LEHNE’S PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE NURSES AND PHYSICIAN ASSISTANTS, Exams of Nursing

Download LEHNE’S PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE NURSES AND PHYSICIAN ASSISTANTS and more Exams Nursing in PDF only on Docsity! 1 LEHNE’S PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE NURSES AND PHYSICIAN ASSISTANTS (2ND EDITION ROSENTHAL TEST BANK) NEWEST WITH COMPLETE 900+ QUESTIONS AND CORRECT SOLUTIONS Ch 1 Prescriptive Authority 2. Which factors increase the need for APRNs to have full prescriptive authority? - ANSWER a. More patients will have access to health care. Ch 1 Prescriptive Authority 3. Which factors could be attributed to limited prescriptive authority for APRNs? Select all that apply. - ANSWER a. Inaccessibility of patient care b. Higher health care costs Ch 1 Prescriptive Authority 4. Which aspects support the APRN's provision for full prescriptive authority? Select all that apply - ANSWER a. Clinical education includes prescription of medications and disease processes. c. National examinations provide validation of the APRN's ability to provide safe care. d. Licensure ensures compliance with health care and safety standards. Ch 1 Prescriptive Authority 5. Which aspects support the APRN's provision for full prescriptive authority? Select all that apply. - 2 ANSWER a. Clinical education includes prescription of medications and disease processes. c. National examinations provide validation of the APRN's ability to provide safe care. d. Licensure ensures compliance with health care and safety standards. Ch 1 Prescriptive Authority 6. A family nurse practitioner practicing in Maine is hired at a practice across state lines in Virginia. Which aspect of practice may change for the APRN? - ANSWER a. The APRN will have less prescriptive authority in the new position. Ch 2 Rational Drug Selection and Prescription Writing 7. How can collaboration with a pharmacist improve positive outcomes for patients? Select all that apply. - ANSWER b. Pharmacists have additional information on drug interactions. c. The pharmacist can suggest adequate medication dosing. d. Pharmacists have firsthand knowledge of the facility formulary. Ch 2 Rational Drug Selection and Prescription Writing 8. A patient presents with delirium tremens requiring Ativan administration. The provider of care is not in the facility. Which action by the nurse is most appropriate? - ANSWER a. Obtain a telephone order. Ch 2 Rational Drug Selection and Prescription Writing 9. A patient with chronic pain calls the provider's office to request a refill on their oxycontin. Which action is most appropriate? - ANSWER b. Schedule an appointment with the patient. Ch 2 Rational Drug Selection and Prescription Writing 10. A patient prescribed amoxicillin for streptococcal pharyngitis reports new onset of a flat, itchy red rash on the chest and neck. Which action is most important? - ANSWER b. Discontinue the medication. 5 received a toxic dose of morphine sulfate. The nurse understands that the naloxone is effective because of which action? - ANSWER c. Preventing activation of opioid receptors through antagonist actions Ch 4 Pharmacokinetics, Pharmacodynamics, and Drug Interactions 22. A patient is taking drug X and receives a new prescription for drug Y, which is listed as an inducing agent. The nurse caring for this patient understands that this patient may require doses of drug - ANSWER c. higher; X Ch 4 Pharmacokinetics, Pharmacodynamics, and Drug Interactions 23. The nurse is preparing to administer penicillin G intramuscularly to a child. The child's parents ask why the drug cannot be given in an oral liquid form. What is the nurse's reply? - ANSWER d. "This drug would be inactivated by enzymes in the stomach." Ch 4 Pharmacokinetics, Pharmacodynamics, and Drug Interactions 24. Which statement about food and drug interactions is true? - ANSWER d. Some foods can inhibit CYP isoenzymes and alter drug metabolism. Ch 4 Pharmacokinetics, Pharmacodynamics, and Drug Interactions 25. A nurse is teaching a patient about a drug that induces P- glycoprotein. The nurse will explain that this drug may cause which effect on other drugs? - ANSWER b. Decreased elimination through the kidneys Ch 4 Pharmacokinetics, Pharmacodynamics, and Drug Interactions 26. A patient claims to get better effects with a tablet of Brand X of a drug than with a tablet of Brand Y of the same drug. Both brands contain the same amount of the active ingredient. What does the nurse know to be most likely? - ANSWER c. Tablets can differ in 6 composition and can have differing rates of disintegration and dissolution, which can alter the drug's effects in the body. Ch 4 Pharmacokinetics, Pharmacodynamics, and Drug Interactions 27. Two nurses are discussing theories of drug-receptor interaction. Which statements are true regarding the affinity of a drug and its receptor? - ANSWER b. Affinity refers to the strength of the attraction between a drug and its receptor. c. Drugs with high affinity are strongly attracted to their receptors. e. The affinity of a drug for its receptors is reflected in its potency. Ch 4 Pharmacokinetics, Pharmacodynamics, and Drug Interactions 28. A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what? - ANSWER c. Monitor plasma drug levels. Ch 4 Pharmacokinetics, Pharmacodynamics, and Drug Interactions 29. What occurs when a drug binds to a receptor in the body? - ANSWER b. It increases or decreases the activity of that receptor. Ch 4 Pharmacokinetics, Pharmacodynamics, and Drug Interactions 30. A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this patient in the past. Which could be a probable cause of the test result? - ANSWER c. The patient is taking another medication that binds to serum albumin. Ch 4 Pharmacokinetics, Pharmacodynamics, and Drug Interactions 31. A patient reports becoming "immune" to a medication because it no longer works to alleviate symptoms. The nurse recognizes that this decreased effectiveness is likely caused by: - ANSWER c. Desensitization of receptor sites by continual exposure to the drug. 7 Ch 4 Pharmacokinetics, Pharmacodynamics, and Drug Interactions 32. A patient who is taking morphine for pain asks the nurse how a pain medication can also cause constipation. What does the nurse know about morphine? - ANSWER d. It is selective to receptors that regulate more than one body process. Ch 4 Pharmacokinetics, Pharmacodynamics, and Drug Interactions 33. The nurse is administering morning medications. The nurse gives a patient multiple medications, two of which compete for plasma albumin receptor sites. As a result of this concurrent administration, the nurse can anticipate that what might occur? - ANSWER a. Binding of one or both agents will be reduced. b. Plasma levels of free drug will rise. d. The increase in free drug will intensify effects. Ch 4 Pharmacokinetics, Pharmacodynamics, and Drug Interactions 34. When administering medications to infants, it is important to remember which of the following? - ANSWER b. Immaturity of renal function in infancy causes infants to excrete drugs less efficiently. <br> c. Infants have immature livers, which slows drug metabolism. <br> d. Infants are more sensitive to medications that act on the central nervous system (CNS). Ch 5 Adverse Drug Reactions and Medication Errors 35. A nursing student is preparing to give a medication that has a boxed warning. The student asks the nurse what this means. What will the nurse explain about boxed warnings? - ANSWER c. They alert prescribers to measures to mitigate potential harm from side effects. Ch 5 Adverse Drug Reactions and Medication Errors 36. A nurse is preparing to administer a drug. Upon reading the medication guide, the nurse notes that the drug has been linked to symptoms of Parkinson disease in some patients. What will the nurse do? - 10 with acetaminophen [Lortab] for pain. What will the nurse do? - ANSWER c. Tell the patient not to drink wine while taking Lortab. Ch 5 Adverse Drug Reactions and Medication Errors 47. Which actions occur in 90% of fatal medication errors? Select all that apply. - ANSWER b. Giving a drug intravenously instead of intramuscularly c. Giving Nasarel instead of Nizoral e. Writing a prescription illegibly Ch 6 Individual Variation in Drug Responses 48. A nurse is caring for a woman with breast cancer who is receiving tamoxifen. A review of this patient's chart reveals a deficiency of the CYP2D6 gene. The nurse will contact the provider to suggest: - ANSWER a. a different medication. Ch 6 Individual Variation in Drug Responses 49. Which groups of people are especially sensitive to medication effects? Select all that apply. - ANSWER a. Older adults c. Infants Ch 6 Individual Variation in Drug Responses 50. A post-operative patient who is worried about pain control will be discharged several days after surgery. The nurse providing discharge teaching tells the patient that the prescribed Lortab is not as strong as the morphine the patient was given in the immediate post-operative period. Which response is the patient likely to experience? - ANSWER b. A negative placebo effect when taking the medication Ch 6 Individual Variation in Drug Responses 51. A patient has been taking narcotic analgesics for chronic pain for several months. The nurse caring for this patient notes that the prescribed dose is higher than the recommended dose. The patient has normal vital signs, is awake and alert, and reports mild pain. What does the nurse recognize about this patient? - ANSWER c. This patient has 11 developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for analgesic effect. Ch 6 Individual Variation in Drug Responses 52. A patient asks a nurse why a friend who is taking the same drug responds differently to that drug. The nurse knows that the most common variation in drug response is due to differences in each patient's: - ANSWER c. metabolism of drugs. Ch 6 Individual Variation in Drug Responses 53. The nurse is assessing a newly admitted older patient who has recently lost 15 pounds. The nurse notes that the patient is taking warfarin (Coumadin). Which laboratory tests will the nurse discuss with this patient's provider? - ANSWER d. Serum albumin and coagulation studies Ch 6 Individual Variation in Drug Responses 54. A nurse is preparing to care for a patient who is receiving digoxin. When screening for potential adverse effects from this drug, the nurse will review which of this patient's laboratory results? - ANSWER d. Serum electrolytes Ch 6 Individual Variation in Drug Responses 55. A nurse administers the same medication in the same preparation in the same dose to several patients and notes that some patients have a better response to the drug than others. What is the most likely explanation for this phenomenon? - ANSWER c. Pharmacogenomic differences among individuals Ch 6 Individual Variation in Drug Responses 56. A nurse is teaching a group of women about medications. The women want to know why so many drugs have unpredictable effects in women. The nurse will tell them that: - ANSWER b. most known drug effects are based on drug trials in men. 12 Ch 6 Individual Variation in Drug Responses 57. The U.S. Food and Drug Administration (FDA) recommends genetic testing of patients receiving certain medications. Genetic testing helps prescribers: - ANSWER b. determine whether a patient is a rapid or slow metabolizer of the drug. Ch 7 Genetic and Genomic Considerations in Pharmacotherapeutics 1. Drugs do not metabolize the same way in all people. For what patient would a nurse expect to assess for an alteration in drug metabolism? - ANSWER C) A 50-year-old man with cirrhosis of the liver Ch 7 Genetic and Genomic Considerations in Pharmacotherapeutics 2. A patient presents to the emergency department with a drug level of 50 units/mL. The half-life of this drug is 1 hour. With this drug, concentrations above 25 units/mL are considered toxic and no more drug is given. How long