Term
A client is to be discharged home with a transdermal nitroglycerin patch. Which instruction will the nurse include in the client's teaching plan?
A) a. “Apply the patch to a nonhairy area of the upper torso or arm.”
B) b. “Apply the patch to the same site each day.”
C) c. “If you have a headache, remove the patch for 4 hours and then reapply.”
D) d. “If you have chest pain, apply a second patch next to the first patch.” |
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Definition
A.
A nitroglycerin patch should be applied to a nonhairy area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation. The drug should be continued if headache occurs, as tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain. |
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Term
A nurse is monitoring a client with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective?
A) a. Blood pressure 120/80 mm Hg
B) b. Heart rate 70 beats per minute
C) c. ECG without evidence of ST changes
D) d. Client stating that pain is 0 out of 10 |
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Definition
D
The client taking nitroglycerin should expect the therapeutic effect of absence of chest pain. |
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Term
The nurse is monitoring a client during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action?
A) a. Blood pressure 110/90 mm Hg
B) b. Flushing
C) c. Headache
D) d. Chest pain |
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Definition
D
The client should not continue to have chest pain while on IV nitroglycerin. This would prompt the nurse to intervene. Blood pressure of 110/90 mm Hg is not cause for concern and is expected with nitroglycerin. Headache and flushing are common side effects of nitroglycerin. |
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Term
Which statement made by the client demonstrates a need for further instruction regarding the use of nitroglycerin?
A) a. “If I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief.”
B) b. “I should keep my nitroglycerin in a cool, dry place.”
C) c. “I should change positions slowly to avoid getting dizzy.”
D) d. “I can take up to five tablets at 3-minute intervals for chest pain if necessary.” |
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Definition
D.
Clients are taught to take up to three tablets every 5 minutes. If no relief from chest pain is obtained after three tablets, they should seek medical assistance. |
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Term
Which client assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker?
A) a. Client states that she has no chest pain.
B) b. Client states that the swelling in her feet is reduced.
C) c. Client states the she does not feel dizzy.
D) d. Client states that she feels stronger. |
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Definition
A.
The workload in the heart should be decreased with the vasodilatation from the calcium channel blocker. With less strain, the client should have fewer incidences of angina as afterload is decreased. |
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Term
What statement is the most important for the nurse to include in the teaching plan for a client who has started on a transdermal nitroglycerin patch?
A) a. “This medication works faster than sublingual nitroglycerin works.”
B) b. “This medication is the strongest of any nitroglycerin preparation available.”
C) c. “This medication should be used only when you are experiencing chest pain.”
D) d. “This medication will work for 24 hours and you will need to change the patch daily.” |
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Definition
D.
The transdermal patch has a duration of action of 24 hours. Sublingual nitroglycerin is more rapid acting than the transdermal patch. There are other preparations that may be considered stronger because they are higher in dosage. Sublingual and IV preparations are preferred during episodes of chest pain. |
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Term
What will the nurse instruct the client to do to prevent the development of tolerance to nitroglycerin?
A) a. Apply the nitroglycerin patch every other day.
B) b. Switch to sublingual nitroglycerin when the client’s systolic blood pressure elevates to more than 140 mm Hg.
C) c. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night.
D) d. Use the nitroglycerin patch for acute episodes of angina only. |
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Definition
C.
Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day. |
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Term
Before the nurse administers isosorbide mononitrate (Imdur) [vasodilator], what is a priority nursing assessment?
A) a. Assess serum electrolytes.
B) b. Measure blood urea nitrogen and creatinine.
C) c. Assess blood pressure.
D) d. Monitor level of consciousness. |
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Definition
C.
Isosorbide mononitrate (Imdur) is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering. |
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Term
The client asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response?
A) a. “You can protect it from heat by placing the bottle in an ice chest.”
B) b. “It’s best to keep it in its original container away from heat and light.”
C) c. “You can put a few tablets in a resealable bag and carry it in your pocket.”
D) d. “It’s best to lock them in the glove compartment to keep them away from heat and light.” |
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Definition
B.
Although nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest where it could freeze. It should also not be locked up and must be kept away from light, not in a clear plastic bag. |
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Term
Which statement indicates to the nurse that the client understands sublingual nitroglycerin medication instructions?
A) a. “I will take up to five doses every 3 minutes for chest pain.”
B) b. “I can chew the tablet for the quickest effect.”
C) c. “I will keep the tablets locked in a safe place until I need them.”
D) d. “I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness.” |
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Definition
D.
Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. Three doses can be taken 5 minutes apart. The tablet should be placed under the tongue to dissolve. The medication should be kept in a readily accessible location for immediate use should chest pain occur. |
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Term
What instruction should the nurse provide to the client who needs to apply nitroglycerin ointment?
A) a. Use the fingers to spread the ointment evenly over a 3-inch area.
B) b. Apply the ointment to a nonhairy part of the upper torso.
C) c. Massage the ointment into the skin.
D) d. Cover the application paper with ointment before use. |
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Definition
B.
Absorption is best over a nonhairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves and squeeze the ointment onto the application patch. Massaging in the ointment is not appropriate. The paper should not be covered with ointment. The ointment is measured as one straight line on the nitroglycerin paper and is then gently spread around and applied, but not rubbed, into the skin. |
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Term
A client receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's priority action?
A) a. Assess the client’s lung sounds.
B) b. Decrease the intravenous nitroglycerin by 10 mcg/min.
C) c. Stop the nitroglycerin infusion for 1 hour, and then restart.
D) d. Recheck the client’s vital signs in 15 minutes but continue the infusion. |
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Definition
B.
Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The client should be monitored every 10 minutes while changing the rate of the intravenous nitroglycerin infusion. |
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Term
The nurse is monitoring a client taking digoxin (Lanoxin) for treatment of heart failure. Which assessment finding indicates a therapeutic effect of the drug?
A) a. Heart rate 110 beats per minute
B) b. Heart rate 58 beats per minute
C) c. Urinary output 40 mL/hr
D) d. Blood pressure 90/50 mm Hg |
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Definition
B.
