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Exam 2 practice questions

Terms in this set (112)

A patient who has been taking an antihypertensive medication for several years is recovering from a myocardial infarction. The prescriber changes the patient's medication to an ACE inhibitor. The patient asks the nurse why a new drug is necessary. What is the nurse's response?

A. "ACE inhibitors help lower LDL cholesterol and raise HDL cholesterol"
B. "ACE inhibitors regulate electrolytes that affect the cardiac rhythm."
C. "ACE inhibitors can prevent or reverse pathologic changes in the heart's structure."
D. "ACE inhibitors increase venous return to the heart, improving cardiac output."
C. "ACE inhibitors can prevent or reverse pathologic changes in the heart's structure."
A patient begins taking an ACE inhibitor and complains of a dry cough. What does the nurse correctly tell the patient about this symptom?

A. It indicates that a serious side effect has occurred
B. It is a common side effect that occurs in almost all patients taking the drug
C. It occurs frequently in patients taking the drug but will subside over time
D. It may be uncomfortable enough that the drug will need to be discontinued
D. It may be uncomfortable enough that the drug will need to be discontinued
A provider has ordered captopril (Capoten) for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril (Vasotec) in the past. Which action by the nurse is correct?

A. Administer the captopril and monitor for adverse effects
B. Request an order to administer fosinopril instead of captopril
C. Reassure the patient that this is not a serous side effect
D. Hold the dose and notify the provider
D. Hold the dose and notify the provider
A patient begins taking long acting nifedipine [Procardia], and metoprolol (lopressor), to treat hypertension. The nurse understands that metoprolol is used to:

A. prevent reflex tachycardia.
B. minimize gingival hyperplasia
C. prevent constipation
D. reduce flushing
A. prevent reflex tachycardia.
A nurse is preparing to assist a nursing student to administer intravenous verapamil to a patient who also receives a beta blocker. The nurse asks the nursing student to discuss the plan of care for this patient. Which statement by the student indicates a need for further teaching?

A. "I will prepare to administer intravenous norepinephrine if necessary."
B. "I will check to see when the last dose of the beta blocker was given."
C. "I will monitor vital signs closely to assess for hypotension."
D. "I will monitor the heart rate frequently to assess for reflex tachycardia."
D. "I will monitor the heart rate frequently to assess for reflex tachycardia."
Which are therapeutic uses for verapamil? (select all that apply)

A. cardiac dysrhythmias
B. angina of effort
C. sick sinus syndrome
D. suppression of preterm labor
E. essential hypertension
A. cardiac dysrhythmias
B. angina of effort
E. essential hypertension
A nurse is administering a vasodilator that dilates resistance vessels. The nurse understands that this drug will have which effect on the patient?

A. increased cardiac output
B. increased ventricular contraction
C. decreased cardiac output
D. decreased cardiac preload
A. increased cardiac output
A patient is taking a vasodilator that relaxes smooth muscles in veins. To help minimize drug side effects, the nurse caring for this patient will:

A. encourage the patient to increase fluid intake
B. Caution the patient not to get up abruptly
C. warn the patient about the possibility of bradycardia
D. tell the patient to report shortness of breath
B. caution the patient not to get up abruptly
The nurse is caring for a patient who is taking a vasodilator that dilates capacitance vessels. The nurse will expect which effect in this patient?

A. increase in cardiac output
B. increase in venous return
C. increase in tissue perfusion
D. decrease in cardiac work
D. decrease in cardiac work
A patient with asthma will be using a metered-dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered 2 puffs to be given twice daily. It is important for the nurse to teach this patient that:

A. The patient should wait 1 minute between doses
B. The patient should store the MDI in the refrigerator between doses
C. the patient should activate the device then exhale
D. the patient should inhale suddenly to receive the maximum dose
A. the patient should wait 1 minute between doses
A patient with stable asthma receives prescriptions for an inhaled glucocorticoid and a short-acting inhaled beta 2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen?

A. "The glucocorticoid is used as prophylaxis to prevent asthma attacks."
B. "The beta 2-adrenergic agonist suppresses the synthesis of inflammatory mediators."
C. "I will need to use the beta 2 adrenergic agonist daily."
D. "I should use the glucocorticoid as needed when symptoms flare."
A. "The glucocorticoid is used as prophylaxis to prevent asthma attacks."
A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do?

A. Ask whether the patient is rinsing the mouth after each dose.
B. Tell the patient to discontinue the glucocorticoid
C. Request an order for an antifungal medication
D. suggest the patient be tested for a bronchial infection
A. Ask whether the patient is rinsing the mouth after each dose.
A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA], 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug?

