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Pharm Test 2
Terms in this set (113)
The patient is receiving digoxin for treatment of heart failure. Which finding would suggest to the nurse that the heart failure is improving?
a. pale and cool extremities
b. absence of peripheral edema
c. urine output of 60 mL every 4 hours
d. complaints of increasing dyspnea
The patient'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 range
b. it is in the low range
c. normal range
d. low-average range
The nurse is assessing a patient for possible evidence of digitalis toxicity. Which of these is included in the signs and symptoms for digitalis toxicity?
a. apical pulse of 100 bpm
b. apical pulse of 72 bpm
c. apical pulse of 90 bpm
d. apical pulse of 48 bpm
A patient is taking a potassium-depleting diuretic and digoxin. The nurse expects that a low potassium level (hypokalemia) could have what affect on digoxin?
a. increase serum digoxin sensitivity level
b. decrease serum digoxin sensitivity level
c. no effect
d. cause a low-average serum digoxin level
A patient takes an initial dose of a nitrate. Which symptom(s) will the nurse expect to occur?
a. nausea and vomiting
c. stomach cramps
d. irregular pulse rates
A patient is prescribed a beta-blocker. 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
The health care provider is planning to discontinue a patient's beta blocker. Which instruction will the nurse give the patient regarding the beta blocker?
a. Should be stopped abruptly
b. should not be stopped abruptly; the dose should be tapered down.
c. the beta blocker dose should be maintained while taking another antianginal drug
d. half the dose should be taken for the next several weeks
The beta blocker acebutolol is prescribed for dysrhythmias. What is the primary purpose of the drug?
a. increase beta1 and beta2 receptors in cardiac tissues
b. increase the flow of oxygen to cardiac tissues
c. block beta1-adrenergic receptors in cardiac tissues
d. block beta2-adrenergic receptors in cardiac tissues.
A patient who has angina is prescribed nitroglycerin. Which are the appropriate nursing interventions for nitroglycerin? (select all that apply).
a. have the patient sit or lie down when taking the medication
b. teach pt who has taken a tablet to call 911 in 5 mins if chest pain persists.
c. apply the nitroglycerin patch to a hairy area to protect skin from burning
d. call health care provider after taking 5 tablets if chest pain persists.
e. warn the patient against ingesting alcohol while taking this med
a, b, e
Along with removing excess fluid volume, Thiazide diuretics have a direct effect on blood pressure by causing dilation in the arterioles.
True or False
A nurse is reviewing a newly admitted client's medication administration record and notes that the client takes a loop diuretic as well as a thiazide diuretic. The nurse understands that the reason for using these two together are:
a. reduced risk of potassium imbalances
b. increased diuretic effect
c. increased adherence to treatment
d. decreased blood pressure without a risk of bradycardia
A client is receiving furosemide and a potassium supplement. When monitoring daily lab results, what would the normal range be for potassium.
a. 5.0-7.5 mEq/L
b. 1.5 to 3.0 mEq/L
c. 3.5 to 5.0 mEq/L
d. 6.0 to 6.5 mEq/L
A client is admitted to the emergency department and is unconscious as a result of a head injury. The client's intracranial pressure is increased, which classification of diuretic will the nurse most likely administer to the patient?
a. Thiazide diuretic
b. Osmotic diuretic
A client is taking spironolactone. When providing client teaching about this medication, what foods should the client be instructed to avoid?
A patient is admitted to the hospital with a diagnosis of heart failure. The client is ordered to receive 40 mg IV. How soon after the administration should the nurse expect to see effects?
a. 30 mins
b. 5 mins
c. 2 hours
d. 1 min
A client has edema of the lower extremities and abdomen. What is the reason for administering a stronger diuretic than a thiazide to this patient?
a. a thiazide diuretic will be ineffective for immediate diuresis.
b. a thiazide diuretic will provide peak effects in 2 hours.
c. a thiazide will be excreted in more than 72 hours.
d. will reabsorb potassium in the distal tube.
