NCLEX PHARMACOLOGY PROCTORED 2019 EXAM - STUDY GUIDE / Correct Questions & Answers, Study notes of Nursing

Download NCLEX PHARMACOLOGY PROCTORED 2019 EXAM - STUDY GUIDE / Correct Questions & Answers and more Study notes Nursing in PDF only on Docsity!

1. The nursing student needs to administer potassium chloride intravenously as prescribed to a client with hypokalemia. The nursing instructor determines that the student is unprepared for this procedure if the student states that which action is part of the plan for preparation and administration of the potassium?
   1. Obtaining an intravenous (IV) infusion pump
   2. Monitoring urine output during administration
   3. Preparing the medication for bolus administration
   4. Ensuring that the medication is diluted in the appropriate amount of normal saline
   5. Preparing the medication for bolus administration
2. A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hour. The nurse determines that the client is receiving the therapeutic effect based on which results?
   1. Prothrombin time of 12.5 seconds
   2. Activated partial thromboplastin time of 60 seconds
   3. Activated partial thromboplastin time of 28 seconds
   4. Activated partial thromboplastin time longer than 120 seconds
   5. Activated partial thromboplastin time of 60 seconds 3. The nurse provides discharge instructions to a client who is taking warfarin sodium (Coumadin). Which statement, by the client, reflects the need for further teaching?
   6. "I will avoid alcohol consumption."
   7. "I will take my pills every day at the same time."
   8. "I have already called my family to pick up a Medic-Alert bracelet."
   9. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."
   10. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."
3. A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3 mEq/L and is complaining of anorexia. The health care provider prescribes determination of the serum digoxin level to rule out digoxin toxicity. The nurse checks the results, knowing that which value is the therapeutic serum level (range) for digoxin?
   1. 0.5 to 2 ng/mL
   2. 1.2 to 2.8 ng/mL
   3. 3.0 to 5.0 ng/mL
   4. 3.5 to 5.5 ng/mL
   5. 0.5 to 2 ng/mL 5. A client is being treated with procainamide for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take first?
   6. Measure the heart rate on the rhythm strip.

2. Administer prescribed nitroglycerin tablets.
3. Obtain a 12 - lead electrocardiogram immediately.
4. Auscultate the client's apical pulse and obtain a blood pressure.
5. Auscultate the client's apical pulse and obtain a blood pressure.
6. The nurse is monitoring a client who is taking propranolol (Inderal LA). Which assessment data indicates a potential serious complication associated with this medication?
7. The development of complaints of insomnia
8. The development of audible expiratory wheezes
9. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/ mm Hg after two doses of the medication
10. A baseline resting heart rate of 88 beats/minute followed by a resting heart rate of 72 beats/minute after two doses of the medication
11. The development of audible expiratory wheezes
12. A client with atrial fibrillation secondary to mitral stenosis is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium (Coumadin) 7.5 mg at 5:00 pm daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT) = 32 seconds; internationalized normalized ratio (INR) = 1.3. The nurse should plan to take which action based on the client's laboratory results?
13. Collaborate with the health care provider (HCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed.
14. Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed.
15. Collaborate with the HCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range.
16. Collaborate with the HCP to continue the heparin infusion at the same rate and to discuss use of dabigatran etexilate (Pradaxa) in place of warfarin sodium.
17. Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed.
18. A client is diagnosed with an ST-segment elevation myocardial infarction (STEMI) and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention?
19. Monitor for kidney failure.
20. Monitor psychosocial status.
21. Monitor for signs of bleeding.
22. Have heparin sodium available.
23. Monitor for signs of bleeding.

9. The nurse is planning to administer hydrochlorothiazide to a client. The nurse understands that which is a concern related to the administration of this medication?
   1. Hypouricemia, hyperkalemia
   2. Increased risk of osteoporosis
   3. Hypokalemia, hyperglycemia, sulfa allergy
   4. Hyperkalemia, hypoglycemia, penicillin allergy
   5. Hypokalemia, hyperglycemia, sulfa allergy 10. The home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which statement, by the client, indicates the need for further education?
   6. "Constipation and bloating might be a problem."
   7. "I'll continue to watch my diet and reduce my fats."
   8. "Walking a mile each day will help the whole process."
   9. "I'll continue my nicotinic acid from the health food store."
   10. "I'll continue my nicotinic acid from the health food store." 11. The nurse is monitoring a client who is taking digoxin (Lanoxin) for adverse effects. Which findings are characteristic of digoxin toxicity? Select all that apply.
   11. Tremors
   12. Diarrhea
   13. Irritability
   14. Blurred vision
   15. Nausea and vomiting o 2. Diarrhea o 4. Blurred vision o 5. Nausea and vomiting
10. Prior to administering a client's daily dose of digoxin, the nurse reviews the client's laboratory data and notes the following results: serum calcium, 9.8 mg/dL; serum magnesium, 1.2 mg/dL; serum potassium, 4.1 mEq/L; serum creatinine, 0.9 mg/dL. Which result should alert the nurse that the client is at risk for digoxin toxicity?
    1. Serum calcium level
    2. Serum potassium level
    3. Serum creatinine level
    4. Serum magnesium level
    5. Serum magnesium level
11. A client being treated for heart failure is administered intravenous bumetanide. Which outcome indicates the medication has achieved the expected effect?

