Louisiana State University:NUR 2134 Module 3 Power Point Answers,100% CORRECT

Louisiana State University:NUR 2134 Module 3 Power Point Answers Chapter 17 1. Answer: B • Rationale: Epinephrine is the drug of choice for patients in anaphylactic shock. 2. Answer: D • Rationale: Dopamine is used for the treatment of shock. Improved clinical status will best be monitored by assessing the patient’s urine output. Dopamine will dilate renal blood vessels, improve renal perfusion, and increase urine output. 3. Answer: A • Rationale: Dobutamine causes the selective activation of beta1-adrenergic receptors, and it is indicated only for the treatment of heart failure. The major adverse effect is tachycardia. 4. Answer: B • Rationale: Albuterol can reduce airway resistance in patients with asthma by causing beta2-mediated bronchodilation. If it is administered in large doses, albuterol will lose selectivity; it will activate beta1 receptors as well as beta2 receptors. Accordingly, patients should be warned not to exceed the recommended dosage, because doing so may cause tachycardia by activating beta1 receptors in the heart. Tremor is a common adverse effect of this drug. Chapter 18 1. Answer: B • Rationale: Orthostatic hypotension is the most serious adverse response to alpha-adrenergic blockade. This hypotension can reduce blood flow to the brain, thereby causing dizziness, lightheadedness, and even syncope (fainting). 2. Answer: C • Rationale: Doxazosin can cause orthostatic hypotension, reflex tachycardia, and nasal congestion. As with prazosin and terazosin, the first dose can cause profound hypotension, which can be minimized by giving the initial dose at bedtime. 3. Answer: B • Rationale: Nonselective beta blockers such as nadolol [Corgard] should be avoided when treating patients with diabetes mellitus. 4. Answer: D • Rationale: All beta blockers are contraindicated for patients with sinus bradycardia or AV heart block of more than the first degree, and they must be used with great caution in patients with heart failure. These are used with caution (especially the nonselective agents) in patients with asthma, bronchospasm, diabetes, or a history of severe allergic reactions. Use all beta blockers with caution in patients with a history of depression and in those taking calcium channel blockers. Chapter 19 1. Answer: B • Rationale: Xerostomia (dry mouth) is common, occurring in about 40% of patients who are taking clonidine. The reaction usually diminishes over the first 2 to 4 weeks of therapy. Although not dangerous, xerostomia can be annoying enough to discourage drug use. Patients should be advised that discomfort can be reduced by chewing gum, sucking hard candy, and taking frequent sips of fluids. Chapter 41 1. Answer: A • Rationale: Furosemide may have the adverse effect of hypokalemia. Hypokalemia can be reduced by consuming foods that are high in potassium, such as nuts, dried fruits, spinach, citrus fruits, potatoes, and bananas. 2. Answer: C • Rationale: Spironolactone is a potassium-sparing diuretic. Medications that are potassium sparing, potassium supplements, and salt substitutes should be avoided. High-potassium foods should also be avoided. 3. Answer: D • Rationale: The nurse should administer oral bumetanide with twice-a-day dosing at 0800 and 1400 to minimize nocturia. Daily weights should be obtained in the morning before eating. Patients receiving IV bumetanide are more likely to need hourly monitoring of urine output with a urinary catheter. Bumetanide may cause hypokalemia; signs and symptoms of hypokalemia include irregular heartbeat, muscle weakness, cramping, flaccid paralysis, leg discomfort, extreme thirst, and confusion. 4. Answer: B • Rationale: High-ceiling loop diuretics may cause hearing impairment; furosemide may result in deafness that is transient. Because of the risk of hearing loss, caution is needed when high-ceiling diuretics are used in combination with other ototoxic drugs (for example, aminoglycoside antibiotics). Gentamicin is an aminoglycoside. The other antibiotics are safe to administer with furosemide. Chapter 42 1. Answer: B • Rationale: The blood gases reflect metabolic alkalosis, and the indicated treatment would be an infusion of sodium chloride with potassium chloride. 2. Answer: A • Rationale: Normal serum potassium levels range from 3.5 to 5 mEq/L. Appropriate treatment for hypokalemia would consist of potassium supplements and foods high in potassium. Furosemide is a loop diuretic that may cause hypokalemia. Sodium polystyrene sulfonate is administered for hyperkalemia. 