A nurse is preparing to administer digoxin to a client who has HF. The client report nausea, vomiting, and a headache. The nurse notes a respiratory rate of 18 bpm, HR of 58 bpm, and BP of 120/78 mm Hg. What will the nurse next do?
a. reassure pt that these are common, self-limiting side effects.
b. hold the dose and notify provider of possible digoxin toxicity
c. request an order for an antiemetic and analgesic medication
d. administer the next dose as ordered since these are mild side effects
A client with COPD has increasing dyspnea and is being evaluated for HF. Which test will be ordered to help determine whether the dyspnea is due to lung dysfunction or HF?
A. cardiac enzymes
b. brain natriuretic peptide (BNP)
c. electrocardiogram (ECG)
d. Atrial natriuretic hormone level (ANH)
A client is diagnosed with heart failure, and the prescriber has ordered digoxin. The client asks what lifestyle changes will help in the management of this condition, the nurse will recommend which changes?
a. increase fluid intake to flush out kidneys
b. consume 2 teaspoons or less of salt every day
c. changing from cigarette to pipe smoking
d. having no more than one alcoholic beverage per day
A patient is to be discharged with a transdermal nitroglycerin patch. Which instruction should the nurse include in the patient's teaching plan?
a. "If you have a headache, remove the patch for 4 hours and then reapply."
b. "If you have chest pain, apply a second patch next to the first patch."
c. "Apply the patch to the same site each day."
d. "Apply the patch to a non-hairy area of the upper torso or arm."
A nurse is monitoring a patient with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective?
a. Blood pressure of 120/80 mm Hg
b. ECG without evidence of ST changes
c. Heart rate of 70 beats/min
d. Patient stating that pain is 0 out of 10
The nurse is monitoring a patient during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action?
b. Chest pain
d. Blood pressure 110/90 mm Hg
Which statement made by the patient demonstrates a need for additional instruction from the nurse 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 can take up to five tablets at 3-minute intervals for chest pain if necessary."
d."I should change positions slowly to avoid getting dizzy."
Which patient assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker?
a. Patient denies dizziness.
b. Absence of chest pain
c. Patient states that she feels stronger.
d. Decreased swelling in the ankles and feet
Before the nurse administers isosorbide dinitrate, what is a priority nursing assessment?
a. Monitor level of consciousness.
b. Check blood urea nitrogen and creatinine levels.
c. Check serum electrolytes results.
d. Assess blood pressure.
Isosorbide dinitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.
The patient asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response?
a. "It's best to lock them in the glove compartment to keep them away from heat and light."
b. "You can put a few tablets in a resealable bag and carry in your pocket."
c. "It's best to keep it in its original container away from heat and light."
d. "You can protect it from heat by placing the bottle in an ice chest."
Which statement indicates to the nurse that the patient understands sublingual nitroglycerin medication instructions?
a. "I can chew the tablet for the quickest effect."
b. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."
c. "I will keep the tablets locked in a safe place until I need them."
d. "I will take up to five doses every 3 min for chest pain."
What instruction should the nurse provide to the patient 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 non-hairy part of the upper torso.
c. Massage the ointment into the skin.
d. Cover the application paper with ointment before use.
A patient 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. Continue the infusion and recheck the patient's vital signs in 15 min.
b. Assess the patient s lung sounds.
c. Decrease the intravenous nitroglycerin by 10 mcg/min.
d. Stop the nitroglycerin infusion for 1 h and then restart.
A patient's serum digoxin level is noted to be 0.4 ng/mL. What is the nurse's priority action?
a. Call the health care provider.
b. Hold future digoxin doses.
c. Administer ordered dose of digoxin.
d. Administer potassium.
normal range is 0.5-2.0 ng/mL
A patient is taking digoxin 0.25 mg and furosemide (Lasix) 40 mg. The patient tells the nurse, there are yellow halos around the lights. Which priority action will the nurse take?
a. Withhold the furosemide.
b. Administer potassium.
c. Evaluate digoxin levels.
d. Document the findings and reassess in 1 hour.
Which assessment finding will alert the nurse to suspect early digitalis toxicity?
a. Heart rate of 110 beats/min
b. Blood pressure of 90/60 mm Hg
c. Confusion and diarrhea
d. Loss of appetite with slight bradycardia
A patient is being treated for short-term management of heart failure with milrinone. What is the primary nursing action?
a. Administer furosemide (Lasix) via IV infusion after the milrinone.
b. Maintain an infusion of lactated Ringer with milrinone infusion.
c. Monitor cardiac rhythm and blood pressure continuously.
d. Administer digoxin via IV infusion with the milrinone.
