Abrams' Clinical Drug Therapy
Rationales for Nursing Practice
13th Edition
• Author(s)Geralyn Frandsen;
Sandra Pennington
TEST BANK
,Question 1
A nurse is preparing to administer the initial dose of an
intravenous angiotensin-converting enzyme (ACE) inhibitor to a
client hospitalized with severe heart failure. Which assessment
finding requires the nurse to hold the medication and notify the
healthcare provider?
A. Serum potassium level of 3.8 mEq/L B. Blood pressure of
102/68 mmHg C. Serum creatinine level of 2.4 mg/dL D. Heart
rate of 92 beats per minute
Correct Answer: C
Rationale: ACE inhibitors are excreted primarily by the kidneys,
and an elevated serum creatinine level indicates significant
renal impairment. Administering an ACE inhibitor to a client
with renal insufficiency can exacerbate kidney injury, potentially
causing acute renal failure. A serum potassium level of 3.8
mEq/L is within normal limits, though potassium must be
monitored closely since ACE inhibitors can cause hyperkalemia.
A blood pressure of 102/68 mmHg is acceptable for a heart
failure client starting therapy, provided the client is
asymptomatic. A heart rate of 92 beats per minute is within
normal limits and does not warrant withholding the medication.
Question 2
,A nurse is providing discharge teaching to a client who has been
prescribed spironolactone for the management of primary
hypertension. Which dietary instruction should the nurse
include?
A. "Increase your intake of bananas, avocados, and spinach." B.
"Avoid using salt substitutes that contain potassium chloride."
C. "Drink at least 3 to 4 liters of fluid every day." D. "Consume
foods high in tyramine, such as aged cheeses."
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic that
blocks the effects of aldosterone, leading to potassium
retention. Using salt substitutes that contain potassium chloride
increases the risk of developing life-threatening hyperkalemia.
Clients should maintain normal fluid intake rather than forcing
excessive fluids unless specifically instructed. Increasing the
intake of high-potassium foods like bananas, avocados, and
spinach is contraindicated. Tyramine restrictions apply to
monoamine oxidase inhibitors (MAOIs), not spironolactone.
Question 3
A client diagnosed with chronic open-angle glaucoma is
prescribed timolol ophthalmic drops. The nurse instructs the
client on the proper technique of administration. Which action
demonstrated by the client indicates effective teaching?
, A. Applying pressure to the inner canthus for 1 to 2 minutes
after instillation. B. Blinking vigorously immediately after placing
the drop in the conjunctival sac. C. Wiping the excess
medication from the outer canthus toward the inner canthus. D.
Dropping the medication directly onto the sensitive cornea of
the eye.
Correct Answer: A
Rationale: Applying pressure to the nasolacrimal duct (inner
canthus) for 1 to 2 minutes prevents systemic absorption of the
beta-blocker through the nasal mucosa, thereby reducing the
risk of systemic side effects such as bradycardia and
hypotension. Blinking vigorously can expel the medication from
the eye. Wiping should move from the inner to the outer
canthus to prevent contamination. Ophthalmic drops should be
placed in the lower conjunctival sac, never directly onto the
cornea, to avoid corneal injury.
Question 4
A nurse is reviewing the laboratory results of a client who is
receiving a continuous intravenous heparin infusion for a deep
vein thrombosis. The client's activated partial thromboplastin
time (aPTT) is 110 seconds. Which action should the nurse take
first?
A. Stop the heparin infusion and prepare to administer
protamine sulfate. B. Decrease the infusion rate according to
Rationales for Nursing Practice
13th Edition
• Author(s)Geralyn Frandsen;
Sandra Pennington
TEST BANK
,Question 1
A nurse is preparing to administer the initial dose of an
intravenous angiotensin-converting enzyme (ACE) inhibitor to a
client hospitalized with severe heart failure. Which assessment
finding requires the nurse to hold the medication and notify the
healthcare provider?
A. Serum potassium level of 3.8 mEq/L B. Blood pressure of
102/68 mmHg C. Serum creatinine level of 2.4 mg/dL D. Heart
rate of 92 beats per minute
Correct Answer: C
Rationale: ACE inhibitors are excreted primarily by the kidneys,
and an elevated serum creatinine level indicates significant
renal impairment. Administering an ACE inhibitor to a client
with renal insufficiency can exacerbate kidney injury, potentially
causing acute renal failure. A serum potassium level of 3.8
mEq/L is within normal limits, though potassium must be
monitored closely since ACE inhibitors can cause hyperkalemia.
A blood pressure of 102/68 mmHg is acceptable for a heart
failure client starting therapy, provided the client is
asymptomatic. A heart rate of 92 beats per minute is within
normal limits and does not warrant withholding the medication.
Question 2
,A nurse is providing discharge teaching to a client who has been
prescribed spironolactone for the management of primary
hypertension. Which dietary instruction should the nurse
include?
A. "Increase your intake of bananas, avocados, and spinach." B.
"Avoid using salt substitutes that contain potassium chloride."
C. "Drink at least 3 to 4 liters of fluid every day." D. "Consume
foods high in tyramine, such as aged cheeses."
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic that
blocks the effects of aldosterone, leading to potassium
retention. Using salt substitutes that contain potassium chloride
increases the risk of developing life-threatening hyperkalemia.
Clients should maintain normal fluid intake rather than forcing
excessive fluids unless specifically instructed. Increasing the
intake of high-potassium foods like bananas, avocados, and
spinach is contraindicated. Tyramine restrictions apply to
monoamine oxidase inhibitors (MAOIs), not spironolactone.
Question 3
A client diagnosed with chronic open-angle glaucoma is
prescribed timolol ophthalmic drops. The nurse instructs the
client on the proper technique of administration. Which action
demonstrated by the client indicates effective teaching?
, A. Applying pressure to the inner canthus for 1 to 2 minutes
after instillation. B. Blinking vigorously immediately after placing
the drop in the conjunctival sac. C. Wiping the excess
medication from the outer canthus toward the inner canthus. D.
Dropping the medication directly onto the sensitive cornea of
the eye.
Correct Answer: A
Rationale: Applying pressure to the nasolacrimal duct (inner
canthus) for 1 to 2 minutes prevents systemic absorption of the
beta-blocker through the nasal mucosa, thereby reducing the
risk of systemic side effects such as bradycardia and
hypotension. Blinking vigorously can expel the medication from
the eye. Wiping should move from the inner to the outer
canthus to prevent contamination. Ophthalmic drops should be
placed in the lower conjunctival sac, never directly onto the
cornea, to avoid corneal injury.
Question 4
A nurse is reviewing the laboratory results of a client who is
receiving a continuous intravenous heparin infusion for a deep
vein thrombosis. The client's activated partial thromboplastin
time (aPTT) is 110 seconds. Which action should the nurse take
first?
A. Stop the heparin infusion and prepare to administer
protamine sulfate. B. Decrease the infusion rate according to
