Spring Hill College: NUR 302 Chapter 1-30 Questions and Answers,100% CORRECT

Spring Hill College: NUR 302 Chapter 1-30 Questions and Answers 1. The nursing student realizes that she has given a patient a double dose of an antihypertensive medication. The tablet was supposed to be cut in half, but the student forgot and administered the entire tablet. The patient’s blood pressure just before the dose was 146/98 mm Hg. What should the student nurse do first? -Notify the clinical faculty -Rationale: The patient’s blood pressure will need to be monitored, but it was just taken, and the medication dose will not have an immediate effect. The student should notify the clinical instructor immediately. 2. The nurse is administering a drug that has been ordered as follows: “Give 10 mg on odd-numbered days and 5 mg on even-numbered days.” When the date changes from May 31 to June 1, what should the nurse do? -Consult the prescriber to verify that the dose should alternate each day, no matter whether the day is odd- or even-numbered -Rationale: While option C seems reasonable, the nurse does not have prescriptive authority to change the order. Therefore, the prescriber should be consulted to verify the order, which can be written in clearer terms. The other options would result in a change in the alternating dose schedule. 3. A patient with newly diagnosed type 1 diabetes mellitus has completed a diabetes education program. One month later, the patient confesses at a follow-up appointment that he “just didn’t feel like” giving himself the insulin injections. Which nursing diagnosis will the nurse assign the patient? -noncompliance -Rationale: Deficient knowledge differs from noncompliance in that the latter occurs when the patient does not take the medication as prescribed or at all—in other words, the patient does not comply with or adhere to the instructions given about the medication. Noncompliance (also called nonadherence) is usually a patient’s choice. 4. A nurse is providing patient teaching for a community health center that serves a primarily Portuguese population. The nurse would best serve this patient population by - Learning portugese - Rationale: The nurse should communicate with the patient in the patient’s native language if at all possible. If the nurse is not able to speak the patient’s native language, then a professional translator should be hired. It is best to avoid family members as translators, if possible, because of issues with bias, misinterpretation, and potential confidentiality issues. 5. After providing education regarding medications to a patient who has been newly diagnosed with type 2 diabetes mellitus, the nurse would use which part of the nursing process to assess whether the patient understands these new instructions? -evaluation -Rationale: The nurse would evaluate the effectiveness of the teaching session and look for areas where the patient needs reinforcement. 6. A 56-year-old man is taking over-the-counter antacids for relief of indigestion. He tells the nurse that he consumes at least one bottle a week and has done so for over a month because “it works for me.” The nurse’s main concern is that A. -this self-treatment may be delaying treatment of a more serious problem. B. Rationale: Normally, over-the-counter medications should be used only for short-term treatment of common minor illnesses. Their use may postpone effective management of chronic disease states and may delay treatment. 7. The nurse associates use of which over-the-counter medication with the development of hepatotoxicity? -Rationale: Acetaminophen (Tylenol) is associated with the development of hepatotoxicity 8. A patient tells the nurse that he wants to stop taking his antilipemic drugs and start taking garlic to lower his cholesterol. The nurse’s best reply would be: A. -“Let’s explore the evidence that supports the use of garlic to lower your cholesterol.” B. The nurse can provide patient education regarding potential risks and adverse drug reactions that are possible with herbal products. 9. Which statement regarding gene therapy is accurate? -The majority of the world’s insulin supply has been produced by recombinant gene technology. -Rationale: The majority of the world’s medical insulin supply has been produced by this method for well over a decade. Gene therapy is not commonly used. During gene therapy, segments of DNA are injected into the patient’s body, and viruses are used for gene transfer. 10. A patient’s daughter asks the nurse, “What did the test results show? I know they were doing genetic testing on my mother.” How should the nurse respond? -Remind the daughter that private information cannot be discussed without the patient’s permission. -Rationale: Nurses must protect against improper disclosure of information to other family members, friends of the family, other health care providers, and insurance providers. Nurses share the responsibility with other health care providers to protect patients and their families against the misuse of the patients’ genetic information. 11. The nurse’s instructions to a patient who is to take an orally disintegrating tablet would include which statement? A. -“Place the tablet on the tongue, and let it dissolve there.” -Rationale: Orally disintegrating medications, either in tablet or medicated strip form, dissolve in the mouth without water in about a minute. These medications are placed on the tongue, not under the tongue, as in the sublingual route. The patient must be instructed to allow the medication to dissolve on the tongue and not to chew or swallow the medication. 12. A patient is ordered to receive two different types of insulin. The nurse will a. draw the clear insulin into the insulin syringe then the cloudy insulin into the same syringe. b. Rationale: When two different types of insulin are ordered for a patient, the same syringe is used. The clear insulin is drawn up into the syringe first followed by the cloudy insulin. There is no need to administer two separate injections. 