Pharmacology of Commonly Prescribed Drugs, Exams of Nursing

Download Pharmacology of Commonly Prescribed Drugs and more Exams Nursing in PDF only on Docsity! 1 [Date] 1 NURSING Exam #2 SG Questions with Answers-PHARM Latest Update Chapter 15: Adrenergic Agonists and Antagonists 1. The nurse is caring for a patient who has asthma and administers a selective beta2-adrenergic agonist to treat bronchospasm. The nurse will expect this drug to also cause which side effect? a. Increased blood glucose b. Increased blood pressure c. Increased heart rate d. Increased gastrointestinal (GI) motility ANS: A Drugs that act on beta2 receptors activate gluconeogenesis in the liver, causing increased blood glucose. Selective beta2 drugs act on beta2 receptors only and not on beta1 receptors, so they do not cause increased blood pressure or increased heart rate. Adrenergic agonists cause decreased GI motility. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A patient who has asthma is diagnosed with hypertension. The nurse understands that which drug will be the safest to give this patient? a. Pindolol (Vise) b. Metoprolol (Lopressor) c. Nadolol (Corgard) 2 [Date] 1 d. Propranolol (Inderal) ANS: B Metoprolol is a cardioselective adrenergic blocker that has a greater affinity for receptors that decrease heart rate and blood pressure and is less likely to cause bronchospasm. The other adrenergic blockers are not selective and can cause bronchoconstriction. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. The nurse administers epinephrine to a patient who is experiencing an anaphylactic reaction. The nurse should expect which of the following? a. Bradycardia b. Decreased urine output c. Hypotension d. Nausea and vomiting ANS: B Epinephrine can cause renal vasoconstriction and thereby reduce renal perfusion and decrease urinary output. Epinephrine causes tachycardia and elevates blood pressure. Nausea and vomiting are not expected to occur. 4. An adult patient is brought to the emergency department for treatment of an asthma exacerbation. The patient uses inhaled albuterol as needed to control wheezing. The nurse notes expiratory wheezing, tremors, restlessness, and a heart rate of 120 beats per minute. The nurse suspects that the patient has: a. overused the albuterol. 5 [Date] 1 b. Reassure the patient that these symptoms are common and not worrisome. c. Recommend that the patient discuss these effects with the provider. d. Suggest that the patient request a different beta-adrenergic blocker. ANS: C Beta-adrenergic blockers can cause these side effects, which are often dose related. Patients experiencing these side effects should be encouraged to discuss them with their providers. Beta blockers should not be discontinued abruptly, or rebound symptoms may occur. Since symptoms may be dose related, reassuring the patient is not correct. All beta blockers have similar side effects. 9. A patient will begin taking albuterol (Proventil) to treat asthma. The patient has no other chronic medical conditions. When teaching the patient about this drug, the nurse will make which recommendation? a. Report rapid or irregular heart rate. b. Drink 8 to 16 extra ounces of fluid each day. c. Monitor serum glucose daily. d. Take a calcium supplement. ANS: A N High dosages of albuterol may affect beta1 receptors, causing an increase in heart rate that could be dangerous. It is not necessary to consume extra fluids or take a calcium supplement while using this drug. Serum glucose may be elevated slightly, but this is not a concern in patients without diabetes. 6 [Date] 1 10. A patient is taking doxazosin mesylate (Cardura) 1 mg/day to treat hypertension. The nurse notes a blood pressure of 110/72 mm Hg and a heart rate of 92 beats per minute. The nurse will contact the provider to discuss which change to the drug regimen? a. Changing to a beta-adrenergic blocker b. Decreasing the drug dose c. Increasing the drug dose d. Adding a diuretic ANS: A Alpha-adrenergic blockers can cause orthostatic hypotension and reflex tachycardia. Beta blockers do not cause reflex tachycardia. Decreasing or increasing the drug dose is not recommended. Diuretics are added if blood pressure is not well controlled. 11. A patient who has Raynaud’s disease will begin taking an alpha- adrenergic blocker. The patient asks the nurse how the drug works to treat symptoms. The nurse explains that alpha-adrenergic blockers treat Raynaud’s disease by causing: a. decreased peripheral vascular resistance. b. orthostatic hypotension. c. reflex tachycardia. d. vasodilation. ANS: D Alpha-adrenergic blockers can be used to treat peripheral vascular disorders like Raynaud’s disease because they cause vasodilation. 7 [Date] 1 12. A patient will be discharged home on a beta blocker. Which skill is essential for the nurse to teach the patient’s family? a. How to prepare a low-sodium diet b. Assessments to detect fluid retention c. How to monitor heart rate and blood pressure d. Early signs of changing level of consciousness ANS: C Because of the action and side effects of beta blockers, heart rate and blood pressure should be monitored frequently. 13. Reserpine would be best categorized as which of the following? a. Adrenergic neuron antagonist b. Alpha blocker c. Beta blocker d. Alpha agonist ANS: A Drugs that block the release of norepinephrine from the sympathetic terminal neurons are called adrenergic neuron antagonists (adrenergic neuron blockers). The clinical use is to decrease blood pressure. For example, reserpine is an antihypertensive agent that closely resembles alpha- and beta-adrenergic blockers; it also reduces the serotonin and catecholamine trANSmitters, depletion of which may lead to severe mental depression. 14. A patient has been started on a treatment regimen that includes atenolol (Tenormin) and complains to the nurse of feeling weak and fatigued. Which is the best response from the nurse? 10 [Date] 1 a. muscarinic receptors are present in many different tissues. b. the action of cholinesterase alters the bioavailability at different sites. c. these drugs can also affect nicotinic receptors. d. they vary in their reversible and irreversible effects. ANS: A Although drugs classified as direct-acting cholinergic agonists are primarily selective for muscarinic receptors, they are non-specific because muscarinic receptors are located in different sites, causing actions in various orgANS. They are not affected differently by cholinesterase activity and have negligible actions on nicotinic receptors. 3. The nurse is preparing to administer bethanechol (Urecholine) to a patient who is experiencing urinary retention. The nurse notes that the patient has a blood pressure of 90/60 mm Hg. The nurse will perform which action? a. Administer the drug and monitor urine output. b. Administer the medication and monitor vital signs frequently. c. Give the medication and notify the provider of the increased heart rate. d. Hold the medication and notify the provider of the decreased blood pressure. ANS: D Bethanechol treatment can result in hypotension. The nurse should hold the drug and notify the provider of the low blood pressure. 