Pharmacology Exam 3 Questions and ANSWERS,100% CORRECT

Pharmacology Exam 3 Questions and ANSWERS Ch 22-25 PPT Questions 1. The number of people with hypertension in the United States is estimated to be a. 10 million. b. 25 million. c. 50 million. d. 70 million. 2. When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of what response? a. Hypotension b. Hyperkalemia c. Oliguria d. Respiratory distress 3. A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions this order because her physician has never told her that she has hypertension. What is the best explanation for this order? a. The doctor knows best. b. The patient is confused. c. This medication has cardioprotective properties. d. This medication has a protective effect on the kidneys for patients with diabetes. 4. A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient? a. Clonidine b. Prazosin c. Diltiazem d. Captopril 5. Which statement about ARBs does the nurse identify as being true? a. Hyperkalemia is more likely to occur than when using ACE inhibitors. b. Cough is more likely to occur than when using ACE inhibitors. c. Chest pain is a common adverse effect. d. Overdose is usually manifested by hypertension and bradycardia. 6. A patient is mowing his lawn on a hot Saturday afternoon. He begins to notice chest pain. What should his first action be? a. Take his nitroglycerin tablet. b. Stop mowing and sit or lie down. c. Go inside the house to cool off and get a drink of water. d. Call 911. 7. A patient with extremely high blood pressure (BP) is in the emergency department. The physician will order therapy with nitroglycerin to manage the patient’s BP. Which form of nitroglycerin is most appropriate? a. Sublingual spray b. Transdermal patch c. Oral capsule d. IV infusion 8. The nurse is obtaining a medication history on a patient presenting with chest pain. What drug classification would necessitate the nurse informing the provider before beginning the prescribed nitroglycerin? a. Proton pump inhibitor b. Phosphodiesterase inhibitors (Erectile Dysfunction medications) c. Inhaled beta blocker d. Acetylsalicylic acid (aspirin) 9. A patient with a known history of angina was walking his dog and developed chest pain. The patient immediately stops walking and sits down. He continues to experience chest pain when sitting down. When should he call 911? a. Immediately b. If the pain becomes more severe c. If one sublingual tablet does not relieve the pain after 5 minutes d. If the pain is not relieved after three sublingual tablets, taken 5 minutes apart 10. A patient who has had an MI is taking a beta blocker. What is the main benefit of beta blocker therapy for this patient? a. Vasodilation of the coronary arteries b. Increased force of cardiac contraction c. Slowing of the heart rate d. Maintaining adequate BP 11. The nurse is preparing to educate a group of patients on the management of angina. a. Which drug groups are most often used to treat patients with angina? 12. A patient asks the nurse to tell her more about a new drug the patient has been prescribed called ranolazine (Ranexa). Which response by the nurse is accurate? a. “We do not know how Ranexa works.” b. “This drug is the first medication your health care provider will use to treat your angina.” c. “This drug must be given intravenously.” d. “Ranexa is safe to use in patients with liver failure.” 13. What information will the nurse include when teaching the patients about taking beta2-blocking drugs for the treatment of angina? a. “Call your health care provider if you heart rate is 64 beats/min.” b. “These drugs are safe to use in patients who have asthma.” c. “Call your health care provider if you experience a weight gain of 2 lb or more in 24 hours or 5 lb or more in 1 week.” d. “Avoid taking these medications with grapefruit juice.” 14. A patient asks how to apply transdermal nitroglycerin. What is the nurse’s best response? a. “Always apply the transdermal patch over the area of your chest where your heart is.” b. “Keep the previous patch on for 1 full day so you always have two patches on at a time.” c. “Apply the patch to hairless areas of the body.” d. “First apply Vaseline to your body; then apply the transdermal patch.” 