NUR 2474 Pharmacology Exam 2, Rasmussen College

Q1) Which information should the nurse include in client education regarding a cholesterollowering agent? (a) This medication will replace other interventions you have been trying (b) It is important for you to double your dose if you miss one (c) Stop taking the medication if you experience constipation (d) You should continue your exercise program to increase your HDL serum level (adjunctive therapy with diet and exercise) Q2) What would the nurse expect has occurred with a client who has taken senna for several days and now experiencing yellowish-brown urea? (a) Renal failure (b) Dehydration (c) Drug toxicity (d) Expected effect of the medication (anthraquinones in laxatives such as senna, change urine to brown, yellow or orange) Q3) A client with heart failure who has been taking an angiotensin converting enzyme inhibitor, a thiazide diuretic and a beta-blocker for several months comes to the clinic for evaluation. As part if the ongoing assessment of this client, the nurse will expect the provider to order which assessment? (a) Complete blood count (b) Ejection fraction (c) Maximal exercise capacity (d) Serum electrolyte levels Q4) A provider has ordered captopril for a client and the nurse notes the client has a history of swelling of the tongue and lips after taking enalapril. Which action by the nurse is correct? (a) Administer the captopril and monitor for adverse effects (b) Hold the dose and notify the provider ( angioedema is a serious side effect of Ace inhibitors) (c) Request an order to administer fosinoprill instead of captopril (d) Reassure the client reaction in the past was an expected side effect Q5) Which statement by the student nurse indicate the need for further teaching regarding the use of sucralfate and ciprofloxacin to treat peptic ulcer disease? (a) Sucralfate atheres to the ulcer and blocks the back-diffusion of hydrogen ions (b) Sucralfate and ciprofloxacin should be administered two hours apart (c) Sucralfate may cause systemic side effects (d) Sucralfate has a potent acid-neutralizing capacity Q6) A nursing student who is preparing to care for a postoperative client with deep vein thrombosis asks the nurse why the client must take heparin rather than warfarin. Which response by the nurse is correct? (a) Heparin has a longer half life (b) Heparin has fewer adverse effect (c) The onset of warfarin is delayed (d) Warfarin prevent platelet aggregation Q7) A client with chronic obstructive pulmonary disease is prescribe tiotropium. After the initial dose, the client reports only mild relief within 30 minutes. What is the nurse’s best response? (a) You may have another dose in four hours (b) You may need to take two inhalations instead of one (c) You should have peak effect in about six hours (d) You should see improved effect within the next week (tiotropium is long acting, usually once a day and it may take several weeks to see full effect. Used for prevention not acute flare). Q8) A client with diabetes develops hypertension. The will anticipate administering which type of medication to treat hypertension in this client? (a) ACE inhibitors (or angiotensin II receptor blockers because they prevent and slow kidney disease in diabetes). (b) Anticoagulant (c) Direct acting vasodilators (d) Aldosterone antagonist Q9) A client with asthma admitted to an emergency department with a respiratory rate of 22 breath per minute and an oxygen saturation level of 90% on room air. The client reports using fluticasone inhaler 110 mcg twice daily and two puffs of albuterol, 90 mcg/puff, every four hours for two days. The nurse will expect to administer which medications? (a) Four puff of albuterol, oxygen, and intravenous theophylline (b) Intramuscular glucocorticoids and salmeterol by metered-dose inhaler (c) Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen (d) Intravenous theophylline, oxygen, and fluticasone 220mcg Q10) A client with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats/min, a blood pressure of 150/90 mmHg bibasilar crackles, 2+ pitting edema of the ankles and distension of the jugular veins. What medication will the nurse expect the provider to order? (a) Angiotensin converting enzyme inhibitor (b) Digoxin (c) …osemide (furosemide i.e. Lasix for diuresis) (d) ….onolactone Q11) Before administering hydrochlorothiazide, the nurse reviews a client’s chart. Which laboratory value causes the nurse the most concern? (a) Elevated creatine clearance (b) High potassium level (c) Normal blood glucose level (d) Low level of low- density lipoprotein cholesterol Q12) Which of these effect associated with the use of protein pump inhibitors in older client would most concern the nurse? Select all that apply. (a) Gastric ulcer (b) Headaches (c) Medication interaction (d) Osteoporosis (increased risk of osteoporosis related fractures with use of PPI). (e) Mineral deficiencies Q13) A client who is taking digoxin is admitted to the hospital for treatment of congestive heart failure, and the provider orders furosemide. The nurse notes bibasilar