A. Intravenous glucocorticoids, nebulizer albuterol and ipratropium, and oxygen
B. Four puffs of albuterol, oxygen, and intravenous theophylline
C. Intramuscular glucocorticoids salmeterol by metered-dose inhaler
D. Intravenous theophylline, oxygen, and fluticasone (Flovent HFA) 220 mcg
A. Intravenous glucocorticoids, nebulizer albuterol and ipratropium, and oxygen
A parent asks nurse about growth suppression resulting from the use of an inhaled glucocorticoid in children. What will the nurse tell the parent?

A. Growth may be slowed, but eventual adult height will not be reduced.
B. The growth rate is not impaired, but overall height will be reduced.
C. The growth rate slows while the drug is used and only resumes when the drug is stopped.
D. Long-term use of the drug results in a decrease in adult height
A. Growth may be slowed, but eventual adult height will not be reduced.
A young adult woman will begin using an inhaled glucocorticoid to treat asthma. The nurse will teach this patient about the importance of which action?

A. Participating in weight-bearing exercises on a regular basis.
B. Taking oral glucocorticoids during times of acute stress.
C. Using two reliable forms of birth control to prevent pregnancy.
D. Lowering her calcium intake and increasing her vitamin D intake.
A. Participating in weight-bearing exercises on a regular basis.
A patient with persistent, frequent asthma exacerbations asks a nurse about a long-acting beta 2-agonist medication. What will the nurse tell this patient?

A. LABAs should be combined with an inhaled glucocorticoid.
B. LABAs are safer than short-acting beta 2 agonist
C. LABAs can be used on an as-needed basis to treat symptoms
D. LABAs reduce the risk of asthma-related deaths
A. LABAs should be combined with an inhaled glucocorticoid.
A patient has just received a prescription for fluticasone/salmeterol [Advair Diskus]. What will the nurse include as part of the teaching for this patient about the use of this device?

A. "You will begin to inhale before activating the device."
B. "You do not need good hand-lung coordination to use this device."
C. "You will need to use a spacer to help control the medication."
D. You will take 2 inhalations twice daily.
A. "You will begin to inhale before activating the device."
What are the results of using glucocorticoid drugs to treat asthma?

A. Reduced bronchial hyperreactivity
B. Increased synthesis of inflammatory mediators
C. Increased responsiveness to beta 2-adrenergic agonists
D. Reduces the number of beta 2-adrenergic receptors.
A. Reduced bronchial hyperreactivity
A patient is receiving an intravenous infusion of heparin to treat a pulmonary embolism. What laboratory value will the nurse monitor to evaluate treatment with this medication?

A. Activated partial thromboplastin time (aPTT)
B. Prothrombin time (PT)
C. Platelet count
D. Hemoglobin and hematocrit
A. Activated partial thromboplastin time (aPTT)
Which patient does the nurse identify as most likely needing an increased dose of warfarin (Coumadin) to have the same anticoagulant effect?

A. patient taking acetaminophen (Tylenol) for back pain
B. Patient taking cimetidine (Tagamet) to prevent gastric ulcers
C. Patient taking oral contraceptives to prevent pregnancy
D. Patient taking prednisone (Deltasone) for rheumatoid arthritis
C. Patient taking oral contraceptives to prevent pregnancy
What is the antidote for heparin?

A. Ferrous sulfate
B. Atropine sulfate
C. Protamine sulfate
D. Magnesium sulfate
C. Protamine sulfate
During administration of alteplase (Activase), the patient's IV site starts to ooze blood around the catheter. Which action by the nurse is most appropriate?

A. discontinue the infusion of alteplase
B. Asses the patients vital signs
C. apply direct pressure over the puncture site
D. administer aminocaproic acid (Amicar)
C. apply direct pressure over the puncture site
Two hours after arriving on the med-surg unit, the client develops dyspnea. SaO2 is 91%, and the client is exhibiting audible wheezing and use of accessory muscles. Which of the following medications should the nurse expect to administer?

A. Antibiotic
B. Beta-blocker
C. Antiviral
D. Beta2 agonist
D. Beta2 agonist
A nurse is completing discharge teaching with a client who has a new prescription for prednisone for asthma. Which of the following statements indicates a need for further teaching?

A. "I will drink plenty of fluids while on this med"
B. "I will tell the doctor if I have black, tarry stools"
C. "I will take my medication on an empty stomach"
D. "I will monitor my mouth for cold sores"
C. "I will take my medication on an empty stomach"
Which of the following parameters indicate deterioration in the clients respiratory status? (select all that apply)

A. SaO2 95%
B. Wheezing
C. Retraction of sternal muscles
D. Warm and pink extremities and mucous membranes
E. Premature ventricular complexes (PVCs)
F. Respiratory rate of 34/min
G. Lethargy
C. Retraction of sternal muscles
E. Premature ventricular complexes (PVCs)
F. Respiratory rate of 34/min
G. Lethargy
When discharging a client home who is on oxygen, which of the following is most important for the nurse to teach?