will it take for the blood level to reach the non-toxic range? - ANSWER B) 1 hour Ch 7 Genetic and Genomic Considerations in Pharmacotherapeutics 3. A patient has recently moved from Vermont to Southern Florida. The patient presents to the clinic complaining of dizzy spells and weakness. While conducting the admission assessment, the patient tells the nurse that he have been on the same antihypertensive drug for 6 years and had stable blood pressures and no adverse effects. Since his move, he has been having problems and he feels that the drug is no longer effective. The clinic nurse knows that one possible reason for the change in the effectiveness of the drug could be what? - ANSWER C) The impact of the warmer environment on the patient's physical status Ch 7 Genetic and Genomic Considerations in Pharmacotherapeutics 4. An important concept taught by the nurse when providing medication teaching is the need to provide a complete list of 15 Ch 8 Drug Therapy During Pregnancy and Breast-Feeding 60. A patient who has just learned she is pregnant has stopped using a prescription medication that she takes for asthma because she does not want to harm her baby. What will the nurse tell her? - ANSWER b. That her baby's health is dependent on hers Ch 8 Drug Therapy During Pregnancy and Breast-Feeding 61. A pregnant patient in active labor is admitted to the emergency department. A toxicology screen and a physical assessment reveal that the patient is an active heroin addict. The nurse who cares for the neonate after delivery should anticipate which clinical manifestations? - ANSWER c. A shrill cry and irritability Ch 8 Drug Therapy During Pregnancy and Breast-Feeding 62. A pregnant patient asks the nurse about the safe use of medications during the third trimester. What will the nurse tell her about drugs taken at this stage? - ANSWER a. They may need to be given in higher doses if they undergo renal clearance. Ch 8 Drug Therapy During Pregnancy and Breast-Feeding 63. A patient has just given birth to a baby boy with a cleft palate. The nurse will review the patient's medication history with special emphasis on drugs taken during which period? - ANSWER b. During the first trimester Ch 8 Drug Therapy During Pregnancy and Breast-Feeding 64. A nurse is caring for a patient and her newborn immediately after delivery. The patient's medication history includes prenatal vitamins throughout pregnancy, one or two glasses of wine before knowing she was pregnant, occasional use of an albuterol inhaler in her last trimester, and intravenous morphine during labor. What will the nurse expect to do? - ANSWER b. Monitor the infant's respirations and prepare to administer naloxone if needed. 16 Ch 8 Drug Therapy During Pregnancy and Breast-Feeding 65. A woman who is breastfeeding her infant must take a prescription medication for 2 weeks. The medication is safe, but the patient wants to make sure her baby receives as little of the drug as possible. What will the nurse tell the patient to do? - ANSWER b. Take the medication immediately after breastfeeding Ch 8 Drug Therapy During Pregnancy and Breast-Feeding 66. A nursing student asks the nurse why more is not known about the teratogenic effects of maternal medication ingestion during pregnancy. Which response by the nurse is correct? - ANSWER a. "Clinical trials to assess this risk would put the fetus at risk." Ch 8 Drug Therapy During Pregnancy and Breast-Feeding 67. A nurse is teaching a class to a group of pregnant patients. The nurse correctly teaches that the highest risk of teratogen-induced gross malformations exists during which time? - ANSWER b. During the first trimester Ch 9 Drug Therapy in Pediatric Patients 1. A nurse is caring for an infant after a surgical procedure. After ensuring that the ordered dose is appropriate for the infant's age and weight, the nurse administers a narcotic analgesic intravenously. When assessing the infant 15 minutes later, the nurse notes respirations of 22 breaths/minute and a heart rate of 110 beats/minute. The infant is asleep in the parent's arms and does not awaken when vital signs are assessed. The nurse understands that these findings are the result of: - ANSWER b. immaturity of the blood-brain barrier in the infant. Ch 9 Drug Therapy in Pediatric Patients 2. A child will receive 750 mg of an antibiotic for 10 days. The child attends day care. The drug may be dosed in several ways and is available in two concentrations. 17 Which dosing regimen will the nurse discuss with the child's provider? - ANSWER d. 500 mg/5 mL to 375 mg PO twice daily Ch 9 Drug Therapy in Pediatric Patients 3. Parents ask the nurse why an over-the-counter cough suppressant with sedative side effects is not recommended for infants. Which response by the nurse is correct? - ANSWER c. "Infants are more susceptible to central nervous system effects than are adults." Ch 9 Drug Therapy in Pediatric Patients 4. A nurse caring for a 5- year-old child notes that the child has discoloration of several teeth. When taking a medication history, the nurse will ask about which group of medications? - ANSWER d. Tetracyclines Ch 9 Drug Therapy in Pediatric Patients 5. An infant has allergies and often develops a pruritic rash when exposed to allergens. The infant's parents ask the nurse about using a topical antihistamine. What should the nurse tell them? - ANSWER b. Applying an antihistamine to the skin can cause toxicity in this age group. Ch 9 Drug Therapy in Pediatric Patients 6. An infant is receiving a medication that has a narrow therapeutic range. The nurse reviews the medication information and learns that the drug is excreted by the kidneys. When giving the medication, the nurse will assess the infant for: - ANSWER c. signs of drug toxicity. Ch 9 Drug Therapy in Pediatric Patients 7. A pediatric nurse is teaching nursing students to calculate medication doses for children using a formula based on body surface area. Which statement by a nursing student indicates understanding of the teaching? - ANSWER a. "This formula helps approximate the first dose; other doses should be based on clinical observations." 20 Ch 10 Drug Therapy in Geriatric 19. A nurse is reviewing an older adult patient's chart before giving medications. Which patient information is of most concern? - ANSWER c. Low serum albumin Ch 10 Drug Therapy in Geriatric 20. A nurse is caring for an older adult patient during the immediate postoperative period after a total hip replacement. The surgeon has ordered meperidine [Demerol] for severe pain. What will the nurse do? - ANSWER c. Request an order for morphine instead of meperidine [Demerol]. Ch 10 Drug Therapy in Geriatric 21. The nurse is teaching a group of nursing students about adherence to medication in older adults. Which statement by a student indicates understanding of the teaching? - ANSWER d. "A majority of older patients who do not adhere to drug regimens do so intentionally." Ch 10 Drug Therapy in Geriatric 22. A nurse is making a home visit to an older adult woman who was recently discharged home from the hospital with a new prescription. The nurse notes that a serum drug level drawn the day before was subtherapeutic. What will the nurse do next? - ANSWER b. Count the pills in the prescription bottle. Ch 10 Drug Therapy in Geriatric 23. An older adult patient is admitted to the hospital for treatment of an exacerbation of a chronic illness. Admission laboratory work reveals an extremely low serum drug level of the drug used to treat this condition. The patient has brought the medication to the hospital, along with other medications taken. The patient's renal and hepatic function tests are normal. What might the nurse suspect as a likely cause of this finding? - ANSWER a. Financial concerns Ch 11 Basic Principles of Neuropharmacology 24. A nursing student asks about drugs that interfere with the termination of transmitter 21 action. Which statement by the nurse is correct? - ANSWER d. "These drugs reduce either reuptake or degradation of the transmitter, causing an increase in receptor activation." Ch 11 Basic Principles of Neuropharmacology 25. A nurse is teaching a group of nursing students about neuropharmacology. Which statement by a student about peripheral nervous system (PNS) drugs indicates a need for further teaching? - ANSWER a. "Drugs affecting axonal conduction have a variety of uses." Ch 11 Basic Principles of Neuropharmacology 26. A nurse is preparing to administer a medication and learns that it is a nonselective agonist drug. What does the nurse understand about this drug? - ANSWER a. It directly activates receptors to affect many physiologic processes. Ch 11 Basic Principles of Neuropharmacology 27. A patient has allergies and takes an antihistamine. The patient wants to know how the drug works. The nurse understands that antihistamines work because they are what? - ANSWER c. Antagonists Ch 11 Basic Principles of Neuropharmacology 28. A patient receiving botulinum toxin injections to control muscle spasticity asks how the drug works. The nurse knows that this drug affects the transmitter acetylcholine by: - ANSWER a. inhibiting its release. Ch 11 Basic Principles of Neuropharmacology 29. A nurse is administering drug X to a patient. The drug information states that the drug acts by activating receptors in the peripheral nervous system by increasing transmitter synthesis. The nurse understands that the effect of this drug is to: - ANSWER c. increase receptor activation. 22 Ch 11 Basic Principles of Neuropharmacology 30. A patient receives morphine and shows signs of toxicity. The prescriber orders naloxone [Narcan] to reverse the effects of the morphine. The nurse understands that the naloxone reverses morphine toxicity by which action on morphine receptor sites? - ANSWER d. Preventing activation of receptors Ch 11 Basic Principles of Neuropharmacology 31. A nurse learns about a drug that interferes with transmitter storage in the PNS. The transmitter affected by this drug causes an increased heart rate. What response will the nurse expect to see when this drug is administered? - ANSWER a. Bradycardia Physiology of the Peripheral Nervous System 32. What is the target organ when a beta1 agonist is administered? - ANSWER a. Heart Physiology of the Peripheral Nervous System 33. A nurse is teaching a group of nursing students about neurotransmitters. Which statement by a student about acetylcholine indicates a need for further teaching? - ANSWER d. "Its transmission is terminated by reuptake into the cholinergic nerve terminal." Physiology of the Peripheral Nervous System 34. A nurse is administering an agonist drug that acts on postganglionic neurons of the sympathetic nervous system. Which response will the nurse expect to see? - ANSWER c. Increased cardiac output Physiology of the Peripheral Nervous System 35. A nurse is teaching a patient about a medication that alters sympathetic nervous system functions. To evaluate understanding, the nurse asks the patient to describe which functions the sympathetic nervous system regulates. Which answer indicates the need for further teaching? - ANSWER a. "The digestive functions of the body" 25 Ch 14 Muscarinic Antagonists 1. The nurse administers an adrenergic blocking agent in order to prevent release of what neurotransmitter? - ANSWER B) Norepinephrine Ch 14 Muscarinic Antagonists 2. What medication, if ordered for an 8-year-old patient, should the nurse question? (Select all that apply.) - ANSWER A) Amiodarone (Cordarone) 400 mg orally per 24 hours <br> B) Labetalol (Normodyne) 100 mg orally b.i.d. <br> E) Carvedilol (Coreg) 6.25 mg orally Ch 14 Muscarinic Antagonists 3. A nurse is working with a patient who is taking an adrenergic blocking agent. While assessing the patient's medication history, the nurse discovers that the patient takes several alternative therapies. What herb is the nurse concerned may interact with the adrenergic blocking agent and affect the patient's blood glucose