NURS 6521 QUESTION BANK
Question 1
A clinic nurse has been assigned a 49-year-old female patient who has a
history of diabetes. A recent diagnosis of hypertension has been made, and
the patient has been prescribed a thiazide diuretic and labetalol. The
patient will be scheduled to return to the clinic once a month for the next 6
months. A priority action by the nurse will be to
Response Monitoring of blood pressure would be the priority assessment in
Feedback: the care of this patient. Questioning the patient about her dietary
intake and weighing her would be appropriate, but secondary in
importance. It is unnecessary to monitor the patient's respiratory
rate.
Question 2
A 55-year-old man's hypertension has not responded adequately to his
current medication regimen consisting or an ACE inhibitor, a beta-blocker
and a thiazide diuretic. As a result, he will soon begin taking hydralazine
(Apresoline) in addition to his existing antihypertensives. The addition of
this medication to his regimen means that the nurse must prioritize which
of the following nursing actions?
Response Hydralazine is associated with an increase in cardiac output that
Feedback: can precipitate palpitations, tachycardia, and angina. As a result,
there is a need for astute cardiac assessment. The use of
hydralazine does not directly necessitate close monitoring of
electrolytes or blood sugars, even though these are prudent
assessment measures. There is a risk of dizziness and possibly
falls with the use of any antihypertensive, but it is unnecessary to
supervise all of the patient's ADLs.
Question 3
A 39-year-old African-American male is 25 pounds overweight and has
been diagnosed with hypertension after three consecutive above-normal
blood pressure readings. The most likely initial drug therapy for this
patient will be
, Response The patient would most likely be prescribed a diuretic in
Feedback: combination with diet and other lifestyle changes. African-
American men are at increased risk for developing hypertension
and tend to respond differently to antihypertensive therapy. The
research shows that African-American men are most responsive
to single-drug therapy and diuretics. The use of a calcium
channel blocker and/or alpha-adrenergic blocker would follow if
he is unresponsive to the diuretic in combination with diet and
other lifestyle changes. African Americans tend to be less
responsive to ACE inhibitors and beta blockers.
Question 4
A patient is brought to the emergency department in hypertensive crisis.
Nitroprusside is administered intravenously. The patient experiences
diaphoresis and dizziness. Which of the following is the appropriate action
by the nurse?
Response Administering nitroprusside too quickly can result in abdominal
Feedback: pain, apprehension, diaphoresis, dizziness, headache, muscle
twitching, nausea, palpitations, restlessness, retching, and
retrosternal discomfort. The nurse should quickly inform the
prescriber and slow the infusion. Symptoms quickly subside
when the nitroprusside infusion is slowed or stopped, and usually
do not return when the infusion resumes at a slower rate.
Consulting the prescriber for a dose change would not help; the
rate of drug administration is the issue. Continuing to give the
nitroprusside at the ordered rate could be fatal.
Question 5
Several months of treatment with a statin accompanied by lifestyle
modifications have failed to appreciably improve a patient's cholesterol
levels. Consequently, the patient has been prescribed cholestyramine. The
nurse should recognize that this drugs achieves its therapeutic effect by
Response Unlike statins, which work by decreasing the synthesis of
Feedback: cholesterol, the bile acid sequestrants such as cholestyramine
promote the oxidation of cholesterol to bile acids. Bile acid
sequestrants do not promote vasodilation or bind HDL to LDL.
Question 6
, A 58-year-old man is admitted to the emergency department. A diagnosis
of severe digoxin toxicity is made. Bradycardia is present, and an
electrocardiogram (ECG) confirms toxicity. The nurse will administer
which of the following drugs?
Response Digoxin immune fab is used as the antidote to digoxin toxicity.
Feedback: The other drugs would not be used to treat digoxin toxicity. The
patient could be taking furosemide as part of his drug regimen
for heart failure.
Question 7
A resident of a long-term care facility receives 12.5 mg metoprolol
(Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the
nurse should perform and document what assessments?
Response Metoprolol has a profound effect on both blood pressure and
Feedback: heart rate. Consequently, the nurse should assess these
parameters prior to administering the drug. Assessments related
to pain, respiratory status, cognition, and temperature are not
central to the administration of a beta blocker.
Question 8
A nurse who provides care in a busy clinic is aware of the high incidence
and prevalence of hyperlipidemia and the consequent need for
antihyperlipidemics in many patients. Treatment of high cholesterol using
statins would be contraindicated in which of the following patients?