Digoxin (Lanoxin) has a negative chronotropic effect (decreased heart rate). The heart rate should become slower and stronger. |
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Term
A client's serum digoxin level is drawn, and it is 0.4 ng/mL. What is the nurse's priority action?
A) a. Administer ordered dose of digoxin.
B) b. Hold future digoxin doses.
C) c. Administer potassium.
D) d. Call the health care provider. |
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Definition
A.
Therapeutic serum digoxin levels are 0.5-2 ng/mL. The client should receive the next dose to bring the level into therapeutic range. |
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Term
A client is taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg. When the nurse enters the room, the client states, "There are yellow halos around the lights." Which action will the nurse take?
A) a. Evaluate digoxin levels.
B) b. Withhold the furosemide
C) c. Administer potassium.
D) d. Document the findings and reassess in 1 hour. |
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Definition
A.
Seeing yellow or green halos around lights is a symptom of digoxin toxicity. The nurse should evaluate the client's digoxin levels. |
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Term
Which assessment finding will alert the nurse to suspect early digitalis toxicity?
A) a. Loss of appetite with slight bradycardia
B) b. Blood pressure 90/60 mm Hg
C) c. Heart rate 110 beats per minute
D) d. Confusion and diarrhea |
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Definition
A.
Early symptoms of digitalis toxicity include anorexia, nausea and vomiting, and bradycardia. |
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Term
The nurse reviews a client's laboratory values and finds a digoxin level of 10 ng/mL and a serum potassium level of 5.9 mEq/L. What is the nurse's primary intervention?
A) a. To administer atropine
B) b. To administer digoxin immune FAB
C) c. To administer epinephrine
D) d. To administer Kayexalate |
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Definition
B.
Digoxin immune FAB is indicated for treatment of severe digoxin toxicity as evidenced by a digoxin level of 10 ng/mL and hyperkalemia. Atropine and epinephrine are not indicated for digoxin toxicity. Kayexalate is not the primary intervention. |
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Term
What must the nurse monitor when titrating intravenous nitroglycerin for a client? (Select all that apply.)
A) a. Continuous oxygen saturation
B) b. Continuous blood pressures
C) c. Hourly ECGs
D) d. Presence of chest pain
E) e. Serum nitroglycerin levels
F) f. Visual acuity |
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Definition
B, D.
Intravenous nitroglycerin can cause hypotension and tachycardia. Relief of chest pain and systolic blood pressure <90 mm Hg are typical parameters used for titrating nitroglycerin. Pulse should also be monitored. |
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Term
What is the best information for the nurse to provide to the client who is receiving spironolactone (Aldactone) [potassium-sparing diuretic]and furosemide (Lasix) [Loop (high-ceiling) diuretic] therapy?
A) a. “Moderate doses of two different diuretics are more effective than a large dose of one.”
B) b. “This combination promotes diuresis but decreases the risk of hypokalemia.”
C) c. “This combination prevents dehydration and hypovolemia.”
D) d. “Using two drugs increases the osmolality of plasma and the glomerular filtration rate.” |
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Definition
B.
Spironolactone is a potassium-sparing diuretic; furosemide causes potassium loss. Giving these together minimizes electrolyte imbalance. |
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Term
The nurse is assessing a client who is taking furosemide (Lasix)[potent loop diuretic]. The client's potassium level is 3.4 mEq/L, chloride is 90 mmol/L, and sodium is 140 mEq/L. What is the nurse's primary intervention?
A) a. Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly.
B) b. Administer Kayexalate.
C) c. Administer 2 mEq potassium chloride per kilogram per day IV.
D) d. Administer PhosLo, two tablets three times per day. |
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Definition
C.
Furosemide is a potent loop diuretic, resulting in the loss of potassium as well as water, sodium, and chloride. The client needs chloride replacement. |
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Term
A nurse admits a client diagnosed with pneumonia. The client has a history of chronic renal insufficiency, and the health care provider orders furosemide (Lasix) 40 mg twice a day. What is most important to include in the teaching plan for this client?
A) a. That the medication will have to be monitored very carefully owing to the client’s diagnosis of pneumonia.
B) b. The fact that Lasix has been proven to decrease symptoms with pneumonia.
C) c. The fact that Lasix has shown efficacy in treating persons with renal insufficiency.
D) d. That the medication will need to be given at a higher than normal dose owing to the client’s medical problems. |
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Definition
C.
Furosemide is effective in clients with creatinine clearance as low as 25 L/min (normal 125 L/min). |
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Term
A client taking spironolactone (Aldactone) [potassium-sparing diuretic] has been taught about the therapy. Which menu selection indicates that the client understands teaching related to this medication?
A) a. Apricots
B) b. Bananas
C) c. Fish
D) d. Strawberries |
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Definition
C.
Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Fish is an appropriate dietary choice, because it is low in potassium. The other foods are high in potassium. |
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Term
Which client would the nurse need to assess first if the client is receiving mannitol (Osmitrol)?
A) a. A 67-year-old client with type 1 diabetes mellitus
B) b. A 21-year-old client with a head injury
C) c. A 47-year-old client with anuria
D) d. A 55-year-old client receiving cisplatin to treat ovarian cancer |
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Definition
C.
Mannitol (Osmitrol) is not metabolized but excreted unchanged by the kidneys. Potential water intoxication could occur if mannitol is given to a client with anuria. |
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Term
A nurse is caring for a client receiving acetazolamide (Diamox). Which assessment finding will require immediate nursing intervention?
A) a. A decrease in bicarbonate level
B) b. An increase in urinary output
C) c. A decrease in arterial pH
D) d. An increase in PaO2 |
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Definition
C.
Acetazolamide (Diamox) causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat metabolic alkalosis, edema, seizures, and acute glaucoma. A decrease in blood pH would indicate that the client was becoming more acidotic. |
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Term
A client is ordered furosemide (Lasix) to be given via intravenous push. What interventions should the nurse perform? (Select all that apply.)
A) a. Administer at a rate no faster than 20 mg/min.
B) b. Assess lung sounds before and after administration.
C) c. Assess blood pressure before and after administration.