4. The nurse administers bethanechol (Urecholine) to a patient to treat urinary retention. After 30 minutes, the patient voids 800 mL of urine and reports having a loose stool but no cramping or gastrointestinal pain. The patient’s blood pressure is 110/70 mm Hg. The nurse will 11 [Date] 1 perform which action? a. Notify the provider of bethanechol adverse effects. b. Record the urine output and the blood pressure and continue to monitor. c. Request an order for intravenous atropine sulfate. d. Suggest another dose of bethanechol to the provider. ANS: B The patient is exhibiting desired effects and mild side effects of bethanechol, so the nurse should record information and continue to monitor the patient. There is no need to notify the provider, give an antidote, or repeat the dose. 5. The nurse is teaching a patient who will begin taking bethanechol (Urecholine). Which statement by the patient indicates a need for further teaching? a. “Excessive sweating is a normal reaction to this medication.” b. “Excess salivation is a serious side effect.” c. “I should get out of bed slowly while taking this drug.” d. “I will not take the drug if my heart rate is less than 60 beats per minute.” ANS: A Patients taking bethanechol should be instructed to report increased salivation and diaphoresis since they can be early signs of overdosing. They should also be taught to rise slowly to avoid orthostatic hypotension and to hold the drug if their heart rate is low. 6. The nurse is caring for a male patient with myasthenia gravis who will begin taking neostigmine. When performing a health history, the nurse will be concerned about a history of which condition in this patient? a. Benign prostatic hypertrophy` 12 [Date] 1 b. Chronic constipation c. Erectile dysfunction d. Upper respiratory infection ANS: A This drug is a reversible cholinesterase inhibitor and is given to increase muscle strength. Cholinesterase inhibitors are contraindicated in patients with urinary tract obstruction. The severity of the benign prostatic hypertrophy would need to be investigated prior to administration. 7. The nurse is preparing to administer the anticholinergic medication benztropine (Cogentin) to a patient who has Parkinson disease. The nurse understands that this drug is used primarily for which purpose? a. To decrease drooling and excessive salivation b. To improve mobility and muscle strength c. To prevent urinary retention d. To suppress tremors and lessen muscle rigidity ANS: D Anticholinergic drugs are used in Parkinson disease mainly to reduce tremors and muscle rigidity. 8. The nurse is caring for a postoperative patient and notes that the patient received atropine sulfate preoperatively. Which assessment finding would prompt the nurse to notify the provider? a. Absent bowel sounds b. Drowsiness c. Dry mouth 15 [Date] 1 TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse is preparing to administer benztropine (Cogentin) to a patient who has Parkinson disease. When performing an assessment, which aspect of the patient’s history would cause the nurse to hold the medication and notify the provider? a. Asthma b. Glaucoma c. Irritable bowel syndrome d. Motion sickness ANS: B Patients who have glaucoma should not take anticholinergic medications. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. The nurse is caring for a patient in the post-anesthesia recovery unit. The nurse notes that the patient received atropine sulfate 2 mg 30 minutes prior to anesthesia induction. The patient has received 1000 mL of intravenous fluids and has 700 mL of urine in the urinary catheter bag. The patient reports having a dry mouth. The nurse notes a heart rate of 82 beats per minute. What action will the nurse perform? a. Administer a fluid bolus. b. Give the patient ice chips. c. Palpate the patient’s bladder. d. Reassess the patient in 15 minutes. ANS: C 16 [Date] 1 Atropine can cause urinary retention. The patient’s urine output is less than the fluid intake, so the nurse should palpate the bladder to assess for distension. Dry mouth is an expected side effect and does not indicate dehydration. 15. A patient who has Parkinson disease will begin treatment with benztropine (Cogentin). Which symptom of Parkinson disease would be a contraindication for this drug? a. Drooling b. Muscle rigidity c. Muscle weakness d. Myasthenia gravis ANS: D Myasthenia gravis is a contraindication for this drug. 16. A patient who is intubated develops sinus bradycardia. Which medication will the nurse anticipate administering to treat this symptom? a. Atropine sulfate (Atropine) b. Benztropine (Cogentin) c. Bethanechol chloride (Urecholine) d. Metoclopramide (Reglan) ANS: A N Atropine is most commonly used to decrease salivation and respiratory secretions preoperatively and to treat sinus bradycardia by increasing the heart rate. 17. The nurse is preparing to administer tolterodine tartrate (Detrol LA) to a patient who has incontinence. Which symptom would warrant holding administration of the drug? a. Decreased bowel sounds 17 [Date] 1 b. Drooling c. Gastric upset d. Pain ANS: A A decrease in bowel sounds could signal the beginning of paralytic ileus. Detrol is contraindicated in patients with paralytic ileus. MULTIPLE RESPONSE 1. Cholinergic drugs have specific effects on the body. What are the actions of cholinergic medications? (Select all that apply.) a. Dilate pupils b. Decrease heart rate c. Stimulate gastric muscle d. Dilate blood vessels e. Dilate bronchioles f. Increase salivation g. Constrict pupils ANS: B, C, D, F, G Decreasing heart rate, stimulating gastric muscles, dilating blood vessels, increasing salivation, and constricting pupils are actions of the cholinergic drugs. Chapter 24: Antiinflammatories 1. A nursing student asks the nurse to explain the role of cyclooxygenase-2 (COX- 2) and its role in inflammation. The nurse will explain that COX-2: a. converts arachidonic acid into a chemical mediator for inflammation. b. directly causes vasodilation and increased capillary permeability. 20 [Date] 1 understands that this is because aspirin: a. increases gastrointestinal secretions. b. increases hypersensitivity reactions. c. inhibits both COX-1 and COX-2. d. selectively inhibits COX-2. ANS: C Aspirin is a non-specific COX-1 and COX-2 inhibitor. COX-1 protects the stomach lining, so when it is inhibited, gastric upset can occur. Aspirin does not increase gastrointestinal secretions or hypersensitivity reactions. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. A patient is taking aspirin for secondary prevention of myocardial infarction and is experiencing moderate gastrointestinal upset. The nurse will contact the patient’s provider to discuss changing from aspirin to which of the following? a. A COX-2 inhibitor b. Celecoxib (Celebrex) c. Enteric-coated aspirin d. Ibuprofen ANS: C Aspirin is often used to inhibit platelet aggregation for cardiovascular prevention. Patients taking aspirin for this purpose would not benefit from COX-2 inhibitors, since the COX-1 enzyme is responsible for inhibiting platelet aggregation. The patient may benefit from taking an enteric-coated aspirin product to lessen the gastrointestinal distress. Celecoxib and is a COX-2 21 [Date] 1 selective inhibitor. Ibuprofen is not indicated for cardiovascular event prevention. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is performing a health history on a patient who has arthritis. The patient reports tinnitus. Suspecting a drug adverse effect, the nurse will ask the patient about which medication? a. Aspirin (Bayer) b. Acetaminophen (Tylenol) c. Anakinra (Kineret) d. Prednisone (Deltasone) ANS: A Aspirin causes tinnitus at low toxicity levels or in patients with hypersensitivity to aspirin. The nurse should question the patient about this medication. The other medications are less likely to contribute to this side effect. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse is teaching a patient about using high-dose aspirin to treat arthritis. What information will the nurse include when teaching this patient? a. “A normal serum aspirin level is between 30 and 40 mg/dL.” b. “You may need to stop taking this drug a week prior to surgery.” c. “You will need to monitor aspirin levels if you are also taking warfarin.” 22 [Date] 1 d. “Your stools may become dark, but this is a harmless side effect.” ANS: B Aspirin should be discontinued prior to surgery to avoid prolonged bleeding time. A normal serum level is 15 to 30 mg/dL. Patients taking warfarin and aspirin will have increased amounts of warfarin, so the INR will need to be monitored. Tarry stools are a symptom of gastrointestinal bleeding and should be reported. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. A patient who takes high-dose aspirin to treat rheumatoid arthritis has a serum salicylate level of 35 mg/dL. The nurse will perform which action? a. Assess the patient for signs of toxicity, such as tinnitus. b. Monitor the patient for signs of Reye’s syndrome. c. Notify the provider of severe aspirin toxicity. d. Request an order for an increased aspirin dose. ANS: A Mild toxicity occurs at levels above 30 mg/dL, so the nurse should assess for signs of toxicity, such as tinnitus. This level will not increase the risk for Reye’s syndrome. Severe toxicity occurs at levels greater than 50 mg/dL. The dose should not be increased. