exam 3 patho

1. A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question?

-spironolactone (potassium-sparing diuretic)

-bumetanide (loop diuretic)

-hydrochlorothiazide (thiazide diuretic)

0furosemide (loop diuretic)

-spironolactone (potassium-sparing diuretic)

2. A gardener needs a decongestant because of seasonal allergy problems and asks the nurse whether he should take an oral form or a nasal spray. which of these is a benefit of orally administered decongestants?

-shorter duration

-lack of rebound congestion

-immediate onset

-a more potent effect

lack of rebound congestion

3. A nurse preceptor asks the nurse they are training what the acronym RIPE stands for in tuberculosis therapy?

- Isoniazid, rifampin, pyrazinamide, and ethambutol TB medications

- Rapid treatment, Isoniazid, pyrazinamide, ear checks

- the labs that should be drawn during TB treatment.

- the foods to avoid while on antitubercular medications

- Isoniazid, rifampin, pyrazinamide, and ethambutol TB medications

4. Complete the equation:

Cardiac output = Volume of blood ejected at each heartbeat _____

-heart rate

-preload

• stroke volume

• afterload

-heart rate

5. A nursing student asks why albuterol, which is selective for beta, receptors, causes an increased heart rate in some patients. How should the nurse respond?

"Bronchodilation lowers blood pressure, which causes a reflex tachycardia."

"Some patients metabolize the drug differently and have unusual side effects."

"Systemic effects are intensified with inhaled doses."

"Adrenergic agonists can lose their selectivity when given at higher doses."'

"Adrenergic agonists can lose their selectivity when given at higher doses."'

6. Which instruction should the nurse include in the teaching for a patient prescribed oral loratidine (2nd generation antihistamine) for seasonal allergic rhinitis?

• "Take a stool softener daily to avoid the side effect of constipation."

• "Clean the nasal applicator after use to prevent contamination."

"Take the medication daily throughout the allergy season."

"Expect a decrease in your nasal congestion in a day or two."

"Take the medication daily throughout the allergy season."

7. When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects?

a. Fatigue and depression

b. Anxiety and palpitations

c. Headache and rapid heart rate

d. Oral candidiasis and dry mouth

d. Oral candidiasis and dry mouth

8. Which finding indicates a positive outcome from treatment with filgrastim (neupogen)

a. cancer goes into remission

b. the neutrophil count increases

c. bone pain is eliminated

b. the neutrophil count increases

9. A patient asks the nurse about taking over-the-counter sleeping aids. The nurse will tell the patient that the active ingredient in these products is often a(n):

-benzodiazepine

-barbiturate

-antiemetic

-antihistamine

antihistamine

10. The nurse understands that muscarinic antagonists are often referred by other names. Which names should the nurse recognize for this category of drug? (Select all that apply.)

a. cholinergic drugs

b. parasympatholytic drugs

c. antimuscarinic drugs

d. anticholinergic drugs

e. muscarinic blockers

b,c,d,e

11. Which complaint indicates that a patient is experiencing an adverse effect of fluticasone [Flonase] nasal spray?

-rebound congestion

-runny nose (rhinitis)

-sore throat

-sneezing

sore throat

12. During a COPD exacerbation, which class of drugs is preferred for bronchodilation?

inhaled short-acting beta2 agonists (SABAs)

antibiotics

systemic glucocorticoids

inhaled long-acting beta2 agonists (LABAs)

inhaled short-acting beta2 agonists (SABAs)

13. The nurse monitors which assessment finding indicates a positive the patient taking glucocorticoids. (SATA)

a. weight loss

b. hyperglycemia

c. infection

d. hypoglycemia

e. weight gain

b, c, e

14. A patient who was in a motor vehicle accident sustained a severe head injury and is brought to into the emergency department. The provider orders intravenous mannitol (osmotic diuretic). The nurse knows the this is given to :

a. reduce peripheral edema

b. reduce intracranial pressure

c. restore extra cellular fluid

b. reduce intracranial pressure

15. A patient with cardiovascular disease is taking atorvastatin (lipitor). The nurse is monitoring potential adverse effects. Which finding indicates a potential adverse effect of this drug.

a. Muscle pain and tenderness

B. Wheezing and shortness of breath

c. blood pressure of 140/90 MMHG.

a. Muscle pain and tenderness

16. A patient 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 caring for this patient will expect to administer which drug?

-hydrochlorothiazide (thiazide diuretic)

-spironolactone (potassium-sparing diuretic)

-furosemide (loop diuretic)

-mannitol (osmotic diuretic)

-furosemide (loop diuretic)

17. A nurse is teaching a patient who is to start taking Guaifenisen, an expectorant. The nurse provides the patient with which of these instructions?

