Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal b. “Insomnia may still occur while taking this drug.” c. “You will need to pick up a written prescription every 30 days.” d. “You may crush the tablets and put them in food.” CORRECT: A Clonidine causes somnolence, which is made worse by alcohol or other CNS depressants, so clients should avoid alcohol while taking clonidine. Insomnia and anorexia are not side effects of clonidine. Clonidine is not a controlled substance, so prescriptions may be refilled over the phone and may be written for more than 1 month at a time. The tablets must be swallowed whole and should not be crushed or chewed. PTS: 1 MULTIPLE RESPONSE 1. A parent thinks a school-aged child has ADHD. The nurse practitioner asks the parent to describe the child’s behaviors. Which behaviors are characteristics of ADHD? (Select all that apply.) a. Anxiety b. Compulsivity c. Hyperactivity d. Inattention e. Impulsivity CORRECT: C, D, E ADHD is characterized by inattention, hyperactivity, and impulsivity. Anxiety and compulsivity are not characteristics of ADHD. PTS: 1 2. A nurse practitioner is providing education to a group of clients regarding amphetamines. To evaluate thegroup’s understanding, the nurse practitioner asks a participant what effects amphetamines would have onher. The participant shows that she understands the effects of these drugs if she gives which answers? (Select all that apply.) a. “Amphetamines increase fatigue.” b. “Amphetamines suppress the perception of pain.” c. “Amphetamines increase appetite.” d. “Amphetamines increase the heart rate.” e. “Amphetamines elevate mood.” CORRECT: B, D, E At customary doses, amphetamines increase wakefulness and alertness, reduce fatigue, elevate mood, and augment self-confidence and initiative. Amphetamines also suppress appetite and the perception of pain and increase the heart rate. Amphetamines do not increase fatigue or appetite. PTS: 1 Chapter 40: Substance Use Disorders I: Basic Considerations Burchum: Lehne’s Pharmacology for Nursing Care, 11th EditionStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal MULTIPLE CHOICE 1. A nurse practitioner is teaching a group of nursing students about substance abuse. Which statement by astudent indicates a need for further teaching? a. “Clients who experience physical dependence will show compulsive drug-seeking behavior.” b. “People who are addicted to a drug do not necessarily have tolerance to that drug.” c. “Physical dependence means that abstinence syndrome will occur if a drug is withdrawn.” d. “Physical dependence often contributes to addictive behavior but does not cause it.” CORRECT: A Physical dependence occurs with prolonged drug exposure and, through neuroadaptive processes, results in abstinence syndrome if a drug is withdrawn. It does not necessarily result in compulsive drug-seeking behavior. Clients can have drug addiction, which involves compulsive drug seeking without having developed a tolerance to drug effects. Addictive behavior is the result of psychologic dependence with an intense subjective need for a drug. Because abstinence syndrome is uncomfortable, physical dependence can increase subjective feelings for a drug. PTS: 1 2. A client is ready for discharge home from a lengthy hospital stay after a motor vehicle accident. The client suffered multiple fractures and required large doses of morphine for several weeks. The nurse practitioner preparing the client for discharge notes that the client requests the maximum dose of the oral opioid analgesic at the exact intervals it is prescribed. The nurse practitioner is correct to suspect what has occurred? a. Addiction b. Compulsive drug seeking c. Cross-tolerance d. Drug tolerance CORRECT: D Clients who use a drug regularly develop tolerance to the drug when a dose produces a smaller response than it did initially. This client has been on large doses of opioids for several weeks and has developed tolerance to this class of drugs. Addiction is characterized by compulsive drug seeking, which has not occurred. A client using narcotics for severe pain is not a compulsive drug seeker. Cross-tolerance occurs when tolerance to one drug confers tolerance to another drug. The opioid analgesic for home use is in the same drug classification, so this is not cross- tolerance. PTS: 1 3. A client who has been taking a medication with a side effect of drowsiness stops taking the medication after several weeks. The client reports feeling anxious and jittery. The nurse practitioner understands that this response is due to: a. addiction.Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal b. psychologic dependence. c. tolerance. d. withdrawal syndrome. CORRECT: D Withdrawal syndrome occurs when clients have developed a physical dependence on a drug and then often show symptoms that are the opposite of the drug’s effect when the drug is withdrawn. Addiction is characterized by compulsive drug seeking. Psychologic dependence is an intense subjective need for a drug. Tolerance develops when increased amounts of a drug are needed to achieve the drug’s effects. PTS: 1 4. A nurse practitioner is caring for four clients. The nurse practitioner would be concerned about which client developing a substance use disorder? a. A college student who reports having experimented with marijuana in the past year b. An older adult client with terminal cancer who requires twice the normal dose of morphine for pain relief c. A client in moderate to severe pain after a total hip replacement who asks for pain medication an hour before the next dose is due d. A client whose history indicates the use of prescription narcotic analgesics for back and headache pain CORRECT: D Clients who use narcotics for minor pains are more likely to be compulsive drug seekers. A college student who experiments with an illegal substance is not necessarily going to develop a substance use disorder. An elderly client with terminal cancer pain has most likely developed physical dependence and tolerance to morphine but is not a substance abuser. Clients with significant pain who ask for more frequent dosing are not showing substance use disorder. PTS: 1 5. A nursing student is caring for a client who is addicted to several drugs. The student tells the nurse practitioner that the client “got this way on purpose.” Which response by the nurse practitioner is most appropriate? a. “Peer pressure and social factors determine individual choices.” b. “Physical dependence is necessary for addiction to occur.” c. “Pre-existing psychopathology underlies most drug abuse.” d. “Some individuals are more vulnerable to drug abuse than others.” CORRECT: D Some individuals are more prone to becoming substance abusers than others for a variety of reasons, including physiologic, psychologic, social, emotional, and genetic reasons. Peer pressure, social factors, the development of physical dependence, and underlying psychologic disorders contribute to the development of addiction but are not determining factors. PTS: 1Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal 6. A nurse practitioner is teaching a class on addiction. Which statement by one of the class participants indicates a need for further teaching? a. “Addictive drugs lead to dopamine release in amounts similar to those released by normal reward circuits.” b. “Neural remodeling leads to decreased dopamine release, leaving users with feelings of lifelessness and depression.” c. “Over time, the brain will develop reduced responses to many addictive drugs.” d. “With the use of a drug over time, the brain undergoes synaptic remodeling.” CORRECT: A Drugs of addiction use the same reward circuits that are used to reward biologically critical behaviors such as eating and sexual intercourse. However, addictive drugs lead to dopamine release that can be 2 to 10 times higher than that released naturally. Eventually, neural remodeling occurs, causing the brain to produce less dopamine and to reduce the number of dopamine receptors, leaving addicts feeling depressed and lifeless. This process of down- regulation reduces the response to the drug. All of this is part of the synaptic remodeling that occurs when the brain is exposed to a drug over a period of time. PTS: 1 7. A psychiatric nurse practitioner is caring for a substance-addicted client. The nurse practitioner knows that the idealgoal of drug rehabilitation for this client is: a. abstinence from the substance. b. decreasing episodes of relapse. c. minimizing substance cravings. d. reduction of substance abuse CORRECT: A The goal of treatment is complete cessation of the drug. Decreasing episodes of relapse, minimizing cravings, and reducing drug use are all steps toward achieving eventual abstinence. PTS: 1 8. The nurse practitioner is teaching a nursing student about management of controlled substances in medication administration. Which statement by the nursing student indicates understanding ofthe teaching? a. “If there is a difference between state and federal laws governing a scheduled drug, the federal law takes precedence.” b. “Prescriptions for drugs in Schedules III and IV may be written to include up to 5 refills.” c. “Schedule I drugs may only be given to hospitalized clients.” d. “To reduce the possibility of abuse of a drug that is Schedule II, the prescriber should call the prescription to the pharmacy.” CORRECT: BStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal Providers may prescribe Schedule III and IV drugs orally by phone, written as a prescription, or electronically, and may provide up to 5 refills. When state and federal laws differ, the more restrictive law takes precedence, whether it is the state or the federal law. Schedule I drugs have no approved uses. Schedule II drugs must be typed or written in indelible ink or pencil and signed by the provider or may be submitted electronically. They may be called in an emergency but must be followed by a written prescription within 72 hours. PTS: 1 Chapter 41: Substance Use Disorders II: Alcohol Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition MULTIPLE CHOICE 1. A client asks a nurse practitioner about the effects of chronic alcohol use on the heart. The nurse practitioner’s best response would be which statement? a. “Chronic alcohol use affects the liver more adversely than it does the heart.” b. “Drinking more than two drinks a day protects the heart from atherosclerosis.” c. “Long-term alcohol use can damage the heart and cause heart failure.” d. “Over time, alcohol use can lower your blood pressure.” CORRECT: C Chronic abuse of alcohol results in direct damage to the myocardium, increasing the risk of heart failure. Chronic alcohol abuse has a significant effect on the heart and also affects the liver. Drinking fewer than two alcoholic beverages a day potentially protects the heart from atherosclerosis. Alcohol consumption produces a dose-dependent elevation of blood pressure. PTS: 1 2. An alcoholic client’s spouse asks a nurse practitioner about recovery from chronic alcoholism. The client is confused and has abnormal eye movements and nystagmus. Which statement by the nurse practitioner iscorrect? a. “The symptoms your spouse shows are partly reversible in most people.” b. “These symptoms can be reversed with vitamin therapy and good nutrition.” c. “Your spouse has symptoms of an irreversible encephalopathy.” d. “Your spouse will probably recover completely after detoxification.” CORRECT: B Chronic use of alcohol can produce severe neurologic and psychiatric disorders. This client shows signs of Wernicke’s encephalopathy, which is readily reversible with thiamine. With proper nutrition, the symptoms will clear completely. Korsakoff’s psychosis is not reversible; signs of this disorder include polyneuropathy, memory disorders, and confabulation. Wernicke’s encephalopathy requires thiamine supplementation and not just detoxification, which is treatment to withdraw alcohol from the client’s system. PTS: 1Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal MULTIPLE RESPONSE 1. A nurse practitioner is conducting a smoking cessation class in the community and is discussing the physiologic effects of nicotine. The nurse practitioner is correct to teach that these effects include which ofthe following? (Select all that apply.) a. Increased blood pressure b. Decreased gastric acid c. Vomiting d. Suppression of nausea e. Increased alertness f. Suppression of appetite CORRECT: A, C, E, F The physiologic effects of nicotine include increased blood pressure and other cardiovascular effects, vomiting, increased alertness, and suppression of appetite. Decreased gastric acid and suppression of nausea are not physiologic responses associated with nicotine use. PTS: 1 Chapter 43: Substance Use Disorders IV: Major Drugs of Abuse Other Than Alcohol and Nicotine Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition MULTIPLE CHOICE 1. A nurse practitioner is teaching a drug prevention class to a group of parents of adolescents. Which statement by a parent indicates understanding of the teaching? a. “Compared with alcohol, marijuana has little or no long-term adverse effects.” b. “Ecstasy causes reversible damage to serotonergic neurons.” c. “LSD does not cause an abstinence syndrome when it is withdrawn.” d. “Most individuals who abuse opioids began using them therapeutically.” CORRECT: C Although tolerance to LSD develops rapidly, there is no abstinence syndrome with abrupt withdrawal of the drug, and tolerance fades rapidly. Many adverse behavioral, subjective, and long-term effects are associated with chronic use of marijuana. MDMA [Ecstasy] can cause irreversible damage to serotonergic neurons. Most people who go on to abuse opioids begin their drug use illicitly; only an exceedingly small percentage of those exposed to opioids therapeutically go on to abuse these drugs. PTS: 1 2. What is the primary reason for opioid abuse? a. Ease of access b. Initial “rush” similar to orgasm c. Peer pressure d. Prolonged sense of euphoriaStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal CORRECT: D The primary reason for opioid abuse is the prolonged sense of euphoria that occurs after the initial rush. Healthcare professionals have easy access to opioids, which makes them more vulnerable to abuse of these drugs, but this is not the primary reason for abuse in the greater population. The initial rush lasts about 45 seconds and is not the primary reason for opioid abuse. Peer pressure is not the primary reason for opioid abuse. PTS: 1 3. A nurse practitioner is discussing the differences between OxyContin OC and OxyContin OP with a group ofnursing students. Which statement by a student indicates understanding of the teaching? a. “OxyContin OC cannot be drawn into a syringe for injection.” b. “OxyContin OP has greater solubility in water and alcohol.” c. “OxyContin OP is not easily crushed into a powder.” d. “Clients using OxyContin OP are less likely to overdose.” CORRECT: C OxyContin OP is a newer formulation that is designed to reduce OxyContin abuse. The OP formulation is much harder to crush into a powder. The OC preparation can be crushed and dissolved in water or alcohol and can easily be drawn into a syringe. The OP preparation does not dissolve easily in these solutions. Despite the differences in preparation, there is no indication that either form is less subject to abuse or overdose. PTS: 1 4. A client arrives in the emergency department complaining of dizziness, lightheadedness, and a pulsating headache. Further assessment reveals a blood pressure of 82/60 mm Hg and palpitations. The client’s friends tell the nurse practitioner that they were experimenting with “poppers.” The nurse practitioner will expect to administer which medication? a. Diazepam [Valium] b. Haloperidol [Haldol] c. Methylene blue and supplemental oxygen d. Naloxone [Narcan] CORRECT: C These findings are consistent with volatile nitrate overdose, as evidenced by the venous dilation. The primary toxicity is methemoglobinemia, which can be treated with methylene blue and supplemental oxygen. Diazepam would not be used for clients experiencing volatile nitrate overdose, but it may be used in clients who have overdosed on hallucinogens. Haloperidol would be used in clients who have overdosed on amphetamines. Naloxone would be used to treat an opioid overdose. PTS: 1 5. A client who has a long-term addiction to opioids takes an overdose of barbiturates. The nurse practitioner preparing to care for this client will anticipate: a. a severe abstinence syndrome when the effects of the barbiturates are reversed. b. minimal respiratory depression, because the client has developed a tolerance toStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal opioids. c. observing pinpoint pupils, respiratory depression, and possibly coma in this client. d. using naloxone [Narcan] to reverse the effects of the barbiturates, because cross- tolerance is likely. CORRECT: C Clients tolerant to opioids do not have cross-tolerance to barbiturates, so this client will show signs of overdose such as pinpoint pupils, respiratory depression, and coma. Because there is no cross-tolerance, a client addicted to opioids will not have an abstinence syndrome when the effects of the barbiturates are reversed. Respiratory depression will be severe. Naloxone cannot be used to reverse the effects of the barbiturates. PTS: 1 6. A client who is a heroin addict is admitted to a methadone substitution program. After administering the first dose of methadone, the nurse practitioner notes that the client shows signs ofeuphoria and complains of nausea. What will the nurse practitioner do? a. Administer nalmefene [Revex]. b. Contact the provider to obtain an order for naloxone [Narcan]. c. Question the client about heroin use that day. d. Suspect that the client exaggerated the amount of heroin used. CORRECT: D Clients entering a methadone substitution program must be carefully questioned about the amount of heroin used; clients may exaggerate the amount used to obtain higher doses of methadone or may minimize the amount used to downplay the extent of their addiction. In clients who exaggerate use, the amount of methadone given may cause euphoria, nausea, and vomiting. Nalmefene and naloxone are used to treat overdose and are not indicated. A client receiving methadone along with a usual heroin dose would be likely to have signs of toxicity. PTS: 1 7. A client who is an opioid addict has undergone detoxification with buprenorphine [Subutex] and has been given a prescription for buprenorphine with naloxone [Suboxone]. The client asks the nurse practitioner why the drug was changed. Which response by the nurse practitioner is correct? a. “Suboxone has a lower risk of abuse.” b. “Suboxone has a longer half-life.” c. “Subutex causes more respiratory depression.” d. “Subutex has more buprenorphine.” CORRECT: A The combination of buprenorphine and naloxone [Suboxone] discourages intravenous abuse, because with IV use, the naloxone precipitates withdrawal; this effect does not occur with sublingual dosing [Subutex]. Suboxone does not differ from Subutex in terms of drug half-life. Subutex does not cause more respiratory depression and does not contain more buprenorphine. PTS: 1Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal 8. A nurse practitioner is caring