crackles, an irregular heart rate of 86 beats per minute. Respiratory rate of 22 breath per minute, and blood pressure of 130/82 mmHg. Which laboratory value would most concern the nurse? (a) Blood glucose level of 129mg/Dl (b) Oxygen saturation of 90% (c) Potassium level of 3.0 mEq/L (d) Sodium level of 140mEq/L Q14) A client is taking gentamicin and furosemide. The nurse should counsel a client taking gentamicin and furosemide to immediately report which symptoms? (a) Frequent nocturia (b) Headache (c) Ringing in the ear (d) Urinary retention Q15) A client who is receiving a factor VIII concentrate to treat hemophilia A develops hives, a low-grade temperature elevation and a stuffy nose. What is the nurse’s best response? (a) Administer subcutaneous epinephrine (b) Give an antipyretic medication (c) Give oral diphenhydramine (mild symptoms; hives, itching, stuffy nose, coughing and fever) (d) Provide respiratory support Q16) The nurse will be most concern with which findings in a client’s history preparing to take propranolol? (a) Asthma (propranolol is a beta blocker and if used in asthma it blocks the adrenergic impulse to the bronchial tree that causes bronchodilation. This means beta blockers increase bronchoconstriction and therefore contraindicated in asthma. (b) Paroxysmal atrial tachycardia associated with emotion (c) exercise-induced tachyarrhythmias (d) hypertension Q17) A client who recently started therapy with an HMG-COA reductase inhibitor asks the nurse, “How long will it take until I see an effect on my LDL cholesterol?” What is the nurse’s best response? (a) It will take six months to see a change (b) A reduction usually is seen within two weeks (c) Blood levels normalize immediately after the drug is started (d) Cholesterol will not be affected, but triglycerides will fall within the first week Q18) What client’s education should the nurse provide in the discharge teaching for a diabetic client starting colesevelam and insulin? (a) The client needs to monitor the blood sugar carefully because colesevelam can cause hypoglycemia (b) The client needs to monitor the blood sugar carefully because colesevelam can cause hyperglycemia (c) The client needs to take the insulin at least three hours before the colesevelam (d) The client needs to use an oral antidiabetic agents, not injectable insulin Q19) A client with asthma will be using a metered-dose for the delivery of an inhaled medication. The provider has ordered two puffs to be given twice daily. What must the nurse include in the client’s education? (a) Inhale suddenly to receive the maximum dose of the medication (b) Activate the device and then inhale the medication (c) Store the metered-dose inhaler in the refrigerator between treatments (d) Wait one minute between puffs for maximum effect Q20) A client is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes that the client has a blood pressure of 90/50 mmHg, a heart rate of 98 beats per minute, and a recent aPTT greater than 90 seconds with reports of lumbar pain. Which order would the nurse expect? (aPTT greater than 90 when on heparin means initiate bleeding precautions) (a) Repeat aptt to be drawn immediately (b) Start oral analgesic (c) Switch to warfarin (d) Administer protamine sulfate Q21) A nurse prepared to administer a scheduled dose of digoxin and finds a newly recorded plasma digoxin level of 0.7 ng/Ml. What is the nurse’s best action? (a) Withhold the drug for an hour and reassess the level (b) Withhold the medication and notify the prescriber immediately (c) Administer digoxin immune fab to counteract the digoxin toxicity (d) Check the client’s apical pulse, and if it is within a safe range, administer the digoxin ( normal range 0.5 – 0.9 ng/ML in heart failure or 0.5 – 2.0 ng/ML in heart arrhythmia) Q22) A prescriber orders filgrastim and the nurse prepares the client for which potential side effects? (a) Bone pain (b) Fatigue (c) Headache (d) Hemorrhage Q23) Which condition would cause the nurse to withhold a dose of magnesium hydroxide (a) Chronic renal failure (b) Cirrhosis (c) Hemorrhoids (d) Prostatitis Q24) A client begins taking nifedipine, along with metoprolol, to treat hypertension. Why was metoprolol added to the medication protocol? (a) Reduced flushing (b) Minimize gingival hyperplasia (c) Prevent constipation (d) Prevent reflex tachycardia Q25) A client who takes nonsteroidal anti-inflammatory drugs for arthritis asks a nurse what other medications can be taken to prevent ulcers. The nurse should ask the provider about which medication is best for this client? (a) Antibiotics (b) Histamine-2 receptors antagonists (c) Proton pump inhibitors (d) Mucosal protectants Q26) A nurse is caring for a client after hip replacement surgery. The client has been receiving iron replacement therapy for two days, and the nurse observes the client’s stools appear black, the client is pale and complains of fatigue, heart rate is 98 beats/min, respirations are 20 breath per minute, and the blood pressure is 100/50 mmHg. What would the nurse expect the provider to order? (a) Abdominal x-ray