15. Which patient is the best candidate to receive nesiritide therapy? a. A patient with atrial fibrillation who has not responded to other drugs b. A patient needing initial treatment for HF c. A patient with reduced cardiac output d. A patient with acutely decompensated HF who has dyspnea at rest 16. A patient is in the emergency department with new-onset atrial fibrillation. Which order for digoxin would most likely have the fastest therapeutic effect? a. Digoxin 0.25 mg PO daily b. Digoxin 1 mg PO now; then 0.25 mg PO daily c. Digoxin 0.5 mg IV push daily d. Digoxin 1 mg IV push now; then 0.25 mg IV daily 17. A patient is receiving digoxin 0.25 mg/day as part of treatment for HF. The nurse assesses the patient before medication administration. Which assessment finding would be of most concern? a. Apical heart rate of 58 beats/min b. Ankle edema +1 bilaterally c. Serum potassium level of 2.9 mEq/L d. Serum digoxin level of 0.8 ng/mL 18. A patient with a history of HF presents to the emergency department with difficulty breathing, cough, and edema of the lower extremities. The nurse anticipates administration of which type of medication? a. Positive chronotrope b. Negative chronotrope c. Positive inotrope d. Negative inotrope 19. The patient is prescribed an ACE inhibitor. What primary mechanism of ACE inhibitors will the nurse understand as the therapeutic action? a. To inhibit catecholamine release b. To inhibit acetylcholine release c. To inhibit aldosterone secretion d. To prevent vagal stimulation 20. The patient is discharged home and returns to the emergency department 4 days later. The patient is admitted to the ICU with acute decompensated HF with dyspnea at rest. The nurse anticipates administration of which medication? a. Atropine b. Carvedilol (Coreg) c. Lisinopril (Prinivil) d. Nesiritide (Natrecor) 21. A patient has received an IV dose of adenosine, and almost immediately the heart monitor shows asystole. What should the nurse do next? a. Check the patient’s pulse. b. Prepare to administer cardiopulmonary resuscitation. c. Set up for defibrillation. d. Continue to monitor the patient. 22. A patient is in the emergency department with an unspecified supraventricular dysrhythmia. The physician orders a dose of diltiazem (Cardizem) IV push. While the nurse administers the medication through the IV lock, the patient says she feels something wet spilling on her arm. Her heart rate was unchanged. What will the nurse do next? a. Assess the patient for diaphoresis. b. Check the IV lock to see if it is functioning properly. c. Repeat the dose of diltiazem (Cardizem). d. Restart the IV in another location. 23. A patient is receiving oral quinidine. Which assessment finding is of most concern? a. Nausea b. Prolonged QT interval c. Diarrhea d. Occasional palpitations Ch 22-25 PPT Answers 1. ANS: D a. Hypertension affects approximately 70 million people in the United States and approximately 1 billion people worldwide, designating it as the most common disease state. 2. ANS: A a. These drugs have strong vasodilating properties and may cause severe hypotension, especially at the beginning of therapy. 3. ANS: D a. ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This property makes them the cardiovascular drug of choice for patients with diabetes. 4. ANS: D a. Captopril is not a prodrug; therefore, it does not need to be metabolized by the liver to be effective. This is an advantage in patients with liver disease. 5. ANS: C a. The most common adverse effects of ARBs are chest pain, fatigue, hypoglycemia, diarrhea, urinary tract infection, anemia, and weakness. Hyperkalemia and cough are less likely to occur than with the ACE inhibitors. b. Overdose may manifest as hypotension and tachycardia; bradycardia occurs less often. Treatment is symptomatic and supportive and includes the administration of IV fluids to expand the blood volume. 6. ANS: B a. At the first sign of chest pain, the person should stop all activity and sit or lie down before taking the nitroglycerin tablet. 7. ANS: D a. The IV infusion of nitroglycerin will have the fastest effect, and the dose will be titrated to the patient’s response. 8. ANS: B a. Phosphodiesterase inhibitors (erectile dysfunction medications) are potent vasodilators and therefore nitrates are contraindicated when the patient is taking this classification of medications. All other medication classifications can safely be used with nitrates. 9. ANS: C a. With sublingual nitroglycerin, the medication should be taken at the first sign of chest pain and not be delayed until the pain is severe. The patient should sit 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 one dose, the patient (or family member) should call 911 immediately. The patient can take one more tablet while awaiting emergency care and a third tablet 5 minutes later but no more than three tablets in total. These guidelines reflect the fact that angina pain that does not respond to nitroglycerin may indicate an MI. 10. ANS: C a. Slowing the heart rate in patients with ischemic heart disease reduces myocardial oxygen demand and allows the coronary arteries time to fill with oxygen- and nutrient-rich blood. Beta blockers also block the irritating effects of circulating catecholamines on the heart. 11. The nitrates and nitrites, the beta blockers, and the CCBs are the drugs most often used to treat patients with angina pectoris. 