D) d. Maintain accurate intake and output record.
E) e. Monitor ECG continuously.
F) f. Insert an arterial line for continuous blood pressure monitoring. |
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Definition
A,B,C,D
Furosemide (Lasix) can be infused via intravenous push at the rate of 20 mg/min. Furosemide is a diuretic and will decrease fluid in alveoli, and assessing lung sounds can help to determine therapeutic effect. Blood pressure should decrease with the administration of a diuretic. It is appropriate to monitor before and after administration. It is appropriate to monitor intake and output for a client receiving a diuretic. |
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Term
A client is ordered furosemide (Lasix) to be given via intravenous push. What interventions should the nurse perform? (Select all that apply.)
A) a. Administer at a rate no faster than 20 mg/min.
B) b. Assess lung sounds before and after administration.
C) c. Assess blood pressure before and after administration.
D) d. Maintain accurate intake and output record.
E) e. Monitor ECG continuously.
F) f. Insert an arterial line for continuous blood pressure monitoring. |
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Definition
A,B,C,D
Furosemide (Lasix) can be infused via intravenous push at the rate of 20 mg/min. Furosemide is a diuretic and will decrease fluid in alveoli, and assessing lung sounds can help to determine therapeutic effect. Blood pressure should decrease with the administration of a diuretic. It is appropriate to monitor before and after administration. It is appropriate to monitor intake and output for a client receiving a diuretic. |
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Term
A client with hyperaldosteronism is prescribed spironolactone (Aldactone). What assessment finding would the nurse evaluate as a positive outcome?
A) a. Decreased potassium level
B) b. Decreased crackles in the lung bases
C) c. Decreased aldosterone
D) d. Decreased ankle edema |
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Definition
C.
Spironolactone (Aldactone) is the direct antagonist for aldosterone. |
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Term
A client with acute pulmonary edema receives furosemide (Lasix). What assessment finding indicates that the intervention is working?
A) a. Potassium level decreased from 4.5 to 3.5 mEq/L.
B) b. Crackles auscultated in the bases.
C) c. Lungs clear.
D) d. Output 30 mL/hr. |
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Definition
C.
Furosemide (Lasix) is a potent, rapid-acting diuretic that would be the drug of choice to treat acute pulmonary edema. |
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Term
Which assessment indicates a therapeutic effect of mannitol (Osmitrol)?
A) a. Decreased intracranial pressure
B) b. Decreased potassium
C) c. Increased urine osmolality
D) d. Decreased serum osmolality |
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Definition
A.
Mannitol (Osmitrol) is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This will decrease intracranial pressure, increase excretion of medications, decrease urine osmolality, and increase serum osmolality. |
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Term
Which intervention will the nurse perform when monitoring a client receiving triamterene (Dyrenium)[potassium-sparing diuretic]?
A) a. Assess urinary output hourly.
B) b. Monitor for side effect of hypoglycemia.
C) c. Assess potassium levels.
D) d. Monitor for Hypernatremia. |
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Definition
C.
Triamterene (Dyrenium) is a potassium-sparing diuretic. The nurse should monitor potassium for potential hyperkalemia. |
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Term
The client asks the nurse why the health care provider prescribed acetazolamide (Diamox), a diuretic, to treat gout. What is the nurse's best response?
A) a. It causes an alkaline urine, which facilitates the elimination of uric acid.
B) b. It increases alkalinity of urine, thus decreasing the formation of uric acid.
C) c. It causes an acid urine, which facilitates the elimination of uric acid.
D) d. It decreases alkalinity of urine, thus decreasing the formation of uric acid. |
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Definition
A.
Acetazolamide causes increased excretion of bicarbonate, which causes alkaline urine and increased excretion of acidic substances, including uric acid. |
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Term
Which statement indicates that the client needs additional instruction about antihypertensive treatment?
A) a. “I will check my blood pressure daily and take my medication when it is over 140/90.”
B) b. “I will include rest periods during the day to help me tolerate the fatigue my medicine may cause.”
C) c. “I will change my position slowly to prevent feeling dizzy.”
D) d. “I will not mow my lawn until I see how this medication makes me feel.” |
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Definition
A.
Antihypertensive medications need to be taken routinely to maintain a normotensive state and prevent occurrence of complications. Many clients do not adhere to this regimen because hypertension itself does not cause symptoms, whereas the medication can cause some untoward effects. Client teaching is essential. |
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Term
A nurse is caring for a client who is taking an angiotensin-converting enzyme inhibitor and develops a dry, nonproductive cough. What is the nurse's priority action?
A) a. Call the health care provider to switch the medication.
B) b. Assess the client for other symptoms of upper respiratory infection.
C) c. Instruct the client to take antitussive medication until the symptoms subside.
D) d. Tell the client that the cough will subside in a few days. |
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Definition
A.
Angiotensin-converting enzyme inhibitors prevent the breakdown of bradykinin, frequently causing a nonproductive cough. Angiotensin receptor blocking agents do not block this breakdown, thus minimizing this annoying side effect. The client should be switched to a different medication if the side effect cannot be tolerated. |
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Term
4. A client is prescribed a noncardioselective beta1 blocker. What nursing intervention is a priority for this client?
A) a. Assessment of blood glucose levels
B) b. Respiratory assessment
C) c. Orthostatic blood pressure assessment
D) d. Teaching about potential tachycardia |
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Definition
B.
Non-cardioselective beta blockers can cause bronchospasms, and a respiratory assessment is indicated to check for potential respiratory side effects. |
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Term
Which client will the nurse assess first?
A) a. The client who has been on beta blockers for 1 day.
B) b. The client who is on a beta blocker and a thiazide diuretic.
C) c. The client who has stopped taking a beta blocker due to cost.
D) d. The client who is taking a beta blocker and Lasix (furosemide) |
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Definition
C.
Abrupt discontinuation of the antihypertensive drug may cause rebound hypertension. |
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Term
The nurse is caring for a client with hypertension who is prescribed Clonidine transdermal preparation. What is the correct information to teach this client?
A) a. Change the patch daily at the same time.
