NUR 258 Pharm OB Q8

NUR 258 Pharm OB Q8 • While preparing to administer a scheduled dose of digoxin, the nurse finds a new lab result showing a digoxin level of 0.7 ng/mL. What action should the nurse take? Answer s: Hold the drug for an hour and reassess the level. Withhold the drug and notify the prescriber immediately. Administer Digibind to counteract the toxicity. Check the patient's apical pulse; if it is within normal limits, administer the digoxin. • Question 2 A client with stable angina is starting treatment with Nifedipine, a calcium channel blocker. The client's spouse asks how Nifedipine alleviates chest pain. How should the nurse respond? Answer s: "They reduce platelet aggregation." "They reduce the work of the heart by reducing aortic pressure (afterload)." "They increase the heart rate and contractility." "They improve cardiac circulation through vasoconstriction." • Question 3 A client, who has been seeing multiple doctors, reports that she is taking Lisinopril and another antihypertensive medication, the name of which she can't recall. What type of antihypertensive is contraindicated when people are taking ACE inhibitors due to the risk of compound effects? Answer s: Thiazide diuretics Beta blockers Potassium-sparing diuretics Calcium Channel blockers • Question 4 A client is starting sildenafil (Viagra) for the treatment of pulmonary hypertension. Which of these medications could cause a serious reaction if they are taken with sildenafil? Answer s: Nitroglycerin, an antianginal Clopidigrel, an antiplatelet Simvastatin, an antilipemic CoEnzyme Q 10, an herbal remedy • Question 5 A client presents in the clinic with concerns of having taken his dabigatran (Pradaxa) twice this morning. Realizing that this is a new oral anticoagulant, what should the nurse do next? (Select all that apply) Answer s: Seek advice from the physician. Ask the client to share how the overdose happened. Have the client eat a spinach salad. Have the lab check a stat INR. Calm the client by explaining that the medication has a 12 hours half-life. Assess for signs of active bleeding. • Question 6 Atenolol (Tenormin) has been prescribed for a client who is recovering from a recent heart attack. The nurse would consult the provider before giving the medicine in which of these situations? (Select all that apply) Answer s: Pulse 52 BP 108/62 Respirations 32 with wheezes Blood glucose of 50 Tension headaches Parkinsonian tremors • Question 7 Potassium chloride 10mEq IV has been ordered for a client whose potassium is 2.9 following diuretics. How will the nurse administer the potassium dose? Answer s: Dilute the dose in 50 mL IV rider/piggyback and infuse over 1 hour. Push the dose as a rapid IV push because of the patient's dangerously low potassium level. Push the dose slowly over 10 minutes. Ask to give the dose in a large muscle since the IV route is too dangerous. • Question 8 A client who has been taking Lisinopril, an ACE inhibitor, for 2 weeks complains of a dry cough. How should the nurse respond to this complaint? Answer s: The cough will subside within 5-7 days when the body becomes accustomed to the medicine. The cough is a sign of impending angioedema. The client should stop the medicine immediately. The cough is a result of immune suppression. The client should stop the medicine immediately. The cough is a common side effect of "prils." "Sartans" may be prescribed instead if it becomes intolerable. • Question 9 A client with angina is preparing to go home with a prescription of Nifedipine, a calcium channel blocker. What should the client be taught? Answer s: Elevate your feet when you are sitting to avoid edema side effects. Drink grapefruit juice with breakfast to reduce your risk of plaque. Eat cheese regularly to restore calcium and manage loose stools. Use salt substitute to replenish your potassium losses due to the diuretic effects. • Question 10 A client has had hypertension for approximately 7 years and now is interested in becoming pregnant. What is the safest antihypertensive for a woman in the early stages of pregnancy? Answer s: Amlodipi ne Lisinopril Methyldo pa Valsartan • Question 11 In preparing discharge education for a client who has just begun hydrochlorothiazide therapy, a nurse reviews the client's lab results. Which finding should the nurse be concerned about in relation to the discharge prescription? Answer s: Blood sugar level of 80 mg/dL Potassium level of 3.1 mEq/L Hemoglobin of 15 g/dL Potassium level of 4.8 mEq/L • Question 12 A client is brought to the emergency department for accidental warfarin (Coumadin) overdose. The nurse determines that the client has no apparent signs of bleeding. Which action should the nurse take next? Answer s: Obtain a stat PTT level. Administer protamine sulfate. Type and cross-match the patient's blood. Draw a stat blood level for PT or INR. • Question 13 A client is being discharged to his home on enoxaparin (Lovenox) injections for treatment of a deep vein thrombosis (DVT). Which of the following statements made by the client indicate a need for further discharge teaching by the nurse? Answer s: "I will inject the enoxaparin into the fatty tissue of my abdomen." "I hate needles, but I know enoxaparin doesn't come in pill form." "I will need to go to my doctor's office each day to have my enoxaparin blood level checked." "I will call my physician if I pass black, tarry stools or pink urine." • Question 14 In which of the following situations should the nurse prepare to administer protamine sulfate? Answer s: A patient on warfarin with an INR of 4 and tarry stools. A patient on warfarin with a PT of 12 seconds and bleeding from a laceration. A patient on a heparin drip with a PTT 120 seconds and active GI bleeding. A patient on a heparin drip with a PTT of 60 seconds and pink-tinged urine. • Question 15 A client presents to the emergency department with chest pain. On a scale of 1:10 he rates the pain as a 6. His respiratory rate is 22/minute. His blood pressure is 156/92. His heart rate is 110/minute. He is afebrile. What other information should the nurse obtain before administering nitroglycerin? Answer s: Has the patient experience any dizziness or nausea within the last 2 weeks? Has the patient used any alcohol or drugs for erectile dysfunction recently? Has the patient taken any drugs within the past 12 hours? Has the patient had a previous heart attack? • Question 16 A client with stable angina asks why the physician told her to put her nitro patch on at 0800 and take it off at 2000. What explanation should the client be given? Answer s: "The doctor is trying to reduce your risk of night falls." "Patch free intervals are needed to sustain medication effectiveness." "The patch should be replaced, not removed, at bedtime." "You should follow this advice for any patch medication you use." • Question 17 A client is experiencing edema. Which over-the-counter medication might be reducing the diuretic effects of her Lisinopril? Answer s: St. John's Wart Glucosamin e Vitamin C Ibuprofen • Question 18 If a client is taking carvedilol, a beta blocker, which adverse effect should the nurse monitor for? Answer s: Hypoventilati on Sinus tachycardia Hyperglycemi a Dizziness • Question 19 A client has been taking digoxin 0.25mg and furosemide 40 mg daily. Upon routine assessment by the nurse, the client states, "I see yellow halos around lights." The nurse should perform which of the following actions based on this assessment? Answer s: Consult the provider, then request a digoxin and potassium level be checked. Withhold the next dose of furosemide. Continue to monitor the patient for heart failure. Document the findings and reassess in 1 hour. • Question 20 The nurse is providing patient education to a patient who has just been given a new prescription for sublingual nitroglycerine tablets. Which statement by the client would indicate a need for additional teaching? Answer s: "I should take the nitro every 2-3 minutes until my pain goes away." "I should take one table every 5 minutes up to a total of 3 tables if needed." "I should store my nitroglycerin in its original dark bottle to protect it from light." "I should keep the bottle of nitro tightly closed to protect the tablets."