13. A patient is to receive a 0.5-mL injection of iron dextran, which can be very irritating to the body’s tissues. The proper technique for administration of this drug would be a(n) a. IM injection using the Z-track technique. 14. Which is the safest site for administration of an intramuscular injection to an adult? a. Ventrogluteal 15. When administering eye drops, where will the nurse place the drop? a. In the conjunctival sac b. Rationale: To avoid trauma to the eye and systemic absorption, the eye drop should be placed in the conjunctival sac. 16. A patient with bone cancer tells the nurse that he is in pain. The nurse knows that bone pain is classified as which type of pain? a. Rationale: Somatic pain, which includes bone pain, originates from the skeletal muscles, ligaments, and joints. Referred pain occurs when visceral nerve fibers synapse at a level in the spinal cord close to fibers that supply specific subcutaneous tissues in the body. Visceral pain originates from organs and smooth muscles. Neuropathic pain usually results from damage to peripheral or CNS nerve fibers or injury but may also be idiopathic. 17. A patient is recovering from an appendectomy. She also has asthma and allergies to shellfish and iodine. To manage her postoperative pain, the physician has prescribed patient-controlled analgesia (PCA) with hydromorphone (Dilaudid). Which vital sign is of greatest concern? a. Respirations b. Rationale: This patient has a history of asthma and allergies, and she will be receiving a drug that can depress respirations. 18. A patient who has metastasized bone cancer has been on transdermal fentanyl patches for pain management for 3 months. He has been hospitalized for tests and has told the nurse that his pain is becoming “unbearable.” The nurse is reluctant to give him the ordered pain medication because the nurse does not want the patient to get addicted to the medication. The nurse’s actions reflect a. a failure to manage the patient’s pain properly. b. Rationale: Patients with severe pain, including metastatic pain or bone pain, may need higher and higher doses of analgesics. The nurse is responsible for ensuring that the patient experiences adequate pain relief. 19. A patient with a history of heavy alcohol use needs a medication for pain. The recommended maximum daily dose of acetaminophen for this patient would be a. 2000 mg. b. Rationale: Chronic heavy alcohol abusers may be at increased risk of liver toxicity from excessive acetaminophen use. For this reason, a maximum daily dose of 2000 mg is generally recommended for these persons. 20. The nurse anesthetist is planning to use balanced anesthesia during a surgical procedure. A characteristic of this type of anesthesia is the a. administration of minimal doses of multiple anesthetic drugs. b. Rationale: The use of a combination of drugs allows less of each drug to be used and a more balanced, controlled state of anesthesia to be achieved. 21. When assessing a patient under general anesthesia, which change to organ systems does the nurse expect? a. Nystagmus b. Nystagmus can occur as a result of the use of general anesthesia. Other findings include skeletal muscle relaxation, hypotension, and increased intracranial pressure. 22. During surgery, the anesthetist notes that the patient’s heart rate is gradually increasing and becoming more irregular, the patient’s blood pressure is becoming unstable, and the patient is starting to sweat profusely. What other assessment should the anesthetist note immediately? a. Temperature b. Rationale: These are indications of malignant hyperthermia, which can progress rapidly. 23. Which statement regarding conscious sedation does the nurse identify as being accurate? a. Mild amnesia is a common effect of midazolam. b. Rationale: Midazolam allows the patient to relax and have markedly reduced or no anxiety, yet still maintain his or her open airway and response to verbal commands while producing mild amnesia. The oral route of drug administration for conscious sedation is preferred for pediatric patients; patients receiving conscious sedation are able to maintain their own airway. Propofol will relieve anxiety; however, pain medications must be used along with propofol therapy for situations that can cause a pain response. 24. When teaching a patient about spinal headaches, which statement will the nurse include? a. Spinal headaches can be prevented with bed rest after the epidural procedure. b. Rationale: Adequate hydration using IV fluids is often used to increase cerebral spinal fluid pressure. A “blood patch” is often used to help close up or seal the leak. A small amount of blood is taken from the patient and injected into the epidural space. The patient should be positioned flat to prevent spinal headache and if a patient has a spinal headache, relief is often obtained by lying flat. 25. A patient is to receive a neuromuscular blocking drug while on mechanical ventilation. While the patient is receiving this medication, the nurse should expect the patient to be: a. awake but unable to move. b. Rationale: Neuromuscular blocking drugs make the patient unable to move, but they do not cause sedation or relieve pain. 26. A patient in the intensive care unit will be receiving a neuromuscular blocking drug. Which piece of equipment is essential to have nearby when the nurse initiates this therapy? a. Mechanical ventilator b. Rationale: Neuromuscular drugs paralyze the respiratory muscles; it is essential to have sufficient ventilator support nearby in case the medication causes the patient to lose the ability to breathe. Oxygen alone is not sufficient. 27. When providing education to the patient on the use of a benzodiazepine medication, the nurse will include which information? a. Using this medication may cause drowsiness the next day. 28. An elderly patient taking multiple medications has a barbiturate added to his medication regimen. When administering a barbiturate to an elderly patient, the nurse should expect a. To administer half of the usual dose of the barbiturate. 29. Barbiturates have a low therapeutic index. This means a. the effective, safe dosage range is narrow. 