1. Cough becomes productive of frothy pink sputum
2. The serum potassium level changes from
3. 8 to 3.1 mEq/L 3.B-natriuretic peptide (BNP) factor increases from 200 to 262 pg/mL
4. Urine output increases from 10 mL/hour to greater than 50 mL hourly
5. Urine output increases from 10 mL/hour to greater than 50 mL hourly
6. Intravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit?
7. Vitamin K
8. Protamine sulfate
9. Potassium chloride
10. Aminocaproic acid (Amicar)
11. Protamine sulfate
12. A client is prescribed nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions?
13. "It is not necessary to avoid the use of alcohol."
14. "The medication should be taken with meals to decrease flushing."
15. "Clay-colored stools are a common side effect and should not be of concern."
16. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."
17. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."
18. The nurse is reviewing the record of a client who arrives at the health care clinic. The nurse notes that irbesartan (Avapro) has been prescribed for the client. The nurse should suspect that the client has which condition?
19. Hypertension
20. Hypothyroidism
21. Diabetes mellitus
22. Renal transplant rejection
23. Hypertension
24. The home care nurse instructs a client on how to administer enoxaparin (Lovenox) subcutaneously. Which statement, if made by the client, indicates an understanding of how to administer this medication?
25. "I need to hold my skin flat before I put the needle into my skin."
26. "I need to massage the skin with the alcohol wipe after I give the injection."
27. "A syringe that has a small ⅝-inch needle is used to administer the injection."
28. "I need to pull back on the syringe and aspirate before pushing the medication into my skin."

3. "A syringe that has a small ⅝-inch needle is used to administer the injection."
4. A client is scheduled for a dose of ramipril (Altace). The nurse should check which measurement before administering the medication?
5. Weight
6. Apical pulse
7. Blood pressure
8. Potassium level
9. Blood pressure 19. The clinic nurse is providing instructions to a client with hypertension who will be taking captopril (Capoten). Which statement by the client indicates a need for further instruction?
10. "I need to change positions slowly."
11. "I need to avoid taking hot baths or showers."
12. "I need to drink at least 4 quarts of water daily."
13. "I need to sit down and rest if dizziness or lightheadedness occurs."
14. "I need to drink at least 4 quarts of water daily."
15. A thrombolytic is administered in the hospital emergency department to a client who has had a myocardial infarction. The client's spouse asks the nurse about the purpose of the medication. The nurse bases the response on which fact regarding this medication?
16. Thrombolytics suppress the production of fibrin.
17. Thrombolytics act to prevent thrombus formation.
18. Thrombolytics act to dissolve thrombi that have already formed.
19. Thrombolytics have been proved to reverse all detrimental effects of heart attacks.
20. Thrombolytics act to dissolve thrombi that have already formed.
21. A client who had surgery 3 days earlier is receiving heparin sulfate by subcutaneous injection every 12 hours. In planning for the client's morning care, the priority nursing intervention is which action?
22. Allow the client to sit only at the bedside.
23. Assist the client to shave using an electric razor.
24. Monitor the prothrombin time (PT) every 4 hours.
25. Tell the client that brushing the teeth is not allowed.
26. Assist the client to shave using an electric razor. 22. A client scheduled to take a subcutaneous anticoagulant at home says to the nurse, "I'm not sure I will be able to take this medication at home." Which statement by the nurse is most appropriate?
27. "Maybe your spouse can give you your shots."
28. "You'll be fine once you get used to giving your own shots."

3. "What are your concerns about taking this medication at home?"
4. "Don't worry. Your health care provider knows what's best for you."
5. "What are your concerns about taking this medication at home?"
6. A client is being discharged on warfarin sodium (Coumadin), and the nurse provides instructions to the client regarding the medication. Which statement, if made by the client, indicates to the nurse that the client understands the teaching provided?
7. "I'll stop my medication if I see bruising."
8. "Stiff joints are common while taking warfarin."
9. "This medication will prevent me from having a stroke."
10. "If I notice blood-tinged urine, I will call the health care provider."
11. "If I notice blood-tinged urine, I will call the health care provider."
12. A client receives education regarding self-administration of enoxaparin (Lovenox) on discharge to home. The client complains, "I feel as if the health care provider is discharging me too soon if I still have to take injections at home." What is the best nursing response?
13. "Are you not happy about going home?"
14. "Do you want to stay in the hospital forever?"
15. "You'll have to take that up with the health care provider."
16. "Research shows that it is best for clients to administer this medication at home rather than stay in the hospital."
17. "Research shows that it is best for clients to administer this medication at home rather than stay in the hospital."
18. The nurse is caring for a client who is taking warfarin (Coumadin), an oral anticoagulant. The nurse notes the presence of gross hematuria and large areas of bruising on the client's body. The nurse notifies the health care provider and ensures that which prescribed medication is available?
19. Heparin sulfate
20. Protamine sulfate
21. Phytonadione (vitamin K)
22. Oral potassium supplements
23. Phytonadione (vitamin K)
24. The home care nurse has given instructions to a client who is beginning therapy with digoxin (Lanoxin). The nurse determines a need for further teaching of the instructions if the client makes which statement?
25. "If I miss a dose, I should just take two the next day."
26. "I shouldn't change brands without asking the health care provider first."
27. "I should call the health care provider if my daily pulse rate is under 60 or over 100."

