Pharm Final Ch 22-29 – Flashcards
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22.1. A 46-year-old man has been taking clonidine for 5 months. For the last 2 months, his blood pressure has been normal. During this office visit, he tells the nurse that he would like to stop taking the drug. What is the nurse's best response?
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a. "I'm sure the doctor will stop it—your blood pressure is normal now." b. "Your doctor will probably have you stop taking the drug for a month, and then we'll see how you do." ****c. "This drug should not be stopped suddenly; let's talk to your doctor."*** d. "It's likely that you can stop the drug if you exercise and avoid salty foods."
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22.2. When administering angiotensin-converting enzyme (ACE) inhibitors, the nurse keeps in mind that which are possible adverse effects? (Select all that apply.)
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a. Diarrhea ***b. Fatigue*** c. Restlessness ***d. Headaches*** ***e. A dry cough*** f. Tremors
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22.3. A patient with type 2 diabetes mellitus has developed hypertension. What is the blood pressure goal for this patient?
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a. Less than 110/80 mm Hg ***b. Less than 130/80 mm Hg*** c. Less than 130/84 mm Hg d. Less than 140/90 mm Hg
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22.4. A patient is being treated for a hypertensive emergency. The nurse expects which drug to be used?
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***a. sodium nitroprusside (Nitropress)*** b. losartan (Cozaar) c. captopril (Capoten) d. prazosin (Minipress)
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22.5. A patient in her eighth month of pregnancy has preeclampsia. Her blood pressure is 210/100 mm Hg this morning. This type of hypertension is classified as which of the following?
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a. Primary b. Idiopathic c. Essential ***d. Secondary***
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22.6. A beta1 blocker is prescribed for a patient with heart failure and hypertension. Which adverse effects, if present, may indicate a serious problem is developing while the patient is on this medication? (Select all that apply.)
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***a. Edema*** b. Nightmares ***c. Shortness of breath*** d. Nervousness e. Constipation
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23. 1. What is the purpose of antianginal drug therapy?
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a. To increase myocardial oxygen demand b. To increase blood flow to peripheral arteries ***c. To increase blood flow to ischemic cardiac muscle*** d. To decrease blood flow to ischemic cardiac muscle
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23.2. The nurse will teach a patient who will be taking nitroglycerin (Nitrostat) about which common adverse effect of this drug?
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a. Blurred vision b. Dizziness ***c. Headache*** d. Weakness
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23.3. The nurse is reviewing dosage forms of nitroglycerin (Nitrostat). This drug can be given by which routes? (Select all that apply.)
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***a. Continuous intravenous drip*** b. Intravenous bolus ***c. Sublingual spray*** ***d. Oral dosage forms*** ***e. Topical ointment*** f. Rectal suppository
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23.4. For a patient using transdermal nitroglycerin patches, the nurse knows that the prescriber will order which procedure for preventing tolerance?
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a. Leave the old patch on for 2 hours when applying a new patch. b. Apply a new patch every other day. c. Leave the patch off for 24 hours once a week. ***d. Remove the patch at night for 8 hours and then apply a new patch in the morning***
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23.5. Patients who are taking beta blockers for angina need to be taught which information?
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***a. These drugs are for long-term prevention of angina episodes.*** b. These drugs must be taken as soon as angina pain occurs. c. These drugs will be discontinued if dizziness is experienced. d. These drugs need to be carried with the patient at all times in case angina occurs.
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23.6. A patient with coronary artery spasms will be most effectively treated with which type of antianginal medication?
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a. Beta blockers ***b. Calcium channel blockers*** c. Nitrates d. Nitrites
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23.7. During his morning walk, a man begins to experience chest pain. He sits down and takes one nitroglycerin sublingual tablet. After 5 minutes, the chest pain is worsening. What action would be the priority in this situation?
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***a. Call 911 (emergency medical services).*** b. Take another nitroglycerin tablet. c. Take two more nitroglycerin tablets at the same time. d. Sit quietly to wait for the pain to subside.
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24.1. As part of treatment for early heart failure, a patient is started on an angiotensin-converting enzyme (ACE) inhibitor. The nurse will monitor the patient's laboratory work for which potential effect?
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a. Agranulocytosis b. Proteinuria ***c. Hyperkalemia*** d. Hypoglycemia
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24.2. Before giving oral digoxin (Lanoxin), the nurse discovers that the patient's radial pulse is 52 beats/min. What will be the nurse's next action?
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a. Give the dose. b. Delay the dose until later. c. Hold the dose and notify the physician. ***d. Check the apical pulse for 1 minute.***
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24.3. Which statement regarding digoxin therapy and potassium levels is correct?