level? - ANSWER C) Di huang Ch 14 Muscarinic Antagonists 4. A priority nursing assessment for a patient who is to receive an alpha- or beta-adrenergic blocking agent would be what? - ANSWER D) Assessing heart rate Ch 14 Muscarinic Antagonists 5. Bisoprolol (Zebeta) would be the drug of choice for which patient with a diagnosis of hypertension? - ANSWER D) A 69-year-old patient Ch 14 Muscarinic Antagonists 6. What would be the teaching priority for a diabetic patient being treated with a nonselective beta- blocker? - ANSWER D) To understand signs and symptoms of hypo- or hyperglycemic reaction Ch 14 Muscarinic Antagonists 7. The nurse is caring for a patient who is receiving an adrenergic blocking agent. While writing the care plan for this patient what nursing diagnoses would be most 26 appropriate concerning comfort? - ANSWER A) Acute pain related to cardiovascular and systemic effects Ch 14 Muscarinic Antagonists 8. A nurse is providing discharge instructions to a patient who is taking atenolol (Tenormin) to treat hypertension. What would the nurse teach the patient regarding a possible drug-drug interaction? - ANSWER C) Nonsteroidal anti- inflammatory drugs (NSAIDs) Ch 14 Muscarinic Antagonists 9. A busy patient with many responsibilities is to have a medication ordered to treat her hypertension. To increase compliance with drug therapy, what drug would be a good choice for this patient? - ANSWER D) Metoprolol (Lopressor) Ch 14 Muscarinic Antagonists 10. The nurse provides patient teaching for a patient who has a new order for nadolol (Corgard) to treat hypertension. What statement by the patient concerning nadolol (Corgard) would indicate that the teaching has been effective? - ANSWER C) I will not stop taking this drug abruptly and will talk to my doctor before discontinuing. Ch 15 Adrenergic Agonists 50. A nursing student asks the nurse about receptor specificity of adrenergic agonist medications. What will the nurse say? - ANSWER d. "Specificity is relative and is dose dependent." Ch 15 Adrenergic Agonists 51. A nurse is teaching parents how to use an Epi-Pen for their child, who has a peanut allergy. Which statement by the parents indicates understanding of the teaching? - ANSWER a. "After using the Epi-Pen, we must go to the emergency department." 27 Ch 15 Adrenergic Agonists 52. A nursing student asks the nurse why epinephrine, and not other adrenergic agonists, is used to treat anaphylactic shock. What will the nurse tell the student? - ANSWER b. "Epinephrine has the ability to activate multiple types of adrenergic receptors." Ch 15 Adrenergic Agonists 53. Dopamine is administered to a patient who has been experiencing hypotensive episodes. Other than an increase in blood pressure, which indicator would the nurse use to evaluate a successful response? - ANSWER b. Increase in urine output Ch 15 Adrenergic Agonists 54. A nursing student asks why albuterol, which is selective for beta2 receptors, causes an increased heart rate in some patients. How should the nurse respond? - ANSWER a. "Adrenergic agonists can lose their selectivity when given at higher doses." Ch 15 Adrenergic Agonists 55. Because they cause vasoconstriction, alpha1-adrenergic agonists are especially useful for: - ANSWER a. causing hemostasis in skin and mucous membranes. Ch 15 Adrenergic Agonists 56. A nurse is teaching a nursing student about the two classes of adrenergic agonist drugs. Which statement by the nursing student indicates understanding of the teaching? - ANSWER b. "Catecholamines often require continuous infusion to be effective." Ch 15 Adrenergic Agonists 57. A patient with asthma uses albuterol [Ventolin] for wheezing. The nurse assesses the patient and notes vital signs of HR, 96 beats/minute; RR, 18 breaths/minute; and BP, 116. What should the nurse do? - ANSWER a. Ask the patient how often the inhaler is used. 30 Ch 16 Adrenergic Antagonists 69. Which are adverse effects of alpha-blockade? Select all that apply - ANSWER b. Reflex tachycardia c. Nasal congestion e. Hypernatremia Ch 16 Adrenergic Antagonists 70. The nurse is discussing home management with a patient who will begin taking an alpha- adrenergic antagonist for hypertension. Which statement by the patient indicates understanding of the teaching? - ANSWER c. "I should take the first dose at bedtime." Ch 16 Adrenergic Antagonists 71. A nurse is teaching nursing students about the use of alpha-adrenergic antagonists. Which statement by a student indicates the need for further teaching? - ANSWER c. "Dilation of veins by alpha-adrenergic antagonists improves cardiac output." Ch 16 Adrenergic Antagonists 72. A patient taking a beta blocker complains of shortness of breath. The patient has respirations of 28 breaths/minute, a blood pressure of 162/90 mm Hg, and a pulse of 88 beats/minute. The nurse auscultates crackles in all lung fields. The nurse understands that these assessments are consistent with: - ANSWER b. left-sided heart failure. Ch 16 Adrenergic Antagonists 73. A male patient is being treated for benign prostatic hyperplasia and has stopped taking his alpha- adrenergic antagonist medication because of ejaculatory difficulties. Which medication does the nurse expect the provider to prescribe? - ANSWER a. Alfuzosin [Uroxatral] Ch 16 Adrenergic Antagonists 74. A patient is taking a beta- adrenergic antagonist medication for angina pectoris and asks the nurse how the drug works to relieve the discomfort associated with this condition. Which statement by the patient after the nurse's 31 teaching indicates understanding of the drug's effects? - ANSWER b. "It helps reduce the heart's oxygen needs." Ch 16 Adrenergic Antagonists 75. A nurse prepares to administer propranolol [Inderal] to a patient recovering from acute myocardial infarction. The patient's heart rate is 52 beats/minute, and the rhythm is regular. What action should the nurse take next? - ANSWER d. Withhold the dose and notify the prescriber. Ch 16 Adrenergic Antagonists 76. A patient will begin taking propranolol [Inderal] for hypertension. Which statement by the nurse is important when teaching this patient about the medication? - ANSWER a. "Check your hands and feet for swelling and report that to your provider." Ch 17 Indirect-Acting Antiadrenergic Agents 77. A patient who has been taking clonidine [Catapres] for several weeks complains of drowsiness and constipation. What will the nurse do? - ANSWER a. Recommend that the patient take most of the daily dose at bedtime. Ch 17 Indirect-Acting Antiadrenergic Agents 78. A prescriber has ordered methyldopa for a patient with hypertension. The nurse teaches the patient about drug actions, adverse effects, and the ongoing blood tests necessary with this drug. The nurse is correct to tell the patient what? - ANSWER d. "You will need to contact the provider and stop taking the medication if your eyes look yellow." Ch 17 Indirect-Acting Antiadrenergic Agents 79. A prescriber has ordered clonidine [Catapres] for a patient who has hypertension. The nurse teaches the patient about side effects of this drug. Which statement by the patient indicates understanding of the teaching? - ANSWER a. "I should chew sugar-free gum or drink water to reduce dry mouth." 32 Ch 17 Indirect-Acting Antiadrenergic Agents 80. A prescriber has ordered methyldopa for a female patient with hypertension. The nurse understands that which laboratory tests are important before beginning therapy with this drug? - ANSWER Select all that apply. a. Coombs test b. Hemoglobin and hematocrit (H&H) c. Liver function tests Ch 17 Indirect-Acting Antiadrenergic Agents 81. A nurse is teaching nursing students about the pharmacology of methyldopa. Which statement by a student indicates the need for further teaching? - ANSWER c. "Methyldopa reduces blood pressure by reducing cardiac output." Ch 17 Indirect-Acting Antiadrenergic Agents 82. A patient complains to the nurse that the clonidine [Catapres] recently prescribed for hypertension is causing drowsiness. Which response by the nurse to this concern is appropriate? - ANSWER a. "Drowsiness is a common side effect initially, but it will lessen with time." Ch 17 Indirect-Acting Antiadrenergic Agents 83. A prescriber orders clonidine [Kapvay] ER tablets for a 12-year-old child. The nurse understands that this drug is being given to treat which condition? - ANSWER a. ADHD Ch 17 Indirect-Acting Antiadrenergic Agents 84. A patient with hypertension has a previous history of opioid dependence. Which medication would the nurse question? - ANSWER a. Clonidine [Catapres] Ch 17 Indirect-Acting Antiadrenergic Agents 85. Clonidine is approved for the treatment of which conditions? Select all that apply. - ANSWER a. ADHD b. Hypertension d. Severe pain 35 Ch 19 Drugs for Parkinson's Disease 97. A 25-year-old patient has been newly diagnosed with Parkinson disease, and the prescriber is considering using pramipexole [Mirapex]. Before beginning therapy with this drug, the nurse will ask the patient about: - ANSWER a. any history of alcohol abuse or compulsive behaviors. Ch 19 Drugs for Parkinson's Disease 98. A patient with Parkinson disease is taking levodopa/carbidopa [Sinemet] and reports occasional periods of loss of drug effect lasting from minutes to several hours. The nurse questions the patient further and discovers that these episodes occur at different times related to the medication administration. The nurse will contact the provider to discuss: - ANSWER a. administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone. Ch 19 Drugs for Parkinson's Disease 99. A nurse is discussing motor symptoms with a patient with Parkinson disease who has been taking levodopa/carbidopa [Sinemet] for 9 months and who is now having regular tics. Which statement by the patient indicates understanding of this symptom? - ANSWER a. "I may need to try a lower dose of Sinemet to reduce my tics." Ch 19 Drugs for Parkinson's Disease 100. A hospitalized patient with Parkinson disease who is receiving apomorphine to treat "off" episodes develops nausea and vomiting. The nurse will discuss the use of which medication with the patient's provider? - ANSWER d. Trimethobenzamide [Tigan] Ch 19 Drugs for Parkinson's Disease 101. A patient has been diagnosed with Parkinson disease (PD) and begins treatment with levodopa/carbidopa [Sinemet]. After several months of therapy, the patient reports no change in symptoms. The nurse will expect the provider to: - ANSWER d. reevaluate the diagnosis. 36 Ch 19 Drugs for Parkinson's Disease 102. A nursing student wants to know why a patient who has been taking levodopa [Dopar] for years will now receive levodopa/carbidopa [Sinemet]. The nurse explains the reasons that levodopa as a single agent is no longer available. Which statement by the student indicates a need for further education? - ANSWER d. "Combination products cause fewer dyskinesias and decrease psychosis." Ch 19 Drugs for Parkinson's Disease 103. A patient has taken levodopa [Dopar] for Parkinson disease for 2 weeks but reports no improvement in the symptoms. Which response by the nurse is correct? - ANSWER c. "It may take several months for a response to occur." Ch 19 Drugs for Parkinson's Disease 104. A patient with Parkinson disease is taking levodopa/carbidopa [Sinemet]. The prescriber orders bromocriptine [Parlodel] to treat dyskinesias. The nurse notes that the patient is agitated, and the patient reports having frequent nightmares. The nurse will contact the provider to discuss: - ANSWER c. reducing the dose of bromocriptine. Ch 19 Drugs for Parkinson's Disease 105. A nurse is teaching a group of nurses about Parkinson medications. The nurse is correct to state that one side effect associated with pramipexole [Mirapex] that is less likely to occur with other dopamine agonists is: - ANSWER a. sleep attacks. Ch 20 Drugs for Alzheimer's Disease 106. A nurse is caring for an older adult man who has Alzheimer disease (AD). The patient's daughter wants to know if testing can be done to determine her risk for developing the disease. What will the nurse tell her? - ANSWER d. Advancing age and family history are known risk factors. 