4. "The pills should be kept in their original container so they don't get mixed up with my other medicines."
5. "If I miss a dose, I should just take two the next day."
6. A client who began medication therapy with prazosin hydrochloride (Minipress) 1 week earlier arrives at the health care clinic for follow-up evaluation and care. The nurse interprets that the client is experiencing the expected benefit of therapy if which is noted?
7. Increased pulse
8. Increased platelet count
9. Decreased blood pressure
10. Decreased blood glucose level
11. Decreased blood pressure 28. A hypertensive client has been prescribed clonidine hydrochloride (Catapres-TTS), a transdermal patch. The nurse provides written instructions to the client on the use of the patch. Which statement by the client indicates the need for further instruction?
12. "I need to change the patch every 24 hours."
13. "I need to apply the patch to a hairless body site."
14. "I need to apply the patch to skin areas that are not broken."
15. "I need to apply the patch to the skin on the upper arm or body."
16. "I need to change the patch every 24 hours."
17. A client with hypertension has begun taking spironolactone (Aldactone). The nurse teaches the client to limit intake of which food?
18. Rice
19. Salad
20. Oatmeal
21. Citrus fruits
22. Citrus fruits
23. A client with hypertension has a new prescription for a medication called moexipril (Univasc). The nurse plans to provide written directions that tell the client to take the medication at which time?
24. At bedtime
25. With meals
26. 1 hour before meals
27. With a snack in late afternoon
28. 1 hour before meals
29. A health care provider (HCP) prescribes warfarin sodium (Coumadin) for a client. The home care nurse visits the client at home and teaches the client about the medication and

its administration. Which statement by the client indicates a need for further teaching?

1. "The urine normally changes to orange."
2. "This medicine will still be working 4 to 5 days after it is discontinued."
3. "This medication will require frequent blood work to monitor its effects."
4. "I cannot take aspirin or any aspirin-containing medications while I'm on this medication."
5. "The urine normally changes to orange."
6. The nurse has been given a medication prescription to administer intravenous (IV) hydralazine (Apresoline). The nurse obtains which priority piece of equipment needed for use during administration of this medication?
7. Pulse oximetry
8. Cardiac monitor
9. Noninvasive blood pressure cuff
10. Nonrebreather oxygen face mask
11. Noninvasive blood pressure cuff
12. The nurse is reviewing the assessment findings for a client who has been taking spironolactone (Aldactone) for treatment of hypertension. Which, if noted in the client's record, would indicate that the client is experiencing an adverse effect related to the medication?
13. Client complaint of dry skin
14. A potassium level of 3.5 mEq/L
15. A potassium level of 5.8 mEq/L
16. Client complaint of constipation
17. A potassium level of 5.8 mEq/L
18. The nurse is providing instructions to a client with chronic atrial fibrillation who is being started on quinidine sulfate. The nurse should plan to provide which instruction to the client?
19. Wear a Medic-Alert bracelet.
20. Take the medication only on an empty stomach.
21. Stop taking the prescribed digoxin (Lanoxin) when this medication is started.
22. Open the sustained-release capsules and mix with applesauce if the medication is difficult to swallow.
23. Wear a Medic-Alert bracelet.
24. The nurse notes a persistent, dry cough in an adult client being seen in the ambulatory clinic. When questioned, the client states that the cough began approximately 2 months ago. On further assessment, the nurse learns that the client began taking quinapril (Accupril) shortly before the time that the cough began. How should the nurse interpret the development of the cough?

1. An early indication of heart failure
2. Caused by neutropenia as a result of therapy
3. Caused by a concurrent upper respiratory infection
4. An expected although bothersome side effect of therapy
5. An expected although bothersome side effect of therapy
6. A client with angina pectoris has been given a new prescription for nitroglycerin transdermal patches. The client indicates an understanding of how to use this medication administration system by making which statement?
7. "I need to wait until the next day to apply a new patch if it falls off."
8. "I need to alternate daily dosage times to prevent tolerance to the medication."
9. "I need to place the patch in the area of a skin fold to promote better adherence."
10. "I need to apply the patch in the morning and leave it in place for 12 to 14 hours as directed."
11. "I need to apply the patch in the morning and leave it in place for 12 to 14 hours as directed."
12. A client in the hospital emergency department who received nitroglycerin for chest pain has obtained relief but now complains of a headache. The nurse should interpret that this client is most likely experiencing which condition?
13. An expected medication side effect
14. An allergic reaction to nitroglycerin
15. An early sign of tolerance to the medication
16. A warning that the medication should not be used again
17. An expected medication side effect
18. A client who has begun taking betaxolol (Kerlone) demonstrates an effective response to the medication as indicated by which nursing assessment finding?
19. Increase in edema to 3+
20. Weight gain of 5 pounds
21. Decrease in pulse rate from 74 beats/min to 58 beats/min
22. Decrease in blood pressure from 142/94 mm Hg to 128/82 mm Hg
23. Decrease in blood pressure from 142/94 mm Hg to 128/82 mm Hg
24. A client who is taking chlorothiazide (HydroDIURIL) comes to the clinic for periodic evaluation. In monitoring the client's laboratory test results for medication side effects, what is the clinic nurse most likely to note if a side effect is present?
25. Hypokalemia
26. Hypocalcemia
27. Hypernatremia
28. Hyperphosphatemia