A. Smoking cessation
B. equipment maintenance
C. incorporating rest into ADLs
D. Anger management
A. smoking cessation
A patient diagnoses with heart failure has a history of diabetes and asthma. Which medication, if ordered by the health care provider, should the nurse question?

A. Angiotensin-converting enzyme inhibitor
B. Calcium channel blocker
C. Thiazide diuretic
D. Beta blocker
D. Beta blocker
Which hemodynamic system serves as a reservoir for circulating blood?

A. Heart
B. Lungs
C. Arteries
D. Veins
D. Veins
Complete the equation: Cardiac Output = Volume of blood ejected at each heartbeat x ___________

A. Stroke volume
B. Preload
C. after load
D. Heart rate
D. Heart rate
Which physiologic mechanism helps to ensure venous return despite low pressure in the venules?

A. positive pressure in the right atrium
B. negative pressure in the right atrium
C. vasodilation in the periphery
D. Cardiac muscle relaxation
B. negative pressure in the right atrium
Which condition do the natriuretic peptides serve to protect the cardiovascular system?

A. hypovolemia
B. volume overload
C. myocardial infarction
D. hypotension
B. volume overload
Which statements accurately reflect Starling's law as applied to a healthy heart? (select all that apply)

A. When venous return increases, stroke volume decreases
B. the right and left ventricles pump the same amount of blood
C. cardiac output is equal to the volume of blood delivered by the veins
D. when venous return increases, cardiac output increases
E. as cardiac muscle fibers increase in length, their contractile force decreases
B. the right and left ventricles pump the same amount of blood
C. cardiac output is equal to the volume of blood delivered by the veins
D. when venous return increases, cardiac output increases
What are the primary regulatory systems of arterial pressure?

A. Autonomic nervous system
B. Renin-angiotensis-aldosterone system
C. Renal system
D. Pulmonary system
E. P450 enzyme system
A. Autonomic nervous system
B. Renin-angiotensis-aldosterone system
C. Renal system
The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising the blood pressure?

A. Angiotensin I
B. Angiotensin II
C. Angiotensin III
D. Renin
B. Angiotensin II
The nurse is caring for a patient with renal artery stenosis who has been prescribed benazepril [Lotensin]. Which laboratory result indicates an adverse effect of this drug?

A. Potassium level of 3.2 mEq/L
B. Blood glucose level of 180 mg/dL
C. Serum creatinine level of 2.3 mg/dL
D. Uric acid level of 10 mg/dL
C. Serum creatinine level of 2.3 mg/dL
The nurse is caring for a patient with bipolar disorder treated with lithium [Eskalith]. The patient has a new prescription for captopril [Capoten] for hypertension. The combination of these two drugs makes which assessment particularly important?

A. Potassium level
B. Lithium level
C. Creatine level
D. Blood pressure
B. Lithium level
A patient is admitted to the hospital with a diagnosis of hypertension. The nurse understands that which medication works by preventing angiotensin II from binding with its receptor sites?

A. Quinapril (Accupril)
B. Aliskiren (Tekturna)
C. Eplerenone (Inspra)
D. Candesartan (Atacand)
D. Candesartan (Atacand)
The nurse has just administered the initial dose of enalapril [Vasotec] to a newly admitted patient with hypertension. What is the priority nursing intervention over the next several hours?

A. monitor blood pressure
B. Check the heart rate
C. Auscultate lung sounds
D. Draw a potassium level
A. monitor blood pressure
The nurse is evaluating the teaching done with a patient who has a new prescription for fosinopril [Monopril]. Which statement by the patient indicates a need for further teaching?

A. "I can take this medicine with breakfast each morning."
B. "I will call if I notice a rash or wheals on my skin."
C. "I will use a salt substitute to lower my sodium intake."
D. "I will call if I develop a bothersome cough."
C. "I will use a salt substitute to lower my sodium intake."
The nurse is caring for a patient prescribed aliskiren [Tekturna]. How does this medication lower blood pressure?

A. It blocks the conversion of angiotensin I to angiotensin II.
B. It prevents angiotensin II from binding to its receptors.
C. It inhibits the conversion of angiotensinogen into angiotensin I.
D. It selectively blocks aldosterone receptors in the kidneys.
C. It inhibits the conversion of angiotensinogen into angiotensin I.
A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug?


A. + 2 edema of the lower extremities
B. Potassium level of 3.5 mEq/L
C. Crackles in the lungs are no longer heard
D. Jugular vein distention
C. Crackles in the lungs are no longer heard
A patient is prescribed lisinopril [Prinivil] 40 mg by mouth once a day for hypertension. For which therapeutic effect will the nurse monitor?

A. Slowing of the heart rate
B. Decrease in blood pressure
C. Symptoms such as dizziness and fainting
D. Pulse oximetry oxygen saturation of 100%
B. Decrease in blood pressure
The nurse is teaching a patient prescribed captopril [Capoten] for the treatment of hypertension. Which instructions should the nurse include? (Select all that apply.)

