pharm review 2 final

A patient about to receive his morning dose of digoxin has an apical pulse of 70 beats per minute. What will the nurse do?
A. Administer the dose.
B. Administer the dose and notify the physician.
C. Check the radial pulse for 1 full minute.
D. Withhold the dose and notify the

A. Administer the dose.

In assessing a patient before administration of a cardiac glycoside, the nurse knows that what condition can predispose a patient to digitalis toxicity?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypernatremia

A. Hypokalemia; control ventricular response to atrial fibrillation and a derived from foxglove. Digoxin is the only available cardiac glycoside\---positive inotropic\---inhibits sodium potassium pump (adenosine tripphophatase) Sodium and calcium rise. Cholinergic stimulation via the vagus nerve of Parasympathetic nervous system. \---Negative chronotropic\---Negative Dromotropic effect

While assessing a patient who is receiving intravenous digitalis, the nurse recognizes that the drug has a negative chronotropic effect. How would this drug effect be evident in the patient?
A. Increased heart rate
B. Decreased heart rate
C. Decreased conduction
D. Increased ectopic beats

B. Decreased heart rate

A patient has been taking digoxin at home but has taken an accidental overdose and has developed toxicity. He has been admitted to the telemetry unit where the physician has ordered digoxin immune Fab (Digibind). The patient asks the nurse why the medication is ordered. What is the nurse's best response?
A. "It works faster than digoxin."
B. "It is safer than digoxin and can be taken orally."
C. "It helps to convert the irregular heart rhythm to a more normal rhythm."
D. "This drug is an antidote to digoxin and will help to lower the blood levels."

D. "This drug is an antidote to digoxin and will help to lower the blood levels." (severe bradycardia, advanced heart block, ventricularr tachycardia, fibrillation, and hyperkalemia); available in parental form. Clinical signs and symptoms are monitored NOT serum levels\----used for systolic heart failure and atrial fibrillation.

5. A patient has been placed on a milrinone infusion as part of the therapy for end-stage heart failure. What risks involved with this drug will the nurse keep in mind while assessing this patient during the infusion?
A. Hypertension
B. Hyperkalemia
C. Nausea and vomiting
D. Cardiac dysrhythmias

D. Cardiac dysrhythmias (contraindictated with ventricular tachycardia, and fibrillation) used for treatment of atrial fibrillation. Available in Oral and injection form.

6. A patient with atrial fibrillation was started on digoxin, and 1 week later a digoxin level was drawn. Which result is within normal therapeutic levels for digoxin?
A. 0.4 ng/mL
B. 0.7 ng/mL
C. 2.1 ng/mL
D. 2.6 ng/mL or higher

B. 0.7 ng/mL (normal 0.5 to 2.0 ng/mL

7. When reviewing the list of medications taken by a patient who will be receiving a new prescription for digoxin, the nurse would be concerned about which medication that may interact with the digoxin?
A. aspirin
B. acetaminophen (Tylenol)
C. furosemide (Lasix)
D. vitamin K

C. furosemide (Lasix); (loop Diuretics); numerous ones on page 341

8. The nurse is reviewing discharge teaching for a patient who will be taking digoxin (Lanoxin) therapy. The patient should be taught to avoid which foods when taking the digoxin?
A. Leafy green vegetables
B. Dairy products
C. Grapefruit juice
D. Bran muffins

D. Bran muffins

9. In assessing a patient before administration of a cardiac glycoside, the nurse knows that which lab result can increase the toxicity of the drug?
A. Potassium level 2.8 mEq/L
B. Potassium level 4.9 mEq/L
C. Sodium level 140 mEq/L
D. Calcium level 10 mg/dL

A. Potassium level 2.8 mEq/L (low potassium normal is 3.5 to 5.0)

10. The nurse administering the phosphodiesterase inhibitor inamrinone recognizes that this drug should have a positive inotropic effect. This effect will result in increased
A. heart rate.
B. blood vessel dilation.
C. force of cardiac contraction.
D. conduction of electrical impulses across the heart.

C. force of cardiac contraction. (increase cAMP) positive inotropic (by more calcium available in SR)effect and vasodilation, (inodilators)\---positive chornotropic effect); USED IN ICU; ADVERSE EFFECT...thrombocytopenia, dysrhythmia, ventricular, hypotension and angina, hypokalemia, tremor.

11. The nurse notes in a patient's medical record that nesiritide has been ordered. Based on this order, the nurse interprets that the patient has which disorder?
A. Atrial fibrillation
B. Acutely decompensated heart failure with dyspnea at rest
C. Systolic heart failure
D. Long-term treatment of heart failure.

B. Acutely decompensated heart failure with dyspnea at rest

SELECT ALL THAT APPLY:

1. When a patient is experiencing digoxin toxicity, which clinical situation would necessitate the use of digoxin immune Fab (Digibind)? Select all that apply.
A. The patient reports seeing colorful halos around lights.
B. The patient's serum potassium level is above 5 mEq/L.
C. The patient is experiencing nausea and anorexia.
D. The patient is experiencing severe sinus bradycardia that does not respond to cardiac pacing.
E. The patient has taken an overdose of greater than 10 mg of digoxin.