B) b. Remove the patch before taking a shower or bath.
C) c. Do not take other antihypertensive medications while on this patch.
D) d. Get up slowly from a sitting to a standing position. |
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Definition
D.
This medication can cause dizziness. Client safety is a priority. The patch is left on for 7 days and can be left on while bathing. This medication is often prescribed with other drugs. |
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Term
The client taking Methyldopa (Aldomet) has elevated liver function tests. What is the nurse's best action?
A) a. Document the finding and continue care.
B) b. Notify the health care provider.
C) c. Immediately stop the medication.
D) d. Change the client’s diet. |
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Definition
B.
This drug should not be used in clients with impaired liver function. The nurse should notify the health care provider so that the client can be tapered off the medication. The nurse should not immediately stop this medication as the client could have a hypertensive crisis. The client's diet is not the cause of elevated liver enzymes and should not make a difference with therapy. |
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Term
A client taking prazosin has a blood pressure of 140/90. The client is complaining of swollen feet. What is the nurse's best action?
A) a. Hold the medication.
B) b. Call the health care provider.
C) c. Determine the client’s history.
D) d. Weigh the client. |
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Definition
C.
The desired therapeutic effect of prazosin may not fully occur for 4 weeks. The nurse does not know how long the client has been on this medication. |
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Term
A calcium channel blocker has been ordered for a client. Which condition in the client's history is a contraindication to this medication?
A) a. Hypokalemia
B) b. Dysrhythmias
C) c. Hypotension
D) d. Increased intracranial pressure |
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Definition
C.
Calcium channel blockers cause vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension. |
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Term
A client who takes clonidine (Catapres) is to be discharged to home. Which instruction will the nurse include when teaching this client?
A) a. “Your blood pressure should be checked by a health care provider at least once a year.”
B) b. “Increasing fluid and fiber in your diet can help prevent the side effect of constipation.”
C) c. “Intense exercise or prolonged standing is not a problem with clonidine as it can be with other antihypertensive agents.”
D) d. “If you are having difficulty with the common side effect of drooling, notify your health care provider so your dosage can be adjusted.” |
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Definition
B.
Constipation is a controllable side effect of clonidine (Catapres). The client's blood pressure should be checked more frequently than once a year. Prolonged standing can cause venous pooling and hypotension. Drooling is not a common side effect of clonidine. |
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Term
Which is a priority nursing diagnosis for a client taking an antihypertensive medication?
A) a. Alteration in cardiac output related to effects on the sympathetic nervous system
B) b. Knowledge deficit related to medication regimen
C) c. Fatigue related to side effects of medication
D) d. Alteration in comfort related to nonproductive cough |
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Definition
A.
Circulation is always a priority over fatigue, pain, and knowledge deficit. |
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Term
A client is receiving an intravenous heparin drip. Which laboratory value will require immediate action by the nurse?
A) a. Platelet count of 150,000
B) b. Activated partial thromboplastin time (aPTT) of 120 seconds
C) c. INR of 1.0
D) d. Blood urea nitrogen (BUN) level of 12 mg/dL |
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Definition
B.
This aPTT value is too prolonged. The heparin drip should be shut off for an hour. |
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Term
A client who has been taking warfarin (Coumadin) is admitted with coffee-ground emesis. What is the nurse's primary action?
A) a. Administer vitamin E.
B) b. Administer vitamin K.
C) c. Administer protamine sulfate.
D) d. Administer calcium gluconate. |
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Definition
B.
Vitamin K is the antagonist for warfarin. |
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Term
The client has an international normalized ratio (INR) value of 1.5. What action will the nurse take?
A) a. Administer an additional dose of warfarin (Coumadin).
B) b. Hold the next dose of warfarin (Coumadin).
C) c. Increase the heparin drip rate.
D) d. Administer protamine sulfate. |
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Definition
A.
A therapeutic INR is 2 to 3. The client needs more Coumadin to reach a therapeutic level. |
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Term
A client is receiving warfarin (Coumadin) for a chronic condition. Which client statement requires immediate action by the nurse?
A) a. “I will avoid contact sports.”
B) b. “I will take my medication in the early evening each day.”
C) c. “I will increase dark-green, leafy vegetables in my diet.”
D) d. “I will contact my health care provider if I develop excessive bruising.” |
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Definition
C.
Dark green, leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Rather than increase the intake of these, it is important to maintain a consistent daily intake of vitamin K. |
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Term
A client is taking enoxaparin (Lovenox) daily. Which client statement requires additional monitoring?
A) a. “I take aspirin daily for headaches.”
B) b. “I take ibuprofen (Motrin) at least once a week for joint pain.”
C) c. “Whenever I have a fever, I take acetaminophen (Tylenol).”
D) d. “I take my medicine first thing in the morning.” |
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Definition
A.
Aspirin is an antiplatelet medication. A client taking both aspirin and Lovenox could cause excessive bleeding. |
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Term
The client is receiving tirofiban (Aggrastat)[Antiplatelet]. What is an essential nursing intervention for this client?
A) a. Have protamine sulfate available in case of an overdose.
B) b. Weigh the client before administration.
C) c. Have vitamin K available in case of an overdose.
D) d. Assess intake and output. |
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Definition
B.
Tirofiban (Aggrastat) is a glycoprotein IIb/IIIa inhibitor that blocks the enzyme essential for platelet aggregation. This is given to prevent the formation of further clots and is faster acting than warfarin. The medication is administered in mcg per kg of body weight per minute. Weighing the client is essential. Protamine sulfate is the antagonist for heparin. Vitamin K is not the antidote to overdose. |
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Term
A nurse is preparing to administer enoxaparin sodium (Lovenox) [LMWH heparin] to a client for prevention of deep vein thrombosis. What is an essential nursing intervention?
A) a. Draw up the medication in a syringe with a 22-gauge, 1-½ inch needle.
B) b. Utilize the Z-track method to inject the medication.
C) c. Administer the medication into subcutaneous tissue.
D) d. Rub the administration site after injecting. |
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Definition
C.