"Increase your fiber and fluid intake to prevent constipation."

"Take the medication once a day only, usually at bedtime."

"Increase your fluid intake to reduce the viscosity of secretions."

"Restrict cold fluids to promote reduced mucus production."

"Increase your fluid intake to reduce the viscosity of secretions."

18. Which drug is the most effective for lowering LDL cholesterol?

colesevelam (bile acid sequestrant)

fish oil

atorvastatin (HMG CoA Reductase Inhibitor)

gemfibrozil (fibrates)

atorvastatin (HMG CoA Reductase Inhibitor)

19. The nurse is caring for a patient after hip replacement surgery. The patient has been receiving iron replacement therapy for two days. The nurse notes that the patient stole appears black. The patient is pale and complains of feeling tired. The patient's heart rate is 98 bpm, respiration rate are 20 breaths, per minute, and the blood pressure is 100/50 mmhg. The nurse will contact the provider to:

a. suggest giving a hypertonic fluid bolus

b. report possible gastrointestinal

c. request a hemoglobin and hematocrit

c. request a hemoglobin and hematocrit

The nursing student explains to the instructor, that patient teaching for Theophylline (a xanthine derivative) should include avoiding:

milk

orange juice

energy drinks

lemon-lime soda

energy drinks

A health care professional who is advising a patient about the use of antihistamines to treat allergic rhinitis should explain that these drugs are effective because they perform which of the following actions?

-blocks H2 receptors.

-prevents histamine from binding to receptors.

-decreases viscosity of nasal secretions.

-reduces nasal

-prevents histamine from binding to receptors.

A patient is admitted to the intensive care unit for treatment of shock. The prescriber orders isoproterenol [Isuprel]. The nurse expects this drug to increase tissue perfusion in this patient by activating:

-beta receptors to cause a positive inotropic effect.

-beta receptors to cause bronchodilation.

-alpha receptors to cause vasoconstriction.

-alpha 1 receptors to increase blood pressure.

-beta receptors to cause a positive inotropic effect.

A patient with a tracheostomy has difficulty coughing up the excessive thick mucus in their respiratory tract. The nurse expects which drug will be ordered to aid in the removal of mucus?

-guaifenesin (expectorant)

-fluticasone (glucocorticoid)

-albuterol (SABA)

-guaifenesin (expectorant)

A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient?

-The fetus most likely will have serious congenital defects.

-The patient should stop taking the medication and contact her provider immediately.

-The fetus must be monitored closely while the patient is taking this drug.

-The patient's prescriber probably will change her medication to an ARB.

-The patient should stop taking the medication and contact her provider immediately.

The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis?

-High-density lipoprotein (HDL)

-Very-low-density lipoprotein (VLDL)

-Low-density lipoprotein (LDL)

-Apolipoprotein B-100

-Low-density lipoprotein (LDL)

A patient who is taking nitrofurantoin calls the nurse to report several side effects. Which side effect of this drug causes the most concern and would require discontinuation of the medication?

-anorexia, nausea, and vomiting

-brown-colored urine

-tingling of the fingers

-drowsiness

tingling of the fingers

A patient is admitted to the hospital with a diagnosis of hypertension. The nurse understands that which medication works by preventing angiotensin II from binding with its receptor sites?

- candesartan (ARB)

-lisinopril (ACE-I)

-eplerenone (selective aldosterone antagonist)

- candesartan (ARB)

A patient with bronchitis is taking (bactrim) TMP/SMZ, 160/800 mg orally, twice daily. Before administering the third dose, the nurse notes that the patient has a widespread rash, a temperature of 103°F, and a heart rate of 100 beats/min. The patient looks ill and reports not feeling well. What will the nurse do?

a. Administer the dose and request an order for an antipyretic medication.

b. Request an order for intravenous TMP/SMZ, because the patient is getting worse.

c. Withhold the dose and notify the provider of the symptoms.

d. Withhold the dose and request an order for an antihistamine to treat the rash.

c. Withhold the dose and notify the provider of the symptoms.

A patient is in an urgent care center with an acute asthma attack. The nurse expects which medication will be used for initial treatment?

-A long-acting beta2 agonist such as salmeterol

-A corticosteroid such as fluticasone

-An anticholinergic such as ipratropium

-A short-acting beta2 agonist such as albuterol

-A short-acting beta2 agonist such as albuterol

When evaluating a patient's use of a metered-dose inhaler (MDI), the nurse notes that the patient is unable to coordinate the activation of the inhaler with her breathing. What intervention is most appropriate at this time?