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

D. The patient is experiencing severe sinus bradycardia that does not respond to cardiac pacing. (E) might be right as well a person taking 10mg of digoxin is a indication of toxicity...page 340 states life threatening digoxin overdose in adults and 4 mg in children)

2. Which drug classes are considered first-line treatment for heart failure? Select all that apply.
A. Angiotensin converting enzyme (ACE) inhibitors
B. Angiotensin II receptor blockers (ARBs)
C. Digoxin (cardiac glycoside)
D. Beta-blockers
E. Nesiritide (Natrecor), the B-type natriuretic peptide

ACE
ARBS
Beta-blockers
loop diuretics

1.When administering topical nitroglycerin ointment, the nurse should use which technique?
A. The ointment should be applied on the chest over the heart.
B. The ointment should be used only in the case of a mild angina episode.
C. The old ointment should be removed before new ointment is applied.
D. The ointment should be massaged gently into the skin, then covered with plastic wrap.

C. The old ointment should be removed before new ointment is applied.

2.The nurse is giving intravenous nitroglycerin to a patient who has just been admitted because of an acute myocardial infarction. Which statement is true regarding the administration of the intravenous form of this medication?
A. Specific nonpolyvinylchloride (non-PVC) plastic intravenous bags and tubing must be used.
B. It is stable for only 24 hours after preparation.
C. It can be given in infusions with other medications.
D. The solution will be slightly colored green or blue.

A. Specific nonpolyvinylchloride (non-PVC) plastic intravenous bags and tubing must be used.

3.A 53-year-old man has been admitted for evaluation of chest pain. He has been diagnosed with angina and will be given a prescription for sublingual nitroglycerin tablets. When teaching the patient how to use sublingual nitroglycerin, what instruction should the nurse include?
A. Take up to five doses at 15-minute intervals for an angina attack.
B. If the tablet does not dissolve quickly, chew the tablet for maximal effect.
C. If the chest pain is not relieved after one tablet, call 911 immediately to activate emergency medical services.
D. Wait 1 minute between doses of sublingual tablets, up to three doses.

C. If the chest pain is not relieved after one tablet, call 911 immediately to activate emergency medical services.

4.A 74-year-old professional golfer has chest pain that occurs toward the end of his golfing games. He says the pain usually goes away after 1 or 2 sublingual nitroglycerin tablets and rest. What type of angina does he have?
A. Classic
B. Variant
C. Unstable
D. Prinzmetal's

A. Classic also called (Chronic stable angina); chest pain that has as its primary cause arteriosclerosis, which results in a long-term but relatively stable level of obstruction in one or more coronary arteries.

5.A patient arrives in the emergency department with severe chest pain. She says she has had pain off and on for a week now. Which assessment finding would indicate the need for cautious use of nitrates and nitrites?
A. Blood pressure of 98/68 mm Hg
B. History of liver disease
C. History of heart failure
D. History of a myocardial infarction 2 years ago

A. Blood pressure of 98/68 mm Hg

6.A calcium channel blocker (CCB) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. What does the nurse tell the patient?
A. The tablet should be chewed for faster release of the medication.
B. To increase the effect of the drug, take it with grapefruit juice.
C. If the adverse effects of chest pain, fainting, or dyspnea occur, discontinue the medication immediately.
D. A high-fiber diet with plenty of fluids will help prevent the constipation that may occur.

D. A high-fiber diet with plenty of fluids will help prevent the constipation that may occur.........CCBs: phenylalkylamins, benzothiazepines, and dihydroridines (verapril, dilitiazem, amlodipine)

7.When applying transdermal nitroglycerin patches, how will the nurse instruct the patient?
A. "Use any nonhairy area on the body."
B. "Use only the chest area for application sites."
C. "Temporarily remove the patch if you go swimming."
D. "Apply the patch to the same site consistently."

A. "Use any nonhairy area on the body.

8.A patient has been taking a beta-blocker for 4 weeks as part of his antianginal therapy. He also has type II diabetes and hyperthyroidism. When discussing possible adverse effects, the nurse should include which information?
A. "Watch for unusual weight loss."
B. "Monitor your pulse for increased heart rate."
C. "Use the hot tub and sauna at the gym as long as time is limited to 15 minutes."
D. "Monitor your blood glucose levels for possible hypoglycemia or hyperglycemia."

D. "Monitor your blood glucose levels for possible hypoglycemia or hyperglycemia."...BBs (-LOL), atenolol, metoprolol, nadolol, and propranolol.

9.What action is recommended to help reduce the tolerance to transdermal nitroglycerin therapy that commonly develops?
A. Omit a dose once a week.
B. Leave the patch on for 2 days at a time.
C. Cut the patch in half for a week until the tolerance subsides.
D. Remove the patch at bedtime, then apply a new one in the morning.