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***a. Low potassium levels increase the chance of digoxin toxicity.*** b. High potassium levels increase the chance of digoxin toxicity. c. Digoxin reduces the excretion of potassium in the kidneys. d. Digoxin promotes the excretion of potassium in the kidneys.
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24.4. When infusing milrinone (Primacor), the nurse will keep which consideration in mind?
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a. The patient must be monitored for hyperkalemia. ***b. The patient's cardiac status must be monitored closely.*** c. The drug may cause reddish discoloration of the extremities. d. Hypertension is the primary effect seen with excessive doses.
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24.5. When caring for a patient who is taking digoxin, the nurse will monitor for which signs and symptoms of toxicity? (Select all that apply.)
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***a. Anorexia*** b. Diarrhea ***c. Visual changes*** ***d. Nausea and vomiting*** ***e. Headache*** ***f. Bradycardia***
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24.6. A patient who has heart failure will be started on an oral ACE inhibitor. While monitoring the patient's response to this drug therapy, which laboratory tests would be a priority? (Select all that apply.)
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a. White blood cell count b. Platelet count ***c. Serum potassium level*** d. Serum magnesium level ***e. Creatinine level*** ***f. Blood urea nitrogen (BUN)***
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25.1. The nurse notes in the patient's medication history that the patient is receiving a lidocaine infusion. Based on this finding, the nurse interprets that the patient has which disorder?
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a. Atrial fibrillation b. Bradycardia c. Complete heart block ***d. Ventricular dysrhythmias***
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25.2. When monitoring a patient who is taking quinidine (Quinidex), the nurse recognizes that possible adverse effects of this drug include which of these conditions? (Select all that apply.)
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a. Weakness b. Tachycardia ***c. Gastrointestinal upset*** ***d. Tinnitus*** ***e. Ventricular ectopic beats***
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25.3. The nurse is administering amiodarone (Cordarone) and should monitor for which potential adverse effect?
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***a. Pulmonary toxicity*** b. Hypertension c. Urinary retention d. Constipation
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25.4. A patient is about to receive a dose of verapamil (Calan). The nurse notes that this medication is used to treat which condition?
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a. Cardiac asystole b. Heart block c. Ventricular dysrhythmia, including premature ventricular contraction ***d. Recurrent paroxysmal supraventricular tachycardia (PSVT)***
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25.5. A patient is experiencing a rapid dysrhythmia, and the nurse is preparing to administer adenosine (Adenocard). Which is the correct administration technique for this drug?
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***a. It should be given as a fast intravenous push.*** b. It should be given intravenously, slowly, over at least 5 minutes. c. It should be taken with food or milk. d. It should be given as an intravenous drip infusion.
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25.6. If a drug has a prodysrhythmic effect, then the nurse must monitor the patient for which effect?
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a. Decreased heart rate ***b. New dysrhythmias*** c. A decrease in dysrhythmias d. Reduced blood pressure
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25.7. A patient will be starting therapy with quinidine (Quinidex). Which of these drugs, if also on the patient's medication list, may cause a potential drug interaction? (Select all that apply.)
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a. cimetidine (Tagamet) ***b. amiodarone (Cordarone)*** ***c digoxin (Lanoxin)*** d. warfarin (Coumadin) ***e. erythromycin (Erythrocin)***
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26.1. _____ A drug that prevents the lysis of fibrin, thereby promoting clot formation
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antifibrinolytic
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26.2. _____ The termination of bleeding by mechanical or chemical means
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hemostasis
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26.3. _____ A substance that prevents platelet plugs from forming
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antiplatelet drug
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26.4. _____ The general term for a drug that dissolves thrombi
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thrombolytic drug
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26.5. _____ The general term for a substance that prevents or delays coagulation of the blood
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anticoagulant
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26.6. _____ A laboratory test used to measure the effectiveness of heparin therapy
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activated partial thromboplastin time (aPTT)
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26.7. _____ Two tests used to monitor the effects of drug therapy with warfarin sodium
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prothrombin time (PT) International Normalized Ratio (INR)
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26.8. _____ A standardized measure of the degree of coagulation achieved by drug therapy with warfarin sodium
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International Normalized Ratio (INR)
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26.9. _____ A substance that reverses the effect of heparin
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protamine sulfate
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26.10. _____ A substance that reverses the effect of warfarin sodium
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vitamin K
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26.11. _____ A pharmaceutically available tissue plasminogen activator (tPA) that is created through recombinant DNA techniques
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alteplase (Activase)
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26.12. _____ A blood clot that dislodges and travels through the bloodstream
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embolus
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26.13. The nurse is reviewing the use of anticoagulants. Anticoagulant therapy is appropriate for which conditions? (Select all that apply.)