37 Ch 20 Drugs for Alzheimer's Disease 107. A patient will begin taking a cholinesterase inhibitor for early Alzheimer disease. The nurse is teaching the patient's spouse about the medication. Which statement by the spouse indicates a need for further teaching? - ANSWER d. "This drug significantly slows the progression of the disease." Ch 20 Drugs for Alzheimer's Disease 108. The spouse of a patient who is newly diagnosed with Alzheimer disease asks the nurse if medications will prevent the need for nursing home care. Which response by the nurse is correct? - ANSWER a. "Drugs to treat Alzheimer disease may slow the progression of memory loss." Ch 20 Drugs for Alzheimer's Disease 109. A nurse is caring for an older adult patient who has Alzheimer disease. The patient is taking a cholinesterase inhibitor drug. Which side effects would concern the nurse? - ANSWER d. Slowed heart rate and lightheadedness Ch 20 Drugs for Alzheimer's Disease 110. An older adult patient with Alzheimer disease is admitted to the hospital. The patient's spouse reports that the patient is often confused and gets lost walking to the store, which is three blocks from their home. That evening, the nurse observes the patient pacing the hall and screaming. What will the nurse do? - ANSWER d. Tell the spouse that this is an expected progression of the disease. Ch 20 Drugs for Alzheimer's Disease 111. A nurse is preparing to administer memantine [Nemanda] to a patient and notes a slight elevation in the patient's creatinine clearance level. What will the nurse expect the provider to order for this patient? - ANSWER d. Reducing the dose of memantine Ch 20 Drugs for Alzheimer's Disease 112. The spouse of a patient with Alzheimer disease asks a nurse for more information about the 40 that she is experiencing nausea. What will the nurse do? - ANSWER a. Ask the patient if she is taking the valproic acid with food, because taking the drug on an empty stomach can cause gastrointestinal side effects. Ch 21 Drugs for Seizure 123. A nurse is discussing partial versus generalized seizures with a group of nursing students. Which statement by a student indicates understanding of the teaching? - ANSWER a. "Febrile seizures are a type of generalized tonic-clonic seizure." Ch 21 Drugs for Seizure 124. A nurse provides teaching for a patient with a newly diagnosed partial complex seizure disorder who is about to begin therapy with antiepileptic drugs (AEDs). Which statement by the patient indicates understanding of the teaching? - ANSWER a. "Even with an accurate diagnosis of my seizures, it may be difficult to find an effective drug." Ch 22 Drugs for Muscle Spasm and Spasticity 125. A nurse is teaching the parent of a child with spastic quadriplegia about intrathecal baclofen [Lioresal]. Which statement by the parent indicates a need for further teaching? - ANSWER d. "If my child has a seizure, I should stop giving the medication immediately." Ch 22 Drugs for Muscle Spasm and Spasticity 126. A nurse is admitting a patient to the hospital. The patient reports taking oral baclofen [Lioresal] but stopped taking the drug the day before admission. The nurse would be correct to anticipate which adverse effects? - ANSWER c. Seizures and hallucinations Ch 22 Drugs for Muscle Spasm and Spasticity 127. A patient with cerebral palsy has severe muscle spasticity and muscle weakness. The patient is unable to take anything by mouth. The nurse is 41 correct to anticipate that which medication will be ordered for home therapy? - ANSWER a. Baclofen [Lioresal] Ch 22 Drugs for Muscle Spasm and Spasticity 128. A patient has localized muscle spasms after an injury. The prescriber has ordered tizanidine [Zanaflex] to alleviate the spasms. When obtaining the patient's health history, the nurse should be concerned about which possible reason for considering another drug? - ANSWER b. A history of hepatitis Ch 22 Drugs for Muscle Spasm and Spasticity 129. A patient with multiple sclerosis needs pharmacologic treatment for spasticity to begin strengthening exercises to improve walking ability. The nurse anticipates that which medication will be ordered for spasticity? - ANSWER a. Baclofen [Lioresal] Ch 22 Drugs for Muscle Spasm and Spasticity 130. A patient with cerebral palsy who has been receiving baclofen [Lioresal] via gastrostomy tube for 3 months is admitted to the hospital for evaluation of new-onset seizures. What may the nurse suspect to be the cause of these seizures? - ANSWER d. Missed doses of baclofen Ch 22 Drugs for Muscle Spasm and Spasticity 131. Which drugs are used to treat spasticity? Select all that apply. - ANSWER a. Baclofen [Lioresal] b. Dantrolene [Dantrium] c. Diazepam [Valium] Ch 22 Drugs for Muscle Spasm and Spasticity 132. A patient who has a lower back injury exhibits muscle spasms. The provider orders cyclobenzaprine [Flexeril] 10 mg three times a day. What will the nurse include when teaching this patient about this drug? - ANSWER c. "You may experience blurred vision, dry mouth, or constipation." 42 Ch 22 Drugs for Muscle Spasm and Spasticity 133. Which patient should receive dantrolene [Dantrium] with caution? - ANSWER c. A 55-year-old woman with multiple sclerosis Ch 22 Drugs for Muscle Spasm and Spasticity 134. A nurse is caring for a patient receiving intrathecal baclofen [Lioresal]. The patient is unresponsive. After asking a coworker to contact the provider, the nurse anticipates performing which intervention? - ANSWER a. Preparing to support respirations Ch 23 Local Anesthetics 135. A nurse is caring for a patient in the immediate postoperative period after surgery in which a spinal anesthetic was used. The patient has not voided and complains of headache. The patient has a pulse of 62 beats/minute, a respiratory rate of 16 breaths/minute, and a blood pressure of 92/48 mm Hg. Which action by the nurse is appropriate? - ANSWER c. Lower the head of the bed to a 10- to 15-degree head-down position. Ch 23 Local Anesthetics 136. A nurse is assisting a physician who is preparing to suture a superficial laceration on a patient's leg. The physician asks the nurse to draw up lidocaine with epinephrine. The nurse understands that epinephrine is used with the lidocaine to: - ANSWER d. prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine. Ch 23 Local Anesthetics 137. A nurse is preparing a patient to go home from the emergency department after receiving sutures for a laceration on one hand. The provider used lidocaine with epinephrine as a local anesthetic. Which symptom in this patient causes the most concern? - ANSWER c. Nervousness and tachycardia Ch 23 Local Anesthetics 138. A nurse is teaching a group of nursing students about local anesthetics. Which statement by a student 45 e. Vasodilation Ch 24 Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics 149. A patient with cancer has been taking an opioid analgesic four times daily for several months and reports needing increased doses for pain. What will the nurse tell the patient? - ANSWER c. The patient should discuss increasing the dose with the provider Ch 24 Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics 150. A patient will receive buprenorphine [Butrans] as a transdermal patch for pain. What is important to teach this patient about the use of this drug? - ANSWER a. Avoid prolonged exposure to the sun. Ch 24 Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics 151. A patient with moderate to severe chronic pain has been taking oxycodone [OxyContin] 60 mg every 6 hours PRN for several months and tells the nurse that the medication is not as effective as before. The patient asks if something stronger can be taken. The nurse will contact the provider to discuss: - ANSWER b. changing the medication to a continued-release preparation. Ch 24 Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics 152. A woman in labor receives meperidine [Demerol] for pain. The nurse caring for the infant will observe the infant closely for: - ANSWER c. respiratory depression. Ch 24 Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics 153. A patient has been taking methadone [Dolophine] for 5 months to overcome an opioid addiction. The nurse should monitor the patient for which of the 46 following electrocardiographic changes? - ANSWER a. Prolonged QT interval Ch 24 Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics 154. A patient who has developed opioid tolerance will experience which effect? - ANSWER a. Decreased analgesic effect Ch 24 Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics 155. A nurse is preparing a pediatric patient for surgery and is teaching the patient and the child's parents about the use of the patient-controlled analgesia pump. The parents voice concern about their child receiving an overdose of morphine. What will the nurse do? - ANSWER a. Instruct the parents not to activate the device when their child is sleeping. Ch 24 Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics 156. A patient is brought to the emergency department by friends, who report finding the patient difficult to awaken. The friends report removing two fentanyl transdermal patches from the patient's arm. On admission to the emergency department, the patient has pinpoint pupils and a respiratory rate of 6 breaths/minute. A few minutes after administration of naloxone, the respiratory rate is 8 breaths/minute and the patient's pupils are dilated. The nurse recognizes these symptoms as signs of: - ANSWER d. worsening hypoxia Ch 24 Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics 157. A patient with chronic pain has been receiving morphine sulfate but now has decreased pain. The prescriber changes the medication to pentazocine [Talwin]. The nurse will monitor the patient for: - ANSWER d. yawning and sweating. 47 Ch 24 Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics 158. A nurse is administering morphine sulfate to a postoperative patient. Which are appropriate routine nursing actions when giving this drug? Select all that apply. - ANSWER a. Counting respirations before and after giving the medication b. Encouraging physical activity and offering increased fluids d. Palpating the patient's lower abdomen every 4 to 6 hours Ch 24 Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics 159. A patient who has biliary colic reports a pain level of 8 on a 1-to-10 pain scale with 10 being the most severe pain. The patient has an order for ibuprofen as needed for pain. Which action by the nurse is correct? - ANSWER c. Request an order for meperidine [Demerol]. Ch 25 Drugs for Headache 160. A young woman with migraine headaches who has recently begun taking sumatriptan [Imitrex] calls the nurse to report a sensation of chest and arm heaviness. The nurse questions the patient and determines that she feels pressure and not pain. What will the nurse do? - ANSWER c. Reassure the patient that this is a transient, reversible side effect of sumatriptan. Ch 25 Drugs for Headache 161. A patient who has migraine headaches has been using sumatriptan [Imitrex] with good results but reports frequent migraine recurrence 24 hours later. Which medication will the nurse expect the provider to order for this patient? - ANSWER c. Naratriptan [Amerge] Ch 25 Drugs for Headache 162. A patient arrives in the emergency department complaining of numbness in the extremities. The nurse notes that the patient's hands and feet are cool and pale. When conducting a health history, the nurse learns that the patient has a 50 Ch 26 Antipsychotic Agents and Their Use in Schizophrenia 173. A patient with schizophrenia receives a dose of risperidone [Risperdal Consta] IM. The nurse teaching this patient about this medication will make which statement? - ANSWER c. "You will need to take an oral antipsychotic drug for 3 weeks." Ch 26 Antipsychotic Agents and Their Use in Schizophrenia 174. A patient with schizophrenia shows suicidal behaviors, and the provider orders clozapine [Clozaril]. The nurse teaches the family about the medication and its side effects. Which statement by a family member indicates a need for further teaching about this drug? - ANSWER c. "If the ANC is less than 3000, the drug will be discontinued permanently." Ch 26 Antipsychotic Agents and Their Use in Schizophrenia 175. A patient in whom drug therapy has failed several times in the past is readmitted to a hospital to begin therapy for schizophrenia. What will the nurse do to help improve adherence? - ANSWER b. Teach the patient about drug side effects and how to manage them. Ch 26 Antipsychotic Agents and Their Use in Schizophrenia 176. A nurse provides teaching for a patient about to begin taking an FGA drug for schizophrenia. Which statement by the patient indicates a need for further teaching about side effects of these drugs? - ANSWER a. "Dry mouth and constipation are uncommon with this medication." Ch 26 Antipsychotic Agents and Their Use in Schizophrenia 177. A patient taking an FGA medication develops severe parkinsonism and is treated with amantadine [Symmetrel]. The amantadine is withdrawn 2 months later, and the parkinsonism returns. The nurse will expect the provider to: - ANSWER d. try a second-generation antipsychotic (SGA). 