D. Remove the patch at bedtime, then apply a new one in the morning.

10.While assessing a patient who is taking a beta-blocker for angina, the nurse knows to monitor for which adverse effect?
A. Nervousness
B. Hypertension
C. Bradycardia
D. Dry cough

C. Bradycardia (blocks beta 1 and beta 2 receptors) other adverse effects: negative chronotropic, decrease cardiac output, and negative dromotropic effect, beta 2: bronchoconstriction, increased airway resistence (asthma and COPD), cardiac rhytm, decrease renin release.

Select all that apply:
1.A patient is experiencing chest pain while playing tennis. He has a bottle of sublingual nitroglycerin with him. Which of the actions are appropriate for the patient to take at this time? Select all that apply.
A. Stop the activity and lie down or sit down.
B. Call 911 immediately.
C. Call 911 if the pain is not relieved after taking 1 sublingual tablet.
D. Call 911 if the pain is not relieved after taking 3 sublingual tablets in 15 minutes.
E. Place a tablet under the tongue.
F. Place a tablet in the space between the gum and cheek.
G. Take another sublingual tablet if chest pain is not relieved after 5 minutes, up to three, total.

A. Stop the activity and lie down or sit down
C. Call 911 if the pain is not relieved after taking 1 sublingual tablet.
E. Place a tablet under the tongue.
F. Place a tablet in the space between the gum and cheek.
G. Take another sublingual tablet if chest pain is not relieved after 5 minutes, up to three, total.

The physician has ordered the adrenergic drug doxazosin (Cardura) for a patient. When providing education about this drug, the nurse should include which instructions?
A. The patient should weigh herself daily and report any weight loss to the physician.
B. The patient should increase her potassium intake by eating more bananas and apricots.
C. The impaired taste associated with the medication usually goes away in 2 to 3 weeks.
D. The patient should take her first dose while lying down because there is a first-dose effect with prazosin.

D. The patient should take her first dose while lying down because there is a first-dose effect with prazosin.

2. A patient with severe liver disease is receiving the angiotensin converting enzyme (ACE) inhibitor, captopril (Capoten). The nurse is aware that the advantage of this drug for this patient is that captopril
A. is a prodrug and is metabolized by the liver before becoming active.
B. is not a prodrug and does not need to be metabolized by the liver before becoming active.
C. rarely causes first-dose hypotensive effects.
D. has little effect on electrolyte levels.

B. is not a prodrug and does not need to be metabolized by the liver before becoming active.

3. During a follow-up visit, the physician examines the fundus of the patient's eye. Afterward, the patient asks the nurse, "Why is he looking at my eyes when I have high blood pressure? It does not make sense to me!" What is the best response by the nurse?
A. "We need to monitor for drug toxicity."
B. "We must watch for increased intraocular pressure."
C. "The physician is assessing for visual changes that may occur with drug therapy."
D. "The physician is making sure the treatment is effective over the long-term."

D. "The physician is making sure the treatment is effective over the long-term.

4. Which of the following parameters determine the regulation of arterial blood pressure?
A. Cardiac output and vascular resistance
B. Heart rate and peripheral resistance
C. Blood volume and renal blood flow
D. Myocardial contractility and arteriolar constriction

A. Cardiac output and vascular resistance

5. When counseling a male patient about the possible adverse effects of antihypertensive drugs, the nurse should discuss which potential problem?
A. Impotence
B. Bradycardia
C. Increased libido
D. Increased weight

A. Impotence

6. Antihypertensive drug therapy for a newly diagnosed, stage 1 hypertensive African American patient would most likely include which drug or drug classes?
A. Vasodilators alone
B. ACE inhibitors alone
C. Calcium channel blockers with thiazide diuretic
D. Beta-blockers with thiazide diuretic

C. Calcium channel blockers with thiazide diuretic

7. The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which is a potential nursing diagnosis for the patient taking antihypertensive medications?
A. Diarrhea
B. Sexual dysfunction
C. Stress urinary incontinence
D. Impaired memory

B. Sexual dysfunction

8. A patient's blood pressure elevates to 210/150 mm Hg, and a hypertensive emergency is obvious. He is transferred to the intensive care unit and started on a sodium nitroprusside (Nipride) 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?
A. 10 minutes
B. 30 minutes
C. 1 hour
D. 24 hours

A. 10 minutes

9. 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 most correct response?
A. "This therapy should take about 3 months."
B. "This therapy should take about a year."
C. "This therapy should go on until your symptoms disappear."
D. "Therapy for high blood pressure is usually life-long."