Enoxaparin (Lovenox) is a low-molecular-weight heparin that is administered subcutaneously. |
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Term
The client asks what the difference is between dalteparin (Fragmin) and heparin. What is the nurse's best response?
A) a. “There is no real difference. Dalteparin is preferred because it is less expensive.”
B) b. “Dalteparin is a low-molecular-weight heparin that is more predictable in its effect and has a lower risk of bleeding.”
C) c. “I’m not sure why some health care providers choose dalteparin and some heparin. You should ask your doctor.”
D) d. “The only difference is that heparin dosing is based on the client’s weight.” |
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Definition
B.
A low-molecular-weight heparin is more predictable in its effect than regular heparin. Dalteparin (Fragmin) is more expensive than heparin and is dosed based on the client's weight. |
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Term
A client has been admitted through the emergency department and requires emergency surgery. The client has been receiving heparin. What nursing intervention is essential?
A) a. Teach the client about the phenytoin.
B) b. Administer protamine sulfate.
C) c. Assess the INR before surgery.
D) d. Administer vitamin K. |
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Definition
B.
Protamine sulfate binds with heparin in the bloodstream to inactivate it and thus reverse its effect. |
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Term
What nursing intervention is essential for the client receiving alteplase [thombolytic]?
A) a. Assess for reperfusion dysrhythmias.
B) b. Monitor liver enzymes.
C) c. Administer vitamin K if bruising is observed.
D) d. Monitor blood pressure and stop the medication if blood pressure drops below 110 systolic. |
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Definition
A.
Alteplase (Activase) can cause bleeding as well as reperfusion dysrhythmias. Alteplase does not directly affect liver enzymes. Vitamin K will not reverse the effects of Activase. Vital sign changes can alert the nurse to complications; however, a blood pressure below 110 systolic is not, in itself, cause for alarm. |
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Term
A client who is taking warfarin (Coumadin) requests an aspirin for headache relief. What is the nurse's best response?
A) a. Administer 650 mg of acetylsalicylic acid (ASA) and reassess pain in 30 minutes.
B) b. Teach the client of potential drug interactions with anticoagulants.
C) c. Explain to the client that ASA is contraindicated and administer ibuprofen as ordered.
D) d. Explain that the headache is an expected side effect and will subside shortly. |
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Definition
B.
Clients taking an anticoagulant should not use medications that would further increase the risk of bleeding, which includes aspirin as well as ibuprofen. Aspirin should not be administered to the client taking other anticoagulants, unless it is ordered specifically as a low dose daily therapy. Ibuprofen is not the best choice of medication for the client receiving Coumadin. Tylenol (acetaminophen) would be preferred for pain relief. Headache is not an expected side effect of Coumadin therapy. |
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Term
client is started on warfarin (Coumadin) therapy while still receiving intravenous heparin. The client questions the nurse about the risk for bleeding. How should the nurse respond?
A) a. “Your concern is valid. I will call the doctor to discontinue the heparin.”
B) b. “It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic.”
C) c. “Because of your valve replacement, it is especially important for you to be anticoagulated. The heparin and warfarin together are more effective than one alone.”
D) d. “Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications.” |
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Definition
B.
Warfarin works by decreasing the production of clotting factors. However, it takes approximately 3 days for the body to metabolize present clotting factors and thus achieve a therapeutic anticoagulant effect. Because of this, heparin is continued until this is achieved. |
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Term
The nurse evaluates that the client understood discharge teaching regarding warfarin (Coumadin) based on which statement?
A) a. “I will double my dose if I forget to take it the day before.”
B) b. “I should keep taking ibuprofen for my arthritis.”
C) c. “I should decrease the dose if I start bruising easily.”
D) d. “I should use a soft toothbrush for dental hygiene.” |
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Definition
| D. This statement is accurate and will reduce the risk of bleeding. Ibuprofen will potentiate bleeding. The client should call the health care provider if experiencing excessive bruising. |
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Term
What intervention is essential before the nurse administers tenecteplase (TNKase)?
A) a. Perform all necessary venipunctures.
B) b. Administer aminocaproic acid (Amicar).
C) c. Have the client void.
D) d. Assess for allergies to iodine. |
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Definition
A.
TNKase is a thrombolytic agent that can interfere with the body's clotting ability. Therefore, all invasive procedures should be completed before administering this drug. |
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Term
Which nursing diagnosis would be possible for a client receiving intravenous heparin therapy?
A) a. Potential for fluid volume excess
B) b. Potential for pain
C) c. Risk for injury
D) d. Potential for body image disturbance |
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Definition
C.
The client receiving heparin is at risk for injury secondary to increased risk of bleeding. |
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Term
| 1.What food and over-the-counter medication issues should the nurse be sure to discuss with P.T. before discharge with regard to (Coumadin) warfarin? |
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Definition
A.Many foods and over-the-counter medications may interact with warfarin to either increase or decrease its effectiveness.
I.Vitamin K is a naturally occurring vitamin that will counteract the effects of warfarin. It is found in high levels in foods such as spinach, brussels sprouts, and broccoli. The client should avoid these foods in his diet.
II.Aspirin-containing products should be avoided as they can have an additive effect on anticoagulation.
III.Many over-the-counter products have a harmful effect when given with warfarin. The client should check with a health care professional before taking any such products. |
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Term
The nurse plans which intervention to decrease the flushing reaction of niacin?
A) a. Administer niacin with an antacid.
B) b. Administer aspirin 30 minutes before nicotinic acid.
C) c. Administer diphenhydramine hydrochloride (Benadryl) with niacin.
D) d. Apply cold compresses to the head and neck. |
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Definition
B.
Administration of an antiinflammatory agent such as aspirin has been shown to decrease the flushing reaction associated with niacin. In addition, avoiding hot beverages, such as coffee, when taking niacin may also prevent flushing. |
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Term
The nurse is reviewing instructions for a client taking an HMG-CoA reductase inhibitor (statin). What information is essential for the nurse to include?
A) a. “Take this medication on an empty stomach.”
B) b. “Take this medication at the same time each day.”
C) c. “Take this medication with breakfast.”
D) d. “Take this medication with an antacid.” |
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Definition
B.