A. Take the medication with food.
B. Expect a sore throat and fever.
C. Avoid potassium salt substitutes.
D. A persistent dry cough may occur.
E. Report difficulty in breathing immediately.
C. Avoid potassium salt substitutes.
D. A persistent dry cough may occur.
E. Report difficulty in breathing immediately.
Calcium channel blockers work by reducing calcium influx into the cells of the heart and blood vessels. Calcium channels are coupled to which type of autonomic nervous system receptors?


A. Alpha1
B. Alpha2
C. Beta1
D. Beta2
C. Beta1
.
The nurse is caring for several patients. For which patient diagnosis would a prescription for nifedipine [Adalat] be least appropriate?

A. Angina pectoris
B. Essential hypertension
C. Atrial fibrillation
D. Vasospastic angina
C. Atrial fibrillation
Which medication is most likely to cause the side effect of constipation?


A. Nifedipine [Adalat]
B. Amlodipine [Norvasc]
C. Isradipine [DynaCirc]
D. Diltiazem [Cardizem]
D. Diltiazem [Cardizem]
The nurse provides discharge instructions to a patient prescribed verapamil [Calan] SR 120 mg PO daily for essential hypertension. Which statement by the patient indicates understanding of the medication?


A. "I will take the medication with grapefruit juice each morning."
B. "I should expect occasional loose stools from this medication."
C. "I'll need to reduce the amount of fiber in my diet."
D. "I must make sure I swallow the pill whole."
D. "I must make sure I swallow the pill whole."
The healthcare provider prescribes an intravenous dose of diltiazem [Cardizem] for treatment of a patient with atrial fibrillation. What is the priority nursing intervention?


A. Assist with cardioversion.
B. Monitor electrocardiogram.
C. Obtain baseline coagulation studies.
D. Assess for increased urinary output.
B. Monitor electrocardiogram.
What is the most appropriate nursing consideration for a patient who is prescribed verapamil [Calan] and digoxin [Lanoxin]?


A. Restrict intake of oral fluids and high-fiber food.
B. Take an apical pulse for 30 seconds before administration.
C. Notify the healthcare provider of nausea, vomiting, and visual changes.
D. Hold the medications if the heart rate is greater than 110 beats/min.
C. Notify the healthcare provider of nausea, vomiting, and visual changes.
Which instructions should the nurse include when developing a teaching plan for a patient prescribed diltiazem [Cardizem] for atrial fibrillation? (Select all that apply.)


A. Weigh yourself daily at the same time each day.
B. The medication will not cause dizziness or headache.
C. Notify the healthcare provider if a skin rash develops.
D. Do not take daily oral calcium supplements.
E. Rise slowly from a lying to a sitting position.
A. Weigh yourself daily at the same time each day.
C. Notify the healthcare provider if a skin rash develops.
E. Rise slowly from a lying to a sitting position.
The nurse is teaching a patient with essential hypertension who has a new prescription for verapamil [Calan]. Which statements by the patient indicate that the teaching was effective? (Select all that apply.)


A. "I will increase my intake of fluid and foods high in fiber."
B. "I should stay out of direct sunlight to prevent exposing my skin to the sun."
C. "I will call my healthcare provider if I notice swelling in my ankles."
D. "I need to avoid salt substitutes and potassium supplements."
E. "I may notice easy bruising and bleeding with this drug."
A. "I will increase my intake of fluid and foods high in fiber."
C. "I will call my healthcare provider if I notice swelling in my ankles."
A patient with angina pectoris has been prescribed nifedipine [Procardia].Which possible adverse effects should the nurse expect with this medication? (Select all that apply.)

A. Headache
B. Constipation
C. Nausea and vomiting
D. Edema of ankles and feet
E. Overgrowth of gum tissue
A. Headache
D. Edema of ankles and feet
E. Overgrowth of gum tissue
The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective?

A. "I can take this medication in the morning to reduce nighttime urination."
B. "I will rise slowly when changing from a sitting to a standing position."
C. "My heart rate may slow down with this drug. I will call if my pulse is below 60."
D. "I need to increase my intake of fluids and foods that are high in fiber."
B. "I will rise slowly when changing from a sitting to a standing position."
Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]?


A. Peripheral pulses
B. Homans' sign
C. Blood pressure
D. Capillary refill
C. Blood pressure
The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose?


A. To reduce the risk of headache
B. To improve hypotensive effects
C. To prevent heart failure
D. To protect against reflex tachycardia
D. To protect against reflex tachycardia
The nurse is preparing to administer minoxidil [Loniten] 5 mg orally. What is the only cardiovascular indication for this medication?


A. Heart failure
B. Myocardial infarction
C. Angina pectoris
D. Severe hypertension
D. Severe hypertension
The nurse is caring for a patient receiving a nitroprusside [Nipride] intravenous infusion. The patient's wife asks why furosemide [Lasix] is being prescribed along with this drug. The nurse's response is based on which concept?