D. "Therapy for high blood pressure is usually life-long."

10. A patient who has been taking antihypertensive drugs for a few months complains of having a persistent dry cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs?
A. Beta-blockers
B. Angiotensin-converting enzyme (ACE) inhibitors
C. Angiotensin-receptor blockers (ARBs)
D. Calcium channel blockers

B. Angiotensin-converting enzyme (ACE) inhibitors other adverse effects are: fatigue, dizziness, mood changes, and headaches. Dry non productive cough which is reversible when stopping ACE therapy. has a first dose hypotension effect

11. Which drug is commonly used for a pregnant patient who is experiencing hypertension?
A. mannitol (Osmitrol)
B. enalapril (Vasotec)
C. hydrochlorothiazide (HydroDIURIL)
D. methyldopa (Aldomet)

D. methyldopa (Aldomet); alpha 2-adrenergic receptor stimulators (agonist); has high incidence of adverse effects: orthostatic hypotension, fatigue, and dizziness. (clondine) is another drug but not used in pregnancy

12. A patient diagnosed with prehypertension has a blood pressure reading of \_____ mm Hg systolic \_____ mm Hg diatolic.
A. less than 120; and less than 80
B. 120 and 139; or 80 and 89
C. 140 and 159; or 90 and 99
D. 160 and 179; or 100 and 109

B. 120 and 139; or 80 and 89

13. A patient has hypertension along with type I diabetes mellitus and proteinuria. The nurse anticipates that a drug from which drug class will be ordered for its renal-protective effects?
A. Beta-blockers
B. ACE inhibitors
C. Diuretics
D. Calcium channel blockers

B. ACE inhibitors (non-prodrugs captopril and lisinpril) doesn't need to be turn into an active form in the liver. (protect the kidneys by reducing the GFR pressure and the number one choice with cardiovascular and diabetes)

14. The nurse is reviewing the orders for a patient and notes a new order for an ACE inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class?
A. Calcium channel blockers
B. Diuretics
C. Nonsteroidal antiinflammatory drugs (NSAIDs)
D. Nitrates

C. Nonsteroidal antiinflammatory drugs (NSAIDs) (iburprohen can reduce the effect of ACE and predispose the pt. with acute renal failure); other adverse effects: potassium levels above 5 mEq/L because they promote hyperkalemia, lactating women, children, bilateral renal disease); rash, pruritus, anemia, neutropenia, thrombocytosis, and agranulocytosis.

1. When teaching a patient about antihypertensive drug therapy, which statement by the nurse is correct? Select all that apply.
A. "You should try to have your blood pressure checked once a week and keep track of the readings."
B. "If you notice that the symptoms have gone away, you should be able to stop taking the drug."
C. "An exercise program may be helpful in treating hypertension, but let's check with your doctor first."
D. "If you experience severe side effects, stop the medicine and let us know at your next office visit."
E. "Most over-the-counter decongestants are compatible with antihypertensive drugs."
f. "please continue the medication, even if you are feeling better"

"You should try to have your blood pressure checked once a week and keep track of the readings."
C. "An exercise program may be helpful in treating hypertension, but let's check with your doctor first."
D. "If you experience severe side effects, stop the medicine and let us know at your next office visit."f. "please continue the medication, even if you are feeling better"

1. When monitoring a patient who has diabetes and is receiving a carbonic anhydrase inhibitor for edema, the nurse monitors for which possible adverse effect?
A. Metabolic alkalosis
B. Elevated blood glucose
C. Hyperkalemia
D. Drowsiness

B. Elevated Blood glucose and glycosuria in diabetics

The nurse should monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of the following diuretics?
A. hydrochlorothiazide (HydroDIURIL)
B. furosemide (Lasix)
C. metolazone (Zaroxolyn)
D. spironolactone (Aldactone)

D. spironolactone (Aldactone); synthetic steriod blocks aldosterone receptors...hyperkalemia common complication, it is a potassium sparing diuretic. Most commonly prescribed for children. only oral form and a pregnancy D drug.

Mannitol (Osmitrol) has been ordered for a patient with acute renal failure. The nurse knows to administer this drug using which procedure?
A. Intravenously, through a filter
B. By rapid intravenous bolus
C. By mouth in a single morning dose
D. Through a gravity intravenous drip with standard tubing

A. Intravenously, through a filter; Osmotic diuretic; can crystalized in cold temperatures and IV only, and it is stored in a warmer in pharmacy. Pregnancy C drug

Furosemide (Lasix) 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?
A. "Keep a weekly journal or log of your weight."
B. "Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and dates."
C. "If you experience weight gain, such as five or more pounds a week, be sure to tell your physician during your next routine visit."
D. "Be sure to change your position slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes."

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

5. When reviewing the mechanisms of action of diuretics, the nurse knows that which statement is true about the loop diuretics?
A. They work by inhibiting aldosterone.
B. They are very potent, having a diuretic effect that lasts at least 6 hours.
C. They are particularly useful when rapid diuresis is desired because their onset of action is rapid.
D. They have the disadvantage of ceasing to be effective when the creatinine clearance decreases below 25 mL/min.

