Pharmacological Interventions for Cardiovascular Conditions, Exams of Nursing

Download Pharmacological Interventions for Cardiovascular Conditions and more Exams Nursing in PDF only on Docsity! 1 Pharmacology Final Exam Review Questions (Open book quizzes & NCLEX Review Questions) Quiz 6 1.) Potassium chloride 10 mEq intravenously has been ordered for a client whose potassium is 2.9 following diuretics. How will the nurse administer the potassium dose? A) Dilute the dose in a 50 ml IV rider and infused over 1 hour B) Push the dose as a rapid IV push because of the patient’s dangerously low potassium level C) Push the dose slowly over 10 minutes D) Ask to give the dose in a large muscle since the intravenously route is too dangerous 2.) A client who has been taking Lisinopril (an ace inhibitor) for 2 weeks complains of a dry cough. How should the nurse respond to this complaint? A) The cough will subside within 5 to 7 days when the body becomes accustomed to the medicine. B) The cough is a sign of impending angioedema. The client should stop the medicine immediately. C) The cough is a result of immune suppression. The client should stop the medicine immediately D) The cough is a common side effect of prils. Sartans may be prescribed instead if it becomes intolerable 3.) A client is experiencing edema. Which over-the-counter medication might be reducing the diuretic effects of her lisinopril? 2 A) St John’s Wort B) Glucosamine C) Vitamin C D) Ibuprofen 4.) A client, who has been seeing multiple doctors, reports that she is taking Lisinopril and another antihypertensive medication, the name of which she can’t recall. What type of antihypertensive is contraindicated when people are taking ACE inhibitors due to risk of compound effects? 5 8.) While preparing to administer a scheduled dose of digoxin, the nurse finds a new lab result showing a digoxin level of 0.7 ng/mL. What action should the nurse take? A) Hold the drug for an hour and reassess the level. B) Withhold the drug and notify the prescriber immediately. C) Administer Digibind to counteract the toxicity. D) Check the patient’s apical pulse, and if it is within a safe range, administer the digoxin. 9.) A client has been taking digoxin 0.25 mg, and furosemide 40 mg, daily. Upon routine assessment by the nurse, the client states, “I see yellow halos around the lights.” The nurse should perform which of the following actions based on this assessment? A) Consult the provider then request a digoxin and potassium level check B) Withhold the next dose of furosemide. C) Continue to monitor the patient for heart failure. D) Document the findings and reassess in 1 hour. 10.) A client with angina is preparing to go home with a prescription for Nifedipine, a calcium channel blocker. What should the client be taught? A) Elevate your feet when you are sitting to avoid edema side effects B) Drink grapefruit juice with breakfast to reduce your risk of plaque. C) Eat cheese regularly to restore calcium and manage loose stools. 6 D) Use salt substitute to replenish your potassium losses due to diuretic effects 11.) A client with stable angina asks why the physician told her to put her nitro patch on at 8am and take it off at 8pm. What explanation should he be given? A) The doctor is trying to reduce your risk of night falls. B) Patch-free intervals are needed to sustain medication effectiveness. 7 C) The patch should be replaced, not removed at bedtime D) You should follow this advice for any patch medications you use. 12.) A client with stable angina as starting treatment with nifedipine a calcium channel blocker. The client’s spouse asks how nifedipine alleviates chest pain. How should the nurse respond? A) “They reduce platelet aggregation.” B) “They reducing the work of the heart by reducing aortic pressure (afterload).” C) “They increase the heart rate and contractility.” D) “They improve cardiac circulation through vasoconstriction.” 13.) The nurse is providing patient education to a patient who has just been given a new prescription for sublingual nitroglycerin tablets. Which statement by the client would indicate a need for additional teaching? A) “I should take the nitro every 2 to 3 minutes until my pain goes away.” B) “I should take one tablet every 5 minutes, up to a total of three tablets if needed.” C) “I should store my nitroglycerin in its original dark bottle to protect it from light.” D) “I should keep the bottle of nitro tightly closed to protect the tablets.” 