NURS-6521D Midterm Exam -Advanced Pharmacology Summer 2020

An expected outcome for a patient who has just taken sublingual nitroglycerin should be Selected Answer: Correct Answer: B. increased heart rate and decreased blood pressure. Response Feedback: Nitroglycerin relaxes vascular smooth muscle and dilates both arterial and venous vessels. Dilation of veins is more predominant than dilation of arteries, resulting in peripheral pooling of blood and decreased preload. Blood pressure will usually decrease as a result of the venous dilation. Reflex tachycardia usually follows the drop in blood pressure. • Question 2 1 out of 1 points A nurse is caring for a patient who is diabetic and has been diagnosed with hypertension. An angiotensin­converting enzyme inhibitor, captopril, has been prescribed for her. Which of the following should the nurse assess before beginning drug therapy? Selected Answer: Correct Answer: D. Serum potassium levels Response Captopril inhibits the angiotensin­converting enzyme that is needed to change the Feedback: inactive angiotensin I to the active form, angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, preventing sodium and water retention. This action decreases peripheral vascular resistance and lowers blood pressure. Serum potassium may increase as a result of decreased aldosterone levels. It would be helpful to have a baseline level at the beginning of the drug therapy to monitor the possible effect of hyperkalemia. There is no need to monitor calcium and magnesium levels. While it is important to always know a diabetic's blood glucose level, captopril does not alter the level during therapy. • Question 3 1 out of 1 points A 77­year­old man's chronic heart failure is being treated with a regimen of quinapril (Accupril) and furosemide (Lasix). Which of the following assessment findings would suggest that the loop diuretic is contributing to a therapeutic effect? Selected Answer: Correct Answer: C. The man's chest sounds are clear and his ankle edema is lessened. Response Feedback: Appropriate diuretic therapy leads to the resolution of pulmonary and peripheral edema. Healthy kidney function, cardiac rhythm, and electrolyte levels are all desirable outcomes, but they are not directly indicative of the therapeutic action of diuretics in the treatment of CHF. • Question 4 1 out of 1 points A patient with class­IV CHF has a medication regimen consisting of metoprolol (Lopressor), enalapril (Vasotec), and furosemide (Lasix). In addition to regularly assessing the patient s heart rate, the nurse should prioritize assessment of the patient's Selected Answer: Correct Answer: C. blood pressure. C. blood pressure. Response Feedback: Fluid balance, cognition, and exercise tolerance are all affected by CHF and should be regularly assessed as part of thorough nursing care. However, the combination of an ACE inhibitor, a beta blocker, and a diuretic constitutes a significant risk for hypotension and indicates a need for frequent blood pressure monitoring. • Question 5 1 out of 1 points A patient is brought to the emergency department in hypertensive crisis. Nitroprusside is administered intravenously. The patient experiences diaphoresis and dizziness. Which of the following is the appropriate action by the nurse? Selected Answer: Correct Answer: C. Slow the rate of the infusion Response Feedback: Administering nitroprusside too quickly can result in abdominal pain, apprehension, diaphoresis, dizziness, headache, muscle twitching, nausea, palpitations, restlessness, retching, and retrosternal discomfort. The nurse should quickly inform the prescriber and slow the infusion. Symptoms quickly subside when the nitroprusside infusion is slowed or stopped, and usually do not return when the infusion resumes at a slower rate. Consulting the prescriber for a dose change would not help; the rate of drug administration is the issue. Continuing to give the nitroprusside at the ordered rate could be fatal. • Question 6 1 out of 1 points A normal maintenance dose for digoxin is 0.125 to 0.5 mg/day. In which of the following patients would the nurse most likely administer a lower­than­normal maintenance dose of digoxin? Selected Answer: Correct Answer: C. A 79­year­old male with cardiomegaly Response Feedback: The nurse should continue regular administration of the drug because digoxin requires a loading dose before the drug's therapeutic effect is present. It may take several days for optimal clinical effects to appear. Therefore, seeking an order to increase the dosage, seeking orders to discontinue digoxin and start another drug, or insisting that another drug be ordered would not be necessary at this time. • Question 