C. They are particularly useful when rapid diuresis is desired because their onset of action is rapid.

6. When teaching about hydrochlorothiazide, the nurse should be sure the patient knows to be cautious in taking which medications with hydrochlorothiazide?
A. Digitalis
B. Penicillin
C. Potassium supplements
D. Over-the-counter vitamins

A. Digitalis, corticosteriods, diazoxide, and oral hypoglycemics

7. When a patient is receiving diuretic therapy, which of the following would best reflect the patient's fluid volume status?
A. Blood pressure and pulse
B. Serum potassium and sodium levels
C. Intake, output, and daily weight
D. Measurements of abdominal girth and calf circumference

C. Intake, output, and daily weight

8. A patient is being discharged to home on a single daily dose of a diuretic. The health care provider instructs the patient to take the dose at which time so it will be least disruptive to the patient's daily routine?
A. In the morning
B. At noon
C. With supper
D. At bedtime

A. In the morning

9. A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which of the following classes is likely to be used initially?
A. Loop diuretics
B. Osmotic diuretics
C. Thiazide diuretics
D. Vasodilators

C. Thiazide diuretics (chlorohiazide,hydrochlorohiazide, and bendroflumthiazide, chlorthalidone, indapamide, and metolazone)

10. A patient in the neurologic intensive care unit is being treated for cerebral edema and is given which type of drug to reduce intracranial pressure?
A. Loop diuretics
B. Osmotic diuretics
C. Thiazide diuretics
D. Vasodilators

B. Osmotic diuretics

11. A 79-year-old patient is taking a diuretic for treatment of hypertension. This patient is very independent and wants to continue to live at home, despite his diagnosis of mild heart failure. The nurse will know that which teaching point is important for this patient?
A. He should take the diuretic with his evening meal.
B. He should skip the diuretic dose if he plans to leave the house.
C. If he feels dizzy while on this medication, he should stop taking it and take potassium supplements instead.
D. He should take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls.

D. He should take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls.

12. A patient on diuretic therapy calls the clinic because he's had the flu, with "terrible vomiting and diarrhea," and he has not kept anything down for 2 days. He feels weak and extremely tired. What will the nurse advise this patient?
A. "It's important to try to stay on your prescribed medication. Try to take it with sips of water."
B. "Stop taking the diuretic for a few days, then restart it when you feel better."
C. "You will need an increased dosage of the diuretic because of your illness. Let me speak to the physician."
D. "Please come into the clinic for an evaluation to make sure there are no complications."

D. "Please come into the clinic for an evaluation to make sure there are no complications."

Select all that apply:

1. When assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency, which would include which symptoms? Select all that apply.
A. Dyspnea
B. Constipation
C. Tinnitus
D. Muscle weakness
E. Leg cramps
F. Lethargy

D. Muscle weakness
E. Leg cramps
F. Lethargy

. Nicotinic acid is prescribed for a patient with elevated lipid levels. The nurse informs the patient that which adverse effects may occur with this medication?
A. Pruritus, cutaneous flushing
B. Tinnitus, urine with a burnt odor
C. Myalgia, fatigue
D. Blurred vision, headaches

Pruritus, cutaneous flushing

2. A patient reports having adverse effects with nicotinic acid. The nurse can suggest that the patient do which of the following to minimize these undesirable effects?
A. Take the drug on an empty stomach.
B. Take the medication every other day until these effects subside.
C. Take small doses of aspirin 30 minutes before taking the nicotinic acid.
D. Take the drug with large amounts of fiber.

C. Take small doses of aspirin 30 minutes before taking the nicotinic acid.

3. A patient calls the clinic office saying that the cholestyramine powder he started yesterday clumps and sticks to the glass when he tries to mix it. The nurse should suggest what method for mixing this medication for administration?
A. The powder dissolves faster in a carbonated soda drink.
B. Add it to any liquid and stir vigorously to dissolve it quickly.
C. Mix it with food or fruit such as crushed pineapple, or at least 4 to 6 ounces of fluid.
D. Sprinkle the powder into a spoon and take it dry, followed by a glass of water.

C. Mix it with food or fruit such as crushed pineapple, or at least 4 to 6 ounces of fluid.

4. A patient is concerned about the adverse effects of the medication she is taking to lower her cholesterol level, a fibric acid derivative. The adverse effects of this class of medication include which of the following?
A. Constipation
B. Diarrhea
C. Joint pain
D. Dry mouth

B. Diarrhea

While a patient is receiving antilipemic therapy, the nurse knows to monitor the patient closely for the development of which problem?
A. Photosensitivity
B. Pulmonary problems
C. Vitamin C deficiency
D. Liver dysfunction

D. Liver dysfunction

6. When reviewing patients' histories, the nurse recognizes that which of the following patients would be likely candidates for drug therapy for cholesterol reduction?
A. A patient who has two risk factors and a low-density lipoprotein (LDL) level of 100 mg/dL, without coronary heart disease
B. A patient who has coronary heart disease and an LDL level of 100 mg/dL
C. A patient who has one risk factor, an LDL level of 170 mg/dL, and no history of coronary heart disease
D. A patient who has coronary heart disease and an LDL level of 165 mg/dL

