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
hospitalized patient with heart failure. Which nursing action is
the priority immediately following the administration of this
medication?
A. Monitor the patient's serum potassium level. B. Maintain the
patient on strict bedrest for at least 3 hours. C. Assess the
patient's blood pressure frequently. D. Check the patient's urine
output hourly.
Correct Answer: C
Rationale: Severe hypotension ("first-dose hypotension") is a
well-documented adverse effect that can occur after the initial
dose of an ACE inhibitor, particularly in patients with heart
failure or those taking diuretics. Monitoring blood pressure
frequently is the priority nursing intervention to ensure patient
safety and detect acute hemodynamic changes. While
monitoring potassium levels and urine output are important
ongoing nursing interventions for patients receiving ACE
inhibitors, they are not the immediate priority following the
first dose. Bedrest may be indicated if the patient becomes
dizzy or hypotensive, but strict bedrest for 3 hours for all
,patients is not a standard protocol; active assessment of the
blood pressure dictates the care.
Question 2
A patient is prescribed oral spironolactone for the management
of primary hyperaldosteronism. Which dietary modification
should the nurse instruct the patient to implement?
A. Increase the intake of citrus fruits and bananas. B. Avoid the
use of salt substitutes containing potassium chloride. C. Limit
the intake of dark green leafy vegetables. D. Consume a high-
sodium diet to balance fluid shifts.
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic that
works by antagonizing aldosterone receptors. Because it
promotes potassium retention, the concurrent use of salt
substitutes containing potassium chloride significantly increases
the risk of developing life-threatening hyperkalemia. Patients do
not need to increase their intake of high-potassium foods like
citrus fruits or bananas; doing so could cause toxicity. Dark
green leafy vegetables do not need to be strictly limited unless
the patient is consuming excessive quantities or has advanced
renal failure. A high-sodium diet would counteract the
therapeutic effects of the medication.
Question 3
, A patient diagnosed with deep vein thrombosis is receiving a
continuous intravenous heparin infusion. The nurse reviews the
laboratory results and notes an activated partial thromboplastin
time (aPTT) of 138 seconds. The control value is 30 seconds.
Which action should the nurse take first?
A. Stop the heparin infusion immediately. B. Prepare to
administer protamine sulfate. C. Notify the primary healthcare
provider. D. Draw a repeat blood sample for an aPTT
verification.
Correct Answer: A
Rationale: A therapeutic aPTT level for a patient receiving
heparin is typically 1.5 to 2.5 times the control value
(approximately 45 to 75 seconds). An aPTT of 138 seconds
indicates critical over-anticoagulation and a high risk for acute
hemorrhage. The nurse's first action must be to stop the
infusion to prevent further administration of the drug. After
stopping the infusion, the nurse should notify the healthcare
provider. Protamine sulfate is the antidote for heparin, but it
may not be automatically required if stopping the infusion
allows the heparin level to drop safely, as heparin has a short
half-life. Repeating the blood draw delays necessary
intervention.
Question 4
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
hospitalized patient with heart failure. Which nursing action is
the priority immediately following the administration of this
medication?
A. Monitor the patient's serum potassium level. B. Maintain the
patient on strict bedrest for at least 3 hours. C. Assess the
patient's blood pressure frequently. D. Check the patient's urine
output hourly.
Correct Answer: C
Rationale: Severe hypotension ("first-dose hypotension") is a
well-documented adverse effect that can occur after the initial
dose of an ACE inhibitor, particularly in patients with heart
failure or those taking diuretics. Monitoring blood pressure
frequently is the priority nursing intervention to ensure patient
safety and detect acute hemodynamic changes. While
monitoring potassium levels and urine output are important
ongoing nursing interventions for patients receiving ACE
inhibitors, they are not the immediate priority following the
first dose. Bedrest may be indicated if the patient becomes
dizzy or hypotensive, but strict bedrest for 3 hours for all
,patients is not a standard protocol; active assessment of the
blood pressure dictates the care.
Question 2
A patient is prescribed oral spironolactone for the management
of primary hyperaldosteronism. Which dietary modification
should the nurse instruct the patient to implement?
A. Increase the intake of citrus fruits and bananas. B. Avoid the
use of salt substitutes containing potassium chloride. C. Limit
the intake of dark green leafy vegetables. D. Consume a high-
sodium diet to balance fluid shifts.
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic that
works by antagonizing aldosterone receptors. Because it
promotes potassium retention, the concurrent use of salt
substitutes containing potassium chloride significantly increases
the risk of developing life-threatening hyperkalemia. Patients do
not need to increase their intake of high-potassium foods like
citrus fruits or bananas; doing so could cause toxicity. Dark
green leafy vegetables do not need to be strictly limited unless
the patient is consuming excessive quantities or has advanced
renal failure. A high-sodium diet would counteract the
therapeutic effects of the medication.
Question 3
, A patient diagnosed with deep vein thrombosis is receiving a
continuous intravenous heparin infusion. The nurse reviews the
laboratory results and notes an activated partial thromboplastin
time (aPTT) of 138 seconds. The control value is 30 seconds.
Which action should the nurse take first?
A. Stop the heparin infusion immediately. B. Prepare to
administer protamine sulfate. C. Notify the primary healthcare
provider. D. Draw a repeat blood sample for an aPTT
verification.
Correct Answer: A
Rationale: A therapeutic aPTT level for a patient receiving
heparin is typically 1.5 to 2.5 times the control value
(approximately 45 to 75 seconds). An aPTT of 138 seconds
indicates critical over-anticoagulation and a high risk for acute
hemorrhage. The nurse's first action must be to stop the
infusion to prevent further administration of the drug. After
stopping the infusion, the nurse should notify the healthcare
provider. Protamine sulfate is the antidote for heparin, but it
may not be automatically required if stopping the infusion
allows the heparin level to drop safely, as heparin has a short
half-life. Repeating the blood draw delays necessary
intervention.
Question 4