10 C) A patient on a heparin drip with a PTT >120 seconds and active GI bleeding D) A patient on a heparin drip with a PTT of 60 seconds and pink-tinged urine 18.) A client is starting sildenafil (Viagra) for the treatment of pulmonary hypertension. Which of these medications could cause a serious reaction if they are taken with sildenafil? A) nitroglycerin, an antianginal 11 B) clopidigrel, and antiplatelet C) simvastatin, an antilipemic D) CoEnzyme Q, an herbal remedy E) doxazosin, an alpha blocker Table for Individual Question Feedback 19.) Atenolol (Tenormin) has been prescribed for a client who is recovering from a recent heart attack. The nurse would consult the provider before giving the medicine in which of these situations? (Select all that apply.) A) Pulse 52 B) BP 108/86 C) Respirations 32 with wheezes D) Blood glucose 50 E) Tension headache F) Parkinsonian tremors 20.) A client presents in the clinic with concerns of having taken his dabigitran (Pradaxa) twice this morning. Realizing that this is a new oral anticoagulant (NOAC), what should the nurse do next? (Select all that apply.) 12 A) Seek advice from the physician B) Ask the client to share how the overdose happened C) Have the client eat a spinach salad D) Have the lab check a stat INR E) Calm the client by explaining that the medication has a 12 hour half life F) Assess for signs of active bleeding 15 D) A client who is allergic to bee stings 3.) A patient with a pneumonia-related cough has been advised to add guaifenesin to the regimen of antibiotics. The client asks about the purpose of the drug. How should the nurse’s respond? guaifenesin will A) Guaifenesin will potentiate the antibiotics you are taking to fight the infection.” B) Guaifenesin will relieve any pain associated with your cough.” C) Guaifenesin will help dry your secretions so that you produce less mucus with your cough.” D) Guaifenesin will help stimulate the flow of secretions and help you bring them up.” 4. ) The nurse is providing patient education to an elderly being treated for duodenal ulcers with Carafate (Sucralfate). The client asks the nurse how sucralfate helps heal ulcers. How should the nurse respond? A) “It creates a protective barrier against pepsin and acid.” B) “It suppresses gastric acidity, irreversibly.” C) “It inhibits the enzyme that generates gastric acid.” D) “It enhances prostaglandin production.” 16 5.) The nurse is providing education to a client who has been prescribed both an antacid and ranitidine (Zantac). Which instruction should the nurse give the client about taking the medications? A) “Take the ranitidine before meals and take the antacid for heartburn if needed after meals.” B) “The antacid and ranitidine should be taken at the same time for better effect.” C) “The antacid should be taken 15 minutes before the ranitidine.” D) “Both medications should be taken on a full stomach.” 17 6.) The nurse is preparing to give medications to a client taking sucralfate (Carafate) and ciprofloxacin (Cipro). The drugs are ordered for 0900. In what manner should the nurse proceed to administer the drugs? A) The nurse should administer the drugs with a full glass of water. B) The nurse should ask the prescriber to stagger the medication times. C) The nurse should administer the two drugs at same time with food. D) The nurse should administer the ciprofloxacin 15 minutes before the sucralfate. 7.) The nurse who is caring for a post-operative client administers Compazine, a phenothiazine (related to Thorazine). What side effects should the nurse watch for, given this classification? A) Extrapyramidal symptoms B) Hyper-vigilance C) Hiccups D) Drooling 20 B) Two finger breadths below the acromium process C) Two inches above or below the umbillicus D) The right lower quadrant of the buttocks 21 12.) A mother brings her 17-year-old daughter to the emergency department and states that the daughter took 40 extended-release acetaminophen tablets. What medication should the nurse procure so it is available when the provider's orders that it should be given. A) flumazenil (Romazicon) B) Solumedrol (methylprednisolone) C) acetylcysteine (Mucomyst) D) protamine sulfate 13.) A spouse is requesting that an alternative for lactulose be given to a constipated client with elevated liver enzymes. How should the nurse respond? A) Explain that Lactulose is the only laxative the Veterans Administration will pay for B) Validate the concern, given the patients liver issues C) Explain that Lactulose binds ammonia in the gut when the impaired liver can't. D) Explain that Lactulose is the final stop. It creates ultimate Laxative dependency 14.) Which antiepileptic medication is considered safer than others in pregnancy A) Lamictal (lamotrigine) B) Dilantin (phenytoin) 22 C) Depakote (valproic acid) D) Neurontin (gabapentin) 15.) Which of these