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***a. Atrial fibrillation*** b. Thrombocytopenia ***c. Myocardial infarction*** ***d. Presence of mechanical heart valve*** e. Aneurysm f. Leukemia
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26.14. During teaching of a patient who will be taking warfarin sodium (Coumadin) at home, which statement by the nurse is correct regarding over-the-counter drug use?
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a. "Choose nonsteroidal antiinflammatory drugs as needed for pain relief." ***b. "Aspirin products may result in increased bleeding."*** c. "Vitamin E therapy is recommended to improve the effect of the warfarin." d. "Mineral oil is the laxative of choice while taking anticoagulants."
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26.15. A patient is at risk for a stroke. Which drug is recommended to prevent platelet aggregation for stroke prevention by the American Stroke Society?
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***a. aspirin*** b. warfarin sodium (Coumadin) c. heparin d. alteplase (Activase)
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26.16. When administering subcutaneous heparin, the nurse will remember to perform which action?
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a. Use the same sites for injection to reduce trauma. b. Use a 1-inch needle for subcutaneous injections. ***c. Inject the medication without aspirating for blood return.*** d. Massage the site after the injection to increase absorption.
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26.17. During thrombolytic therapy, the nurse monitors for bleeding. Which symptoms may indicate a serious bleeding problem? (Select all that apply.)
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a. Hypertension ***b. Hypotension*** ***c. Decreased level of consciousness*** ***d. Increased pulse rate*** ***e. Restlessness***
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26.18. Which drug is most often used for deep vein thrombosis (DVT) prevention after major orthopedic surgery, even after the patient has gone home?
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a. Antiplatelet drugs, such as aspirin b. Adenosine diphosphate (ADP) inhibitors, such as clopidogrel (Plavix) c. Anticoagulants, such as warfarin sodium (Coumadin) ***d. Low-molecular-weight heparins, such as enoxaparin (Lovenox)***
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26.19. The nurse is preparing a patient's morning medications and, upon reviewing the list of drugs, notes that the patient is to receive heparin 5,000 units and enoxaparin (Lovenox), both subcutaneously. What is the nurse's priority action at this time?
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a. Administer the drugs in separate sites. ***b. Hold the drugs and clarify the order with the prescriber.*** c. Administer the enoxaparin and hold the heparin. d. Check the patient's aPTT.
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27.1. Patients taking cholestyramine (Questran) may experience which adverse effects?
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a. Blurred vision and photophobia b. Drowsiness and difficulty concentrating c. Diarrhea and abdominal cramps ***d. Belching and bloating***
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27.2. The nurse will instruct the patient who is taking antilipemic drugs about which dietary measures? (Select all that apply.)
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***a. Taking supplements of fat-soluble vitamins*** b. Taking supplements of B vitamins ***c. Increasing fluid intake*** ***d. Choosing foods that are lower in cholesterol and saturated fats*** ***e. Increasing the intake of raw vegetables, fruit, and bran***
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27.3. In reviewing the history of a newly admitted cardiac patient, the nurse knows that the patient would have a contraindication to antilipemic therapy if which condition is present?
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***a. Liver disease*** b. Renal disease c. Coronary artery disease d. Diabetes mellitus
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27.4. A woman is being screened in the cardiac clinic for risk factors for coronary artery disease. Which would be considered a negative (favorable) risk factor for her?
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a. High-density lipoprotein (HDL) cholesterol level of 30 mg/dL ***b. HDL cholesterol level of 75 mg/dL*** c. Low-density lipoprotein (LDL) level of 25 mg/dL d. History of diabetes mellitus
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27.5. A patient who has started taking niacin complains that he "hates the side effects." Which statement by the nurse is most appropriate?
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a. "You will soon build up tolerance to these side effects." b. "You need to take the niacin on an empty stomach." c. "You can take the niacin every other day if the side effects are bothersome." ***d. "Try taking a small dose of ibuprofen (Advil) 30 minutes before taking the niacin."***
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27.6. A patient asks, "What is considered the 'good cholesterol?'" How will the nurse answer?
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a. Very low-density lipoprotein (VLDL) b. LDL ***c. HDL*** d. Triglycerides
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27.7. The nurse is preparing to administer a newly ordered statin drug to a patient, and is reviewing the patient's list of current medications. Which medications may cause an interaction with the statin drug? (Select all that apply.)
