pharm unit 3 pre exam quiz

A patient is in the clinic for a follow-up visit 3 months after starting a beta blocker for treatment of hypertension. During this visit, his blood pressure is 169/98 mm Hg, and he eventually confesses that he stopped taking this medicine 2 months ago because of an "embarrassing problem." What problem did the patient most likely experience with this medication that caused him to stop taking it?

Urge incontinence

Dizziness when standing up

Excessive flatus

Impotence

Impotence

• Beta blockers (like propranolol or metoprolol) are commonly associated with sexual dysfunction, including erectile dysfunction (impotence)

The nurse administering the phosphodiesterase inhibitor milrinone recognizes that this drug will have a positive inotropic effect. Which result reflects this effect?

Increased heart rate

Increased blood vessel dilation

Increased force of cardiac contractions

Increased conduction of electrical impulses across the heart

Increased force of cardiac contractions

A patient who has recently started therapy on a statin drug asks the nurse how long it will take until he sees an effect on his serum cholesterol. Which statement would be the nurse's best response?

"Blood levels return to normal within a week of beginning therapy."

"It takes 6 to 8 weeks to see a change in cholesterol levels."

"It takes at least 6 months to see a change in cholesterol levels."

"You will need to take this medication for almost a year to see significant results."

"It takes 6 to 8 weeks to see a change in cholesterol levels."

A patient has a digoxin level of 1.1 ng/mL. Which interpretation by the nurse is correct?

It is below the therapeutic level.

It is within the therapeutic range.

It is above the therapeutic level.

It is at a toxic level.

It is within the therapeutic range.

When monitoring a patient who is taking hydrochlorothiazide, the nurse notes that which drug is most likely to cause a severe interaction with the diuretic?

Digoxin

Penicillin

Potassium supplements

Aspirin

Digoxin

When teaching a patient about antihypertensive drug therapy, which statements by the nurse are correct? (Select all that apply.)

"You need to have your blood pressure checked once a week and keep track of the readings."

"If you notice that the symptoms have gone away, you should be able to stop taking the drug."

"An exercise program may be helpful in treating hypertension, but let's check with your doctor first."

"If you experience severe side effects, stop the medicine and let us know at your next office visit."

"Most over-the-counter decongestants are compatible with antihypertensive drugs."

"Please continue taking the medication, even if you are feeling better."

"You need to have your blood pressure checked once a week and keep track of the readings."

"An exercise program may be helpful in treating hypertension, but let's check with your doctor first."

"Please continue taking the medication, even if you are feeling better."

The nurse is preparing to administer adenosine to a patient who is experiencing an acute episode of paroxysmal supraventricular tachycardia. When giving this medication, which is important to remember?

The onset of action occurs within 5 minutes.

The medication must be given as a slow intravenous (IV) push.

Asystole may occur for a few seconds after administration.

The medication has a long half-life, and therefore duration of action is very long.

Asystole may occur for a few seconds after administration.

A patient who is now in heart failure after a recent myocardial infarction will be receiving a new prescription for lisinopril. The nurse is reviewing the patient's laboratory results and will report which of these as a potential contraindication?

Serum sodium level 136 mEq/L

Serum potassium 5.6 mEq/L

Elevated white blood cell count

Elevated cardiac troponin levels

Serum potassium 5.6 mEq/L

A patient will be receiving a thrombolytic drug as part of the treatment for acute myocardial infarction. The nurse explains to the patient that this drug is used for which purpose?

To relieve chest pain

To prevent further clot formation

To dissolve the clot in the coronary artery

To control bleeding in the coronary vessels

To dissolve the clot in the coronary artery

When applying transdermal nitroglycerin patches, which instruction by the nurse is correct?

"Rotate application sites with each dose."

"Use only the chest area for application sites."

"Temporarily remove the patch if you go swimming."

"Apply the patch to the same site each time."

"Rotate application sites with each dose."

The nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of these diuretics?

Hydrochlorothiazide

Furosemide

Acetazolamide

Spironolactone

Spironolactone

The nurse is screening a patient who will be taking a nonspecific/nonselective beta blocker. Which condition, if present, may cause serious problems if the patient takes this medication?

Angina

Hypertension

Glaucoma

Asthma

Asthma

The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class?

Calcium channel blockers

Diuretics

Nonsteroidal anti-inflammatory drugs

Nitrates

Nonsteroidal anti-inflammatory drugs

The nurse is reviewing drug therapy for hypertension. According to the JNC-8 guidelines, antihypertensive drug therapy for a newly diagnosed hypertensive black patient would most likely include which drug or drug classes?