Because the liver produces the most cholesterol during the night, it was previously believed that statin drugs, which work to decrease this synthesis, should be given during the evening so that blood levels were highest coinciding with this production. However, with the prolonged duration of action of some statin drugs, administration does not have to be specifically in the evening, but it is important to take them at approximately the same time every day. |
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Term
Which statement made by the client indicates understanding about discharge instructions on antihyperlipidemic medications?
A) a. “Antihyperlipidemic medications will replace the other interventions I have been doing to try to decrease my cholesterol.”
B) b. “It is important to double my dose if I miss one in order to maintain therapeutic blood levels.”
C) c. “I will stop taking the medication if it causes nausea and vomiting.”
D) d. “I will continue my exercise program to help increase my high-density lipoprotein serum levels.” |
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Definition
D.
Antihyperlipidemic medications are an addition to, not a replacement for, the therapeutic regimen used to decrease serum cholesterol levels. |
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Term
A client is prescribed ezetimibe (Zetia). Which assessment finding will require immediate action by the nurse?
A) a. Headache.
B) b. Slight nausea.
C) c. Muscle pain.
D) d. Fatigue. |
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Definition
C.
Clients who experience severe muscle pain while taking Ezetimibe (Zetia) need to report the findings right away, as this may be indicative of a serious problem. |
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Term
A nurse is caring for a client taking cholestyramine (Questran). The client is complaining of constipation. What will the nurse do?
A) a. Call the health care provider to change the medication.
B) b. Tell the client to skip a dose of the medication.
C) c. Have the client increase fluids and fiber in his diet.
D) d. Administer an enema to the client. |
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Definition
C.
Cholestyramine is an anion exchange resin that binds to bile to form an insoluble complex that is excreted. Constipation can occur and can be treated with conventional therapy, which includes increasing fluid and fiber in the diet. |
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Term
1. A newly admitted client takes digoxin 0.25 mg/day. The nurse knows that which is the serum therapeutic range for digoxin?
a. 0.1 to 1.5 ng/mL
b. 0.5 to 2.0 ng/mL
c. 1.0 to 2.5 ng/mL
d. 2.0 to 4.0 ng/mL |
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Definition
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Term
2. The client's serum digoxin level is 3.0 ng/mL. What does the nurse know about this serum digoxin level?
a. It is in the high (elevated) range.
b. It is in the low (decreased) range.
c. It is within the normal range.
d. It is in the low average range. |
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Definition
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Term
3. The nurse is assessing the client for possible evidence of digitalis toxicity. The nurse acknowledges that which is included in the signs and symptoms for digitalis toxicity?
a. Pulse (heart) rate of 100 beats/min
b. Pulse of 72 with an irregular rate
c. Pulse greater than 60 beats/min and irregular rate
d. Pulse below 60 beats/min and irregular rate |
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Definition
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Term
4. The client is also taking a diuretic that decreases her potassium level. The nurse expects that a low potassium level (hypokalemia) could have what effect on the digoxin?
a. Increase the serum digoxin sensitivity level
b. Decrease the serum digoxin sensitivity level
c. Not have any effect on the serum digoxin sensitivity level
d. Cause a low average serum digoxin sensitivity level |
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Definition
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Term
5. When a client first takes a nitrate, the nurse expects which symptom that often occurs?
a. Nausea and vomiting
b. Headaches
c. Stomach cramps
d. Irregular pulse rate |
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Definition
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Term
6. The nurse acknowledges that beta blockers are as effective as antianginals because they do what?
a. Increase oxygen to the systemic circulation.
b. Maintain heart rate and blood pressure.
c. Decrease heart rate and decrease myocardial contractility.
d. Decrease heart rate and increase myocardial contractility. |
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Definition
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Term
7. The health care provider is planning to discontinue a client's beta blocker. What instruction should the nurse give the client regarding the beta blocker?
a. The beta blocker should be abruptly stopped when another cardiac drug is prescribed.
b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down.
c. The beta blocker dose should be maintained while taking another antianginal drug.
d. Half the beta blocker dose should be taken for the next several weeks. |
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Definition
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Term
8. The beta blocker acebutolol (Sectral) is prescribed for dysrhythmias. The nurse knows that what is the primary purpose of the drug?
a. To increase the beta1 and beta2 receptors in the cardiac tissues
b. To increase the flow of oxygen to the cardiac tissues
c. To block the beta1-adrenergic receptors in the cardiac tissues
d. To block the beta2-adrenergic receptors in the cardiac tissues |
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Definition
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Term
1. A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. What type of electrolyte imbalance does the nurse expect to occur?
a. Hypocalcemia
b. Hypokalemia
c. Hyperkalemia
d. Hypermagnesemia |
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Definition
|
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Term
2. What would cause the same client's electrolyte imbalance?
a. High dose of digoxin
b. Digoxin taken daily
c. Hydrochlorothiazide
d. Low dose of hydrochlorothiazide |
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Definition
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Term
3. A nurse is teaching a client who has diabetes mellitus and is taking hydrochlorothiazide 50 mg/day. The teaching should include the importance of monitoring which levels?
a. Hemoglobin and hematocrit
b. Blood urea nitrogen (BUN)
c. Arterial blood gases
d. Serum glucose (sugar) |
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Definition
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Term
4. A client has heart failure and is prescribed Lasix. The nurse is aware that furosemide (Lasix) is what kind of drug?
a. Thiazide diuretic
b. Osmotic diuretic
c. High-ceiling (loop) diuretic
d. Potassium-sparing diuretic |
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Definition
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Term
5. The nurse acknowledges that which condition could occur when taking furosemide?
a. Hypokalemia
b. Hyperkalemia
c. Hypoglycemia
d. Hypermagnesemia |
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Definition
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Term
6. For the client taking a diuretic, a combination such as triamterene and hydrochlorothiazide may be prescribed. The nurse realizes that this combination is ordered for which purpose?
a. To decrease the serum potassium level
b. To increase the serum potassium level
c. To decrease the glucose level
d. To increase the glucose level |
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Definition
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Term
7. The client has been receiving spironolactone (Aldactone) 50 mg/day for heart failure. The nurse should closely monitor the client for which condition?
