NR 293 Pharm quiz 3 Questions and answers + rationales

What is the purpose of antianginal drug therapy?

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

c

The nurse will teach a patient who will be taking nitroglycerin about which common adverse effect of this drug?

a. Blurred vision

b. Dizziness

c. Headache

d. Weakness

c

The nurse is reviewing dosage forms of nitroglycerin. This drug can be given by which routes? (Select all that apply.)

a. Continuous intravenous drip

b. Intravenous bolus

. Sublingual spray

d. Oral

e. Topical ointment

f. Rectal suppository

a,c,d,e

For a patient using transdermal nitroglycerin patches, the nurse knows that the prescriber will order which procedure for preventing tolerance?

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

d

Patients who are taking beta blockers for angina need to be taught which information?

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

a

The nurse would recognize which of the following symptoms as descriptive of a side effect of nitrates?

a. Reflex tachycardia

b. Hypertension

c. Nausea

d. Cough

a

. Which of the following describes the rationale for the administration of nitroglycerin by the sublingual route?

a. The first-pass effect is avoided.

b. Side effects are lessened.

c. Patients can self-administer.

d. It can be used in patients with swallowing problems

a

A patient with coronary artery spasms will be most effectively treated with which type of antianginal medication?

a. Beta blockers

b. Calcium channel blockers

c. Nitrates

d. Nitrites

b

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?

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.

a

The nurse is preparing for administration of a nitrate to a patient. After reviewing the patient's current medications, the nurse holds the nitrate and contacts the provider. Which medication concerned the nurse?

a. Furosemide

b. Sildenafil

c. Digoxin

d. lisinopril

b

The order reads: "Give isosorbide dinitrate 80 mg twice a day." The medication is available in 40-mg capsules. How many capsules will the patient receive for each dose?

2 capsules

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?

a. Agranulocytosis

b. Proteinuria

c. Hyperkalemia

d. Hypoglycemia

c

Before giving oral digoxin, the nurse discovers that the patient's radial pulse is 52 beats/min when assessed apically for 1 minute. What will be the nurse's next action?

a. Give the dose.

b. Delay the dose until later.

c. Hold the dose and notify the physician.

d. Obtain a blood pressure reading

d

Which statement regarding digoxin therapy and potassium levels is correct?

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.

a

When infusing milrinone, the nurse will keep which consideration in mind?

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.

b

The nurse would identify the most serious side effect of milrinone as

a. cardiac dysrhythmias.

b. hypotension.

c. heart failure.

d. liver toxicity.

a

When caring for a patient who is taking digoxin, the nurse will monitor for which signs and symptoms of toxicity? (Select all that apply.)

a. Anorexia

b. Diarrhea

c. Visual changes

d. Nausea and vomiting

e. Headache

f. Bradycardia

a,c,d,e,f

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.)

a. White blood cell count

b. Platelet count

c. Serum potassium level

d. Serum magnesium level

e. Creatinine level

f. Blood urea nitrogen (BUN)

a,c,e,f

he nurse would recognize that a rise in human B-type natriuretic peptide (BNP) would indicate which of the following?

a. Increases in myocardial damage b. Decreased renal perfusion

c. Increases in sodium retention

d. Worsening of heart failure

d

Adverse effects of nesiritide include which of the following? (Select all that apply.)

a. Hypotension

b. Cardiac dysrhythmias

c. Insomnia

d. Headache

e. Abdominal pain

f. Photosensitivity

a,b,c,d,e

The nurse is preparing to administer the initial dose of ivabradine. The nurse will monitor the patient for which adverse effect?

a. Hypotension

b. Bradycardia

c. Hyperkalemia

d. Asthma

b

A patient is to receive an initial dose of digoxin, 0.5 mg IV push, followed by an oral maintenance dose of 0.25 mg PO daily, starting the next day. The medication is available in ampules that contain 0.25 mg/mL. How many mil-liliters will he receive for the IV dose?