30. Which statement regarding muscle relaxants does the nurse identify as being accurate? a. Baclofen (Lioresal) is available as an injectable form for use with an implantable pump device. 31. A teenaged boy will be receiving atomoxetine (Strattera) as part of treatment for attention deficit hyperactivity disorder (ADHD). Which statement about this drug therapy is accurate? a. Rationale: Prescribers are advised to work with parents to monitor closely for suicidal thoughts and behavior. In addition, psychosocial problems within the patient's family should be addressed if needed. Strattera is not addictive, and it is not used to treat narcolepsy. 32. A patient wants to take orlistat (Xenical) to assist in her weight loss program, but she is wary of its unpleasant adverse effects. What measure can be suggested to reduce these effects? a. Restrict dietary intake of fat b. Rationale: Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects of orlistat, which include oily spotting, flatulence, and fecal incontinence in 20% to 40% of patients. 33. Prior to administering a serotonin agonist, it is most important for the nurse to assess the patient for a history of a. Hypertension b. Rationale: The nurse should complete a thorough cardiac history as well as measurement of blood pressure and pulse rate and rhythm. If a patient has a history of hypertension, there is risk of further increases in blood pressure to dangerous levels with use of these drugs, and thus the need for careful assessment and documentation. In fact, generally these drugs are not prescribed for patients with migraines who also have coronary artery disease unless a thorough cardiac evaluation has been performed. 34. A patient is prescribed an anorexiant. Which statement will the nurse include in patient teaching? a. "Avoid intake of caffeine." b. Rationale: Caffeine in any form must be avoided by patients taking anorexiants. These medications should be taken in the morning to prevent interference with sleep. The drugs are taken on a short-term basis. Dry mouth frequently develops and can be managed by sucking ice chips and keeping a bottle of water nearby at all times. These drugs should not be abruptly stopped as a rebound increase of appetite may develop. c. 35. A patient in a long-term care facility has a new order for carbamazepine (Tegretol) for seizure management. The nurse monitors for autoinduction, which will result in a. lower than expected drug levels. b. 36. The nurse is assessing the current medication list of a newly admitted patient. The drug gabapentin (Neurontin) is listed, but the patient states that he does not have any problems with seizures. The nurse suspects that the patient a. may be taking this drug for neuropathic pain Rationale: Gabapentin is commonly used to treat neuropathic pain. 37. Before a patient is to receive phenytoin (Dilantin), the nurse practitioner orders lab work. Which lab result is of greatest concern? a. Low serum albumin levels Rationale: Phenytoin is highly bound to plasma proteins. If serum albumin levels are low, more free drug will be available to exert an effect, and toxicity may occur. 38. A patient with unstable epilepsy is receiving IV doses of phenytoin (Dilantin). The latest drug level is 12 mcg/mL. Which administration technique will the nurse use? a. Infuse slowly, not exceeding 50 mg/min Rationale: Phenytoin should be mixed only with normal saline, and it should be given by slow IV infusion (but not as a continuous infusion). 39. Which information will the nurse provide to the patient who is receiving antiepileptic drug therapy? a. Call your health care provider if you experience a sore throat or fever b. 40. The “off-on phenomenon” that some patients with Parkinson’s disease (PD) experience is best explained as the a. variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms. b. Rationale: Some patients who take levodopa on a long-term basis experience times when their PD symptoms are under control and other times when symptoms are not well controlled. 41. Which drug used for the management of the patient with Parkinson’s disease is most likely to cause postural hypotension? a. amantadine (Symmetrel) b. Rationale: Amantadine, carbidopa-levodopa, and ropinirole are most likely to cause postural hypotension. 42. The beneficial role of the NDDRA ropinirole (Requip) is that it a. appears to delay the start of levodopa therapy. b. Rationale: The longer that levodopa therapy can be delayed, the longer the benefit of the therapy will be experienced once it is eventually started. 43. When providing teaching to a patient receiving an anticholinergic for the treatment of Parkinson’s disease, the nurse will include which information? a. Do not take this medication at the same time as other medications. b. Rationale: When anticholinergics are used for the treatment of Parkinson’s disease, these medications should not be taken at the same time as other mediations. The medications should be administered at bedtime. Fluid intake should not be restricted as they cause dry mouth, and it may take several days to weeks for the beneficial effects of the medication to become evident. 44. Which drug will the nurse anticipate administering to a patient experiencing benzodiazepine overdose? a. flumazenil b. Flumazenil is a benzodiazepine reversal agent. Flumazenil antagonizes the action of benzodiazepines on the CNS by directly competing with them for binding at the benzodiazepine receptor in the CNS and thus reversing sedation. For opioid abuse or dependence, naltrexone, an opioid antagonist, is administered. Naltrexone, which is also available as an injection called Vivitrol, works by blocking the opioid receptors so that use of opioid drugs does not produce euphoria. Flunitrazepam is a benzodiazepine. 45. A patient with a diagnosis of delirium tremens is admitted to the acute care facility. Which finding does the nurse expect upon assessment of the patient? a. Hyperthermia b. Rationale: Delirium tremens are characterized by hypertensive crisis, tachycardia, agitation, and hyperthermia and may be life threatening. 