NUR 3145 Part 4 and 7 Exam 2.

NUR 3145 Part 4 and 7 Exam 2. Chapter 22: Antihypertensive Drugs Lilley: Pharmacology and the Nursing Process, 8th Edition MULTIPLE CHOICE 1. A patient has a new order for the adrenergic drug doxazosin (Cardura). When providing education about this drug, the nurse will include which instructions? a. “Weigh yourself daily, and report any weight loss to your prescriber.” b. “Increase your potassium intake by eating more bananas and apricots.” c. “The impaired taste associated with this medication usually goes away in 2 to 3 weeks.” d. “Be sure to lie down after taking the first dose, because first-dose hypotension may make you dizzy.” ANS: D A patient who is starting doxazosin should take the first dose while lying down because there is a first-dose hypotensive effect with this medication. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 354 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 2. A patient with severe liver disease is receiving the angiotensin-converting enzyme (ACE) inhibitor, captopril (Capoten). The nurse is aware that the advantage of this drug for this patient is which characteristic? a. Captopril rarely causes first-dose hypotensive effects. b. Captopril has little effect on electrolyte levels. c. Captopril is a prodrug and is metabolized by the liver before becoming active. d. Captopril is not a prodrug and does not need to be metabolized by the liver before becoming active. ANS: D A prodrug relies on a functioning liver to be converted to its active form. Captopril is not a prodrug, and therefore it would be safer for the patient with liver dysfunction. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 348 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. During a follow-up visit, the health care provider examines the fundus of the patient’s eye. Afterward, the patient asks the nurse, “Why is he looking at my eyes when I have high blood pressure? It does not make sense to me!” What is the best response by the nurse? a. “We need to monitor for drug toxicity.” b. “We must watch for increased intraocular pressure.” c. “The provider is assessing for visual changes that may occur with drug therapy.” d. “The provider is making sure the treatment is effective over the long term.” ANS: D The physician would examine the fundus of a patient’s eyes during antihypertensive therapy because it is a more reliable indicator than blood pressure readings of the long-term effectiveness of treatment. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 358 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The nurse is preparing for a community education program on hypertension. Which of these parameters determine the regulation of arterial blood pressure? a. Cardiac output and systemic vascular resistance b. Heart rate and peripheral resistance c. Blood volume and renal blood flow d. Myocardial contractility and arteriolar constriction ANS: A Blood pressure is determined by the product of cardiac output and systemic vascular resistance. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 343 TOP: NURSING PROCESS: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. When counseling a male patient about the possible adverse effects of antihypertensive drugs, the nurse will discuss which potential problem? a. Impotence b. Bradycardia c. Increased libido d. Weight gain ANS: A Sexual dysfunction is a common complication of antihypertensive medications and may be manifested in men as decreased libido or impotence. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 358 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is reviewing drug therapy for hypertension. According to the JNC-8 guidelines, antihypertensive drug therapy for a newly diagnosed hypertensive African-American patient would most likely include which drug or drug classes? a. Vasodilators alone b. ACE inhibitors alone c. Calcium channel blockers with thiazide diuretics d. Beta blockers with thiazide diuretics ANS: C According to the JNC-8 guidelines, calcium channel blockers and diuretics are recommended as first-line therapy for management of hypertension in African-American patients. The other drugs are not recommended as first-line drugs for this group. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 355 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which is a potential nursing diagnosis for the patient taking antihypertensive medications? a. Diarrhea b. Sexual dysfunction c. Urge urinary incontinence d. Impaired memory ANS: B Sexual dysfunction is a potential nursing diagnosis related to possible adverse effects of antihypertensive drug therapy. The other nursing diagnoses are not appropriate. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 355 TOP: NURSING PROCESS: Nursing Diagnosis MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. A patient’s blood pressure elevates to 270/150 mm Hg, and a hypertensive emergency is obvious. He is transferred to the intensive care unit and started on a sodium nitroprusside (Nipride) drip to be titrated per his response. With this medication, the nurse knows that the maximum dose of this drug should be infused for how long? a. 10 minutes b. 30 minutes c. 1 hour d. 24 hours ANS: A Sodium nitroprusside is a potent vasodilator and may lead to extreme decreases in the patient’s blood pressure. For this reason, it is never infused at the maximum dose for more than 10 minutes. If this drug does not control a patient’s blood pressure after 10 minutes, it will most likely be ordered to be discontinued. The other times listed are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 357 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be needed. Which answer by the nurse is the correct response? a. “This therapy will take about 3 months.” b. “This therapy will take about a year.” c. “This therapy will go on until your symptoms disappear.” d. “Therapy for high blood pressure is usually lifelong.” ANS: D There is no cure for the disease, and treatment will be lifelong. The other answers are not appropriate. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 355 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. A patient who has been taking antihypertensive drugs for a few months complains of having a persistent dry cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs? a. Beta blockers b. Angiotensin-converting enzyme (ACE) inhibitors c. Angiotensin II receptor blockers (ARBs) d. Calcium channel blockers ANS: B ACE inhibitors cause a characteristic dry, nonproductive cough that reverses when therapy is stopped. The other drug classes do not cause this cough. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 349 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A pregnant woman is experiencing hypertension. The nurse knows that which drug is commonly used for a pregnant patient who is experiencing hypertension? a. Mannitol (Osmitrol) b. Enalapril (Vasotec) c. Hydrochlorothiazide (HydroDIURIL) d. Methyldopa (Aldomet) ANS: D Methyldopa is used in the treatment of hypertension during pregnancy. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 347 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 12. A patient with type 2 diabetes mellitus has been found to have trace proteinuria. The prescriber writes an order for an angiotensin-converting enzyme (ACE) inhibitor. What is the main reason for prescribing this class of drug for this patient? a. Cardioprotective effects b. Renal protective effects c. Reduces blood pressure d. Promotes fluid output ANS: B ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This is one reason that they are among the cardiovascular drugs of choice for diabetic patients. The other drugs do not have this effect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 349 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class? a. Calcium channel blockers b. Diuretics c. Nonsteroidal anti-inflammatory drugs d. Nitrates ANS: C Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can reduce the antihypertensive effect of ACE inhibitors. In addition, the use of NSAIDs and ACE inhibitors may also predispose patients to the development of acute renal failure. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 349 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. An older adult patient will be taking a vasodilator for hypertension. Which adverse effect is of most concern for the older adult patient taking this class of drug? a. Dry mouth b. Restlessness c. Constipation d. Hypotension ANS: D The older adult patient is more sensitive to the blood pressure–lowering effects of vasodilators, and consequently experience more problems with hypotension, dizziness, and syncope. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 355 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential MULTIPLE RESPONSE 1. When teaching a patient about antihypertensive drug therapy, which statements by the nurse are correct? (Select all that apply.) a. “You need to have your blood pressure checked once a week and keep track of the readings.” b. “If you notice that the symptoms have gone away, you should be able to stop taking the drug.” c. “An exercise program may be helpful in treating hypertension, but let’s check with your doctor first.” d. “If you experience severe side effects, stop the medicine and let us know at your next office visit.” e. “Most over-the-counter decongestants are compatible with antihypertensive drugs.” f. “Please continue taking the medication, even if you are feeling better.” ANS: A, C, F Keeping a record of weekly blood pressure checks helps to monitor the effectiveness of the therapy. Remind the patient not to stop taking the medication just because he or she is feeling better. Abruptly stopping the medication may lead to rebound hypertension. Therapy is often lifelong, even though symptoms may improve. Many over-the-counter drugs, especially decongestants, have serious interactions with antihypertensive drugs. The patient needs to consult his or her prescriber before taking any other medication. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 359 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION 1. A patient is to receive enalapril (Vasotec) 5 mg IV every 6 hours. Each dose is given over 5 minutes. The medication is available in an injectable form, 1.25 mg/mL. Identify how many milliliters of medication will the nurse draw up for each dose. ANS: 4 mL DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 23: Antianginal Drugs Lilley: Pharmacology and the Nursing Process, 8th Edition MULTIPLE CHOICE 1. When the nurse is administering topical nitroglycerin ointment, which technique is correct? a. Apply the ointment on the skin on the forearm. b. Apply the ointment only in the case of a mild angina episode. c. Remove the old ointment before new ointment is applied. d. Massage the ointment gently into the skin, and then cover the area with plastic wrap. ANS: C The old ointment should be removed before a new dose is applied. The ointment should be applied to clean, dry, hairless skin of the upper arms or body, not below the elbows or below the knees. The ointment is not massaged or spread on the skin, and it is not indicated for the treatment of acute angina. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 372 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. The nurse is giving intravenous nitroglycerin to a patient who has just been admitted because of an acute myocardial infarction. Which statement is true regarding the administration of the intravenous form of this medication? a. The solution will be slightly colored green or blue. b. The intravenous form is given by bolus injection. c. It can be given in infusions with other medications. d. Non-polyvinylchloride (non-PVC) plastic intravenous bags and tubing must be used. ANS: D The non-PVC infusion kits are used to avoid absorption and/or uptake of the nitrate by the intravenous tubing and bag and/or decomposition of the nitrate. The medication is given by infusion via an infusion pump and not with other medications. It is not given by bolus injection. If the parenteral solution is discolored blue or green, it should be discarded. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 372 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A patient has been diagnosed with angina and will be given a prescription for sublingual nitroglycerin tablets. When teaching the patient how to use sublingual nitroglycerin, the nurse will include which instruction? a. Take up to 5 doses at 15-minute intervals for an angina attack. b. If the tablet does not dissolve quickly, chew the tablet for maximal effect. c. If the chest pain is not relieved after one tablet, call 911 immediately. d. Wait 1 minute between doses of sublingual tablets, up to 3 doses. ANS: C According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after 1 dose, the patient (or family member) must call 911 immediately. The patient may take one more tablet while awaiting emergency care and may take a third tablet 5 minutes later, but no more than a total of three tablets. The sublingual dose is placed under the tongue, and the patient needs to avoid swallowing until the tablet has dissolved. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 373 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A 74-year-old professional golfer has chest pain that occurs toward the end of his golfing games. He says the pain usually goes away after one or two sublingual nitroglycerin tablets and rest. What type of angina is he experiencing? a. Classic b. Variant c. Unstable d. Prinzmetal’s ANS: A Classic, or chronic stable, angina is triggered by either exertion or stress and usually subsides within 15 minutes with either rest or drug therapy. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 363 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. A patient arrives in the emergency department with severe chest pain. The patient reports that the pain has been occurring off and on for a week now. Which assessment finding would indicate the need for cautious use of nitrates and nitrites? a. Blood pressure of 88/62 mm Hg b. Apical pulse rate of 110 beats/min c. History of renal disease d. History of a myocardial infarction 2 years ago ANS: A Hypotension is a possible contraindication to the use of nitrates because the medications may cause the blood pressure to decrease. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 364 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 6. A calcium channel blocker (CCB) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. Which instruction is correct? a. Chew the tablet for faster release of the medication. b. To increase the effect of the drug, take it with grapefruit juice. c. If the adverse effects of chest pain, fainting, or dyspnea occur, discontinue the medication immediately. d. A high-fiber diet with plenty of fluids will help prevent the constipation that may occur. ANS: D Constipation is a common effect of CCBs, and a high-fiber diet and plenty of fluids will help to prevent it. Grapefruit juice decreases the metabolism of CCBs. Extended-release tablets must never be chewed or crushed. These medications should never be discontinued abruptly because of the risk for rebound hypertension. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 373 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. When applying transdermal nitroglycerin patches, which instruction by the nurse is correct? a. “Rotate application sites with each dose.” b. “Use only the chest area for application sites.” c. “Temporarily remove the patch if you go swimming.” d. “Apply the patch to the same site each time.” ANS: A Application sites for transdermal nitroglycerin patches need to be rotated. Apply the transdermal patch to any nonhairy area of the body; the old patch should first be removed. The patch may be worn while swimming, but if it does come off, it should be replaced after the old site is cleansed. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 374 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. A patient has been taking a beta blocker for 4 weeks as part of his antianginal therapy. He also has type II diabetes and hyperthyroidism. When discussing possible adverse effects, the nurse will include which information? a. “Watch for unusual weight loss.” b. “Monitor your pulse for increased heart rate.” c. “Use the hot tub and sauna at the gym as long as time is limited to 15 minutes.” d. “Monitor your blood glucose levels for possible hypoglycemia or hyperglycemia.” ANS: D Beta blockers can cause both hypoglycemia and hyperglycemia. They may also cause weight gain if heart failure is developing, and decreased pulse rate. The use of hot tubs and saunas is not recommended because of the possibility of hypotensive episodes. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 367 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 9. What action is often recommended to help reduce tolerance to transdermal nitroglycerin therapy? a. Omit a dose once a week. b. Leave the patch on for 2 days at a time. c. Cut the patch in half for 1 week until the tolerance subsides. d. Remove the patch at bedtime, and then apply a new one in the morning. ANS: D To prevent tolerance, remove the transdermal patch at night for 8 hours, and apply a new patch in the morning. Transdermal patches must never be cut or left on for 2 days, and doses must not be omitted. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 365 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. While assessing a patient who is taking a beta blocker for angina, the nurse knows to monitor for which adverse effect? a. Nervousness b. Hypertension c. Bradycardia d. Dry cough ANS: C Adverse effects of beta blockers include bradycardia, hypotension, dizziness, lethargy, impotence, and several other effects, but not dry cough or nervousness. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 367 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. When teaching a patient who has a new prescription for transdermal nitroglycerin patches, the nurse tells the patient that these patches are most appropriately used for which situation? a. To prevent low blood pressure b. To relieve shortness of breath c. To prevent the occurrence of angina d. To keep the heart rate from rising too high during exercise ANS: C Transdermal dosage formulations of nitroglycerin are used for the long-term prophylactic management (prevention) of angina pectoris. Transdermal nitroglycerin patches are not appropriate for the relief of shortness of breath, to prevent palpitations, or to control the heart rate during exercise. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 366 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. The nurse is providing education about the use of sublingual nitroglycerin tablets. She asks the patient, “What would you do if you experienced chest pain while mowing your yard? You have your bottle of sublingual nitroglycerin with you.” Which actions by the patient are appropriate in this situation? (Select all that apply.) a. Stop the activity, and lie down or sit down. b. Call 911 immediately. c. Call 911 if the pain is not relieved after taking one sublingual tablet. d. Call 911 if the pain is not relieved after taking three sublingual tablets in 15 minutes. e. Place a tablet under the tongue. f. Place a tablet in the space between the gum and cheek. g. Take another sublingual tablet if chest pain is not relieved after 5 minutes, up to three total. ANS: A, C, E, G With sublingual forms, the medication is taken at the first sign of chest pain, not delayed until the pain is severe. The patient needs to sit down or lie down and take one sublingual tablet. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after 1 dose, the patient (or family member) must call 911 immediately. The patient can take one more tablet while awaiting emergency care and may take a third tablet 5 minutes later, but no more than a total of three tablets. These guidelines reflect the fact that angina pain that does not respond to nitroglycerin may indicate a myocardial infarction. The sublingual dose is placed under the tongue, and the patient needs to avoid swallowing until the tablet has dissolved. Placing a tablet between the gum and cheek is the buccal route. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 372 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A patient with a history of angina will be started on ranolazine (Ranexa). The nurse is reviewing the patient’s history and will note potential contraindications to this drug therapy if which condition is present? (Select all that apply.) a. Type 2 diabetes mellitus b. Prolonged QT interval on the electrocardiogram c. Heart failure d. Closed-angle glaucoma e. Decreased liver function ANS: B, E Ranolazine is contraindicated in patients with pre-existing QT prolongation or hepatic impairment. The other options are not contraindications. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 370 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION 1. A patient will be receiving metoprolol (Lopressor) 5 mg IV push for angina. The medication is available in a strength of 1 mg/mL. Identify how much medication will the nurse draw up for each dose. ANS: 5 mL DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 24: Heart Failure Drugs Lilley: Pharmacology and the Nursing Process, 8th Edition MULTIPLE CHOICE 1. A patient about to receive a morning dose of digoxin has an apical pulse of 53 beats/min. What will the nurse do next? a. Administer the dose. b. Administer the dose, and notify the prescriber. c. Check the radial pulse for 1 full minute. d. Withhold the dose, and notify the prescriber. ANS: D Digoxin doses are held and the prescriber notified if the apical pulse is 60 beats/min or lower or is higher than 100 beats/min. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 385 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A patient is taking digoxin (Lanoxin) and a loop diuretic daily. When the nurse enters the room with the morning medications, the patient states, “I am seeing a funny yellow color around the lights.” What is the nurse’s next action? a. Assess the patient for symptoms of digoxin toxicity. b. Withhold the next dose of the diuretic. c. Administer the digoxin and diuretic together as ordered. d. Document this finding, and reassess in 1 hour. ANS: A Seeing colors around lights is one potential indication of developing digoxin toxicity. If a patient complains of this, the nurse needs to assess for other signs and symptoms of digoxin toxicity including bradycardia, headache, dizziness, confusion, nausea, and blurred vision, and then notify the prescriber. Administering the drug or withholding the diuretic are incorrect options. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 382 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 3. While assessing a patient who is receiving intravenous digitalis, the nurse recognizes that the drug has a negative chronotropic effect. How would this drug effect be evident in the patient? a. Decreased blood pressure b. Decreased heart rate c. Decreased conduction d. Decreased ectopic beats ANS: B A negative chronotropic effect results in a decreased heart rate; this is one effect of cardiac glycosides. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 381 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient has been taking digoxin at home but took an accidental overdose and has developed toxicity. The patient has been admitted to the telemetry unit, where the physician has ordered digoxin immune Fab (Digifab). The patient asks the nurse why the medication is ordered. What is the nurse’s best response? a. “It will increase your heart rate.” b. “This drug helps to lower your potassium levels.” c. “It helps to convert the irregular heart rhythm to a more normal rhythm.” d. “This drug is an antidote to digoxin and will help to lower the blood levels.” ANS: D Digoxin immune Fab (Digifab) is the antidote for a severe digoxin overdose. It is given intravenously. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 383 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. A patient has been placed on a milrinone (Primacor) infusion as part of the therapy for end-stage heart failure. What adverse effect of this drug will the nurse watch for when assessing this patient during the infusion? a. Hypertension b. Hyperkalemia c. Nausea and vomiting d. Cardiac dysrhythmias ANS: D The primary adverse effects seen with milrinone are cardiac dysrhythmias, mainly ventricular. It may also cause hypotension, hypokalemia, and other effects, but not nausea and vomiting. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 381 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 6. A patient has a digoxin level of 1.1 ng/mL. Which interpretation by the nurse is correct? a. It is below the therapeutic level. b. It is within the therapeutic range. c. It is above the therapeutic level. d. It is at a toxic level. ANS: B The normal therapeutic drug level of digoxin is between 0.5 and 2 ng/mL. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 383 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse is reviewing discharge teaching for a patient who will be taking digoxin (Lanoxin) therapy. The nurse will teach the patient to avoid which foods when taking the digoxin? a. Leafy green vegetables b. Dairy products c. Grapefruit juice d. Bran muffins ANS: D Bran, in large amounts, may decrease the absorption of oral digitalis drugs. The other foods do not affect digoxin levels. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 385 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. In assessing a patient before administration of a cardiac glycoside, the nurse knows that which lab result can increase the toxicity of the drug? a. Potassium level 2.8 mEq/L b. Potassium level 4.9 mEq/L c. Sodium level 140 mEq/L d. Calcium level 10 mg/dL ANS: A Hypokalemia increases the chance of digitalis toxicity. The other levels listed are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 384 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. The nurse administering the phosphodiesterase inhibitor milrinone (Primacor) recognizes that this drug will have a positive inotropic effect. Which result reflects this effect? a. Increased heart rate b. Increased blood vessel dilation c. Increased force of cardiac contractions d. Increased conduction of electrical impulses across the heart ANS: C Positive inotropic drugs increase myocardial contractility, thus increasing the force of cardiac conduction. Positive chronotropic drugs increase the heart rate. Positive dromotropic drugs increase the conduction of electrical impulses across the heart. Blood vessel dilation is not affected. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 377 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The nurse notes in a patient’s medical record that nesiritide (Natrecor) has been ordered. Based on this order, the nurse interprets that the patient has which disorder? a. Atrial fibrillation b. Acutely decompensated heart failure with dyspnea at rest c. Systolic heart failure d. Chronic, stable heart failure ANS: B Nesiritide is indicated for the treatment of acutely decompensated heart failure with dyspnea at rest. Digoxin is used for the treatment of atrial fibrillation and systolic heart failure. Nesiritide is not indicated for chronic, stable heart failure. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 380 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. When administering digoxin immune Fab (Digibind) to a patient with severe digoxin toxicity, the nurse knows that each vial can bind with how much digoxin? a. 0.5 mg b. 5 mg c. 5.5 mg d. 15 mg ANS: A One vial of digoxin immune Fab binds 0.5 mg of digoxin. The other options are incorrect. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 383 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. A patient is in the intensive care unit and receiving an infusion of milrinone (Primacor) for severe heart failure. The prescriber has written an order for an intravenous dose of furosemide (Lasix). How will the nurse give this drug? a. Infuse the drug into the same intravenous line as the milrinone. b. Stop the milrinone, flush the line, and then administer the furosemide. c. Administer the furosemide in a separate intravenous line. d. Notify the prescriber that the furosemide cannot be given at this time. ANS: C Furosemide must not be injected into an intravenous line with milrinone because it will precipitate immediately. The infusion must not be stopped because of the patient’s condition. A separate line will be needed. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 381 TOP: NURSING PROCESS: Planning MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control MULTIPLE RESPONSE 1. When a patient is experiencing digoxin toxicity, which clinical situation would necessitate the use of digoxin immune Fab (Digifab)? (Select all that apply.) a. The patient reports seeing colorful halos around lights. b. The patient’s serum potassium level is above 5 mEq/L. c. The patient is experiencing nausea and anorexia. d. The patient is experiencing severe sinus bradycardia that does not respond to cardiac pacing. e. The patient has received an overdose of greater than 10 mg of digoxin. f. The patient reports fatigue and headaches. ANS: B, D, E Clinical situations that would require the use of digoxin immune Fab in a patient with digoxin toxicity include serum potassium level above 5 mEq/L, severe sinus bradycardia that does not respond to cardiac pacing, or an overdose of more than 10 mg of digoxin. Seeing colorful halos around lights and experiencing nausea, anorexia, fatigue, and headaches are potential adverse effects of digoxin therapy but are not necessarily reasons for digoxin immune Fab treatment. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 382 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. Which drug classes are considered first-line treatment for heart failure? (Select all that apply.) a. Angiotensin-converting enzyme (ACE) inhibitors b. Angiotensin II receptor blockers (ARBs) c. Digoxin (cardiac glycoside) d. Beta blockers e. Nesiritide (Natrecor), the B-type natriuretic peptide ANS: A, B, D ACE inhibitors, ARBs, and beta blockers are now considered the first-line treatments for heart failure. Digoxin is used when the first-line treatments are not successful; nesiritide is considered a last-resort treatment. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 378 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION 1. The medication order for a 4-year-old child reads, “Give digoxin elixir, 15 mcg/kg, PO now.” Convert the micrograms to milligrams. ANS: 0.015 mg DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 25: Antidysrhythmic Drugs Lilley: Pharmacology and the Nursing Process, 8th Edition MULTIPLE CHOICE 1. The nurse is reviewing the classes of antidysrhythmic drugs. Amiodarone (Cordarone) is classified on the Vaughan Williams classification as a class III drug, which means it works by which mechanism of action? a. Blocking slow calcium channels b. Prolonging action potential duration c. Blocking sodium channels and affecting phase 0 d. Decreasing spontaneous depolarization and affecting phase 4 ANS: B Vaughan Williams class III drugs (amiodarone, dronedarone, sotalol, ibutilide, and dofetilide) increase the action potential duration by prolonging repolarization in phase 3. The other answers are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 396 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A patient is taking procainamide (Pronestyl) for a cardiac dysrhythmia. The nurse will monitor the patient for which possible adverse effect? a. Bradycardia b. Shortened QT interval c. Dyspnea d. Diarrhea ANS: D Diarrhea is a potential adverse effect of procainamide therapy. Prolonged QT interval on the ECG is also possible. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 398 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. Which nursing diagnosis is appropriate for a patient receiving antidysrhythmics? a. Risk for infection b. Deficient knowledge c. Deficient fluid volume d. Urinary retention ANS: B Deficient knowledge related to lack of experience with medication therapy is a potential nursing diagnosis for a patient receiving antidysrhythmics. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 406 TOP: NURSING PROCESS: Nursing Diagnosis MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient will be discharged on quinidine sulfate (Quinidex) extended-release tablets for the treatment of ventricular ectopy. The nurse will include which information in the teaching plan? a. The medication should be stopped once the cardiac symptoms subside. b. Signs of cinchonism, such as tinnitus, loss of hearing, or slight blurring of vision, may occur. c. It is important to use sunscreen products when outside because of increased photosensitivity. d. If any tablet or capsule is visible in the stool, contact the prescriber immediately. ANS: B Quinidine, a cinchona alkaloid, may cause the symptoms of cinchonism, including tinnitus, loss of hearing, slight blurring of vision, and gastrointestinal upset. The medication will need to be continued even after symptoms subside, or the symptoms may return. Tablets or capsules that are visible in the stool are actually the wax matrices that contained the drug; the medication is extracted while in the intestines. Photosensitivity occurs with class III drugs, not with quinidine (class Ia). DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 401 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. A patient is in the intensive care unit because of an acute myocardial infarction. He is experiencing severe ventricular dysrhythmias. The nurse will prepare to give which drug of choice for this dysrhythmia? a. Diltiazem (Cardizem) b. Verapamil (Calan) c. Amiodarone (Cordarone) d. Adenosine (Adenocard) ANS: C Amiodarone (Cordarone) is the drug of choice for ventricular dysrhythmias according to the Advanced Cardiac Life Support guidelines. The other drugs are not used for acute ventricular dysrhythmias. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 403 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is preparing to administer adenosine (Adenocard) to a patient who is experiencing an acute episode of paroxysmal supraventricular tachycardia. When giving this medication, which is important to remember? a. The onset of action occurs in 5 minutes. b. The medication must be given as a slow intravenous (IV) push. c. Asystole may occur for a few seconds after administration. d. The medication has a long half-life, and therefore duration of action is very long. ANS: C Adenosine has an extremely short half-life of less than 10 seconds; its onset occurs within 1 minute; and it must be given as a fast IV push injection. In addition, a very brief episode of asystole may occur after administration. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 405 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. A 62-year-old man is to receive lidocaine as treatment for a symptomatic dysrhythmia. Upon assessment, the nurse notes that he has a history of alcoholism and has late-stage liver failure. The nurse will expect which adjustments to his drug therapy? a. The dosage will be reduced by 50%. b. A diuretic will be added to the lidocaine. c. The lidocaine will be changed to an oral dosage form. d. An increased dosage of lidocaine will be prescribed so as to obtain adequate blood levels. ANS: A Because lidocaine is metabolized primarily by the liver, a reduction of the dosage by 50% may be necessary in cases of liver failure or cirrhosis. Lidocaine does not come in oral form. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 401 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 8. A patient has been started on therapy of a continuous infusion of lidocaine after receiving a loading dose of the drug. The nurse will monitor the patient for which adverse effect? a. Drowsiness b. Nystagmus c. Dry mouth d. Convulsions ANS: D Convulsions are possible if lidocaine reaches toxic levels. The other options are not adverse effects of lidocaine. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 401 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. When starting a patient on antidysrhythmic therapy, the nurse will remember that which problem is a potential adverse effect of any antidysrhythmic drug? a. Deficiency of fat-soluble vitamins b. Hyperkalemia c. Heart failure d. Dysrhythmias ANS: D Many antidysrhythmics are themselves capable of producing new dysrhythmias (the prodysrhythmic effect). The other options are not adverse effects of antidysrhythmic drugs. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: pp. 397-398 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. A patient is in the emergency department with a new onset of rapid-rate atrial fibrillation, and the nurse is preparing a continuous infusion. Which drug is most appropriate for this dysrhythmia? a. Diltiazem (Cardizem) b. Atenolol (Tenormin) c. Lidocaine d. Adenosine (Adenocard) ANS: A Diltiazem (Cardizem) is indicated for the temporary control of a rapid ventricular response in a patient with atrial fibrillation or flutter and paroxysmal supraventricular tachycardia. It is given by continuous infusion after a loading dose given by IV bolus. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 405 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. The nurse notes in the patient’s medication orders that the patient will be taking ibutilide (Corvert). Based on this finding, the nurse interprets that the patient has which disorder? a. Ventricular ectopy b. Atrial fibrillation c. Supraventricular tachycardia d. Bradycardia ANS: B Ibutilide (Corvert) is one of two class III antidysrhythmic drugs available for rapid conversion of these atrial fibrillations and atrial flutters into normal sinus rhythm. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 404 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. Which patient-teaching instructions are appropriate for a patient taking an antidysrhythmic drug? (Select all that apply.) a. “Do not chew or crush extended-release forms of medication.” b. “Take the medication with food if gastrointestinal distress occurs.” c. “If a dose is missed, the missed dose should be taken along with the next dose that is due to be taken.” d. “Take the medications with an antacid if gastrointestinal distress occurs.” e. “Limit or avoid the use of caffeine.” f. “The presence of a capsule in the stool should be reported to the physician immediately.” ANS: A, B, E Appropriate teaching instructions for a patient taking an antidysrhythmic drug include: do not chew or crush extended-release forms; if gastrointestinal distress occurs, take the drug with food; and limit or avoid the use of caffeine. Do not double medication doses or take medications with an antacid. The presence of a portion of a capsule or tablet in the stool is actually the wax matrix that carried the medication, which has been absorbed. The physician does not need to be notified. DIF: COGNITIVE LEVEL: Applying (Application) REF: pp. 408-409 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. The nurse is monitoring for adverse effects in a patient who is receiving an amiodarone (Cordarone) infusion. Which are adverse effects for amiodarone? (Select all that apply.) a. Tachycardia b. Constipation c. Chest pain d. QT prolongation e. Headache f. Hypotension g. Blue-gray coloring of the skin on the face, arms, and neck ANS: B, D, F, G There are numerous adverse effects of amiodarone, including pulmonary toxicity, thyroid disorders, bradycardia, hypotension, SA node dysfunction, QT prolongation, blue-gray coloring of the skin (face, arms, and neck), constipation, and others. Tachycardia, chest pain, and headache are not adverse effects of amiodarone therapy. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 399 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION 1. The nurse is preparing to administer a bolus dose of verapamil (Calan) as follows: “Give 5-mg bolus of verapamil, IV push, over 2 minutes. May repeat in 30 minutes if needed.” The medication is available in a 2.5-mg/mL strength solution. Identify how many milliliters will the nurse draw into the syringe for this dose. ANS: 2 mL DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 26: Coagulation Modifier Drugs Lilley: Pharmacology and the Nursing Process, 8th Edition MULTIPLE CHOICE 1. A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient asks the nurse why he has to be on two medications. The nurse’s response is based on which rationale? a. The oral and injection forms work synergistically. b. The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used alone. c. Oral anticoagulants are used to reach an adequate level of anticoagulation when heparin alone is unable to do so. d. Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels. ANS: D This overlap therapy is required in patients who have been receiving heparin for anticoagulation and are to be switched to warfarin so that prevention of clotting is continuous. This overlapping is done purposefully to allow time for the blood levels of warfarin to rise, so that when the heparin is eventually discontinued, therapeutic anticoagulation levels of warfarin will have been achieved. Recommendations are to continue overlap therapy of the heparin and warfarin for at least 5 days; the heparin is stopped after day 5 when the international normalized ratio (INR) is above 2. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 417 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A patient is receiving thrombolytic therapy, and the nurse monitors the patient for adverse effects. What is the most common undesirable effect of thrombolytic therapy? a. Dysrhythmias b. Nausea and vomiting c. Anaphylactic reactions d. Internal and superficial bleeding ANS: D Bleeding, both internal and superficial, as well as intracranial, is the most common undesirable effect of thrombolytic therapy. The other options list possible adverse effects of thrombolytic drugs, but they are not the most common effects. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 424 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. A patient who has been anticoagulated with warfarin (Coumadin) has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the patient may have taken too much warfarin. The nurse anticipates that the patient will receive which antidote? a. Vitamin E b. Vitamin K c. Protamine sulfate d. Potassium chloride ANS: B Vitamin K is given to reverse the anticoagulation effects of warfarin toxicity. Protamine sulfate is the antidote for heparin overdose. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 416 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. When administering heparin subcutaneously, the nurse will follow which procedure? a. Aspirating the syringe before injecting the medication b. Massaging the site after injection c. Applying heat to the injection site d. Using a - to -inch 25- to 28-gauge needle ANS: D A - to -inch 25- to 28-gauge needle is the correct needle to use for a subcutaneous heparin injection. The other options would encourage hematoma formation at the injection site. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 429 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. A patient has been instructed to take one enteric-coated low-dose aspirin a day as part of therapy to prevent strokes. The nurse will provide which instruction when providing patient teaching about this medication? a. Aspirin needs to be taken on an empty stomach to ensure maximal absorption. b. Low-dose aspirin therapy rarely causes problems with bleeding. c. Take the medication with 6 to 8 ounces of water and with food. d. Coated tablets may be crushed if necessary for easier swallowing. ANS: C Enteric-coated aspirin is best taken with 6 to 8 ounces of water and with food to help decrease gastrointestinal upset. Enteric-coated tablets should not be crushed. Risk for bleeding increases with aspirin therapy, even at low doses. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 431 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. A patient will be receiving a thrombolytic drug as part of the treatment for acute myocardial infarction. The nurse explains to the patient that this drug is used for which purpose? a. To relieve chest pain b. To prevent further clot formation c. To dissolve the clot in the coronary artery d. To control bleeding in the coronary vessels ANS: C Thrombolytic drugs lyse, or dissolve, thrombi. They are not used to prevent further clot formation or to control bleeding. As a result of dissolving of the thrombi, chest pain may be relieved, but that is not the primary purpose of thrombolytic therapy. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 414 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. A patient is receiving heparin therapy as part of the treatment for a pulmonary embolism. The nurse monitors the results of which laboratory test to check the drug’s effectiveness? a. Bleeding times b. Activated partial thromboplastin time (aPTT) c. Prothrombin time/international normalized ratio (PT/INR) d. Vitamin K levels ANS: B Ongoing aPTT values are used to monitor heparin therapy. PT/INR is used to monitor warfarin therapy. The other two options are not used to monitor anticoagulant therapy. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 432 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse notes in the patient’s medication orders that the patient will be starting anticoagulant therapy. What is the primary goal of anticoagulant therapy? a. Stabilizing an existing thrombus b. Dissolving an existing thrombus c. Preventing thrombus formation d. Dilating the vessel around a clot ANS: C Anticoagulants prevent thrombus formation but do not dissolve or stabilize an existing thrombus, nor do they dilate vessels around a clot. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 414 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient is being discharged on anticoagulant therapy. The nurse will include in the patient-education conversation that it is important to avoid herbal products that contain which substance? a. Valerian b. Ginkgo c. Soy d. Saw palmetto ANS: B Capsicum pepper, feverfew, garlic, ginger, ginkgo, St. John’s wort, and ginseng are some herbals that have potential interactions with anticoagulants, especially with warfarin. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 417 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 10. A patient has had recent mechanical heart valve surgery and is receiving anticoagulant therapy. While monitoring the patient’s laboratory work, the nurse interprets that the patient’s international normalized ratio (INR) level of 3 indicates that: a. the patient is not receiving enough warfarin to have a therapeutic effect. b. the patient’s warfarin dose is at therapeutic levels. c. the patient’s intravenous heparin dose is dangerously high. d. the patient’s intravenous heparin dose is at therapeutic levels. ANS: B A normal INR (without warfarin) is 1.0. A therapeutic INR for patients who have had mechanical heart valve surgery ranges from 2.5 to 3.5, with a middle value of 3. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 419 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A patient has received an overdose of intravenous heparin, and is showing signs of excessive bleeding. Which substance is the antidote for heparin overdose? a. Vitamin E b. Vitamin K c. Protamine sulfate d. Potassium chloride ANS: C Protamine sulfate is a specific heparin antidote and forms a complex with heparin, completely reversing its anticoagulant properties. Vitamin K is the antidote for warfarin (Coumadin) overdose. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 416 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. The nurse is reviewing new medication orders for a patient who has an epidural catheter for pain relief. One of the orders is for enoxaparin (Lovenox), a low–molecular-weight heparin (LMWH). What is the nurse’s priority action? a. Give the LMWH as ordered. b. Double-check the LMWH order with another nurse, and then administer as ordered. c. Stop the epidural pain medication, and then administer the LMWH. d. Contact the prescriber because the LMWH cannot be given if the patient has an epidural catheter. ANS: D LMWHs are contraindicated in patients with an indwelling epidural catheter; they can be given 2 hours after the epidural is removed. This is very important to remember, because giving an LMWH with an epidural has been associated with epidural hematoma. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 416 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. A patient will be taking dabigatran (Pradaxa) as part of treatment for chronic atrial fibrillation. Which statements about dabigatran are true? (Select all that apply.) a. The dose of dabigatran is reduced in patients with decreased renal function. b. Bleeding is the most common adverse effect. c. Potassium chloride is given as an antidote in cases of overdose. d. Dabigatran levels are monitored by measuring prothrombin time/international normalized ratio (PT/INR) results. e. This drug is a prodrug and becomes activated in the liver. ANS: A, B, E Dabigatran is excreted extensively in the kidneys, and the dose is dependent upon renal function. The normal dose is 150 mg twice daily, but it must be reduced to 75 mg twice daily if creatinine clearance is less than 30 mL/min. The most common and serious side effect is bleeding. Dabigatran is a prodrug that becomes activated in the liver. There is no antidote to dabigatran. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 417 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION 1. A patient has received an overdose of enoxaparin (Lovenox). The order was for 30 mg, but the patient received 90 mg. The nurse notes that the patient is showing signs of bleeding (oozing blood from the intravenous sites, increased bruising) and notifies the physician, who prescribes protamine sulfate to cover the excess amount of enoxaparin that the patient received. Calculate how much protamine sulfate the patient will receive. ANS: 60 mg Protamine sulfate is used to reverse the effects of low–molecular-weight heparins (LMWHs). A 1-mg dose of protamine is administered for each milligram of the LMWH. This patient received 60 mg of enoxaparin more than the ordered dose of 30 mg; therefore, 60 mg of protamine sulfate will be used as an antidote. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 416 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. An elderly patient has had hip surgery and will be receiving heparin, 4000 units subcutaneously every 12 hours. The heparin is available in vials of 5000 units/mL. Calculate how much heparin the nurse will administer for this dose. ANS: DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 27: Antilipemic Drugs Lilley: Pharmacology and the Nursing Process, 8th Edition MULTIPLE CHOICE 1. A patient with elevated lipid levels has a new prescription for nicotinic acid (niacin). The nurse informs the patient that which adverse effects may occur with this medication? a. Pruritus, cutaneous flushing b. Tinnitus, urine with a burnt odor c. Myalgia, fatigue d. Blurred vision, headaches ANS: A Possible adverse effects of nicotinic acid include pruritus, cutaneous flushing, and gastrointestinal distress. Tinnitus, urine with a burnt odor, and headaches are possible adverse effects of bile acid sequestrants. Headaches are also possible adverse effects of HMG-CoA reductase inhibitors, as are myalgia and fatigue. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 444 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A patient reports having adverse effects with nicotinic acid (niacin). The nurse can suggest performing which action to minimize these undesirable effects? a. Take the drug on an empty stomach. b. Take the medication every other day until the effects subside. c. Take an aspirin tablet 30 minutes before taking the drug. d. Take the drug with large amounts of fiber. ANS: C The undesirable effects of nicotinic acid can be minimized by starting with a low initial dose, taking the drug with meals, and taking small doses of aspirin with the drug to minimize cutaneous flushing. Fiber intake has no effect on niacin’s adverse effects, and it is not within the nurse’s scope of practice to suggest a change of medication dosage. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 444 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. A patient calls the clinic office saying that the cholestyramine (Questran) powder he started yesterday clumps and sticks to the glass when he tries to mix it. The nurse will suggest what method for mixing this medication for administration? a. Mix the powder in a carbonated soda drink to dissolve it faster. b. Add the powder to any liquid, and stir vigorously to dissolve it quickly. c. Mix the powder with food or fruit, or at least 4 to 6 ounces of fluid. d. Sprinkle the powder into a spoon and take it dry, followed by a glass of water. ANS: C Mix the powder with food or at least 4 to 6 ounces of fluid. The powder may not mix completely at first, but patients should be sure to mix the dose as much as possible and then dilute any undissolved portion with additional fluid. The powder should be dissolved for at least 1 full minute. Powder and granule dosages are never to be taken in dry form. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 447 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient is concerned about the adverse effects of the fibric acid derivative she is taking to lower her cholesterol level. Which is an adverse effect of this class of medication? a. Constipation b. Diarrhea c. Joint pain d. Dry mouth ANS: B Fibric acid derivatives may cause nausea, vomiting, diarrhea, drowsiness, and dizziness. Other effects are listed in Table 27-8. The other options are not adverse effects of fibric acid derivatives. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 445 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. While a patient is receiving antilipemic therapy, the nurse knows to monitor the patient closely for the development of which problem? a. Neutropenia b. Pulmonary problems c. Vitamin C deficiency d. Liver dysfunction ANS: D Antilipemic drugs may adversely affect liver function; therefore, liver function studies need to be closely monitored. The other options do not reflect problems that may occur with antilipemic drugs. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 446 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. A patient tells the nurse that he likes to eat large amounts of garlic “to help lower his cholesterol levels naturally.” The nurse reviews his medication history and notes that which drug has a potential interaction with the garlic? a. Acetaminophen (Tylenol) b. Warfarin (Coumadin) c. Digoxin (Lanoxin) d. Phenytoin (Dilantin) ANS: B When using garlic, it is recommended to avoid any other drugs that may interfere with platelet and clotting function. These drugs include antiplatelet drugs, anticoagulants, nonsteroidal anti-inflammatory drugs, and aspirin. The other drugs listed do not have known interactions with garlic. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 437 TOP: NURSING PROCESS: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A patient with coronary artery disease asks the nurse about the “good cholesterol” laboratory values. The nurse knows that “good cholesterol” refers to which lipids? a. Triglycerides b. Low-density lipoproteins (LDLs) c. Very-low-density lipoproteins (VLDLs) d. High-density lipoproteins (HDLs) ANS: D HDLs are responsible for the “recycling” of cholesterol. HDLs are sometimes referred to as the “good” lipid (or good cholesterol) because they are believed to be cardioprotective. LDLs are known as the “bad” cholesterol. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 437 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. A patient who has recently started therapy on a statin drug asks the nurse how long it will take until he sees an effect on his serum cholesterol. Which statement would be the nurse’s best response? a. “Blood levels return to normal within a week of beginning therapy.” b. “It takes 6 to 8 weeks to see a change in cholesterol levels.” c. “It takes at least 6 months to see a change in cholesterol levels.” d. “You will need to take this medication for almost a year to see significant results.” ANS: B The maximum extent to which lipid levels are lowered may not occur until 6 to 8 weeks after the start of therapy. The other responses are incorrect. DIF: COGNITIVE LEVEL: Ap