for a client who is addicted to barbiturates and who will begin receivingphenobarbital. The nurse practitioner discusses the care of this client with a nursing student. Which statement by the student indicates understanding of the teaching? a. “Phenobarbital acts as an antagonist to barbiturates and prevents toxicity.” b. “Phenobarbital has a long half-life and can be tapered gradually to minimize abstinence symptoms.” c. “Phenobarbital can be administered on an as-needed basis to treat withdrawal symptoms.” d. “Phenobarbital prevents respiratory depression associated with barbiturate withdrawal.” CORRECT: B Phenobarbital has a long half-life and can be given to ease barbiturate withdrawal and suppress symptoms of abstinence. Phenobarbital is not an antagonist to barbiturates. It is not used on a PRN basis. Phenobarbital does not prevent respiratory depression associated with acute toxicity. PTS: 1 9. A client arrives in the emergency department acutely intoxicated and difficult to arouse. The client’s friends tell the nurse practitioner that the client took a handful of diazepam [Valium] pills while at a party several hours ago. The nurse practitioner will expect to administer which drug? a. Buprenorphine [Subutex] b. Flumazenil [Romazicon] c. Nalmefene [Revex] d. Naloxone [Narcan] CORRECT: B Flumazenil can reverse signs and symptoms of benzodiazepine overdose. Buprenorphine, nalmefene, and naloxone are all used to treat opioid addiction or toxicity. PTS: 1 10. A client who is agitated and profoundly anxious is brought to the emergency department. The client acts paranoid and keeps describing things in the room that do not exist. A cardiac monitor shows an irregular ventricular tachycardia. Which medication will the nurse practitioner expect to administer? a. Anticocaine vaccine b. Diazepam [Valium] c. Disulfiram [Antabuse] d. Vigabatrin [Sabril] CORRECT: B This client is showing signs of acute cocaine toxicity. Diazepam can be given to reduce anxiety and suppress seizures, which may occur. Anticocaine vaccine, disulfiram, and vigabatrin are drugs under investigation for treating cocaine addiction. PTS: 1Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal 11. A young adult client is admitted to the hospital for evaluation of severe weight loss. The nurse practitioner admitting this client notes that the client has missing teeth and severe tooth decay. The client’s blood pressure is 160/98 mm Hg. The client has difficulty answering questions andhas trouble remembering simple details. The nurse practitioner suspects abuse of which substance? a. Cocaine b. Ecstasy c. Marijuana d. Methamphetamine CORRECT: D Methamphetamine causes all of the symptoms shown by this client. These are not symptomsassociated with cocaine, Ecstasy, or marijuana. PTS: 1 12. A school nurse practitioner is teaching a high school health class about the effects of marijuana use. Whichstatement by a student indicates a need for further teaching? a. “Chronic use of marijuana can result in irreversible brain changes.” b. “Higher doses of marijuana are likely to produce increased euphoria.” c. “Marijuana is unique in that it produces euphoria, sedation, and hallucinations.” d. “Marijuana has more prolonged effects when it is ingested than when it is smoked.” CORRECT: B With higher doses of marijuana, euphoria may be displaced by intense anxiety. Chronic use may cause irreversible brain changes. Euphoria, sedation, and hallucinations can all occur with marijuana use. Ingesting marijuana causes prolonged effects. PTS: 1 13. A pregnant client reports using marijuana during her pregnancy. She asks the nurse practitioner whether thiswill affect the fetus. What should the nurse practitioner tell her? a. Children born to clients who use marijuana will have smaller brains. b. Neonates born to clients who use marijuana will have withdrawal syndromes. c. Preschool-aged children born to clients who use marijuana are more likely to be hyperactive. d. School-aged children born to clients who use marijuana often have difficulty with memory. CORRECT: D School-aged children born to clients who use marijuana may show deficits in memory, attentiveness, and problem solving. Chronic marijuana use alters brain size in individuals who use marijuana but not in children born to parents who use marijuana. Newborns will not show withdrawal symptoms. Preschool-aged children have difficulty with memory and sustained attention. PTS: 1Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal 14. A college student admits frequent use of LSD to a nurse practitioner and reports plans to stop using it. What will the nurse practitioner tell this student? a. Flashback episodes and episodic visual disturbances are common. b. Tolerance to the effects of LSD will fade quickly once use of the drug has stopped. c. Withdrawal symptoms can be mitigated with haloperidol [Haldol]. d. Withdrawal from LSD is associated with a severe abstinence syndrome. CORRECT: B Tolerance to the effects of LSD develops rapidly but fades quickly when the drug is stopped. Flashback episodes may occur but are not common. Haloperidol may actually intensify symptoms associated with an acute panic reaction; it is not indicated for LSD withdrawal. Abstinence syndrome does not occur when LSD is stopped. PTS: 1 15. A college student is brought to the emergency department by a group of friends who report that they had been dancing at a nightclub when their friend collapsed. The client has a temperature of 105°F and shows jaw clenching and confusion. The nurse practitioner will expect to administer which medication? a. Dantrolene [Dantrium] b. Haloperidol [Haldol] c. Methadone d. Naloxone [Narcan] CORRECT: A This client shows signs of Ecstasy toxicity. Dantrolene can be given to relax skeletal muscle to reduce heat generation and prevent the risk of rhabdomyolysis. The other medications are not used to treat Ecstasy toxicity. PTS: 1 16. In discussing the rationale for using methadone to ease opioid withdrawal, the nurse practitioner wouldexplain that it has which pharmacologic properties or characteristics? a. Methadone can prevent abstinence syndrome. b. Methadone has a shorter duration of action than other opioids. c. Methadone is a nonopioid agent. d. Methadone lacks cross-tolerance with other opioids. CORRECT: A Methadone is used to ease opioid withdrawal and can prevent abstinence syndrome. Methadone does not have a shorter duration of action. Methadone is not a nonopioid agent. Methadone does not lack cross-tolerance with other opioids. PTS: 1 17. A college student tells the nurse practitioner that several friends have been using synthetic marijuana to get high. What will the nurse practitioner tell this client about this type of substance? a. “These substances are fairly safe because they are derived from herbs.” b. “They can cause hypertension, nausea, vomiting, and hallucinations.”Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal c. “These substances do not have mind-altering affects.” d. “These substances produce a high and they are not illegal.” CORRECT: B Synthetic marijuana can produce severe symptoms including hypertension, nausea, vomiting, and hallucinations. Although once thought safe, it is no longer considered safe. It produces a high and can cause hallucinations. Many types of synthetic marijuana are now illegal. PTS: 1 MULTIPLE RESPONSE 1. Which factors make meperidine an opioid of choice among nurse practitioners and physicians who abuseopioids? (Select all that apply.) a. Easy access to syringes for administration of the drug b. Highly effective oral dosing c. Increased effects on smooth muscle function d. Less pupillary constriction than other opioids e. Shorter half-life than other opioids CORRECT: B, D Meperidine is often abused by medical personnel because oral dosing is highly effective, so telltale injection marks are unnecessary. Also, the drug causes less pupillary constriction than other opioids. Access to syringes is not necessary with oral dosing. Meperidine has fewer effects on smooth muscle function, causing less constipation and urinary retention. PTS: 1 Chapter 44: Diuretics Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition MULTIPLE CHOICE 1. A client is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse practitioner caring for thisclient will expect to administer which drug? a. Furosemide [Lasix] b. Hydrochlorothiazide [HydroDIURIL] c. Mannitol [Osmitrol] d. Spironolactone [Aldactone] CORRECT: A Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is needed. This client shows severe signs of congestive heart failure with respiratory distress and pulmonary edema and needs immediate mobilization of fluid. Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema, because their diuretic effects are less rapid. Mannitol is indicated for clients with increased intracranial pressure and must be discontinued immediately if signs of pulmonary congestion or heart failure occur.Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal b. D5 NS with 60 mEq KCl for a client with a serum potassium of 3.2 mEq/L c. K-Dur, 1 tablet daily for a client with diabetic ketoacidosis d. K-Dur, 1 tablet with a full glass of water e. Potassium chloride, 10 mEq rapid IV push CORRECT: B, C, E Clients receiving potassium should not receive potassium in solution diluted at more than 40 mEq/L. Diabetic ketoacidosis causes decreased cellular uptake of potassium, and clients in whom acidosis is present should also receive sodium bicarbonate if they need potassium. IV potassium should not be infused faster than 10 mEq/hr. D5 NS with 20 mEq KCl is an appropriate solution for a client with intact renal function. Oral potassium should be given witha full glass of water to minimize gastrointestinal (GI) effects. PTS: 1 Chapter 46: Review of Hemodynamics Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition MULTIPLE CHOICE 1. A client is taking a beta1-adrenergic drug to improve the stroke volume of the heart. The nurse practitioner caring for this client knows that this drug acts by increasing: a. cardiac afterload. b. cardiac preload. c. myocardial contractility. d. venous return. CORRECT: C Beta1-adrenergic agents help increase the heart’s stroke volume by increasing myocardial contractility. Cardiac afterload is determined primarily by the degree of peripheral resistance caused by constriction of arterioles; increasing afterload would decrease stroke volume. Beta1- adrenergic agents do not affect afterload. Cardiac preload is the amount of stretch applied to the cardiac muscle before contraction and is determined by the amount of venous return. Beta1- adrenergic agents do not affect cardiac preload. Venous return is determined by the systemic filling pressure and auxiliary muscle pumps and is not affected by beta1-adrenergic agents. PTS: 1 2. A nurse practitioner is caring for a client who is receiving a drug that causes constriction of arterioles. Thenurse practitioner expects to observe which effect from this drug? a. Decreased stroke volume b. Increased stroke volume c. Decreased myocardial contractility d. Increased myocardial contractility CORRECT: AStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal Constriction of arterioles increases the load against which the heart must pump to eject blood. Increased constriction of arterioles would decrease, not increase, the stroke volume of the heart. Myocardial contractility is determined by the sympathetic nervous system, acting through beta1- adrenergic receptors in the myocardium. PTS: 1 3. A client with a history of hypertension is admitted for a procedure. If the client’s arterial pressure decreases, which clinical manifestation would the nurse practitioner expect to see? a. Decreased heart rate b. Increased heart rate c. Decreased blood pressure d. Syncope CORRECT: B When arterial pressure decreases, the vasoconstrictor center causes constriction of nearly all arterioles, leading to an increase in peripheral resistance, constriction of veins, increasing venous return, and subsequent acceleration of the heart rate. A decrease in arterial pressure would not cause a decrease in the heart rate or blood pressure, nor would it cause syncope. PTS: 1 4. A nurse practitioner is teaching a nursing student how blood can return to the heart when pressure in the venous capillary beds is very low. Which statement by the student indicates a need for furtherteaching? a. “Constriction of small muscles in the venous wall increases venous pressure.” b. “Negative pressure in the left atrium draws blood toward the heart.” c. “Skeletal muscles relax to allow the free flow of blood.” d. “Venous valves help prevent the backflow of blood.” CORRECT: C Skeletal muscle contraction, along with one-way venous valves, helps create an “auxiliary” venous pump that helps drive blood toward the heart. Constriction of small muscles in venous walls helps increase venous pressure. Negative pressure in the left atrium sucks blood toward the heart. Valves, which are one way, work with the contraction of skeletal muscles to create a venous pump. PTS: 1 5. A nurse practitioner is assessing a client who has heart failure. The client complains of shortness of breath, and the nurse practitioner auscultates crackles in both lungs. The nurse practitioner understands that these symptoms are the result of: a. decreased force of ventricular contraction. b. increased force of ventricular contraction. c. decreased ventricular filling. d. increased ventricular filling. CORRECT: AStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal In the failing heart, Starling’s law breaks down, and the force of contraction no longer increases in proportion to the amount of ventricular filling. The result is the backup of blood into the lungs and the symptoms of shortness of breath and crackles caused by fluid. Increased ventricular contraction would not result in a backup of blood into the lungs. Changes in ventricular filling are not the direct cause of this symptom. PTS: 1 6. A client with hypertension is admitted to the hospital. On admission the client’s heart rate is 72 beats/min, and the blood pressure is 140/95 mm Hg. After administering an antihypertensive medication, the nurse practitioner notes a heart rate of 85 beats/ min and a blood pressure of 130/80 mm Hg.What does the nurse practitioner expect to occur? a. A decrease in the heart rate back to baseline in 1 to 2 days b. An increase in the blood pressure within a few days c. An increase in potassium retention in 1 to 2 days d. A decrease in fluid retention within a week CORRECT: A When blood pressure drops, the baroreceptors in the aortic arch and carotid sinus sense this and relay information to the vasoconstrictor center of the medulla; this causes constriction of arterioles and veins and increased sympathetic impulses to the heart, resulting in an increased heart rate. After 1 to 2 days, this system resets to the new pressure, and the heart rate returns to normal. The blood pressure will not increase when this system resets. Increased potassium retention will not occur. Over time, the body will retain more fluid to increase the blood pressure. PTS: 1 7. A client is taking a drug that interferes with venous constriction. The nurse practitioner will tell the client to: a. ask for assistance when getting out of bed. b. expect bradycardia for a few days. c. notify the provider if headache occurs. d. report shortness of breath. CORRECT: A A drop in venous pressure reduces venous return to the heart, and as blood pools in the extremities, orthostatic hypotension can occur. Clients taking drugs that reduce venous constriction should be cautioned to ask for assistance when getting out of bed. Bradycardia, headache, and shortness of breath are not expected effects. PTS: 1 Chapter 47: Drugs Acting on the Renin-Angiotensin-Aldosterone System Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition MULTIPLE CHOICEStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal 1. A client with hypertension is prescribed an angiotensin-converting enzyme (ACE) inhibitor. The nurse practitioner reviewing this client’s chart before administering the medication will be most concerned about which other disease process? a. Bronchial asthma b. Coronary artery disease c. Diabetes mellitus d. Renal artery stenosis CORRECT: D ACE inhibitors can cause severe renal insufficiency in clients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney. Bronchial asthma, coronary artery disease, and diabetes mellitus are not comorbidities that are contraindications to treatment with an ACE inhibitor. PTS: 1 2. A nurse practitioner administers an ACE inhibitor to a client who is taking the drug for the first time. What will the nurse practitioner do? a. Instruct the client not to get up without assistance. b. Make sure the client takes a potassium supplement. c. Report the presence of a dry cough to the prescriber. d. Request an order for a diuretic to counter the side effects of the ACE inhibitor. CORRECT: A Severe hypotension can result with the first dose of an ACE inhibitor. The client should be discouraged from getting up without assistance. Potassium supplements are contraindicated. A dry cough is an expected side effect that eventually may cause a client to discontinue the drug; however, it is not a contraindication to treatment. Diuretics can exacerbate hypotension and should be discontinued temporarily when a client starts an ACE inhibitor. PTS: 1 3. A client who has been taking an antihypertensive medication for several years is recovering from a myocardial infarction. The prescriber changes the client’s medication to an ACE inhibitor. The client asks the nurse practitioner why a new drug is necessary. What is the nurse practitioner’s response? a. “ACE inhibitors can prevent or reverse pathologic changes in the heart’s structure.” b. “ACE inhibitors help lower LDL cholesterol and raise HDL cholesterol.” c. “ACE inhibitors increase venous return to the heart, improving cardiac output.” d. “ACE inhibitors regulate electrolytes that affect the cardiac rhythm.” CORRECT: A ACE inhibitors have many advantages over other antihypertensive medications, the most important of which is their ability to prevent or reverse pathologic changes in the heart and reduce the risk of cardiac mortality caused by hypertension. They are useful in clients with high low-density lipoprotein (LDL) or low high-density lipoprotein (HDL) cholesterol, but they do not directly affect this comorbidity. They reduce venous return to the heart, thereby reducing right heart size. They do not alter serum electrolyte levels.Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal PTS: 1 4. A prescriber orders ramipril [Altace] for an obese client with type 2 diabetes mellitus who has developed hypertension. The nurse practitioner provides teaching before dismissing the client home. Whichstatement by the client indicates understanding of the teaching? a. “I am less likely to develop diabetic nephropathy when taking this medication.” b. “I should check my blood sugar more often, because hyperglycemia is a side effect of this drug.” c. “Taking this medication helps reduce my risk of stroke and heart attack.” d. “This medication will probably prevent the development of diabetic retinopathy.” CORRECT: C Ramipril [Altace] is approved for reducing the risk of stroke and myocardial infarction (MI) in clients at high risk for a major cardiovascular event because they have hypertension in conjunction with a history of stroke or MI or because they have diabetes. ACE inhibitors cannot be used for primary prevention of diabetic nephropathy, but they can delay the onset of overt nephropathy in clients who already have less advanced nephropathy. ACE inhibitors do not affect serum electrolytes or glucose. One ACE inhibitor, enalapril, can reduce the risk of diabetic retinopathy in some clients with type 1 diabetes mellitus. PTS: 1 5. A client begins taking an ACE inhibitor and complains of a dry cough. What does the nurse practitioner correctly tell the client 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 clients taking the drug. c. It may be uncomfortable enough that the drug will need to be discontinued. d. It occurs frequently in clients taking the drug but will subside over time. CORRECT: C A cough occurs in about 10% of clients taking ACE inhibitors and is the most common reasonfor discontinuing therapy. It does not indicate a serious condition. It occurs in about 10% of all clients and is more common in women, older adults, and those of Asian ancestry. It does not subside until the medication is discontinued. PTS: 1 6. A provider has ordered captopril [Capoten] for a client who has hypertension. The client reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nurse practitioner is correct? a. Administer the captopril and monitor for adverse effects. b. Hold the dose and notify the provider. c. Request an order to administer fosinopril instead of captopril. d. Reassure the client that this is not a serious side effect. CORRECT: BStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal Angioedema is a potentially life-threatening reaction to ACE inhibitors. If a client has exhibited this reaction with any ACE inhibitor, he or she should not receive ACE inhibitors again. The nurse practitioner should hold the medication and notify the provider. Fosinopril is an ACE inhibitor and should not be given. PTS: 1 7. A nurse practitioner is reviewing a client’s medications before administration. Which drug-to-druginteractions will most concern the nurse practitioner in a client with a history of heart failure and a potassium level of 5.5 mEq/L? a. Furosemide [Lasix] and enalapril [Vasotec] b. Amlodipine [Norvasc] and spironolactone [Aldactone] c. Captopril [Capoten] and spironolactone [Aldactone] d. Metoprolol [Lopressor] and furosemide [Lasix] CORRECT: C ACE inhibitors increase the risk of hyperkalemia, and combining this drug with a potassium- sparing diuretic creates a significant risk of hyperkalemia. Furosemide and enalapril, an ACE inhibitor, would not be contraindicated in this client. Amlodipine and spironolactone would not cause hyperkalemia. The combination of metoprolol, a beta blocker, and furosemide would not be contraindicated in this client. PTS: 1 8. A client who is taking furosemide [Lasix] and digoxin will begin taking captopril [Capoten]. The nurse practitioner is providing information about the drug. Which statement by the client indicates aneed for further teaching? a. “I can use acetaminophen for analgesia if needed.” b. “I should stop taking the Lasix about a week before starting the Capoten.” c. “I should take this medication on a full stomach.” d. “I will need to have blood tests done every 2 weeks for a few months.” CORRECT: C Most oral formulations of ACE inhibitors may be given without regard for meals; captopril and moexipril, however, should be given 1 hour before meals. Nonsteroidal anti-inflammatory medications should be avoided; acetaminophen is not contraindicated. Clients taking diuretics should stop taking them 1 week before starting an ACE inhibitor to minimize the risk of hypotension. A WBC with differential should be evaluated at baseline and, after treatment starts, every 2 weeks for several months to monitor for neutropenia. PTS: 1 9. A client who stops taking an ACE inhibitor because of its side effects will begin taking an angiotensin II receptor blocker (ARB) medication. Which side effect of ACE inhibitors will not occur with an ARB medication? a. Angioedema b. Cough c. HyperkalemiaStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal d. Renal failure CORRECT: C ARBs do not produce clinically significant hyperkalemia. Angioedema may occur with ARBs, but the incidence is lower than with ACE inhibitors. They do not promote the accumulation of bradykinin in the lungs and produce a lower incidence of cough. An increased risk of cancer may be a concern with ARBs but is not a concern with ACE inhibitors. As with ACE inhibitors, renal failure can occur in clients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney. PTS: 1 10. A female client who is not taking any other medications is prescribed aliskiren [Tekturna], a direct renin inhibitor (DRI). The nurse practitioner reviews medication information with the client. Whichstatement by the client indicates understanding of the teaching? a. “If I get pregnant, I should stop taking this drug by the second trimester.” b. “If I take this drug with a high-fat meal, it will be more effective.” c. “I should restrict my potassium intake while taking this drug.” d. “I should take this medication 1 hour before sitting down to a meal.” CORRECT: D DRIs should be taken on an empty stomach to improve their bioavailability. Clients should not take this drug when pregnant and should stop immediately upon finding out they are pregnant. Dosing with a high-fat meal reduces the drug’s bioavailability. DRIs rarely cause hyperkalemia when taken alone. PTS: 1 11. A female client who begins taking spironolactone [Aldactone] as an adjunct to furosemide [Lasix] complains that her voice is deepening. What will the nurse practitioner do? a. Contact the provider to obtain an order for a complete blood count (CBC) and liver function tests. b. Explain that this drug binds with receptors for steroid hormones, causing this effect. c. Report this side effect to the provider and request another medication for this client. d. Teach the client to report any associated cough, which may indicate a more severe side effect. CORRECT: B Spironolactone binds with receptors for aldosterone and with other steroid hormones, causing side effects such as gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of the voice. There is no indication for a CBC or for liver function tests in this client with this side effect. Deepening of the voice is not an indication for withdrawal of the drug. This side effect is not associated with cough. PTS: 1Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal 12. A female client taking an ACE inhibitor learns that she is pregnant. What will the nurse practitioner tell thisclient? a. The fetus most likely will have serious congenital defects. b. The fetus must be monitored closely while the client is taking this drug. c. The client’s prescriber probably will change her medication to an ARB. d. The client should stop taking the medication and contact her provider immediately. CORRECT: D ACE inhibitors are known to cause serious fetal injury during the second and third trimesters of pregnancy. Whether injury occurs earlier in pregnancy is unknown, and the incidence probably is low. However, women should be counseled to stop taking the drug if they become pregnant, and they should not take it if they are contemplating becoming pregnant. Women who take ACE inhibitors in the first trimester should be counseled that the risk to the fetus is probably low. Women should stop taking the drug when pregnant. ARBs carry the same risk as ACE inhibitors. PTS: 1 Chapter 48: Calcium Channel Blockers Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition MULTIPLE CHOICE 1. A nurse practitioner is caring for a client who is receiving verapamil [Calan] for hypertension and digoxin[Lanoxin] for heart failure. The nurse practitioner will observe this client for: a. AV blockade. b. gingival hyperplasia. c. migraine headaches. d. reflex tachycardia. CORRECT: A Verapamil and digoxin both suppress impulse conduction through the AV node; when the two drugs are used concurrently, the risk of AV blockade is increased. Gingival hyperplasia can occur in rare cases with verapamil, but it is not an acute symptom. Verapamil can be used to prevent migraine, and its use for this purpose is under investigation. Verapamil and digoxin both suppress the heart rate. Nifedipine causes reflex tachycardia. PTS: 1 2. A client begins taking nifedipine [Procardia], along with metoprolol, to treat hypertension. The nurse practitioner understands that metoprolol is used to: a. reduce flushing. b. minimize gingival hyperplasia. c. prevent constipation. d. prevent reflex tachycardia. CORRECT: DStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal Beta blockers are combined with nifedipine to prevent reflex tachycardia. Beta blockers do not reduce flushing, minimize gingival hyperplasia, or prevent constipation. Beta blockers can reduce the adverse cardiac effects of nifedipine. PTS: 1 3. A nurse practitioner is teaching a client who will begin taking verapamil [Calan] for hypertension about thedrug’s side effects. Which statement by the client indicates understanding of the teaching? a. “I may become constipated, so I should increase fluids and fiber.” b. “I may experience a rapid heart rate as a result of taking this drug.” c. “I may have swelling of my hands and feet, but this will subside.” d. “I may need to increase my digoxin dose while taking this drug.” CORRECT: A Constipation is common with verapamil and can be minimized by increasing dietary fiber and fluids. Verapamil lowers the heart rate. Peripheral edema may occur secondary to vasodilation, and clients should notify their prescriber if this occurs, because the prescriber may use diureticsto treat the condition. Verapamil and digoxin have similar cardiac effects; also, verapamil may increase plasma levels of digoxin by as much as 60%, so digoxin doses may need to be reduced. PTS: 1 4. A nurse practitioner is preparing to assist a nursing student to administer intravenous verapamil to a client who also receives a beta blocker. The nurse practitioner asks the nursing student to discuss the plan of care for this client. Which statement by the student indicates a need for further teaching? a. “I will check to see when the last dose of the beta blocker was given.” b. “I will monitor vital signs closely to assess for hypotension.” c. “I will monitor the heart rate frequently to assess for reflex tachycardia.” d. “I will prepare to administer intravenous norepinephrine if necessary.” CORRECT: C Reflex tachycardia is not an expected effect; the greater risks are cardiosuppression and bradycardia. Because beta blockers and verapamil have the same effects on the heart, there is a risk of excessive cardiosuppression. To minimize this risk, the two drugs should be given several hours apart. Hypotension may occur and should be treated with IV norepinephrine. PTS: 1 5. A client who took an overdose of verapamil has been treated with gastric lavage and a cathartic. The emergency department nurse practitioner assesses the client and notes a heart rate of 50 beats/min and ablood pressure of 90/50 mm Hg. The nurse practitioner will anticipate: a. administering intravenous norepinephrine (NE) and atropine and glucagon. b. assisting with direct-current (DC) cardioversion. c. placing the client in an upright position. d. preparing to administer a beta blocker. CORRECT: AStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal Verapamil toxicity can cause bradycardia and hypotension. Atropine and glucagon should be given to treat bradycardia and NE for hypotension. DC cardioversion is indicated for ventricular tachydysrhythmias, which this client does not have. Clients with hypotension should be placed in Trendelenburg’s position. Beta blockers will only exacerbate these effects. PTS: 1 6. A client who has been taking verapamil [Calan] for hypertension complains of constipation. The client will begin taking amlodipine [Norvasc] to avoid this side effect. The nurse practitioner providesteaching about the difference between the two drugs. Which statement by the client indicates that further teaching is needed? a. “I can expect dizziness and facial flushing with nifedipine.” b. “I should notify the provider if I have swelling of my hands and feet.” c. “I will need to take a beta blocker to prevent reflex tachycardia.” d. “I will need to take this drug once a day.” CORRECT: C Amlodipine produces selective blockade of calcium channels in blood vessels with minimal effects on the heart. Reflex tachycardia is not common, so a beta blocker is not indicated to prevent this effect. Dizziness and facial flushing may occur. Peripheral edema may occur and should be reported to the provider. Amlodipine is given once daily. PTS: 1 MULTIPLE RESPONSE 1. Which are therapeutic uses of verapamil? (Select all that apply.) a. Angina of effort b. Cardiac dysrhythmias c. Essential hypertension d. Sick sinus syndrome e. Suppression of preterm labor CORRECT: A, B, C Verapamil is used to treat both vasospastic angina and angina of effort. It slows the ventricular rate in clients with atrial flutter, atrial fibrillation, and paroxysmal supraventricular tachycardia. It is a first-line drug for the treatment of essential hypertension. It is contraindicated in clients with sick sinus syndrome. Nifedipine has investigational uses in suppressing preterm labor. PTS: 1 Chapter 49: Vasodilators Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition MULTIPLE CHOICE 1. A nurse practitioner is administering a vasodilator that dilates resistance vessels. The nurse practitioner understands thatthis drug will have which effect on the client?Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal a. Decreased cardiac preload b. Decreased cardiac output c. Increased tissue perfusion d. Increased ventricular contraction CORRECT: C Vasodilators that dilate resistance vessels, or arterioles, cause a decrease in afterload, which allows cardiac output and tissue perfusion to increase. A decrease in preload would be the result of dilation of capacitance vessels, or veins. Dilation of arterioles increases cardiac output. Ventricular contraction results when preload is increased. PTS: 1 2. A client is taking a vasodilator that relaxes smooth muscles in veins. To help minimize drug side effects, the nurse practitioner caring for this client will: a. caution the client not to get up abruptly. b. encourage the client to increase fluid intake. c. tell the client to report shortness of breath. d. warn the client about the possibility of bradycardia. CORRECT: A Postural hypotension occurs when moving from a supine or seated position to an upright position. It is caused by relaxation of smooth muscle in veins, which allows blood to pool in veins and decreases venous return of blood to the heart. Clients taking such drugs should avoid abrupt transitions to prevent falls. Prolonged use of vasodilators can lead to expansion of blood volume and fluid overload, so increasing fluid intake is not appropriate. Shortness of breath is a symptom associated with heart failure. Tachycardia can occur when the blood pressure drops as a result of the baroreceptor reflex. PTS: 1 3. A nurse practitioner is caring for a client who will begin taking hydralazine to treat hypertension. Whichstatement by the client indicates understanding of the nurse practitioner’s teaching about this drug? a. “I will need to ask for assistance when getting up out of a chair.” b. “I will also take a beta blocker medication with this drug to prevent rapid heart rate.” c. “I may develop joint pain, but this side effect will decrease over time.” d. “This drug may cause excessive hair growth on my face, arms, and back.” CORRECT: B Hydralazine can cause severe reflex tachycardia; a beta blocker is usually given to counter this effect. Postural hypotension is minimal with hydralazine. Clients should be taught to report joint pain, which indicates an SLE syndrome and requires discontinuation of the drug. Minoxidil can cause excessive hair growth, not hydralazine. PTS: 1 4. The nurse practitioner is caring for a client who is taking a vasodilator that dilates capacitance vessels. Thenurse practitioner will expect which effect in this client?Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal a. Decrease in cardiac work b. Increase in cardiac output c. Increase in tissue perfusion d. Increase in venous return CORRECT: A Vasodilators that dilate capacitance vessels, or veins, lead to a decrease in venous return to the heart, which reduces preload and the force of ventricular contraction. The resultant effect is a decrease in cardiac work. With a decrease in ventricular contraction, cardiac output is reduced, as is tissue perfusion. Dilation of veins causes a decrease in venous return. PTS: 1 5. A nurse practitioner is reviewing the phenomenon of reflex tachycardia with a group of nursing students. Which statement by a student indicates understanding of this phenomenon? a. “Baroreceptors in the aortic arch stimulate the heart to beat faster.” b. “Reflex tachycardia can negate the desired effects of vasodilators.” c. “Reflex tachycardia is more likely to occur when beta blockers are given.” d. “Venous dilation must occur for reflex tachycardia to occur.” CORRECT: B Reflex tachycardia, which is a compensatory mechanism in response to decreased blood pressure, can negate the desired effect of a vasodilator by eventually increasing blood pressure. Baroreceptors relay information to the vasomotor center of the medulla; the medulla sends impulses to the heart. Beta blockers are given to counter reflex tachycardia. Reflex tachycardia can be produced by dilation of both arterioles and veins. PTS: 1 6. A female client with essential hypertension is being treated with hydralazine 25 mg twice daily. The nurse practitioner assesses the client and notes a heart rate of 96 beats/min and a blood pressure of 110/72 mm Hg. The nurse practitioner will request an order to: a. administer a beta blocker. b. administer a drug that dilates veins. c. reduce the dose of hydralazine. d. give the client a diuretic. CORRECT: A This client is showing signs of reflex tachycardia, so a beta blocker is indicated to slow the heart rate. Clients with heart failure who take hydralazine often require the addition of isosorbide dinitrate, which also dilates veins. There is no indication for reducing the dose of hydralazine. A diuretic can be given with hydralazine if sodium and water retention is present. PTS: 1 7. A nurse practitioner is obtaining a medication history on a newly admitted client, who reports taking minoxidil for hypertension. Admission vital signs reveal a heart rate of 78 beats/min and a bloodpressure of 120/80 mm Hg. What is an important part of the initial assessment for this client? a. Evaluating ankle edemaStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal b. Monitoring for nausea and vomiting c. Noting the presence of hypertrichosis d. Obtaining a blood glucose CORRECT: A Fluid retention is a common and serious adverse effect of minoxidil, because it can lead to cardiac decompensation. If present, a diuretic is indicated. Nausea and vomiting may occur with this drug but is not a serious