1. Hypokalemia
2. A client is taking amiloride (Midamor) 10 mg orally daily. What medication instruction should the nurse provide to the client?
3. Take the dose without food.
4. Eat foods with extra sodium.
5. Take the dose in the morning.
6. Withhold the dose if the blood pressure is high.
7. Take the dose in the morning.
8. Lisinopril (Prinivil) has been prescribed for a client. What should the nurse instruct the client to do?
9. Take the medication with food only.
10. Discontinue the medication if nausea occurs.
11. Rise slowly from a reclining to a sitting position.
12. Expect to note a full therapeutic effect immediately.
13. Rise slowly from a reclining to a sitting position.
14. A health care provider (HCP) prescribes quinidine gluconate for a client. The nurse decides to withhold the medication and contact the HCP if which assessment finding is documented in the client's medical record?
15. Muscle weakness
16. History of asthma
17. Presence of infection
18. Complete atrioventricular (AV) block
19. Complete atrioventricular (AV) block 43. A client is to be discharged from the hospital on quinidine gluconate to control ventricular ectopy. The nurse provides instructions to the client about the medication. Which statement by the client indicates a need for further instruction?
20. "The best time to schedule this medication is with meals."
21. "I need to avoid alcohol, caffeine, and cigarettes while I am on this medication."
22. "I need to stop the medication immediately if diarrhea, nausea, or vomiting occurs."
23. "I need to take this medication regularly, even if the heartbeat feels strong and regular."
24. "I need to stop the medication immediately if diarrhea, nausea, or vomiting occurs."
25. A client has been prescribed pindolol (Visken) for hypertension. The nurse provides anticipatory guidance, knowing that which common side effect of this medication may decrease client compliance?
26. Impotence
27. Mood swings

3. Increased appetite
4. Difficulty swallowing
5. Impotence
6. A client receiving total parenteral nutrition (TPN) has a history of heart failure. The health care provider has prescribed furosemide (Lasix) 40 mg by mouth daily to prevent fluid overload. Which laboratory value should the nurse monitor to identify the presence of an adverse effect from this medication?
7. Sodium
8. Glucose
9. Potassium
10. Magnesium
11. Potassium
12. A client with heart failure is scheduled to be discharged to home with digoxin (Lanoxin) and furosemide (Lasix) as daily prescribed medications. The nurse tells the client to report which finding as an indication that the medications are not having the intended effect?
13. Sudden increase in appetite
14. Weight gain of 2 to 3 lb in a few days
15. Increased urine output during the day
16. Cough accompanied by other signs of respiratory infection
17. Weight gain of 2 to 3 lb in a few days
18. A client with pulmonary edema has a prescription to receive morphine sulfate intravenously. The nurse should determine that the client is experiencing an intended effect of the medication as indicated by which assessment finding?
19. Increased pulse rate
20. Relief of apprehension
21. Decreased urine output
22. Increased blood pressure
23. Relief of apprehension 48. The nurse has provided instructions to a client receiving enalapril maleate (Vasotec). Which statement by the client indicates a need for further instruction?
24. "I need to rise slowly from a lying to sitting position."
25. "I need to notify the health care provider if fatigue occurs."
26. "I need to notify the health care provider (HCP) if a sore throat occurs."
27. "I know that several weeks of therapy may be required for the full therapeutic effect."
28. "I need to notify the health care provider if fatigue occurs."

49. A health care provider writes a prescription for lisinopril (Zestril) for a hospitalized client. The nurse caring for the client determines that the medication has been prescribed to treat which disorder?
    1. Hypertension
    2. Immune disorder
    3. Venous insufficiency
    4. Gastroesophageal reflux disorder
    5. Hypertension
50. A client taking an angiotensin-converting enzyme (ACE) inhibitor to treat hypertension calls the clinic nurse and reports that he has a dry, nonproductive cough that is very bothersome. The nurse should respond by making which statement?
    1. The medication may need to be changed.
    2. The cough must be the start of a respiratory infection.
    3. The medication needs to be taken with large amounts of water to prevent the cough.
    4. This sometimes happens, and the client will need to take a cough medication with each dose of medication.
    5. The medication may need to be changed.
51. The home care nurse visits a client with a diagnosis of unstable angina. The client is taking acetylsalicylic acid (aspirin) on a daily basis to reduce the risk of myocardial infarction (MI). Which medication dose would the nurse expect the client to be taking?
    1. 300 to 325 mg daily
    2. 650 to 700 mg daily
    3. 1.3 g daily
    4. 3 g daily
    5. 300 to 325 mg daily
52. The nurse prepares to teach a client with subarachnoid hemorrhage about the effects of nimodipine. The nurse plans to explain which information about the purpose of this medication?
    1. β-Adrenergic blocker that will decrease blood pressure
    2. Vasodilator that has an affinity for cerebral blood vessels
    3. Diuretic that will decrease blood pressure by decreasing fluid volume
    4. Calcium channel blocker that will decrease spasm in cerebral blood vessels
    5. Calcium channel blocker that will decrease spasm in cerebral blood vessels
53. A client is being treated for moderate hypertension and has been taking diltiazem (Cardizem) for several months. The client schedules an appointment with the health care provider because of episodes of chest pain, and Prinzmetal's angina is diagnosed. The nurse understands that this medication will provide which therapeutic effect for this new diagnosis?