A. Furosemide will help reduce reflex tachycardia.
B. Many vasodilators cause retention of sodium and water.
C. Thiocyanate may accumulate in patients receiving nitroprusside.
D. Vasodilators can cause serious orthostatic hypotension.
B. Many vasodilators cause retention of sodium and water.
The patient is admitted for the management of a hypertensive emergency. The healthcare provider prescribes sodium nitroprusside [Nipride] drug therapy. What is the priority nursing action during this treatment?


A. Observe for respiratory depression.
B. Monitor the electrocardiogram for tachycardia.
C. Initiate oxygen therapy via nasal cannula at 2 L/min.
D. Adjust the intravenous infusion rate to the blood pressure response.
D. Adjust the intravenous infusion rate to the blood pressure response.
A patient with hypertensive emergency is admitted to the hospital. Which medication should the nurse be prepared to administer to this patient?


A. Minoxidil [Loniten]
B. Hydralazine [Apresoline]
C. Sodium nitroprusside [Nipride]
D. Hydralazine and isosorbide dinitrate [BiDil]
C. Sodium nitroprusside [Nipride]
The nurse is caring for a patient who has been receiving intravenous sodium nitroprusside [Nitropress] for 3 days. Which assessment data indicate the patient may be experiencing thiocyanate toxicity?


A. Sudden confusion
B. Difficulty breathing
C. Erythematous rash
D. Gastrointestinal bleeding
A. Sudden confusion
A patient in a hypertensive crisis is being started on a continuous sodium nitroprusside [Nipride] infusion. Which interventions are essential before the nurse administers nitroprusside [Nipride]? (Select all that apply.)


A. Obtain a baseline weight and weigh daily.
B. Prepare for arterial line insertion.
C. Discontinue the infusion when blood pressure is controlled.
D. Observe for signs of hypertrichosis during the infusion.
E. Cover the solution with an opaque bag.
A. Obtain a baseline weight and weigh daily.
B. Prepare for arterial line insertion.
E. Cover the solution with an opaque bag.
A patient is prescribed hydralazine [Apresoline] for the treatment of essential hypertension. Which expected adverse effects should the nurse discuss with the patient? (Select all that apply.)


A. Nausea
B. Fatigue
C. Dizziness
D. Headache
E. Joint pain
B. Fatigue
C. Dizziness
D. Headache
An adult male patient is taking medication for blood pressure management. The patient states to the nurse, "I'm not going to take these drugs anymore, because they are interfering with my sex life." What is the most appropriate response by the nurse?


A. "It is unfortunate these drugs can cause erectile dysfunction but managing your blood pressure is more important than your sexual performance."
B. "I understand how discouraging it must be to live with this adverse effect, but you could have a stroke if you do not take your blood pressure medications."
C. "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect."
D. "I am glad you told me about your experience with this common side effect. Sexual performance can be a difficult subject to discuss."
C. "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect."
The nurse is caring for a pregnant patient experiencing a new episode of hypertension. Which medication does the nurse anticipate will be prescribed for this patient?


A. Methyldopa [Aldomet]
B. Propranolol [Inderal]
C. Captopril [Capoten]
D. Valsartan [Diovan]
A. Methyldopa [Aldomet]
The nurse is caring for a patient who has diabetes and hypertension. Which medication is most likely to be prescribed to treat this patient's hypertension?


A. Hydrochlorothiazide [HCTZ]
B. Enalapril [Vasotec]
C. Propranolol [Inderal]
D. Methyldopa [Aldomet]
B. Enalapril [Vasotec]
A patient is admitted to the unit in a hypertensive emergency and examination reveals papilledema. The nurse should expect which IV medications to be administered to achieve rapid, controlled reduction of the patient's blood pressure?


A. Furosemide [Lasix]
B. Sodium nitroprusside [Nitropress]
C. Metoprolol [Lopressor]
D. Diltiazem [Cardizem]
B. Sodium nitroprusside [Nitropress]
Which laboratory result may be a consequence of therapy with a thiazide diuretic?


A. Serum glucose level of 58 mg/dL
B. Serum potassium level of 5.3 mEq/L
C. Serum sodium level of 135 mEq/L
D. Serum uric acid level of 10.4 mg/dL
D. Serum uric acid level of 10.4 mg/dL
The nurse is teaching a patient about the side effects associated with doxazosin [Cardura]. Which statement by the patient indicates an understanding of the nurse's instructions?


A. "I may experience an increase in hair growth as a side effect."
B. "I'll notify the healthcare provider if I develop a persistent cough."
C. "I'll make sure I include extra sources of potassium in my diet, such as bananas and baked potatoes."
D. "When getting out of bed in the morning, I will sit on the side of the bed for several minutes before standing."
D. "When getting out of bed in the morning, I will sit on the side of the bed for several minutes before standing."
Which classes of medications are prescribed as initial therapy for hypertension after a myocardial infarction (MI)?