2mL

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? a. Atrial fibrillation

b. Bradycardia

c. Complete heart block

d. Ventricular dysrhythmias

d

When monitoring a patient who is taking quinidine, the nurse recognizes that possible adverse effects of this drug include which conditions? (Select all that apply.)

a. Weakness

b. Tachycardia

c. Gastrointestinal upset

d. Tinnitus

e. Ventricular ectopic beats

c,d,e

The nurse is administering amiodarone and should monitor for which potential adverse effect?

a. Pulmonary toxicity

b. Hypertension

c. Urinary retention

d. Constipation

a

The nurse is caring for a patient receiving amiodar-one. Which drug, if added to the patient's current medication regimen, would cause the nurse concern?

a. Lidocaine

b. Ibuprofen

c. Warfarin

d. Lasix

a

The nurse would be correct in identifying which condition as a major complication of atrial fibrillation?

a. Myocardial infarction (MI)

b. Stroke

c. Pulmonary edema

d. Pneumonia

b

A patient is about to receive a dose of verapamil. The nurse notes that this medication is used to treat which condition?

a. Cardiac asystole

b. Heart block

c. Ventricular dysrhythmia, including premature ventricular contraction

d. Recurrent paroxysmal supraventricular tachycardia (PSVT)

d

A patient is experiencing a rapid dysrhythmia, and the nurse is preparing to administer adenosine. Which is the correct administration technique for this drug?

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.

a

If a drug has a prodysrhythmic effect, then the nurse must monitor the patient for which effect?

a. Decreased heart rate

b. New dysrhythmias

c. A decrease in dysrhythmias

d. Reduced blood pressure

b

A patient will be starting therapy with quinidine. Which of these drugs, if also on the patient's medication list, may cause a potential drug interaction? (Select all that apply.)

a. Cimetidine

b. Amiodarone

c. Digoxin

d. Warfarin

e. Erythromycin

b,c,e

Which medication has recently been approved for the treatment of atrial fibrillation?

a. Lidocaine

b. Propafenone

c. Adenosine

d. Bretylium

b

A patient with sustained ventricular tachycardia will be receiving a lidocaine infusion after a bolus dose. The order reads, "Give a bolus of 1.5 mg/kg, then start a drip at 2 mg/min." The lidocaine is available as 20 mg/mL, and the patient weighs 220 lb. How many milligrams of lidocaine will be given in the bolus dose?

150mg

Antifibrinolytic

A drug that prevents the lysis of fibrin, thereby promoting clot formation

Hemostasis

the termination of bleeding by mechanical or chemical means

Antiplatelet drug

a substance that prevents platelet plugs from forming

Thrombolytic drug

The general term for a drug that dissolves thrombi

Anticoagulan

The general term for a substance that prevents or delays coagulation of the blood

. Activated partial thromboplastin time (aPTT)

A laboratory test used to measure the effectiveness of heparin therapy

Prothrombin time (PT) & International normalized ratio (INR)

_ Two tests used to monitor the effects of drug therapy with warfarin sodium

. International normalized ratio (INR)

A standardized measure of the degree of coagulation achieved by drug therapy with warfarin sodium

Protamine sulfate

A substance that reverses the effect of heparin

Vitamin K

A substance that reverses the effect of warfarin sodium

Alteplase

A pharmaceutically available tissue plasminogen activator (tPA) that is created through recombinant DNA techniques

Embolus

A blood clot that dislodges and travels through the bloodstream

The nurse is reviewing the use of anticoagulants. Anticoagulant therapy is appropriate for which conditions? (Select all that apply.)

a. Atrial fibrillation

b. Thrombocytopenia

c. Myocardial infarction

d. Presence of mechanical heart valve

e. Aneurysm

f. Leukemia

a,c,d

Which statement is true regarding enoxaparin and dalteparin?

a. Their method of action is to interrupt vitamin K-dependent clotting factors.

b. They do not require clotting-time monitoring.

c. They are administered deep IM.

d. They have thrombolytic properties.

b

During the teaching of a patient who will be taking warfarin sodium at home, which statement by the nurse is correct regarding over-the-counter drug use?

a. "Choose nonsteroidal anti-inflammatory 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 warfarin."

d. "Mineral oil is the laxative of choice while taking anticoagulants."

b

A patient is at risk for a stroke. Which drug is recommended to prevent platelet aggregation for stroke prevention by the American Stroke Society?

a. Aspirin

b. Warfarin sodium

c. Heparin

d. Alteplase

a

When administering subcutaneous heparin, the nurse will remember to perform which action?