side effect. Hypertrichosis occurs in about 80% of clients taking the drug, but its effects are cosmetic and not life threatening. It may be important to monitor the blood glucose level in some clients, because the drug can alter glucose tolerance, but this effect is not as serious as fluid retention. PTS: 1 8. A client is admitted with severe hypertensive crisis. The nurse practitioner will anticipate administeringwhich medication? a. Captopril PO b. Hydralazine [Apresoline] 25 mg PO c. Minoxidil 20 mg PO d. Sodium nitroprusside [Nitropress] IV CORRECT: D Sodium nitroprusside is the drug of choice for hypertensive emergencies and is given intravenously. ACE inhibitors, such as captopril, are not used. Hydralazine may be used but should be given IV. Minoxidil is effective, but its severe side effects make it a second-line drug. PTS: 1 9. A nursing student asks a nurse practitioner why a client in hypertensive crisis is receiving both intravenous sodium nitroprusside [Nitropress] and oral hydralazine. The nurse practitioner will explain that this is done to prevent: a. cyanide poisoning. b. fluid retention. c. rebound hypertension. d. reflex tachycardia. CORRECT: C Sodium nitroprusside acts rapidly and is given only intravenously. Rebound hypertension occurs immediately when the IV is stopped, so an oral antihypertensive should be given simultaneously. Cyanide poisoning can occur with sodium nitroprusside, but giving hydralazine does not counter this adverse effect. Hydralazine does not prevent fluid retention or reflex tachycardia. PTS: 1 MULTIPLE RESPONSE 1. Which medications are most likely to cause postural hypotension? (Select all that apply.) a. MinoxidilStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal b. Diltiazem [Cardizem] c. Prazosin [Minipress] d. Captopril [Capoten] e. Losartan [Cozaar] CORRECT: C, D, E Postural, or orthostatic, hypotension is defined as a fall in blood pressure related to a change in position. Minoxidil and diltiazem dilate arterioles; therefore, they are not likely to cause postural hypotension. Prazosin, captopril, and losartan all reportedly can cause orthostatic hypotension. PTS: 1 2. Which clients may receive hydralazine to treat hypertension? (Select all that apply.) a. A 1-month-old infant b. A 5-year-old child c. A pregnant woman d. A mother breast-feeding a newborn e. An older adult CORRECT: A, B, E Hydralazine may be used in infants as young as 1 month of age, in children, and in older adults. Hydralazine is labeled pregnancy category C and data is lacking regarding transmission of hydralazine in breast-feeding women, so benefits should outweigh risks. PTS: 1 Chapter 50: Drugs for Hypertension Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition MULTIPLE CHOICE 1. A client has had blood pressures of 150/95 and 148/90 mm Hg on two separate office visits. The client reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The client’s diagnostic tests are all normal. The nurse practitioner will expect this client’s provider to order: a. a beta blocker. b. a loop diuretic and spironolactone. c. a thiazide diuretic. d. counseling on lifestyle changes. CORRECT: C This client has primary, or essential, hypertension as evidenced by systolic pressure greater than 140 and diastolic pressure greater than 90, along with normal tests ruling out another primary cause. Thiazide diuretics are first-line drugs for hypertension. Beta blockers are effective but are most often used to counter reflex tachycardia associated with reduced blood pressure caused by therapeutic agents. Loop diuretics cause greater diuresis than is usually needed and so are not first-line drugs. This client should be counseled on lifestyle changes as an adjunct to drug therapy but should also begin drug therapy because hypertension already exists. PTS: 1Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal 2. A client with diabetes develops hypertension. The nurse practitioner will anticipate administering whichtype of medication to treat hypertension in this client? a. ACE inhibitors b. Beta blockers c. Direct-acting vasodilators d. Thiazide diuretics CORRECT: A ACE inhibitors slow the progression of kidney injury in diabetic clients with renal damage. Beta blockers can mask signs of hypoglycemia and must be used with caution in diabetics. Direct-acting vasodilators are third-line drugs for chronic hypertension. Thiazide diuretics promote hyperglycemia. PTS: 1 3. A client has three separate blood pressure (BP) readings of 120/100, 138/92, and 126/96 mm Hg. Which category describes this client’s BP? a. Hypertension b. Isolated systolic hypertension c. Normal d. Prehypertension CORRECT: A Hypertension is defined as systolic BP over 140 mm Hg or diastolic BP over 90 mm Hg. When systolic and diastolic BP fall into different categories, classification is based on the higher category. This client has a hypertensive diastolic BP. Isolated systolic hypertension occurs if the systolic BP is greater than 140 mm Hg with a diastolic BP less than 90 mm Hg. Because this client has an elevated diastolic BP, it is not considered normal. Prehypertension occurs with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg. PTS: 1 4. A nurse practitioner checks a client’s vital signs in the hospital and notes a blood pressure of 146/98 mmHg. What will the nurse practitioner do? a. Instruct the client to consume a low-sodium diet. b. Prepare the client for an electrocardiogram and blood tests. c. Recheck the client’s blood pressure in the other arm. d. Request an order for a thiazide diuretic. CORRECT: C Diagnosis of hypertension should be based on several blood pressure readings, not just one. High readings should be confirmed in the contralateral arm. Low-sodium diets are indicated for clients with confirmed hypertension. An electrocardiogram and blood tests are indicated for clients with confirmed hypertension to rule out primary causes. Thiazide diuretics are first-line drugs for confirmed hypertension. PTS: 1Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal 5. A client who does not consume alcohol or nicotine products reports a strong family history of hypertension and cardiovascular disease. The client has a blood pressure of 126/82 and a normal weight and body mass index for height and age. The nurse practitioner will expect to teach this client about: a. ACE inhibitors and calcium channel blocker medications. b. the DASH diet, sodium restriction, and exercise. c. increased calcium and potassium supplements. d. thiazide diuretics and lifestyle changes. CORRECT: B This client has prehypertension without other risk factors. Lifestyle changes are indicated at this point. If blood pressure rises to hypertension levels, other measures, including drug therapy, will be initiated. Calcium and potassium supplements are not indicated. PTS: 1 6. A client with hypertension with a blood pressure of 168/110 mm Hg begins taking hydrochlorothiazide and verapamil. The client returns to the clinic after 2 weeks of drug therapy, and the nurse practitioner notes a blood pressure of 140/85 mm Hg and a heart rate of 98 beats/min. What will the nurse practitioner do? a. Notify the provider and ask about adding a beta-blocker medication. b. Reassure the client that the medications are working. c. Remind the client to move slowly from sitting to standing. d. Request an order for an electrocardiogram. CORRECT: A Beta blockers are often added to drug regimens to treat reflex tachycardia, which is a common side effect of lowering blood pressure, caused by the baroreceptor reflex. The client’s blood pressure is responding to the medications, but the tachycardia warrants treatment. Reminding the client to move slowly from sitting to standing is appropriate with any blood pressure medication, but this client has reflex tachycardia, which must be treated. An electrocardiogram is not indicated. PTS: 1 7. A client has been taking chlorthalidone to treat hypertension. The client’s prescriber has just ordered the addition of spironolactone to the client’s drug regimen. Which statement by the client indicates a need for further teaching? a. “I should continue following the DASH diet when adding this drug.” b. “I should not take an ACE inhibitor when adding this drug.” c. “I will need to take potassium supplements when adding this drug.” d. “I will not experience a significant increase in diuresis when adding this drug.” CORRECT: CStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal Spironolactone is given in addition to thiazide diuretics to balance potassium loss caused by the thiazide diuretic. Clients should be advised against taking potassium supplements with spironolactone, because hyperkalemia can result. The DASH diet may be continued. ACE inhibitors are contraindicated because they promote hyperkalemia. Spironolactone does not significantly increase diuresis. PTS: 1 8. A nurse practitioner is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching? a. “Beta blockers block the actions of angiotensin II.” b. “Beta blockers decrease heart rate and contractility.” c. “Beta blockers decrease peripheral vascular resistance.” d. “Beta blockers decrease the release of renin.” CORRECT: A Beta blockers reduce the release of renin by blockade of beta1 receptors on juxtaglomerular cells in the kidney, which reduce angiotensin II–mediated vasoconstriction, but do not block the actions of angiotensin II directly. Beta blockers decrease heart rate and cardiac contractility, decrease peripheral vascular resistance, and decrease the release of renin. PTS: 1 9. A client with hypertension will begin taking an alpha1 blocker. What will the nurse practitioner teach thisclient? a. A persistent cough is a known side effect of this drug. b. Eat foods rich in potassium while taking this drug. c. Move slowly from sitting to standing when taking this drug. d. Report shortness of breath while taking this drug. CORRECT: C The most disturbing side effect of alpha blockers is orthostatic hypotension. Clients taking these drugs should be cautioned to stand up slowly to avoid lightheadedness or falls. A persistent cough is a common side effect of ACE inhibitors. It is not necessary to increase dietary potassium intake when taking this drug. Shortness of breath may occur in individuals with asthma who are taking beta blockers. PTS: 1 10. A client is taking clonidine for hypertension and reports having dry mouth and drowsiness. What will the nurse practitioner tell the client? a. Beta blockers can reverse these side effects. b. Discontinue the medication immediately and notify the provider. c. Drink extra fluids and avoid driving when drowsy. d. Notify the provider if symptoms persist after several weeks. CORRECT: CStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal Clonidine can cause dry mouth and sedation; clients should be warned to drink extra fluids and avoid driving. Beta blockers do not reverse these drug side effects. Discontinuing clonidine abruptly can cause severe rebound hypertension. These are common side effects that do not abate over time. PTS: 1 11. A client takes an ACE inhibitor to treat hypertension and tells the nurse practitioner that she wants tobecome pregnant. She asks whether she should continue taking the medication while she ispregnant. What will the nurse practitioner tell her? a. Controlling her blood pressure will decrease her risk of preeclampsia. b. Ask the provider about changing to an ARB during pregnancy. c. Continue taking the ACE inhibitor during her pregnancy. d. Discuss using methyldopa instead while she is pregnant. CORRECT: D Methyldopa has limited effects on uteroplacental and fetal hemodynamics and does not adversely affect the fetus or neonate. Controlling blood pressure does not lower the risk of preeclampsia. ACE inhibitors and ARBs are specifically contraindicated during pregnancy. PTS: 1 12. A hospitalized client has a blood pressure of 145/96 mm Hg. The nurse practitioner caring for this client notes that the blood pressure the day before was 132/98 mm Hg. The client reports ambulatoryblood pressure readings of 136/98 and 138/92 mm Hg. The client has a history of a previous myocardial infarction and has adopted a lifestyle that includes use of the DASH diet and regularexercise. What will the nurse practitioner do? a. Notify the provider and discuss ordering a beta blocker for this client. b. Notify the provider and suggest a thiazide diuretic as initial therapy. c. Order a diet low in sodium and high in potassium for this client. d. Recheck the client’s blood pressure in 4 hours to verify the result. CORRECT: A Initial drug selection is determined by the presence or absence of a compelling indication or comorbid condition. This client has a history of MI; beta blockers are indicated for clients with pre-existing heart disease. Thiazide diuretics are first-line drugs of choice in clients without compelling indications. The client is already consuming a DASH diet; closer monitoring of sodium or potassium will not help lower blood pressure. The client has a record of hypertension, so it is unnecessary to recheck the blood pressure to verify the condition. PTS: 1 13. Which two-drug regimen would be appropriate for a client with hypertension who does not have other compelling conditions? a. Hydrochlorothiazide and nadolol b. Hydralazine and minoxidil c. Spironolactone and amiloride d. Trichlormethiazide and hydrochlorothiazideStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal CORRECT: A When two or more drugs are used to treat hypertension, each drug should come from a different class. Hydrochlorothiazide is a diuretic and nadolol is a beta blocker, so this choice is appropriate. Hydralazine and minoxidil are vasodilators. Spironolactone and amiloride are potassium-sparing diuretics. Trichlormethiazide and hydrochlorothiazide are both thiazide diuretics. PTS: 1 14. A nursing student asks the nurse practitioner why multi-drug therapy is often used to treat hypertension. Which statement by the student indicates a need for further teaching? a. “Multi-drug therapy often means that drugs may be given in lower doses.” b. “Some agents are used to offset adverse effects of other agents.” c. “Treatment of hypertension via different mechanisms increases success.” d. “Two or more drugs will lower blood pressure more quickly.” CORRECT: D Multi-drug therapy does not lower blood pressure more quickly. Using more than one drug often means that doses can be decreased. Some agents can offset adverse effects of other agents. Treatment via different mechanisms increases the likelihood of success. PTS: 1 15. A client with a recent onset of nephrosclerosis has been taking an ACE inhibitor and a thiazide diuretic. The client’s initial blood pressure was 148/100 mm Hg. After 1 month of drug therapy, the client’s blood pressure is 130/90 mm Hg. The nurse practitioner will contact the provider to discuss: a. adding a calcium channel blocker to this client’s drug regimen. b. lowering doses of the antihypertensive medications. c. ordering a high-potassium diet. d. adding spironolactone to the drug regimen. CORRECT: A In clients with renal disease, the goal of antihypertensive therapy is to lower the blood pressure to 130/80 mm Hg or less. Adding a third medication is often indicated. Lowering the dose of the medications is not indicated because the client’s blood pressure is not in the target range. Adding potassium to the diet and using a potassium-sparing diuretic are contraindicated. PTS: 1 16. A 5-year-old client seen in an outclient clinic is noted to have hypertension on three separate visits. Ambulatory blood pressure monitoring confirms that the child has hypertension. As an initial intervention with the child’s parents, the nurse practitioner will expect to: a. perform a detailed health history on the child. b. provide teaching about antihypertensive medications. c. reassure the parents that their child may outgrow this condition. d. teach the parents about lifestyle changes and a special diet. CORRECT: AStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal Because the incidence of secondary hypertension is much higher in children than adults, it is important to obtain an accurate health history to help uncover primary causes. Once the type of hypertension is established, the teaching interventions may be useful. Hypertension must be treated, and it is incorrect to reassure parents that their child may just outgrow the condition. PTS: 1 17. The nurse practitioner is caring for a pregnant client who is in labor. The woman reports having had mild preeclampsia with a previous pregnancy. The nurse practitioner notes that the woman has a blood pressure of168/102 mm Hg. The nurse practitioner will contact the provider to request an order for which drug? a. Angiotensin-converting enzyme (ACE) inhibitor b. Hydralazine (Apresoline) c. Magnesium sulfate d. Sodium nitroprusside CORRECT: B The drug of choice for lowering blood pressure in a client with severe preeclampsia is hydralazine. Sodium nitroprusside is not indicated. Magnesium sulfate is given as prophylaxis against seizures but does not treat hypertension. ACE inhibitors are contraindicated because of their potential for fetal harm. PTS: 1 18. A nurse practitioner has provided education for a client newly diagnosed with hypertension who is just beginning therapy with antihypertensive medications. Which statement by the client indicates aneed for further teaching? a. “I may experience serious long-term problems even if I am not having symptoms.” b. “I should report side effects to the provider since other drugs may be substituted.” c. “I will need to take medications on a long-term basis.” d. “When my symptoms subside, I may discontinue the medications.” CORRECT: D Clients should be taught that hypertension treatment is lifelong and that medications must be continued even when symptoms subside. Long-term problems may still occur without symptoms. Reporting drug side effects is necessary so that other drugs may be tried if needed. PTS: 1 19. A 60-year-old African American client has a blood pressure of 120/80 mm Hg and reports a family history of hypertension. The client has a body mass index of 22.3. The client reports consuming alcohol occasionally. Which therapeutic lifestyle change will the nurse practitioner expect to teach this client? a. Alcohol cessation b. Potassium supplementation c. Sodium restriction d. Weight loss CORRECT: CStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal Current recommendations for African Americans to prevent hypertension include sodium restriction of less than 1500 mg/day, although this is under investigation. The client has a normal BMI and does not consume alcohol excessively, so weight loss and alcohol cessation are not necessary. Potassium supplements are not indicated; clients should be advised to consume foods high in potassium. PTS: 1 Chapter 51: Drugs for Heart Failure Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition MULTIPLE CHOICE 1. A client is taking enalapril [Vasotec]. The nurse practitioner understands that clients taking this type ofdrug for heart failure need to be monitored carefully for: a. hypernatremia. b. hypertension. c. hyperkalemia. d. hypokalemia. CORRECT: C One of the principal effects of angiotensin-converting enzyme (ACE) inhibitors is hyperkalemia, which is due to decreased