Vasodilators alone

ACE inhibitors alone

Calcium channel blockers with thiazide diuretics

Beta blockers with thiazide diuretics

Calcium channel blockers with thiazide diuretics

A patient has been taking digoxin at home but took an accidental overdose and has developed toxicity. The patient has been admitted to the telemetry unit, where the physician has ordered digoxin immune Fab. The patient asks the nurse why the medication is ordered. What is the nurse's best response?

"It will increase your heart rate."

"This drug helps to lower your potassium levels."

"It causes your heart to beat at a slower rate."

"This drug is an antidote to digoxin and will help your heart to return to normal functioning."

"This drug is an antidote to digoxin and will help your heart to return to normal functioning.”

Furosemide is prescribed for a patient who is about to be discharged, and the nurse provides instructions to the patient about the medication. Which statement by the nurse is correct?

"Take this medication in the evening."

"Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and dates."

"If you experience weight gain, such as 5 pounds or more per week, be sure to tell your physician during your next routine visit."

"Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes."

"Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes."

A patient is in the intensive care unit because of an acute myocardial infarction. He is experiencing severe ventricular dysrhythmias. The nurse will prepare to give which drug of choice for this dysrhythmia?

Diltiazem

Verapamil

Amiodarone

Adenosine

Amiodarone

A patient about to receive a morning dose of digoxin has an apical pulse of 50 beats/min. What will the nurse do next?

Administer the dose.

Administer the dose, and notify the prescriber.

Check the radial pulse for 1 full minute.

Withhold the dose, and notify the prescriber.

Withhold the dose, and notify the prescriber.

The nurse notes in the patient's medication orders that the patient will be starting anticoagulant therapy. What is the primary goal of anticoagulant therapy?

Stabilizing an existing thrombus

Dissolving an existing thrombus

Preventing thrombus formation

Dilating the vessel around a clot

Preventing thrombus formation

While a patient is receiving antilipemic therapy, the nurse knows to monitor the patient closely for the development of which problem?

Neutropenia

Pulmonary problems

Vitamin C deficiency

Liver dysfunction

Liver dysfunction

A patient is taking digoxin and a loop diuretic daily. When the nurse enters the room with the morning medications, the patient states, "I am seeing a funny yellow color around the lights." What is the nurse's next action?

Assess the patient for symptoms of digoxin toxicity.

Withhold the next dose of the diuretic.

Administer the digoxin and diuretic together as ordered.

Document this finding, and reassess in 1 hour.

Assess the patient for symptoms of digoxin toxicity.

The nurse is providing education about the use of sublingual nitroglycerin tablets. She asks the patient, "What would you do if you experienced chest pain while mowing your yard? You have your bottle of sublingual nitroglycerin with you." Which actions by the patient are appropriate in this situation? (Select all that apply.)

Stop the activity, and lie down or sit down.

Call 911 immediately.

Call 911 if the pain is not relieved after taking one sublingual tablet.

Call 911 if the pain is not relieved after taking three sublingual tablets in 30 minutes.

Place a tablet under the tongue.

Place a tablet in the space between the gum and cheek.

Take another sublingual tablet if chest pain is not relieved after 5 minutes, up to three total.

Stop the activity, and lie down or sit down.

Call 911 if the pain is not relieved after taking one sublingual tablet.

Place a tablet under the tongue.

Take another sublingual tablet if chest pain is not relieved after 5 minutes, up to three total.

A patient with coronary artery disease asks the nurse about the "good cholesterol" laboratory values. The nurse knows that "good cholesterol" refers to which lipids?

Triglycerides

Low-density lipoproteins (LDLs)

Very–low-density lipoproteins (VLDLs)

High-density lipoproteins (HDLs)

High-density lipoproteins (HDLs)

A patient is being discharged to home on a single daily dose of a diuretic. The nurse instructs the patient to take the dose at which time so it will be least disruptive to the patient's daily routine?

In the morning

At noon

With supper

At bedtime

In the morning

In assessing a patient before administration of a cardiac glycoside, the nurse knows that which lab result can increase the toxicity of the drug?

Potassium level 2.8 mEq/L

Potassium level 4.9 mEq/L

Sodium level 140 mEq/L

Calcium level 10 mg/dL

Potassium level 2.8 mEq/L

When teaching a patient who has a new prescription for transdermal nitroglycerin patches, the nurse tells the patient that these patches are most appropriately used for which situation?