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.

c

During thrombolytic therapy, the nurse monitors for bleeding. Which symptoms may indicate a serious bleeding problem? (Select all that apply.)

a. Hypertension

b. Hypotension

c. Decreased level of consciousness d. Increased pulse rate

e. Restlessness

b,c,d,e,f

Which drug is most often used for the prevention of deep vein thrombosis (DVT) after major orthopedic surgery, even after the patient has gone home?

a. Antiplatelet drugs, such as aspirin b. Adenosine diphosphate (ADP) inhibitors, such as clopidogrel

c. Anticoagulants, such as warfarin sodium

d. Low-molecular-weight heparins, such as enoxaparin

d

Which of the following findings would the nurse expect to observe in the patient experiencing heparin-induced thrombocytopenia?

a. Red blood cell count of 3.0/mL

b. White blood cell count of less than 5000/mL

c. Platelet count of 50,000/mL

d. Creatine kinase of 230 U/L

c

The nurse would recognize which drug as the recommended drug for thrombotic stroke prevention?

a. Warfarin

b. Clopidogrel

c. Enoxaparin

d. Aspirin

d

The nurse is preparing a patient's morning medications and, upon reviewing the list of drugs, notes that the patient is to receive heparin 5000 units and enoxaparin, both subcutaneously. What is the nurse's priority action at this time?

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.

b

Idarucizumab is a specific antidote for which drug?

a. Heparin

b. Dabigatran

c. Warfarin

d. Enoxaparin

b

A patient is to receive a bolus dose of heparin 8000 units via IV push. The vial contains heparin 10,000 units/mL. How many milliliters of medication will the nurse draw up to administer the ordered dose?

0.8mL

Patients taking cholestyramine may experience which adverse effects? a. Blurred vision and photophobia

b. Drowsiness and difficulty concentrating

c. Diarrhea and abdominal cramps d. Belching and bloating

d

The nurse will instruct the patient who is taking antilipemic drugs about which dietary measures? (Select all that apply.)

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

a,c,d,e

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?

a. Phenylketonuria

b. Renal disease

c. Coronary artery disease

d. Diabetes mellitus

a

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?

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

b

A patient who has started taking niacin complains that he "hates the side effects." Which statement by the nurse is most appropriate?

a. "You will soon build up tolerance to these side effects."

b. "You need to take niacin on an empty stomach."

c. "You can take niacin every other day if the side effects are bothersome."

d. "Try taking a small dose of ibuprofen 30 minutes before taking niacin."

d

A patient asks, "What is considered the 'good cholesterol'?" How will the nurse answer?

a. Very low-density lipoprotein (VLDL)

b. LDL

c. HDL

d. Triglycerides

c

A patient taking a statin calls the office to report an increase in muscle pain. Which information takes priority as the nurse communicates with the patient?

a. "This could be the sign of a serious side effect; stop taking the medication immediately."

b. "You should take a dose of ibuprofen for the next few days."

c. "This is an expected occurrence; continue the dose as prescribed."

d. "Did you pull a muscle or injure yourself?"

a

The nursing student would be correct in identifying which of the following as features of metabolic syndrome? (Select all that apply.)

a. Waist circumference greater than 40 inches in men

b. Serum triglycerides greater than 150 mg/dL

c. HDL greater than 80 mg/dL in men and women

d. Normal blood pressure

e. Fasting serum glucose of 110 mg/dL or higher

a,b,e

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.)

a. Warfarin

b. Metformin

c. Erythromycin

d. Cyclosporine

e. Gemfibrozil

a,c,d,e

Which route will the nurse select for the administration of alirocumab?

a. Oral

b. Rectal

c. Subcutaneous

d. Intramuscular

c

The medication order reads, "Give lovastatin (Mevacor) 30 mg daily at bedtime, PO." The medication is available in 20-mg tablets. How many tablets will the nurse administer to the patient?

1.5 tabs

Diuretics

A general term for drugs that accelerate the rate of urine formation

Potassium-sparing diuretics

Diuretics that result in the diuresis of sodium and water and the retention of potassium; spironolactone is an example

Loop of Henle

Part of the kidney structure located between the proximal and distal convoluted tubules

Osmotic diuretics

Drugs that induce diuresis by increasing the osmotic pressure of the glomerular filtrate, which results in rapid diuresis; mannitol is an example

Thiazides

iuretics that act on the distal convoluted tubule, where they inhibit sodium and water resorption; hydrochlorothiazide (HCTZ) is an example

Ascites

an abnormal intraperitoneal accumulation of a fluid

CAIs

Abbreviation for a class of diuretics that inhibit the enzyme carbonic anhydrase; acetazolamide is an example

Loop diuretics

Potent diuretics that act along the ascending limb of the loop of Henle; furosemide is an example

Nephron

The main structural unit of the kidney

GFR

abbreviation for the term that describes a gauge of how well the kidneys are functioning as filters

. Which are indications for the use of diuretics? (Select all that apply.)