1. Increases oxygen demands within the myocardium
2. Increases the force of contraction of ventricular tissues
3. Prevents influx of calcium ions in vascular smooth muscle
4. Leads to an increase in calcium absorption in the vascular smooth muscle
5. Prevents influx of calcium ions in vascular smooth muscle4.Leads to an increase in calcium absorption in the vascular smooth muscle 54. A client with chronic atrial fibrillation is being started on quinidine sulfate (Quinidine) as maintenance therapy for dysrhythmia suppression, and the nurse provides instructions to the client about the medication. Which statement by the client indicates a need for further instruction?
6. "I will avoid chewing the tablets."
7. "I will take the dose at the same time each day."
8. "I will take the medication with food if my stomach becomes upset."
9. "I will stop taking the prescribed anticoagulant after starting this new medication."
10. "I will stop taking the prescribed anticoagulant after starting this new medication."
11. Fenofibrate (Tricor) is prescribed for a client with hyperlipidemia. The nurse reviews the client's medical history for the presence of what condition that contraindicates the use of this medication?
12. Angina
13. Mitral valve stenosis
14. Cirrhosis of the liver
15. Coronary artery disease
16. Cirrhosis of the liver
17. Acetylsalicylic acid (ASA), or aspirin, has been prescribed for a client with angina, and the client asks the nurse how the medication will help. The nurse responds that this medication has been prescribed for which purpose?
18. Reduce pain.
19. Reduce inflammation.
20. Inhibit platelet aggregation.
21. Maintain a normal body temperature.
22. Inhibit platelet aggregation.
23. A nurse is collecting data from a client and notes that the client is taking atenolol (Tenormin). What has this medication been prescribed to treat?
24. Hypertension
25. Ulcerative colitis
26. Rheumatoid arthritis
27. Second-degree heart block

1. Hypertension
2. Atenolol (Tenormin) has been prescribed for a client, and the client asks the nurse about the action of the medication. How should the nurse respond regarding the action of this medication?
3. Slows the heart rate
4. Increases cardiac output
5. Increases myocardial oxygen demand
6. Maintains the blood pressure at a level within the 140/90 mm Hg range
7. Slows the heart rate
8. The health care provider (HCP) writes a prescription for atenolol (Tenormin) for a client who was admitted to the hospital. The nurse contacts the HCP to verify the prescription if which finding is noted in the assessment data?
9. Temperature is 100.1° F.
10. Apical heart rate is 48 beats/min.
11. Blood pressure is 138/82 mm Hg.
12. Pedal pulses are bounding and strong.
13. Apical heart rate is 48 beats/min.
14. Atenolol (Tenormin) has been prescribed for a hospitalized client. The nurse should check which item before administering this medication?
15. Pedal pulses
16. Apical heart rate
17. Most recent potassium level
18. Most recent electrolyte levels
19. Apical heart rate
20. Atenolol (Tenormin) has been prescribed for a client, and the client asks the nurse about the side effects of the medication. What should the nurse tell the client is an occasional side effect of this medication?
21. Dry skin
22. Flushing
23. Decreased libido
24. Increased blood pressure
25. Decreased libido
26. A client admitted to the hospital is taking atenolol (Tenormin). The nurse monitors the client for which sign or symptom of an adverse effect of the medication?
27. Nausea
28. Diaphoresis

3. Hypotension
4. Tachycardia
5. Hypotension 63. Atenolol (Tenormin) has been prescribed for a client, and the nurse provides instructions to the client about the medication. Which statement by the client indicates the need for further teaching?
6. "I need to rise slowly from a lying to a sitting position."
7. "If I feel that my heart rate is too low, I should stop the medication."
8. "It will take 1 to 2 weeks before my blood pressure becomes controlled."
9. "I should avoid tasks that require alertness until I know how the medication will affect my body."
10. "If I feel that my heart rate is too low, I should stop the medication."
11. A nurse is collecting subjective and objective data from a client and notes that the client is taking atorvastatin (Lipitor). What should the nurse determine that this medication has been prescribed to specifically treat?
12. Heart failure
13. Hypertension
14. Angina pectoris
15. Hypercholesterolemia
16. Hypercholesterolemia
17. Atorvastatin (Lipitor) has been prescribed for a client, and the client asks the nurse about the action of the medication. How should nurse respond about the action of this medication?
18. Increases plasma cholesterol
19. Increases plasma triglycerides
20. Decreases low-density lipoproteins (LDLs)
21. Decreases high-density lipoproteins (HDLs)
22. Decreases low-density lipoproteins (LDLs)
23. The health care provider (HCP) writes a prescription for atorvastatin (Lipitor) for a client who was admitted to the hospital. The nurse contacts the HCP to verify the prescription if which finding is noted in the assessment data?
24. Renal calculi
25. Chronic heart failure
26. Cirrhosis of the liver
27. Coronary artery disease
28. Cirrhosis of the liver