Response Active liver disease is a contraindication to the use of statins. As
Feedback: well, heavy alcohol use increases the risk of liver dysfunction.
Respiratory disease, recent surgery, and organic cognitive
deficits do not preclude the use of statins for high cholesterol.
Question 9
A nurse is caring for a male patient who has a diagnosis of coronary artery
disease (CAD). His drug therapy includes lovastatin. Because the patient
has a history of severe renal disease, the nurse will assess for which of the
following?
, Respons Patients with severe renal disease may have an increased plasma
e concentration of lovastatin because 10% of the drug is eliminated in
Feedbac the urine. Patients with renal disorders are not likely to experience a
k: decrease in LDL or an increase in the statin tolerance level.
Question 10
A nurse is caring for a patient who is admitted into the cardiac care unit
with acute, decompensated heart failure. Nesiritide (Natrecor) has been
ordered. When preparing for administration of the drug, the nurse will
Response Nesiritide must be reconstituted and then further diluted for
Feedback: infusion. Reconstitute one vial by adding 5 mL of diluent that
has been removed from a 250-mL plastic IV bag. Do not shake
the vial. Rock the vial gently so that all surfaces, including the
stopper, are in contact with the diluent. Add the entire contents
of the reconstituted vial back to the 250-mL plastic IV bag and
invert the bag several times to ensure complete mixing. Use the
reconstituted nesiritide solution within 24 hours. The initial IV
bolus must be drawn from the prepared infusion bag and
administered over approximately 60 seconds through an IV
port.
Question 11
A 70-year-old woman with a history of atrial fibrillation takes digoxin and
verapamil to control her health problem. Verapamil achieves a therapeutic
effect by
Response Verapamil acts by inhibiting the movement of calcium ions
Feedback: across the cardiac and arterial muscle cell membrane. It works
preferentially in “slow response” myocardial tissue, such as the
SA and AV nodes. Beta blockers inhibit adrenergic receptors and
Class IB antiarrhythmics are among the drugs that decrease
sodium and potassium conduction. Lidocaine weakens phase 4
diastolic depolarization and decreases the action potential
duration and the effective refractory period of Purkinje fibers and
ventricular muscle.
Question 12
Question 1
A clinic nurse has been assigned a 49-year-old female patient who has a
history of diabetes. A recent diagnosis of hypertension has been made, and
the patient has been prescribed a thiazide diuretic and labetalol. The
patient will be scheduled to return to the clinic once a month for the next 6
months. A priority action by the nurse will be to
Response Monitoring of blood pressure would be the priority assessment in
Feedback: the care of this patient. Questioning the patient about her dietary
intake and weighing her would be appropriate, but secondary in
importance. It is unnecessary to monitor the patient's respiratory
rate.
Question 2
A 55-year-old man's hypertension has not responded adequately to his
current medication regimen consisting or an ACE inhibitor, a beta-blocker
and a thiazide diuretic. As a result, he will soon begin taking hydralazine
(Apresoline) in addition to his existing antihypertensives. The addition of
this medication to his regimen means that the nurse must prioritize which
of the following nursing actions?
Response Hydralazine is associated with an increase in cardiac output that
Feedback: can precipitate palpitations, tachycardia, and angina. As a result,
there is a need for astute cardiac assessment. The use of
hydralazine does not directly necessitate close monitoring of
electrolytes or blood sugars, even though these are prudent
assessment measures. There is a risk of dizziness and possibly
falls with the use of any antihypertensive, but it is unnecessary to
supervise all of the patient's ADLs.
Question 3
A 39-year-old African-American male is 25 pounds overweight and has
been diagnosed with hypertension after three consecutive above-normal
blood pressure readings. The most likely initial drug therapy for this
patient will be
, Response The patient would most likely be prescribed a diuretic in
Feedback: combination with diet and other lifestyle changes. African-
American men are at increased risk for developing hypertension
and tend to respond differently to antihypertensive therapy. The
research shows that African-American men are most responsive
to single-drug therapy and diuretics. The use of a calcium
channel blocker and/or alpha-adrenergic blocker would follow if
he is unresponsive to the diuretic in combination with diet and
other lifestyle changes. African Americans tend to be less
responsive to ACE inhibitors and beta blockers.
Question 4
A patient is brought to the emergency department in hypertensive crisis.