12. ANS: A a. The mechanism of action of Ranexa is not known. Ranexa is used only after treatment with other antianginals have not been effective. Ranexa is administered by mouth and is contraindicated for use in patients with liver failure. 13. ANS: C a. Weight gain can indicate serious adverse effects of beta2-blocking drugs, so the health care provider should be called. A pulse of 64 beats/min is acceptable; these drugs should be avoided in patients with asthma, and there is no interaction with grapefruit juice. CCBs should not be administered with grapefruit juice. 14. ANS: C a. The transdermal patch should be applied to a hairless, residual-free area of the body with the sites being rotated each time. The old transdermal patch should be completely removed and a new one applied. 15. ANS: D a. At this time, nesiritide is generally used in the intensive care setting as a final effort to treat severe, life-threatening HF, often in combination with several other cardiostimulatory medications. The manufacturer recommends that nesiritide not be used as a first-line drug for this purpose. In 2005, an expert panel reviewed nesiritide at the request of the US Food and Drug Administration in response to reports of worsened renal function and mortality. The expert panel stated that the use of nesiritide should be strictly limited to treatment of patients with acutely decompensated HF who have dyspnea at rest. It should not be used to replace diuretics and should not be used repetitively or to improve renal function. 16. ANS: D a. A digitalizing dose is often used to quickly bring serum levels of the drug up to a therapeutic level. IV doses would accomplish this more quickly. 17. ANS: C a. The hypokalemia may precipitate digoxin toxicity; therefore, it is the biggest concern. The apical pulse is slightly under 60 beats/min, but bradycardia may occur with digoxin therapy, and the heart rate should be monitored. The ankle edema may be a manifestation of his HF and not a new concern. The digoxin level is within the normal range. 18. ANS: C a. Positive inotropes are used to increase the force of myocardial contraction in the treatment of patients with HF. Negative inotropes would cause the heart to have a decreased force of myocardial contraction and would not be effective. Positive chronotropes increase the rate at which the heartbeats, and negative chronotropes decrease the rate at which the heartbeats. 19. ANS: C a. The ACE inhibitors are beneficial in the treatment of HF because they prevent sodium and water resorption by inhibiting aldosterone secretion. This causes diuresis, which decreases blood volume and blood return to the heart. This in turn decreases preload, or the left ventricular end-diastolic volume, and the work required of the heart. 20. ANS: D a. Nesiritide is used in the ICU setting as a final effort to treat severe, life-threatening HF, often in combination with several other cardiostimulatory medications. Lisinopril (Prinivil) is an ACE inhibitor that is used in the management of HF. Carvedilol (Coreg) has been shown to slow the progression of HF and to decrease the frequency of hospitalization in patients with mild to moderate (class II or III) HF. Atropine is used to increase heart rate. 21. ANS: D a. The half-life of adenosine is very fast—only 10 seconds—and the asystole only lasts for a few seconds. The nurse should continue to monitor the patient for therapeutic and adverse effects of the medication. 22. ANS: B a. Because the heart rate was unchanged and the patient felt fluid on her arm, the IV lock is probably not working properly. Before anything else is done, the IV lock should be checked for proper functioning. Another dose would be wasted if the IV lock is not working. 23. ANS: B a. Patients taking quinidine need to be monitored for prolonged QRS and QT intervals, which may be a precursor to more serious dysrhythmia problems. Ch 26-29 PPT Questions 1. A patient is receiving an IV infusion of heparin and was started on warfarin therapy the night before. Which statement is most correct? a. The patient is receiving a double dose of anticoagulants. b. The heparin therapy was ineffective, so the warfarin was started. c. The heparin provides anticoagulation until therapeutic levels of warfarin are reached. d. The heparin and warfarin work together synergistically to provide anticoagulation. 