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NUR 2474 PHARM EXAM 2 NCLEX REAL QUESTIONS
AND ACCURATE CORRECT UPDATED WITH ACCURATE
ANSWERS
- A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to administer which drug? a.Furosemide (Lasix) b.Hydrochlorothiazide (HydroDIURIL) c.Mannitol (Osmitrol) d.Spironolactone (Aldactone): a.Furosemide (Lasix) Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is needed. This patient shows severe signs of congestive heart failure with respi- ratory distress and pulmonary edema and needs immediate mobilization of fluid. Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema, because their diuretic effects are less rapid. Mannitol is indicated for patients with increased intracranial pressure and must be discontinued immediately if signs of pulmonary congestion or heart failure occur.
- A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide (Lasix). The nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern? a. Blood glucose level of 120 mg/dL b. Oxygen saturation of 90% c.Potassium level of 3.5 mEq/L d.Sodium level of 140 mEq/L: c.Potassium level of 3.5 mEq/L
This patient has an irregular, rapid heartbeat that might be caused by a dysrhythmia. This patient's serum potassium level is low, which can trigger fatal dysrhythmias, especially in patients taking digoxin. Furosemide contributes to loss of potassium through its effects on the distal nephron. Potassium-sparing diuretics often are used in conjunction with furosemide to prevent this complication. This patient's serum glucose and sodium levels are normal and of no concern at this point, although they can be affected by furosemide. The oxygen saturation is somewhat low and needs to be monitored, although it may improve with diuresis.
done this morning. Requesting an order for furosemide is appropriate only after the provider has been notified of the laboratory values.
- 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?
a.Bumetanide (Bumex) b.Chlorothiazide (Diuril) c.Hydrochlorothiazide (HydroDIURIL) d.Spironolactone (Aldactone): d.Spironolactone (Aldactone) Spironolactone is used in conjunction with furosemide because of its potassi- um-sparing effects. Furosemide can contribute to hypokalemia, which can increase the risk of fatal dysrhythmias, especially with digoxin administration. The other diuretics listed are all potassium-wasting diuretics.
- A patient is taking gentamicin (Garamycin) and furosemide (Lasix). The nurse should counsel this patient to report which symptom? a. Frequent nocturia b.Headaches c.Ringing in the ears d.Urinary retention: c.Ringing in the ears Patients taking furosemide should be advised that the risk of furosemide- induced hearing loss can be increased when other ototoxic drugs, such as gentamicin, are also taken. Patients should be told to report tinnitus or dizziness or hearing loss. Nocturia may be an expected effect of furosemide. Headaches are not likely to occur with concomitant use of gentamicin and furosemide. Urinary retention is not an expected side effect.
- An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hy- drochlorothiazide (HydroDIURIL). Before administering this medication, the nurse reviews the patient's chart. Which laboratory value causes the nurse the most concern? a. Elevated creatinine clearance b. Elevated serum potassium level c. Normal blood glucose level d. Low levels of low-density lipoprotein (LDL) cholesterol: a.Elevated creatinine clearance
potassium level. Thiazides may elevate the serum glucose level in diabetic patients. Thiazides increase LDL cholesterol; however, this patient's levels are low, so this is not a risk.
- A patient with chronic congestive heart failure has repeated hospitaliza- tions 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? a. "I can expect improvement within a few hours after taking this drug." b. "I need to stop taking potassium supplements." c. "I should use salt substitutes to prevent toxic side effects." d. "I should watch closely for dehydration.": b."I need to stop taking potassium supplements." Spironolactone is a potassium-sparing diuretic used to counter the potassium-wast- ing effects of hydrochlorothiazides. Patients taking potassium supplements are at risk for hyperkalemia when taking this medication, so they should be advised to stop the supplements. Spironolactone takes up to 48 hours to have effects. Salt substitutes contain high levels of potassium and are contraindicated. Spironolactone is a weak diuretic, so the risk of dehydration is not increased.
- A patient with hypertension is prescribed an angiotensin-converting en- zyme (ACE) inhibitor. The nurse reviewing this patient's chart before admin- istering the medication will be most concerned about which other disease process? a. Bronchial asthma b. Coronary artery disease c. Diabetes mellitus d. Renal artery stenosis: d.Renal artery stenosis ACE inhibitors can cause severe renal insufficiency in patients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney. Bronchial asthma, coronary artery disease, and diabetes mellitus are not comorbidities that are contraindications to treatment with an ACE inhibitor.
- A nurse administers an ACE inhibitor to a patient who is taking the drug for the first time. What will the nurse do?
dismissing the patient home. Which statement by the patient indicates understanding of the teaching?
a. "I am less likely to develop diabetic nephropathy when taking this medica- tion." b. "I should check my blood sugar more often, because hyperglycemia is a side effect of this drug." c. "Taking this medication helps reduce my risk of stroke and heart attack." d. "This medication will probably prevent the development of diabetic retinopa- thy.": c."Taking this medication helps reduce my risk of stroke and heart attack." Ramipril (Altace) is approved for reducing the risk of stroke and myocardial infarction (MI) in patients at high risk for a major cardiovascular event because they have hypertension in conjunction with a history of stroke or MI or because they have dia- betes. ACE inhibitors cannot be used for primary prevention of diabetic nephropathy, but they can delay the onset of overt nephropathy in patients who already have less advanced nephropathy. ACE inhibitors do not affect serum electrolytes or glucose. One ACE inhibitor, enalapril, can reduce the risk of diabetic retinopathy in some patients with type 1 diabetes mellitus.