To treat acute chest pain

To relieve shortness of breath

To prevent the occurrence of angina

To keep the heart rate from rising too high during exercise

To prevent the occurrence of angina

Which drug classes are considered first-line treatment for heart failure? (Select all that apply.)

Angiotensin-converting enzyme (ACE) inhibitors

Angiotensin II receptor blockers (ARBs)

Digoxin, a cardiac glycoside

Beta blockers

Nesiritide, the B-type natriuretic peptide

Angiotensin-converting enzyme (ACE) inhibitors

Angiotensin II receptor blockers (ARBs)

Beta blockers

When a patient is experiencing digoxin toxicity, which clinical situation would necessitate the use of digoxin immune Fab? (Select all that apply.)

The patient reports seeing colorful halos around lights.

The patient's serum potassium level is above 5 mEq/L.

The patient is experiencing nausea and anorexia.

The patient is experiencing severe sinus bradycardia that does not respond to cardiac pacing.

The patient has received an overdose of greater than 10 mg of digoxin.

The patient reports fatigue and headaches.

The patient's serum potassium level is above 5 mEq/L.

The patient is experiencing severe sinus bradycardia that does not respond to cardiac pacing

The patient has received an overdose of greater than 10 mg of digoxin.

A patient is going home with a new prescription for the beta-blocker atenolol. The nurse will include which content when teaching the patient about this drug?

Never stop taking this medication abruptly.

The medication will be stopped once symptoms subside.

If adverse effects occur, stop taking the drug for 24 hours, and then resume.

Be watchful for first-dose hypotension.

Never stop taking this medication abruptly.

A 58-year-old man has had a myocardial infarction, has begun rehabilitation, and is ready for discharge. He is given a prescription for metoprolol and becomes upset after reading the patient education pamphlet. "I don't have high blood pressure—why did my doctor give me this medicine?" Which explanation by the nurse is correct?

"This medication will prevent blood clots that may lead to another heart attack."

"Beta blockers will improve blood flow to the kidneys."

"This drug is prescribed to prevent the high blood pressure that often occurs after a heart attack."

"Studies have shown that this medication has greatly increased survival rates in patients who have had a heart attack."

"Studies have shown that this medication has greatly increased survival rates in patients who have had a heart attack."

The nurse notes in a patient's medical record that ivabradine has been ordered. Based on this order, the nurse interprets that the patient has which disorder?

Heart failure with atrial fibrillation

Early stages of heart failure

Stable, symptomatic heart failure with an ejection fraction of 35% or less

Unstable heart failure with an ejection fraction of less than 15%

Stable, symptomatic heart failure with an ejection fraction of 35% or less

When administering digoxin immune Fab to a patient with severe digoxin toxicity, the nurse knows that each vial can bind with how much digoxin?

0.5 mg

5 mg

15 mg

25 mg

0.5 mg

A patient's blood pressure elevates to 270/150 mm Hg, and a hypertensive emergency is obvious. He is transferred to the intensive care unit and started on a sodium nitroprusside drip to be titrated per his response. With this medication, the nurse knows that the maximum dose of this drug should be infused for how long?

10 minutes

30 minutes

1 hour

24 hours

10 minutes

An older adult patient will be taking a vasodilator for hypertension. Which adverse effect is of most concern for the older adult patient taking this class of drug?

Dry mouth

Restlessness

Constipation

Hypotension

Hypotension

A patient is receiving thrombolytic therapy, and the nurse monitors the patient for adverse effects. What is the most common undesirable effect of thrombolytic therapy?

Dysrhythmias

Nausea and vomiting

Anaphylactic reactions

Internal and superficial bleeding

Internal and superficial bleeding

A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be needed. Which answer by the nurse is the correct response?

"This therapy will take about 3 months."

"This therapy will take about a year."

"This therapy will go on until your symptoms disappear."

"Therapy for high blood pressure is usually lifelong."

"Therapy for high blood pressure is usually lifelong."

A patient with elevated lipid levels has a new prescription for niacin. The nurse informs the patient that which adverse effects may occur with this medication?

Pruritus, cutaneous flushing

Tinnitus, urine with a burnt odor

Myalgia, fatigue

Blurred vision, headaches

Pruritus, cutaneous flushing

A patient is receiving heparin therapy as part of the treatment for a pulmonary embolism. The nurse monitors the results of which laboratory test to check the drug's effectiveness?