46. Which statement does the nurse include when teaching a patient about disulfiram (Antabuse) therapy? a. “You cannot drink alcohol for at least 3 or 4 days after taking disulfiram (Antabuse).” b. Rationale: The rationale for the use of disulfiram (Antabuse) is that patients know that if they are to avoid the devastating experience of acetaldehyde syndrome, they cannot drink for at least 3 or 4 days after taking disulfiram. Disulfiram (Antabuse) does not cure aolcoholism; blood pressure gets very low if alcohol is consumed with disulfiram (Antabuse); and patients should follow the prescribed dosing schedule and not double a dose. 47. The nurse is explaining the differences between transdermal nicotine and nicotine gum programs. Which statement by the nurse is correct? a. “Chewing the gum rapidly will release an immediate dose of nicotine.” b. Rationale: The patch system uses a stepwise reduction in subcutaneous delivery to gradually decrease the nicotine dose, and patient treatment compliance seems higher than with the gum. Acute relief from withdrawal symptoms is most easily achieved with the use of the gum, because rapid chewing releases an immediate dose of nicotine. The dose is approximately half the dose the average smoker receives in one cigarette, however. 48. A patient has two inhalers that are due to be taken at the same time. One is a bronchodilator. The other is a corticosteroid. Which inhaler should the patient take first? a. The bronchodilator b. Rationale: Taking the bronchodilator first will result in a more open airway and thus allow for better penetration by the inhaled corticosteroid. 49. A patient is experiencing bronchospasms after running half a mile. He has several inhalers with him. Which one would be appropriate for treatment at this time? a. albuterol b. Rationale: Albuterol is a beta2 agonist that is used for acute bronchospasms. Salmeterol is appropriate for prevention of bronchospasms. Fluticasone is a corticosteroid that is not effective for acute bronchospasms. Advair Diskus is used for daily maintenance, not acute exacerbations. 50. A patient on a dobutamine drip starts to complain that her intravenous line “hurts.” The nurse checks the insertion site and sees that the area is swollen and cool. What will the nurse do first? a. Stop the intravenous infusion b. Rationale: Infiltration of an intravenous solution containing an adrenergic drug may lead to tissue necrosis from excessive vasoconstriction around the intravenous site. Phentolamine is often used for the treatment of infiltration, but the first thing the nurse must do is to stop the infusion of the adrenergic drug. Slowing the medication will not stop further tissue damage. The physician should be notified, but the infusion should be stopped first. 51. A patient on a dobutamine drip starts to complain that he feels a “tightness” in his chest that he had not felt before. What will the nurse do first? a. Check the patient’s vital signs b. Rationale: Before anything else is done, the patient’s vital signs should be checked for alterations. The dopamine rate should not be increased. Extravasation rarely causes chest tightness. While an electrocardiogram would be prudent, it's not the priority until after the vital signs demonstrate that the patient is stable. 52. A 10-year-old child is brought to the emergency department while having an asthma attack. She is given a nebulizer treatment with albuterol. The nurse’s immediate assessment priority would be to a. monitor Spo2 with a pulse oximeter. b. Rationale: During administration of albuterol, a fast-acting beta2 agonist, the nurse should monitor the patient’s respiratory status including Spo2 (with a pulse oximeter), respiratory rate, and breath sounds to ensure that the medication is having a therapeutic effect. The other items can be handled after her respiratory status is stable. 53. When phentolamine is used to diagnose the presence of pheochromocytoma, the nurse will assess for what indicative finding? a. Rapid decrease in blood pressure b. Rationale: To help establish a diagnosis of pheochromocytoma, a single intravenous dose of phentolamine is given to the hypertensive patient who is suspected of having the tumor. If the blood pressure declines rapidly, it is highly likely that the patient has a pheochromocytoma. 54. When administering an alpha blocker for the first time, it is most important for the nurse to assess the patient for the development of a. hypotension. b. Rationale: The primary adverse effects of alpha blockers are those related to their effects on the vasculature. First-dose phenomenon, which is a severe and sudden drop in blood pressure after the administration of the first dose of an alpha-adrenergic blocker, can cause patients to fall or pass out. All patients must be warned about this adverse effect before they take their first dose of an alpha blocker. Orthostatic hypotension can occur with any dose of an alpha blocker, and patients must be warned to get up slowly from a supine position. 55. A 58-year-old patient is recovering in the intensive care unit after a myocardial infarction (MI). The nurse notes an order for the beta blocker metoprolol (Lopressor). The purpose of this drug is to a. inhibit stimulation of the myocardium by circulating catecholamines. b. Rationale: Studies have shown increased survival in patients given metoprolol after experiencing an MI. Metoprolol has a cardioprotective effect by decreasing the heart’s response to circulating catecholamines resulting from the myocardial infarction. 56. The nurse knows that the adverse effects of a nonselective beta blocker are likely to be the most immediately life threatening in which patient? a. Patient with asthma b. Rationale: While beta blockers may mask signs and symptoms of hypoglycemia, nonselective beta blockers may cause bronchoconstriction, which would be detrimental to the patient with asthma. 57. A patient with type 2 diabetes is taking a beta blocker as part of treatment for hypertension. Which complication is most likely to develop? a. Hypoglycemia b. Rationale: Beta blockers may mask the signs and symptoms of hypoglycemia. 