51 Ch 26 Antipsychotic Agents and Their Use in Schizophrenia 178. What are negative symptoms of schizophrenia? Select all that apply. - ANSWER c. Poor judgment d. Poor self-care e. Poverty of speech Ch 26 Antipsychotic Agents and Their Use in Schizophrenia 179. A patient is taking an FGA for schizophrenia. The nurse notes that the patient has trouble speaking and chewing and observes slow, wormlike-movements of the patient's tongue. The nurse recognizes which adverse effect in this patient? - ANSWER d. Tardive dyskinesia Ch 26 Antipsychotic Agents and Their Use in Schizophrenia 180. A nurse and a nursing student are discussing the plan of care for a patient with schizophrenia. The patient, who has been taking a high- potency FGA for 2 months, has become restless and constantly needs to be in motion. Which statement by the student indicates a need for further education? - ANSWER b. "Because this may be an exacerbation of psychosis, the provider may increase the dose of the FGA." Ch 26 Antipsychotic Agents and Their Use in Schizophrenia 181. A patient who is taking a first-generation antipsychotic (FGA) drug for schizophrenia comes to the clinic for evaluation. The nurse observes that the patient has a shuffling gait and mild tremors. The nurse will ask the patient's provider about which course of action? - ANSWER b. Giving an anticholinergic medication Ch 26 Antipsychotic Agents and Their Use in Schizophrenia 182. A patient with schizophrenia has been taking an oral FGA for 1 week. The patient has been taking the drug daily in two divided doses. The individual complains of daytime drowsiness. The patient's family reports a decrease in the person's hostility and anxiety but states 52 that the patient remains antisocial with disordered thinking. What will the nurse tell the patient and the family? - ANSWER c. Some symptoms take months to improve. Ch 26 Antipsychotic Agents and Their Use in Schizophrenia 183. A patient with schizophrenia has been taking an antipsychotic drug for several days. The nurse enters the patient's room to administer a dose of haloperidol [Haldol] and finds the patient having facial spasms. The patient's head is thrust back, and the patient is unable to speak. What will the nurse do? - ANSWER c. Request an order to give diphenhydramine. Ch 26 Antipsychotic Agents and Their Use in Schizophrenia 184. A parent reports being afraid that a child may have schizophrenia because of disorganized speech and asocial behaviors. The nurse will tell this parent that which of the following must also be present to make a diagnosis? Select all that apply. - ANSWER a. A decrease in self-care, job, or school function c. A 1-month duration of active phase symptoms d. Continuous signs of disturbance for longer than 6 months Ch 26 Antipsychotic Agents and Their Use in Schizophrenia 185. Which side effects are more common in second-generation antipsychotic medications than in first-generation antipsychotic medications? Select all that apply. - ANSWER a. Agranulocytosis b. Anticholinergic effects d. Metabolism by CYP3A4 Ch 26 Antipsychotic Agents and Their Use in Schizophrenia 186. A nurse in a mental health hospital finds a patient with schizophrenia who takes haloperidol [Haldol] lying rigid in bed with a temperature of 41.3°C. A cardiac monitor shows cardiac dysrhythmias. What will be included in the treatment of this patient? Select all that apply. - ANSWER c. Dantrolene 55 Ch 27 Antidepressants 197. A patient taking an MAOI is seen in the clinic with a blood pressure of 170/96 mm Hg. What will the nurse ask this patient? - ANSWER c. To list all foods eaten that day Ch 27 Antidepressants 198. A patient taking fluoxetine [Prozac] complains of decreased sexual interest. A prescriber orders a "drug holiday." What teaching by the nurse would best describe a drug holiday? - ANSWER c. "Don't take the medication on Friday and Saturday." Ch 28 Drugs for Bipolar Disorder 199. A patient with bipolar disorder who wants to minimize the need for drug therapy asks the nurse what else can be done to treat the disorder. The nurse will recommend which measures? Select all that apply. - ANSWER c. Psychotherapy d. Regular sleep and exercise e. Using a chart to monitor mood changes Ch 28 Drugs for Bipolar Disorder 200. A patient with bipolar disorder who is taking divalproex sodium [Valproate] has just been admitted to the hospital. During the admission assessment, the patient tells the nurse about recent suicidal ideation. The nurse observes several areas of bruising over soft tissue areas and notes a weight gain of 10 pounds since the last admission 1 year ago. What will the nurse do? - ANSWER b. Contact the provider to report these findings. Ch 28 Drugs for Bipolar Disorder 201. A patient with bipolar disorder takes lamotrigine [Lamictal]. Which statement by the patient would prompt the nurse to hold the drug and notify the prescriber for further assessment? - ANSWER c. "I've broken out in a rash on my chest and back." 56 Ch 28 Drugs for Bipolar Disorder 202. A patient who has recently begun taking carbamazepine [Equetro] for bipolar disorder reports having vertigo and headaches. Which action by the nurse is appropriate? - ANSWER c. Reassure the patient that these effects occur early in treatment and will resolve over time. Ch 28 Drugs for Bipolar Disorder 203. A patient is admitted to a hospital for treatment for first-time symptoms of mania and is exhibiting euphoric mania. Which medication will the provider order? - ANSWER a. Lithium [Lithobid] Ch 28 Drugs for Bipolar Disorder 204. A patient with bipolar disorder has been taking lithium [Lithobid] for several years. The patient has developed a goiter, and serum tests reveal hypothyroidism. What will the nurse expect the provider to order for this patient? - ANSWER a. Administration of levothyroxine Ch 28 Drugs for Bipolar Disorder 205. A nurse is preparing to administer medications to a hospitalized patient who has been taking lithium [Lithobid] for 3 days. The patient is complaining of mild nausea and abdominal bloating. The patient's lithium level is 0.8 mEq/L. What will the nurse do? - ANSWER a. Administer the dose and tell the patient that the side effects are temporary. Ch 28 Drugs for Bipolar Disorder 206. A patient recently was diagnosed with bipolar disorder. The patient, who has a history of seasonal allergies, is an athlete who participates in track. The nurse is teaching the patient about lithium [Lithobid], which the prescriber has just ordered. Which statement by the patient indicates the need for further teaching? - ANSWER a. "I can continue to use ibuprofen as needed for muscle pain." Ch 28 Drugs for Bipolar Disorder 207. A patient with bipolar disorder is admitted to the hospital. The patient has been taking 57 lithium [Lithobid] for several years and has not been evaluated by a provider for over a year. Besides obtaining a lithium level, the nurse caring for this patient will anticipate orders for which laboratory tests? Select all that apply. - ANSWER b. Complete blood count with differential d. Renal function tests f. Thyroid function tests Ch 28 Drugs for Bipolar Disorder 208. The spouse of a patient with bipolar disorder (BPD) tells the nurse that the patient will not stay on the lithium ordered by the provider longer than 1 or 2 months at a time. The nurse understands that adherence to medication regimens in patients with BPD is problematic and will tell the spouse: - ANSWER a. "During manic episodes, many patients don't see the benefit of prophylactic medications." Ch 28 Drugs for Bipolar Disorder 209. A patient with bipolar disorder has frequent manic episodes alternating with depressive episodes. The prescriber orders risperidone [Risperdal] in addition to the lithium [Lithobid] that the patient is already taking. The patient asks the nurse why another drug is needed. The nurse will tell the patient that the risperidone is used to: - ANSWER b. help control symptoms during manic episodes. Ch 29 Sedative-Hypnotic Drugs 210. A patient with a new-onset seizure disorder receives a prescription for phenobarbital. The patient reports being concerned about the sedative side effects of this drug. Which response by the nurse is correct? - ANSWER a. "Phenobarbital doses for seizures are nonsedating." Ch 29 Sedative-Hypnotic Drugs 211. A patient who travels frequently for business reports occasional instances of being unable to fall asleep. The patient tells the nurse that job demands require staying up late and then getting up early for meetings. The nurse 60 drug in which drug class? - ANSWER c. Selective serotonin reuptake inhibitors Ch 30 Management of Anxiety Disorders 222. Selective serotonin reuptake inhibitors are known to be effective for which disorders? Select all that apply. - ANSWER a. Generalized anxiety disorder (GAD) b. Obsessive-compulsive disorder c. Panic disorder e. Social anxiety disorder Ch 30 Management of Anxiety Disorders 223. During an admission history, a patient reports a frequent need to return to a room multiple times to make sure an iron or other appliance is unplugged. What does the nurse understand about this patient's behavior? - ANSWER a. It helps the patient reduce anxiety about causing a fire. Ch 30 Management of Anxiety Disorders 224. A patient describes feelings of anxiety and fear when speaking in front of an audience and is having difficulty at work because of an inability to present information at meetings three or four times each year. The patient is reluctant to take long-term medications. The nurse will expect the provider to order which treatment? - ANSWER a. Alprazolam [Xanax] as needed Ch 30 Management of Anxiety Disorders 225. A patient who has obsessive-compulsive disorder (OCD) has been undergoing behavioral therapy but continues to exhibit symptoms that interfere with daily life. Which intervention will the nurse expect the provider to order for this patient? - ANSWER d. Fluoxetine [Paxil] Ch 30 Management of Anxiety Disorders 226. A nurse is performing an admission assessment on a patient. The patient reports taking alprazolam [Xanax] for "nerves." The nurse knows that this patient 61 is most likely being treated for which condition? - ANSWER a. Generalized anxiety disorder Ch 30 Management of Anxiety Disorders 227. An agitated, extremely anxious patient is brought to the emergency department. The prescriber orders a benzodiazepine. The nurse understands that benzodiazepines are used in this clinical situation based on which principle? - ANSWER d. Benzodiazepines have a rapid onset of action. Ch 31 Central Nervous System Stimulants and Attention- Deficit/Hyperactivity Disorder 228. A child will begin taking methylphenidate [Ritalin] for attention-deficit/hyperactivity disorder. Important baseline information about this patient will include: - ANSWER c. height and weight Ch 31 Central Nervous System Stimulants and Attention- Deficit/Hyperactivity Disorder 229. A child has been taking SD methylphenidate [Ritalin], 10 mg at 0800 and 1200 and 5 mg at 1600, for 2 months. The parents tell the nurse that the child sometimes misses the noon dose while at school. The child's appetite is normal. The teacher has reported a slight improvement in hyperactivity and impulsivity. What will the nurse do? - ANSWER a. Ask the prescriber whether this child could be given methylphenidate [Concerta]. Ch 31 Central Nervous System Stimulants and Attention- Deficit/Hyperactivity Disorder 230. An adult patient will begin taking atomoxetine [Strattera] for attention-deficit/hyperactivity disorder. What will the nurse teach this patient? - ANSWER d. Therapeutic effects may not be felt for 1 to 3 weeks after beginning therapy. 