immune modifiers would the nurse question in pregnancy? A) Methotrexate (Trexall) B) Etanercept (Enbrel) 25 C) Attention deficit disorder D) History of migraines E) History of anemia 19.) A spouse of a hospice client wants to know why the sublingual dose of morphine is so much lower than the MS Contin dose that was given orally, and the IM injection dose that was given in the hospital. How should the nurse respond? (Select all that apply) A) The oral dose was a slow delivery dose. Sublingual is rapid, and given more often B) He is losing consciousness, so his need for pain control is less C) The MS Contin was partly metabolized in the liver before it started working D) Sublingual medications enter the bloodstream more quickly than IM doses E) This must be a mistake. He should need more pain control, not less. 20.) A client who is taking Haldol, Aricept, Colace, TUMs and Ampicillin is having loose stools. Which of these may be contributing to the diarrhea? A) Ampicillin B) Haldol (haloperidol) C) Aricept (donepezil) 26 D) Colace (docusate) E) TUMs (calcium carbonate) Correct Answers: 27 1. B 2. B 3. D 4. A 5. A 6. B 7. A 8. C 9. D 10. B 11. A 12. C 13. C 14. A 15. A 16. A 17. A, B, C 18. A, B 19. A, C, D 20. A, C, D Mixed Review Questions from Previous Open Book Quizzes (Quizzes 2, 3, 4, 5) 1.) When metronidazole (Flagyl) is a component of the H. pylori treatment regimen, what instructions should the client receive? A) Avoid foods containing tyramine. B) Take the drug with food. C) Take the drug on an empty stomach. D) Avoid any alcoholic beverages. 30 B) It is customary to administer the same dose IV that would be given subcutaneously per sliding scale C) Insulin should never be given IV, so this order should be questioned. D) Only regular insulin can be administered IV. It is given in smaller increments. 6.) A client calls from home to report that his lispro (Humalog) insulin appears cloudy. What would be the nurse’s best response? A) “Agitate the solution, and the granules should disperse.” B) “Discard the vial. The solution should be clear.” 31 C) “Proceed with the injection. Drawing the solution into the syringe will mix the particles.” D) “Lispro is always cloudy. Proceed with the injection.” 7.) A client with type I diabetes who takes insulin reports taking propranolol for hypertension. Why would this cause the nurse to be concerned? A) the beta blocker can cause insulin resistance and hyperglycemia. B) using the two agents together increases the risk of ketoacidosis. C) propranolol increases insulin requirements because of receptor blocking. D) the beta blocker can mask the symptoms of hypoglycemia. 8.) The nurse manages care for a client with diabetes who takes metformin (Glucophage). Which laboratory result would cause the nurse to question the prescription? A) Elevated creatinine B) Decreased hemoglobin C) Decreased platelets D) Increased iron 9.) The nurse is providing client education after laboratory findings reveal am elevated thyroid- stimulating hormone (TSH). How would the nurse best explain the implications of the laboratory finding to the client? 32 A) “Hypothyroidism causes a decrease in TSH.” B) “The test probably is erroneous, because you don’t have a goiter.” C) “TSH is not a good screening test for thyroid disease.” D) “The low TSH is consistent with hyperthyroidism.” 10.) A steroid dependent client has a blood glucose level of 249 mg/dL. Her blood pressure is 178/99 and she is complaining of muscle aches and weakness. Her face appears very round and puffy.” What would the nurse suspect? What type of advocacy does the client need? 35 14.) A client taking amitriptyline (Elavil) complains of having blurred vision and dry mouth, and he states that he hasn’t had a bowel movement in 3 days, whereas he normally has one daily. His vital signs are temperature 97.6° F, pulse 90/minute, blood pressure 130/79 mm Hg, and respirations 20/minute. Based on this assessment, the nurse should suspect which of the following causes? A) Medication incompatibilities B) Sympatholytic effects C) Dehydration D) Anticholinergic effects 15.) The nurse is preparing to administer lithium (Eskalith), to a client with bipolar disorder whose lithium level is 2.0 mEq/L. What symptoms might the nurse expect to see? (Select all that apply.) A) Irregular heart rate B) Hunger C) Slurred speech D) Unsteady gate E) Pacing F) Drooling 16.) A client who has been taking an antiepileptic medication with a narrow therapeutic window for 2 weeks seems confused and forgetful. What should be the priority action of the nurse? 