58. The nurse is assessing a patient who has been taking a cholinergic drug for 3 days. The patient has flushed skin, orthostatic blood pressure changes, and is complaining of abdominal cramps and nausea. The nurse recognizes that the patient is most likely experiencing a. early signs of a cholinergic crisis. b. Rationale: The items listed are early signs of a cholinergic crisis, which can become more severe and lead to hypotension, circulatory collapse, bloody diarrhea, shock, and cardiac arrest. 59. A 60-year-old woman asks the nurse about taking ginkgo to help with her memory. The patient has a history of arthritis, type 2 diabetes, thyroid disease, and hypertension. She is currently taking NSAIDs for arthritis, oral antidiabetic medications, thyroid replacement hormone, and a beta blocker for blood pressure. What potential adverse effect from the gingko would be of most concern for this patient? a. Bleeding b. Rationale: Potential adverse effects of gingko include stomach or intestinal upset, headache, bleeding, and allergic skin reaction. Potential drug interactions include aspirin, nonsteroidal antiinflammatory drugs (NSAIDs), anticoagulants, and other drugs. The ginkgo may interact with the NSAID medication and cause increased bleeding. 60. A patient is scheduled to have lunch at 1200. The nurse will administer the pyridostigmine (Mestinon) at what time for optimal therapeutic effect? a. 1130 b. Rationale: The drug should be taken 30 minutes before a meal for maximal therapeutic effect. 61. A patient with Alzheimer’s disease accidentally took 2 weeks’ worth of a cholinergic medication. He is brought to the emergency department, is going into shock, and experiencing severe hypotension and vomiting. The nurse will expect which initial treatment? a. Administration of atropine b. Rationale: Atropine can be given to reverse the effects of an overdose of a cholinergic drug. 62. Which finding would the nurse anticipate when assessing a patient with an atropine overdose? a. Urinary retention b. Rationale: Atropine overdose is manifested by flushing, dry skin and mucous membranes, mydriasis, altered mental status, and fever. Other serious effects include sinus tachycardia, urinary retention, hypertension, hallucinations, and cardiovascular collapse. Activated charcoal is usually given along with supportive therapy. 63. Glycopyrrolate (Robinul) and an opioid are administered to a patient prior to surgery in the preoperative area. The anticholinergic is used to a. control secretions during surgery. b. Rationale: Anticholinergics such as glycopyrrolate and atropine are given preoperatively to reduce or control secretions before and during surgery. 64. Prior to administering tolterodine (Detrol) it is most important for the nurse to assess the patient for a history of which condition? a. Angle-closure glaucoma b. Rationale: Tolterodine (Detrol) may worsen pre-existing angle-closure glaucoma and urinary retention, so its use should be avoided in patients with these conditions. 65. The number of people with hypertension in the United States is estimated to be: a. 50 million. b. Rationale: As many as 50 million people in the United States have some form of hypertension, which makes it the most common disease in the population of the Western hemisphere. 66. When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of: a. hypotension. b. Rationale: These drugs have strong vasodilating properties and may cause severe hypotension, especially at the beginning of therapy. 67. A patient with type II diabetes has a new prescription for the angiotensin-converting enzyme (ACE) inhibitor lisinopril. She questions this order because her physician has never told her that she has hypertension. What is the best explanation for this order? a. This medication has a protective effect on the kidneys for patients with type II diabetes. b. Rationale: ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This property makes them the cardiovascular drug of choice for diabetic patients. 68. A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient? a. captopril b. Explanation: Captopril is not a prodrug; therefore it does not need to be metabolized by the liver to be effective. This is an advantage in patients with liver disease. 69. Which statement about angiotensin II receptor blockers does the nurse identify as being true? a. Upper respiratory infection is a common adverse effect. b. Rationale: Angiotensin II receptor blockers have the common adverse effect of upper respiratory infection. Hyperkalemia and cough are less likely to occur than when using ACE inhibitors and overdose of angiotensin II receptor blockers is manifested by hypotension and tachycardia. 70. A patient is mowing his lawn on a hot Saturday afternoon. He begins to notice chest pain. What should his first action be? a. Stop mowing and sit or lie down b. Rationale: At the first sign of chest pain, the person should stop all activity and sit or lie down before taking the nitroglycerin tablet. 71. A patient with extremely high blood pressure is in the emergency department. The physician will be ordering therapy with nitroglycerin to manage the patient’s blood pressure. Which form of nitroglycerin is most appropriate? a. IV infusion b. Rationale: The IV infusion of nitroglycerin will have the fastest effect, and the dose will be titrated to the patient’s response. 72. A patient who was walking his dog developed chest pain and sat down. He continues to experience chest pain when sitting down. When should he call 911? a. If one sublingual tablet does not relieve the pain after 5 minutes b. Rationale: With sublingual nitroglycerin, the medication should be taken at the first sign of chest pain and not be delayed until the pain is severe. The patient should sit or lie down and take 1 sublingual tablet. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes after 1 dose, the patient (or family member) should call 911 immediately. The patient can take 1 more tablet while awaiting emergency care, and a third tablet 5 minutes later, but no more than 3 tablets total. These guidelines reflect the fact that angina c. pain that does not respond to nitroglycerin may indicate a myocardial infarction. 