3. Answer: C • Rationale: The patient has hyperkalemia (elevated serum potassium) and acidosis (low pH). Appropriate treatment for hyperkalemia includes (1) infusion of a calcium salt (for example, calcium gluconate) to offset the effects of hyperkalemia on the heart; (2) infusion of glucose and insulin to promote uptake of potassium by cells and thereby decrease extracellular potassium levels; and (3) if acidosis is present (which is likely), infusion of sodium bicarbonate to move pH toward alkalinity and thereby increase cellular uptake of potassium. Spironolactone [Aldactone] is a potassium-sparing diuretic; this is the medication the nurse should question because the patient’s potassium level, at 6.4 mEq/L, is critically high. 4. Answer: B • Rationale: Administration of magnesium may lead to excessive levels of magnesium. Symptoms of hypermagnesemia include muscle weakness, hypotension, sedation, electrocardiographic (ECG) changes, respiratory paralysis, and cardiac arrest. Symptoms of hypomagnesemia include muscle excitability, tetany, disorientation, psychoses, and seizures. Symptoms of hyperkalemia include alterations in the ECG and cardiac rhythm (for example, peaked T wave, prolonged PR interval, ventricular tachycardia or fibrillation, cardiac arrest), confusion, anxiety, dyspnea, weakness or heaviness of the legs, and numbness or tingling of the hands, feet, and lips. Symptoms of hypokalemia include weakness or paralysis of skeletal muscle, risk of fatal dysrhythmias, and intestinal dilation and ileus. Chapter 43 1. Answer: C • Rationale: Drugs that lower the arterial pressure will trigger the baroreceptor reflex with the response of reflex tachycardia. 2. Answer: B • Rationale: Postural hypotension may occur with drugs that promote the dilation of veins or that prevent the veins from constricting. 3. Answer: B • Rationale: The average value for cardiac output is 4.9 liters per minute. An increase in stroke volume will increase cardiac output. Stroke volume is determined by contractility, preload, and afterload. A decrease in contractility or preload will decrease stroke volume and cardiac output. An increase in afterload (or arterial blood pressure) will decrease stroke volume and cardiac output. 4. Answer: D • Rationale: Postural (orthostatic) hypotension is caused by decreased venous return as a result of the pooling of blood in the veins, which can occur when a person assumes an erect posture. Drugs that dilate the veins intensify and prolong postural hypotension. Chapter 44 1. Answer: A • Rationale: An adverse effect of angiotensin-converting enzyme (ACE) inhibitors (for example, benazepril) is hyperkalemia. Significant potassium accumulation is usually limited to patients taking potassium supplements, salt substitutes (which contain potassium), or a potassium-sparing diuretic. Patients should be instructed to avoid potassium supplements and potassium-containing salt substitutes unless they are prescribed. Sweet potatoes and prune juice are foods high in potassium; asparagus is high in vitamin K. Foods high in vitamin K are restricted for patients who are prescribed warfarin [Coumadin]. 2. Answer: D • Rationale: These medications may be administered together without serious drug interactions. Spironolactone is a potassium-sparing diuretic, and losartan is an angiotensin II receptor blocker (ARB). The hypotensive effects of ARBs are additive with those of other antihypertensive drugs. When an ARB is added to an antihypertensive regimen, dosages of the other drugs may require reduction. The patient would be observed for hypotension (not first-dose hypotension). 3. Answer: B • Rationale: Inhibitors of CYP3A4 can increase levels of eplerenone, thereby posing a risk of toxicity. Weak inhibitors (for example, erythromycin, saquinavir, verapamil, fluconazole) can double eplerenone levels. Strong inhibitors (for example, ketoconazole, itraconazole) can increase levels fivefold. If eplerenone is combined with a weak inhibitor, the eplerenone dosage should be reduced. Eplerenone should not be combined with a strong inhibitor. Chapter 45 1. Answer: D • Rationale: Diltiazem is contraindicated in patients with second-degree or third-degree heart block; diltiazem can exacerbate cardiac dysfunction. 2. Answer: B • Rationale: Patients should swallow sustained-release tablets whole, without crushing or chewing. Nifedipine may cause reflex tachycardia; beta blockers are prescribed to prevent reflex tachycardia. Nifedipine causes very little constipation. Nifedipine cannot be used to treat dysrhythmias. 