36 A) Call the prescriber and have them change the seizure medication changed. B) Give an antihistamine like diphenhydramine under house protocol for a suspected allergy. C) Seek a plasma drug level from the client’s physician. D) Set up oxygen and obtain an order for activated charcoal. 17.) A nurse in the emergency department is caring for a client whose family reports that she had taken an overdose of diazepam. Which of the following medications should the nurse have available to reverse the CNS depression caused by this drug? 37 A) Ondasteron (Zofran) B) Magnesium sulfate C) Flumazanil (Romazicon) D) Protamine sulfate 18.) A nurse is reviewing a client’s list of medications and notices that he is taking two anticholinergics. Which of his recent symptoms could be caused by his anticholinergic medications? (Select all that apply) A) Epigastric distress B) Tachycardia C) Dry mouth D) Frequent loose stools E) Blurred vision 19.) A client is using a prn scopolamine patch for motion sickness. Knowing that the medication has anticholinergic side effects, the client should be taught to anticipate which side effects? (Select all that apply!) A) Urine retention B) Blurred vision C) Dry mouth 40 16.) C 17.) C 18.) B, C, E 19.) A, B, C 20.) A, B, C 21.) C, D NCLEX Study Questions from textbook Respiratory 41 1.) A patient tells the nurse that he has started to take an over-the-counter (OTC) antihistamine, diphenhydramine (Benadryl). In teaching about side effects, what is most important for the nurse to tell the patient? A. Do not to take this drug at bedtime to avoid insomnia. B. Avoid driving a motor vehicle until stabilized on the drug. C. Nightmares and nervousness are more likely in an adult. D. Medication may cause him to have excessive secretions. 2.) A patient complains of a sore throat and has been told it is due to beta-hemolytic streptococcal infection. The nurse anticipates that the patient has which acute condition? A. Rhinitis B. Sinusitis C. Pharyngitis D. Rhinorrhea 3.) A patient is prescribed the decongestant oxymetazoline (Afrin) nasal spray. What will the nurse teach the patient? A. Take this drug at bedtime because it may cause drowsiness. B. Directly spray the medication away from the nasal septum, and gently sniff. C. This drug may be used in maintenance treatment for asthma. D. Limit use of the drug to 5 to 7 days to prevent rebound nasal congestion. 42 4.) A patient has been prescribed guaifenesin (Robitussin). The nurse understands that the purpose of the drug is to accomplish what? A. Treat allergic rhinitis and prevent motion sickness. B. Loosen bronchial secretions so coughing can eliminate them. C. Compete with histamine for receptor sites, thus preventing a histamine response. D. Stimulate alpha-adrenergic receptors, thus producing vascular constriction of capillaries in nasal mucosa. 5.) Beclomethasone (Beconase) has been prescribed for a patient with allergic rhinitis. What should the nurse teach the patient regarding this medication? 45 D. It is taken as one puff two times a day. E. It promotes bronchodilation. 2.) A patient with COPD has an acute bronchospasm. The nurse anticipates that the health care provider will prescribe which medication? A. zafirlukast (Accolate) B. epinephrine (Adrenalin) C. dexamethasone (Decadron) D. oxtriphylline-theophyllinate 3.) A patient is prescribed aminophylline–theophylline. For what adverse effect should the nurse monitor the patient? A. Drowsiness B. Hypoglycemia C. Increased heart rate D. Decreased white blood cell count 4.) A patient is receiving IV aminophylline. The nurse checks the patient's lab values. The serum theophylline level is 32 mcg/mL. What action should the nurse take? A. Assess the patient's breath sounds for improvement. B. Increase the dosage per sliding scale directions. C. Notify the health care provider of the level. 46 D. Have the laboratory collect another sample to verify the results. 5.) A patient with COPD is taking a leukotriene antagonist, montelukast (Singulair). The nurse is aware that this medication is given for which purpose? A. Maintenance treatment of asthma B. Treatment of acute asthmatic attack C. Reversing bronchospasm associated with COPD D. Treatment of inflammation in chronic bronchitis 47 Correct Answers: 1.) B, D, E 2.) B 3.) C 4.) C 5.) A Cardiac 1.) The patient is receiving digoxin for treatment of heart failure. Which finding would suggest to the nurse that heart failure is improving? A. Pale and cool extremities B. Absence of peripheral edema C. Urine output of 60 mL/4 h D. Complaints of increasing dyspnea 2.) The patient's serum digoxin level is 3.0 ng/mL. What does the nurse know about this serum digoxin level? A. It is in the high (elevated) range. B. It is in the low (decreased) range. C. It is within the normal range. D. It is in the low average range. 