Nitroprusside is administered intravenously. The patient experiences
diaphoresis and dizziness. Which of the following is the appropriate action
by the nurse?
Response Administering nitroprusside too quickly can result in abdominal
Feedback: pain, apprehension, diaphoresis, dizziness, headache, muscle
twitching, nausea, palpitations, restlessness, retching, and
retrosternal discomfort. The nurse should quickly inform the
prescriber and slow the infusion. Symptoms quickly subside
when the nitroprusside infusion is slowed or stopped, and usually
do not return when the infusion resumes at a slower rate.
Consulting the prescriber for a dose change would not help; the
rate of drug administration is the issue. Continuing to give the
nitroprusside at the ordered rate could be fatal.
Question 5
Several months of treatment with a statin accompanied by lifestyle
modifications have failed to appreciably improve a patient's cholesterol
levels. Consequently, the patient has been prescribed cholestyramine. The
nurse should recognize that this drugs achieves its therapeutic effect by
Response Unlike statins, which work by decreasing the synthesis of
Feedback: cholesterol, the bile acid sequestrants such as cholestyramine
promote the oxidation of cholesterol to bile acids. Bile acid
sequestrants do not promote vasodilation or bind HDL to LDL.
Question 6
, A 58-year-old man is admitted to the emergency department. A diagnosis
of severe digoxin toxicity is made. Bradycardia is present, and an
electrocardiogram (ECG) confirms toxicity. The nurse will administer
which of the following drugs?
Response Digoxin immune fab is used as the antidote to digoxin toxicity.
Feedback: The other drugs would not be used to treat digoxin toxicity. The
patient could be taking furosemide as part of his drug regimen
for heart failure.
Question 7
A resident of a long-term care facility receives 12.5 mg metoprolol
(Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the
nurse should perform and document what assessments?
Response Metoprolol has a profound effect on both blood pressure and
Feedback: heart rate. Consequently, the nurse should assess these
parameters prior to administering the drug. Assessments related
to pain, respiratory status, cognition, and temperature are not
central to the administration of a beta blocker.
Question 8
A nurse who provides care in a busy clinic is aware of the high incidence
and prevalence of hyperlipidemia and the consequent need for
antihyperlipidemics in many patients. Treatment of high cholesterol using
statins would be contraindicated in which of the following patients?
Response Active liver disease is a contraindication to the use of statins. As
Feedback: well, heavy alcohol use increases the risk of liver dysfunction.
Respiratory disease, recent surgery, and organic cognitive
deficits do not preclude the use of statins for high cholesterol.
Question 9
A nurse is caring for a male patient who has a diagnosis of coronary artery
disease (CAD). His drug therapy includes lovastatin. Because the patient
has a history of severe renal disease, the nurse will assess for which of the
following?
, Respons Patients with severe renal disease may have an increased plasma
e concentration of lovastatin because 10% of the drug is eliminated in
Feedbac the urine. Patients with renal disorders are not likely to experience a
k: decrease in LDL or an increase in the statin tolerance level.
Question 10
A nurse is caring for a patient who is admitted into the cardiac care unit
with acute, decompensated heart failure. Nesiritide (Natrecor) has been
ordered. When preparing for administration of the drug, the nurse will
Response Nesiritide must be reconstituted and then further diluted for
Feedback: infusion. Reconstitute one vial by adding 5 mL of diluent that
has been removed from a 250-mL plastic IV bag. Do not shake
the vial. Rock the vial gently so that all surfaces, including the
stopper, are in contact with the diluent. Add the entire contents
of the reconstituted vial back to the 250-mL plastic IV bag and
invert the bag several times to ensure complete mixing. Use the
reconstituted nesiritide solution within 24 hours. The initial IV
bolus must be drawn from the prepared infusion bag and
administered over approximately 60 seconds through an IV
port.
Question 11
A 70-year-old woman with a history of atrial fibrillation takes digoxin and
verapamil to control her health problem. Verapamil achieves a therapeutic
effect by
Response Verapamil acts by inhibiting the movement of calcium ions
Feedback: across the cardiac and arterial muscle cell membrane. It works
preferentially in “slow response” myocardial tissue, such as the
SA and AV nodes. Beta blockers inhibit adrenergic receptors and
Class IB antiarrhythmics are among the drugs that decrease
sodium and potassium conduction. Lidocaine weakens phase 4
diastolic depolarization and decreases the action potential
duration and the effective refractory period of Purkinje fibers and
ventricular muscle.
Question 12