3. Answer: C • Rationale: The adverse effects of verapamil occur secondary to vasodilation. Common adverse effects include constipation, dizziness, facial flushing, headache, and edema of the ankles and feet. 4. Answer: A • Rationale: Digoxin and verapamil suppress impulse conduction through the atrioventricular (AV) node. When these drugs are used concurrently, the risk of AV block is increased. The cardiac rhythm of patients receiving both medications should be monitored closely. The patient should be monitored for bradycardia and hypotension. Bed rest is not indicated. Constipation may occur; increased dietary fiber and fluids are indicated to prevent constipation. Chapter 46 1. Answer: B • Rationale: Hydralazine is usually combined with a beta blocker to protect against reflex tachycardia. Hydralazine is an arterial vasodilator; postural hypotension is minimal. Hydralazine is inactivated by acetylation, and the ability to acetylate drugs is genetically determined. To avoid hydralazine accumulation, the dosage should be reduced in slow acetylators. Minoxidil commonly causes hypertrichosis, or increased hair growth. 2. Answer: D • Rationale: Sodium nitroprusside is used to treat hypertensive emergencies. The medication is administered intravenously, with continuous monitoring of blood pressure. 3. Answer: B • Rationale: Minoxidil may cause adverse responses (for example, reflex tachycardia, expansion of blood volume, pericardial effusion). Minoxidil should be used with a beta blocker (for example, propranolol) plus intensive diuretic therapy (for example, furosemide). Chapter 47 1. Answer: D • Rationale: Stages 1 and 2 hypertension should be treated with both lifestyle changes and drug therapy to control blood pressure. 2. Answer: C • Rationale: The treatment goal for a person with hypertension and diabetes or chronic kidney disease is less than 130/80 mm Hg. 3. Answer: A • Rationale: A combination of drugs is used to treat stage 2 hypertension; each drug has a different mechanism of action. The nurse should administer antihypertensive medications even if the blood pressure is normal. Thiazide diuretics should be given in the morning because of diuresis. 4. Answer: B • Rationale: The patient with heart failure should not receive a calcium channel blocker (for example, verapamil, diltiazem); calcium channel blockers may act on the heart to decrease myocardial contractility, thereby further reducing cardiac output. Chapter 48 1. Answer: C • Rationale: Furosemide is a loop diuretic that promotes loss of potassium and thereby increases the risk of digoxin-induced dysrhythmias. When digoxin and furosemide are used concurrently, serum potassium levels must be monitored and maintained within a normal range (3.5 to 5 mEq/L). 2. Answer: B • Rationale: Digoxin toxicity manifests with dysrhythmias, bradycardia, muscles weakness, anorexia, nausea, vomiting, fatigue, and visual disturbances. 3. Answer: A • Rationale: Digoxin increases the cardiac output of patients with heart failure; it improves cardiac output, decreases the heart rate, decreases heart size, decreases constriction of arterioles and veins, reverses water retention, decreases blood volume, decreases peripheral and pulmonary edema, decreases weight (by water loss), and improves exercise tolerance. 4. Answer: A • Rationale: The optimal therapeutic range for digoxin is 0.5 to 0.8 ng/mL; levels higher than 2 ng/mL usually are associated with toxic symptoms. A priority action is to assess for dysrhythmias; the nurse should immediately initiate continuous heart monitoring. Serum creatinine indicates renal function, and digoxin is eliminated primarily by renal excretion. Renal impairment can lead to toxic accumulation, and the dosage must be reduced if kidney function declines. Digoxin should not be given to a patient suspected of having digoxin toxicity. If a severe digoxin overdose is responsible for dysrhythmias, digoxin levels can be lowered using Fab antibody fragments. Chapter 49 2. Answer: D • Rationale: Adenosine is intended for bolus IV administration; it is injected as close to the heart as possible and followed by a saline flush. 3. Answer: B • Rationale: Procainamide is contraindicated in patients with systemic lupus erythematosus (SLE). SLE symptoms include pain and inflammation of the joints, pericarditis, fever, and hepatomegaly. Procainamide is associated with severe immunologic reactions; patients with SLE most likely will develop antinuclear antibodies (ANAs) directed against the patient’s own nucleic acids, and SLE symptoms will worsen. 4. Answer: C • Rationale: The most common adverse effects of intravenous amiodarone are hypotension and bradydysrhythmias. Chapter 50 1. Answer: B • Rationale: Lovastatin should be taken with the evening meal to increase absorption. Cholesterol synthesis normally increases during the night; statins are most effective when given in the evening. 2. Answer: B • Rationale: Aspirin reduces flushing by preventing the synthesis of prostaglandins, which mediate the flushing response. 