- A patient begins taking an ACE inhibitor and complains of a dry cough. What does the nurse correctly tell the patient about this symptom? a. It indicates that a serious side effect has occurred. b. It is a common side effect that occurs in almost all patients taking the drug. c. It may be uncomfortable enough that the drug will need to be discontinued. d. It occurs frequently in patients taking the drug but will subside over time.: - c.It may be uncomfortable enough that the drug will need to be discontinued. A cough occurs in about 10% of patients taking ACE inhibitors and is the most common reason for discontinuing therapy. It does not indicate a serious condition. It occurs in about 10% of all patients and is more common in women, older adults, and those of Asian ancestry. It does not subside until the medication is discontinued.
- A nurse is reviewing a patient's medications before administration. Which drug-to- drug interactions should most concern the nurse in a patient with a history of heart failure and a potassium level of 5.5 mEq/L?
d. The patient should stop taking the medication and contact her provider immediately.: d.The patient should stop taking the medication and contact her provider immediately. ACE inhibitors are known to cause serious fetal injury during the second and third trimesters of pregnancy. Whether injury occurs earlier in pregnancy is unknown, and the incidence probably is low. However, women should be counseled to stop taking the drug if they become pregnant, and they should not take it if they are contemplating becoming pregnant. Women who take ACE inhibitors in the first trimester should be counseled that the risk to the fetus is probably low. Women should stop taking the drug when pregnant. ARBs carry the same risk as ACE inhibitors.
- A nurse is caring for a patient who is receiving verapamil (Calan) for hypertension and digoxin (Lanoxin) for heart failure. The nurse will observe this patient for: a.AV blockade. b.gingival hyperplasia. c.migraine headaches. d.reflex tachycardia.: a.AV blockade. Verapamil and digoxin both suppress impulse conduction through the AV node; when the two drugs are used concurrently, the risk of AV blockade is increased. Gingival hyperplasia can occur in rare cases with verapamil, but it is not an acute symptom. Verapamil can be used to prevent migraine, and its use for this purpose is under investigation. Verapamil and digoxin both suppress the heart rate. Nifedipine causes reflex tachycardia.
- A patient begins taking nifedipine (Procardia), along with a beta blocker, to treat hypertension. The nurse understands that the beta blocker is used to: a.reduce flushing.
b.minimize gingival hyperplasia. c.prevent constipation. d.prevent reflex tachycardia.: d.prevent reflex tachycardia. Beta blockers are combined with nifedipine to prevent reflex tachycardia. Beta block- ers do not reduce flushing, minimize gingival hyperplasia, or prevent constipation. Beta blockers can reduce the adverse cardiac effects of nifedipine.
- A nurse is teaching a patient who will begin taking verapamil (Calan) for hypertension about the drug's side effects. Which statement by the patient indicates understanding of the teaching? a. "I may become constipated, so I should increase fluids and fiber." b. "I may experience a rapid heart rate as a result of taking this drug." c. "I may have swelling of my hands and feet, but this will subside." d. "I may need to increase my digoxin dose while taking this drug.": a."I may become constipated, so I should increase fluids and fiber." Constipation is common with verapamil and can be minimized by increasing dietary fiber and fluids. Verapamil lowers the heart rate. Peripheral edema may occur secondary to vasodilation, and patients should notify their prescriber if this occurs, because the prescriber may use diuretics to treat the condition. Verapamil and digoxin have similar cardiac effects; also, verapamil may increase plasma levels of digoxin by as much as 60%, so digoxin doses may need to be reduced.
- A nurse is preparing to assist a nursing student in administering intra- venous verapamil to a patient who also receives a beta blocker. The nurse asks the nursing student to discuss the plan of care for this patient. Which statement by the student indicates a need for further teaching? a. "I will check to see when the last dose of the beta blocker was given." b. "I will monitor vital signs closely to assess for hypotension." c. "I will monitor the heart rate frequently to assess for reflex tachycardia." d. "I will prepare to administer intravenous norepinephrine if necessary.": c."I will monitor the heart rate frequently to assess for reflex tachycardia."
Peripheral edema may occur and should be reported to the provider. Amlodipine is given once daily.
- Which are therapeutic uses for verapamil? (Select all that apply.) a. Angina of effort b. Cardiac dysrhythmias c.Essential hypertension d.Sick sinus syndrome e.Suppression of preterm labor: a.Angina of effort b.Cardiac dysrhythmias c.Essential hypertension Verapamil is used to treat both vasospastic angina and angina of effort. It slows the ventricular rate in patients with atrial flutter, atrial fibrillation, and paroxysmal supraventricular tachycardia. It is a first-line drug for the treatment of essential hypertension. It is contraindicated in patients with sick sinus syndrome. Nifedipine has investigational uses in suppressing preterm labor.