aldosterone release arising from blockage of angiotensin II. There is no indication that careful monitoring of sodium for increased levels is indicated. Vasotec is indicated for heart failure, not hypertension. The drug therapy should be monitored to ascertain its effectiveness, but hyperkalemia is the main concern. Hyperkalemia, not hypokalemia, is a concern because of the decreased aldosterone release that occurs with blockage of angiotensin II. PTS: 1 2. A nurse practitioner is discussing heart failure with a group of nursing students. Which statement by a student reflects an understanding of how compensatory mechanisms can compound existingproblems in clients with heart failure? a. “An increase in arteriolar tone to improve tissue perfusion can decrease resistance.” b. “An increase in contractility to increase cardiac output can cause pulmonary edema.” c. “When the heart rate increases to increase cardiac output, it can prevent adequate filling of the ventricles.” d. “When venous tone increases to increase ventricular filling, an increase in arterial pressure occurs.” CORRECT: CStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal c. Decreased heart rate d. Modulation of neurohormonal systems e. Positive inotropic effects CORRECT: C, D, E Digoxin slows the heart rate, modulates the activity of neurohormonal systems, and increases the force of contraction. It does not decrease cardiac output or reduce the force of contraction. PTS: 1 Chapter 52: Antidysrhythmic Drugs Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition MULTIPLE CHOICE 1. Which two classes of antidysrhythmic drugs have nearly identical cardiac effects? a. Beta blockers and calcium channel blockers b. Beta blockers and potassium channel blockers c. Calcium channel blockers and sodium channel blockers d. Sodium channel blockers and potassium channel blockers CORRECT: A Calcium channel blockade has the same impact on cardiac action potentials as does beta blockade, so these agents have nearly identical effects on cardiac function; that is, they reduce automaticity in the SA node, delay conduction through the AV node, and reduce myocardial contractility. Potassium channel blockers act by delaying repolarization of fast potentials. Sodium channel blockers block sodium channels to slow impulse conduction in the atria, ventricles, and His-Purkinje system. PTS: 1 2. A client with atrial fibrillation is taking verapamil [Calan]. The client has read about the drugon the internet, and wants to know why a drug that affects the rate of ventricular contraction is used to treat an abnormal atrial contraction. What will the nurse practitioner tell the client? a. “Drugs that treat ventricular dysrhythmias help to restore normal sinus rhythm.” b. “Atrial dysrhythmias can have life-threatening effects on ventricular function.” c. “Treating ventricular dysrhythmias helps prevent the likelihood of stroke.” d. “When ventricular contraction slows, atrial contraction is also slowed.” CORRECT: B Dysrhythmic activity in the atria does not significantly reduce cardiac output but can be dangerous when dysrhythmic impulses cross the AV node, causing ventricular dysrhythmias, which can be life threatening. Treating ventricular dysrhythmia helps improve ventricular pumping. These drugs do not restore normal sinus rhythm. To prevent stroke, an anticoagulant, such as warfarin, is used. Slowing ventricular contraction does not affect the rate of atrial contraction. Restoring normal sinus rhythm requires cardioversion, short-term treatment with amiodarone or sotalol, or RF ablation of the dysrhythmia source. PTS: 1Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal 3. A nurse practitioner is teaching a client who is about to undergo direct-current (DC) cardioversion to treat atrial flutter. The client has been taking verapamil and warfarin for 6 months. Which statement by the client indicates understanding of the teaching? a. “I may need long-term therapy with another cardiac medication after the procedure.” b. “I should stop taking warfarin a few days before the procedure.” c. “I will need to take a beta blocker after the procedure to prevent recurrence of atrial flutter.” d. “I will not have to take antidysrhythmic medications after the procedure.” CORRECT: A After cardioversion for atrial flutter, clients may continue to need long-term therapy with either a class IC agent or a class III agent to prevent recurrence. Clients undergoing DC cardioversion need to take warfarin 3 to 4 weeks before the procedure and for several weeks afterward. Beta blockers are not indicated for postprocedural prophylaxis. Class IC and class III agents are antidysrhythmic drugs. PTS: 1 4. A nurse practitioner is teaching a group of nursing students about antidysrhythmic medications. Whichstatement by a student indicates understanding of the teaching? a. “Antidysrhythmic drugs can cause new dysrhythmias or worsen existing ones.” b. “Adverse effects of these drugs are mainly noncardiac in nature.” c. “For most antidysrhythmic drugs, there is evidence of reduced mortality.” d. “Use of these drugs may be necessary even if the benefits are unknown.” CORRECT: A Because antidysrhythmic drugs have prodysrhythmic actions, they can exacerbate existing dysrhythmias or generate new ones. Most adverse effects are cardiac related. There is evidence of increased mortality with many of these drugs. Use of these drugs should be limited to situations in which there is a clear benefit and only if that benefit outweighs any risks. PTS: 1 5. A client is taking digoxin [Lanoxin] and quinidine to treat sustained ventricular tachycardia. Before giving medications, the nurse practitioner reviews the client’s electrocardiogram (ECG) and notes aQRS complex that has widened by 50% from the baseline ECG. What will the nurse practitioner do? a. Administer the medications as ordered, because this indicates improvement. b. Contact the provider to discuss reducing the digoxin dose. c. Contact the provider to request an increase in the quinidine dose. d. Withhold the quinidine and contact the provider to report the ECG finding. CORRECT: DStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal Quinidine widens the QRS complex by slowing depolarization of the ventricles. As cardiotoxicity develops as a result of quinidine toxicity, the QRS complex widens excessively. Any widening of the QRS complex of 50% or more warrants notifying the provider, so the nurse practitioner should withhold the medication and contact the provider. Widening of the QRS complex by more than 50% of baseline indicates cardiotoxicity. Quinidine can double digoxin levels, so it is not likely that the digoxin dose would need to be increased, and an increase in the QRS complexdoes not indicate a need for more digoxin. The quinidine dose should not be increased, because the findings indicate cardiotoxicity from the quinidine. PTS: 1 6. A nurse practitioner provides teaching for a client who will begin taking procainamide [Procanbid] for long-term suppression of a dysrhythmia. Which statement by the client indicates a need for further teaching? a. “I need to take this drug at evenly spaced intervals around the clock.” b. “I may have increased bruising, but this is a temporary side effect.” c. “I should report pain and swelling in my joints when taking this drug.” d. “I will need to have blood tests at regular intervals while taking this drug.” CORRECT: B Blood dyscrasias are a rare but potentially fatal side effect of procainamide and are an indication for withdrawing the drug. Procainamide should be taken around the clock at evenly spaced intervals. Lupus-like symptoms may occur; inflammation of the joints is one manifestation and should be reported so that antinuclear antibody (ANA) titers can be monitored. Because of the risk of lupus-like symptoms and blood dyscrasias, blood tests need to be done weekly at first and then periodically thereafter. PTS: 1 7. A nurse practitioner is caring for a client in the intensive care unit who is receiving intravenous lidocaine. The client is drowsy, confused, and reports numbness of the fingers and toes. Which standingorder will the nurse practitioner initiate at this time? a. Administer diazepam. b. Reduce the rate of infusion. c. Discontinue the infusion. d. Prepare for mechanical ventilation. CORRECT: B This client is showing signs that are common with high therapeutic levels of lidocaine. Because lidocaine is rapidly degraded, slowing the rate of infusion can help remove excess drug from the circulation. Seizures are possible with toxic doses; diazepam should be used to control seizures. It is not necessary to discontinue the infusion, because this client is showing signs common to high therapeutic doses. Respiratory arrest is possible with toxic doses; mechanical ventilation may be needed. PTS: 1Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal 8. A client with diabetes develops ventricular tachycardia and is in the hospital for evaluation of this condition. The nurse practitioner reviews the history and learns that the client takes mexiletine [Mexitil] for pain caused by peripheral neuropathy. What should the nurse practitioner do? a. Discuss common side effects associated with taking mexiletine with cardiac agents. b. Understand that this drug will help with both peripheral neuropathy and dysrhythmias. c. Notify the provider to request that another drug be used for peripheral neuropathy pain. d. Request an order for renal function and hepatic function tests. CORRECT: C Mexiletine is an antidysrhythmic medication that can also cause dysrhythmias. It is used to treat the pain associated with peripheral neuropathy in diabetic clients, but it is contraindicated in diabetic clients with heart disease, and so it should be stopped now that this client has developed a heart disorder. Because it is contraindicated, the nurse practitioner will not teach the client about side effects with other agents. It can exacerbate cardiac symptoms, so it should not be used to treat dysrhythmias in diabetic clients. There is no indication for tests of renal and hepatic functions. PTS: 1 9. A prescriber has ordered propranolol [Inderal] for a client with recurrent ventricular tachycardia. The nurse practitioner preparing to administer this drug will be concerned about what in theclient’s history? a. Asthma b. Exercise-induced tachyarrhythmias c. Hypertension d. Paroxysmal atrial tachycardia associated with emotion CORRECT: A Propranolol is contraindicated in clients with asthma, because it is a nonselective beta- adrenergic antagonist and can cause bronchoconstriction and exacerbate asthma. It is used to treat tachyarrhythmias and paroxysmal atrial tachycardia evoked by emotion, so it is not contraindicated for clients with these conditions. It lowers blood pressure, so it would be helpful in clients with hypertension. PTS: 1 10. A nurse practitioner is providing teaching to a client who is admitted to the hospital for initiation of treatment with amiodarone [Cordarone] for atrial fibrillation that has been refractory to other medications. Which statement by the client indicates a need for further teaching? a. “I may have itching, malaise, and jaundice, but these symptoms will subside.” b. “I need to use sunblock to help keep my skin from turning bluish gray.” c. “I should not drink grapefruit juice while taking this medication.” d. “I should report shortness of breath and cough and stop taking the drug immediately.”Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31U |AsRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal CORRECT: A Amiodarone has many toxic effects. Liver toxicity is rare but serious and should be reported and the drug discontinued. Dermatologic toxicity can occur, and sunblock helps protect the skin, which, with prolonged exposure to the sun, can turn bluish gray. Drinking grapefruit juice can increase amiodarone levels. Pulmonary toxicity is the greatest concern, and clients with pulmonary symptoms should report these to the provider. PTS: 1 11. A client is in the intensive care unit after a myocardial infarction. The nurse practitioner notes that the QTinterval on this client’s electrocardiogram has been elongating. The nurse practitioner is concerned that which cardiac dysrhythmia may occur? a. AV block b. Bradycardia c. Supraventricular tachycardia d. Torsades de pointes CORRECT: D Torsades de pointes is a dysrhythmia that can occur with prolongation of the QT interval and can progress to fatal ventricular fibrillation. A prolonged QT interval does not signal the development of AV block, bradycardia, or SVT. PTS: 1 12. A prescriber is considering prescribing the amiodarone derivative dronedarone [Multaq] for a client with atrial flutter. The nurse practitioner should be concerned about which of the following? a. History of asthma b. History of hypothyroidism c. PR interval of 260 msec d. QT interval of 520 msec CORRECT: D Because dronedarone prolongs the QT interval by about 10 msec, it should not be used in clients with a QT interval of more than 500 msec. It does not have significant pulmonary orthyroid toxicity. It should not be used in clients with a PR interval of more than 280 msec. PTS: 1 13. A prescriber orders verapamil [Covera-HS] for a client who is taking digoxin [Lanoxin] and warfarin. The nurse practitioner will expect the prescriber to the dose of . a. lower; digoxin b. increase; digoxin c. lower; warfarin d. increase; warfarin CORRECT: A Calcium channel blockers, such as verapamil, can increase levels of digoxin, so clients taking these drugs may need to have their digoxin dose reduced. Increasing the dose of digoxin can result in digoxin toxicity. Verapamil does not affect warfarin levels.Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31U |AsRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal PTS: 1 14. A nurse practitioner is discussing adenosine with a nursing student. Which statement by the student indicatesa need for further teaching? a. “Adenosine acts by suppressing action potentials in the SA and AV nodes.” b. “Adenosine can be used to prevent paroxysmal supraventricular tachycardia and Wolff-Parkinson-White syndrome.” c. “Adenosine has a half-life that lasts only a few seconds and must be given intravenously.” d. “Adenosine is not effective for treating atrial fibrillation, atrial flutter, or ventricular dysrhythmias.” CORRECT: B Adenosine is used to terminate paroxysmal supraventricular tachycardia (SVT) and Wolff- Parkinson-White (WPW) syndrome, not to prevent symptoms. Adenosine suppresses action potentials in the SA and AV nodes. Because it has a very short half-life of 1.5 to 10 seconds, it must be given IV bolus, as close to the heart as possible. Adenosine is not active against atrial fibrillation, atrial flutter, or ventricular dysrhythmias. PTS: 1 15. A nursing student asks a nurse practitioner how digoxin causes dysrhythmias. The nurse practitioner correctly states that digoxin: a. reduces automaticity in the AV node. b. increases automaticity in the Purkinje fibers. c. increases automaticity in the SA node. d. speeds up AV conduction. CORRECT: B Digoxin increases automaticity in the Purkinje fibers, which contributes to dysrhythmias caused by digoxin. Decreased automaticity in the AV node is a desired effect of digoxin. Digoxin does not increase automaticity in the SA node. It does not increase AV node conduction. PTS: 1 16. The nurse practitioner is teaching a class on dysrhythmias and associated therapy. The nurse practitioner asks the class, “Which cardiac dysrhythmia would result in the lowest cardiac output, and what treatment wouldbe effective?” The class best demonstrates understanding by responding that results in the lowest cardiac output, and treatment includes . a. atrial flutter; lidocaine b. tachycardia; atropine c. first-degree heart block; verapamil [Calan] d. ventricular fibrillation; defibrillation CORRECT: D With ventricular fibrillation there is no cardiac output, because the pumping action of the heart stops. Treatment with electrical countershock is indicated to restore cardiac function. Atrial flutter, tachycardia, and first-degree heart block do not result in the lowest cardiac output.Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal PTS: 1 17. The nurse practitioner educator is providing client education about the Cardiac Arrhythmia SuppressionTrial (CAST). The nurse practitioner correctly explains that the trial demonstrated what effect from the pharmacologic suppression of dysrhythmias? a. It reduced mortality by 50% but increased morbidity. b. It significantly reduced the risk of a second myocardial infarction (MI). c. It doubled the risk of a second MI. d. It should be used in all clients who have had an MI, regardless of rhythm. CORRECT: C In the CAST, class IC dysrhythmic drugs were used to prevent dysrhythmias after MI. These drugs were found to actually double the rate of mortality. The antidysrhythmic drugs did not reduce mortality or the risk of a second MI. They should not be used for any MI clients with associated dysrhythmias unless the dysrhythmias are life threatening. PTS: 1 18. The nurse practitioner is teaching a group of nursing students about dofetilide [Tikosyn] to treat dysrhythmias. Which statement by a student indicates understanding of the teaching? a. “Dofetilide is a first-line medication to treat atrial flutter or atrial fibrillation.” b. “Dofetilide carries a lower risk of causing torsades de pointes than other drugs.” c. “Dofetilide is used for clients with severe symptoms of atrial dysrhythmias.” d. “Dofetilide may be safely used as outclient therapy to treat atrial fibrillation.” CORRECT: C Dofetilide is used for clients with severe, highly symptomatic atrial dysrhythmias because of its higher than usual risk of torsades de pointes. It is used only when other medications have not been effective. It is used for hospitalized clients with close ECG monitoring. PTS: 1 MULTIPLE RESPONSE 1. A client is taking digoxin [Lanoxin] and develops a dysrhythmia. The nurse practitioner reports this findingto the prescriber, who will most likely order what? (Select all that apply.) a. Amiodarone b. Diltiazem c. Phenytoin [Dilantin] d. Quinidine e. Serum electrolytes CORRECT: C, E Phenytoin is an antiseizure medication used to treat digoxin-induced dysrhythmias. Because digoxin-induced dysrhythmias can be caused by hypokalemia, it is appropriate to evaluate the serum electrolyte levels. Amiodarone, diltiazem, and quinidine increase digoxin levels.Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal PTS: 1 2. A client will be taking amiodarone [Cordarone]. Which baseline tests are necessary before this medication is started? (Select all that apply.) a. Chest radiograph and pulmonary function tests b. Complete blood count with differential c. Ophthalmologic examination d. Renal function tests e. Thyroid function tests CORRECT: A, C, E Amiodarone has many potential toxic side effects, including pulmonary toxicity, ophthalmic effects, and thyroid toxicity, so these systems should be evaluated at baseline and periodically while the client is taking the drug. A complete blood count is not indicated. Renal function tests are not indicated. PTS: 1 Chapter 53: Drugs That Help Normalize Cholesterol and Triglyceride Levels Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition MULTIPLE CHOICE 1. A client with a history of elevated triglycerides and LDL cholesterol begins taking nicotinic acid [Niacin]. The client reports uncomfortable flushing of the face, neck, and ears when taking the drug. What will the nurse practitioner advise the client? a. “Ask your provider about taking an immediate-release form of the medication.” b. “Ask your provider about assessing your serum uric acid levels which may be elevated.” c. “You should stop taking the Niacin immediately since this is a serious adverse effect.” d. “You should take 325 mg of aspirin a half hour before each dose of Niacin to prevent this effect.” CORRECT: D Intense flushing of the face, neck, and ears occurs in practically all clients taking nicotinic acid in pharmacologic doses. Clients should be advised to take 325 mg of ASA 30 minutes prior to each dose to minimize this effect or to use an extended-release form of the drug. Serum uric acid levels may increase with Niacin use, but flushing does not indicate elevated levels. This side effect is not serious and does not warrant discontinuation of the drug. PTS: 1 2. Which plasma lipoprotein level is most concerning when considering the risk of coronary atherosclerosis? a. Elevated cholesterol b. Elevated high-density lipoprotein c. Elevated low-density lipoproteinStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal d. Elevated very-low-density lipoprotein CORRECT: C Elevated LDL levels make the greatest contribution to coronary atherosclerosis with the probability of developing coronary heart disease (CHD) directly related to the LDL level in the blood. Total cholesterol levels do not have the same direct link. HDL levels cause increased risk when they are low. The relation between elevated very-low-density lipoprotein levels and CHD is not clear. PTS: 1 3. A client who is taking simvastatin [Zocor] develops an infection and the provider orders azithromycin [Zithromax] to treat the infection. The nurse practitioner should be concerned if the client complains of: a. nausea. b. tiredness. c. muscle pain. d. headache. CORRECT: C Statins can injure muscle tissue, causing muscle aches and pain known as myopathy/rhabdomyolysis. Daptomycin also can cause myopathy and therefore should be used with caution in clients concurrently taking simvastatin. Nausea, tiredness, and headache would not cause the nurse practitioner as much concern as the likelihood of myopathy. PTS: 1 4. A client who recently started therapy with an HMG-COA reductase inhibitor asks the nurse practitioner, “How long will it take until I see an effect on my LDL cholesterol?” The nurse practitioner gives which correct answer? a. “It will take 6 months to see a change.” b. “A reduction usually is seen within 2 weeks.” c. “Blood levels normalize immediately after the drug is started.” d. “Cholesterol will not be affected, but triglycerides will fall within the first week.” CORRECT: B Reductions in LDL cholesterol are significant within 2 weeks and maximal within 4 to 6 weeks. It does not take 6 months to see a change. The blood level of LDL cholesterol is not reduced immediately upon starting the drug; a reduction is seen within 2 weeks. Blood cholesterol is affected, specifically LDL cholesterol, not triglycerides. PTS: 1 5. A client taking gemfibrozil [Lopid] and rosuvastatin [Crestor] concurrently begins to complain of muscle aches, fatigue, and weakness. What should the nurse practitioner monitor? a. For tendon tenderness b. For a lupus-like syndrome c. The client’s liver function test results d. The client’s creatinine kinase levelsStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal CORRECT: D Creatinine kinase levels are the best laboratory indicator of myopathy and/or rhabdomyolysis, which may lead to renal failure. As with the statins, gemfibrozil and other fibrates can cause myopathy. Fibrates must be used with caution in clients taking statins. Concurrent use of gemfibrozil and rosuvastatin does not cause tendon tenderness or a lupus-like syndrome. Liver function levels should be determined at the start of statin therapy and every 6 months thereafter in clients who do not have liver disease. PTS: 1 6. A client will begin taking atorvastatin [Lipitor] to treat elevated LDL levels. The client asks the nurse practitioner what to do to minimize the risk of myositis associated with taking this drug. What willthe nurse practitioner counsel this client? a. “Consume an increased amount of citrus fruits while taking this drug.” b. “Take vitamin D and coenzyme Q supplements.” c. “Ask your provider about adding a fibrate medication to your regimen.” d. “Have your creatine kinase levels checked every 4 weeks.” CORRECT: B Clients taking a statin medication may take vitamin D and coenzyme Q supplements to reduce their risk of developing myositis. Citrus fruits can elevate statin levels and increase the risk of myositis. Fibrates also cause myositis in some clients, and adding a fibrate will increase the risk. Creatine kinase levels should be determined at baseline and as needed if symptoms occur but do not need to be monitored every 4 weeks. PTS: 1 7. A client has begun taking an HMG-COA reductase inhibitor. Which statement about this class of drugs made by the nurse practitioner during client education would be inappropriate? a. “Statins reduce the risk of morbidity from influenza.” b. “You should come into the clinic for liver enzymes in 1 month.” c. “Statins reduce the risk of coronary events in people with normal LDL levels.” d. “You should maintain a healthy lifestyle and avoid high-fat foods.” CORRECT: B Baseline liver enzyme tests should be done before a client starts taking an HMG-COA reductase inhibitor. They should be measured again in 6 to 12 months unless the client has poorliver function, in which case the tests are indicated every 3 months. A recent study demonstrated protection against influenza morbidity in clients because of a decrease in proinflammatory cytokine release. Statins do reduce the risk of stroke and coronary events in people with normal LDL levels. Maintaining a healthy lifestyle is important, as is avoiding high-fat foods. PTS: 1 8. A nurse practitioner is instructing a client receiving a cholesterol-lowering agent. Which information shouldthe nurse practitioner include in the client education? a. “This medication will replace other interventions you have been trying.” b. “It is important for you to double your dose if you miss one to maintain therapeuticStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal blood levels.” c. “Stop taking the medication if you experience constipation.” d. “You should continue your exercise program to increase your HDL serum levels.” CORRECT: D Regular exercise can reduce LDL cholesterol and elevate HDL cholesterol, thereby reducing the risk of coronary heart disease (CHD). The client should consider the cholesterol-lowering drugan adjunct to a proper diet and exercise. Drug therapy cannot replace other important interventions, such as diet and exercise. The client should never be instructed to double the dose. Constipation is a side effect of most cholesterol-lowering agents. The client should be encouraged to eat a high-fiber diet and increase fluids if not contraindicated. PTS: 1 9. An Asian client will begin taking rosuvastatin [Crestor] to treat hypercholesterolemia. What will the nurse practitioner include when teaching this client about this medication? a. Higher than usual doses may be necessary for this client. b. Renal toxicity is a common adverse effect among Asian clients. c. Serum drug levels must be monitored more frequently than with other clients. d. Yellow skin and sclera are more common side effects with Asian clients but are not concerning. CORRECT: C Rosuvastatin reaches abnormally high levels in people of Asian heritage. Consequently, serum drug levels must be monitored closely. Asian clients may require lower than usual doses. Renal toxicity does not occur. Yellow skin and sclera occur with hepatotoxicity and are a cause for concern. PTS: 1 10. Lovastatin [Mevacor] is prescribed for a client for the first time. The nurse practitioner should provide theclient with which instruction? a. “Take lovastatin with your evening meal.” b. “Take this medicine before breakfast.” c. “You may take lovastatin without regard to meals.” d. “Take this medicine on an empty stomach.” CORRECT: A Clients should be instructed to take lovastatin with the evening meal. Statins should be taken with the evening meal, not before breakfast. Statins should not be administered without regard to meals and should not be taken on an empty stomach. PTS: 1 11. A nurse practitioner is providing discharge teaching instructions for a client taking cholestyramine [Questran]. Which statement made by the client demonstrates a need for further teaching? a. “I will take warfarin [Coumadin] 1 hour before my medicine.” b. “I will increase the fluids and fiber in my diet.” c. “I can take cholestyramine with my hydrochlorothiazide.”Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal d. “I will take digoxin 4 hours after taking the cholestyramine.” CORRECT: C Drugs known to form complexes with the sequestrants include thiazide diuretics, such as hydrochlorothiazide, digoxin, warfarin, and some antibiotics. To reduce the formation of sequestrant-drug complexes, oral medication should be administered either 1 hour before the sequestrant or 4 hours after. Further teaching is needed. Warfarin should be taken 1 hour before or 4 hours after cholestyramine. Adverse effects of Questran are limited to the gastrointestinal (GI) tract. Constipation, the principal complaint, can be minimized by increasing dietary fiber and fluids. Digoxin should be taken 1 hour before or 4 hours after cholestyramine. PTS: 1 12. A nurse practitioner is providing client education about colesevelam [Welchol], a bile-acid sequestrant. Which statement made by the client demonstrates a need for further teaching? a. “Colesevelam will reduce my levels of low-density lipoprotein.” b. “Colesevelam will augment my statin drug therapy.” c. “I will not have to worry about having as many drug interactions as I did when I took cholestyramine.” d. “I will need to take supplements of fat-soluble vitamins.” CORRECT: D Colesevelam [Welchol] does not reduce absorption of fat-soluble vitamins as do other bile-acid sequestrants, so supplements are not needed. Colesevelam reduces the LDL cholesterol level, which is one of its therapeutic uses. Colesevelam augments statin therapy. Colesevelam does not significantly interact with or reduce the absorption of statins, digoxin, warfarin, or most other drugs. PTS: 1 13. A nurse practitioner is reviewing the medications of a client with diabetes before discharge. The nurse practitioner realizes that the client will be going home on colesevelam, a bile-acid sequestrant, and insulin. What client education should the nurse practitioner provide in the discharge teaching for this client? a. The client needs to monitor the blood sugar carefully, because colesevelam can cause hypoglycemia. b. The client needs to monitor the blood sugar carefully, because colesevelam can cause hyperglycemia. c. The client needs to take the insulin at least 3 hours before the colesevelam. d. The client needs to use an oral antidiabetic agent or agents, not insulin, with colesevelam. CORRECT: A Colesevelam can help control hyperglycemia in clients with diabetes; therefore, hypoglycemia is a possible risk. Hyperglycemia is not a risk for clients with diabetes who take colesevelam. Insulin and colesevelam do not interact; therefore, the insulin can be taken at the client’s preferred time or times. Either insulin or oral antidiabetic agents can be taken with colesevelam. PTS: 1Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal 14. A nurse practitioner is reviewing a client’s medications and realizes that gemfibrozil [Lopid] and warfarin [Coumadin] are to be administered concomitantly. Which effect will the nurse practitioner anticipate in thisclient? a. Increased levels of gemfibrozil b. Decreased levels of gemfibrozil c. Increased anticoagulant effects d. Reduced anticoagulant effects CORRECT: C Gemfibrozil displaces warfarin from the plasma albumin, thereby increasing anticoagulant effects. The level of gemfibrozil will not be increased or decreased. The anticoagulation effects will not be reduced, because free-floating drug is present in the system; the dosage of warfarin may have to be reduced. PTS: 1 15. While giving discharge instructions to a client who will be taking cholestyramine [Questran], the nurse practitioner wants to assess the client’s understanding of the treatment. Which statement made bythe client best demonstrates a need for additional teaching? a. “I will take cholestyramine [Questran] 1 hour before my other medications.” b. “I will increase fluids and fiber in my diet.” c. “I will weigh myself weekly.” d. “I will have my blood pressure checked weekly.” CORRECT: C Clients need not weigh themselves weekly when taking cholestyramine. Cholestyramine should be taken at least 1 hour before other medications. When taken with other medications, cholestyramine can inhibit the absorption of the other drugs. Constipation is the principal complaint with cholestyramine. It can be minimized by increasing dietary fiber and fluids. Regular blood pressure checks are a good idea. The client is taking cholestyramine because of high cholesterol, which contributes to hypertension. PTS: 1 16. Which is a possible benefit of taking fish-oil supplements? a. A decrease in low-density lipoprotein and triglyceride levels b. Decreased risk of thrombotic stroke c. Prevention of heart disease in high-risk clients d. Reduced risk of dysrhythmia in clients after myocardial infarction CORRECT: D Fish oil may be beneficial in prevention of heart dysrhythmias in clients who have had myocardial infarction or heart failure. It has not shown to be beneficial in decreasing cholesterol, reducing the risk of thrombotic stroke, or preventing heart disease. PTS: 1Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal 17. A postmenopausal woman will begin taking atorvastatin [Lipitor] to treat hypercholesterolemia. The woman reports a history of osteopenia with a family risk of osteoporosis. What will the nurse practitioner include when teaching this client? a. The need to discuss taking a bisphosphonate medication with her provider b. That statins are known to reduce the risk of osteoporosis c. That she should avoid foods high in calcium d. To discuss vitamin D supplements with her provider since statins deplete calcium CORRECT: A Studies demonstrating a protective effect of statins in reducing the risk of osteoporosis have been inconclusive. Women at risk should discuss taking a bisphosphonate medication with their providers. Statins are not known to reduce the risk of osteoporosis. She should consume foods containing calcium. Vitamin D supplements are not indicated. PTS: 1 MULTIPLE RESPONSE 1. A client is being started on nicotinic acid [Niaspan] to reduce triglyceride levels. The nurse practitioner is providing client education and should include teaching about which adverse effects? (Select allthat apply.) a. Facial flushing b. Constipation c. Hypoglycemia d. Gastric upset e. Itching CORRECT: A, D, E Adverse effects of nicotinic acid include intense flushing of the face, neck, and ears; itching; and GI upset (nausea, vomiting, and diarrhea). Constipation and hypoglycemia are not adverse effects of niacin therapy. PTS: 1 Chapter 54: Drugs for Angina Pectoris Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition MULTIPLE CHOICE 1. A nurse practitioner is providing teaching for a client with stable angina who will begin taking nitroglycerin. Which statement by the client indicates understanding of the teaching? a. “I should not participate in aerobic exercise while taking this drug.” b. “I should take aspirin daily to reduce my need for nitroglycerin.” c. “If I take nitroglycerin before exertion, I can reduce the chance of an anginal attack.” d. “I take nitroglycerin to increase the amount of oxygen to my heart.” CORRECT: CStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal Nitroglycerin can be taken before stressful events or exertion to reduce the chance of an attack of angina. Aerobic exercise is an important part of nondrug therapy to reduce the risk of heart attack. Aspirin therapy is an important adjunct to treatment to prevent coronary thrombus formation, but it does not reduce the need for nitroglycerin. Nitroglycerin reduces cardiac oxygen demand, but it does not increase the amount of oxygen available to the heart. PTS: 1 2. A nurse practitioner is discussing the difference between stable and variant angina with a group of nursingstudents. Which statement by a student indicates the need for further teaching? a. “Beta blockers are effective for stable angina but not for variant angina.” b. “In both types of angina, prophylactic treatment is possible.” c. “Variant angina is primarily treated with vasodilators to increase oxygen supply.” d. “Variant angina is the result of increased oxygen demand by the heart.” CORRECT: D Variant angina is caused by coronary artery spasm, which reduces the oxygen supply to the heart. Beta blockers are not effective in variant angina but are useful with stable angina. Medications may be given to prevent anginal attacks in both types of angina. Vasodilators are used in variant angina to relieve coronary artery spasm and increase the oxygen supply to the heart. PTS: 1 3. A client with new-onset exertional angina has taken three nitroglycerin sublingual tablets at 5- minute intervals, but the pain has intensified. The nurse practitioner notes that the client has a heart rate of 76 beats/min and a blood pressure of 120/82 mm Hg. The electrocardiogram is normal. The client’s lips and nail beds are pink, and there is no respiratory distress. The nurse practitioner will anticipateproviding: a. an angiotensin-converting enzyme (ACE) inhibitor. b. intravenous nitroglycerin and a beta blocker. c. ranolazine (Ranexa) and quinidine. d. supplemental oxygen and intravenous morphine. CORRECT: B This client has unstable angina, and the next step, when pain is unrelieved by sublingual nitroglycerin, is to give intravenous nitroglycerin and a beta blocker. ACE inhibitors should be given to clients with persistent hypertension if they have left ventricular dysfunction or congestive heart failure (CHF). Ranolazine is a first-line angina drug, but it should not be given with quinidine because of the risk of increasing the QT interval. Supplemental oxygen is indicated if cyanosis or respiratory distress is present. IV morphine may be given if the pain is unrelieved by nitroglycerin. PTS: 1 4. A client asks a nurse practitioner how nitroglycerin works to relieve anginal pain. The nurse practitioner correctlystates, “Nitroglycerin: a. dilates coronary arteries to increase blood flow to the heart.”Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal b. increases the oxygen supply to the cardiac muscle.” c. increases ventricular filling to improve cardiac output.” d. promotes vasodilation, which reduces preload and oxygen demand.” CORRECT: D Nitroglycerin dilates the veins, which reduces venous return to the heart, which in turn decreases ventricular filling. The resulting decrease in preload reduces the oxygen requirements of the heart. Nitroglycerin does not increase the blood flow or oxygen supply to the heart. An increase in ventricular filling would increase oxygen demand and result in increased anginal pain. PTS: 1 5. A hospitalized client complains of acute chest pain. The nurse practitioner administers a 0.3-mg sublingualnitroglycerin tablet, but the client continues to complain of pain. Vital signs remain stable. What is the nurse practitioner’s next step? a. Apply a nitroglycerin transdermal patch. b. Continue dosing at 10-minute intervals. c. Give a second dose of nitroglycerin in 5 minutes. d. Request an order for intravenous nitroglycerin. CORRECT: C An initial dose of sublingual nitroglycerin is taken, and if the chest pain persists, as in this case, the client should take another dose in 5 minutes. Transdermal delivery systems are not useful for terminating an ongoing attack. Dosing at 10-minute intervals is incorrect. If the client failsto respond or if the pain intensifies, intravenous nitroglycerin may be indicated. PTS: 1 6. A client who has begun using transdermal nitroglycerin for angina reports occasional periods of tachycardia. The nurse practitioner will expect the prescriber to order: a. digoxin [Lanoxin] to slow the heart rate. b. immediate discontinuation of the nitroglycerin. c. periods of rest when the heart rate increases. d. verapamil as an adjunct to nitroglycerin therapy. CORRECT: D Nitroglycerin lowers blood pressure by reducing venous return and dilating the arterioles. The lowered blood pressure activates the baroreceptor reflex, causing reflex tachycardia, which can increase cardiac demand and negate the therapeutic effects of nitroglycerin. Treatment with a beta blocker or verapamil suppresses the heart to slow the rate. Digoxin is not recommended. Discontinuation of the nitroglycerin is not indicated. Resting does not slow the heart when the baroreceptor reflex is the cause of the tachycardia. PTS: 1 7. A client with angina who uses sublingual nitroglycerin tells the nurse practitioner that the episodes are increasing in frequency, and usually occur when the client walks the dog. The client reportsneeding almost daily doses of the nitroglycerin and states that one tablet usually provides complete relief. What will the nurse practitioner do?Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal a. Contact the provider to suggest ordering a transdermal patch for this client. b. Question the client about consumption of grapefruit juice. c. Suggest that the client limit walking the dog to shorter distances less frequently. d. Suggest that the client take two tablets of nitroglycerin each time, because the symptoms are increasing in frequency. CORRECT: A Transdermal patches are good for sustained prophylaxis for anginal attacks and are especially useful when clients have a regular pattern of attacks. Grapefruit juice does not affect the metabolism of nitroglycerin. Clients with angina should be encouraged to increase, not decrease, exercise. Taking two tablets is not recommended when one is effective. PTS: 1 8. A nursing student asks a nurse practitioner how beta blockers increase the oxygen supply to the heart in thetreatment of anginal pain. The nurse practitioner tells the student that beta blockers: a. dilate arterioles to improve myocardial circulation. b. improve cardiac contractility, which makes the heart more efficient. c. increase arterial pressure to improve cardiac afterload. d. increase the time the heart is in diastole. CORRECT: D Beta blockers increase the time the heart is in diastole, which increases the time during which blood flows through the myocardial vessels, allowing more oxygen to reach the heart. Beta blockers do not dilate arterioles. They do not increase cardiac contractility; they decrease it, which reduces the cardiac oxygen demand. They do not increase arterial pressure, which would increase the cardiac oxygen demand. PTS: 1 9. A client with stable exertional angina has been receiving a beta blocker. Before giving the drug, the nurse practitioner notes a resting heart rate of 55 beats/min. Which is an appropriate nursing action? a. Administer the drug as ordered, because this is a desired effect. b. Withhold the dose and notify the provider of the heart rate. c. Request an order for a lower dose of the medication. d. Request an order to change to another antianginal medication. CORRECT: A When beta blockers are used for anginal pain, the dosing goal is to reduce the resting heart rate to 50 to 60 beats/min. Because this heart rate is a desired effect, there is no need to withhold the dose or notify the provider. The dosage does not need to be lowered, because a heart rate of 55 beats/min is a desired effect. There is no indication of a need to change medications for this client. PTS: 1 10. A client is taking a calcium channel blocker (CCB) for stable angina. The client’s spouse asks how calcium channel blockers relieve pain. The nurse practitioner will explain that CCBs: a. help relax peripheral arterioles to reduce afterload.Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal b. improve coronary artery perfusion. c. increase the heart rate to improve myocardial contractility. d. increase the QT interval. CORRECT: A CCBs promote relaxation of peripheral arterioles, resulting in a decrease in afterload, which reduces the cardiac oxygen demand. CCBs do not improve coronary artery perfusion. CCBs reduce the heart rate and suppress contractility; they do not affect the QT interval. PTS: 1 11. A client with variant angina wants to know why a beta blocker cannot be used to treat the angina. Which response by the nurse practitioner is correct? a. “A beta1-selective beta blocker could be used for variant angina.” b. “Beta blockers do not help relax coronary artery spasm.” c. “Beta blockers do not help to improve the cardiac oxygen supply.” d. “Beta blockers promote constriction of arterial smooth muscle.” CORRECT: B Variant angina occurs when coronary arteries go into spasm, thus reducing the circulation and oxygen supply to the heart. CCBs help to reduce coronary artery spasm; beta blockers do not. Beta1-selective beta blockers are used for stable angina for clients who also have asthma, because they do not activate beta2 receptors in the lungs to cause bronchoconstriction. Beta blockers help improve the oxygen supply in stable angina, but they do not relieve coronary artery spasm, so they are not useful in variant angina. Beta blockers do not constrict arterial smooth muscle. PTS: 1 12. A nursing student is helping to care for a client who takes verapamil for stable angina. The nurse practitioner asks the student to explain the purpose of verapamil in the treatment of this client. Whichstatement by the student indicates a need for further teaching? a. “It relaxes coronary artery spasms.” b. “It reduces peripheral resistance to reduce oxygen demands.” c. “It reduces the heart rate, AV conduction, and contractility.” d. “It relaxes the peripheral arterioles to reduce afterload.” CORRECT: A Verapamil does relax coronary artery spasms, but this is not useful in stable angina. Verapamil is used to relax coronary artery spasms in variant asthma. When used to treat stable angina, verapamil promotes relaxation of peripheral arterioles, which reduces peripheral resistance and decreases afterload. It also reduces the heart rate, AV conduction, and contractility. PTS: 1Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal 13. A client with angina who is taking ranolazine [Ranexa] has developed a respiratory infection and a dysrhythmia. The provider has ordered azithromycin [Zithromax] for the infection and amlodipine for the dysrhythmia. A nursing student caring for this client tells the nurse practitioner that theclient’s heart rate is 70 beats/min, and the blood pressure is 128/80 mm Hg. The nurse practitioner asks thestudent to discuss the plan for this client’s care. Which action is correct? a. Observe the client closely for signs of respiratory toxicity. b. Question the order for azithromycin [Zithromax]. c. Report the client’s increase in blood pressure to the provider. d. Request an order for a different calcium channel blocker. CORRECT: B Agents that inhibit CYP3A4 can increase levels of ranolazine and also the risk of torsades de pointes. Macrolide antibiotics, such as azithromycin, are CYP3A4 inhibitors. Respiratory toxicity is not an expected effect with this client. The client’s blood pressure is not elevated enough to notify the provider. Amlodipine is the only CCB that should be used with ranolazine. PTS: 1 14. A nurse practitioner provides teaching to a client with angina who also has type 2 diabetes mellitus, asthma, and hypertension. Which statement by the client indicates a need for further teaching? a. “An ACE inhibitor, in addition to nitroglycerin, will lower my risk of cardiovascular death.” b. “Beta blockers can help me control hypertension.” c. “I should begin regular aerobic exercise.” d. “Long-acting, slow-release calcium channel blockers can help with anginal pain.” CORRECT: B Beta blockers can be used for angina in most clients but are contraindicated in clients with asthma, because they cause bronchoconstriction. ACE inhibitors help reduce the risk of death in clients with hypertension. Regular aerobic exercise is recommended to control weight and improve cardiovascular function. Long-acting, slow-release CCBs are recommended for clients who have coexisting type 2 diabetes. PTS: 1 15. A client who takes nitroglycerine to treat stable angina reports having erectile dysfunction and states that he plans to ask his primary provider for a prescription for tadalafil [Cialis]. What will the nurse practitioner tell this client? a. “You may take these two drugs together safely as long as you take them as directed.” b. “You should not take tadalafil and nitroglycerine within 30 to 60 minutes of each other.” c. “You should discuss another antiangina medication with your provider.” d. “You should avoid sexual activity since this increases oxygen demands on the heart.” CORRECT: CStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal Use of nitroglycerine with any phosphodiesterase type 5 inhibitor, such as sildenafil or tadalafil, is absolutely contraindicated. The client should be advised to discuss another antianginal agent with the provider. Clients should be taught to increase all activity to maintain as normal a lifestyle as possible. PTS: 1 16. A client who has renal impairment will begin taking ranolazine [Ranexa] as an adjunct to nitroglycerine to treat angina. What will the nurse practitioner include when teaching this client? a. “You will need to monitor your blood pressure closely while taking this drug.” b. “You should take this drug 1 hour before or 2 hours after a meal.” c. “You may experience rapid heart rate while taking this medication.” d. “You do not need to worry about drug interactions with this medication.” CORRECT: A Ranolazine can elevate blood pressure in clients with renal impairment, so clients taking this drug will need to monitor blood pressure. The drug can be taken without regard to food. It does not cause reflex tachycardia. It has many significant drug interactions. PTS: 1 MULTIPLE RESPONSE 1. A client with asthma and depression develops stable angina. In addition to organic nitrites, which other medications will be used to treat this condition? (Select all that apply.) a. ACE inhibitors b. Antiplatelet drugs c. Beta blockers d. Calcium channel blockers e. Cholesterol-lowering drugs CORRECT: A, B, D, E ACE inhibitors have shown benefit in reducing the incidence of adverse outcomes in clients with coronary artery disease (CAD) and are recommended as part of therapy. Antiplatelet drugs are recommended to reduce the risk of thrombus formation. CCBs are used as adjuncts to nitroglycerin and are safe in clients with asthma and depression. Cholesterol-lowering drugs are recommended to help slow the progression of CAD. Beta blockers are not recommended in clients with asthma or depression. PTS: 1 Chapter 55: Anticoagulant, Antiplatelet, and Thrombolytic Drugs Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition MULTIPLE CHOICEStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal 1. A nursing student, who is preparing to care for a postoperative client with deep vein thrombosis, asks the nurse practitioner why the client must take heparin rather than warfarin. Whichresponse by the nurse practitioner is correct? a. “Heparin has a longer half-life.” b. “Heparin has fewer adverse effects.” c. “The onset of warfarin is delayed.” d. “Warfarin prevents platelet aggregation.” CORRECT: C Warfarin is not useful for treating existing thromboses or for emergencies because the onset of action is delayed. Heparin has a shorter half-life and has more side effects. Warfarin does not prevent platelet aggregation. PTS: 1 2. A client is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse practitioner notesthat the client has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats/min. The client’s most recent aPTT is greater than 90 seconds. The client reports lumbar pain. The nurse practitioner will request an order for: a. a repeat aPTT to be drawn immediately. b. analgesic medication. c. changing heparin to aspirin. d. protamine sulfate. CORRECT: D Heparin overdose may cause hemorrhage, which can be characterized by low blood pressure, tachycardia, and lumbar pain. Protamine sulfate should be given, and the heparin should be discontinued. An aPTT may be drawn later to monitor the effectiveness of protamine sulfate. Analgesics are not indicated because the lumbar pain is likely caused by adrenal hemorrhage. Aspirin will only increase the risk of hemorrhage. PTS: 1 3. A client has been receiving heparin while in the hospital to treat deep vein thromboses and will be discharged home with a prescription for enoxaparin [Lovenox]. The nurse practitioner provides teaching for the nursing student who asks about the advantages of enoxaparin over heparin. Which statement by the student indicates a need for further teaching? a. “Enoxaparin does not require coagulation monitoring.” b. “Enoxaparin has greater bioavailability than heparin.” c. “Enoxaparin is more cost-effective than heparin.” d. “Enoxaparin may be given using a fixed dosage.” CORRECT: C Low-molecular-weight (LMW) heparins have higher bioavailability and longer half-lives, so routine coagulation monitoring is not necessary and fixed dosing is possible. LMW heparins are more expensive, however, so this statement indicates a need for further teaching. PTS: 1Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31U |AsRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal 4. A client with atrial fibrillation is receiving warfarin [Coumadin]. The nurse practitioner notes that the client’s INR is 2.7. Before giving the next dose of warfarin, the nurse practitioner will notify the provider and: a. administer the dose as ordered. b. request an order to decrease the dose. c. request an order to give vitamin K (phytonadione). d. request an order to increase the dose. CORRECT: A This client has an INR in the appropriate range, which is 2 to 3 for most clients and 2.5 to 3.5 for some, so no change in warfarin dosing is necessary. It is not correct to request an order to either decrease or increase the dose of warfarin. It is not necessary to give vitamin K, which is an antidote for warfarin toxicity. PTS: 1 5. A client who takes warfarin for atrial fibrillation undergoes hip replacement surgery. On the second postoperative day, the nurse practitioner assesses the client and notes an oxygen saturation of 83%, pleuritic chest pain, shortness of breath, and hemoptysis. The nurse practitioner will contact the provider to report possible and request an order for . a. congestive heart failure; furosemide [Lasix] b. hemorrhage; vitamin K (phytonadione) c. myocardial infarction; tissue plasminogen activator (tPA) d. pulmonary embolism; heparin CORRECT: D This client is exhibiting signs of pulmonary embolism. Heparin is used when rapid onset of anticoagulants is needed, as with pulmonary embolism. The client would have respiratory cracks and a cough with congestive heart failure. Hemorrhage involves a decrease in blood pressure, bruising, and lumbar pain. The client has pleuritic pain, which is not consistent withthe chest pain of a myocardial infarction. PTS: 1 6. A client who takes warfarin [Coumadin] is brought to the emergency department after accidentally taking too much warfarin. The client’s heart rate is 78 beats/min, and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The client does not have any obvious hematoma or petechiae and does not complain of pain. The nurse practitioner will anticipate an order for: a. vitamin K (phytonadione). b. protamine sulfate. c. a PTT. d. a PT and an INR. CORRECT: DStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal This client does not exhibit any signs of bleeding from a warfarin overdose. The vital signs are stable; there are no hematomas or petechiae; and the client does not have pain. A PT and INR should be drawn to evaluate the anticoagulant effects. Vitamin K may be given if laboratory values indicate overdose. Protamine sulfate is given for heparin overdose. PTT evaluation is used to monitor heparin therapy. PTS: 1 7. A client who has taken warfarin [Coumadin] for a year begins taking carbamazepine. The nurse practitioner will anticipate an order to: a. decrease the dose of carbamazepine. b. increase the dose of warfarin. c. perform more frequent aPTT monitoring. d. provide extra dietary vitamin K. CORRECT: B Carbamazepine is a powerful inducer of hepatic drug-metabolizing enzymes and can accelerate warfarin degradation. The warfarin dose should be increased if the client begins taking carbamazepine. Decreasing the dose of carbamazepine is not indicated. It is not necessary to perform more frequent aPTT monitoring or to add extra vitamin K. PTS: 1 8. A client has been taking warfarin [Coumadin] for atrial fibrillation. The provider has ordered dabigatran etexilate [Pradaxa] to replace the warfarin. The nurse practitioner teaches the client about the change in drug regimen. Which statement by the client indicates understanding of the teaching? a. “I may need to adjust the dose of dabigatran after weaning off the warfarin.” b. “I should continue to take the warfarin after beginning the dabigatran until my INR is greater than 3.” c. “I should stop taking the warfarin 3 days before starting the dabigatran.” d. “I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2.” CORRECT: D When switching from warfarin to dabigatran, clients should stop taking the warfarin and begin taking the dabigatran when the INR is less than 2. It is not correct to begin taking the dabigatran before stopping the warfarin. While warfarin is stopped before beginning the dabigatran, the decision to start taking the dabigatran is based on the client’s INR and not on the amount of time that has elapsed. PTS: 1 9. A client will begin taking dabigatran etexilate [Pradaxa] to prevent stroke. The nurse practitioner willinclude which statement when teaching this client? a. Dabigatran should be taken on an empty stomach to improve absorption. b. It is important not to crush, chew, or open capsules of dabigatran. c. The risk of bleeding with dabigatran is less than that with warfarin [Coumadin]. d. To remember to take dabigatran twice daily, a pill organizer can be useful.Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal CORRECT: A Clients should be taught to swallow capsules of dabigatran intact; absorption may be increasedas much as 75%, increasing the risk of bleeding, if the capsules are crushed, chewed, or opened. Dabigatran may be taken with or without food. The risk of bleeding is not less than that of warfarin. Dabigatran is unstable when exposed to moisture, so using a pill organizer is not recommended. PTS: 1 10. A postoperative client will begin anticoagulant therapy with rivaroxaban [Xarelto] after knee replacement surgery. The nurse practitioner performs a history and learns that the client is taking erythromycin. The client’s creatinine clearance is 50 mL/min. The nurse practitioner will: a. administer the first dose of rivaroxaban as ordered. b. notify the provider to discuss changing the client’s antibiotic. c. request an order for a different anticoagulant medication. d. request an order to increase the dose of rivaroxaban. CORRECT: B Clients with impaired renal function who are taking macrolide antibiotics will experience increased levels of rivaroxaban, increasing the risk of bleeding. It is correct to discuss using a different antibiotic if possible. The nurse practitioner should not administer the dose without discussing the situation with the provider. The client’s renal impairment is minor; if it were more severe, usinga different anticoagulant might be appropriate. It is not correct to increase the dose of rivaroxaban. PTS: 1 11. A 50-year-old female client asks a nurse practitioner about taking aspirin to prevent heart disease. The client does not have a history of myocardial infarction. Her cholesterol and blood pressure arenormal, and she does not smoke. What will the nurse practitioner tell the client? a. Aspirin is useful only for preventing a second myocardial infarction. b. She should ask her provider about using a P2Y12 ADP receptor antagonist. c. She should take one 81-mg tablet per day to prevent myocardial infarction. d. There is most likely no protective benefit for clients of her age. CORRECT: D ASA is used for primary prevention of myocardial infarction (MI) in men and in women older than 65 years. Aspirin for primary prevention may be used in women ages 55 to 79 years when the potential benefit of a reduction in MI outweighs the potential harm of increased GI hemorrhage. This client has no previous history of MI, so the use of ASA is not indicated. ASAis useful for primary prevention, but only when indicated by cardiovascular risk, based on age, gender, cholesterol levels, blood pressure, and smoking status. A P2Y12 ADP receptor antagonist is used as secondary prevention. This client should not begin taking ASA unless her risk factors change, or until she is 65 years old. PTS: 1Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal 12. A client who is taking clopidogrel [Plavix] calls the nurse practitioner to report black, tarry stools andcoffee-ground emesis. The nurse practitioner will tell the client to: a. ask the provider about using aspirin instead of clopidogrel. b. consume a diet high in vitamin K. c. continue taking the clopidogrel until talking to the provider. d. stop taking the clopidogrel immediately. CORRECT: C Clients who experience bleeding should be warned not to stop taking the clopidogrel until the prescriber says they should, since abrupt withdrawal may precipitate a thrombotic event. Taking aspirin with an active GI bleed is contraindicated. Warfarin is a vitamin K inhibitor; consuming extra vitamin K will not reverse the effects of clopidogrel. PTS: 1 13. A client is admitted to the hospital with unstable angina and will undergo a percutaneous coronary intervention. Which drug regimen will the nurse practitioner expect to administer to prevent thrombosis in this client? a. Aspirin, clopidogrel, omeprazole b. Aspirin, heparin, abciximab [ReoPro] c. Enoxaparin [Lovenox], prasugrel [Effient], warfarin [Coumadin] d. Heparin, alteplase, abciximab [ReoPro] CORRECT: B Abciximab, combined with ASA and heparin, is approved for IV therapy for clients undergoing PCI. PTS: 1 14. A postoperative client reports pain in the left lower extremity. The nurse practitioner notes swelling in the lower leg, which feels warm to the touch. The nurse practitioner will anticipate giving which medication? a. Aspirin b. Clopidogrel [Plavix] c. Enoxaparin [Lovenox] d. Warfarin [Coumadin] CORRECT: C Enoxaparin is a low-molecular-weight heparin and is used in situations requiring rapid onset of anticoagulant effects, such as massive DVT. Aspirin, clopidogrel, and warfarin are useful for primary prevention but are not used when rapid anticoagulation is required. PTS: 1 15. A nurse practitioner caring for a client receiving heparin therapy notes that the client has a heart rate of 98beats/min and a blood pressure of 110/72 mm Hg. The client’s fingertips are purplish in color.A stat CBC shows a platelet count of less than 100,000 mm3. The nurse practitioner will: a. administer oxygen and notify the provider. b. discontinue the heparin and notify the provider. c. request an order for protamine sulfate.Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal d. request an order for vitamin K (phytonadione). CORRECT: B This client is showing signs of heparin-induced thrombocytopenia, so the heparin should be discontinued immediately and the provider should be notified. The purplish color of the fingertips is caused by thrombosis, not hypoxia, so oxygen is not indicated. This client may need continued anticoagulation therapy, so a request for protamine sulfate is not correct. Heparinis not a vitamin K inhibitor. PTS: 1 16. A client is admitted to the emergency department with chest pain. An electrocardiogram shows changes consistent with an evolving myocardial infarction. The client’s cardiac enzymes are pending. The nurse practitioner caring for this client will expect to: a. administer aspirin when cardiac enzymes are completed. b. give alteplase [Activase] within 2 hours. c. give tenecteplase [TNKase] immediately. d. obtain an order for an INR. CORRECT: B When alteplase is given within 2 hours after symptom onset, the death rate for MI has been shown to be 5.4%, compared with 9.4% if given 4 to 6 hours after symptom onset. ASA may be given at the first sign of MI; it is not necessary to wait for cardiac enzyme results. Tenecteplase may be given more than 2 hours after onset of symptoms. Obtaining an order for an INR is not indicated. PTS: 1 17. A client who is taking warfarin [Coumadin] has just vomited blood. The nurse practitioner notifies the provider, who orders laboratory work revealing a PT of 42 seconds and an INR of 3.5. The nurse practitioner will expect to administer: a. phytonadione (vitamin K1) 1 mg IV over 1 hour. b. phytonadione (vitamin K1) 2.5 mg PO. c. protamine sulfate 20 mg PO. d. protamine sulfate 20 mg slow IV push. CORRECT: A Vitamin K1 is given for warfarin overdose and may be given IV in an emergency. To reduce the incidence of an anaphylactoid reaction, it should be infused slowly. In a nonemergency situation, it would be appropriate to give vitamin K1 orally. Protamine sulfate is used for heparin overdose. PTS: 1 18. The nurse practitioner has just received an order for tenecteplase [TNKase] for a client experiencing anacute myocardial infarction. The nurse practitioner should administer this drug: a. by bolus injection. b. by infusion pump over 24 hours. c. slowly over 90 minutes. d. via monitored, prolonged infusion.Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal CORRECT: A Tenecteplase [TNKase] is given by bolus injection. Tissue plasminogen activator (tPA) must be infused over 90 minutes. Because tenecteplase [TNKase] is given by bolus injection, an infusion pump is not required. Although the client should be monitored, tenecteplase [TNKase] does not require a prolonged infusion time. PTS: 1 Chapter 56: Management of ST-Elevation Myocardial Infarction Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition MULTIPLE CHOICE 1. A client arrives in the emergency department complaining of chest pain that has lasted longer than 1 hour and is unrelieved by nitroglycerin. The client’s electrocardiogram reveals elevation of the ST segment. Initial cardiac troponin levels are negative. The client is receiving oxygen via nasal cannula. Which drug should be given immediately? a. Aspirin 325 mg chewable b. Beta blocker given IV c. Ibuprofen 400 mg orally d. Morphine intravenously CORRECT: A This client shows signs of acute ST-elevation myocardial infarction (STEMI). Because cardiac troponin levels usually are not detectable until 2 to 4 hours after the onset of symptoms, treatment should begin as symptoms evolve. Chewable aspirin (ASA) should be given immediately to suppress platelet aggregation and produce an antithrombotic effect. Beta blockers are indicated but do not have to be given immediately. Ibuprofen is contraindicated. Morphine is indicated for pain management and should be administered after aspirin has been given. PTS: 1 2. A nurse practitioner is discussing fibrinolytic therapy for the acute phase of STEMI management with a group of nursing students. Which statement by a student indicates understanding of this therapy? a. “Fibrinolytics are effective when the first dose is given up to 24 hours after symptom onset.” b. “Fibrinolytics should be given once cardiac troponins reveal the presence of STEMI.” c. “Fibrinolytics should be used with caution in clients with a history of cerebrovascular accident.” d. “Clients should receive either an anticoagulant or an antiplatelet agent with a fibrinolytic drug.” CORRECT: CStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal Clients with a history of cerebrovascular accident (CVA) should not receive fibrinolytic agents because of the increased risk of intracranial hemorrhage. Fibrinolytics are most effective when given within 30 minutes of arrival in the emergency department. Because cardiac troponins are not detectable until 2 to 4 hours after the onset of symptoms, fibrinolytics should be administered before these laboratory values are available. Clients receiving fibrinolytics should receive both an anticoagulant and an antiplatelet drug. PTS: 1 3. A nurse practitioner is evaluating a client admitted to the emergency department with an evolving STEMI for possible administration of thrombolytic therapy. Which information, identified during historytaking, would contraindicate this type of therapy? a. The client just completed her last menstrual cycle. b. The client states that the chest pain started 1 hour ago. c. The client has a history of a small cerebral aneurysm. d. The client has hypertension that is well controlled by diuretic therapy. CORRECT: C Clients with a history of CVA should not receive fibrinolytic therapy. This client has had a known cerebral aneurysm. Active internal bleeding is a contraindication for thrombolysis except for menses, but the client has indicated she has completed her last cycle. Fibrinolytic therapy should be administered for chest pain that has been present for no longer than 12 hours. Poorly controlled or severe hypertension is a relative contraindication. Thrombolytics can be administered with caution. PTS: 1 4. A client diagnosed with STEMI is about to undergo a primary percutaneous coronary intervention (PCI). Which combination of pharmacotherapeutic agents will be given to augment this procedure? a. Beta blocker and nitroglycerin b. Abciximab and a fibrinolytic drug c. Angiotensin-converting enzyme (ACE) inhibitor and aspirin d. Heparin, aspirin, and clopidogrel CORRECT: D Clients undergoing a primary PCI should receive heparin intravenously combined with aspirin and either clopidogrel or prasugrel. Abciximab and fibrinolytic drugs are not indicated. Beta blockers and nitroglycerin do not prevent thromboses. ACE inhibitors do not prevent thromboses. PTS: 1 5. A client in the emergency department has severe chest pain. The nurse practitioner administers morphine intravenously. The client asks the nurse practitioner why morphine is given. Which response by the nurse practitioner iscorrect? a. “Morphine helps by reducing anxiety and relieving pain.” b. “Morphine helps by reducing pain and dissolving clots.”Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal c. “Morphine helps by relieving pain and lowering blood pressure.” d. “Morphine helps by relieving pain and reducing the cardiac oxygen demand.” CORRECT: D IV morphine is the treatment of choice for STEMI-associated pain. Besides relieving pain, it promotes vasodilation and reduces cardiac preload, which lowers the cardiac oxygen demand. It does not reduce anxiety, dissolve clots, or lower blood pressure. PTS: 1 6. A client is admitted to the coronary care unit from the emergency department after initial management of STEMI. A primary percutaneous coronary intervention has been performed. The nurse practitioner notes an initial heart rate of 56 beats/min and a blood pressure of 120/80 mm Hg. The client has a history of stroke and a previous myocardial infarction. Which order will the nurse practitioner question? a. Aspirin b. Beta blocker c. Clopidogrel d. Heparin CORRECT: B A beta blocker would be contraindicated in this client, because it slows the heart, and this client is already bradycardic. Aspirin, clopidogrel, and heparin are recommended in clientswho have had a primary PCI. PTS: 1 7. A nurse practitioner is giving aspirin to a client during acute management of STEMI. The client asks whya chewable tablet is given. Which response by the nurse practitioner is correct? a. “Aspirin is absorbed more quickly when it is chewed.” b. “Chewing aspirin prevents it from being metabolized by the liver.” c. “Chewing aspirin prevents stomach irritation.” d. “More of the drug is absorbed when aspirin is chewed.” CORRECT: A Aspirin should be chewed to allow rapid absorption across the buccal mucosa. Chewing aspirin does not affect hepatic metabolism, stomach irritation, or the amount absorbed. PTS: 1 8. A client has undergone a primary percutaneous coronary intervention with a stent placement. The provider has ordered a daily dose of 81 mg of aspirin and clopidogrel. The client asks the nurse practitioner how long the medications must be taken. What will the nurse practitioner tell this client about the medication regimen? a. This drug regimen will continue indefinitely. b. The clopidogrel will be discontinued in 1 year and the aspirin will be given indefinitely. c. The aspirin will be discontinued in 1 year and the clopidogrel will be given indefinitely.Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal d. Both drugs will be discontinued in 1 year. CORRECT: B Clients who have undergone PCI with a stent will take ASA indefinitely along with an antiplatelet drug for 1 year. The clopidogrel will be discontinued in 1 year, but the aspirin will be given indefinitely. PTS: 1 9. A client has undergone a PCI, and the provider orders clopidogrel to be given for 12 months, along with an ACE inhibitor and heparin. What will the nurse practitioner do? a. Question the need for heparin. b. Request an order for a beta blocker. c. Request an order for aspirin. d. Suggest ordering clopidogrel for 14 days. CORRECT: C Clients who have undergone a PCI should receive heparin, ASA, and a fibrinolytic; therefore, this client needs ASA added to the drug regimen. Heparin should be given before, during, and for at least 48 to 72 hours after the procedure. Beta blockers are not necessarily indicated. Clopidogrel should be given at least 12 months after the procedure. PTS: 1 10. A client who is recovering from a STEMI 3 months prior is in the clinic for a follow-up evaluation. The client is taking 81 mg of aspirin, a beta blocker, and an ACE inhibitor daily and uses nitroglycerine as needed for angina. The client’s BMI is 24.5 kg/m2, and serum LDL is 150 mg/dL. The client has a blood pressure of 135/80 mm Hg. What will the nurse practitioner expect the provider to order for this client? a. An antihypertensive medication b. Counseling about a weight loss diet c. Discontinuing the ACE inhibitor d. High-dose statin therapy CORRECT: D To help prevent recurrence of MI in clients post-STEMI, a high-dose statin should be given to clients with elevated cholesterol. This client’s blood pressure and BMI are normal, so antihypertensives and a weight loss diet are not recommended. The three drugs should be continued indefinitely. PTS: 1 11. A client who is receiving reperfusion therapy has a history of heparin-induced thrombosis (HIT). The client has a creatinine clearance of 28 mL/min. In addition to the fibrinolytic agent, which medication will the nurse practitioner expect to administer to this client? a. Aspirin b. Bivalirudin [Angiomax] c. Clopidogrel [Plavix] d. Fondaparinux [Arixtra]Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?
Stuvia.com - The Marketplace to Buy and Sell your Study MaterialStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: sass1y0s0im%8G31UA| sRaAsNsyTsEimE831@gmail.com Distribution of this document is illegal CORRECT: B Clients receiving a fibrinolytic medication will also need an anticoagulant to reduce the risk of thrombosis. This client cannot receive heparin because of the history of HIT, so he or she will need either bivalirudin or fondaparinux. Bivalirudin may be used at reduced doses in clients with a creatinine clearance less than 30 mL/min, but fondaparinux is contraindicated in such clients. Antiplatelet drugs such as aspirin or clopidogrel are not used for this purpose. PTS: 1 MULTIPLE RESPONSE 1. Clients with a history of myocardial infarction should take which medications indefinitely? (Select all that apply.) a. ACE inhibitors b. Alteplase c. Aspirin d. Beta blockers e. Clopidogrel CORRECT: A, C, D Clients who have had an MI should take ACE inhibitors, ASA, and beta blockers indefinitely to prevent recurrence and to minimize continuing cardiac remodeling. Alteplase is given during acute management, and clopidogrel is used during acute management and as an adjunct to reperfusion therapy. PTS: 1 Chapter 57: Drugs for Hemophilia Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition MULTIPLE CHOICE 1. A client with epistaxis and a history of hemophilia A is admitted to the unit and is scheduled for replacement therapy. The nurse practitioner should prepare to administer which medication? a. Tranexamic acid [Cyklokapron] b. Aminocaproic acid [Amicar] c. Desmopressin [Stimate] d. Factor VIII CORRECT: D The cornerstone of treatment for hemophilia A is replacement therapy with factor VIII. Tranexamic acid and aminocaproic acid are antifibrinolytic agents that act primarily by preventing the formation of plasmin from its precursor. Desmopressin promotes the release of factor VIII from the vascular endothelium and has the advantage of being cheaper than factor VIII. Also, it can be administered by nasal spray or by IV infusion. However, repeated use of desmopressin can deplete stored factor VIII.Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: fatokiabimbola | bimtoluv@gmail.com Distribution of this document is illegal Want to earn $1.236 extra per year?