NURS 6521 Week 3 Quiz – Question and Answers
NURS 6521 Week 3 Quiz – Question and Answers
Question 1
1 out of 1 points
A normal maintenance
... [Show More] dose for digoxin is 0.125 to 0.5 mg/day. In which of the following patients would the nurse most likely administer a lower-than-normal maintenance dose of digoxin?
Response Feedback: The nurse should continue regular administration of the drug because digoxin requires a loading dose before the drug's therapeutic effect is present. It may take several days for optimal clinical effects to appear. Therefore, seeking an order to increase the dosage, seeking orders to discontinue digoxin and start another drug, or insisting that another drug be ordered would not be necessary at this time.
Question 2
1 out of 1 points
A nurse is caring for a patient who is taking digoxin and a loop diuretic. Which of the following would be most important for the nurse to monitor?
Response Feedback: Although it is important to monitor the patient's ECG, it is more important to closely monitor potassium levels when the patient is taking a drug that promotes the loss of potassium, such as thiazide or loop diuretics. Hypokalemia increases the effect of digoxin and increases the risk for digoxin toxicity. The patient's sodium levels and liver enzyme levels may need to be monitored periodically, but not as closely as potassium levels.
Question 3
1 out of 1 points
Which of the following patients is most likely to benefit from the administration of an adrenergic agonist?
Response Feedback: One of the most frequent indications for adrenergic agonist drugs is shock. Their use is contraindicated in labor, and they would exacerbate hypertension.
Question 4
1 out of 1 points
A nurse has been following a male patient who is taking hydralazine, clonidine, and a diuretic for hypertension. After 2 weeks of medication therapy, the patient begins to complain of numbness and tingling in his hands and feet. The nurse suspects that these signs or symptoms are
Response Feedback: The nurse will evaluate the numbness and tingling in the patient's hands and feet as signs of peripheral neuritis, which is an adverse effect of the hydralazine. If a diagnosis is made to confirm the nurse's suspicion, pyridoxine should be administered because the neuritis may be caused by the antipyridoxine effect of the drug therapy. The numbness and tingling are not associated with clonidine and a diuretic. An increased risk of diabetes has not been identified as being related to this combination of medications.
Question 5
1 out of 1 points
Several months of treatment with a statin accompanied by lifestyle modifications have failed to appreciably improve a patient's cholesterol levels. Consequently, the patient has been prescribed cholestyramine. The nurse should recognize that this drugs achieves its therapeutic effect by
Response Feedback: Unlike statins, which work by decreasing the synthesis of cholesterol, the bile acid sequestrants such as cholestyramine promote the oxidation of cholesterol to bile acids. Bile acid sequestrants do not promote vasodilation or bind HDL to LDL.
Question 6
1 out of 1 points
A nurse has administered a medication to a patient with hypertension. The prescribed drug is supposed to decrease cardiac output. A decrease in cardiac output would most likely
Response Feedback: A drug-induced decrease in cardiac output would cause a decrease in the amount of circulating blood sent through the kidneys. If a patient has normal kidney function, a decrease in cardiac output would not result in an increased serum creatinine level. Further, the decrease in cardiac output would not cause an increased synergistic effect of the drug, nor would it decrease drug absorption in the blood.
Question 7
1 out of 1 points
A nurse is providing patient education to a 35-year-old man who has been prescribed clonidine (Catapres) as part of step 2 antihypertensive therapy. The nurse should anticipate that the drug will be administered
Response Feedback: Clonidine may be administered orally or parenterally but is most frequently administered transdermally.
Question 8
1 out of 1 points
A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by
Response Feedback: Verapamil acts by inhibiting the movement of calcium ions across the cardiac and arterial muscle cell membrane. It works preferentially in “slow response” myocardial tissue, such as the SA and AV nodes. Beta blockers inhibit adrenergic receptors and Class IB antiarrhythmics are among the drugs that decrease sodium and potassium conduction. Lidocaine weakens phase 4 diastolic depolarization and decreases the action potential duration and the effective refractory period of Purkinje fibers and ventricular muscle.
Question 9
1 out of 1 points
A 55-year-old man's hypertension has not responded adequately to his current medication regimen consisting or an ACE inhibitor, a beta-blocker and a thiazide diuretic. As a result, he will soon begin taking hydralazine (Apresoline) in addition to his existing antihypertensives. The addition of this medication to his regimen means that the nurse must prioritize which of the following nursing actions?
Response Feedback: Hydralazine is associated with an increase in cardiac output that can precipitate palpitations, tachycardia, and angina. As a result, there is a need for astute cardiac assessment. The use of hydralazine does not directly necessitate close monitoring of electrolytes or blood sugars, even though these are prudent assessment measures. There is a risk of dizziness and possibly falls with the use of any antihypertensive, but it is unnecessary to supervise all of the patient's ADLs.
