Pharmacological and Parenteral Therapies for Adults Questions/Answers (New)

Pharmacological and Parenteral Therapies for Adults Questions/Answers 1. The client who is to receive a scheduled dose of digoxin has an irregular apical pulse at 92 bpm and a serum potassium of 3.9 mEq/L. Which nursing documentation reflects the most appropriate action? A. Serum potassium level WNL. Digoxin given for rapid apical pulse. B. Digoxin withheld because the client’s apical heart rate is irregular. C. Di goxin withheld to prevent toxicity due to the low potassium level. D. HCP informed of irregular heart rate and low serum potassium level. ANSWER: A A. A normal serum potassium level is 3.5 to 5.0 mEq/L. Digoxin (Lanoxin), a cardiac glycoside, slows and strengthens the heart. It is used for rate control in clients with atrial fibrillation, which often produces an irregular rhythm. B. Dysrhythmias can occur ifdigoxin is given when the serum potassium level is low, but the serum potassium level is WNL. Digoxin is used for rate control and would not be withheld due to an irregular HR. C. Although it is important to monitor for digoxin toxicity, the serum potassium level is WNL. D. Withholding digoxin and notifying the HCP are unnecessary; the serum potassium is WNL. 2. The client has been receiving clonidine 0.1 mg via transdermal patch once every 7 days. The NA removes the patch with morning cares. Eight hours later, the nurse discovers that the clonidine patch is no longer present. Which assessment finding should be most conceming to the nurse? A. Skin tear is noted on the client’s upper chest. B. Client reports having an excruciating headache. C. Blood pressure is noted to be 182/ 100 mm Hg. D. The ECG monitor shows a heart rate of 120 bpm. ANSWER: C A. Although a skin tear is concerning and may have occurred during removal, it is not the most concerning. B. Headache can occur from the abrupt removal of clonidine but is not the most concerning. C. Clonidine (Catapres) is an antihypertensive medication. Rebound hypertension occurs from abrupt withdrawal. Immediate intervention is required to lower the BP. D. Tachycardia is an adverse effect of clonidine. 3. The client with chronic, stable angina telephones the clinic nurse and reports a headache lasting for several days after taking one dose of isosorbide mononitrate. The client also reports symptoms of orthostatic hypotension and palpitations. Which is the nurse’s best action? A. Recommend that the client make an appointment with the health care provider. B. Have the client retime the dose for a later time when the client is more active. C. Instruct the client to take two acetaminophen 325-mg tablets with the next dose. D. Teach the client that the headaches will subside over time with continued use. ANSWER: A A. Severe headaches, orthostatic hypotension, and palpitations may be a sign of isosorbide mononitrate (Imdur) toxicity; thus, the client should be evaluated by an HCP. Other signs of toxicity include syncope, dizziness, blurred vision, and light-headedness. B. Isosorbide mononitrate should be taken in the morning to improve blood flow to the heart and prevent angina attacks that can occur due to increased oxygen demand from activity. C. A headache (but not a severe headache) can be treated with or prevented by analgesics taken either before or at the same time as the isosorbide mononitrate. D. Although the headaches will subside over time, the client is experiencing symptoms of isosorbide mononitrate toxicity. 4. The client is taking metolazone and diltiazem for treatment of hypertension. Which statement made by the client to the nurse indicates further teaching is needed? A. “I eat foods high in potassium to prevent the development of hypokalemia.” B. “Metolazone makes me urinate more, so I take my last dose at suppertime.” C. “I took my medication at breakfast with eggs, toast, grapefruit juice, and milk.” D. “Ibuprofen affects my urine output, so I prefer to take acetaminophen for pain. ANSWER: C A. Consuming foods daily that are high in potassium is recommended. Thiazide diuretics such as metolazone (Zaroxolyn) can result in hypokalemia. B. The diuretic metolazone (Zaroxolyn) should not be taken at bedtime to avoid nocturia and the subsequent loss of sleep. C. The client should not consume grapefruit juice because it inhibits the metabolism of diltiazem (Cardizem) and can cause toxicity. This client statement indicates the need for further teaching. D. NSAle such as ibuprofen (Advil, Motrin) can decrease the diuretic and antihypertensive effects of thiazide diuretics. 5. The HCP prescribes a second antihypertensive medication for the client who has poorly controlled BP on one medication. If prescribed, which medication combination should the nurse question? A. Atenolol and metoprolol B. Metolazone and valsartan C. Captopril and furosemide D. Bumetanide and diltiazem ANSWER: A A. The nurse should question this medication combination. When two medications are used to treat hypertension, each should be from different drug classifications. Atenolol (Tenormin) and metoprolol (Lopressor) are both beta-adrenergic blockers and have the same general mechanism of action. B. Metolazone (Zaroxolyn) is a thiazide-like diuretic, and valsartan (Diovan) is an ARE. C. Captopril (Capoten) is an ACE inhibitor, and furosemide (Lasix) is a loop diuretic. D. Bumetanide (Bumex) is a loop diuretic, and diltiazem (Cardizem) is a calcium channel blocker. 