67. Atorvastatin (Lipitor) has been prescribed for a client. The nurse tells the client that which blood test will be done periodically while the client is taking this medication?
    1. Neutrophil count
    2. Liver function studies
    3. White blood cell count
    4. Complete blood cell (CBC) count
    5. Liver function studies
68. Atorvastatin (Lipitor) has been prescribed for a client, and the client asks the nurse about the side effects of the medication. What should the nurse tell the client is a frequent side effect of this medication?
    1. Tremors
    2. Lethargy
    3. Headache
    4. Tiredness
    5. Headache
69. A client seen in the health care clinic for follow-up care is taking atorvastatin (Lipitor). The nurse should assess the client for which adverse effect of the medication?
    1. Earache
    2. Hearing loss
    3. Photosensitivity
    4. Lung congestion
    5. Photosensitivity 70. Atorvastatin (Lipitor) has been prescribed for a client, and the nurse provides instructions to the client about the medication. Which statement by the client indicates the need for further teaching?
    6. "This medication will lower my cholesterol level."
    7. "I will need to have blood tests drawn while I am taking this medication."
    8. "I won't need to adhere to a low-fat diet as long as I take this medication faithfully."
    9. "I need to talk to the health care provider (HCP) before taking any over-the-counter medications."
    10. "I won't need to adhere to a low-fat diet as long as I take this medication faithfully."
70. Diltiazem (Cardizem) is prescribed for a client with Prinzmetal's variant angina. The nurse should plan care, knowing that this medication works by which method?
    1. Increasing the heart rate
    2. Constricting peripheral arteries
    3. Increasing sinoatrial (SA) and atrioventricular (AV) conduction
    4. Inhibiting calcium movement across cell membranes of cardiac and smooth muscle

4. Inhibiting calcium movement across cell membranes of cardiac and smooth muscle
5. A client with cardiac disease has begun taking propranolol (Inderal LA), and the nurse provides information to the client about the medication. The nurse should tell the client to contact the health care provider (HCP) if which symptoms develop?
6. Insomnia and headache
7. Nausea and constipation
8. Night cough and dyspnea
9. Drowsiness and nightmares
10. Night cough and dyspnea
11. Hydrochlorothiazide (HydroDIURIL) has been prescribed for a client. The nurse contacts the health care provider to verify the prescription if which condition is noted in the assessment data?
12. Hypertension
13. Allergy to eggs
14. Nephrotic syndrome
15. Allergy to sulfonamides
16. Allergy to sulfonamides
17. A client is seen in the clinic complaining of anorexia and nausea. The health care provider suspects that the client may be experiencing digoxin toxicity. While waiting for test results to become available, the nurse should assess the client for which sign or symptom that would support a diagnosis of digoxin toxicity?
18. Edema
19. Chest pain
20. Constipation
21. Photophobia
22. Photophobia
23. The nurse is administering a dose of intravenous hydralazine (Apresoline) to a client. The nurse should ensure that which item is in place before injecting the medication?
24. Central line
25. Foley catheter
26. Pulse oximeter
27. Blood pressure cuff
28. Blood pressure cuff
29. The nurse is performing an assessment on a client with a diagnosis of chronic angina pectoris. The client is receiving sotalol (Betapace) orally daily. Which assessment finding indicates to the nurse that the client is experiencing a side/adverse effect related to the medication?

1. Dry mouth
2. Diaphoresis
3. Palpitations
4. Difficulty swallowing
5. Palpitations
6. The nurse is caring for a client with hypertension receiving torsemide (Demadex) orally daily. Which laboratory test result would indicate to the nurse that the client may be experiencing an adverse effect related to the medication?
7. A chloride level of 98 mEq/L
8. A sodium level of 135 mEq/L
9. A potassium level of 3.1 mEq/L
10. A blood urea nitrogen (BUN) of 15 mg/dL
11. A potassium level of 3.1 mEq/L
12. The nurse has given a client information about the use of nitroglycerin sublingual tablets. The client has a prescription for PRN use if chest pain occurs. Which client statement indicates an understanding of this medication?
13. "It's best to keep this medication in a shirt pocket close to the body."
14. "I need to discard unused tablets 6 to 9 months after the bottle is opened."
15. "I will avoid using the medication until the chest pain actually begins and gets worse."
16. "I can take aspirin for any headache that occurs when I first start taking the nitroglycerin."
17. "I need to discard unused tablets 6 to 9 months after the bottle is opened."
18. A client is due for a dose of bumetanide. The nurse should temporarily withhold the dose and notify the health care provider (HCP) if which laboratory test result is noted?
19. Sodium 137 mEq/L
20. Chloride 106 mEq/L
21. Potassium 2.9 mEq/L
22. Magnesium 2.6 mg/dL
23. Potassium 2.9 mEq/L
24. The nurse has given a client the prescribed dose of intravenous hydralazine (Apresoline). The nurse evaluates the effectiveness of the medication by monitoring which client parameter?
25. Pulse rate
26. Urine output
27. Blood pressure
28. Potassium level
29. Blood pressure

81. The nurse has completed giving medication instructions to a client receiving benazepril (Lotensin). Which client statement indicates to the nurse that the client needs further instruction? 1. "I need to change positions slowly." 2. "I will monitor my blood pressure every week." 3. "I will report signs and symptoms of infection immediately." 4. "I can use salt substitutes freely and eat foods high in potassium." 4. "I can use salt substitutes freely and eat foods high in potassium."