2. A patient is receiving an IV infusion of a thrombolytic drug during treatment for an acute MI. The nurse notices that there is a slight amount of bleeding from the antecubital area where venous lab work was drawn. What will the nurse do first? a. Monitor the site for further bleeding. b. Apply pressure to the site with a gauze pad. c. Slow the rate of infusion of the thrombolytic drug. d. Stop the infusion of the thrombolytic drug. 3. A 75-year-old man fell at home and hit his head against a table. His wife reports to their daughter that he does not have cuts or scratches, but there is a small lump on his upper scalp. She does not see any blood. He is taking warfarin and an antidysrhythmic as part of his treatment for chronic atrial fibrillation. What is the main concern at this time? a. Pressure should be applied to the lump for 3 to 5 minutes. b. He will need to take two doses of warfarin tonight to prevent blood clotting. c. He needs to be examined for possible internal bleeding from the fall. d. As long as there is no bleeding, there is no concern. 4. A 72-year-old woman is taking an over-the-counter multivitamin that contains ginkgo. Her physician has recommended that she start taking low-dose aspirin therapy as part of her treatment for transient ischemic attacks. What is the concern with taking these two drugs together? a. Increased risk of gastric ulcer b. Decreased action of the aspirin because of the interaction with the ginkgo c. Increased risk of bleeding because of the ginkgo d. Antagonism of the action of the aspirin because of the multivitamins 5. The nurse is caring for a patient receiving IV heparin therapy for treatment of a pulmonary embolus. The patient is being converted to warfarin (Coumadin) therapy. The following questions relate nursing considerations when caring for this patient. Nursing considerations for conversion of IV heparin to oral warfarin (Coumadin) therapy will include a. immediate discontinuation of IV heparin and administration of oral warfarin (Coumadin) therapy only. b. overlapping therapy of IV heparin and warfarin are for at least 5 days. c. monitoring the INR and stopping the IV heparin when the INR is 1.0. 6. When converting from IV heparin to oral warfarin (Coumadin) therapy, the prescriber monitors which of the following to determine the next appropriate dose of warfarin? a. Platelet levels b. aPTT c. Red blood cell count d. PT/INR 7. Which of the following should the nurse include when providing dietary teaching for the patient receiving warfarin (Coumadin) therapy? a. Avoid drinking large amounts of green tea. b. Cranberry juice will provide you with needed nutrients while taking Coumadin. c. You must never eat spinach. d. You can only eat lettuce once a month. 8. The patient accidentally takes too much of the prescribed warfarin (Coumadin) and is readmitted to the hospital with bleeding. Which drug can the nurse anticipates administrating? a. Protamine sulfate b. Alteplase (Activase, Cathflo Activase) c. Reteplase (Retavase) d. Vitamin K 9. A patient with a new prescription for a HMG-CoA (statin) drug is instructed to take the medication with the evening meal or at bedtime. The patient asks why it must be taken at this time of day. What is the nurses’ best response? a. “The medication is better absorbed at this time.” b. “This timeframe correlates better with the natural diurnal rhythm of cholesterol production.” c. “There will be fewer adverse effects if taken at night instead of with the morning meal.” d. “This timing reduces the incidence of myopathy.” 10. A patient has been ordered the powdered form of the bile acid sequestrant colestipol. Which of the following does the nurse identify as true? a. The nurse should have the patient swallow the dose of the colestipol powder one teaspoonful at a time. b. The powder should be dissolved and immediately administered. c. The colestipol should be administered 1 hour before or 4 to 6 hours after any other oral medication. d. The colestipol should be administered with meals. 11. A patient will be taking niacin as part of antilipemic therapy. What is the best way to avoid problems with flushing or pruritus? a. Take the medication at bedtime. b. Take the medication with a small dose of a steroid. c. Take the medication with a full glass of water on an empty stomach. d. Start with a low initial dose and then increase it gradually. 12. A patient wants to take garlic tablets to improve his cholesterol levels. Which condition would be a contraindication? a. Hypertension b. Bowel obstruction c. Sinus infection d. Scheduled surgery 13. Which patient would benefit from administration of simvastatin (Zocor) 80 mg? a. A patient newly diagnosed with hyperlipidemia b. A patient with muscle aches who was taking another antilipidemic drug c. A patient who is taking verapamil d. A patient who has already been taking simvastatin (Zocor) for 12 months with no evidence of myopathy 14. What patient history would the nurse recognize as a contraindication for beginning Niacin therapy? a. Allergy to erythromycin b. Gout c. Coronary artery disease d. Hypothyroidism 15. Which location is the area where the highest percentage of sodium and water are resorbed back into the bloodstream? a. Glomerulus b. Proximal tubule c. Ascending loop of Henle d. Distal tubule 16. When administering a loop diuretic to a patient, it is most important for the nurse to determine if the patient is also taking which drug? a. Lithium (Eskalith) b. Acetaminophen (Tylenol) c. Penicillin d. Theophylline 17. While preparing an infusion of mannitol (Osmitrol), the nurse notices small crystals in the IV tubing. What is the most appropriate action by the nurse? a. Administer the infusion slowly. b. Discard the solution and obtain another bag of medication. c. Obtain a filter and then infuse the solution. d. Return the fluid to the IV bag to dissolve the crystals. 