a. Hypokalemia
b. Hyperkalemia
c. Hypoglycemia
d. Hypermagnesemia |
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Definition
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Term
8. A client who has angina is prescribed nitroglycerin. The nurse reviews which appropriate nursing interventions for nitroglycerin? (Select all that apply.)
a. Have client lie down when taking a nitroglycerin sublingual tablet.
b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists.
c. Apply Transderm-Nitro patch to a hairy area to protect skin from burning.
d. Call the health care provider after taking 5 tablets if chest pain persists.
e. Warn client against ingesting alcohol while taking nitroglycerin. |
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Definition
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Term
1. A client's blood pressure (BP) is 145/90. According to the guidelines for determining hypertension, the nurse realizes that the client's BP is at which stage?
a. Normal
b. Prehypertension
c. Stage 1 hypertension
d. Stage 2 hypertension |
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Definition
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Term
2. The nurse acknowledges that the first-line drug for treating this client's blood pressure might be which drug?
a. Diuretic
b. Alpha blocker
c. ACE inhibitor
d. Alpha/beta blocker |
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Definition
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Term
3. The nurse is aware that which group(s) of antihypertensive drugs are less effective in African-American clients?
a. Diuretics
b. Calcium channel blockers and vasodilators
c. Beta blockers and ACE inhibitors
d. Alpha blockers |
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Definition
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Term
4. The nurse knows that which diuretic is most frequently combined with an antihypertensive drug?
a. chlorthalidone
b. hydrochlorothiazide
c. bendroflumethiazide
d. potassium-sparing diuretic |
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Definition
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Term
5. The nurse explains that which beta blocker category is preferred for treating hypertension?
a. Beta1 blocker
b. Beta2 blocker
c. Beta1 and beta2 blockers
d. Beta2 and beta3 blockers |
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Definition
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Term
6. Captopril (Capoten) has been ordered for a client. The nurse teaches the client that ACE inhibitors have which common side effects?
a. Nausea and vomiting
b. Dizziness and headaches
c. Upset stomach
d. Constant, irritating cough |
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Definition
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Term
7. A client is prescribed losartan (Cozaar). The nurse teaches the client that an angiotensin II receptor blocker (ARB) acts by doing what?
a. Inhibiting angiotensin-converting enzyme
b. Blocking angiotensin II from AT1 receptors
c. Preventing the release of angiotensin I
d. Promoting the release of aldosterone |
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Definition
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Term
8. During an admission assessment, the client states that she takes amlodipine (Norvasc). The nurse wishes to determine whether or not the client has any common side effects of a calcium channel blocker. The nurse asks the client if she has which signs and symptoms? (Select all that apply.)
a. Insomnia
b. Dizziness
c. Headache
d. Angioedema
e. Ankle edema
f. Hacking cough |
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Definition
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Term
1. When a newly admitted client is placed on heparin, the nurse acknowledges that heparin is effective for preventing new clot formation in clients who have which disorder(s)? (Select all that apply.)
a. Coronary thrombosis
b. Acute myocardial infarction
c. Deep vein thrombosis (DVT)
d. Cerebrovascular accident (CVA) (stroke)
e. Venous disorders |
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Definition
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Term
2. A client who received heparin begins to bleed, and the physician calls for the antidote. The nurse knows that which is the antidote for heparin?
a. protamine sulfate
b. vitamin K
c. aminocaproic acid
d. vitamin C |
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Definition
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Term
3. A client is prescribed enoxaparin (Lovenox). The nurse knows that low–molecular-weight heparin (LMWH) has what kind of half-life?
a. A longer half-life than heparin
b. A shorter half-life than heparin
c. The same half-life as heparin
d. A four-times shorter half-life than heparin |
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Definition
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Term
4. The nurse is teaching a client about clopidogrel (Plavix). What is important information to include?
a. Constipation may occur.
b. Hypotension may occur.
c. Bleeding may increase when taken with aspirin.
d. Normal dose is 25 mg tablet per day. |
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Definition
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Term
5. A client is prescribed dalteparin (Fragmin). LMWH is administered via which route?
a. Intravenously
b. Intramuscularly
c. Intradermally
d. Subcutaneously |
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Definition
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Term
6. A client is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally?
a. enoxaparin sodium (Lovenox)
b. warfarin (Coumadin)
c. bivalirudin (Angiomax)
d. lepirudin (Refludan) |
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Definition
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Term
7. A client is taking warfarin 5 mg/day for atrial fibrillation. The client's international normalized ratio (INR) is 3.8. The nurse would consider the INR to be what?
a. Within normal range
b. Elevated INR range
c. Low INR range
d. Low average INR range |
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Definition
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Term
8. Cilostazol (Pletal) is being prescribed for a client with coronary artery disease. The nurse knows that which is the major purpose for antiplatelet drug therapy?
a. To dissolve the blood clot
b. To decrease tissue necrosis
c. To inhibit hepatic synthesis of vitamin K
d. To suppress platelet aggregation |
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Definition
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Term
9. A client is to undergo a coronary angioplasty. The nurse acknowledges that which drug is used primarily for preventing reocclusion of coronary arteries following a coronary angioplasty?
a. clopidogrel (Plavix)
b. abciximab (ReoPro)
c. warfarin (Coumadin)
d. streptokinase |
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Definition
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Term
10. A client is admitted to the emergency department with an acute myocardial infarction. Which drug category does the nurse expect to be given to the client early for the prevention of tissue necrosis following blood clot blockage in a coronary or cerebral artery?
a. Anticoagulant agent
b. Antiplatelet agent
c. Thrombolytic agent
d. Low–molecular-weight heparin (LMWH) |
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Definition
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Term
A nurse who is giving a statin(Lipitor) realizes the importance of monitoring for which serious adverse reaction?
A. Pharyngitis
B. Rash/pruritus
C. Rhabdomyolysis
D. Agranulocytosis |
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Definition
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Term
A client’s serum lipids are cholesterol 197
mg/dl, low-density lipoprotein (LDL) 110 mg/dl, and
high-density lipoprotein (HDL) 35 mg/dl. The nurse
knows what about these values?
