Elevated liver function tests
Which assessment finding in a client taking an HMG-CoA reductase inhibitor will the nurse act on immediately?

a. Decreased hemoglobin
b. Elevated liver function tests
c. Elevated HDL
d. Elevated LDL
b. "These factors may put you at higher risk for myopathy."
A 70-year-old client who is taking several cardiac antidysrhythmic medications has been prescribed simvastatin (Zocor) 80 mg/day. What is essential information for the nurse to teach the client?

a. "This dose may lower your cholesterol too much."
b. "These factors may put you at higher risk for myopathy."
c. "You should not take this drug with cardiac medications."
d. "This combination will cause you to have nausea and vomiting."
b. Hepatic disease
A client diagnosed with hypercholesterolemia is prescribed lovastatin (Mevacor). The nurse is reviewing the client's history and would contact the health care provider about which of these conditions in the client's history?

a. Chronic pulmonary disease
b. Hepatic disease
c. Leukemia
d. Renal disease
c. gemfibrozil (Lopid)
A nurse is caring for a client with elevated triglyceride levels who is unresponsive to HMG-CoA reductase inhibitors. What medication will the nurse administer?

a. cholestyramine (Questran)
b. colestipol (Colestid)
c. gemfibrozil (Lopid)
d. simvastatin (Zocor)
a. Impaction
The nurse would question an order for cholestyramine (Questran) if the client has which condition?

a. Impaction
b. Glaucoma
c. Hepatic disease
d. Renal disease
c. Client is on oral contraceptives.
The nurse reviews the history for a client taking atorvastatin (Lipitor). What will the nurse act on immediately?

a. Client takes medications with grape juice.
b. Client takes herbal therapy including kava kava.
c. Client is on oral contraceptives.
d. Client was started on penicillin for a respiratory infection.