82. The nurse has conducted medication instructions with a client receiving lovastatin (Mevacor). Which periodic blood study will be necessary and included in the client's instructions?
    1. Bleeding time
    2. Blood glucose levels
    3. Liver function studies
    4. Complete blood cell count
    5. Liver function studies
83. Daily administration of dipyridamole (Persantine) been prescribed for the client, and the nurse teaches the client about the medication. Which client statement indicates an understanding of the instructions?
    1. "This medication will prevent a stroke."
    2. "This medication will prevent a heart attack."
    3. "This medication will help keep my blood pressure down."
    4. "If I take this medicine with my Coumadin, it will protect my artificial heart valve."
    5. "If I take this medicine with my Coumadin, it will protect my artificial heart valve."
84. A client in the postpartum care unit who is recovering from disseminated intravascular coagulopathy is to be discharged on low dosages of an anticoagulant medication. In developing home care instructions for this client, the nurse should include which priority safety instruction regarding this medication?
    1. Avoid brushing the teeth.
    2. Avoid taking acetylsalicylic acid (aspirin).
    3. Avoid walking long distances and climbing stairs.
    4. Avoid all activities because bruising injuries can occur.
    5. Avoid taking acetylsalicylic acid (aspirin).
85. Levothyroxine (Synthroid) is prescribed for a client diagnosed with hypothyroidism. The nurse reviews the client's record and notes that the client is presently taking warfarin (Coumadin). The nurse contacts the health care provider (HCP), anticipating that the HCP will prescribe which medication?
    1. A decreased dosage of warfarin

2. An increased dosage of warfarin
3. A decreased dosage of levothyroxine
4. An increased dosage of levothyroxine
5. A decreased dosage of warfarin
6. A nurse prepares to administer sodium polystyrene sulfonate (Kayexalate) to a client. Before administering the medication, the nurse reviews the action of the medication and understands that which is released by this medication?
7. Bicarbonate in exchange for primarily sodium ions
8. Potassium ions in exchange for primarily sodium ions
9. Sodium ions in exchange for primarily potassium ions
10. Sodium ions in exchange for primarily bicarbonate ions
11. Sodium ions in exchange for primarily potassium ions
12. A home health nurse instructs a client about the use of a nitrate patch. The nurse should make which statement to the client to prevent client tolerance to nitrates?
13. "Do not remove the patches."
14. "Have a 12-hour ‘no-nitrate' time."
15. "Ensure a 24 - hour ‘no-nitrate' time."
16. "Keep nitrates on 24 hours, then off 24 hours."
17. "Have a 12 - hour ‘no-nitrate' time."
18. A client with nausea and bradycardia is admitted to a medical unit. The family hands a nurse a small white envelope labeled "heart pill." The envelope is sent to the pharmacy and it is found to be digoxin (Lanoxin). A family member states, "That health care provider doesn't know how to take care of my family." Which statement would convey a therapeutic response by the nurse?
19. "Don't worry about this. I'll take care of everything."
20. "You are concerned your loved one receives the best care."
21. "You're right! I've never seen them put pills in an envelope."
22. "I think you're wrong. That health care provider (HCP) has been in practice more than 30 years."
23. "You are concerned your loved one receives the best care."
24. A male client is on enalapril (Vasotec) for the treatment of hypertension. The nurse teaches the client that he should seek emergent care if he experiences which adverse effect?
25. Nausea
26. Insomnia
27. Dry cough
28. Swelling of the tongue

4. Swelling of the tongue
5. What should the nurse teach a client about an expected outcome of nesiritide (Natrecor) administration?
6. The client will have an increase in urine output.
7. The client will have an absence of dysrhythmias.
8. The client will have an increase in blood pressure.
9. The client will have an increase in pulmonary capillary wedge pressure.
10. The client will have an increase in urine output.
11. A client is admitted to a hospital with acute myocardial infarction and is started on tissue plasminogen activator (tPA, Activase) by infusion. Of the following parameters, which one should a nurse determine requires the least frequent assessment to detect complications of therapy with tPA?
12. Neurological signs
13. Blood pressure and pulse
14. Presence of bowel sounds
15. Complaints of abdominal and back pain
16. Presence of bowel sounds 92. A hospitalized client with coronary artery disease complains of substernal chest pain. After assessing the client's heart rate and blood pressure, a nurse administers nitroglycerin, 0.4 mg, sublingually. After 5 minutes the client states, "My chest still hurts." Which actions should the nurse take? Select all that apply.
17. Call a Code Blue.
18. Contact the client's family.
19. Assess the client's pain level.
20. Check the client's blood pressure.
21. Contact the health care provider (HCP).
22. Administer a second nitroglycerin, 0.4 mg, sublingually. o 3. Assess the client's pain level. o 4. Check the client's blood pressure. o 6. Administer a second nitroglycerin, 0.4 mg, sublingually.
23. A client has developed paroxysmal nocturnal dyspnea. Which medication should the nurse anticipate will be prescribed by the health care provider?
24. Bumetanide
25. Lidocaine (Xylocaine)
26. Propranolol (Inderal LA)
27. Streptokinase (Streptase)

1. Bumetanide 94. A home health care nurse is visiting an older client at home. Furosemide (Lasix) is prescribed for the client and the nurse teaches the client about the medication. Which statement, if made by the client, indicates the need for further teaching?
2. "I will sit up slowly before standing each morning."
3. "I will take my medication every morning with breakfast."
4. "I need to drink lots of coffee and tea to keep myself healthy."
5. "I will call my health care provider (HCP) if my ankles swell or my rings get tight."
6. "I need to drink lots of coffee and tea to keep myself healthy."
7. In reviewing the medication records of the following group of clients, the nurse determines that which client would be at greatest risk for developing hyperkalemia?
8. Client receiving bumetanide
9. Client receiving furosemide (Lasix)
10. Client receiving spironolactone (Aldactone)
11. Client receiving hydrochlorothiazide (HCTZ)
12. Client receiving spironolactone (Aldactone)
13. The nurse is caring for a client who is receiving dopamine. Which potential problem is a priority concern for this client?
14. Fluid overload
15. Peripheral vasoconstriction
16. Inability to perform self-care
17. Inability to discriminate hot or cold sensations
18. Peripheral vasoconstriction
19. The health care provider has prescribed clonidine (Catapres) for a client with hypertension. The nurse should inform the client that which is a side effect of this medication?
20. Diarrhea
21. Constipation
22. Hypertension
23. Increased salivation
24. Constipation
25. Gemfibrozil (Lopid) is prescribed for a client. Which laboratory finding should alert the nurse about the need to withhold the medication and contact the health care provider?
26. Elevated glucose
27. Elevated triglycerides
28. Elevated liver function tests
29. Elevated blood urea nitrogen (BUN)