3. Answer: A • Rationale: Cholestyramine is a bile acid sequestrant. Cholestyramine can impair absorption of fat- soluble vitamins (A, D, E, and K); vitamin supplements may be required. Cholestyramine causes constipation; patients should be informed that constipation can be minimized by increasing dietary fiber and fluids. A mild laxative may be used if needed. Instruct patients taking cholestyramine or colestipol to notify the prescriber if constipation becomes bothersome, in which case a switch to colesevelam should be considered. Cholestyramine can bind with other drugs and prevent their absorption. Advise patients to administer other medications 1 hour before or 4 hours after cholestyramine. Cholestyramine powder should be mixed with water, fruit juice, soup, or pulpy fruit (for example, applesauce, crushed pineapple) to reduce the risk of esophageal irritation and impaction. Inform patients that the sequestrants are not water soluble, therefore the mixtures will be cloudy suspensions, not clear solutions. Chapter 51 1. Answer: A • Rationale: Headache is a common adverse effect of nitroglycerin and is due to vasodilation. If chest pain is not relieved in 5 minutes, the person should dial 911. A sublingual tablet should be placed under the tongue and allowed to dissolve. Sublingual nitroglycerin is used to abort anginal attacks and is not a scheduled medication. 2. Answer: C • Rationale: A transdermal nitroglycerin patch is applied once daily to a hairless area of skin. The site should be rotated to avoid local irritation. Tolerance develops if patches are used continuously. A patch- free interval of 10 to 12 hours is recommended. Patches are suited for sustained prophylaxis and will not abort an ongoing attack. 3. Answer: D • Rationale: Patients taking nitroglycerin should be instructed about symptoms of hypotension (for example, dizziness, lightheadedness) and advised to sit or lie down if these occur. Patients should be advised to avoid overexertion but should be encouraged to establish a regular program of aerobic exercise. Sustained-release nitroglycerin should be swallowed, not placed under the tongue. Sustained- release nitroglycerin is prescribed 1 to 4 times daily, not as needed. 4. Answer: C • Rationale: Nitroglycerin relieves the pain of stable angina by dilating veins; this decreases venous return, which decreases preload, which decreases oxygen demand. Chapter 52 1. Answer: A • Rationale: The most commonly used laboratory value that monitors the effect of heparin is the activated partial thromboplastin time (aPTT). 2. Answer: C • Rationale: Oral contraceptives decrease the effects of warfarin; therefore, warfarin doses may need to be increased. Acetaminophen and cimetidine increase the effects of warfarin. Prednisone increases the risk of bleeding. 3. Answer: C • Rationale: Protamine sulfate is an antidote to severe heparin overdose. 4. Answer: C • Rationale: Alteplase may cause bleeding, and the management of bleeding depends on its severity. Oozing at sites of cutaneous puncture can be controlled with direct pressure or a pressure dressing. If severe bleeding occurs, alteplase should be discontinued. Excessive fibrinolysis can be reversed with IV aminocaproic acid [Amicar], a compound that prevents activation of plasminogen and directly inhibits plasmin. Chapter 53 1. Answer: D • Rationale: The first dose of aspirin should be given immediately. The dose (162-325 mg) is chewed to allow rapid absorption across the buccal mucosa. Aspirin suppresses platelet aggregation and thereby decreases mortality, reinfarction, and stroke. All patients should chew a 162- to 325-mg dose upon hospital admission and should take 81 to 162 mg/day indefinitely after discharge. 2. Answer: C • Rationale: Aspirin, beta blocker, oxygen, morphine, and nitroglycerin are considered routine therapy for patients with ST-elevation myocardial infarction. 3. Answer: B • Rationale: Glycoprotein IIb/IIIa inhibitors (for example, abciximab) are powerful intravenous antiplatelet drugs that can enhance the benefits of primary percutaneous coronary intervention (PCI). Treatment with abciximab should begin as soon as possible before PCI and should continue for 12 hours afterward. 4. Answer: D • Rationale: Estrogen therapy for postmenopausal women is not effective as secondary prevention of another myocardial infarction and should not be initiated. In patients with acute MI, ACE inhibitors decrease severe heart failure. A post-MI patient should take a beta blocker, an ACE inhibitor, and an antiplatelet drug indefinitely. To prevent mortality after an MI, a diabetic patient’s blood pressure should be less than 130/80 mm Hg.