ALH 2202-General Pharmacology Exam 2-NCLEX practice questions

ALH 2202-General Pharmacology Exam 2-NCLEX practice questions CHAPTER 18 The nurse has a prescription to infuse dobutamine (Dobutrex) intravenously at 3 mcg/kg/min in a pediatric patient with cardiac decompensation. The patient's weight is 77 lb. What is the correct dosage to administer? a) 105 mcg/min  The patient's weight of 77 lb is converted to kilograms by dividing 77 by 2.2, which equals 35 kg. 3 mcg/kg/min multiplied by 35 kg equals 105 mcg/min. The nurse has a prescription to infuse dopamine (Intropin) intravenously at 30 mcg/kg/min in an adult patient for cardiopulmonary arrest. If the patient weighs 143 lb, what is the correct dosage to administer? a) 1950 mcg/min  The patient's weight of 143 lb is converted to kilograms by dividing 143 by 2.2, which equals 65 kg. When 65 kg is multiplied by 30 mcg/kg/min, the result is 1950 mcg/min. The health care provider has prescribed dopamine (Intropin) to treat the patient’s hypovolemic shock secondary to severe blood loss. For the medication to be effective, the health care provider must also prescribe which treatment? a) Fluid replacement  Dopamine increases blood pressure secondary to vasoconstriction, which has a limited effect if there is not enough volume within the circulatory system. b) Temporary pacing c) Beta-stimulating drugs d) Induced hypothermia A patient weighing 176 lb is to receive a dopamine (Intropin) continuous intravenous (IV) infusion at 5 mcg/kg/min. The solution strength available is dopamine 400 mg in 500 mL D5W. The nurse will infuse the medication at which rate? a) 30 mL/hr  The patient’s weight of 176 lb is converted to kilograms by dividing 176 by 2.2, which equals 80 kg. 5 mcg/kg/min multiplied by 80 kg equals 400 mcg, or 0.4 mg/min. Page 1 Dividing 0.4 mg/min by 400 mg/500 mL = 0.5 mL/min, which when multiplied by 60 minutes = 30 mL/hour. b) 50 mL/hr c) 40 mL/hr d) 20 mL/hr When assessing for cardiovascular effects of an adrenergic (sympathomimetic) drug, the nurse understands that these drugs produce which effect on the heart? a) A positive inotropic, positive chronotropic, and positive dromotropic effect  Adrenergic stimulation of the beta1-adrenergic receptors on the myocardium and in the conduction system of the heart results in an increased heart rate (positive chronotropic effect), increased contractility (positive inotropic effect), and increased conductivity (positive dromotropic effect). b) A positive inotropic, negative chronotropic, and negative dromotropic effect c) A negative inotropic, positive chronotropic, and positive dromotropic effect d) A negative inotropic, negative chronotropic, and negative dromotropic effect A hypertensive crisis may occur if adrenergic (sympathomimetic) drugs are given along with which of the following drug classes? a) Alpha1 blockers b) Direct renin inhibitors c) Monoamine oxidase inhibitors (MAOIs)  Adrenergic drugs combined with MAOIs may cause a possibly life-threatening hypertensive crisis. All of the other drugs listed are used to treat hypertension. Page 2 d) Beta blockers The nurse assesses the patient’s IV site, and it has infiltrated during the infusion of dopamine (Intropin). The nurse will prepare which medication to treat this infiltration? a) Naloxone (Narcan) b) Lidocaine (Xylocaine) c) Phentolamine (Regitine)  Phentolamine is an alpha blocker that causes vasodilation, thus counteracting the vasoconstrictive effects of the infiltrated dopamine. The vasodilation will increase blood flow to the site and decrease the risk of tissue necrosis. d) Nitroprusside (Nipride) A patient using Afrin nasal spray complains of worsening cold symptoms and tells the nurse, “I don’t understand why this is not working. I am using it almost every 3 hours.” The nurse’s response is based on knowledge of which drug information? a) The patient is experiencing rebound congestion related to excessive use of the medication.  Afrin nasal spray is a sympathomimetic drug with both alpha- and beta-adrenergic effects. The alpha-adrenergic activity is responsible for causing vasoconstriction in the nasal mucosa. However, excessive use of nasal decongestants can lead to greater congestion because of a rebound phenomenon that occurs when use of the product is stopped. b) The medication needs to be used every 30 minutes for maximum effectiveness. c) Afrin nasal spray may be minimally effective to relieve the nasal congestion. d) Adrenergic decongestants should only be used prophylactically, not to treat acute congestion. Epinephrine, as an adrenergic (sympathomimetic) drug, produces which therapeutic effect? Page 3 a) Urinary retention b) Bronchial constriction c) Decreased intestinal motility d) Increased heart rate and contractility  Epinephrine causes sympathomimetic actions, including increased heart rate and contractility. The other effects listed are parasympathomimetic in nature. CHAPTER 19 Nonselective beta blockers may be used to treat hypertension and what other condition? a) Chronic obstructive pulmonary disease (COPD) b) Heart failure c) Supraventricular