3. Elevated liver function tests
4. A nurse is caring for a client with hyperlipidemia who is taking cholestyramine (Questran). Which nursing assessment is most significant for this client relative to the medication therapy?
5. Observe for joint pain.
6. Auscultate bowel sounds.
7. Assess deep tendon reflexes.
8. Monitor cardiac rate and rhythm.
9. Auscultate bowel sounds.
10. A nurse should educate the client receiving pravastatin (Pravachol) to immediately report which finding?
11. Fatigue
12. Diarrhea
13. Sore throat
14. Muscle pain
15. Muscle pain
16. The nurse has completed medication administration that included a nitroglycerin. Within minutes, the client is complaining of a headache. Which is the priority nursing action at this time?
17. Evaluate pupil response.
18. Place the client on the left side.
19. Administer the prescribed analgesic.
20. Notify the health care provider (HCP) immediately.
21. Administer the prescribed analgesic.
22. A client is admitted to the emergency department with a diagnosis of myocardial infarction (MI). The health care provider (HCP) prescribes the administration of alteplase (Activase). To achieve the best therapeutic outcome, the nurse understands this medication must be administered at which time?
23. Within 4 to 6 hours after onset of chest pain
24. Concurrently with the administration of heparin
25. With the administration solution set protected from light
26. After the results of all laboratory tests have been received
27. Within 4 to 6 hours after onset of chest pain
28. The nurse is preparing to administer furosemide (Lasix) to a client with a diagnosis of heart failure. Which is the most important laboratory test result for the nurse to check before administering this medication?
29. Blood urea nitrogen

2. Cholesterol level
3. Potassium level
4. Creatinine level
5. Potassium level
6. The nurse is preparing to administer furosemide (Lasix) 40 mg by intravenous (IV) injection (IV push) to a client. The nurse should administer the medication over which time period?
7. 10 seconds
8. 30 seconds
9. 1 minute
10. 5 minutes
11. 1 minute
12. A health care provider writes a prescription for digoxin (Lanoxin), 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is most important to be sure to implement which measure?
13. Count the radial and carotid pulses every morning.
14. Check the blood pressure every morning and evening.
15. Stop taking the medication if the pulse is faster than 100 beats/min.
16. Withhold the medication, and call the health care provider if the pulse is slower than 60 beats/min.
17. Withhold the medication, and call the health care provider if the pulse is slower than 60 beats/min.
18. A client with angina pectoris is experiencing chest pain that radiates down the left arm. The nurse administers a sublingual nitroglycerin tablet to the client. The client's pain is unrelieved, and the nurse determines that the client needs another nitroglycerin tablet. Which vital sign is the most important for the nurse to check before administering the medication?
19. Temperature
20. Respirations
21. Blood pressure
22. Radial pulse rate
23. Blood pressure
24. Atenolol hydrochloride (Tenormin) is prescribed for a hospitalized client. The nurse should perform which action as a priority before administering this medication?
25. Listen to the client's lung sounds.
26. Check the client's blood pressure.
27. Assess the client for muscle weakness.
28. Check the client's most recent electrolyte levels.

2. Check the client's blood pressure.
3. A man who has developed atrial fibrillation and has been placed on warfarin (Coumadin). The nurse is doing discharge dietary teaching with the client and determines that the client needs additional education if he stated he would choose which foods while taking this medication?
4. Cherries
5. Potatoes
6. Broccoli
7. Spaghetti
8. Broccoli
9. A client with heart disease is taking digoxin (Lanoxin) and complains of having no appetite, and experiencing diarrhea and blurry vision. The nurse notes that the client's serum potassium (K) level is 3.0 mEq/L. Based on analysis of the data, what might the nurse expect to note when reviewing the digoxin level results?
10. Digoxin level of 1.8 ng/mL
11. Digoxin level higher than 2 ng/mL
12. Digoxin level lower than 0.5 ng/mL
13. Digoxin level of 0 ng/mL because of diarrhea
14. Digoxin level higher than 2 ng/mL
15. The nurse is providing medication information to a client who is beginning medication therapy with enalapril (Vasotec). The nurse should tell the client that which is an anticipated, although unpleasant, side effect of this medication?
16. Rapid pulse
17. Persistent dry cough
18. Increased blood pressure
19. Metallic taste in the mouth
20. Persistent dry cough
21. A client has recently begun medication therapy with propranolol (Inderal LA). The long-term care nurse should plan to notify the health care provider (HCP) if which assessment finding is noted?
22. Complaints of insomnia
23. Audible expiratory wheezes
24. Decrease in heart rate from 86 to 78 beats/min
25. Decrease in blood pressure from 162/90 to 136/84 mm Hg
26. Audible expiratory wheezes
27. A client is receiving scheduled doses of lovastatin (Mevacor). The nurse determines that the medication is having the intended effect if which is noted?