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LEHNE’S PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE NURSES AND PHYSICIAN ASSISTANTS 2ND EDITION ROSENTHAL TEST BANK EXAM WITH ACTUAL QUESTIONSAND COMPLETE 100%CORRECT ANSWERS WITH VERIFIED AND WELL EXPLAINED RATIONALES ALREADY GRADED A+ BY EXPERTS |LATEST

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LEHNE’S PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE NURSES AND PHYSICIAN ASSISTANTS 2ND EDITION ROSENTHAL TEST BANK EXAM WITH ACTUAL QUESTIONSAND COMPLETE 100%CORRECT ANSWERS WITH VERIFIED AND WELL EXPLAINED RATIONALES ALREADY GRADED A+ BY EXPERTS |LATEST VERSION 2024 WITH GUARANTEED SUCCESS AFTER DOWNLOAD ALREADY PASSED!!!!!!! (PROVEN ITS ALL YOU NEED TO EXCEL IN YOUR EXAMS An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide [HydroDIURIL]. Before administering this medication, the nurse reviews the patient’s chart. Which laboratory value causes the nurse the most concern? Elevated creatinine clearance Elevated serum potassium level Normal blood glucose level Low levels of low-density lipoprotein (LDL) cholesterol ANS: A Hydrochlorothiazide should not be given to patients with severe renal impairment; therefore, an elevated creatinine clearance would cause the most concern. Thiazide diuretics are potassium- wasting drugs and thus may actually improve the patient’s potassium level. Thiazides may elevate the serum glucose level in diabetic patients. Thiazides increase LDL cholesterol; however, this patient’s levels are low, so this is not a risk.DIF: Cognitive Level: ApplicationREF: pp. 349TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed spironolactone [Aldactone]. The nurse assesses the patient and notes dyspnea, bilateral crackles, and pitting edema in both feet. Which intervention is appropriate? Administer the medications as ordered. Ask the patient about the use of salt substitutes. Contact the provider to request an order for serum electrolytes. Request an order for furosemide [Lasix]. ANS: D Spironolactone takes up to 48 hours for its effects to develop, so it should not be used when the patient needs immediate diuresis. This patient has shortness of breath, crackles, and edema, and needs a short-acting diuretic, such as furosemide. Asking the patient about the use of salt substitutes is not indicated. The patient does not need assessment of serum electrolytes.DIF: Cognitive Level: ApplicationREF: pp. 350TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential A patient is taking gentamicin [Garamycin] and furosemide [Lasix]. The nurse should counsel this patient to report which symptom? Frequent nocturia Headaches Ringing in the ears Urinary retention ANS: C Patients taking furosemide should be advised that the risk of furosemide-induced hearing losscan be increased when other ototoxic drugs, such as gentamicin, are also taken. Patients should be told to report tinnitus, dizziness, or hearing loss. Nocturia may be an expected effect of furosemide. Headaches are not likely to occur with concomitant use of gentamicin and furosemide. Urinary retention is not an expected side effect.DIF: Cognitive Level: ApplicationREF: pp. 347TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential A patient with hypertension is taking furosemide [Lasix] for congestive heart failure. The prescriber orders digoxin to help increase cardiac output. What other medication will the nurse expect to be ordered for this patient? Bumetanide [Bumex] Chlorothiazide [Diuril] Hydrochlorothiazide [HydroDIURIL] Spironolactone [Aldactone] ANS: D Spironolactone is used in conjunction with furosemide because of its potassium-sparing effects. Furosemide can contribute to hypokalemia, which can increase the risk of fatal dysrhythmias, especially with digoxin administration. The other diuretics listed are all potassium-wasting diuretics.DIF: Cognitive Level: ApplicationREF: pp. 347TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential Besides having diuretic effects for patients with congestive heart failure, thiazides are also used to treat what? Select all that apply. Diabetes insipidus Hepatic failure Increased intracranial pressure Intraocular pressure Postmenopausal osteoporosis ANS: A , B , E Thiazide diuretics have the paradoxical effect of reducing urine output in patients with diabetes insipidus. They can also be used to mobilize edema associated with liver disease. They promote tubular reabsorption of calcium, which may reduce the risk of osteoporosis in postmenopausal women. Mannitol is used to treat edema that causes increased intracranial pressure and intraocular pressure.DIF: Cognitive Level: AnalysisREF: pp. 349TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] and digoxin. The prescriber has ordered spironolactone [Aldactone] to be added to this patient’s drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching? “I can expect improvement within a few hours after taking this drug.” “I need to stop taking potassium supplements.” “I should use salt substitutes to prevent toxic side effects.” “I should watch closely for dehydration.” ANS: B Spironolactone is a potassium-sparing diuretic used to counter the potassium-wasting effects of hydrochlorothiazides. Patients taking potassium supplements are at risk for hyperkalemia when taking this medication, so they should be advised to stop the supplements. Spironolactone takes up to 48 hours to have effects. Salt substitutes contain high levels of potassium and are contraindicated. Spironolactone is a weak diuretic, so the risk of dehydration is not increased.DIF: Cognitive Level: ApplicationREF: pp. 347TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Providers, 2nd Ed. Chapter 38: Drugs Acting on the Renin-Angiotensin-Aldosterone System Test Bank Multiple Choice