dysrhythmias  Nonselective beta blockers are used to treat supraventricular dysrhythmias secondary to their negative chronotropic effects (decreasing heart rate). They may exacerbate heart failure, COPD, and heart block secondary to their negative inotropic effect (heart failure), blocking of bronchodilation (COPD), and negative chronotropic effects (heart block). d) Heart block The nurse knows which drug is an example of a cardioselective beta blocker? a) Atenolol (Tenormin)  At therapeutic dosages, atenolol selectively blocks only the beta1 receptors in the heart, not the beta2 receptors located in the lungs. b) Sotalol (Betapace) c) Labetalol (Normodyne) Page 4 d) Propranolol (Inderal) When teaching a patient about beta blockers such as atenolol (Tenormin) and metoprolol (Lopressor), it is important for the nurse to instruct the patient about which drug information? a) Alcohol intake is encouraged for its vasodilating effects. b) Abrupt medication withdrawal may lead to a rebound hypertension.  Abrupt withdrawal of a beta-blocking drug can cause rebound hypertension. These drugs should not be withdrawn abruptly, but should be tapered over 1 to 2 weeks. Antacids should not be taken with beta blockers because they may decrease absorption. c) These medications may be taken with antacids to minimize gastrointestinal distress. d) Hot baths and showers will help increase the therapeutic effects of this drug. Which is the pharmacological action of propranolol (Inderal)? a) Beta2-adrenergic antagonist b) Selective alpha-adrenergic antagonist c) Nonselective beta-adrenergic antagonist  Propranolol is nonselective; it blocks both beta1 and beta2 receptors at therapeutic doses. d) Beta1-adrenergic antagonist During assessment of a patient diagnosed with pheochromocytoma, the nurse auscultates a blood pressure of 210/110 mm Hg. The nurse would expect to administer which medication? a) Verapamil (Calan) b) Nadolol (Corgard) Page 5 c) Phentolamine (Regitine)  Phentolamine is a potent alpha-blocking drug specifically effective for treatment of hypertension associated with pheochromocytoma. d) Dobutamine (Dobutrex) The nurse understands beta blockers produce which cardiovascular effects? a) Positive inotropic, negative chronotropic, and negative dromotropic b) Positive inotropic, positive chronotropic, and positive dromotropic c) Negative inotropic, negative chronotropic, and negative dromotropic  Beta blockers exert a sympatholytic effect, blocking the effects of sympathetic nervous system stimulation, causing a decrease in heart rate (negative chronotropic), conductivity (negative dromotropic), and contractility (negative inotropic). d) Negative inotropic, positive chronotropic, and positive dromotropic What is the priority nursing diagnosis for a patient prescribed metoprolol (Lopressor)? a) Risk for injury related to possible adverse effects of the adrenergic blockers b) Acute confusion related to adverse central nervous system effects of the drug c) Risk for decreased cardiac tissue perfusion related to effects of medication  Using the ABCs of prioritization, risk for decreased cardiac tissue perfusion puts the patient at highest risk. Although the other nursing diagnoses are pertinent, they are not the priority. d) Deficient knowledge related to lack of information about the therapeutic regimen When performing discharge instructions to a patient prescribed metoprolol (Lopressor), which statement by the nurse is correct? Page 6 a) “If you become dizzy, do not take your medication for 2 days and then restart on the third day.” b) “If you take your pulse and it is less than 60 beats/min, hold your medicine and call your health care provider for instructions.”  Beta blockers have a negative chronotropic effect and could cause symptomatic bradycardia or heart block. The health care provider should be consulted before administering to a patient with bradycardia (heart rate 60 beats/min). c) “Increase your intake of green leafy vegetables to prevent bleeding problems that can be caused by this medication.” d) “This medication may make you fatigued; increasing caffeine in your diet may help alleviate this problem.” Beta blockers are used to treat which conditions? (Select all that apply.) a) Raynaud’s disease b) Hypertension c) Cardiac dysrhythmias d) COPD e) Angina pectoris  Beta blockers are effective in treating hypertension (secondary to negative inotropic effects), angina pectoris (decreases cardiac workload when decreasing heart rate and contractility), and cardiac dysrhythmias (decreasing heart rate and conductivity). Beta blockers can exacerbate COPD because they block beta22 receptors and subsequent bronchodilation. Raynaud’s disease may be treated with alpha, not beta, blockers. The nurse is caring for a patient with a history of angina and hypertension who is diagnosed with moderate heart failure. The patient’s current medication regimen includes digoxin (Lanoxin), furosemide (Lasix), and quinapril (Accupril). Which medication would be most beneficial for the health care provider to add to this patient’s treatment plan