Question 10
1 out of 1 points
A 77-year-old patient has a long-standing history of hypertension, a health problem that is being treated with metoprolol and a thiazide diuretic. Before administering the 8 AM dose of these medications, what assessments should the nurse perform and document? (Select all that apply.)
Response Feedback: Because of its effects on blocking beta-1 receptors, metoprolol slows the heart rate, the speed of conduction, and decreases the force of contraction, thus cardiac output is decreased, decreasing blood pressure. Consequently, it is necessary to assess the patient's heart rate in addition to his or her blood pressure. Neither beta blockers nor thiazide diuretics create a direct need for the assessment of temperature, respiratory rate, or oxygen saturation level.
Question 11
1 out of 1 points
An expected outcome for a patient who has just taken sublingual nitroglycerin should be
Response Feedback: Nitroglycerin relaxes vascular smooth muscle and dilates both arterial and venous vessels. Dilation of veins is more predominant than dilation of arteries, resulting in peripheral pooling of blood and decreased preload. Blood pressure will usually decrease as a result of the venous dilation. Reflex tachycardia usually follows the drop in blood pressure.
Question 12
1 out of 1 points
A patient is diagnosed with heart failure and is started on digoxin. On the second day of therapy, lab values, the ECG results, and the patient's symptoms indicate that the medication is not producing a therapeutic effect. An appropriate nursing action would be to
Response Feedback: The nurse should continue regular administration of the drug because digoxin requires a loading dose before the drug's therapeutic effect is present. It may take several days for optimal clinical effects to appear. Therefore, seeking an order to increase the dosage, seeking orders to discontinue digoxin and start another drug, or insisting that another drug be ordered would not be necessary at this time.
Question 13
1 out of 1 points
A nurse is the cardiac care unit is preparing to hang an intravenous dose of dofetilide (Tikosyn) for a patient who has just been admitted. What is the most likely goal of this intervention?
Response Feedback: Dofetilide is used to convert patients in atrial fibrillation to normal sinus rhythm and maintain them in sinus rhythm. This drug is not used in the treatment of bradycardia, heart failure, or ventricular arrhythmias.
Question 14
1 out of 1 points
A nurse explains to a patient that nitroglycerin patches should be applied in the morning and removed in the evening. This medication schedule reduces the potential for
Response Feedback: The nurse will stress that it is important to remove the patch for 10 to 12 hours every 24 hours to prevent nitrate tolerance from developing. If anginal symptoms develop at night, the use of a beta blocker or calcium channel blocker should be considered. Patients who normally have angina only during daytime hours are not at substantial risk for developing nighttime angina with a nightly nitrate-free period. Applying the nitroglycerin patch in the morning and removing it in the evening would not significantly limit the adverse effects from the drug. Dependency does not occur with nitroglycerin, and prescribed dosages should not cause toxic effects.
Question 15
1 out of 1 points
A 39-year-old African-American male is 25 pounds overweight and has been diagnosed with hypertension after three consecutive above-normal blood pressure readings. The most likely initial drug therapy for this patient will be
Response Feedback: The patient would most likely be prescribed a diuretic in combination with diet and other lifestyle changes. African-American men are at increased risk for developing hypertension and tend to respond differently to antihypertensive therapy. The research shows that African-American men are most responsive to single-drug therapy and diuretics. The use of a calcium channel blocker and/or alpha-adrenergic blocker would follow if he is unresponsive to the diuretic in combination with diet and other lifestyle changes. African Americans tend to be less responsive to ACE inhibitors and beta blockers.
Question 16
1 out of 1 points
A nurse is caring for a male patient who has a diagnosis of coronary artery disease (CAD). His drug therapy includes lovastatin. Because the patient has a history of severe renal disease, the nurse will assess for which of the following?
Response Feedback: Patients with severe renal disease may have an increased plasma concentration of lovastatin because 10% of the drug is eliminated in the urine. Patients with renal disorders are not likely to experience a decrease in LDL or an increase in the statin tolerance level.
Question 17
1 out of 1 points
A patient is admitted to the emergency department with severe chest pain. The emergency department physician orders intravenous nitroglycerin 5 mcg/min, titrate dose by 5 mcg/min every 3 to 5 minutes per infusion pump as needed. Before administering the nitroglycerin, the nurse should prioritize which of the following assessments?
Response Feedback: Before administering IV nitroglycerin, the nurse should first assess blood pressure to make sure that the patient does not have hypotension and to establish a baseline blood pressure. It is also important to assess the heart rate and urinary function (urinary output and BUN). However, in the case of administering intravenous nitroglycerin, the nurse would first assess the blood pressure.