62 Ch 31 Central Nervous System Stimulants and Attention- Deficit/Hyperactivity Disorder 231. A child is diagnosed with attention-deficit/hyperactivity disorder (ADHD). The prescriber orders a central nervous system stimulant. Which statement by the child's parent indicates a need for further teaching? - ANSWER c. "This drug will make him less impulsive while he's at school." Ch 31 Central Nervous System Stimulants and Attention- Deficit/Hyperactivity Disorder 232. A university student who is agitated and restless and has tremors is brought to the emergency department. The patient's heart rate is 110 beats/minute, the respiratory rate is 18 breaths/minute, and the blood pressure is 160/95 mm Hg. The patient reports using concentrated energy drinks to stay awake during finals week. What complication will the nurse monitor for in this patient? - ANSWER d. Seizures Ch 31 Central Nervous System Stimulants and Attention- Deficit/Hyperactivity Disorder 233. A patient who is morbidly obese is admitted for treatment. The prescriber orders lisdexamfetamine [Vyvanse]. The nurse will be concerned if this patient shows signs of: - ANSWER b. dyspnea. Ch 31 Central Nervous System Stimulants and Attention- Deficit/Hyperactivity Disorder 234. A nurse is providing education to a group of patients regarding amphetamines. To evaluate the group's understanding, the nurse asks a participant what effects amphetamines would have on her. The participant shows that she understands the effects of these drugs if she gives which answers? - ANSWER b. "Amphetamines suppress the perception of pain." d. "Amphetamines increase the heart rate." e. "Amphetamines elevate mood." Ch 31 Central Nervous System Stimulants and Attention- Deficit/Hyperactivity Disorder 235. A nurse working the night shift 65 dose of the oral opioid analgesic at the exact intervals it is prescribed. The nurse is correct to suspect that what has occurred? - ANSWER d. Drug tolerance Ch 32 Drug Abuse I: Basic Considerations 246. A nursing student is caring for a patient who is addicted to several drugs. The student tells the nurse that the patient "got this way on purpose." Which response by the nurse is most appropriate? - ANSWER d. "Some individuals are more vulnerable to drug abuse than others." Ch 33 Drug Abuse II: Alcohol 247. A nurse is providing education to a group of college students about the long-term effects of alcohol. Which statement by a student indicates understanding of the teaching? - ANSWER c. "Even small amounts of alcohol are related to the development of certain cancers." Ch 33 Drug Abuse II: Alcohol 248. A nurse is obtaining an admission history on a patient who reports daily drinking for several years. When the nurse questions the patient further, the patient reports drinking up to five or six drinks each day. The patient expresses worry about liver damage. What will the nurse do? - ANSWER a. Contact the patient's provider to request liver function studies. Ch 33 Drug Abuse II: Alcohol 249. During a health history, the nurse asks a male patient about alcohol use. The patient tells the nurse that he and his wife are trying to conceive a pregnancy and he is using alcohol to lower his inhibitions. What will the nurse counsel this patient? - ANSWER b. "Alcohol may cause testicular atrophy and sterility." Ch 33 Drug Abuse II: Alcohol 250. A nursing student asks a nurse to discuss alcoholism and alcohol use disorder. Which statement by the nurse is correct? - ANSWER a. "Alcohol use disorder can occur without the development of tolerance or physical dependence." 66 Ch 33 Drug Abuse II: Alcohol 251. A pregnant patient in labor tells the nurse that she is afraid she may have harmed her fetus by consuming alcohol. What is an appropriate response by the nurse? - ANSWER a. Ask the patient how much alcohol she consumed, and at which stage of her pregnancy. Ch 33 Drug Abuse II: Alcohol 252. A male patient tells a nurse that he drinks a six-pack of beer a day. When the nurse begins to question him further about his alcohol consumption, he says, "You sound like my wife. She's always nagging me to quit. It's only beer!" Which response by the nurse is most appropriate? - ANSWER c. "The amount you drink is equivalent to six shots of whiskey each day." Ch 33 Drug Abuse II: Alcohol 253. A nurse is discussing alcohol abuse with a group of nursing students. One student asks whether alcohol consumption has any beneficial effects. The nurse replies that, in moderate amounts, alcohol: - ANSWER c. may protect against dementia. Ch 33 Drug Abuse II: Alcohol 254. A college student who is unresponsive is brought to the emergency department by friends, who say that their friend drank more than half of a large bottle of whiskey 3 hours ago. Assessment reveals a blood alcohol level of 0.32%. The vital signs are BP, 88/32 mm Hg; R, 6/minute; T, 96.8° F; and P, 76/minute and weak and thready. The nurse should prepare the patient for which intervention? - ANSWER c. Gastric lavage and dialysis Ch 33 Drug Abuse II: Alcohol 255. A patient is brought to the emergency department after a motor vehicle accident. The patient's speech is slurred. The nurse notes the smell of alcohol on the patient's breath and observes hand tremors. The patient's blood 67 alcohol level is 0.4%. The nurse will expect to: - ANSWER d. provide mechanical ventilation and oxygen. Ch 33 Drug Abuse II: Alcohol 256. A patient asks a nurse about the effects of chronic alcohol use on the heart. The nurse's best response would be which statement? - ANSWER c. "Long-term alcohol use can damage the heart and cause heart failure." Ch 33 Drug Abuse II: Alcohol 257. A patient who is an active alcoholic is admitted to the hospital for surgery. The nurse reviewing orders for this patient would be correct to question which postoperative medication for this patient? - ANSWER a. Acetaminophen Ch 34 Drug Abuse III: Nicotine and Smoking 258. A 4-year-old child is brought to the emergency department with symptoms of nausea and vomiting and a weak, thready pulse of 120 beats/minute after ingesting several cigarettes at home. The nurse caring for this child will expect to provide which treatment? - ANSWER c. Respiratory support Ch 34 Drug Abuse III: Nicotine and Smoking 259. A patient reports a desire to stop smoking and asks what is available without a prescription to help with smoking cessation. The nurse tells the patient that which method is best? - ANSWER b. Nicotine replacement and 1-800-QUITNOW Ch 34 Drug Abuse III: Nicotine and Smoking 260. A patient who wants to quit smoking has begun taking varenicline [Chantix]. The patient reports experiencing mood swings and depression and a desire to cause harm to herself. What will the nurse tell this patient? - ANSWER d. "You should notify your provider of these symptoms immediately." 70 Ch 35 Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine 271. A provider orders clonidine [Catapres] for a patient withdrawing from opioids. When explaining the rationale for this drug choice, the nurse will tell this patient that clonidine is used to: - ANSWER c. relieve symptoms of nausea, vomiting, and diarrhea. Ch 35 Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine 272. A young adult patient is admitted to the hospital for evaluation of severe weight loss. The nurse admitting this patient notes that the patient has missing teeth and severe tooth decay. The patient's blood pressure is 160/98 mm Hg. The patient has difficulty answering questions and has trouble remembering simple details. The nurse suspects abuse of which substance? - ANSWER d. Methamphetamine Ch 35 Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine 273. A nurse is discussing the differences between OxyContin OC and OxyContin OP with a group of nursing students. Which statement by a student indicates understanding of the teaching? - ANSWER c. "OxyContin OP is not easily crushed into a powder." Ch 35 Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine 274. A college student tells the nurse that several friends have been using synthetic marijuana to get high. What will the nurse tell this patient about this type of substance? - ANSWER b. "They can cause hypertension, nausea, vomiting, and hallucinations." Ch 35 Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine 275. In discussing the rationale for using methadone to ease opioid withdrawal, the nurse would explain that it has which pharmacologic properties or characteristics? - ANSWER a. Methadone can prevent abstinence syndrome 71 Ch 35 Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine 276. A patient who is agitated and profoundly anxious is brought to the emergency department. The patient acts paranoid and keeps describing things in the room that do not exist. A cardiac monitor shows an irregular ventricular tachycardia. Which medication will the nurse expect to administer? - ANSWER b. Diazepam [Valium] Ch 35 Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine 277. A nurse is teaching a drug prevention class to a group of parents of adolescents. Which statement by a parent indicates understanding of the teaching? - ANSWER c. "LSD does not cause an abstinence syndrome when it is withdrawn." Ch 35 Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine 278. A nurse is caring for a patient who is addicted to barbiturates and who will begin receiving phenobarbital. The nurse discusses the care of this patient with a nursing student. Which statement by the student indicates understanding of the teaching? - ANSWER b. "Phenobarbital has a long half-life and can be tapered gradually to minimize abstinence symptoms." Ch 35 Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine 279. Which factors make meperidine an opioid of choice among nurses and physicians who abuse opioids? Select all that apply - ANSWER b. Highly effective oral dosing d. Less pupillary constriction than other opioids Ch 35 Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine 280. A college student is brought to the emergency department by a group of friends who report that they had been dancing at a nightclub when their friend collapsed. The patient has a temperature of 105° F and shows jaw clenching and confusion. The 72 nurse will expect to administer which medication? - ANSWER a. Dantrolene [Dantrium] Ch 35 Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine 281. A patient arrives in the emergency department acutely intoxicated and difficult to arouse. The patient's friends tell the nurse that the patient took a handful of diazepam [Valium] pills while at a party several hours ago. The nurse will expect to administer which drug? - ANSWER b. Flumazenil [Romazicon] Ch 35 Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine 282. A patient who has a long-term addiction to opioids takes an overdose of barbiturates. The nurse preparing to care for this patient will anticipate: - ANSWER c. observing pinpoint pupils, respiratory depression, and possibly coma in this patient. Ch 35 Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine 283. A college student admits frequent use of LSD to a nurse and reports plans to stop using it. What will the nurse tell this student? - ANSWER b. Tolerance to the effects of LSD will fade quickly once use of the drug has stopped. Ch 35 Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine 284. A school nurse is teaching a high school health class about the effects of marijuana use. Which statement by a student indicates a need for further teaching? - ANSWER b. "Higher doses of marijuana are likely to produce increased euphoria." Ch 35 Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine 285. A pregnant patient reports using marijuana during her pregnancy. She asks the nurse whether this will affect the fetus. What should the nurse tell her? - ANSWER d. School-aged children born to patients who use marijuana often have difficulty with memory. 