A. Diuretic and beta blocker
B. Beta blocker and ACE inhibitor
C. ACE inhibitor and calcium channel blocker
D. Diuretic and calcium channel blocker
B. Beta blocker and ACE inhibitor
The nurse reviews the medication treatment regimen for a patient with chronic hypertension. To promote optimal medication adherence, which frequency of drug dosing should the nurse advocate for this patient?


A. Once a day
B. Three times a day
C. Four times a day
D. Every 8 hours
A. Once a day
Which medications should be used with caution in a hypertensive diabetic patient? (Select all that apply.)


A. Furosemide [Lasix]
B. Metoprolol [Lopressor]
C. Diltiazem [Cardizem]
D. Hydrochlorothiazide [HCTZ]
E. Enalapril [Vasotec]
A. Furosemide [Lasix]
B. Metoprolol [Lopressor]
D. Hydrochlorothiazide [HCTZ]
A patient with deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response?


A. Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting factors.
B. Heparin suppresses coagulation by helping antithrombin perform its natural functions.
C. Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot matrix.
D. Heparin inhibits the enzyme responsible for platelet activation and aggregation within vessels.
B. Heparin suppresses coagulation by helping antithrombin perform its natural functions.
The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin?


A. Heart rate of 60 beats/min
B. Blood pressure of 160/88 mm Hg
C. Discolored urine
D. Inspiratory wheezing
C. Discolored urine
The laboratory calls to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate?


A. Notify the healthcare provider to discuss the reduction or withdrawal of heparin.
B. Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level.
C. Obtain vitamin K and prepare to administer it by intramuscular (IM) injection.
D. Observe the patient and monitor the activated partial thromboplastin time (aPTT) as indicated.
A. Notify the healthcare provider to discuss the reduction or withdrawal of heparin.
The nurse is ready to begin a heparin infusion for a patient with evolving stroke. The baseline activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved?


A. 50
B. 70
C. 90
D. 110
B. 70
The nurse is caring for a patient who takes warfarin [Coumadin] for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate?


A. Administer intravenous (IV) push protamine sulfate.
B. Continue with the current prescription.
C. Prepare to administer vitamin K.
D. Call the healthcare provider to increase the dose.
D. Call the healthcare provider to increase the dose.
The nurse is caring for a patient receiving clopidogrel [Plavix] to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel?


A. Aspirin [Bayer]
B. Omeprazole [Prilosec]
C. Acetaminophen [Tylenol]
D. Warfarin [Coumadin]
B. Omeprazole [Prilosec]
A patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which finding by the nurse most likely indicates an adverse reaction to this drug?


A. Urticaria, itching, and flushing
B. Blood pressure of 90/50 mm Hg
C. Decreasing level of consciousness
D. Potassium level of 5.5 mEq/L
C. Decreasing level of consciousness
The nurse knows that which statement is accurate for enoxaparin [Lovenox]?


A. It equally reduces the activity of thrombin and factor Xa.
B. It has selective inhibition of factor Xa and no effect on thrombin.
C. It reduces the activity of factor Xa more than the activity of thrombin.
D. It has a lower bioavailability and shorter half-life than unfractionated heparin.
C. It reduces the activity of factor Xa more than the activity of thrombin.
A patient with nonvalvular atrial fibrillation is to be discharged on dabigatran etexilate [Pradaxa]. Which statement should the nurse include in the discharge teaching?


A. "The medication must be stored in the manufacturer-supplied bottle."
B. "Once a new bottle is opened, the capsules maintain efficacy for 90 days."
C. "If you have difficulty swallowing the capsule, you can open it and mix it with food."
D. "You will need to learn how to give yourself a subcutaneous injection in your abdomen."
A. "The medication must be stored in the manufacturer-supplied bottle."
A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. What medication would be appropriate for this patient who has a history of heparin-induced thrombocytopenia (HIT)?


A. Warfarin [Coumadin]
B. Lepirudin [Refludan]
C. Bivalirudin [Angiomax]
D. Eptifibatide [Integrilin]
B. Lepirudin [Refludan]
Which instruction about clopidogrel [Plavix] should the nurse include in the discharge teaching for a patient who has received a drug-eluting coronary stent?


A. "Constipation is a common side effect of clopidogrel, so take a stool softener daily."
B. "If you see blood in your urine or black stools, stop the clopidogrel immediately."
C. "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity."
D. "Keep the amount of food containing vitamin K, such as mayonnaise, canola and soybean oil, and green, leafy vegetables, consistent in your diet."
C. "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity."
The nurse is caring for a group of patients taking warfarin [Coumadin]. Which patients are at moderate to high risk for harm as a result of warfarin therapy? (Select all that apply.)


