NURS 6521N 32,Advanced Pharmacology Week 3 Quiz Attempt Score 25 out of 25 points
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QUESTION 1
1. 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?
A Potassium levels
.
B Liver enzymes
.
C Electrocardiogram
. results
D Sodium levels
.
QUESTION 2
1. 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
A intake and
. output.
B cognition.
.
C exercise
. tolerance.
D blood
. pressure.
QUESTION 3
1. 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
A decrease drug absorption in the blood.
.
B increase the synergistic effect of the drug.
.
C decrease the amount of circulating blood sent
. through the kidneys.
D increase the serum creatinine level.
.
QUESTION 4
1. 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?
A To resolve the patient's uncompensated heart
. failure
B To treat sinus bradycardia accompanied by
. hypotension
C To convert the patient's atrial fibrillation to normal
. sinus rhythm
D To treat the patient's ventricular tachycardia
.
QUESTION 5
1. 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
A avoid prolonged exposure to sunlight.
.
B use over-the-counter (OTC) drugs to treat any muscle
. cramps or pain.
C drink moderate amounts of alcohol.
.
D change to another similar drug if lovastatin proves to
. be ineffective.
QUESTION 6
1. A nurse who provides care in a busy clinic is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics in many patients. Treatment of high cholesterol using statins would be contraindicated in which of the following patients?
A A 72-year-old man who has emphysema and a 55-pack-year history of
. cigarette smoking
B An obese male client who is a heavy alcohol user and who has cirrhosis
. of the liver
C A female client who had a laparoscopic cholecystectomy (gall bladder
. removal) earlier this year
D A resident of a long-term care facility whose Alzheimer disease is being
. treated with donepezil (Aricept)
QUESTION 7
1. A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the nurse should perform and document what assessments?
A Oxygen saturation and
. respiratory rate
B Level of consciousness and
. pain level
C Temperature and respiratory
. rate
D Heart rate and blood pressure
.
QUESTION 8
1. 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?
A Heart rate
.
B Blood pressure
.
C Blood urea nitrogen
. (BUN)
D Urinary output
.
QUESTION 9
1. A normal maintenance 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?
A A 25-year-old male with congestive heart failure and
. atrial fibrillation
B A 32-year-old female with cardiomegaly
.
C A 42-year-old female with a third heart sound
.
D A 79-year-old male with cardiomegaly
.
QUESTION 10
1. A nurse is caring for a patient who is admitted into the cardiac care unit with acute, decompensated heart failure. Nesiritide (Natrecor) has been ordered. When preparing for administration of the drug, the nurse will
A use the reconstituted solution within a 36-hour
. period.
B shake the vial vigorously to mix the medication for
. reconstitution.
C add the reconstituted vial of medication to a 1,000
. mL IV bag.
D administer the initial IV bolus over approximately 60
. seconds.
QUESTION 11
1. 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
A an adrenergic
. antagonist.
B a cardiotonic.
.
C a neurotransmitter.
.
D an adrenergic
. agonist.
QUESTION 12
1. A 77-year-old man's chronic heart failure is being treated with a regimen of quinapril (Accupril) and furosemide (Lasix). Which of the following assessment findings would suggest that the loop diuretic is contributing to a therapeutic effect?
A The man's potassium and sodium levels remain with reference
. ranges.
B The man's glomerular filtration rate and creatinine levels are within
. reference ranges.
C The man's heart rate is between 60 and 70 beats per minute with a
. regular rhythm.
D The man's chest sounds are clear and his ankle edema is lessened.
.
QUESTION 13
1. 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
A two hours before a
. meal.
B at bedtime.
.
C after a meal.
.
D before a meal.
.
QUESTION 14
1. 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?
A Have the patient swallow a tablet every 5 minutes for 15 minutes
.
B Call the physician
.
C Administer a tablet under his tongue and repeat the action in 5 and 10
. minutes if the pain has not subsided
D Ask the patient to lie back and try to relax
.
QUESTION 15
1. 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
A nitrate
. tolerance.
B toxic effects.
.
C nitrate
. dependence.