3.) The nurse is assessing a patient for possible evidence of digitalis toxicity. The nurse acknowledges that which is included in the signs and symptoms for digitalis toxicity? 50 C. The beta blocker dose should be maintained while taking another antianginal drug. D. Half the beta blocker dose should be taken for the next several weeks. 8.) The beta blocker acebutolol (Sectral) is prescribed for dysrhythmias. The nurse knows that what is the primary purpose of the drug? A. Increase beta1 and beta2 receptors in cardiac tissues B. Increase the flow of oxygen to cardiac tissues C. Block beta1-adrenergic receptors in cardiac tissues D. Block beta2-adrenergic receptors in cardiac tissues 51 9.) A patient who has angina is prescribed nitroglycerin. Which are appropriate nursing interventions for nitroglycerin? (Select all that apply.) A. Have patient sit or lie down when taking a nitroglycerin sublingual tablet. B. Teach patient who has taken a tablet to call 911 in 5 minutes if chest pain persists. C. Apply Transderm-Nitro patch to a hairy area to protect skin from burning. D. Call the health care provider after taking five tablets if chest pain persists. E. Warn patient against ingesting alcohol while taking nitroglycerin. Correct Answers: 1.) B 2.) A 3.) D 4.) A 5.) B 6.) C 7.) B 8.) C 9.) A, B, E Cardiac 1.) A patient is taking hydrochlorothiazide (HCTZ) 50 mg/day and digoxin (Lanoxin) 0.25 mg/day. The nurse plans to monitor the patient for which potential electrolyte imbalance? A. Hypocalcemia B. Hypokalemia C. Hyperkalemia 52 D. Hypermagnesemia 2.) The nurse knows that which statement is correct regarding nursing care of a patient receiving hydrochlorothiazide (HCTZ)? (Select all that apply.) A. Monitor patient for signs of hypoglycemia. B. Administer ordered potassium supplements. C. Monitor serum potassium and uric acid levels. 55 A. Hypokalemia B. Hyperkalemia C. Hypoglycemia D. Hypermagnesemia Correct Answers: 1.) B 2.) B, C, D, E 3.) B 4.) A 5.) B 6.) B 7.) B 1.) A patient's blood pressure (BP) is 130/84. The health care provider plans to suggest nonpharmacologic methods for the patient. Which should the nurse include in teaching? (Select all that apply.) A. Stress-reduction techniques B. Starting an exercise program C. Salt restriction D. Smoking cessation E. Diet with increased protein 2.) A patient has developed mild hypertension. The nurse acknowledges that the first-line drug for treating this patient's blood pressure might be which drug? A. Diuretic B. Alpha blocker 56 C. ACE inhibitor D. Alpha/beta blocker 3.) An African-American patient has developed hypertension. The nurse is aware that which group(s) of antihypertensive drugs are less effective in African-American patients? A. Diuretics B. Calcium channel blockers and vasodilators 57 C. Beta blockers and ACE inhibitors D. Alpha blockers 4.) The nurse knows that which diuretic is most frequently combined with an antihypertensive drug? A. chlorthalidone B. hydrochlorothiazide C. bendroflumethiazide D. potassium-sparing diuretic 5.) The nurse is administering a beta blocker to a patient. Which is an important assessment to perform before administration? A. Urine output B. Apical pulse C. Potassium level D. Serum level of medication 6.) Captopril (Capoten) has been ordered for a patient. The nurse teaches the patient that angiotensin- converting enzyme (ACE) inhibitors have which common side effects? A. Nausea and vomiting B. Dizziness and headaches C. Upset stomach 60 E. Disseminated intravascular coagulation 2.) A patient who received heparin begins to bleed. The nurse anticipates that the health care provider will order which antidote? A. protamine sulfate B. vitamin K1 (Mephyton) C. aminocaproic acid (Amicar) 61 D. potassium chloride (KCl) 3.) A patient is prescribed enoxaparin (Lovenox). The nurse knows that low–molecular-weight heparin has what kind of half-life? A. A longer half-life than heparin B. A shorter half-life than heparin C. The same half-life as heparin D. A four times shorter half-life than heparin 4.) The nurse is teaching a patient about clopidogrel (Plavix). Which information will the nurse include in the patient's teaching plan? A. Constipation may occur. B. Hypotension may occur. C. Bleeding may increase when taken with aspirin. D. Normal dose is 25 mg tablet per day. 5.) A patient had an orthopedic surgery and is prescribed dalteparin (Fragmin). What would the nurse teach the patient and/or family about this low–molecular-weight heparin (LMWH) before discharge? A. How to administer the medication intramuscularly B. PT and INR monitoring will be done weekly. C. Avoidance of green leafy vegetables is recommended. D. Watch for bleeding or excessive bruising. 