75 Ch 37 Diuretics 297. A patient who was in a motor vehicle accident sustained a severe head injury and is brought into the emergency department. The provider orders intravenous mannitol [Osmitrol]. The nurse knows that this is given to: - ANSWER a. reduce intracranial pressure. Ch 37 Diuretics 298. An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide [HydroDIURIL]. Before administering this medication, the nurse reviews the patient's chart. Which laboratory value causes the nurse the most concern? - ANSWER a. Elevated creatinine clearance Ch 37 Diuretics 299. A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed spironolactone [Aldactone]. The nurse assesses the patient and notes dyspnea, bilateral crackles, and pitting edema in both feet. Which intervention is appropriate? - ANSWER d. Request an order for furosemide [Lasix]. Ch 37 Diuretics 300. A patient is taking gentamicin [Garamycin] and furosemide [Lasix]. The nurse should counsel this patient to report which symptom? - ANSWER c. Ringing in the ears Ch 37 Diuretics 301. A patient with hypertension is taking furosemide [Lasix] for congestive heart failure. The prescriber orders digoxin to help increase cardiac output. What other medication will the nurse expect to be ordered for this patient? - ANSWER d. Spironolactone [Aldactone] Ch 37 Diuretics 302. Besides having diuretic effects for patients with congestive heart failure, thiazides are also used to treat what? - ANSWER a. Diabetes insipidus 76 b. Hepatic failure e. Postmenopausal osteoporosis Ch 37 Diuretics 303. A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] and digoxin. The prescriber has ordered spironolactone [Aldactone] to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching? - ANSWER b. "I need to stop taking potassium supplements." Ch 38 Drugs Acting on the Renin-Angiotensin-Aldosterone System 304. A patient who stops taking an ACE inhibitor because of its side effects will begin taking an angiotensin II receptor blocker (ARB) medication. Which side effect of ACE inhibitors will not occur with an ARB medication? - ANSWER c. Hyperkalemia Ch 38 Drugs Acting on the Renin-Angiotensin-Aldosterone System 305. A patient who is taking furosemide [Lasix] and digoxin will begin taking captopril [Capoten]. The nurse is providing information about the drug. Which statement by the patient indicates a need for further teaching? - ANSWER c. "I should take this medication on a full stomach." Ch 38 Drugs Acting on the Renin-Angiotensin-Aldosterone System 306. A female patient who is not taking any other medications is prescribed aliskiren [Tekturna], a direct renin inhibitor (DRI). The nurse reviews medication information with the patient. Which statement by the patient indicates understanding of the teaching? - ANSWER d. "I should take this medication 1 hour before sitting down to a meal." 77 Ch 38 Drugs Acting on the Renin-Angiotensin-Aldosterone System 307. A nurse administers an ACE inhibitor to a patient who is taking the drug for the first time. What will the nurse do? - ANSWER a. Instruct the patient not to get up without assistance. Ch 38 Drugs Acting on the Renin-Angiotensin-Aldosterone System 308. 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? - ANSWER b. Hold the dose and notify the provider. Ch 38 Drugs Acting on the Renin-Angiotensin-Aldosterone System 309. A patient with hypertension is prescribed an angiotensin- converting enzyme (ACE) inhibitor. The nurse reviewing this patient's chart before administering the medication will be most concerned about which other disease process? - ANSWER d. Renal artery stenosis Ch 38 Drugs Acting on the Renin-Angiotensin-Aldosterone System 310. A patient who has been taking an antihypertensive medication for several years is recovering from a myocardial infarction. The prescriber changes the patient's medication to an ACE inhibitor. The patient asks the nurse why a new drug is necessary. What is the nurse's response? - ANSWER a. "ACE inhibitors can prevent or reverse pathologic changes in the heart's structure." Ch 38 Drugs Acting on the Renin-Angiotensin-Aldosterone System 311. A female patient who begins taking spironolactone [Aldactone] as an adjunct to furosemide [Lasix] complains that her voice is deepening. What will the nurse do? - ANSWER b. Explain that this drug binds with receptors for steroid hormones, causing this effect 80 The nurse understands that metoprolol is used to: - ANSWER d. prevent reflex tachycardia. Ch 40 323. Which medications are most likely to cause postural hypotension? Select all that apply. - ANSWER c. Prazosin [Minipress] d. Captopril [Capoten] e. Losartan [Cozaar] Ch 40 324. The nurse is caring for a patient who is taking a vasodilator that dilates capacitance vessels. The nurse will expect which effect in this patient? - ANSWER a. Decrease in cardiac work Ch 40 325. A nurse is obtaining a medication history on a newly admitted patient, who reports taking minoxidil for hypertension. Admission vital signs reveal a heart rate of 78 beats/minute and a blood pressure of 120/80 mm Hg. What is an important part of the initial assessment for this patient? - ANSWER a. Evaluating ankle edema Ch 40 326. A female patient with essential hypertension is being treated with hydralazine 25 mg twice daily. The nurse assesses the patient and notes a heart rate of 96 beats/minute and a blood pressure of 110/72 mm Hg. The nurse will request an order to: - ANSWER a. administer a beta blocker. Ch 40 327. A nurse is administering a vasodilator that dilates resistance vessels. The nurse understands that this drug will have which effect on the patient? - ANSWER c. Increased tissue perfusion Ch 40 328. A patient is taking a vasodilator that relaxes smooth muscles in veins. To help minimize drug side effects, the nurse caring for this patient will: - ANSWER a. caution the patient not to get up abruptly. 81 Ch 40 329. Which patients may receive hydralazine to treat hypertension? Select all that apply - ANSWER a. A 1-month-old infant b. A 5-year-old child e. An older adult Ch 40 330. A nurse is caring for a patient who will begin taking hydralazine to treat hypertension. Which statement by the patient indicates understanding of the nurse's teaching about this drug? - ANSWER b. "I will also take a beta blocker medication with this drug to prevent rapid heart rate." Ch 40 331. A nursing student asks a nurse why a patient in hypertensive crisis is receiving both intravenous sodium nitroprusside [Nitropress] and oral hydralazine. The nurse will explain that this is done to prevent: - ANSWER c. rebound hypertension Ch 40 332. A nurse is reviewing the phenomenon of reflex tachycardia with a group of nursing students. Which statement by a student indicates understanding of this phenomenon? - ANSWER b. "Reflex tachycardia can negate the desired effects ofvasodilators." Ch 40 333. A patient is admitted with severe hypertensive crisis. The nurse will anticipate administering which medication? - ANSWER d. Sodium nitroprusside [Nitropress] IV Ch 41 Drugs for Hypertension 334. A nurse has provided education for a patient newly diagnosed with hypertension who is just beginning therapy with antihypertensive medications. Which statement by the patient indicates a need for further teaching? - ANSWER d. "When my symptoms subside, I may discontinue the medications." 82 Ch 41 Drugs for Hypertension 335. A hospitalized patient has a blood pressure of 145/96 mm Hg. The nurse caring for this patient notes that the blood pressure the day before was 132/98 mm Hg. The patient reports ambulatory blood pressure readings of 136/98 and 138/92 mm Hg. The patient has a history of a previous myocardial infarction and has adopted a lifestyle that includes the use of the DASH diet and regular exercise. What will the nurse do? - ANSWER a. Notify the provider and discuss ordering a beta blocker for this patient. Ch 41 Drugs for Hypertension 336. A patient has been taking chlorthalidone to treat hypertension. The patient's prescriber has just ordered the addition of spironolactone to the patient's drug regimen. Which statement by the patient indicates a need for further teaching? - ANSWER c. "I will need to take potassium supplements when adding this drug." Ch 41 Drugs for Hypertension 337. A patient with hypertension will begin taking an alpha1 blocker. What will the nurse teach this patient? - ANSWER c. Move slowly from sitting to standing when taking this drug. Ch 41 Drugs for Hypertension 338. A nurse checks a patient's vital signs in the hospital and notes a blood pressure of 146/98 mm Hg. What will the nurse do? - ANSWER c. Recheck the patient's blood pressure in the other arm. Ch 41 Drugs for Hypertension 339. A nursing student asks the nurse why multidrug therapy is often used to treat hypertension. Which statement by the student indicates a need for further teaching? - ANSWER d. "Two or more drugs will lower blood pressure more quickly." 85 nurse do? - ANSWER a. Notify the provider and ask about adding a beta blocker medication Ch 41 Drugs for Hypertension 351. A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching? - ANSWER a. "Beta blockers block the actions of angiotensin II." Ch 41 Drugs for Hypertension 352. A 5-year-old patient seen in an outpatient clinic is noted to have hypertension on three separate visits. Ambulatory blood pressure monitoring confirms that the child has hypertension. As an initial intervention with the child's parents, the nurse will expect to: - ANSWER a. perform a detailed health history on the child. Ch 42 Drugs for Heart Failure 353. A patient asks a nurse why he cannot use digoxin [Lanoxin] for his heart failure, because both of his parents used it for HF. The nurse will explain that digoxin is not the first-line therapy for which reason? - ANSWER b. It does not correct the underlying pathology of heart failure. Ch 42 Drugs for Heart Failure 354. A patient has been taking digoxin [Lanoxin] 0.25 mg, and furosemide [Lasix] 40 mg, daily. Upon routine assessment by the nurse, the patient states, "I see yellow halos around the lights." The nurse should perform which action based on this assessment? - ANSWER a. Check the patient for other symptoms of digitalis toxicity. Ch 42 Drugs for Heart Failure 355. A patient has heart failure and is taking an ACE inhibitor. The patient has developed fibrotic changes in the heart and vessels. The nurse expects the provider to order which medication to counter this development? - ANSWER a. Aldosterone antagonist 86 Ch 42 Drugs for Heart Failure 356. A patient with heart failure who has been taking an ACE inhibitor, a thiazide diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the nurse will expect the provider to evaluate: - ANSWER d. serum electrolyte levels. Ch 42 Drugs for Heart Failure 357. A patient is taking enalapril [Vasotec]. The nurse understands that patients taking this type of drug for heart failure need to be monitored carefully for: - ANSWER c. hyperkalemia. Ch 42 Drugs for Heart Failure 358. A patient is recovering from a myocardial infarction but does not have symptoms of heart failure. The nurse will expect to teach this patient about: - ANSWER a. ACE inhibitors and beta blockers. Ch 42 Drugs for Heart Failure 359. The potassium-sparing diuretic spironolactone [Aldactone] prolongs survival and improves heart failure symptoms by which mechanism? - ANSWER a. Blocking aldosterone receptors Ch 42 Drugs for Heart Failure 360. An 88-year-old patient with heart failure has progressed to Stage D and is hospitalized for the third time in a month. The nurse will expect to discuss which topic with the patient's family? - ANSWER b. End-of-life care Ch 42 Drugs for Heart Failure 361. A patient with heart failure who has been given digoxin [Lanoxin] daily for a week complains of nausea. Before giving the next dose, the nurse will: - ANSWER a. assess the heart rate (HR) and give the dose if the HR is greater than 60 beats/minute. 