73. A patient who has had a myocardial infarction is on a beta blocker. What is the main benefit of beta blocker therapy for this patient? a. Slowing of the heart rate b. Rationale: Slowing the heart rate in patients with ischemic heart disease reduces myocardial oxygen demand and allows the coronary arteries time to fill with oxygen- and nutrient-rich blood. Beta blockers also block the irritating effects of circulating catecholamines on the heart. 74. The nurse is preparing to educate a group of patients on the management of angina. a. Which drug groups are most often used to treat patients with angina? b. 1. The nitrates and nitrites, the beta blockers, and the calcium channel blockers (CCBs) are the drugs most often used to treat patients with angina pectoris. 75. One of the patients asks the nurse to tell her more about a new drug the patient has been prescribed called ranolazine (Ranexa). Which response by the nurse is accurate? a. “We do not know how Ranexa works.” b. Rationale: The mechanism of action of Ranexa is not known. Ranexa is used only after treatment with other antianginals have not been effective. Ranexa is administered by mouth and is contraindicated for use in patients with liver failure. 76. What information will the nurse include when teaching the patients about taking beta2-blocking drugs for the treatment of angina? a. “Call your health care provider if you experience a weight gain of 2 pounds or more in 24 hours or 5 pounds or more in 1 week.” b. Rationale: Weight gain can indicate serious adverse effects of beta2-blocking drugs, so the health care provider should be called. A pulse of 64 is acceptable; these drugs should be avoided in patients with asthma and there is no interaction with grapefruit juice. Calcium channel blockers should not be administered with grapefruit juice. 77. A patient asks how to apply transdermal nitroglycerin. What is the nurse’s best response? a. “Apply the patch to hairless areas of the body.” b. Rationale: The transdermal patch should be applied to a hairless, residual free area of the body with the sites being rotated each time. The old transdermal patch should be completely removed and a new one applied. 78. Which patient is the best candidate to receive nesiritide therapy? a. A patient with acutely decompensated heart failure who has dyspnea at rest b. Rationale: At this time, nesiritide is generally used in the intensive care setting as a final effort to treat severe, life-threatening heart failure, often in combination with several other cardiostimulatory medications. The manufacturer recommends that nesiritide not be used as a first-line drug for this purpose. In 2005, an expert panel reviewed nesiritide at the request of the U.S. Food and Drug Administration in response to reports of worsened renal function and mortality. The expert panel stated that the use of nesiritide should be strictly limited to treatment of patients with acutely decompensated heart failure who have dyspnea at rest. It should not be used to replace diuretics and should not be used repetitively or to improve renal function. 79. A patient is in the emergency department with new onset atrial fibrillation. Which order for digoxin would most likely have the fastest therapeutic effect? a. Digoxin 1 mg IV push now, then 0.25 mg IV daily b. Rationale: A digitalizing dose is often used to quickly bring serum levels of the drug up to a therapeutic level. IV doses would accomplish this more quickly. 80. A patient is receiving digoxin 0.25 mg daily as part of treatment for heart failure. The nurse assesses the patient before medication administration. Which assessment finding would be of most concern? a. Serum potassium level of 2.9 mEq/L b. Rationale: The hypokalemia may precipitate digoxin toxicity; therefore it is the biggest concern. The apical pulse is slightly under 60, but bradycardia may occur with digoxin therapy and the heart rate should be monitored. The ankle edema may be a manifestation of his heart failure and not a new concern. The digoxin level is within normal range. 81. A patient with a history of heart failure presents to the emergency department with difficulty breathing, cough, and edema of the lower extremities. The nurse anticipates administration of which type of medication? a. Positive inotrope b. Rationale: Positive inotropes are used to increase the force of myocardial contraction in the treatment of a patient with heart failure. Negative inotropes would cause the heart to have a decreased force of myocardial contraction and would not be effective. Positive chrontropes increase the rate at which the heart beats, and negative chronotropes decrease the rate at which the heart beats. 82. The patient is prescribed an ACE inhibitor. The nurse understands the primary mechanism by which the ACE inhibitors exert their therapeutic effect in a patient in heart failure is: a. to inhibit aldosterone secretion. b. Rationale: The ACE inhibitors are beneficial in the treatment of heart failure because they prevent sodium and water resorption by inhibiting aldosterone secretion. This causes diuresis, which decreases blood volume and blood return to the heart. This in turn decreases preload, or the left ventricular end-diastolic volume, and the work required of the heart. 83. The patient is discharged home and returns to the emergency department 4 days later. The patient is admitted to the intensive care unit with acute decompensated heart failure with dyspnea at rest. The nurse anticipates administration of which medication? a. nesiritide (Natrecor) b. Rationale: Nesiritide is used in the intensive care setting as a final effort to treat severe, life- threatening heart failure, often in combination with several other cardiostimulatory medications. Lisinopril (Prinivil) is an ACE inhibitor that is used in the management of heart failure. Carvedilol (Coreg) has been shown to slow the progression of heart failure and to decrease the frequency of hospitalization in patients with mild to moderate (class II or III) heart failure. Atropine is used to increase heart rate. 84. A patient has received an IV dose of adenosine, and almost immediately the heart monitor shows asystole. What should the nurse do next? a. Continue to monitor the patient. b. Rationale: The half-life of adenosine is very fast—only 10 seconds, and the asystole only lasts for a few seconds. The nurse should continue to monitor the patient for therapeutic and adverse effects of the medication. 