18. A patient with a creatinine clearance of 20 mL/min is admitted to the medical-surgical unit. The patient is in need of rapid diuresis. Which class of diuretic does the nurse anticipate administering? a. Potassium sparing b. Thiazide c. Osmotic d. Loop 19. The patient is ordered furosemide (Lasix). Before administering furosemide, it is most important for the nurse to assess the patient for allergies to which drug class? a. Aminoglycosides b. Sulfonamides c. Macrolides d. Penicillins 20. Two days after admission, the nurse is reviewing laboratory results of the patient. Which is the most common electrolyte finding resulting from the administration of furosemide (Lasix)? a. Hypocalcemia b. Hypophosphatemia c. Hypokalemia d. Hypomagnesemia 21. The patient is being discharged home with furosemide (Lasix). When providing discharge teaching, which instruction will the nurse include? a. Avoid prolonged exposure to the sun. b. Avoid foods high in potassium content. c. Stop taking the medication if you feel dizzy. d. Weigh yourself once a week and report a gain or loss of more than 1 lb. 22. Intravenous (IV) therapy is ordered for a patient with a serum sodium of 150 mEq/L. Which of the following does the nurse anticipate administering? a. 0.45% NS b. 0.25% NS c. 3% NS d. 5% NS 23. Which of the following statements regarding colloid administration does the nurse identify as being true? a. Colloids enhance the oxygen-carrying capacity of the blood. b. Colloids increase the coagulation properties of blood. c. Dextran therapy can cause anaphylaxis or renal failure. d. Colloids are contraindicated in the treatment of hypovolemia. 24. A patient is taken to the trauma unit after a motorcycle accident. It is estimated that he has lost 30% of his blood volume and he is in hypovolemic shock. The nurse anticipates a transfusion with which blood product? a. PRBCs b. Whole blood c. Cryoprecipitate d. FFP 25. Which condition does the nurse identify as a late manifestation of hypokalemia? a. Muscle weakness b. Hypotension c. Palpitations d. Lethargy 26. A patient is hypokalemic and will be receiving IV potassium. The patient is not on a heart monitor. How should the nurse administer the potassium replacement? a. IV push b. No more than 10 mEq/hour c. No more than 20 mEq/hour d. 40 mEq/hour 27. A patient with a serum potassium of 6.0 mEq/L is ordered polystyrene sulfonate (Kayexalate) via the nasogastric tube. What additive should be included with the Kayexalate administration? a. Sorbitol b. Water c. An antacid d. A laxative 28. Which solution should the nurse administer with packed red blood cells? a. Lactated Ringer’s solution b. 0.9% sodium chloride c. D5W d. 0.45% sodium chloride Ch 26-29 PPT Answers 1. ANS: C a. Heparin has a faster onset and therefore is used to provide anticoagulation until therapeutic levels of warfarin are reached. 2. ANS: B a. The most common undesirable effect of thrombolytic therapy is internal, intracranial, and superficial bleeding. If invasive procedures must be performed or injections given, appropriate pressure should be applied to bleeding sites, and all areas of venous or arterial catheter insertion should be closely watched for bleeding. This type of superficial bleeding is to be expected and does not warrant cessation of the thrombolytic therapy. 3. ANS: C a. Careful examination will be needed to ensure that there is no hematoma or other internal bleeding as a result of the fall even if superficial bleeding is not noted. 4. ANS: C a. Ginkgo may cause some increased bleeding times, so taking aspirin with ginkgo may put the patient at a higher risk for bleeding episodes. 5. ANS: B a. When the oral anticoagulant warfarin is prescribed, therapy is often initiated while the patient is still receiving heparin. 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 for overlapping therapy of heparin and warfarin are for at least 5 days; the heparin is stopped after 5 days when the INR is above 2. 