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LEHNE’S
PHARMACOTHERAPEUTICS FOR
ADVANCED PRACTICE NURSES
AND PHYSICIAN ASSISTANTS 2ND
EDITION ROSENTHAL TEST
BANK EXAM WITH ACTUAL
QUESTIONSAND COMPLETE
100%CORRECT ANSWERS WITH
VERIFIED AND WELL EXPLAINED
RATIONALES ALREADY GRADED
A+ BY EXPERTS |LATEST
VERSION 2024 WITH
GUARANTEED SUCCESS AFTER
DOWNLOAD ALREADY
PASSED!!!!!!! (PROVEN ITS ALL
YOU NEED TO EXCEL IN YOUR
EXAMS

,
, Chapter 1: Prescriptive Authority
Multiple Choice




3. A patient with type 1 diabetes recently became pregnant. What blood glucose testing schedule
will the provider recommended during the pregnancy?

a. Before each meal and before bed
b. In the morning for a fasting level and at 4:00 PM for the peak level
c. Six or seven times a day
d. Three times a day, along with urine glucose testing ANS: C

A pregnant patient with type 1 diabetes must have frequent blood sugar monitoring (e.g., six or
seven times a day) to manage the patient's glucose levels & to ensure that no harm occurs to the
fetus. Monitoring the blood sugar level before meals & at bedtime is not significant enough to
provide the necessary glycemic control. Morning and 4:00 PM monitoring is not enough to
provide glycemic control. Urine glucose testing is not sensitive enough to aid glycemic control,
& monitoring three times a day is not enough.
4. An adolescent had a serum glucose test at a health fair. The parent calls the clinic and says,
"The level was 125 mg/dL. Does that mean my child has diabetes?" What is the provider's most
accurate response?

a. "Unless your child were fasting for longer than 8 hours, this does not necessarily indicate
diabetes."
b. "At this level, there is a possibility of diabetes. We'll schedule your child for an oral glucose
tolerance test this week."
c. "This level is conclusive evidence that your child has diabetes."
d. "This level is conclusive evidence that your child do not have diabetes." ANS: A

If a person has not fasted for 8 hours, a blood sugar level of 125 mg/dL would be considered
normal, because it is less than 200 mg/dL for a random sampling. Also, a person must have
positive outcomes on two separate days to be diagnosed with diabetes. This patient does not need
to have an oral glucose tolerance test, because the 125 mg/dL reading is so far below 200 mg/dL,
which would require further work-up. No conclusive evidence indicates that this patient has
diabetes, because the random sample value is so low, and the patient has not had two separate
tests on different days. However, this also is not conclusive evidence that the patient does not
have diabetes.
5. What method will the provider consider the most reliable measure for assessing a patient's
diabetes control over the preceding 3-month period?

a. Self-monitoring blood glucose (SMBG) graph report

, b. Random blood glucose level
c. Fasting blood glucose level
d. Glycosylated hemoglobin level (A1c) ANS: D

The glycosylated hemoglobin level tells much about what the plasma glucose concentration has
been, on average, over the previous 2 to 3 months. The SMBG graph report is done by the patient
and indicates each blood sugar level the patient has on a daily basis. It is not as reliable as the
glycosylated hemoglobin level, because the equipment used might not be accurate and the testing
may not reflect actual measurements 100% of the time. Random blood sugar levels are not as
accurate as the glycosylated hemoglobin level for the same reason that the SMBG is not. One
fasting blood glucose level indicates the patient's blood sugar level for that one time when it was
obtained but is not reflective of a 3-month period.
6. Insulin glargine is prescribed by the provider for a hospitalized patient with type 1 diabetes.
When will the provider order this medication to be administered?

a. Approximately 15 to 30 minutes before each meal
b. In the morning and at 4:00 PM
c. Once daily at bedtime
d. After meals and at bedtime ANS: C

Glargine insulin is indicated for once-daily subcutaneous administration to treat adults and
children with type 1 diabetes and adults with type 2 diabetes. According to the package labeling,
the once-daily injection should be given at bedtime. Glargine insulin should not be given more
than once a day, although some patients require bid dosing to achieve a full 24 hours of basal
coverage.
7. A patient with type 1 diabetes reports taking propranolol for hypertension. What concern does
this information present for the provider?

a. The β blocker can cause insulin resistance.
b. Using propranolol with insulin increases the risk of diabetic ketoacidosis (DKA).
c. Propranolol increases insulin requirements because of receptor blocking.
d. The β blocker can mask the symptoms of hypoglycemia. ANS: D

β blockers can delay awareness of and response to hypoglycemia by masking signs associated
with stimulation of the sympathetic nervous system (e.g., tachycardia, palpitations) that
hypoglycemia normally causes. Furthermore, β blockade impairs glycogenolysis, which is one
means by which the body can counteract a fall in blood glucose; β blockers, therefore, can
worsen insulin-induced hypoglycemia. Propranolol does not cause insulin resistance. The
incidence of DKA is not increased by concurrent use of propranolol and insulin. Insulin
requirements are not increased because of receptor blocking by propranolol.
8. An older adult patient with type 2 diabetes has a history of severe hypoglycemia. The patient's
partner asks the provider what A1c level they should strive to achieve. What guideline will the
prescriber provide?

a. Between 6.5 and 7.0
b. Below 7.0

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