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***a. warfarin (Coumadin)*** b. metformin (Glucophage) ***c. erythromycin (Erythrocin)*** ***d. cyclosporine (Gengraf)*** ***e. gemfibrozil (Lopid)***
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28.1. _____ Diuretics
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A general term for drugs that accelerate the rate of urine formation
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28.2. _____ Potassium-sparing diuretics
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Diuretics that result in the diuresis of sodium and water and the retention of potassium; spironolactone is an example
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28.3. _____ Loop of Henle
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Part of the kidney structure located between the proximal and distal convoluted tubules
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28.4. _____ Osmotic diuretics
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Drugs that induce diuresis by increasing the osmotic pressure of the glomerular filtrate, which results in rapid diuresis; mannitol is an example
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28.5. _____ Thiazides
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Diuretics that act on the distal convoluted tubule, where they inhibit sodium and water resorption; hydrochlorothiazide (HCTZ) is an example
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28.6. _____ Ascites
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An abnormal intraperitoneal accumulation of fluid
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28.7. _____ CAIs
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Abbreviation for a class of diuretics that inhibit the enzyme carbonic anhydrase; acetazolamide is an example
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28.8. _____ Loop diuretics
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potent diuretics that act along the ascending limb of the loop of Henle; furosemide is an example
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28.9. _____ Nephron
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The main structural unit of the kidney
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28.10. _____ GFR
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Abbreviation for the term that describes a gauge of how well the kidneys are functioning as filters
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28.11. Which are indications for the use of diuretics? (Select all that apply.)
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***a. To increase urine output*** b. To reduce uric acid levels ***c. To treat hypertension*** ***d. To treat open-angle glaucoma*** ***e. To treat edema associated with heart failure***
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28.12. When providing patient teaching to a patient who is taking a potassium-sparing diuretic such as spironolactone (Aldactone), the nurse will include which dietary guidelines?
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a. There are no dietary restrictions with this medication. b. The patient needs to consume foods high in potassium, such as bananas and orange juice. ***c. The patient needs to avoid excessive intake of foods high in potassium.*** d. The patient needs to drink 1 to 2 liters of fluid per day.
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28.13. When teaching a patient about diuretic therapy, which would the nurse indicate as the best time of day to take these medications?
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***a. Morning*** b. Midday c. Bedtime d. Time of day does not matter.
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28.14. When monitoring a patient for hypokalemia related to diuretic use, the nurse looks for which possible symptoms?
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a. Nausea, vomiting, and anorexia b. Diarrhea and abdominal pain c. Orthostatic hypotension ***d. Muscle weakness and lethargy***
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28.15. A patient with severe heart failure has been started on therapy with a carbonic anhydrase inhibitor (CAI), but the nurse mentions that this medication may be stopped in a few days. What is the reason for this short treatment?
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a. CAIs are not the first choice for treatment of heart failure. ***b. Metabolic acidosis develops in 2 to 4 days after therapy is started.*** c. It is expected that CAIs will dramatically reduce the fluid overload related to heart failure. d. Allergic reactions to CAIs are common
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28.16. A patient has a new order for daily doses of spironolactone (Aldactone). Which condition, if present, may be a contraindication to this drug therapy? (Select all that apply.)
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a. Heart failure ***b. Renal failure*** c. Diabetes mellitus d. Deep vein thrombosis ***e. Hyperkalemia***
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29.1. Which are common uses of crystalloids? (Select all that apply.)
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***a. Fluid replacement*** ***b. Promotion of urinary flow*** c. Transport of oxygen to cells ***d. Replacement of electrolytes*** ***e. As maintenance fluids*** f. Replacement of clotting factors
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29.2. The intravenous order for a newly admitted patient calls for "Normal saline to run at 100 mL/hr." The nurse will choose which concentration of normal saline?
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a. 0.33% b. 0.45% ***c. 0.9%*** d. 3.0%
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29.3. A patient has been admitted with severe dehydration after working outside on a very hot day. The nurse expects which intravenous product to be ordered?
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a. Albumin b. Hetastarch c. Fresh frozen plasma ***d. 0.9% sodium chloride***
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29.4. When giving intravenous potassium, which is important for the nurse to remember?
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a. Intravenous doses are preferred over oral dosage forms. b. Intravenous solutions should contain at least 50 mEq/L. ***c. Potassium must always be given in diluted form.*** d. It is given by slow intravenous bolus.
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29.5. The nurse monitors for which signs of a possible transfusion reaction when a patient is receiving blood products?
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a. Subnormal temperature and hypertension ***b. Apprehension, restlessness, fever, and chills*** c. Decreased pulse and respirations and fever d. Headache, nausea, and lethargy
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29.6. A patient with a blood disorder needs a replacement product that contains clotting factors. The nurse expects which product to be given?
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a. Albumin ***b. Fresh frozen plasma*** c. Packed red blood cells d. 0.9 % normal saline
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29.7. A patient is receiving conivaptan (Vaprisol). Which of these are appropriate actions by the nurse?
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a. Administer the drug by slow IV push over 10 minutes. ***b. Report serum sodium levels of 149 mEq/L.*** c. Monitor for hyperkalemia. d. Implement measures to prevent constipation.