6. ANS: D a. For conversion from heparin to an oral anticoagulant such as warfarin, the dose of the oral drug is the usual initial dosage amount, with the prescriber using the PT/INR levels to determine the next appropriate dosage of warfarin. When there is continuous therapeutic anticoagulation coverage and warfarin has reached therapeutic levels, the heparin or LMWH may be discontinued without tapering. 7. ANS: A a. For patients taking warfarin therapy, it is recommended to avoid eating or drinking large amounts of kale, spinach, Brussels sprouts, collard or mustard greens, lettuce, chard, and green tea. Beverages that may increase the effect of warfarin and to be avoided include cranberry juice and alcohol. 8. ANS: D a. High doses of vitamin K (10 mg) given IV will reverse the anticoagulation of warfarin within 6 hours. Protamine sulfate is used to reverse heparin. Alteplase and reteplase are thrombolytics. 9. ANS: B a. All statins are generally dosed once daily, usually with the evening meal or at bedtime to best coincide with the body’s natural diurnal rhythm of cholesterol production. 10. ANS: C a. It is important that colestipol and any bile acid sequestrant be taken 1 hour before or 4 to 6 hours after any other oral medication or meals because of the high risk for drug-drug and drug-food interactions. The powder should be dissolved for 1 full minute before administration and should not be taken in dry form. 11. ANS: D a. Cutaneous flushing may be minimized if the niacin is started at a smaller dose and gradually increased. Premedication with a small dose of aspirin or a nonsteroidal antiinflammatory drug 30 minutes before taking the niacin, as well as taking the niacin with meals, may help to minimize these undesirable effects. 12. ANS: D a. Garlic has antiplatelet activity and is contraindicated in patients who will undergo surgery within 2 weeks and in patients with human immunodeficiency virus infection or diabetes 13. ANS: D a. In 2011, the Food and Drug Administration imposed new prescribing restrictions on simvastatin, stating: “Physicians should limit using the 80-mg dose unless the patient has already been taking the drug for 12 months and there is no evidence of myopathy. Simvastatin 80 mg should not be started in new patients, including patients already taking lower doses of the drug.” In patients taking verapamil, the dose of simvastatin is not to exceed 10 mg. 14. ANS: B a. With niacin, patient assessment includes noting contraindications such as liver disease, peptic ulcer disease, gout, hypertension, and any active bleeding. Although a thorough assessment of all patient conditions is helpful, the other conditions do not preclude use of niacin. 15. ANS: B a. The proximal convoluted (twisted) tubule or, more simply, proximal tubule, anatomically follows the glomerulus and returns 60% to 70% of the sodium and water from the filtered fluid back into the bloodstream. Another 20% to 25% of sodium is resorbed into the bloodstream in the ascending loop of Henle. The remaining 5% to 10% of sodium resorption takes place in the distal convoluted tubule, often called simply the distal tubule, which anatomically follows the ascending loop of Henle. The glomerulus does not resorb sodium or water but instead is the point of initial filtration of the blood. 16. ANS: A a. Use of loop diuretics with lithium can increase the risk of lithium toxicity. Drug interactions with loop diuretic therapy can occur with concurrent use of nonsteroidal antiinflammatory drugs (NSAIDs), and vancomycin can cause increased neuro- and ototoxicity when used with loop diuretics. There is no associated risk of drug interaction when taking acetaminophen, penicillin, or theophylline with loop diuretics. 17. ANS: B a. Even though a filter should always be used with this medication infusion, a solution with crystals present in the bag or tubing should never be infused. The nurse should first discard the solution and then restart the infusion with a new bag, ensuring that there is a filter on the IV line. 18. ANS: D a. The loop diuretics provide rapid diuresis because of their rapid onset of action. Loop diuretics are effective for patients with reduced kidney function (creatinine clearance below 25 mL/min). 19. ANS: B a. The nurse should assess patients receiving furosemide (Lasix) for cross-sensitivity to sulfonamides. Although allergy to sulfonamide antibiotics is listed as a contraindication, analysis of the literature indicates that cross-reaction with the loop diuretics is unlikely to occur. Loop diuretics are commonly given to such patients in clinical practice. The nurse should closely monitor these patients. 20. ANS: C a. Of all of the adverse effects of furosemide (Lasix) administration, hypokalemia is of serious clinical importance. To prevent hypokalemia, patients often receive potassium supplements along with furosemide. The other electrolyte disturbances listed do not occur as a result of furosemide (Lasix) therapy. 