B. A patient who has coronary heart disease and an LDL level of 100 mg/dL

A patient tells the nurse that he likes to eat large amounts of garlic for its cardiovascular benefits. The nurse reviews his medication history, and notes that which drug would have a potential interaction with the garlic?
A. acetaminophen (Tylenol)
B. warfarin (Coumadin)
C. digoxin (Lanoxin)
D. phenytoin (Dilantin)

B. warfarin (Coumadin)

8. A patient with risk factors for coronary artery disease asks the nurse about the "good cholesterol" laboratory values. The nurse knows that this term refers to which of the following?
A. Chylomicrons
B. Low-density lipoproteins (LDLs)
C. High-density lipoproteins (HDLs)
D. Very-low-density lipoproteins (VLDLs)

C. High-density lipoproteins (HDLs)

9. 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 of the following would be the nurse's best response?
A. "Blood levels return to normal within a week of beginning therapy."
B. "It takes several weeks to see a change in cholesterol levels."
C. "It takes at least 6 months to see a change in cholesterol levels."
D. "You will need to take this medication for almost a year to see significant results."

B. "It takes several weeks to see a change in cholesterol levels."

10. The nurse should monitor for muscle pain and possible myopathy when a patient is taking which class of antilipemic drugs?
A. Bile acid sequestrants
B. HMG-CoA reductase inhibitors
C. Fibric acid derivatives
D. Niacin

B. HMG-CoA reductase inhibitors

11. When teaching a patient who is beginning antilipemic therapy about possible drug-food interactions, the nurse should discuss which food?
A. Oatmeal
B. Grapefruit juice
C. Licorice
D. Dairy products

B. Grapefruit juice

12. The nurse is conducting a class about antilipemic drugs. The newer antilipemic drug ezetimibe (Zetia) works by which mechanism?
A. Preventing resorption of bile acids from the small intestines
B. Inhibiting HMG-CoA reductase
C. Activating lipase, which breaks down cholesterol
D. Inhibiting cholesterol absorption in the small intestine

D. Inhibiting cholesterol absorption in the small intestine

A pt. who has been on antibiotic therapy for 2 weeks has developed persistent diarrhea. The nurse expects which medication to be ordered to treat this diarrhea?
a. mineral oil
b. absorbednts such as Pepto-bismol
c. Anticholinergics such as belladonna alkaloids
d. Intestinal flora modifers such as Lactinex

d. Intestinal flora modifiers such as Lactinex pg. 798

A laxative has been ordered for a pt. The nurse checks the patient's medical history, knowing that this medication is contraindicated with which condition?

a. High ammonia levels due to liver failure
b. Diverticulosis
c. Abdominal pain of unknown orgin
d. Chronic constipation

c. Abdominal pain of unknown orgin pg. 802

The nurse is preparing to administer medications to a pt. who is receiving a gastric tube feeding. When reviewing the patients medication list, the nurse notes a potential concern about a food-drug interaction if which medication is listed?

a. actaminophen, (Tylenol)
b. phenytoin, (Dilatin)
c. metoclopramide, (Reglan)
d. warfarin, (Coumadin)

B. Phenytoin, (Dilantin) pg. 843-844

A. patient will be taking bismuth subsalicylate, (Pepto-Bismol) to control is diarrhea. When reviewing the patient's other ordered medications, the nurses recognizes that which medication will interact significantly with the Pepto-Bismol?
a. digoxin, (Lanoxin)
b. Antacids
c. Acetaminophen, Tylenol
d. Tricyclic antidepressants

a. digoxin, (Lanoxin) pg. 798

The nurse is preparing a plan of care for a patient undergoing therapy with vitamin A. Which nursing diagnosis is appropriate for this patient?

a. risk for impaired skin integrity r/t vitamin deficiency
b. distrubed sensory perception (visual) r/t night blindness caused by vitamin deficiency
c. Impaired physical mobility (muscle weakness) r/t vitamin deficiency
d. Disturbed though process (confusion and psychosis) r/t vitamin deficiency

b. distrubed sensory perception (visual) r/t night blindness caused by vitamin deficiency
pg. 838

The nurse is reviewing the mechanism of action of antidiarrheal drugs. Which type of antidiarrheal medication works by decreasing the intestinal muscle tone and peristalsis of the intestine?

a. absorbents such as Pepto-Bismol
b. Anticholinergics such as belladonna alkaloids
c. Intestinal flora modifiers such as Lactinex
d. Lubricants such as glycerin