62 6.) A patient is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally? A. enoxaparin sodium (Lovenox) B. warfarin (Coumadin) C. bivalirudin (Angiomax) D. lepirudin (Refludan) 7.) A patient is taking warfarin 5 mg/day for atrial fibrillation. The patient's international normalized ratio (INR) is 3.8. The nurse would consider the INR to be what? 65 4.) C 5.) D 6.) B 7.) B 8.) D 9.) B 10.) C 1.) A patient has a serum cholesterol level of 265 mg/dL, triglyceride level of 235 mg/dL, and LDL of 180 mg/dL. What do these serum levels indicate? A. Hypolipidemia B. Normolipidemia C. Hyperlipidemia D. Alipidemia 2.) The nurse knows that a patient's total cholesterol level should be within which range? A. 150 to 200 mg/dL B. 200 to 225 mg/dL C. 225 to 250 mg/dL D. >250 mg/dL 3.) A patient has a low-density lipoprotein (LDL) of 175 mg/dL and a high-density lipoprotein (HDL) of 30 mg/dL. What teaching should the nurse implement for this patient? A. Discuss medications ordered, dietary changes, and exercise. B. No changes in lifestyle are needed and continue with current plan. C. Discuss how to have fat intake be 40% of caloric intake. 66 D. Begin keeping a food diary and schedule lab work to be repeated in 6 months. 4.) Which laboratory test value does the nurse realize can contribute to the development of cardiovascular disease and stroke? A. Decreased antidiuretic hormone B. Increased homocysteine level C. Decreased triglycerides D. Increased HDL level 67 5.) A patient is taking lovastatin (Mevacor). Which serum level is most important for the nurse to monitor? A. Blood urea nitrogen B. blood count C. Cardiac enzymes D. Liver enzymes 6.) For what severe skeletal muscle adverse reaction should the nurse observe in a patient taking rosuvastatin (Crestor)? A. Myasthenia gravis B. Rhabdomyolysis C. Dyskinesia D. Agranulocytosis 7.) A patient is taking ezetimibe (Zetia) and asks the nurse how it works. The nurse should explain that ezetimibe does what? A. Inhibits absorption of dietary cholesterol in the intestines. B. Binds with bile acids in the intestines to reduce LDL levels. C. Inhibits HMG-CoA reductase, which is necessary for cholesterol production in the liver. D. Forms insoluble complexes and reduces circulating cholesterol in the blood. 8.) A patient is diagnosed with peripheral arterial disease. He is prescribed pentoxifylline (Trental). What does the nurse realize are the effects of pentoxifylline? (Select all that apply.) 70 3.) A patient who has constipation is prescribed a bisacodyl (Dulcolax) suppository. Which explanation will the nurse use to explain the action of bisacodyl? A. Acts on smooth intestinal muscle to gently increase peristalsis B. Absorbs water into the intestines to increase bulk and peristalsis C. Lowers surface tension and increases water accumulation in the intestines D. Pulls salts into the colon and increases water in the feces to increase bulk 4.) A patient is using scopolamine (Transderm-Scōp) to prevent motion sickness. About which common side effect should the nurse teach the patient? 71 A. Diarrhea B. Vomiting C. Insomnia D. Dry mouth 5.) When metoclopramide (Reglan) is given for nausea, the nurse plans to caution the patient to avoid which substance? A. Milk B. Coffee C. Alcohol D. Carbonated beverages 6.) The nurse is administering diphenoxylate with atropine (Lomotil) to a patient. Which should be included in the patient teaching regarding this medication? (Select all that apply.) A. Caution the patient to avoid laxative abuse. B. Record the frequency of bowel movements. C. Caution the patient against taking sedatives concurrently. D. Encourage the patient to increase fluids. E. Instruct the patient to avoid this drug if he or she has narrow-angle glaucoma. F. Teach the patient that the drug acts by drawing water into the intestine. Correct Answers: 72 1.) B 2.) B 3.) A 4.) D 5.) C 6.) A, B, C, D, E 1.) A patient is diagnosed with peptic ulcer disease. The nurse realizes that which factor is a predisposing factor for this condition? A. Helicobacter pylori 75 C. Dry mouth D. Headaches E. Blurred vision F. Decreased libido 6.) The patient is taking esomeprazole magnesium (Nexium) for an erosive GERD. Which should the nurse include in patient teaching? A. Take with breakfast daily. B. Healing should occur in one week. C. This medication decreases stomach acid secretion. D. Blood test to check kidney function should be done. Correct Answers: 1.) A 2.) D 3.) C, E, F 4.) D 5.) B, D, F 6.) C Emergency Drugs 1.) The nurse is administering atropine 0.3 mg IV to a 75-year-old patient with a heart rate of 45, and his heart rate decreases to 38. What is the most likely explanation? 