A nurse is caring for a patient who has been started on ibutilide. Which assessment is a priority for this patient?
a. Lung sounds
b. BUN and creatinine
c. ECG and palpitations
d. Blood pressure measurement
When titrating intravenous nitroglycerin for a patient, what is most important for the nurse to monitor? (Select all that apply.)
b. Continuous blood pressure
c. Presence of chest pain
d. Continuous oxygen saturation
e. Serum nitroglycerin levels
f. Hourly electrocardiograms
A patient is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. The nurse plans to monitor the patient for which potential electrolyte imbalance?
The nurse knows that which statement is correct regarding nursing care of a patient receiving hydrochlorothiazide? (Select all that apply)
a. monitor patients for signs of hypoglycemia
b. administer ordered potassium supp
c. monitor serum potassium and uric acid levels
d. assess bp before admin
e. notify health care provider if a pt has had oliguria for 24 hrs
f. assess decreased cholesterol and triglyceride levels
b, c, d, e
A patient has heart failure, and a high dose of furosemide is ordered. What suggests a favorable response to furosemide?
a. a decrease in level of consciousness occurs, and the patient sleeps more
b. Respiratory rate decreases from 28/min to 20/min and the depth increases
c. Breath sounds reveal increased congestion and the patient complains of SOB
d. Urine output is 50mL/4hours and intake is 200 mL
What does the nurse know to be correct concerning the use of mannitol in patients?
a. decreases intracranial pressure
b. increases intracranial pressure
c. causes sodium and potassium retention
d. causes diuresis in several days
What should the nurse do when a patient is taking furosemide?
a. instruct patient to change positions quickly when getting out of bed.
b. assess blood pressure before administering
c. administer the drug at bedtime for maximum effectiveness
d. teach patient to avoid fruits to prevent hyperkalemia
For the patient 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 serum potassium level
b. To increase serum potassium level
c. To decrease glucose level
d. To increase glucose level
The patient has been receiving spironolactone 50 mg/day for heart failure. The nurse should closely monitor the pt for what condition?
Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide?
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
What is the best information for the nurse to provide to the patient who is receiving spironolactone and furosemide (Lasix) therapy?
a. This combination promotes diuresis but decreases the risk of hypokalemia.
b. Moderate doses of two different diuretics are more effective than a large dose of one.
c. Using two drugs increases the osmolality of plasma and the glomerular filtration rate.
d. This combination prevents dehydration and hypovolemia.
A patient taking spironolactone has been taught about the medication. Which menu selection indicates that the patient understands teaching related to this medication?
d. Lima beans
Which patient would the nurse need to assess first if the patient is receiving mannitol?
a. A 67-year-old patient with type 1 diabetes mellitus
b. A 21-year-old patient with a head injury
c. A 47-year-old patient with anuria
d. A 55-year-old patient receiving cisplatin to treat ovarian cancer
A nurse is caring for a patient receiving acetazolamide. Which assessment finding will require immediate nursing intervention?
a. A decrease in bicarbonate level
b. A decrease in arterial pH
c. An increase in PaO2
d. An increase in urinary output
A patient is prescribed chlorthalidone. What is the most important information the nurse will teach the patient?
a. "Take this medication before bed each night."
b. "Do not drink more than 10 ounces of fluid a day while on this medication."
c. "Wear protective clothing and sunscreen while taking this medication."
d. "Take this medication on an empty stomach."
A patient with acute pulmonary edema is receiving furosemide. What assessment finding indicates to the nurse that the intervention is working?
a, Improvement in mental status
b. Output 30 mL/h
c. Potassium level decreased from 4.5-3.5 mEq/L
d. Lungs clear to auscultation
Which assessment indicates to the nurse a therapeutic effect of mannitol has been achieved?
a. Decreased intracranial pressure
b. Increased urine osmolality
c. Decreased potassium
d. Decreased serum osmolality
What intervention should the nurse perform when monitoring a patient receiving triamterene?
a. Assess urinary output every other day.
b. Assess potassium levels.
c. Monitor for side effect of hypoglycemia.
d. Monitor for hypernatremia.
The nurse notes that the patient is receiving hydrochlorothiazide for hypertension. Which additional medication in the patient's drug regimen would cause concern on the part of the nurse?