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

a,c,d,e

When providing patient teaching to a patient who is taking a potassium-sparing diuretic such as spironolactone, the nurse will include which dietary guidelines?

a. The patient needs to drink grapefruit with the diuretic.

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 L of fluid per day.

c

When teaching a patient about diuretic therapy, which would the nurse indicate as the best time of day to take these medications?

a. Morning

b. Midday

c. Bedtime

d. The time of day does not matter

a

When monitoring a patient for hypokalemia related to diuretic use, the nurse looks for which possible symptoms?

a. Nausea, vomiting, and anorexia

b. Diarrhea and abdominal pain

c. Orthostatic hypotension

d. Muscle weakness and lethargy

d

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?

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.

b

Which diuretic remains effective when creatinine clearance drops below 25 mL/min?

a. Loop

b. Thiazide

c. Osmotic

d. Potassium sparing

a

The greatest volume of diuresis is produced by which class of diuretics?

a. Loop

b. Thiazide

c. Osmotic

d. Potassium sparing

a

Which diuretic class has its action at the end point of the nephron?

a. Loop

b. Thiazide

c. Osmotic

d. Potassium sparing

d

A patient has a new order for daily doses of spironolactone. Which conditions, if present, may be a contraindication to this drug therapy? (Select all that apply.)

a. Heart failure

b. Renal failure

c. Diabetes mellitus

d. Deep vein thrombosis

e. Hyperkalemia

b,e

Three days after beginning therapy with oral iron tablets, a patient calls the office, saying, "I'm very worried because my bowel movements are black!" What will the nurse do?

a. Instruct the patient to stop the iron tablets for a week.

b. Instruct the patient to take the tablets every other day instead of daily.

c. Ask the patient to come into the office for a checkup.

d. Explain to the patient that this is an expected effect of the medication.

d

A patient will be taking an oral iron preparation. Which of these are possible adverse effects? (Select all that apply.)

a. Dizziness

b. Nausea

c. Vomiting

d. Drowsiness

e. Orthostatic hypotension

f. Stomach cramps

b,c,f

The nurse is preparing to administer folic acid. What occurs if folic acid is given to treat anemia without determining the underlying cause of the anemia?

a. Erythropoiesis is inhibited.

b. Excessive levels of folic acid may accumulate, causing toxicity.

c. The symptoms of pernicious anemia may be masked, delaying treatment.

d. Intestinal intrinsic factor is destroyed.

c

A patient is about to receive folic acid supplementation. The nurse knows that indications for folic acid supplementation include which of the following? (Select all that apply.)

a. Iron-deficiency anemia

b. Tropical sprue

c. Prevention of fetal neural tube defects

d. Pernicious anemia e. Hemolytic anemia

b,c

When teaching a patient about oral iron preparations, the nurse will include which instructions? (Select all that apply.)

a. Mix the liquid iron preparations with antacids to reduce gastrointestinal distress.

b. Take the iron with meals if gastrointestinal distress occurs.

c. Liquid forms should be taken through a straw to avoid discoloration of tooth enamel.

d. Oral forms should be taken with juice or water, not milk.

e. Iron products will turn the stools black.

b,c,d,e

. A patient will be receiving darbepoetin as part of treatment for post chemotherapy bone marrow suppression. Which finding is a contraindication to darbepoetin therapy?

a. Pulse rate of 100 beats/min

b. Blood pressure of 128/79 mm Hg c. Hemoglobin level of 11 g/dL

d. White blood cell count of 7000/mm3

c

The nurse is preparing to give iron sucrose (Venofer) to a 58-year-old patient and will monitor for which common adverse effect?

a. Hypotension

b. Dyspnea

c. Itching

d. Cramps

a

Which laboratory finding would indicate to the nurse that the patient is responding favorably to epoetin alfa?

a. An increase in reticulocytes

b. A decrease in clotting time

c. An increase in platelets

d. A decrease in leukocytes

a

The nurse would be correct in identifying that iron sucrose would be appropriate in the treatment of anemia secondary to which disorder?

a. Emphysema

b. Chronic renal disease

c. Hemorrhage from trauma

d. Hypoalbuminemia

b

A patient will be receiving epoetin alfa 150 units/kg, subcutaneously, three times a week. The patient weighs 110 lb. The medication is available in a concentration of 10,000 units/mL. How many milliliters will the nurse administer for each dose? (Record answer using two decimal places.)

0.75 mL