76 A. Atropine exerts its effects by stimulating the vagus nerve. B. The ordered dose was too low. C. Adenosine was indicated, not atropine. D. Atropine typically slows heart rate first and then increases it. 2.) An 80-year-old woman with a hip fracture received morphine 3 mg IV 20 minutes ago. The patient's son runs to the nurses' station and says that his mother is no longer responding to him. What actions should the nurse take? 77 A. Assess the patient; call for additional assistance; support breathing with a bag-valve-mask device as indicated, and prepare to administer flumazenil. B. Call the physician and report that the patient most likely suffered a stroke and now has elevated intracranial pressure; prepare to administer mannitol. C. Assess the patient; call for additional assistance; support breathing with a bag-valve-mask device as indicated, and prepare to administer naloxone. D. Explain to the patient's son that the morphine is taking effect and that unresponsiveness is the desired outcome to best manage her pain. 3.) The nurse is caring for a 21-year-old woman with a closed head injury. Her intracranial pressure is 35 (normal <20). Her serum osmolality is 330. The nurse should anticipate which action? A. Administer mannitol. B. Withhold mannitol at this time, but take other measures to reduce intracranial pressure. C. Administer sodium nitroprusside. D. Take no action at this time because the patient has a serum osmolality of 330, which will offset the effects of the elevated intracranial pressure. 4.) A dopamine infusion was started in a patient's antecubital vein during resuscitation after cardiac arrest. The electronic infusion device is now sounding an alert for an occlusion. What is the most important immediate concern for the nurse? A. Infiltration with phentolamine will be necessary if there is extravasation. B. An interruption in the infusion can produce hypotension in the patient. C. The device will need to be reported to the hospital's clinical engineering department for service. D. The patient could develop hypertension as a result of the alarm. 80 9.) A 25-year-old woman was admitted to the emergency department after a successful prehospital resuscitation from cardiac arrest owing to an asthma attack. On arrival, her pulse oximeter reading is 85%. Given her condition, what is the most important initial medication to administer as ordered? A. epinephrine B. sodium bicarbonate C. albuterol D. oxygen 81 10.) The nurse practitioner orders epinephrine 0.3 mg IM for a severe allergic reaction to a bee sting in an adult patient. Which concentration of epinephrine should the nurse select to administer this particular dose? A. 1 :10,000 B. 1 : 1000 C. 1 : 100 D. 1 : 10 11.) The emergency physician orders activated charcoal for a teenage girl who took an intentional overdose of aspirin and several unknown drugs from her parent's medicine cabinet. Upon preparing to administer the activated charcoal by mouth, the nurse notes that the patient has become very somnolent and opens her eyes only to a noxious stimulus. Which action by the nurse is most appropriate at this point? A. Immediately discuss the change in the patient's mental status with the physician so that the plan of care can be reevaluated. B. Immediately insert a nasogastric tube, and administer the activated charcoal. C. Immediately elevate the head of the patient's stretcher, and coax her to drink the activated charcoal while applying noxious stimuli as necessary to keep her awake. D. Give only half the dose now, and wait until her mental status improves before giving the remainder of the dose. 12.) While getting dressed to go home after minor outpatient surgery on his leg for removal of a mole, a 62-year-old patient notifies the nurse that he has severe chest pain. He is also diaphoretic and complains of shortness of breath. The surgeon is notified and orders administration of aspirin 325 mg PO while quickly making arrangements to transfer the patient to the emergency department. Which is the best course of action by the nurse? A. Question the aspirin order because the patient just had a surgical procedure and might have bleeding complications. 82 B. After checking for drug allergies, first instruct the patient to chew the aspirin tablet and then administer the aspirin. C. After checking for drug allergies, instruct the patient to swallow the aspirin tablet whole. D. Suggest to the surgeon that the enteric-coated form of aspirin might be better tolerated by the patient to avoid GI distress.