21. ANS: A a. Patients taking furosemide (Lasix) should avoid prolonged exposure to the sun because the drug can cause photosensitivity. Although orthostatic hypotension is a possible adverse effect of the medication, patients should not stop taking the medication without consultation with their health care provider. Patients should weigh themselves once a day and report a weight gain or loss of approximately 3 lb. Patients taking furosemide (Lasix) should be encouraged to eat foods rich in potassium. 22. ANS: A a. Hypertonic saline injections (3% and 5%) are contraindicated in the presence of increased, normal, or only slightly decreased sodium concentrations. Conversely, infusing very low hypotonic saline (0.25% NaCl) is not recommended because it can cause hemolysis of the red blood cells. 23. ANS: C a. Rarely, dextran therapy causes anaphylaxis or renal failure. Colloids have no oxygen-carrying ability and contain no clotting factors, unlike blood products. Because of this, they can alter the coagulation system through a dilutional effect, which results in impaired coagulation and possibly bleeding. Colloids are contraindicated in the treatment of hypervolemia. 24. ANS: B a. Whole blood is more beneficial in cases of extreme loss of blood volume (more than 25%). 25. ANS: C a. Palpitations are a late manifestation of hypokalemia. Early manifestations of hypokalemia include muscle weakness, lethargy, and hypotension. 26. ANS: B a. If IV potassium is administered too rapidly, cardiac arrest may occur. IV potassium should be given no faster than 10 mEq/hour to patients who are not on cardiac monitors. For critically ill patients on cardiac monitors, rates of 20 mEq/hour or more may be used. 27. ANS: B a. Polystyrene should be administered with water based on the dose. The nurse should administer each dose as a suspension in a small quantity of water for improved palatability. Follow directions regarding the amount of water to use; it generally ranges from 20 to 100 mL, depending on the dose. The drug should not be administered with sorbitol, antacids, or laxatives. 28. ANS: B a. Blood products must be given only with NS (0.9% sodium chloride) because the solution of D5W results in hemolysis of red blood cells. Ch 22 Questions 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.” 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. 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.” 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 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 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 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 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 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.” 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 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) 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 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 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 15. 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.” Ch 22 Answers 1. ANS: D a. 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. 2. ANS: D a. 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. 3. ANS: D a. 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. 4. ANS: A a. Blood pressure is determined by the product of cardiac output and systemic vascular resistance. The other options are incorrect. 5. ANS: A 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. 6. ANS: C a. 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. 7. ANS: B a. Sexual dysfunction is a potential nursing diagnosis related to possible adverse effects of antihypertensive drug therapy. The other nursing diagnoses are not appropriate. 8. ANS: A 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 9. ANS: D a. There is no cure for the disease, and treatment will be lifelong. The other answers are not appropriate. 10. ANS: B a. ACE inhibitors cause a characteristic dry, nonproductive cough that reverses when therapy is stopped. The other drug classes do not cause this cough. 11. ANS: D a. Methyldopa is used in the treatment of hypertension during pregnancy. The other options are incorrect. 12. ANS: B a. 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. 13. ANS: C a. 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. 14. ANS: D a. 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. 15. ANS: A, C, F a. 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. Ch 23 Questions 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. 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. 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. 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 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 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. 