A. A patient with variant genes that code for VKORC1 and CYP2CP
B. A patient with a current INR of 2.2 treated for deep vein thrombosis
C. A woman with a new onset of symptoms of a pulmonary embolus
D. A patient on day 4 after hip replacement with a new order for warfarin
E. A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen
A. A patient with variant genes that code for VKORC1 and CYP2CP
C. A woman with a new onset of symptoms of a pulmonary embolus
E. A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen
A patient diagnosed with a pulmonary embolism is receiving a continuous heparin infusion at 1000 units/hr. Of which findings should the nurse immediately notify the healthcare provider? (Select all that apply.)


A. aPTT of 65 seconds
B. aPTT of 40 seconds
C. Nosebleeds
D. aPTT of 100 seconds
E. Platelet count of 300,000/mcL
B. aPTT of 40 seconds
C. Nosebleeds
D. aPTT of 100 seconds
A patient is being discharged from the hospital on warfarin [Coumadin] for deep vein thrombosis prevention. Which instructions should the nurse include in the patient's discharge teaching plan? (Select all that apply.)


A. Wear a medical alert bracelet.
B. Check all urine and stool for discoloration.
C. Do not start any new medication without first talking to your healthcare provider.
D. Enteric-coated aspirin and any aspirin products can be used unless they cause a gastrointestinal ulcer.
E. No laboratory or home monitoring of international normalized ratio (INR) is required after the first 6 months.
A. Wear a medical alert bracelet.
B. Check all urine and stool for discoloration.
C. Do not start any new medication without first talking to your healthcare provider.
A patient is receiving continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor? (Select all that apply.)


A. Platelets
B. Vitamin K
C. Prothrombin time (PT)
D. International normalized ratio (INR)
E. Activated partial thromboplastin time (aPTT)
A. Platelets
E. Activated partial thromboplastin time (aPTT)
A patient with asthma is scheduled to start taking a glucocorticoid medication with a metered-dose inhaler (MDI). The nurse should give the patient which instruction about correct use of the inhaler?


A. "After you inhale the medication once, repeat until you obtain symptomatic relief."
B. "Wait no longer than 30 seconds after the first puff before taking the second one."
C. "Use a spacer with the inhaler and rinse your mouth after each dose administration."
D. "Breathe in through the nose and hold for 2 seconds just before activating the inhaler."
C. "Use a spacer with the inhaler and rinse your mouth after each dose administration."
To achieve therapeutic effectiveness, a nurse teaches a patient with chronic asthma to use an inhaled glucocorticoid medication according to which schedule?


A. Only in an emergency
B. On a continuing, daily basis
C. To abort an asthma attack
D. 2 weeks on, 2 weeks off
B. On a continuing, daily basis
A patient is taking oral theophylline for maintenance therapy of stable asthma. A nurse instructs the patient to avoid using which substance to prevent a complication?


A. Echinacea
B. Cimetidine [Tagamet]
C. Sunscreen products
D. Caffeine
D. Caffeine
A nurse is teaching a patient about montelukast [Singulair]. Which statement by the patient would indicate that the nurse's teaching was effective?


A. "I'll take a dose as soon as I feel short of breath and start to cough."
B. "While taking this medicine, I may be able to reduce my steroid medication."
C. "This is the priority medication for preventing exercise-induced asthma symptoms."
D. "If I have nosebleeds or excessive bruising, I'll stop the medication immediately."
B. "While taking this medicine, I may be able to reduce my steroid medication."
A patient who takes cromolyn for exercise-induced bronchospasm should follow which approach for maximum therapeutic effectiveness?


A. It should be used infrequently because of systemic adverse effects.
B. One 10-mg tablet should be taken at least 2 hours before exercising.
C. It should be administered by inhalation 15 minutes before anticipated exertion.
D. It should be used as a quick-relief agent if exercise triggers asthma symptoms.
C. It should be administered by inhalation 15 minutes before anticipated exertion.
Which outcome should a nurse establish as a priority for a patient taking an oral glucocorticoid for long-term treatment of asthma?


A. Increases the daily intake of vitamin D and calcium.
B. Records daily peak expiratory flow rates.
C. Supplements additional doses at times of stress.
D. Uses alternate-day therapy to reduce adverse effects.
C. Supplements additional doses at times of stress.
Using a stepwise approach to managing asthma, a nurse teaches a patient who is at step 1 to use albuterol MDI [Proventil] at which of these times?


A. Whenever needed (PRN) as a quick-relief agent
B. Twice daily combined with an inhaled glucocorticoid
C. Only with a long-acting beta2 agonist (LABA)
D. If nighttime awakenings occur more than 2 days a week
A. Whenever needed (PRN) as a quick-relief agent
A patient is admitted to the emergency department with acute severe exacerbation of asthma. Which drug should the nurse anticipate will be included in the treatment plan?