D adverse
. effects.
QUESTION 16
1. 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?
A Checking the patient's blood glucose levels before each
. meal and at bedtime
B Frequent assessment of the patient's cardiac status
.
C Close monitoring of the patient's electrolyte levels
.
D Supervision of the patient when performing activities of
. daily living
QUESTION 17
1. 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
A an idiosyncratic reaction to
. clonidine.
B a result of new onset
. diabetes.
C an adverse effect of the
. diuretic.
D signs of peripheral neuritis.
.
QUESTION 18
1. A clinic nurse has been assigned a 49-year-old female patient who has a history of diabetes. A recent diagnosis of hypertension has been made, and the patient has been prescribed a thiazide diuretic and labetalol. The patient will be scheduled to return to the clinic once a month for the next 6 months. A priority action by the nurse will be to
A monitor the patient's respiratory
. rate.
B monitor the patient's blood
. pressure.
C weigh the patient.
.
D question the patient about her
. dietary intake.
QUESTION 19
1. 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
A an ACE inhibitor.
.
B a beta blocker.
.
C a calcium channel
. blocker.
D a diuretic.
.
QUESTION 20
1. 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.)
A Blood
. pressure
B Respiratory
. rate
C Temperature
.
D Heart rate
.
E. Oxygen
saturation
QUESTION 21
1. A 62-year-old man has been prescribed extended-release lovastatin. The nurse will instruct the patient to take the medication
A at bedtime.
.
B in the early
. morning.
C in the evening.
.
D in the afternoon.
.
QUESTION 22
1. A patient has been prescribed lovastatin for a high cholesterol level. The nurse's teaching plan will include a basic explanation of how the drug produces its therapeutic effect. The nurse will explain that lovastatin lowers cholesterol levels because it
A consists of a fibric acid
. derivative.
B is a bile-acid resin.
.
C is a hormone.
.
D inhibits cholesterol
. syntheses.
QUESTION 23
1. An expected outcome for a patient who has just taken sublingual nitroglycerin should be
A increased heart rate and decreased
. blood pressure.
B increased heart rate and increased
. blood pressure.
C decreased heart rate and decreased
. blood pressure.
D decreased heart rate and increased
. blood pressure.
QUESTION 24
1. A patient is brought to the emergency department in hypertensive crisis. Nitroprusside is administered intravenously. The patient experiences diaphoresis and dizziness. Which of the following is the appropriate action by the nurse?
A Ask the prescriber to reduce the
. dose
B Give the nitroprusside at the
. ordered rate
C Obtain an order for naloxone
.
D Slow the rate of the infusion
.
QUESTION 25
1. Which of the following patients is most likely to benefit from the administration of an adrenergic agonist?
A A man who is in cardiogenic shock following a
. myocardial infarction
B A woman who is in labor and may require a caesarean
. section
C A man who has a diagnosis of primary hypertension
.
D A woman who has been admitted with a suspected
. ischemic stroke
Review Test Submission: Week 3 - Quiz
Feedback
• Question 1
A nurse is caring for a patient who is taking digoxin and a loop diuretic.
1 out of 1 points
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 2
A patient with class-IV CHF has a medication regimen consisting of metoprolol (Lopressor), enalapril (Vasotec), and furosemide (Lasix). In
1 out of 1 points
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 3
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 4
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 5
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 6
1 out of 1 points
A nurse who provides care in a busy clinic is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics in many patients. Treatment of high cholesterol using statins would be contraindicated in which of the following patients?
Response Feedback:
Active liver disease is a contraindication to the use of statins. As well, heavy alcohol use increases the risk of liver dysfunction.
Respiratory disease, recent surgery, and organic cognitive deficits do not preclude the use of statins for high cholesterol.
• Question 7
A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the nurse should perform and document what assessments?
1 out of 1 points
Response Feedback:
Metoprolol has a profound effect on both blood pressure and heart rate. Consequently, the nurse should assess these parameters prior to administering the drug. Assessments related to pain, respiratory status, cognition, and temperature are not central to the administration of a beta blocker.