A patient is ordered furosemide to be given via intravenous push. Which interventions should the nurse perform? (Select all that apply.)
Select all that apply.
a. Administer at a rate no faster than 20 mg/min.
b. Insert an arterial line for continuous blood pressure monitoring.
c. Assess lung sounds before and after administration.
d. Assess blood pressure before and after administration.
e. Maintain accurate intake and output record.
f. Monitor the electrocardiogram continuously.
a, c, d, e
Normal electrolyte levels; Potassium
Normal electrolyte levels; Magnesium
Normal electrolyte levels; Calcium
Normal electrolyte levels; Chloride
Normal electrolyte levels; Bicarbonate
Normal electrolyte levels; Uric Acid
Normal electrolyte levels; Blood glucose
What statement indicates to the nurse that the patient needs additional instruction about antihypertensive treatment?
a. "I will change my position slowly to prevent feeling dizzy."
b. "I will check my blood pressure daily and take my medication when it is over 140/90."
c. "I will include rest periods during the day to help me tolerate the fatigue my medicine may cause."
d. "I will not mow my lawn until I see how this medication makes me feel."
A nurse is caring for a patient 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. Tell the patient that the cough will subside in a few days.
c. Assess the patient for other symptoms of upper respiratory infection.
d. Instruct the patient to take antitussive medication until the symptoms subside.
The nurse is reviewing a medication history on a patient taking an ACE inhibitor. The nurse plans to contact the health care provider if the patient is also taking which medication?
a. Docusate sodium
b. Morphine sulfate
A patient is prescribed a noncardioselective beta1 blocker. What nursing intervention is a priority for this patient?
a. Orthostatic blood pressure assessment
b. Auscultation of the lungs
c. Teaching about potential tachycardia
d. Assessment of blood glucose levels
The nurse is caring for several patients who are all being treated for hypertension. Which patient will the nurse assess first?
a. The patient who has been on beta blockers for 1 day
b. The patient who has stopped taking a beta blocker due to cost
c. The patient who is on a beta blocker and a thiazide diuretic
d. The patient who is taking a beta blocker and Lasix (furosemide)
The nurse is caring for a patient with hypertension who is prescribed a clonidine transdermal patch. What is the correct information to teach this patient?
a. Do not take other antihypertensive medications while on this patch.
b. Change the patch daily at the same time.
c. Remove the patch before taking a shower or bath.
d. Get up slowly from a sitting to a standing position.
The patient taking methyldopa has elevated liver function tests. What is the nurse's best action?
a. Change the patient's diet.
b. Immediately stop the medication.
c. Notify the health care provider.
d. Document the finding and continue care.
A patient taking prazosin has a blood pressure of 140/90 mm Hg and is complaining of swollen feet. What is the nurse's best action?
a. Weigh the patient.
b. Call the health care provider to change to an alternative medication.
c. Determine the patient's drug history with this medication.
d. Hold the medication.
A calcium channel blocker has been ordered for a patient. Which condition in the patient's history is a contraindication to this medication?
c. Increased intracranial pressure
During assessment of a patient diagnosed with pheochromocytoma, the nurse auscultates a blood pressure of 210/110 mm Hg. What is the nurse's best action?
a. Assess the patient's dietary intake of sodium and fluid.
b. Ask the patient to lie down and rest.
c. Administer phentolamine.
d. Administer nitroprusside.
What is a priority nursing diagnosis for a patient 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
The patient is caring for the patient receiving nitroprusside. Which interventions should be included in the nurse's plan of care? (Select all that apply.)
a. Monitor potassium levels.
b. Monitor for thiocyanate levels.
c. Provide continuous blood pressure monitoring.
d. Assess chest pain level.
e. Protect fluid bag from light.
b, c, e
What are osmotic diuretics primarily used for?
a. Peripheral Edema
b. Pulmonary edema
c. Heart Failure
d. Intraocular Pressure
Which of the following BP meds would cause the nurse to watch for angioedema?
Loop diuretics are also potassium sparing.
All diuretics can be used for patients with gout.
All of the following are things to watch with Metoprolol except:
Patients report which of the following side effects of ACE inhibitors is the most annoying?
A patient taking HCTZ and digoxin should be monitored for which electrolyte imbalance?