Question 18
1 out of 1 points
A patient has recently been prescribed a drug that treats his hypertension by blocking the sympathetic receptors in his sympathetic nervous system. This action is characteristic of
Response Feedback: Those drugs that stimulate sympathetic receptors are referred to as adrenergic or dopaminergic agonists (stimulators) and those that block are referred to as adrenergic antagonists (blockers). Adrenergic antagonism is not synonymous with the action of a cardiotonic drug.
Question 19
1 out of 1 points
A 45-year-old man who is a construction worker has been diagnosed with hyperlipidemia and has been prescribed lovastatin. The nurse will advise the patient to
Response Feedback: Since the patient works outdoors most of the time, the nurse should advise him to avoid prolonged exposure to sunlight by wearing protective gear. Advising the patient regarding the use of OTC drugs and drug changes would be better handled by the prescriber. The patient should not drink moderate amounts of alcohol, but should avoid alcohol altogether while taking lovastatin.
Question 20
1 out of 1 points
A priority nursing assessment for a patient who is to receive an alpha- or beta-adrenergic antagonist would be to
Response Feedback: The patient's heart rate must be assessed prior to administration of alpha- and beta-adrenergic antagonists. These drugs are contraindicated in a patient who has bradycardia; both these drugs could further decrease the heart rate and cause serious conduction complications. Caution should also be exercised in patients with bronchospasms and diabetes mellitus because the combination could worsen both conditions. Because these drugs are mostly excreted in the urine, it would be important for the nurse to be aware of the patient's output. However, the most serious adverse effect would be severe bradycardia, so the nurse's priority would be assessment of the heart rate.
Question 21
1 out of 1 points
A patient with class-IV CHF has a medication regimen consisting of metoprolol (Lopressor), enalapril (Vasotec), and furosemide (Lasix). In addition to regularly assessing the patient s heart rate, the nurse should prioritize assessment of the patient's
Response Feedback: Fluid balance, cognition, and exercise tolerance are all affected by CHF and should be regularly assessed as part of thorough nursing care. However, the combination of an ACE inhibitor, a beta blocker, and a diuretic constitutes a significant risk for hypotension and indicates a need for frequent blood pressure monitoring.
Question 22
1 out of 1 points
A nurse is responsible for patient education for a 48-year-old woman who has been prescribed colestipol. The nurse will instruct the patient to take the medication
Response Feedback: Colestipol is a bile acid sequestrant that promotes the oxidation of cholesterol to bile acids. Cholesterol is the major precursor to bile acids. Bile acids are secreted from the gallbladder and liver into the intestine during digestion. In the intestine, bile acids emulsify the fat and lipid particles from food, promoting absorption. Much of the bile acid that is secreted is reabsorbed and returned to the liver by hepatic circulation. Colestipol binds with the bile acids in the intestine to make them nonresorbable. The bile acids are then eliminated in the stool. Because of this mechanism of action, the drug should be administered before a meal.
Question 23
1 out of 1 points
The nurse is performing patient education for a woman who will soon begin treatment of hyperlipidemia with simvastatin (Zocor). The patient has asked the nurse if there are any “bad side effects” that she should be aware of. Which of the following statements should underlie the nurse's response?
Response Feedback: Adverse effects of lovastatin are usually mild and transient; the drug is generally well tolerated. A fairly common complaint with all statins, including lovastatin, is nonspecific muscle aches or joint aches, weakness, and/or cramps (myalgias), which are not associated with any signs of muscle damage. GI upset and cough are not associated with the use of statins. Renal disease may contraindicate the use of statins, but frequent analysis of kidney function is not necessary for patients with no preexisting indications.
Question 24
1 out of 1 points
A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which of the following actions should the nurse do first when he complains of chest pain?
Response Feedback: The initial action by the nurse should be sublingual administration of the drug by placing one tablet under the patient's tongue and repeating the action in 5 and 10 minutes if necessary. Asking the patient to relax is important and should be done, but administering the tablets would need to be done first. The nurse would not call the physician if the pain has subsided by the third tablet. If the pain has not subsided, the patient is considered to be having an acute MI, and it would be urgent to call the physician. Nitroglycerin does not come in oral form; therefore, it would not be swallowed.
Question 25
1 out of 1 points
A 62-year-old man has been prescribed extended-release lovastatin. The nurse will instruct the patient to take the medication
Response Feedback: Patients who are prescribed extended-release lovastatin should take the medication at bedtime, without food, to be most effective. This is because most cholesterol synthesis occurs during this time. Immediate-release lovastatin should be taken after the evening meal. It would not be appropriate to take lovastatin in the afternoon or the early morning. [Show Less]