-Ask the prescriber if the medication can be given orally.

-Obtain an order for a peak flow meter.

-Obtain an order for a spacer device.

-Notify the prescriber that the patient is unable to use the MDI.

-Obtain an order for a spacer device.

A provider has ordered captopril [Capoten] for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nurse is correct?

-Hold the dose and notify the provider.

-Administer the captopril and monitor for adverse effects.

-Request an order to administer fosinopril instead of captopril.

-Reassure the patient that this is not a serious side effect

-Hold the dose and notify the provider.

Drugs / drug classes that affect the Renin-Angiotensin-Aldosterone System

- losartan

-captopril

-ace inhibitors

-Angiotensin II receptor blocker (ARBS)

-direct renin inhibitors

Drugs for the Cold / Flu and/or other Respiratory Disorders:

theophylline

acetylcysteine

albuterol (beta2-agonist)

ipratropium

guaifenesin

prednisone

Drugs that are Diuretics:

furosemide

hydrochlorothiazide

mannitol

spironolactone

eplerenone

The nurse plans to closely monitor for which clinical manifestation after administering furosemide [Lasix](loop diuretic)?

-decreased temperature

-decreased respiratory rate

-decreased blood pressure

-decreased pulse

-decreased blood pressure

The nurse is administering epoetin alfa [Procrit] to a patient receiving chemotherapy. Which adverse effect is a potential risk with this drug?

hypotension

-easy bruising

-bone pain

-accelerated tumor progression

accelerated tumor progression

A patient with asthma uses albuterol [Ventolin] for wheezing. The nurse assesses the patient and notes vital signs of HR, 96 beats/min; RR, 18 breaths per minute; and BP, 116/78 mm Hg. The patient has clear breath sounds and hand tremors. What will the nurse do?

-Ask the patient how often the inhaler is used.

-Request an order for isoproterenol [Isuprel] to reduce side effects.

-Stop the medication and report the tremors to the provider.

-Check the patient's blood glucose level.

-Ask the patient how often the inhaler is used.

The nurse has just administered the initial dose of enalapril [Vasotec](ACE-Inhibitor) to a newly admitted patient with hypertension. What is the priority nursing intervention over the next several hours?

-Monitor blood pressure.

-Auscultate lung sounds.

-Check the heart

-Monitor blood pressure.

The nurse is taking a medication history on a newly admitted patient. The patient reports taking folic acid and vitamin B12. The nurse notifies the provider because of the concern that folic acid can:

-negatively affect potassium levels.

-worsen megaloblastic anemia.

-cause fetal malformation.

-mask the signs of vitamin B12 deficiency.

-mask the signs of vitamin B12 deficiency.

The nurse is preparing to administer a dose of epoetin alfa to a patient and notes that the patient has a hemoglobin level of 11.7 gm/dL. Which action by the nurse is correct?

• Request an order for a reduced dose.

•Administer the dose as ordered.

- Suggest that the provider increase the dose.

- Hold the dose and notify the provider.

- Hold the dose and notify the provider.

A prescriber has ordered filgrastim (granulocyte colony-stimulating factor) for a patient undergoing myelosuppressive chemotherapy. The nurse will prepare the patient for which potential side effect?

-fatigue

-hemorrhage

-bone pain

-headache

-bone pain

A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9°F, a pulse of 92 beats/min, respirations of 24 breaths per minute, and a blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of:

-acute cystitis.

-urinary tract infection.

-prostatitis.

-pyelonephritis.

pyelonephritis.

A nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin [Rifadin]. What would be an expected finding?

-peripheral neuropathy

-crystalluria

-red-orange tinged urine

-myopathy

-red-orange tinged urine

Select the drug and/or drug class that most closely fits each statement.

OPTIONS:

-Blocks angiotensin II receptors.

-Adverse effects include gynecomastia and hirsutism

-Administer slowly when IV to reduce the risk of ototoxicity

-Not to be used for patients that are anuric.

-Common side effect includes a persistent dry cough.

- Blocks angiotensin Il receptors = losartan (ARB)

- Adverse effects include gynecomastia and hirsutism=

spironolactone (potassium-sparing diuretic)

-Administer slowly when IV to reduce the risk of ototoxicity= furosemide (loop diuretic)

hydrochlorothiazide (thiazide diuretic)

Not to be used for patients that are anuric.= hydrochlorothiazide (thiazide diuretic)

Common side effect includes a persistent dry cough.=

captopril (ACE-I)