- A patient has had blood pressures of 150/95 mm Hg and 148/90 mm Hg on two separate office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient's diagnostic tests are all normal. The nurse will expect this patient's provider to order: a.a beta blocker. b.a loop diuretic and spironolactone. c.a thiazide diuretic. d.counseling on lifestyle changes.: c.a thiazide diuretic. This patient has primary, or essential, hypertension as evidenced by systolic pres- sure greater than 140 and diastolic pressure greater than 90, along with normal tests ruling out another primary cause. Thiazide diuretics are first-line drugs for hypertension. Beta blockers are effective, but are most often used to counter reflex tachycardia associated with reduced blood pressure caused
by therapeutic agents. Loop diuretics cause greater diuresis than is usually needed and so are not first-line drugs. This patient should be counseled on lifestyle changes as an adjunct to drug therapy, but should also begin drug therapy because hypertension already exists.
- A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient? a. ACE inhibitors b. Beta blockers c. Direct-acting vasodilators d.Thiazide diuretics: a.ACE inhibitors ACE inhibitors slow the progression of kidney injury in diabetic patients with renal damage. Beta blockers can mask signs of hypoglycemia and must be used with caution in diabetics. Direct-acting vasodilators are third-line drugs for chronic hyper- tension. Thiazide diuretics promote hyperglycemia.
- A patient who does not consume alcohol or nicotine products reports a strong family history of hypertension and cardiovascular disease. The patient has a blood pressure of 126/82 and a normal weight and body mass index for height and age. The nurse will expect to teach this patient about: a.ACE inhibitors and calcium channel blocker medications. b.the DASH diet, sodium restriction, and exercise. c.increased calcium and potassium supplements. d.thiazide diuretics and lifestyle changes.: b.the DASH diet, sodium restriction, and exercise. This patient has prehypertension without other risk factors. Lifestyle changes are indicated at this point. If blood pressure rises to hypertension levels, other measures, including drug therapy, will be initiated. Calcium and potassium supplements are not indicated.
a.hypernatremia. b.hypertension. c.hyperkalemia. d.hypokalemia.: c.hyperkalemia. One of the principal effects of angiotensin-converting enzyme (ACE) inhibitors is hy- perkalemia, which is due to decreased aldosterone release arising from blockage of angiotensin II. There is no indication that careful monitoring of sodium for increased levels is indicated. Vasotec is indicated for heart failure, not hypertension. The drug therapy should be monitored to ascertain its effectiveness, but hyperkalemia is the main concern. Hyperkalemia, not hypokalemia, is a concern because of the decreased aldosterone release that occurs with blockage of angiotensin II.
- A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats per minute, a blood pressure of 150/90 mm Hg, bibasilar crackles, 2+ pitting edema of the ankles, and distension of the jugular veins. The nurse will contact the provider to request an order for which medication? a. ACE inhibitor b. Digoxin (Lanoxin) c.Furosemide (Lasix) d.Spironolactone (Aldactone): c.Furosemide (Lasix) This patient shows signs of fluid volume overload and needs a diuretic. Furosemide is a high-ceiling (loop) diuretic, which can produce profound diuresis very quickly even when the glomerular filtration rate (GFR) is low. An ACE inhibitor will not reduce fluid volume overload. Digoxin has a positive inotropic effect on the heart, which may improve renal perfusion, but this is not its primary effect. Spironolactone is a potassium-sparing diuretic with weak diuresis effects; it is used in conjunction with other diuretics to improve electrolyte balance.
- A diabetic patient is recovering from a myocardial infarction but does not have symptoms of heart failure. The nurse will expect to teach this patient about: a.ACE inhibitors and beta blockers. b.biventricular pacemakers. c.dietary supplements and exercise. d.diuretics and digoxin.: a.ACE inhibitors and beta blockers. This patient is classified as having Stage B heart failure with no current symptoms but with structural heart disease strongly associated with the development of heart failure. Treatment at this stage includes an ACE inhibitor and a beta blocker to help prevent the progression of symptoms. Biventricular pacemakers are used for patients in Stage C heart failure and have more advanced structural disease and symptoms. Dietary supplements and exercise have not been proven to prevent structural heart disease. Diuretics and digoxin are used for patients with Stage C heart failure.
- 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 evalua- tion. As part of the ongoing assessment of this patient, the nurse will expect the provider to evaluate: a.complete blood count. b.ejection fraction. c.maximal exercise capacity. d.serum electrolyte levels.: d.serum electrolyte levels. Patients taking thiazide diuretics can develop hypokalemia, which can increase the risk for dysrhythmias; therefore, the serum electrolyte levels should be monitored closely. A complete blood count is not recommended. This patient is taking the drugs recommended for patients with Stage C heart failure; although the patient's quality of life and ability to participate in activities should be monitored, routine measurement of the ejection fraction and maximal exercise capacity is not recommended.