7 1 out of 1 points A patient has been prescribed lovastatin for a high cholesterol level. The nurse's teaching plan will include a basic explanation of how the drug produces its therapeutic effect. The nurse will explain that lovastatin lowers cholesterol levels because it Selected Answer: Correct Answer: A. inhibits cholesterol syntheses. Response Feedback: Lovastatin belongs to a group of drugs classified as statins. These drugs work by inhibiting cholesterol synthesis in the liver. Fibric acid derivatives and bile­acid resins also decrease cholesterol levels but they work at different sites. Fibric acid derivatives work on lipoproteins and triglycerides to reduce cholesterol, and bile­ acid resins work in the gastrointestinal tract and bind bile salts in the intestine. Lovastatin is not a hormone. • Question 8 1 out of 1 points A 39­year­old African­American male is 25 pounds overweight and has been diagnosed with hypertension after three consecutive above­normal blood pressure readings. The most likely initial drug therapy for this patient will be Selected Answer: D. a diuretic. Correct Answer: D. a diuretic. Response Feedback: The patient would most likely be prescribed a diuretic in combination with diet and other lifestyle changes. African­American men are at increased risk for developing hypertension and tend to respond differently to antihypertensive therapy. The research shows that African­American men are most responsive to single­drug therapy and diuretics. The use of a calcium channel blocker and/or alpha­adrenergic blocker would follow if he is unresponsive to the diuretic in combination with diet and other lifestyle changes. African Americans tend to be less responsive to ACE inhibitors and beta blockers. • Question 9 1 out of 1 points A patient has recently been prescribed a drug that treats his hypertension by blocking the sympathetic receptors in his sympathetic nervous system. This action is characteristic of Selected Answer: Correct Answer: A. an adrenergic antagonist. Response Feedback: Those drugs that stimulate sympathetic receptors are referred to as adrenergic or dopaminergic agonists (stimulators) and those that block are referred to as adrenergic antagonists (blockers). Adrenergic antagonism is not synonymous with the action of a cardiotonic drug. • Question 10 0 out of 1 points The nurse is performing patient education for a woman who will soon begin treatment of hyperlipidemia with simvastatin (Zocor). The patient has asked the nurse if there are any “bad side effects” that she should be aware of. Which of the following statements should underlie the nurse's response? Selected Answer: Correct Answer: B. Most patients tolerate statins well, with minor muscle aches being among the most common adverse effects. Response Feedback: Adverse effects of lovastatin are usually mild and transient; the drug is generally well tolerated. A fairly common complaint with all statins, including lovastatin, is nonspecific muscle aches or joint aches, weakness, and/or cramps (myalgias), which are not associated with any signs of muscle damage. GI upset and cough are not associated with the use of statins. Renal disease may contraindicate the use of statins, but frequent analysis of kidney function is not necessary for patients with no preexisting indications. • Question 11 0 out of 1 points A nurse is providing patient education to a 35­year­old man who has been prescribed clonidine (Catapres) as part of step 2 antihypertensive therapy. The nurse should anticipate that the drug will be administered Selected Answer: Correct Answer: C. orally. B. transdermally. Response Feedback: Clonidine may be administered orally or parenterally but is most frequently administered transdermally. • Question 12 1 out of 1 points A 62­year­old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which of the following actions should the nurse do first when he complains of chest pain? Selected Answer: Correct Answer: C. Administer a tablet under his tongue and repeat the action in 5 and 10 minutes if the pain has not subsided Response Feedback: The initial action by the nurse should be sublingual administration of the drug by placing one tablet under the patient's tongue and repeating the action in 5 and 10 minutes if necessary. Asking the patient to relax is important and should be done, but administering the tablets would need to be done first. The nurse would not call the physician if the pain has subsided by the third tablet. If the pain has not subsided, the patient is considered to be having an acute MI, and it would be urgent to call the physician. Nitroglycerin does not come in oral form; therefore, it would not be swallowed.