A. Oral theophylline [Elixophyllin]
B. Subcutaneous omalizumab [Xolair]
C. Inhaled mometasone furoate [Asmanex]
D. High-dose albuterol [Proventil] via nebulizer treatment
D. High-dose albuterol [Proventil] via nebulizer treatment
Which instruction should be included in the teaching for a patient for whom fluticasone propionate [Flovent] MDI has been ordered?


A. "Gargle after using your inhaler."
B. "Take the medication immediately at the onset of an attack."
C. "Take your albuterol first, followed by the Flovent 5 minutes later."
D. "Make sure you monitor your fingerstick blood glucose level each morning."
A. "Gargle after using your inhaler."
A history of allergy to which substance is a contraindication to the use of ipratropium/albuterol [Combivent]?


A. Mold
B. Peanuts
C. Penicillin
D. Dairy products
B. Peanuts
Which structure in a normal heart is responsible for electrical impulse stimulation?


A. Bundle of His
B. Sinoatrial (SA) node
C. Right bundle branch
D. Atrioventricular (AV) node
B. Sinoatrial (SA) node
Which classification of drugs decreases the strength of cardiac contraction?


A. Adenosine
B. Narcotics (morphine)
C. Calcium channel blockers
D. Aspirin
C. Calcium channel blockers
Which item is a characteristic of the Frank-Starling law of the heart?


A. Tension generation and left ventricular pressure
B. Resting sarcomere length to end-diastolic volume
C. Tension generation and diastolic filling pressures
D. Resting sarcomere length to tension generation
D. Resting sarcomere length to tension generation
Which is a characteristic of cardiac preload?


A. Pressure generated by the end-diastolic volume
B. Wall tension related to internal blood vessel radius
C. Impedance to ejection of blood from the left ventricle
D. A lower than normal tension curve
A. Pressure generated by the end-diastolic volume
Which process has control over slowing human heart rates?


A. Vagal parasympathetic nerve activity
B. Bainbridge reflex
C. Baroreceptor reflex
D. Sympathetic nerve fiber innervation
A. Vagal parasympathetic nerve activity
Which hormone is released from heart tissue in response to increases in blood volume?


A. Epinephrine
B. Thyroid hormone
C. Natriuretic peptide
D. Norepinephrine
C. Natriuretic peptide
Which two factors determine cardiac output?


A. Heart rate and stroke volume
B. Preload and afterload
C. Parasympathetic and sympathetic activity
D. Right and left atrial pressure
A. Heart rate and stroke volume
An increase in the release of renin is the result of which event?


A. Decrease in blood pressure at the renal artery
B. Low potassium concentration
C. β-Adrenergic stimuli
D. Decrease in the amount of sodium delivered to the kidney
A. Decrease in blood pressure at the renal artery
What is the effect of angiotensin II on blood vessels?


A. A potent vasodilator
B. Inhibition of aldosterone
C. Excretion of sodium by the kidney
D. Vascular vasoconstriction
D. Vascular vasoconstriction
Which statement regarding arteriosclerosis is TRUE? Arteriosclerosis is:


A. an acute process of heart muscle degeneration.
B. fatty streaks and foam cells that are identical.
C. thickening and hardening of the vessel wall.
D. plaque caused by accumulation of hormones.
C. thickening and hardening of the vessel wall.
A condition in which blood has pooled, producing distended and palpable vessels, is referred to as a:


A. varicose veins.
B. deep vein thrombosis.
C. thrombus.
D. venous stasis ulcers.
A. varicose veins.
Which complication occurs secondary to hypertension?


A. Hypoglycemia
B. Decreased demand for coronary perfusion
C. Cardiovascular muscle atrophy
D. Congestive heart failure
D. Congestive heart failure
A young woman presents with pallor, numbness, and a sensation of cold temperature of her digits. Which condition is the most likely cause for these symptoms?


A. Varicose veins
B. Peripheral vascular disease
C. Raynaud phenomenon
D. Thromboangiitis obliterans
C. Raynaud phenomenon
Which is the MOST common complication of an acute myocardial infarction (AMI)?


A. Arrhythmia
B. Heart failure
C. Pericarditis
D. Dressler syndrome
A. Arrhythmia
Which characteristics are associated with hypertension? (Select all that apply.)


A. Glucose intolerance
B. Obesity
C. High dietary sodium
D. Asian race
E. Family history positive for hypertension
A. Glucose intolerance
B. Obesity
C. High dietary sodium
E. Family history positive for hypertension
Which symptoms are typically observed with the presence of an acute myocardial infarction (AMI)? (Select all that apply.)


A. Unrelenting indigestion
B. Cough
C. Substernal pain
D. Diaphoresis
E. Cool, clammy skin
A. Unrelenting indigestion
C. Substernal pain
D. Diaphoresis
E. Cool, clammy skin
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