6 . The nurse is caring for the client taking atorvastatin. The nurse should assess for which adverse effects? A. Constipation and hemorrhoids B. Muscle pain and weakness C. Fatigue and dysrhythmias D. Flushing and postural hypotension ANSWER: B A. Bile acid sequestrants act by inhibiting bile acids from absorption by the small intestine. This results in fewer bile acids in the small intestine, which may lead to constipation and hemorrhoids. B. Atorvastatin (Lipitor) is a 3—hydroxy- 3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor (statin) used to lower lipid levels. Statins can cause muscle tissue injury manifested by muscle ache or weakness. Muscle injury can progress to myositis (muscle inflammation) or rhabdomyolysis (muscle disintegration). C. Diarrhea, not constipation, has been found to be a side effect of statin medications. D. Side effects of niacin, a lipid-lowering agent, include flushing, dysrhythmias, and postural hypotension. 7. PHABE The nurse is reviewing the chart illustrated of the client diagnosed with stage II IIF. Which conclusion should the nurse make? A. The medications should be administered as prescribed. B. The client may be experiencing toxicity from digoxin. C. Hyperkalemia likely caused the client’s cardiac dysrhythmias. D. Seeing halos can result from the atrial fibrillation or anticoagulants. ANSWER: B A. The digoxin should be Withheld and not given until a serum digoxin level is determined. B. Signs of digoxin (Lanoxin) toxicity include seeing yellow halos around objects and dysrhythmias. The furosemide (Lasix) diuretic increases urinary excretion of potassium and can cause hypokalemia. I-Iypokalemia can contribute to both cardiac dysrhythmias and digoxin toxicity. C. A serum potassium level of 2.9 mEq/L indicates hypokalemia, not hyperkalemia. D. The yellow vision is a characteristic sign of digoxin toxicity and is not a sign of cerebral damage from an infarct due to atrial fibrillation or bleeding from the anticoagulants. 8. The nurse is providing teaching to the client receiving a thiazide diuretic. Which points should the nurse plan to include? Select all that apply. A. Take the radial pulse before setting up the medication. B. Include fruits such as melons and bananas in the diet. C. Report side effects such as muscle cramps, nausea, or a skin rash. D. Take the last dose at bedtime when fluids are at the highest level. E. Avoid high-fat foods; thiazide diuretics increase cholesterol levels. ANSWER: B, C, E A. It is unnecessary for the client to monitor the pulse prior to taking thiazide diuretics. B. Thiazide diuretics can cause hypokalemia, and potassium-rich foods can help maintain potassium levels. C. Muscle cramps are a sign of possible medication side effects of hypokalemia and hypocalcemia. Nausea and rash are also medication side effects. D. A diuretic taken at bedtime can cause nocturia and loss of sleep. The usual timing of the last daily dose of a diuretic is at suppertime. E. Thiazide diuretics can increase serum cholesterol, LDL, and triglyceride levels, so teaching the client to avoid high-fat foods will help maintain cholesterol levels. 9. The nurse is reviewing the client’s medication list illustrated, prepared by the client’s daughter. The nurse is most concerned about which finding? A. Some medication doses are missing. B. Some administration routes are missing. C. Some medications are being duplicated. D. Some medications have drug—drug interactions. ANSWER: C A. Missing doses of medication is important to address; however, duplicate medications should be addressed first. B. It is important to address the administration routes, but the duplication of medications is the priority to address. C. Hydrochlorothiazide + captopril (Capozide) is a combination product. The nurse should first determine if the client is taking the combination product along with the individual products due to the potential for overdosing. The client may be clear regarding the dose and the route but may not realize that two medications were replaced with one combination product. D. Drug-drug interactions are important to address and should be addressed, but the duplicate medications are the priority. 10. Following a THR, the client asks the nurse, “Why am I receiving enoxaparin? With my last hip surgery, I was given a heparin injection.” What is the nurse’s best response? A. “Enoxaparin is less expensive for you and much easier to administer than the heparin.” B. “There is less risk of bleeding with enoxaparin, and it doesn’t affect your laboratory results.” C. “Enoxaparin is a low-molecular-weight heparin that lasts twice as long as regular heparin.” D. “Enoxaparin can be administered orally, whereas heparin is administered only by injection.” ANSWER: C A. The cost of enoxaparin is more than twice the cost of the equivalent dose of heparin per injection. Both are available in prefilled syringes for subcutaneous injection. B. Both enoxaparin and heparin increase aPTT, which affects clotting. C. Because enoxaparin is more specific in inhibiting active factor X, the response is more stable, and the effect is two to four times longer than that of heparin. D. Enoxaparin is only administered subcutaneously. Heparin can be administered both subcutaneously and intravenously. 11. The client with CRF is receiving epoetin alfa. Which finding should indicate to the nurse that the action of the medication has been effective? A. Urine output increased to 30 mL per hour B. Hemoglobin 12 g/dL and hernatocrit 36% C. BP 110/70 mm Hg and heart rate 68 bpm D. Reports an increased energy level and less fatigue ANSWER: B A. Epoetin alfa does not have an effect on urine output or BP. B. Epoetin alfa stimulates erythropoiesis, or the production of RBCs. It is used in treating anemias associated with decreased RBC production, such as in renal failure. Hgb and Hct are used to evaluate the medication’s effectiveness. The target Hgb for the client with CRF is 12 g/dL. C. Epoetin alfa does not have an effect on BP or HR. D. The client may report increased energy and less fatigue because of the increased Hgb levels, but these findings are not used to evaluate the medication’s action. 12. The client with CRF receives a sodium polystyrene sulfonate enema. Which finding indicates that the medication is achieving the desired therapeutic effect? A. Returns of dark-colored stool