Anticholinergics such as belladonna alkaloids
pg. 798

The nurse will monitor for which signs of toxicity when a patient is on Vitamin D supplemental therapy?
a. Urticaria
b. Anorexia
c. Diarrhea
D. Tinnitus

b. Anorexia
pg. 826

When administering mineral, oil, the nurse recognizes that it can interfere with the absorption of which substance?
a. Vitamin A
b. Vitamin C
c. Iron
D. Potassium

a. Vitamin A
pg. 803

A patient is taking chemotherapy with a drug that has a high potential for causing nausea and vomiting. The nurse is preparing to administer an antiemetic drug. Which class of antiemetic drugs has proven most effective in preventing nausea and vomiting for patients receiving chemotherapy?
a. Prokinetic drugs
b. Serotonin blockers
c. Antihistamines
d. Anticholinergic drugs

b. Serotonin blockers
pg. 816

An elderly patient needs to take an enteral supplement to improve her overall nutrition staus. When considering enteral supplements, the nurse notes that which formulation provides complex nutrients?
a. ensure
b.Moducal
c.Propac
d.Microlipid

a. ensure
pg. 844

the nurse is giving oral mineral oil as an ordered laxative dose. The nurse will take measure to prevent which potential problem that may occur with mineral oil.
a. Fecal impaction
b.Constipation
C. Lipid pneumonia
d. Esophageal blockage

C. Lipid pneumonia
pg. 803

Niacin is prescribed for a patient who has hyperlipidemia. The nurse checks the patient's medical history, knowning this medication is contraindicated in which disorder?
a. Renal disease
b. Cardiac Disease
c. Liver disease
d. Thyroid disease

c. Liver disease
pg. 830

A patient with a history of alcohol abuse has been admitted for severe weakness and malnutrition. The nurse will prepare to administer which vitamin preparation to prevent Wernicke's encephalopathy?
a. vitamin B3 (niacin)
b. Vitamin B1 (Thiamine)
c. Vitamin B2 (Riboflavin)
d. Vitamin B6 (pyridoxine)

b. Vitamin B1 (Thiamine)
pg. 829

A mother calls the pediatrician's office to report that her 18 month old child has eaten half of a bottle of baby aspirin. She says, "I have a bottle of syrup of ipecac. Should I give it to him? he seems fine right now. What do I do? What is the nurse's best response?
a. "Go ahead and give him the ipecac, then call 911"
b. "Dont give him the ipecac, but call the Poison Control number immediately for instructions"
c."Please come to the office right away so that we can check him:"
d. "Call 911 now and wait for them to come"

b. "Dont give him the ipecac, but call the Poison Control number immediately for instructions"
pg. 811

The nurse notes that a patient is taking tegaserod (Zelnorm) to treat irritable bowel syndrom, (IBS). The nurse will monitor the patient for which adverse effect?
a. Chest pain
b. Dyspnea
c. Abdominal cramps
d. Chronic constipation

a. Chest pain
pg. 806

When giving nutrition supplements, the nurse keeps in mind that the most common adverse effect is
a. diarrhea
b. constipation
c.fluid overload
d. peptic ulcer disease

a. diarrhea
pg. 843

While recovering from surgery, a 74 year old women stated taking a stimulant laxative, senna (senokot), to relieve constipation caused by the pain medications. She tells the nurse that she likes how "regular" her bowel movements are now that she is taking the laxative. While teaching principle is appropriate for this patient?
a. Use of a stimulant laxative will not affect teh absorption of her other medications.
b. It is important to have a daily bowel movement to promote bowel health.
c.Long-term use of laxatives often results in decreased bowel tone and may lead to dependency.
d. She should switch to glycerin suppositories to continue having daily bowel movements

c.Long-term use of laxatives often results in decreased bowel tone and may lead to dependency.
pg. 806

A patient is severely constipated and needs immediate relief. The nurse knows that which type of laxative will provide the most rapid results?
a. Bulk-forming laxative, such as psyllium, (Metamucil)
b. Stool softener, such as docusate salts (Colace)
c. Magnesium hydroxide (MOM)
d. Magnesium oxide tablets

c. Magnesium hydroxide (MOM)
pg. 805

The nurse is reviewing conditions caused by nutrients deficiencies. Conditions such as infantile rickets, tetany, and osteomalcia are caused by a deficiency in which vitamin or mineral?
a. Vitamin D
b. Vitamin K
c. Magnesium
D. Cyanocobalamin (Vitamin B12)

a. Vitamin D
pg. 826

A patient is receiving a tube feeding through a gastrostomy. The nurse expects that which type of drug will be used to promote gastric emptying for this patient?
a. Prokinetic drug
b.Serotonin blockers
c. Anticholinergic drugs
d. Neuroleptic drugs

a. Prokinetic drug

The patient asks advice about which type of laxative is safe to use while at home so as to prevent problems with constipation. The nurse explains that which class of laxative is considered safe to use on a long-term basis?
a. Emollient laxative
b. Bulk forming laxatives
c. Hyperosmotic laxatives
d. Stimulant laxatives

b. Bulk forming laxatives
pg. 801

The nurse is considering the use of oral laxatives. All of the conditions below are contraindicated in or require caution with the use of oral laxatives except:
a. Nausea and vomiting
b. Acute surgical abdomen
c. Fecal impaction
d. GERD

d. GERD
pg. 802

A women who is in the first trimester of pregnancy has been experiencing severe morning sickness. She asks, "I've heard that ginger tablets may be a natural way to ease the nausea and vomiting. Is it okay to try them? What is the nurse best response?
a. "They are great natural remedy for nausea when you are pregnant"
b. "Go ahead and try them, but stop taking them once the nausea is relieved"
c. "Some health care providers do not recommend ginger during pregnancy. Let's check with your doctor."
d. Wait until you are in your second trimester, then try them. They may be more effective then"

c. "Some health care providers do not recommend ginger during pregnancy. Let's check with your doctor."
pg. 817