85. A patient is in the emergency department with an unspecified supraventricular dysrhythmia. The physician orders a dose of diltiazem (Cardizem) IV push. While the nurse administers the medication through the IV lock, the patient states she feels something wet spilling on her arm. Her heart rate was unchanged. What will the nurse do next? a. Check the IV lock to see if it is functioning properly. b. Rationale: Since the heart rate was unchanged and the patient felt fluid on her arm, the IV lock is probably not working properly. Before anything else is done, the IV lock should be checked for proper functioning. Another dose would be wasted if the IV lock is not working. 86. A patient is receiving oral quinidine. Which assessment finding is of most concern? a. Prolonged QT interval b. Rationale: Patients on quinidine need to be monitored for prolonged QRS or QT intervals, which may be a precursor to more serious dysrhythmia problems. 87. A patient is receiving an IV infusion of heparin and was started on warfarin therapy the night before. Which statement is most correct? a. The heparin provides anticoagulation until therapeutic levels of warfarin are reached. b. Rationale: Heparin has a faster onset and therefore is used to provide anticoagulation until therapeutic levels of warfarin are reached. 88. A patient is receiving an intravenous infusion of a thrombolytic drug during treatment for an acute MI. The nurse notices that there is a slight amount of bleeding from the antecubital area where venous lab work was drawn. What will the nurse do first? a. Apply pressure to the site with a gauze pad. b. Rationale: The most common undesirable effect of thrombolytic therapy is internal, intracranial, and superficial bleeding. If invasive procedures must be performed or injections given, appropriate pressure should be applied to bleeding sites, and all areas of venous or arterial catheter insertion should be closely watched for bleeding. This type of superficial bleeding is to be expected and does not warrant cessation of the thrombolytic therapy. 89. A 75-year-old man fell at home and hit his head against a table. His wife reports to their daughter that he does not have cuts or scratches, but there is a small lump on his upper scalp. She does not see any blood. He is taking warfarin and an antidysrhythmic as part of his treatment for chronic atrial fibrillation. What is the main concern at this time? a. He needs to be examined for possible internal bleeding from the fall. b. Rationale: Careful examination will be needed to ensure that there is no hematoma or other internal bleeding as a result of the fall, even if superficial bleeding is not noted. 90. A 72-year-old woman is taking an over-the-counter multivitamin that contains ginkgo. Her physician has recommended that she start taking low-dose aspirin therapy as part of her treatment for transient ischemic attacks (TIAs). The concern with taking these two drugs together is: a. increased risk of bleeding because of the ginkgo. b. Rationale: Ginkgo may cause some increased bleeding times, so taking aspirin with ginkgo may put the patient at a higher risk for bleeding episodes. Capsicum pepper c. Garlic d. Ginger e. Ginkgo f. St. John’s wort g. Feverfew 91. A patient with a new prescription for a HMG-CoA (statin) drug is instructed to take the medication with the evening meal or at bedtime. The patient asks why it must be taken at this time of day. The reason is: a. This timeframe correlates better with the natural diurnal rhythm of cholesterol production. b. Rationale: All statins are generally dosed once daily, usually with the evening meal or at bedtime, to better coincide with the body’s natural diurnal rhythm of cholesterol production. 92. A patient will be taking niacin as part of antilipemic therapy. The best way to avoid problems with flushing or pruritus would be to: a. start with a low initial dose, and then increase it gradually. b. Rationale: Cutaneous flushing may be minimized if the niacin is started at a smaller dose and gradually increased. Premedication with a small dose of aspirin or a nonsteroidal antiinflammatory drug (NSAID) 30 minutes before taking the niacin, as well as taking the niacin with meals, may help to minimize these undesirable effects. 93. A patient wants to take garlic tablets to improve his cholesterol levels. Which condition would be a contraindication? a. Scheduled surgery b. Rationale: Garlic has antiplatelet activity, and is contraindicated in patients who will undergo surgery within 2 weeks and in patients with human immunodeficiency virus infection or diabetes. 94. Which patient would benefit from administration of simvastatin (Zocor) 80 mg? a. A patient who has already been taking simvastatin (Zocor) for 12 months with no evidence of myopathy b. Rationale: In 2011, the FDA imposed new prescribing restrictions on simvastatin, stating “Physicians should limit using the 80-mg dose unless the patient has already been taking the drug for 12 months and there is no evidence of myopathy. Simvastatin 80 mg should not be started in new patients, including patients already taking lower doses of the drug.” In patients taking verapamil, the dose of simvastatin is not to exceed 10 mg. 95. Before administering niacin, it is most important for the nurse to assess the patient for a. gout. b. Rationale: With niacin, patient assessment includes noting contraindications such as liver disease, peptic ulcer disease, gout, hypertension, and any active bleeding. Although a thorough assessment of all patient conditions is helpful, the other conditions do not preclude use of niacin. 