• Question 8
A patient is admitted to the emergency department with severe chest pain. The emergency department physician orders intravenous
1 out of 1 points
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 9
1 out of 1 points
A normal maintenance 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 10
A nurse is caring for a patient who is admitted into the cardiac care unit with acute, decompensated heart failure. Nesiritide (Natrecor) has been ordered. When preparing for administration of the drug, the nurse will
1 out of 1 points
Response Feedback
:
Nesiritide must be reconstituted and then further diluted for infusion. Reconstitute one vial by adding 5 mL of diluent that has been removed from a 250-mL plastic IV bag. Do not shake the vial. Rock the vial gently so that all surfaces, including the stopper, are in contact with the diluent. Add the entire contents of the reconstituted vial back to the 250-mL plastic IV bag and invert the bag several times to ensure complete mixing. Use the reconstituted nesiritide solution within 24 hours. The initial IV bolus must be drawn from the prepared infusion bag and administered over approximately 60 seconds through an IV port.
• Question 11
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 12
1 out of 1 points
A 77-year-old man's chronic heart failure is being treated with a regimen of quinapril (Accupril) and furosemide (Lasix). Which of the following assessment findings would suggest that the loop diuretic is contributing to a therapeutic effect?
Response Feedback:
Appropriate diuretic therapy leads to the resolution of pulmonary and peripheral edema. Healthy kidney function, cardiac rhythm, and electrolyte levels are all desirable outcomes, but they are not directly indicative of the therapeutic action of diuretics in the treatment of CHF.
• Question 13
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 14
A 62-year-old man is admitted to the hospital with a diagnosis of chest
1 out of 1 points
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 15
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 16
A 55-year-old man's hypertension has not responded adequately to his
1 out of 1 points
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 17
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
1 out of 1 points
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 18
1 out of 1 points
A clinic nurse has been assigned a 49-year-old female patient who has a history of diabetes. A recent diagnosis of hypertension has been made, and the patient has been prescribed a thiazide diuretic and labetalol. The patient will be scheduled to return to the clinic once a month for the next 6 months. A priority action by the nurse will be to
Response Monitoring of blood pressure would be the priority assessment in
Feedback: the care of this patient. Questioning the patient about her dietary intake and weighing her would be appropriate, but secondary in importance. It is unnecessary to monitor the patient's respiratory rate.
• Question 19
A 39-year-old African-American male is 25 pounds overweight and has
1 out of 1 points
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 20
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 21
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.
• Question 22
1 out of 1 points
A patient has been prescribed lovastatin for a high cholesterol level. The nurse's teaching plan will include a basic explanation of how the drug produces its therapeutic effect. The nurse will explain that lovastatin lowers cholesterol levels because it
Response Feedback
:
Lovastatin belongs to a group of drugs classified as statins. These drugs work by inhibiting cholesterol synthesis in the liver. Fibric acid derivatives and bile-acid resins also decrease cholesterol levels but they work at different sites. Fibric acid derivatives work on lipoproteins and triglycerides to reduce cholesterol, and bile- acid resins work in the gastrointestinal tract and bind bile salts in the intestine. Lovastatin is not a hormone.
• Question 23
An expected outcome for a patient who has just taken sublingual nitroglycerin should be
1 out of 1 points
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 24
1 out of 1 points
A patient is brought to the emergency department in hypertensive crisis. Nitroprusside is administered intravenously. The patient experiences diaphoresis and dizziness. Which of the following is the appropriate action by the nurse?
Response Feedback
:
Administering nitroprusside too quickly can result in abdominal pain, apprehension, diaphoresis, dizziness, headache, muscle twitching, nausea, palpitations, restlessness, retching, and retrosternal discomfort. The nurse should quickly inform the prescriber and slow the infusion. Symptoms quickly subside when the nitroprusside infusion is slowed or stopped, and usually do not return when the infusion resumes at a slower rate. Consulting the prescriber for a dose change would not help; the rate of drug administration is the issue. Continuing to give the nitroprusside at the ordered rate could be fatal.
• Question 25
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. [Show Less]