A patient has been receiving total parenteral nutrition (TPN). Upon assessment, the nurse notes that his blood pressure is elevated, his pulse is weak and elevated, he seems confused, and he has new pitting edema around his ankles. Which condition does the nurse suspect the patient is experiencing?
a. Hyperglycemia
b. Hypoglycemia
c. Infection
d. Fluid overload

d. Fluid overload
pg. 849

When counseling a patient about calcium supplements, the nurse should include which dietary information?
a. Oral calcium supplements should be taken with meals.
b. Calcium products bind with tetracyclines and thus increase their effects.
c. Foods high in calcium include beef, egg yolks, and liver
d. Foods high in calcium include dairy products and salmon.

d. Foods high in calcium include dairy products and salmon.
pg. 824

During the night shift, a patients TPN infusion ran out, and there was no TPN solution on hand to continue the infusion. The nurse will have to implement measure to prevent what consequence of abruptly discontinuing TPN infusion?
a. Fluid overload
b. Hyperglycemia
c. Dumping syndrome
d. Rebound hypoglycemia

d. Rebound hypoglycemia
pg. 849

A patient with motion sickness is planning a cross-country car trip to attend a family reunion. He has a prescription for a scopolamine transdermal patch. The nurse should instruct the patient that the patch should be changed
a. every day
b. every other day
c. every 3 days
d. only if it stops working

c. every 3 days
pg. 815

Which one of the following interventions is correct regarding the pharmacologic management of nausea and vomiting?
a. Give antinausea drugs immediately after chemotherapy is administered.

b. taking antinausea drugs at night may causes restlessness and interfere with sleep

c. Instruct the patient to rise slowly from a sitting or lying position due to possible orthostatic hypotension

d. Medicate only when nausea is severe

c. Instruct the patient to rise slowly from a sitting or lying position due to possible orthostatic hypotension
pg, 819

When monitoring a patient who has been on peripheral parenteral nutrition (PPN) for more than 3 weeks, the nurse monitors for which possible complication?
a. Diarrhea
b. Phlebitis
c. Hypokalemia
d. Hypoglycemia

b. Phlebitis
pg. 845

A patient who has severe nausea and vomiting following a case of food poisoning comes to the clinic. When receiving his medication history, the nurse notes that he has an allergy to procainamide. The nurse would question an order for which antimetic drug if ordered for this patient.
a. metoclopramide, Reglan
b. promethazine, Phenergan
c. phosphorated carbohydrate solution, Emetrol
d. granisetron, Kytril

A. metoclopramide, Reglan
pg. 814

A patient with type 2 diabetes will be receiving a nasogastric tube feeding for a few days. The nurse expects which type of formula to be used?
a. Vivonex Plus
b. Ensure plus
c. Glucerna
d. Moducal

c. Glucerna
pg. 843

A patient will be taking bismuth subsalicylate Pepto Bismo to control his diarrhea. When revewing the patients other ordered medications, the nurse recognizes that which medications will interact significantly with the Pepto-Bismol?
a. acetaminophen, Tylenol
b. Thyroid replacement drugs
c. warfarin, Coumadin
d. Antidepressants

c. warfarin, Coumadin

A patient on chemotherapy is using ondansetron, Zofran for treatmetn of nausea. The nurse will instruct the patient to watch for which adverse effect of this drug?
a. Dizziness
b. Headache
c. Dry mouth
d. Blurred vision

b. Headache
pg. 814

A patient is receiving lactulose (Chronulac) three times a day. The nurse knows that the patient is not constipated and is receiving this drug for which reason?
a. High ammonia levels due to liver failure
b. Preparation for bowel surgery
c. Abdominal pain of unknown orgin
d. Chronic diarrhea

a. High ammonia levels due to liver failure
pg. 805

A patient who has been newly diagnosed with vertigo will be taking an antihistamine antimetic drug. The nurse will include which information when teaching the patient about this drug?
a. Doses may be skipped if she is feeling well
b. The patient should avoid driving because of possible drowsiness
c. The patient may experience transient taste problems.
d. It is safe to take it with a glass of wine in the evening to help settle her stomach

b. The patient should avoid driving because of possible drowsiness
pg. 819

A patient who has AIDS has lost weight and is easily fatigued because of his malnourished state. The nurse anticipates using which antinausea drug to stimulate this appetite?
a. aprepitant (Emend) a substance P/NK1 receptor antagonist
d. Dronabinol, Marinol, tetrahydrocannabinoid
c. ondansetron, Zofran, serotonin blocker
d. metochlopramide, Reglan, a prokinetic drug

d. Dronabinol, Marinol, tetrahydrocannabinoid
pg. 816