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.” 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.” 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 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 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 12. 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. 13. 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 functio Ch 23 Answers 1. ANS: C a. 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. 2. ANS: D a. 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. 3. ANS: C a. 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. 4. ANS: A 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. 5. ANS: A 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. 6. ANS: D a. 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. 7. ANS: A 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 8. ANS: D a. 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. 9. ANS: D a. 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. 10. ANS: C a. Adverse effects of beta blockers include bradycardia, hypotension, dizziness, lethargy, impotence, and several other effects, but not dry cough or nervousness. 11. ANS: C a. 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. 12. ANS: A, C, E, G a. 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. 13. ANS: B, E a. Ranolazine is contraindicated in patients with pre-existing QT prolongation or hepatic impairment. The other options are not contraindications. Ch 24 Questions 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. 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. 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 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.” 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 dysrhythmia 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 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 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 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 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 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 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. 13. 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. 14. 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 Ch 24 Answers 1. ANS: D a. 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 2. ANS: A 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. 3. ANS: B a. A negative chronotropic effect results in a decreased heart rate; this is one effect of cardiac glycosides. The other options are incorrect. 4. ANS: D a. Digoxin immune Fab (Digifab) is the antidote for a severe digoxin overdose. It is given intravenously. The other options are incorrect. 5. ANS: D a. 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. 6. ANS: B a. The normal therapeutic drug level of digoxin is between 0.5 and 2 ng/mL. The other options are incorrect. 7. ANS: D a. Bran, in large amounts, may decrease the absorption of oral digitalis drugs. The other foods do not affect digoxin levels. 8. ANS: A a. Hypokalemia increases the chance of digitalis toxicity. The other levels listed are incorrect. 9. ANS: C a. 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. 10. ANS: B a. 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. 11. ANS: A a. One vial of digoxin immune Fab binds 0.5 mg of digoxin. The other options are incorrect. 12. ANS: C a. 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. 13. ANS: B, D, E a. 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. 14. ANS: A, B, D a. 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. Ch 25 Questions 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 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 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 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. 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) 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. 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. 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 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 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) 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 12. 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. 13. 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 Ch 25 Answers 1. ANS: B a. 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. 2. ANS: D a. Diarrhea is a potential adverse effect of procainamide therapy. Prolonged QT interval on the ECG is also possible. The other options are incorrect. 3. ANS: B a. 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. 4. ANS: B a. 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,