Bleeding times

Activated partial thromboplastin time (aPTT)

Prothrombin time/international normalized ratio (PT/INR)

Vitamin K levels

Activated partial thromboplastin time (aPTT)

While assessing a patient who is taking a beta blocker for angina, the nurse knows to monitor for which adverse effect?

Nervousness

Hypertension

Bradycardia

Dry cough

Bradycardia

A patient is in the intensive care unit and receiving an infusion of milrinone for severe heart failure. The prescriber has written an order for an intravenous dose of furosemide. How will the nurse give this drug?

Infuse the drug into the same intravenous line as the milrinone.

Stop the milrinone, flush the line, and then administer the furosemide.

Administer the furosemide in a separate intravenous line.

Notify the prescriber that the furosemide cannot be given at this time.

Administer the furosemide in a separate intravenous line.

A patient has been diagnosed with angina and will be given a prescription for sublingual nitroglycerin tablets. When teaching the patient how to use sublingual nitroglycerin, the nurse will include which instruction?

Take up to 5 doses at 15-minute intervals for an angina attack.

If the tablet does not dissolve quickly, chew the tablet for maximal effect.

If the chest pain is not relieved after one tablet, call 911 immediately.

Wait 1 minute between doses of sublingual tablets, up to 3 doses.

If the chest pain is not relieved after one tablet, call 911 immediately.

A patient with severe liver disease is receiving the angiotensin-converting enzyme (ACE) inhibitor, captopril. The nurse is aware that the advantage of this drug for this patient is which characteristic?

Captopril rarely causes first-dose hypotensive effects.

Captopril has little effect on electrolyte levels.

Captopril is a prodrug and is metabolized by the liver before becoming active.

Captopril does not need to be metabolized by the liver before becoming active because it is not a prodrug.

Captopril does not need to be metabolized by the liver before becoming active because it is not a prodrug.

A patient arrives in the emergency department with severe chest pain. The patient reports that the pain has been occurring off and on for a week now. Which assessment finding would indicate the need for cautious use of nitrates and nitrites?

Blood pressure of 88/62 mm Hg

Apical pulse rate of 110 beats/min

History of renal disease

History of a myocardial infarction 2 years ago

Blood pressure of 88/62 mm Hg

A patient who has been taking antihypertensive drugs for a few months states that a new, persistent dry cough is very bothersome. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs?

Beta blockers

Angiotensin-converting enzyme (ACE) inhibitors

Angiotensin II receptor blockers (ARBs)

Calcium channel blockers

Angiotensin-converting enzyme (ACE) inhibitors

During a teaching session about self-monitoring while taking a beta blocker at home, the nurse has taught the patient to take his apical pulse daily for 1 minute. If the pulse rate decreases to less than 60 beats/min, the nurse will instruct the patient to do which of these?

Notify his prescriber.

Reduce the dose of his beta blocker by half.

Continue the medication because this is an expected effect.

Skip the medication dose that day, and check his pulse again the next day.

Notify his prescriber.

A patient who has been anticoagulated with warfarin has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the patient may have taken too much warfarin. The nurse anticipates that the patient will receive which antidote?

Vitamin E

Vitamin K

Protamine sulfate

Potassium chloride

Vitamin K

When the nurse is administering topical nitroglycerin ointment, which technique is correct?

Apply the ointment on the skin on the forearm.

Apply the ointment only in the case of a mild angina episode.

Remove the old ointment before new ointment is applied.

Massage the ointment gently into the skin, and then cover the area with plastic wrap.

Remove the old ointment before new ointment is applied.

A patient is taking an alpha blocker as treatment for benign prostatic hyperplasia. The nurse will monitor for which potential drug effect?

Orthostatic hypotension

Increased blood pressure

Decreased urine flow

Discolored urine

Orthostatic hypotension

The medication order for a 5-year-old child reads, "Give digoxin elixir, 15 mcg/kg, PO now." Convert the 15 micrograms to milligrams. __

To convert micrograms (mcg) to milligrams (mg), remember:

1 mg=1000 mcg

So, for 15 mcg:

15 mcg × 1 mg / 1000 mcg = 0.015 mg

A patient has a new order for the adrenergic drug doxazosin. When providing education about this drug, the nurse will include which instructions?

"Weigh yourself daily, and report any weight loss to your prescriber."

"Increase your potassium intake by eating more bananas and apricots."

"The impaired taste associated with this medication usually goes away in 2 to 3 weeks."

"Be sure to lie down after taking the first dose, because first-dose hypotension may make you dizzy."

"Be sure to lie down after taking the first dose, because first-dose hypotension may make you dizzy."