A. Serum lipids are within desirable values.
B. Cholesterol is within desirable value, but LDL and HDL are not.
C. Cholesterol is not within desirable value, though LDL and HDL are.
D. Cholesterol, LDL, and HDL are not within desirable values. |
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Definition
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Term
Which statement indicates the client understands discharge instructions regarding cholestyramine (Questran)?
A) a. “I will take Questran 1 hour before my other medications.”
B) b. “I will increase fiber in my diet.”
C) c. “I will weigh myself weekly.”
D) d. “I will have my blood pressure checked weekly.” |
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Definition
|
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Term
The nurse plans which intervention to decrease the flushing reaction of niacin?
A) a. Administer niacin with an antacid.
B) b. Administer aspirin 30 minutes before nicotinic acid.
C) c. Administer diphenhydramine hydrochloride (Benadryl) with niacin.
D) d. Apply cold compresses to the head and neck. |
|
Definition
|
|
Term
The nurse plans which intervention to decrease the flushing reaction of niacin?
A) a. Administer niacin with an antacid.
B) b. Administer aspirin 30 minutes before nicotinic acid.
C) c. Administer diphenhydramine hydrochloride (Benadryl) with niacin.
D) d. Apply cold compresses to the head and neck. |
|
Definition
|
|
Term
The nurse is reviewing instructions for a client taking an HMG-CoA reductase inhibitor (statin). What information is essential for the nurse to include?
A) a. “Take this medication on an empty stomach.”
B) b. “Take this medication at the same time each day.”
C) c. “Take this medication with breakfast.”
D) d. “Take this medication with an antacid.” |
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Definition
|
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Term
A client is prescribed gemfibrozil (Lopid) for treatment of hyperlipidemia type IV. What is important for the nurse to teach the client?
A) a. “Take aspirin before the medication if you experience facial flushing.”
B) b. “You may experience headaches with this medication.”
C) c. “You will need to have weekly blood drawn to assess for hyperkalemia.”
D) d. “Cholesterol levels will need to be assessed daily for one week.” |
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Definition
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Term
Which statement made by the client indicates understanding about discharge instructions on antihyperlipidemic medications?
A) a. “Antihyperlipidemic medications will replace the other interventions I have been doing to try to decrease my cholesterol.”
B) b. “It is important to double my dose if I miss one in order to maintain therapeutic blood levels.”
C) c. “I will stop taking the medication if it causes nausea and vomiting.”
D) d. “I will continue my exercise program to help increase my high-density lipoprotein serum levels.” |
|
Definition
|
|
Term
A client is prescribed ezetimibe (Zetia). Which assessment finding will require immediate action by the nurse?
A) a. Headache.
B) b. Slight nausea.
C) c. Muscle pain.
D) d. Fatigue. |
|
Definition
|
|
Term
A nurse is caring for a client taking cholestyramine (Questran). The client is complaining of constipation. What will the nurse do?
A) a. Call the health care provider to change the medication.
B) b. Tell the client to skip a dose of the medication.
C) c. Have the client increase fluids and fiber in his diet.
D) d. Administer an enema to the client. |
|
Definition
|
|
Term
Which statement indicates to the nurse that the client needs further medication instruction about colestipol (Colestid)?
A) a. "The medication may cause constipation, so I will increase fluid and fiber in my diet."
B) b. "I should take this medication 1 hour after or 4 hours before my other medications."
C) c. "I might need to take fat-soluble vitamins to supplement my diet."
D) d. "I should stir the powder in as small an amount of fluid as possible to maintain potency of the medication." |
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Definition
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Term
Which assessment finding in a client taking an HMG-CoA reductase inhibitor (statin) will the nurse act on immediately?
A) a. Decreased hemoglobin
B) b. Elevated liver function tests
C) c. Elevated HDL
D) d. Elevated LDL |
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Definition
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Term
A 70-year-old client who is taking several cardiac antidysrhythmic medications has been prescribed simvastatin (Zocor){a Antihyperlipidemics statin} 80 mg/day. What is essential information for the nurse to teach the client?
A) a. “This dose may lower your cholesterol too much.”
B) b. “These factors may put you at higher risk for myopathy.”
C) c. “You should not take this drug with cardiac medications.”
D) d. “This combination will cause you to have nausea and vomiting.” |
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Definition
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Term
A client diagnosed with hypercholesterolemia is prescribed lovastatin (Mevacor){a Antihyperlipidemics statin}. The nurse is reviewing the client's history and would contact the health care provider about which of these conditions in the client's history?
A) a. Chronic pulmonary disease
B) b. Hepatic disease
C) c. Leukemia
D) d. Renal disease |
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Definition
|
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Term
A nurse is caring for a client with elevated triglyceride levels who is unresponsive to HMG-CoA reductase inhibitors (statin). What medication will the nurse administer?
A) a. cholestyramine (Questran)
B) b. colestipol (Colestid)
C) c. gemfibrozil (Lopid)
D) d. simvastatin (Zocor) |
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Definition
| C. Gemfibrozil (Lopid), a fibric acid derivative, promotes catabolism of triglyceride-rich lipoproteins. |
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Term
The nurse would question an order for cholestyramine (Questran) if the client has which condition?
A) a. Impaction
B) b. Glaucoma
C) c. Hepatic disease
D) d. Renal disease |
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Definition
| AA. Cholestyramine (Questran) binds with bile in the intestinal tract to form an insoluble complex. It can also bind to other substances and lead to intestinal obstruction. |
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Term
The nurse reviews the history for a client taking atorvastatin (Lipitor) {a Antihyperlipidemics statin}. What will the nurse act on immediately?
A) a. Client takes medications with grape juice.
B) b. Client takes herbal therapy including kava kava.
C) c. Client is on oral contraceptives.
D) d. Client was started on penicillin for a respiratory infection. |
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Definition
| C. Atorvastatin (Lipitor) increases the estrogen levels of oral contraceptives. The client's oral contraceptive may need to be altered. |
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