87 Ch 42 Drugs for Heart Failure 362. Which medications are included in first-line therapy for heart failure? Select all that apply. - ANSWER a. Agents that inhibit the renin-angiotensin-aldosterone system (RAAS) c. Beta blockers e. Diuretics Ch 42 Drugs for Heart Failure 363. A nurse prepares to administer a scheduled dose of digoxin. The nurse finds a new laboratory report showing a plasma digoxin level of 0.7 ng/mL. What action should the nurse take? - ANSWER d. Check the patient's apical pulse, and if it is within a safe range, administer the digoxin. Ch 42 Drugs for Heart Failure 364. A patient with Stage C heart failure (HF) who has been taking an ACE inhibitor, a beta blocker, and a diuretic begins to have increased dyspnea, weight gain, and decreased urine output. The provider orders spironolactone [Aldactone]. The nurse will instruct the patient to: - ANSWER a. avoid potassium supplements Ch 42 Drugs for Heart Failure 365. Which are expected effects of cardiac glycosides? Select all that apply. - ANSWER c. Decreased heart rate d. Modulation of neurohormonal systems e. Positive inotropic effects Ch 42 Drugs for Heart Failure 366. A nurse is preparing to administer digoxin [Lanoxin] to a patient. The patient's heart rate is 62 beats/minute, and the blood pressure is 120/60 mm Hg. The last serum electrolyte value showed a potassium level of 5.2 mEq/L. What will the nurse do? - ANSWER b. Give the dose of digoxin and notify the provider of the potassium level. 90 electrocardiogram (ECG) and notes a QRS complex that has widened by 50% from the baseline ECG. What will the nurse do? - ANSWER d. Withhold the quinidine and contact the provider to report the ECG finding. Ch 43 Antidysrhythmic Drugs 378. A nursing student asks a nurse how digoxin causes dysrhythmias. The nurse correctly states that digoxin: - ANSWER b. increases automaticity in the Purkinje fibers. Ch 43 Antidysrhythmic Drugs 379. A nurse is caring for a patient in the intensive care unit who is receiving intravenous lidocaine. The patient is drowsy and confused and reports numbness of the fingers and toes. Which standing order will the nurse initiate at this time? - ANSWER b. Reduce the rate of infusion. Ch 43 Antidysrhythmic Drugs 380. A patient is taking digoxin [Lanoxin] and develops a dysrhythmia. The nurse reports this finding to the prescriber, who will most likely order what? Select all that apply. - ANSWER c. Phenytoin [Dilantin] e. Serum electrolytes Ch 43 Antidysrhythmic Drugs 381. A prescriber has ordered propranolol [Inderal] for a patient with recurrent ventricular tachycardia. The nurse preparing to administer this drug will be concerned about what in the patient's history? - ANSWER a. Asthma Ch 43 Antidysrhythmic Drugs 382. A patient with atrial fibrillation is taking verapamil [Calan]. The patient has read about the drug on the Internet and wants to know why a drug that affects the rate of ventricular contraction is used to treat an abnormal atrial contraction. What will the nurse tell the patient? - ANSWER b. "Atrial dysrhythmias can have life-threatening effects on ventricular function." 91 Ch 43 Antidysrhythmic Drugs 383. A prescriber orders verapamil [Covera-HS] for a patient who is taking digoxin [Lanoxin] and warfarin. The nurse will expect the prescriber to the dose of : - ANSWER a. lower; digoxin Ch 43 Antidysrhythmic Drugs 384. A nurse provides teaching for a patient who will begin taking procainamide [Procanbid] for long- term suppression of a dysrhythmia. Which statement by the patient indicates a need for further teaching? - ANSWER b. "I may have increased bruising, but this is a temporary side effect." Ch 43 Antidysrhythmic Drugs 385. Which two classes of antidysrhythmic drugs have nearly identical cardiac effects? - ANSWER a. Beta blockers and calcium channel blockers Ch 43 Antidysrhythmic Drugs 386. A nurse is teaching a group of nursing students about antidysrhythmic medications. Which statement by a student indicates understanding of the teaching? - ANSWER a. "Antidysrhythmic drugs can cause new dysrhythmias or worsen existing ones." Ch 43 Antidysrhythmic Drugs 387. The nurse is teaching a group of nursing students about dofetilide [Tikosyn] to treat dysrhythmias. Which statement by a student indicates understanding of the teaching? - ANSWER c. "Dofetilide is used for patients with severe symptoms of atrial dysrhythmias." Ch 43 Antidysrhythmic Drugs 388. A prescriber is considering prescribing the amiodarone derivative dronedarone [Multaq] for a patient with atrial flutter. The nurse should be concerned about which of the following? - ANSWER d. QT interval of 520 msec Ch 43 Antidysrhythmic Drugs 389. A nurse is teaching a patient who is about to undergo direct-current (DC) cardioversion to treat atrial 92 flutter. The patient has been taking verapamil and warfarin for 6 months. Which statement by the patient indicates understanding of the teaching? - ANSWER a. "I may need long-term therapy with another cardiac medication after the procedure." Ch 43 Antidysrhythmic Drugs 390. The nurse educator is providing patient education about the Cardiac Arrhythmia Suppression Trial (CAST). The nurse correctly explains that the trial demonstrated what effect from the pharmacologic suppression of dysrhythmias? - ANSWER c. It doubled the risk of a second MI. Ch 43 Antidysrhythmic Drugs 391. A nurse is teaching a class on dysrhythmias and associated therapy. The nurse asks the class, "Which cardiac dysrhythmia would result in the lowest cardiac output, and what treatment would be effective?" The class best demonstrates understanding by responding that results in the lowest cardiac output, and treatment includes . - ANSWER d. ventricular fibrillation; defibrillation Ch 43 Antidysrhythmic Drugs 392. A patient with diabetes develops ventricular tachycardia and is in the hospital for evaluation of this condition. The nurse reviews the history and learns that the patient takes mexiletine [Mexitil] for pain caused by peripheral neuropathy. What should the nurse do? - ANSWER c. Notify the provider to request that another drug be used for peripheral neuropathy pain. Ch 44 Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels 393. Which is a possible benefit of taking fish-oil supplements? - ANSWER d. Reduced risk of dysrhythmia in patients after myocardial infarction Ch 44 Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels 394. A nurse is providing discharge teaching instructions for a patient 95 risk of coronary atherosclerosis? - ANSWER c. Elevated low-density lipoprotein Ch 44 Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels 404. A patient taking gemfibrozil [Lopid] and rosuvastatin [Crestor] concurrently begins to complain of muscle aches, fatigue, and weakness. What should the nurse monitor? - ANSWER d. The patient's creatine kinase levels Ch 44 Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels 405. A nurse is reviewing the medications of a patient with diabetes before discharge. The nurse realizes that the patient will be going home on colesevelam, a bile acid sequestrant, and insulin. What patient education should the nurse provide in the discharge teaching for this patient? - ANSWER a. The patient needs to monitor the blood sugar carefully, because colesevelam can cause hypoglycemia Ch 44 Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels 406. A patient is being started on nicotinic acid [Niaspan] to reduce triglyceride levels. The nurse is providing patient education and should include teaching about which adverse effects? - ANSWER a. Facial flushing d. Gastric upset e. Itching Ch 44 Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels 407. A patient who is taking simvastatin [Zocor] develops an infection and the provider orders azithromycin [Zithromax] to treat the infection. The nurse should be concerned if the patient complains of: - ANSWER c. muscle pain. 96 Ch 44 Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels 408. A patient will begin taking atorvastatin [Lipitor] to treat elevated LDL levels. The patient asks the nurse what to do to minimize the risk of myositis associated with taking this drug. What will the nurse counsel this patient? - ANSWER b. "Take vitamin D and coenzyme Q supplements." Ch 44 Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels 409. An Asian patient will begin taking rosuvastatin [Crestor] to treat hypercholesterolemia. What will the nurse include when teaching this patient about this medication? - ANSWER c. Serum drug levels must be monitored more frequently than with other patients. Ch 44 Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels 410. A nurse is providing patient education about colesevelam [Welchol], a bile acid sequestrant. Which statement made by the patient demonstrates a need for further teaching? - ANSWER d. "I will need to take supplements of fat-soluble vitamins." Ch 45 Drugs for Angina Pectoris 411. A patient who takes nitroglycerin to treat stable angina reports having erectile dysfunction and states that he plans to ask his primary provider for a prescription for tadalafil [Cialis]. What will the nurse tell this patient? - ANSWER c. "You should discuss another antianginal medication with your provider." Ch 45 Drugs for Angina Pectoris 412. A patient with angina who uses sublingual nitroglycerin tells the nurse that the episodes are increasing in frequency and usually occur when the patient walks the dog. The patient reports needing almost daily doses of 97 nitroglycerin and states that one tablet usually provides complete relief. What will the nurse do? - ANSWER a. Contact the provider to suggest ordering a transdermal patch for this patient Ch 45 Drugs for Angina Pectoris 413. A patient who has begun using transdermal nitroglycerin for angina reports occasional periods of tachycardia. The nurse will expect the prescriber to order: - ANSWER d. verapamil as an adjunct to nitroglycerin therapy. Ch 45 Drugs for Angina Pectoris 414. A patient who has renal impairment will begin taking ranolazine [Ranexa] as an adjunct to nitroglycerin to treat angina. What will the nurse include when teaching this patient? - ANSWER a. "You will need to monitor your blood pressure closely while taking this drug." Ch 45 Drugs for Angina Pectoris 415. A nurse provides teaching to a patient with angina who also has type 2 diabetes mellitus, asthma, and hypertension. Which statement bythe patient indicates a need for further teaching? - ANSWER b. "Beta blockers can help me control hypertension." Ch 45 Drugs for Angina Pectoris 416. A patient is taking a calcium channel blocker (CCB) for stable angina. The patient's spouse asks how calcium channel blockers relieve pain. The nurse will explain that CCBs: - ANSWER a. help relax peripheral arterioles to reduce afterload. Ch 45 Drugs for Angina Pectoris 417. A nurse is discussing the difference between stable and variant angina with a group of nursing students. Which statement by a student indicates the need for further teaching? - ANSWER d. "Variant angina is the result of increased oxygen demand by the heart."