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 25 [Date] 1 The patient reports decreased pain, but the nurse notes continued swelling of the affected joints. The nurse will perform which action? a. Assess the patient for drug-seeking behaviors. b. Notify the provider that the drug is not effective. c. Reassure the patient that swelling will decrease eventually. d. Remind the patient that this drug is given for pain only. ANS: B TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N This medication is effective for both pain and swelling. After 4 weeks, there should be some decrease in swelling, so the nurse should report that this medication is ineffective. There is no indication that this patient is seeking an opioid analgesic. The drug should be effective within several weeks. NSAIDs are given for pain and swelling. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse is caring for a patient who has rheumatoid arthritis and who is receiving infliximab (Remicade) IV every 8 weeks. Which laboratory test will the nurse anticipate that this patient will need? a. Calcium level b. Complete blood count c. Electrolytes d. Potassium ANS: B 26 [Date] 1 Infliximab is an immunomodulator and can cause agranulocytosis, so patients should have regular CBC monitoring. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. The nurse is teaching a patient about taking colchicine to treat gout. What information will the nurse include when teaching this patient about this drug? a. Avoid all alcohol except beer. b. Include salmon in the diet. c. Increase fluid intake. d. Take on an empty stomach. ANS: C The patient who is taking colchicine should increase fluid intake to promote uric acid excretion and prevent renal calculi. Foods rich in purine should be avoided, including beer, and some sea foods, such as salmon. Gastric irritation is a common problem, so colchicine should be taken with food. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning/Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. Which antigout medication is considered first-line to treat chronic tophaceous gout? a. Allopurinol (Zyloprim) b. Colchicine c. Probenecid (Benemid) d. Celecoxib (Celebrex) ANS: A 27 [Date] 1 Allopurinol inhibits the biosynthesis of uric acid and is used long-term to manage chronic gout. Colchicine does not inhibit uric acid synthesis or promote uric acid secretion and is not used for chronic gout. Probenecid can be used for chronic gout but is not the first choice. Celecoxib is a COX-2 selective anti- inflammatory and does not have a role in treating chronic tophaceous gout. TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim). The nurse reviews the patient’s medical record and will be concerned about which of the following findings? a. History of kidney stones b. Increased serum uric acid c. Slight increase in the white blood count d. Increased serum glucose ANS: A Allopurinol use can increase the risk of kidney stones resulting from uric acid secretion. This can be prevented by increasing water intake and maintaining a urine pH above 6. A history of kidney stones would not be a contraindication to allopurinol use, but additional caution and patient teaching to prevent kidney stone formation is warranted. 30 [Date] 1 1. The nurse is evaluating a patient 2 hours after giving a dose of 30 mg of codeine with acetaminophen for postoperative pain following abdominal surgery. The patient reports a pain level of 7 on a scale of 1 to 10. The patient is not satisfied with their current level of pain relief. The nurse notes a heart rate of 110 beats per minute, a respiratory rate of 28 breaths per minute, and a blood pressure of 180/90 mm Hg. Which action will the nurse take? a. Administer the next dose of codeine 1 hour early. b. Ask the provider if the codeine dose can be increased. c. Contact the provider to ask if a dose of ibuprofen may be given now. d. Request an order for oxycodone with acetaminophen (Percocet). ANS: D The patient is showing signs of moderate to severe pain unrelieved by codeine, so the nurse should request a more potent opioid analgesic such as oxycodone. Codeine is effective for mild to moderate pain so will not be effective for this patient even if the dose is increased. The medication should not be given more frequently than every 4 hours. Ibuprofen is used for musculoskeletal pain and not postoperative pain. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The nurse is teaching a female patient who will begin taking 2 tablets of 325 mg acetaminophen every 4 to 6 hours as needed for pain. Which statement by the patient indicates understanding of the teaching? a. “I may take acetaminophen up to 6 times daily if needed.” 31 [Date] 1 b. “I should increase the dose of acetaminophen if I drink caffeinated coffee.” c. “If I take oral contraceptive pills, I should use back-up contraception.” d. “It is safe to take acetaminophen with any over-the-counter medications.” ANS: A The maximum daily dose of acetaminophen is 4000 mg. If this patient takes 650 mg/dose 6 times daily, this amount is safe. Taking acetaminophen with caffeine increases the effect of the acetaminophen. Taking acetaminophen with OCPs decreases the effect of the acetaminophen but does not diminish the effect of the OCP. Many over-the-counter medications contain acetaminophen, so patients should be advised to read labels carefully to avoid overdose. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. The parent of a 5-year-old child asks the nurse to recommend an over- the-counter pain medication for the child. Which analgesic will the nurse recommend? a. Acetaminophen (Tylenol) b. Aspirin (Ecotrin) TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N c. Diflunisal (Dolloped) d. Celecoxib (Celebrex) ANS: A 32 [Date] 1 Acetaminophen is a commonly used analgesic in children. Aspirin carries an increased risk of Reye’s syndrome in children. Diflunisal (Dolloped) and celecoxib (Celebrex) are not available over the counter. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. The nurse is performing an admission assessment on an adolescent who reports taking extra-strength acetaminophen (Tylenol) regularly to treat daily headaches. The nurse will notify the patient’s provider and discuss an order for which of the following? a. a selective serotonin receptor agonist (SSRA). b. hydrocodone with acetaminophen for headache pain. c. liver enzyme testing. d. serum glucose testing. ANS: C Large doses or overdoses of acetaminophen can be toxic to hepatic cells, so when large doses are administered over a long period, liver function should be assessed. Daily headaches are not typical of migraine headaches, so SSRA medication is likely not indicated. Hydrocodone with acetaminophen is not indicated without further evaluation of headaches. Serum glucose is not indicated. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment/Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 35 [Date] 1 8. The nurse is performing an admission assessment on a stable patient admitted after a motor vehicle accident. The patient reports having “bad pain.” What will the nurse do first? a. Administer acetaminophen (Tylenol). b. Ask the patient to rate the pain on a 1 to 10 scale. c. Attempt to determine what type of pain the patient has. d. Request an order for an intravenous opioid analgesic. ANS: B To ascertain severity of pain, the nurse should ask the patient to rate the pain on a scale of 1 to 10. Further assessments include location and type of pain. Pain medication should be given after the severity of pain is assessed so that an appropriate analgesic may be given. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N 9. The nurse assumes care of a patient in the post-anesthesia care unit (PACU). The patient had abdominal surgery and is receiving intravenous morphine sulfate for pain. The patient is asleep and has not voided since prior to surgery. The nurse assesses a respiratory rate of 10 breaths per minute and notes hypoactive bowel sounds. The nurse will contact the surgeon primarily to report which condition? a. Paralytic ileus b. Respiratory depression 36 [Date] 1 c. Somnolence d. Urinary retention ANS: B The patient’s respiratory rate of 10 breaths per minute is lower than normal and is a sign of respiratory depression, which is a common adverse effect of opioid analgesics. The other effects may occur with opioids but are also not expected this soon after abdominal surgery. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. One hour after receiving intravenous morphine sulfate, a patient reports generalized itching. The nurse assesses the patient and notes clear breath sounds, no rash, respirations of 14 breaths per minute, a heart rate of 68 beats per minute, and a blood pressure of 110/70 mm Hg. Which action will the nurse take? a. Administer naloxone to reverse opiate overdose. b. Have resuscitation equipment available at the bedside. c. Prepare an epinephrine injection in case of an anaphylactic reaction. d. Reassure the patient that this is a common side effect of this drug. ANS: D Pruritus is a common opioid side effect and can be managed with diphenhydramine. Patients developing anaphylaxis will have urticaria and hypotension, and these patients will need epinephrine and resuscitation. Respiratory depression is a sign of morphine overdose, which will require naloxone. 37 [Date] 1 DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. The nurse administers nalbuphine (Nubain) to a patient who is experiencing severe pain. Which statement by the patient indicates a need for further teaching about this drug? a. “I may experience unusual dreams while taking this medication.” b. “I may need to use a laxative when taking this drug.” c. “I should ask for assistance when I get out of bed.” d. “I should expect to have more frequent urination.” ANS: D A common side effect of opioid agents is urinary retention. Patients should notify the nurse if they cannot void. Side effects may include unusual dreams, constipation, and dizziness. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N 12. The nurse is caring for a patient who was admitted with a fractured leg and for observation of a closed head injury after a motor vehicle accident. The patient reports having pain at a level of 3 on a 1 to 10 pain scale. The nurse will expect the provider to order which analgesic medication for this patient? a. Acetaminophen (Tylenol) PO 40 [Date] 1 15. A postoperative patient has a history of opioid abuse. Which analgesic medication will the nurse expect the provider to order for this patient? a. Buprenorphine (Burdened) b. Butorphanol tartrate (Stadol) c. Naloxone (Narcan) d. Pentazocine (Tailwind) ANS: A Buprenorphine is an opioid agonist–antagonist analgesic and was developed to help decrease opioid abuse. Butorphanol and pentazocine are also in this class, but reports say that they cause dependence. Naloxone is an opioid antagonist and is given to reverse the effects of opioids if toxicity occurs. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. The nurse checks on a patient who received a dose of sumatriptan (Imitrex) for treatment of a migraine headache 15 minutes ago. The patient reports moderate improvement in headache pain and reports feeling dizzy. The nurse notes a blood pressure of 160/85 mm Hg. Which action by the nurse would be most appropriate? a. Notify the provider of the dizziness. b. Notify the provider of the increased blood pressure. c. Plan to administer a second dose in 30 minutes. d. Request an order for intranasal sumatriptan. ANS: B Trip tans can cause increased blood pressure, which is an adverse drug reaction and should be reported to the provider. Dizziness is a common side effect but 41 [Date] 1 not potentially life-threatening. A second dose can be given after 2 hours as needed, but giving a second dose should be first confirmed with the provider due to the observed elevation in blood pressure. Intranasal sumatriptan has the same adverse effects. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention/Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. The nurse is caring for a 6-year-old child who had surgery that morning. The child is awake and lying very still in bed and won’t respond when the nurse asks about pain. The nurse will perform which action? a. Ask the child to rate the pain on a scale of 1 to 10. b. Encourage the child to request pain medication when needed. c. Evaluate the child’s pain using an “ouch” scale. d. Plan to administer pain medication if the child begins to cry. ANS: C TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N Some children will not verbalize discomfort even when they have severe pain because they fear injections. Nurses may use an “ouch” scale or a faces scale to evaluate pain if the child won’t respond. Waiting for severe pain is not appropriate. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment/Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 42 [Date] 1 Chapter 35 and 36= RESPIRATORY Chapter 37: Cardiac Glycosides, Antianginals, and Antidysrhythmics MULTIPLE CHOICE 1. A patient who has atrial fibrillation is taking digoxin. The nurse expects which medication to be given concurrently to treat this condition? a. Hydrochlorothiazide (HydroDIURIL) b. Inamrinone (Inocor) c. Milrinone (Premcor) d. Warfarin (Coumadin) ANS: D Digoxin is given for atrial fibrillation to restore a normal heart rhythm. To prevent thromboembolic, warfarin is given concurrently. Hydrochlorothiazide is a diuretic medication. Inamrinone and milrinone are inotropic agents that could be used instead of digoxin. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A patient is diagnosed with heart failure (HF), and the prescriber has ordered digoxin. The patient asks what lifestyle changes will help in the management of this condition. The nurse will recommend which changes? a. Aerobic exercise and weight lifting 2 or 3 times weekly b. Changing from cigarette smoking to pipe smoking c. Consuming 2 teaspoons or less of salt every day d. Having no more than one alcoholic beverage per day 45 [Date] 1 The antidysrhythmics phenytoin and lidocaine are effective in treating digoxin- induced ventricular dysrhythmias. Digoxin immune Fab is used to treat severe digitalis toxicity, characterized by bradycardia, nausea, and vomiting. Unless a potassium deficit is present, giving potassium could worsen the dysrhythmia. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. A patient who takes digoxin to treat HF will begin taking a vasodilator. The patient asks the nurse why this new drug has been ordered. The nurse will explain that the vasodilator is used to: a. decrease ventricular stretching. b. improve renal perfusion. c. increase cardiac output. d. promote peripheral fluid loss. ANS: A Vasodilators are given to decrease venous blood return to the heart, resulting in decreased cardiac filling and decreased ventricular stretching, in turn reducing preload, contractility, and oxygen demand of the heart. TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 46 [Date] 1 7. The nurse performs a medication history and learns that the patient takes a loop diuretic and digoxin (Lanoxin). The nurse will question the patient to ensure that the patient is also taking which medication? a. Cortisone b. Lidocaine c. Nitroglycerin d. Potassium ANS: D If a patient is taking digoxin and a potassium-wasting diuretic such as a loop diuretic, the patient should also take a potassium supplement to prevent hypokalemia that could result in digoxin toxicity. It is not necessary to take cortisone, lidocaine, or nitroglycerin unless the patient has symptoms that warrant these drugs. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse administers a dose of digoxin (Lanoxin) to a patient who has HF and returns to the room later to reassess the patient. Which finding indicates that the medication is effective? a. Decreased dyspnea b. Decreased urine output c. Increased blood pressure d. Increased heart rate ANS: A The patient should show improvement in breathing and oxygenation. Urine output should increase. Blood pressure and heart rate will decrease. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation 47 [Date] 1 MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient who has HF receives digoxin (Lanoxin) and an angiotensin- converting enzyme (ACE) inhibitor. The patient will begin taking spironolactone (Aldactone). The patient asks why the new drug is necessary. The nurse will tell the patient that spironolactone will be given for which reason? a. To enhance potassium excretion b. To increase cardiac contractility c. To minimize fluid losses d. To provide cardioprotective effects ANS: D Spironolactone is a potassium-sparing diuretic that blocks production of aldosterone, causing improved heart rate variability and decreased myocardial fibrosis. It is given in congestive HF for its cardioprotective effects. Spironolactone does not directly alter cardiac contractility but may slightly decrease contractility if fluid volume is decreased. It is a mild diuretic but is not given in this instance to minimize fluid losses. TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 50 [Date] 1 DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. A patient who just started using trANSdermal nitroglycerin reports having headaches. The nurse will counsel the patient to perform which action? a. Call 911 when this occurs. b. Notify the provider. c. Reapply the patch three times daily. d. Take acetaminophen as needed. ANS: D Headaches are one of the most common side effects of nitroglycerin, but they may become less frequent; acetaminophen is generally recommended for pain. If the headaches do not resolve after continued use it would be appropriate to discuss alternatives with the provider. The headaches are not an emergency, and the patient does not need to call 911. The patch is applied once daily. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. A patient is ordered to receive a nitrate to relieve stable angina. What side effect(s) will the nurse anticipate in a patient receiving this medication? a. Nausea and vomiting b. Increased blood pressure c. Pruritus and skin rash d. Headache ANS: D 51 [Date] 1 Headache is a common side effect to nitrates and is related to vasodilation of the cerebral vessels. Headaches often improve with continued use. Nitrates decrease blood pressure. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. A patient asks the nurse why nitroglycerin is given sublingually. The nurse will explain that nitroglycerin is administered by this route for which reason? a. To avoid hypotension b. To increase the rate of absorption c. To minimize gastrointestinal upset d. To prevent hepatotoxicity ANS: B Nitroglycerin is given sublingually to avoid first-pass metabolism by the liver, which would occur if the drug is swallowed, and to increase the rate of absorption. It does not prevent hypotension. Gastrointestinal upset and hepatotoxicity usually do not occur. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N 52 [Date] 1 16. A patient who has been taking nitroglycerin for angina has developed variant angina, and the provider has added verapamil (Clan) to the patient’s regimen. The nurse will explain that verapamil is given for which purpose? a. To facilitate oxygen use by the heart b. To improve renal perfusion c. To increase cardiac contractility d. To relax coronary arteries ANS: D Verapamil is a calcium channel blocker and is used to relax coronary artery spasm in patients with variant angina. It does not facilitate coronary muscle oxygen use, improve renal function, or increase cardiac contractility. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. A patient who has begun taking nifedipine (Procardia) to treat variant angina has had a recurrent blood pressure of 90/60 mm Hg or less. The nurse will anticipate that the provider will do which of the following? a. add digoxin to the drug regimen. b. change to a beta blocker. c. order serum liver enzymes. d. switch to diltiazem (Cardizem). ANS: D Hypotension is a common effect of calcium channel blockers and is more common with nifedipine. It is less common with diltiazem, so the provider may 55 [Date] 1 Bradycardia, not tachycardia, will likely be noted. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 38: DUIERETICS 1. The nurse is preparing to administer the first dose of hydrochlorothiazide (HydroDIURIL) 50 mg to a patient who has a blood pressure of 160/95 mm Hg. The nurse notes that the patient had a urine output of 200 mL in the past 12 hours. The nurse will perform which action? a. Administer the medication as ordered. b. Encourage the patient to drink more fluids. c. Hold the medication and request an order for serum BUN (blood urea nitrogen) and creatinine. d. Request an order for serum electrolytes and administer the medication. ANS: C Thiazide diuretics are contraindicated in renal failure. This patient has oliguria and should be evaluated for renal failure prior to administration of the diuretic —especially in the absence of known renal failure for this patient. Drinking more fluids will not increase urine output in patients with renal failure. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 56 [Date] 1 2. The nurse is preparing to administer doses of hydrochlorothiazide (HydroDIURIL) and digoxin (Lanolin) to a patient who has heart failure. The patient reports having blurred vision. The nurse notes a heart rate of 60 beats per minute and a blood pressure of 140/78 mm Hg. Which action will the nurse take? a. Administer the medications and request an order for serum electrolytes. b. Give both medications and evaluate serum blood glucose frequently. c. Hold the digoxin and notify the provider. d. Hold the hydrochlorothiazide and notify the provider. ANS: C When thiazide diuretics are taken with digoxin, patients are at risk of digoxin toxicity because thiazides can cause hypokalemia. The patient has bradycardia and blurred vision, which are both signs of digoxin toxicity. The nurse should hold the digoxin and notify the provider. Serum electrolytes may be ordered, but the digoxin should not be given. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention/Evaluation MSC: NCLEX: Physiological Integrity: Pathophysiology 3. The nurse is teaching a patient about taking hydrochlorothiazide. Which statement by the patient indicates a need for further teaching? a. “I may need extra sodium and calcium while taking this drug.” b. “I should eat plenty of fruits and vegetables while taking this medication.” c. “I should take care when rising from a bed or chair when I’m starting this medication.” 57 [Date] 1 TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N d. “I will take the medication in the morning to minimize certain side effects.” ANS: A Patients do not need extra sodium or calcium while taking thiazide diuretics. Thiazide diuretics can lead to hypokalemia, so patients should be counseled to eat fruits and vegetables that are high in potassium. Patients can develop orthostatic hypotension and should be counseled to rise from sitting or lying down slowly. Taking the medication in the morning helps to prevent nocturia- induced insomnia. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. The nurse is caring for a patient who is to begin receiving a thiazide diuretic to help manage heart failure. When performing a health history on this patient, the nurse will be concerned about a history of which condition? a. Asthma b. Glaucoma c. Gout d. Hypertension ANS: C Thiazides block uric acid secretion, and elevated levels can contribute to gout. Patients with a history of gout should take thiazide diuretics with caution; they may need behavioral and/or pharmacologic changes to their gout treatment. DIF: Cognitive Level: Applying (Application) 60 [Date] 1 MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is caring for a patient who has metabolic alkalosis and is experiencing fluid overload. The provider orders acetazolamide (Diamox). The patient reports right-sided flank pain after taking this medication. The nurse suspects that this patient has developed which condition? a. Gout b. Hemolytic anemia c. Metabolic acidosis d. Renal calculi ANS: D Carbonic anhydrase inhibitors, such as acetazolamide, are used to treat patients who are in metabolic alkalosis and need a diuretic. They can cause electrolyte imbalance, metabolic acidosis, hemolytic anemia, and renal calculi. This patient has right-sided flank pain, which occurs with renal calculi. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient has begun taking spironolactone (Aldactone) in addition to a thiazide diuretic. With the addition of the spironolactone, the nurse will counsel this patient to do which of the following? TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N a. continue taking a potassium supplement daily. b. Recognize that abdominal cramping is a transient side effect. c. report decreased urine output to the provider. d. take these medications at bedtime. 61 [Date] 1 ANS: C Caution must be used when giving potassium-sparing diuretics to patients with poor renal function, so patients should be taught to report a decrease in urine output. Patients taking potassium-sparing diuretics are at risk for hyperkalemia, so they should not take potassium supplements. Abdominal cramping should be reported to the provider. The medications should be taken in the morning for patients who sleep during the night. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The nurse is caring for a patient who is taking hydrochlorothiazide (HydroDIURIL) and digoxin (Lanolin). Which potential electrolyte imbalance will the nurse monitor for in this patient? a. Hypermagnesemia b. Hypernatremia c. Hypocalcemia d. Hypokalemia ANS: D Thiazide diuretics can cause hypokalemia, which enhances the effects of digoxin and can lead to digoxin toxicity. Thiazides can cause hypercalcemia. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 62 [Date] 1 11. A patient has been taking spironolactone (Aldactone) to treat heart failure. The nurse will monitor for which of the following electrolyte abnormalities? a. hyperkalemia. b. hypermagnesemia. c. hypocalcemia. d. hypoglycemia. ANS: A Spironolactone is a potassium-sparing diuretic and can induce hyperkalemia. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N Chapter 39: Antihypertensives 1. A patient is diagnosed with borderline hypertension and states a desire to make lifestyle changes to avoid needing to take medication. The nurse will recommend which changes? a. Changing from weight bearing exercise to yoga b. Decreased fluid intake and increased potassium intake c. Stress reduction and increased protein intake d. Weight reduction and decreased sodium intake ANS: D Weight loss decreases the stress on the heart. Decreasing salt intake decreases vascular volume. Changing to yoga from weight-bearing exercise, limiting fluids, 65 [Date] 1 TOP: Nursing Process: Nursing Intervention/Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is preparing to care for a Native American patient who has hypertension. The nurse understands that which antihypertensive medication would be most effective in this patient? a. Acebutolol (Sectral) b. Captopril (Capoten) c. Carteolol HCl (Cartrol) d. Metoprolol (Lopressor) ANS: B Captopril is an ACE inhibitor. Native American patients have a reduced response to treatment with beta blockers. Acebutolol, carteolol, and metoprolol are all beta blockers. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is caring for an 80-year-old patient who has just begun taking a thiazide diuretic to treat hypertension. What is an important aspect of care for this patient? a. Encouraging increased fluid intake b. Increasing activity and exercise c. Initiating a fall risk protocol d. Providing a low potassium diet ANS: C Older patients experience a higher risk of orthostatic hypotension when taking antihypertensive medications. Fall risk also increases with a need for increased 66 [Date] 1 trips to the bathroom. A fall risk protocol should be implemented. Increasing fluids and activity and limiting potassium are not indicated. N MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse is performing an assessment on a patient who will begin taking propranolol (Inderal) to treat hypertension. The nurse learns that the patient has a history of asthma and diabetes. The nurse will take which action? a. Administer the medication and monitor the patient’s serum glucose. b. Contact the provider to discuss another type of antihypertensive medication. c. Request an order for renal function tests prior to administering this drug. d. Teach the patient about the risks of combining herbal medications with this drug. ANS: B Patients with chronic lung disease are at risk for bronchospasm with beta blockers, especially those like propranolol, which are nonselective. Beta blockers, with the exception of carvedilol, also decrease the efficacy of many oral antidiabetic medications. Noncardioselective beta blockers may also impair recovery from hypoglycemia by inhibiting conversion of glycogen to glucose in the liver. The nurse should discuss a change in medications to one that does not carry these risks. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is admitting a patient who has been taking minoxidil (Loniten) to treat resistant hypertension. Prior to beginning therapy with this medication, 67 [Date] 1 the patient had a blood pressure of 170/95 mm Hg and a heart rate of 72 beats per minute. The nurse assesses the patient and notes a blood pressure of 130/72 mm Hg and a heart rate of 78 beats per minute, and also notes a 2.2-kg weight gain since the previous hospitalization and edema of the hands and feet. The nurse will contact the provider to discuss which intervention? a. Adding hydrochlorothiazide to help increase urine output b. Adding metoprolol (Lopressor) to help decrease the heart rate c. Increasing the dose of minoxidil to lower the blood pressure d. Restricting fluids to help with weight reduction ANS: A Minoxidil is a direct-acting vasodilator, which can cause sodium and water retention. Combining this drug with a diuretic can help reduce edema by increasing urine output. If the patient were tachycardic, a beta blocker might be added. It is not necessary to increase the minoxidil dose or to restrict fluids. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. The nurse is teaching a patient who has hypertension about long-term management of the disease with alpha blocker therapy. The patient reports typically consuming 1 to 2 glasses of wine each evening with meals. How will the nurse respond? a. “Alpha blockers and wine cause a reflex hypertension.” b. “Four to 6 ounces of wine is considered safe with these medications.” 70 [Date] 1 12. The nurse is caring for a patient who will begin taking lisinopril (Zestril) for hypertension. The nurse reviews the patient’s laboratory test results and notes increased BUN and creatinine. Which action will the nurse take? TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N a. Administer the captopril and monitor vital signs. b. Contact the provider to discuss changing to eosinophil (Monorail). c. Obtain an order for intravenous fluids to improve urine output. d. Request an order to add hydrochlorothiazide (HydroDIURIL). ANS: B Patients who have renal insufficiency will not require a decrease in dose with eosinophil, as they would with other ACE inhibitors. If lisinopril is given, it should be given at a dose appropriate for the patients current kidney function. Increased IV fluids are not indicated. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse is caring for a hospitalized patient who experiences an acute spike in blood pressure. The nurse will expect an order to administer which medication? a. Amlodipine (Norvasc) b. Nifedipine (Procardia) c. Nifedipine extended release (Procardia XL) d. Verapamil (Clan) 71 [Date] 1 ANS: B The short-acting nifedipine is used to treat rapid rises in blood pressure but cannot be used for out-patient treatment at high dosages because of an increased risk for sudden cardiac death. The other drugs are not used for rapid rise in BP. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. The nurse is caring for a 70-year-old patient who has recently begun taking amlodipine (Norvasc) 5 mg/day to control hypertension. The nurse notes mild edema of the patient’s ankles, a blood pressure of 130/70 mm Hg, and a heart rate of 80 beats per minute. The patient reports flushing and dizziness. The nurse will notify the provider and: a. ask to decrease the dose to 2.5 mg/day. b. discuss twice daily dosing. c. request an order for a diuretic. d. suggest adding propranolol to the regimen. ANS: A This patient is experiencing side effects of the medication. Elderly patients often require lower doses, so the nurse should ask about a dose reduction. Older adults generally require 2.5 to 5.0 mg/day. Twice daily dosing is not recommended. Unless edema persists, a diuretic is not indicated. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 72 [Date] 1 MULTIPLE RESPONSE TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N 1. The nurse teaches a patient about their antihypertensive medication. Which statements by the patient indicate understanding of the teaching? (Select all that apply.) a. “I should be careful when I stand up from a chair when I start this medication.” b. “I should not add extra salt to my foods.” c. “If I have side effects, I should stop taking the drug immediately.” d. “If my blood pressure returns to normal, I can stop taking this drug.” e. “I may need to take a combination of drugs, including diuretics.” f. “I will not need to make lifestyle changes since I am taking a medication.” ANS: A, B, E The patient receiving an antihypertensive medication should be warned to rise slowly to avoid orthostatic hypotension. Patients should be counseled to continue to make lifestyle changes, including decreasing sodium. Often, more than one medication is required. Patients should not stop taking the drug abruptly to avoid rebound hypertension and will not stop the drug when blood pressure returns to normal. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 75 [Date] 1 another route is not indicated when there is a need to reverse the effects of heparin. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient who has received heparin after previous surgeries will be given enoxaparin sodium (Love ox) after knee-replacement surgery. The patient asks how this drug is different from heparin. The nurse will explain that the benefit of enoxaparin over heparin is that it: a. decreases the need for laboratory tests. b. has a shorter half-life than heparin. c. increases the risk of hemorrhage. d. may be taken orally instead of subcutaneously. ANS: A Enoxaparin is a low–molecular-weight heparin, which produces more stable responses at lower doses, thus reducing the need for frequent lab monitoring. It has a longer half-life than heparin. It decreases the risk of hemorrhage because it is more stable at lower doses. It is given subcutaneously. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is caring for a patient who is receiving warfarin (Coumadin) and notes bruising and petechiae on the patient’s extremities. The nurse will request an order for which laboratory test? a. International normalized ratio (INR) 76 [Date] 1 b. Platelet level c. PTT and apt d. Vitamin K level ANS: A The INR is the test used most frequently to report prothrombin time results in patients taking warfarin. Warfarin is not an antiplatelet drug, so platelet levels are not indicated. PTT and apt are used to monitor heparin therapy. Vitamin K is an antidote for warfarin; levels are not routinely checked. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. A patient who is taking warfarin has an international normalized ratio (INR) of 5.5. The nurse will anticipate giving which of the following? a. fresh frozen plasma. b. intravenous iron. c. oral vitamin K. TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N d. protamine sulfate. ANS: C Vitamin K is antagonizes the effects of warfarin, an oral anticoagulant. Patients with an INR of 5.5 should be given a low dose of oral vitamin K. Too much vitamin K may reduce the effectiveness of warfarin for up to 2 weeks. Fresh 77 [Date] 1 frozen plasma and intravenous iron are given for anemia caused by blood loss. Protamine sulfate is given for heparin overdose. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse is teaching a patient who will begin taking warfarin (Coumadin) for atrial fibrillation. Which statement by the patient indicates understanding of the teaching? a. “I should eat plenty of green, leafy vegetables while taking this drug.” b. “I should take a nonsteroidal anti-inflammatory drug (NSAID) instead of acetaminophen for pain or fever.” c. “I will take cimetidine (Tagamet) to prevent gastric irritation and bleeding.” d. “I will tell my dentist that I am taking this medication.” ANS: D Patients taking warfarin should tell their dentists that they are taking the medication because of the increased risk for bleeding. Patients should avoid foods high in vitamin K, which can decrease the effects of warfarin. Patients should not take NSAIDs or cimetidine (Tagamet) because they can displace warfarin from protein-binding sites. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is assessing a patient who takes warfarin (Coumadin). The nurse notes a heart rate of 92 beats per minute and a blood pressure of 88/78 mm 80 [Date] 1 11. A patient experiences a blood clot in one leg, and the provider has ordered a thrombolytic medication. The patient learns that the medication is expensive and asks the nurse if it is necessary. Which response by the nurse is correct? a. “The drug will decrease the likelihood of permanent tissue damage.” b. “This medication also acts to prevent future blood clots from forming.” c. “You could take aspirin instead of this drug to achieve the same effect.” d. “Your body will break down the clot, so the drug is not necessary.” ANS: A Thrombolytic medications are given primarily to prevent permanent tissue damage caused by compromised blood flow to the affected area. Thrombolytics do not prevent clots from forming. Aspirin prevents, but does not dissolve, clots. Although the body will break down the clot, the drug is needed to prevent tissue damage due to active ischemia. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N 12. Which of the following thrombolytics carries a higher risk for anaphylaxis? a. Streptokinase (Striptease) b. Alteplase (Activate) c. Tenecteplase (TNK tPA) d. They all carry the same level of risk. ANS: A 81 [Date] 1 Of the thrombolytic agents, streptokinase (Striptease) carries the highest risk for anaphylaxis (vascular collapse). DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse is caring for a postoperative patient who is receiving alteplase tape (Activate) after developing a blood clot. The nurse notes a heart rate of 110 beats per minute and a blood pressure of 90/60 mm Hg. The nurse will perform which action? a. Ask the patient about itching or shortness of breath. b. Assess the surgical dressing for bleeding. c. Evaluate the patient’s urine output and fluid intake. d. Recheck the patient’s vital signs in 15 minutes. ANS: B Tachycardia and hypotension indicate bleeding. The nurse should check the patient’s surgical dressing to assess for bleeding. These signs do not indicate anaphylaxis. They may indicate dehydration, but bleeding is the more likely cause of fluid volume deficit. The nurse should continue to evaluate vital signs, but it is imperative that the nurse assess the patient to explore the potential cause. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 82 [Date] 1 14. A patient is receiving a thrombolytic medication. The patient calls the nurse to report having bloody diarrhea. The nurse will anticipate administering which medication? a. Aminocaproic acid (Amici) b. Enoxaparin sodium (Love ox) c. Protamine sulfate d. Vitamin K ANS: A The antithrombotic drug aminocaproic acid is used to treat hemorrhage. Nurses giving thrombolytic drugs should monitor patients for bleeding from the mouth and rectum. Enoxaparin is given for DIC. Protamine sulfate is an antidote for heparin. Vitamin K is an antidote for warfarin. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N 15. The nurse is assessing a patient prior to administering thrombolytic therapy. Which is an important assessment for this patient? a. Determining whether the patient has a history of diabetes b. Finding out about a history of renal disease c. Assessing which medications are taken for discomfort/pain d. Assessing whether the patient eats green, leafy vegetables ANS: C 85 [Date] 1 Antiplatelet agents like clopidogrel are not associated with clot formation and ischemia. Clopidogrel has been associated with life threatening adverse reactions such as hepatic failure, thrombocytopenia, and Stevens-Johnson syndrome. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies CHAPTER 41: Antihyperlipidemics and Peripheral Vasodilators 1. A female patient has serum lipid levels performed, which reveal a total cholesterol of 285 mg/dL, triglycerides of 188 mg/dL, a low-density lipoprotein (LDL) of 175 mg/dL, and a high-density lipoprotein (HDL) of 40 mg/dL. The patient’s blood pressure is 138/72 mm Hg. The patient is currently not receiving any prescription medications. Which of the following would be the most appropriate medication (or medications) to be started at this time? a. Amlodipine and atorvastatin (Cadet) b. Cholesterol HCl (Closeted) c. Fen fibrate (TRICOR) d. Atorvastatin (Lipitor) ANS: D Statins have actions in decreasing serum cholesterol, LDL, VLDL, and triglycerides, and they slightly elevate HDL. Because the patient has elevated cholesterol levels, starting a statin at this time would be appropriate and considered an appropriate first-line antihyperlipidemic therapy. DIF: Cognitive Level: Analyzing (Analysis) 86 [Date] 1 TOP: Nursing Process: Assessment/Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A patient has a serum cholesterol level of 270 mg/dL. The patient asks the nurse what this level means. Which response by the nurse is correct? a. “You have a high cholesterol which places you at risk for coronary artery disease.” b. “You have a moderately elevated cholesterol and risk for coronary artery disease.” c. “You have a low risk for coronary artery disease.” d. “You have no risk for coronary artery disease.” ANS: A A value of 270 mg/dL for serum cholesterol puts the patient at high risk. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pathophysiology 3. A patient begins taking cholestyramine (Questran) to treat hyperlipidemia. The patient reports abdominal discomfort and constipation. The nurse will provide which instruction to the patient? a. Increase fluid intake and slowly increase fiber intake. b. Stop taking the medication immediately. c. Take an over-the-counter laxative. d. Take the medication on an empty stomach. ANS: A TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N 87 [Date] 1 Cholestyramine can cause gastrointestinal upset and constipation, and these symptoms can be reduced with increased fluids and foods high in fiber. Stopping the medication is not indicated. Over-the-counter laxatives are not recommended until other methods have been tried. Giving the medication on an empty stomach will not relieve the discomfort. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient has been taking cholestyramine (Questran) to treat hyperlipidemia. The patient reports abdominal cramping and constipation. The patient’s serum low-density lipoprotein (LDL) has decreased from 170 to 110 mg/dL, and triglycerides have not changed from 150 mg/dL since beginning the medication. The provider changes the medication to colesevelam HCl (Elcho). The patient asks the nurse why the medication was changed, and the nurse will explain that colesevelam HCl is ordered for which reason? a. It has fewer side effects. b. It has more convenient dosing. c. It provides greater LDL reduction. d. It provides greater triglyceride reduction. ANS: A Colesevelam is similar to cholestyramine but has fewer gastrointestinal side effects. This patient has demonstrated good results with the bile acid sequestrant, so the provider has decided to offer a preparation with fewer adverse effects. Both drugs are given twice daily. 90 [Date] 1 indicated. Ibuprofen may be useful, but notifying the provider is essential. Patients should not abruptly discontinue statins without discussing this with the provider. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse provides teaching to a patient who will begin taking simvastatin (Zocor) to treat hyperlipidemia. Which statement by the patient indicates understanding of the teaching? a. “I may have diarrhea as a result of taking this medication.” b. “I may stop taking this medication when my lipid levels are normal.” c. “I will need an annual eye examination while taking this medication.” d. “I will increase my intake of vitamins A, D, and E while taking this medication. ANS: C The statins can affect visual acuity, so patients should be counseled to have annual eye examinations for assessment of cataract formation. The bile acid sequestrants, not statins, cause diarrhea. Statin drug therapy is lifelong or until behavioral changes prove equally effective (uncommon). Bile acid sequestrants, not statins, decrease the absorption of fat-soluble vitamins. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION TESTBANKWORLD.ORG N 91 [Date] 1 9. A patient, who has intermittent claudication, has been taking 100 mg of cilostazol (Petal) twice times daily with meals for 2 weeks. The patient calls the clinic and reports continued pain in both legs during exercise. How will the nurse advise the patient? a. “It can take from 2-12 weeks for the medication to help with your claudication symptoms.” b. “Notify the provider of the continued pain and request increasing the dose.” c. “You should stop the medication immediately since it is not working.” d. “Take the medication right before you exercise for best effects.” ANS: A Patients should be counseled that the desired therapeutic effects may take to 3 months. The patient is currently taking the maximum recommended daily dose of cilostazol, so an increase in dose would not be recommended. The medication should be taken 30 minutes before or 2 hours after the morning and evening meals. Taking it immediately before bouts of exercise will not increase effectiveness. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. A patient will begin taking simvastatin (Zocor) to decrease serum cholesterol. When teaching the patient about this medication, the nurse will counsel the patient to take which action? a. Return to the clinic annually for laboratory testing. b. Take care when rising from a sitting to standing position. c. Take the medication in the evening for best effect. 92 [Date] 1 d. Use ibuprofen as needed for severe muscle aches and pain. ANS: C Simvastatin is given in the evening. Laboratory tests are performed every 3 to 6 months, not annually. Statins do not cause postural hypotension. Patients taking statins should report severe muscle aches and weakness immediately. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A patient will begin taking rosuvastatin (Crestor) to treat hyperlipidemia. The patient asks the nurse how to take the medication for best effect. Which statement by the nurse is correct? a. “Increase your fluid intake while taking this medication.” b. “Stop taking the medication if you develop muscle aches.” c. “Take the medication with food to improve absorption.” d. “You may increase dietary fat while taking this medication.” ANS: A Patients taking antihyperlipidemics should be advised to increase fluid intake. It is not necessary to take with food. Patients should never stop taking a statin without consulting the provider. Patients should continue a low-fat diet while taking statins. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. A patient has been prescribed cilostazol. Which statement by the client indicates the need for further teaching?