What should the nurse do when a patient is taking furosemide (Lasix)?
Instruct patient to change positions quickly
Assess blood pressure before administration
Administer at bedtime for maximum effectiveness
Teach to avoid fruits to prevent hyperkalemia
A patient taking a potassium-sparing diuretic (spironolactone) should be monitored for?
If a patient is showing signs of an overdose of Amlodipine what electrolyte will help fix it?
All of the above
Which is a contraindication for diuretics?
All of the following are signs and symptoms of Right Sided Heart Failure except:
crackles in lungs
jugular vein distention
Which of the following is a common side effect of nitroglycerine?
Decreased coronary perfusion
You would expect to see signs of Digatalis toxicity in patients with a serum dig level of what?
0.5- 1 ng/ml
higher than 1.5 ng/ml
higher than 2 ng/ml
Which of the following diuretics should be given slowly IV due to ototoxcicity?
Based on the symptoms below, which is a favorable response to furosemide?
Urine output of 50 mL/4 hr, intake of 200 mL
Increased congestion heard in breath sounds
Decrease in LOC and sleeping more
Respirations decrease from 28 to 20 a minute
Angiotensin II Receptor Blockers end in -sartan
A patient is receiving an angiotensin II receptor blocker. Which does the nurse recognize as an angiotensin II receptor blocker?
A patient is receiving an angiotensin II receptor blocker. It is most important for the nurse to assess the patient for
An African-American patient is to be treated with initial monotherapy to control hypertension. The nurse expects the patient to receive
B. angiotensin-converting enzyme inhibitors.
C. alpha-adrenergic blockers.
D. beta blockers.
a or c
The nurse should instruct a patient to not suddenly stop taking antihypertensives in order to avoid
A patient with hypertension is ordered to receive an angiotensin-converting enzyme inhibitor. The nurse identifies a common benign side effect of this class of medications as
d. a dry cough
Before administering the alpha-adrenergic blocker prazosin, it is most important for the nurse to assess the patient for a history of
B.refractory heart failure.
d. benign prostatic hypertrophy
When administering antihypertensive medications to Asian Americans, it is most important for the nurse to
A.increase the dose of beta blockers.
B.monitor blood pressure carefully.
C.expect to administer the usual dose of antihypertensive medications.
D.understand that this cultural group does not believe in treating hypertension.
A patient's blood pressure is 130/84. The health care provider plans to suggest nonpharmacologic methods to lower BP. Which should the nurse include in teaching? (select all that apply)
diet with increased protein
a, b, c, d
A patient has developed mild HTN. The nurse acknowledges that the first-line drug for treating this patient's blood pressure would be?
angiotensin-converting enzyme inhibitor
An African American patient has developed HTN. The nurse is aware that which group(s) of antihypertensive drugs are less effective in African Americans?
calcium channel blockers and vasodilators
beta blockers and angiotensin-converting enzyme inhibitors
The nurse knows that which diuretic is most frequently combined with an antihypertensive drug?
A potassium sparing diuretic
The nurse is administering a beta blocker to a patient. Which is the most important assessment to perform before administration?
serum level of medication
Catopril has been ordered for a patient. The nurse should teach the patient that the most commonly occurring side effect of an angiotensin-converting enzyme (ACE) drug is which of the following?
Dizziness and headaches
constant, irritating cough
A patient is prescribed losartan. The nurse teaches the patient that an angiotensin II-receptor acts by doing what?
inhibiting angiotensin-converting enzyme
blocking angiotensin II from angiotensin I receptors
preventing release of angiotensin I
Promoting release of aldosterone
During an admission assessment, a patient states that she takes amlodipine. The nurse should inquire about which signs and symptoms to determine whether the patient has any common side effect of a calcium channel blocker?
a, b, c, d, e
A patient can take ACE and ARBS medication while pregnant.
Digoxin is a BP medicine.
Antihypertensive drugs that are effective for African-Americans?
Beta blockers and ACE inhibitors
Alpha1 blockers and CCB
Spironolactone causes what major side effect??
Licorice and aloe can lead to hypokalemia
CCB end in "_____"
ARBs (angiotensin II receptor blockers)
- example: losartan
ACE (angiotensin converting enzyme)
Beta blockers end in
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