96. Which location is the area where the highest percentage of sodium and water are resorbed back into the bloodstream? a. Proximal tubule b. Rationale: The proximal convoluted (twisted) tubule or, more simply, proximal tubule, anatomically follows the glomerulus and returns 60% to 70% of the sodium and water from the filtered fluid back into the bloodstream. Another 20% to 25% of sodium is resorbed into the bloodstream in the ascending loop of Henle. The remaining 5% to 10% of sodium resorption takes place in the distal convoluted tubule, often called simply the distal tubule, which anatomically follows the ascending loop of Henle. The glomerulus does not resorb sodium or water, but instead is the point of initial filtration of the blood. 97. When administering a loop diuretic to a patient, it is most important for the nurse to determine if the patient is also taking which drug? a. lithium (Eskalith) b. Rationale: Use of loop diuretics with lithium can increase the risk of lithium toxicity. Drug interactions with loop diuretic therapy can occur with concurrent use of nonsteroidal antiinflammatory drugs (NSAIDs), and vancomycin can cause increased neuro- and ototoxicity when used with loop diuretics. There is no associated risk of drug interaction when taking acetaminophen, penicillin, or theophylline with loop diuretics. 98. While preparing an infusion of mannitol (Osmitrol), the nurse notices small crystals in the IV tubing. The most appropriate action by the nurse is to a. discard the solution and obtain another bag of medication. b. Rationale: Even though a filter should always be used with this medication infusion, a solution with crystals present in the bag or tubing should never be infused. The nurse should first discard the solution and then restart the infusion with a new bag, ensuring that there is a filter on the IV line. 99. A patient with a creatinine clearance of 20 mL/min is admitted to the medical surgical unit. The patient is in need of rapid diuresis. Which class of diuretic does the nurse anticipate administering? a. Loop b. Rationale: The loop diuretics provide rapid diuresis because of their rapid onset of action. Loop diuretics are effective for patients with reduced kidney function (creatinine clearance below 25 mL/min). 100. The patient is ordered furosemide (Lasix). Before administering furosemide, it is most important for the nurse to assess the patient for allergies to which drug class? a. Sulfonamides b. Rationale: The nurse should assess patients receiving furosemide (Lasix) for cross-sensitivity to sulfonamides. Although allergy to sulfonamide antibiotics is listed as a contraindication, analysis of the literature indicates that cross-reaction with the loop diuretics is unlikely to occur. Loop diuretics are commonly given to such patients in clinical practice. The nurse should closely monitor these patients. 101. Two days after admission, the nurse is reviewing laboratory results of the patient. Which is the most common electrolyte finding resulting from the administration of furosemide (Lasix)? a. Hypokalemia b. Rationale: Of all of the adverse effects of furosemide (Lasix) administration, hypokalemia is of serious clinical importance. To prevent hypokalemia, patients often receive potassium supplements along with furosemide. The other electrolyte disturbances listed do not occur as a result of furosemide (Lasix) therapy. 102. The patient is being discharged home with furosemide (Lasix). When providing discharge teaching, which instruction will the nurse include? a. Avoid prolonged exposure to the sun. b. Rationale: Patients taking furosemide (Lasix) should avoid prolonged exposure to the sun because the drug can cause photosensitivity. Although orthostatic hypotension is a possible adverse effect of the medication, patients should not stop taking the medication without consultation with their health care provider. Patients should weigh themselves once a day and report a weight gain or loss of approximately 3 pounds. Patients taking furosemide (Lasix) should be encouraged to eat foods rich in potassium. 103. A patient is taken to the trauma unit after a motorcycle accident. It is estimated that he has lost 30% of his blood volume and he is in hypovolemic shock. The nurse anticipates a transfusion with which blood product? a. Whole blood b. Rationale: Whole blood is more beneficial in cases of extreme loss of blood volume (over 25%). 104. Which condition does the nurse identify as a late manifestation of hypokalemia? a. Palpitations b. Rationale: Palpitations are a late manifestation of hypokalemia. Early manifestations of hypokalemia include muscle weakness, lethargy, and hypotension. 105. A patient is hypokalemic and will be receiving intravenous potassium. The patient is not on a heart monitor. How should the nurse administer the potassium replacement? a. No more than 10 mEq/hr b. Rationale: If IV potassium is administered too rapidly, cardiac arrest may occur. IV potassium should be given no faster than 10 mEq/hr to patients who are not on cardiac monitors. For critically ill patients on cardiac monitors, rates of 20 mEq/hr or more may be used. 106. A patient with a serum potassium of 6.0 mEq/L is ordered polystyrene sulfonate (Kayexalate) via the NG. When administering the medication the nurse should a. administer the drug with water. b. Rationale: Polystyrene should be administered with water based on the dose. The nurse should administer each dose as a suspension in a small quantity of water for improved palatability. Follow directions regarding the amount of water to use; it generally ranges from 20 to 100 mL, depending on the dose. The drug should not be administered with sorbitol, antacids, or laxatives. 107. Which solution should the nurse administer with packed red blood cells? a. 0.9 % NaCl b. Rationale: Blood products must be given only with normal saline (0.9% sodium chloride), because the solution of D5W results in hemolysis of red blood cells. 108. 108.