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PHARM #3
Diuretics, antihypertensives, cardiac glycosides, antianginals, and antidysrhyth
| Question | Answer |
|---|---|
| The nurse is preparing to administer the first dose of hydrochlorothiazide 50 mg to a patient who has a blood pressure of 160/95 mm Hg. The nurse notes the patient had a urine output of 200 mL in the past 12 hours. The nurse will perform which action? | Hold the medication and request an order for serum BUN and creatinine. |
| The nurse is preparing to administer doses of hydrochlorothiazide and digoxin to a patient who has heart failure. The patient reports having blurred vision, a heart rate of 60 bpm and a blood pressure of 140/78 mm Hg. Which action will the nurse take? | Hold the digoxin and notify the provider. |
| The nurse is teaching a patient about taking hydrochlorothiazide. Which statement by the patient indicates a need for further teaching? | I may need extra sodium and calcium while taking this drug. |
| The nurse is caring for a patient who is to begin receiving a thiazide diuretic to treat heart failure. When performing a health history on this patient, the nurse will be concerned about a history of which condition? | Gout |
| The nurse is caring for a patient who develops marked edema and a low urine output as a result of heart failure. Which medication will the nurse expect the provider to order for this patient? | Furosemide (Lasix) |
| The nurse is caring for a patient who is receiving furosemide (Lasix) and an aminoglycoside antibiotic. The nurse will be most concerned if the patient reports which symptom? | Tinnitus |
| The nurse is teaching a patient who will begin taking furosemide. The nurse learns that the patient has just begun a 2-week course of a steroid medication. What will the nurse recommend? | Obtain an order for a potassium supplement. |
| The nurse is caring for a patient who has metabolic alkalosis experiencing fluid overload. Provider orders acetazolamide (Diamox). Pt reports right-sided flank pain after taking this medication. The nurse suspects that this patient has developed? | Renal calculi |
| A patient has begun taking spironolactone (Aldactone) in addition to a thiazide diuretic. With the addition of the spironolactone, the nurse will counsel this patient to | report decreased urine output to the provider. |
| The nurse notes a blood pressure of 160/90 mm Hg in a patient taking a thiazide diuretic. The patient reports taking an herbal medication that a friend recommended. Which herbal product is likely, given this patients blood pressure? | Ginkgo |
| The nurse is caring for a patient who is taking hydrochlorothiazide (HydroDIURIL) and digoxin (Lanoxin). Which potential electrolyte imbalance will the nurse monitor for in this patient? | Hypokalemia |
| A patient has been taking spironolactone (Aldactone) to treat heart failure. The nurse will monitor for | hyperkalemia. |
| A patient is diagnosed with borderline hypertension and states a desire to make lifestyle changes to avoid needing to take medication. The nurse will recommend which changes? | Weight reduction and decreased sodium intake |
| A patient has a blood pressure of 135/85 mm Hg on three separate occasions. The nurse understands that this patient should be treated with | lifestyle changes. |
| A patient has a blood pressure of 155/95 mm Hg. The nurse understands that this patients risk of cardiovascular disease is _____ greater than normal. | four times |
| The nurse is caring for an African-American patient who has been taking a beta blocker to treat hypertension for several weeks with only slight improvement in blood pressure. The nurse will contact the provider to discuss | adding a diuretic medication. |
| The nurse understands that a medication such as carvedilol (Coreg) may not be effective in an African- American patient because of its effects on | renin release. |
| The nurse is preparing to care for a Native-American patient who has hypertension. The nurse understands that which antihypertensive medication would be most effective in this patient? | Captopril (Capoten) |
| The nurse is caring for an 80-year-old patient who has just begun taking a thiazide diuretic to treat hypertension. What is an important aspect of care for this patient? | Initiating a fall risk protocol |
| The nurse is performing an assessment on a patient who will begin taking propranolol (Inderal) to treat hypertension. The nurse learns that the patient has a history of asthma and diabetes. The nurse will take which action? | Contact the provider to discuss another type antihypertensive medication. |
| The nurse is admit a pT who has been taking minoxidil to treat HTN. Prior to this, the PT had BP of 170/95 and HR of 72. The nurse notes BP of 130/72, and HR of 78, and a 2.2-kg gain since previous hospitalization and edema of the hands/feet. Nurse will | Adding hydrochlorothiazide to help increase urine output |
| The nurse is teaching a patient who has hypertension about long-term management of the disease and a beta blocker. The patient reports typically consuming 1 to 2 glasses of wine each evening with meals. How will the nurse respond? | Wine increases the hypotensive effects of the beta blocker. |
| A patient who has recently begun taking captopril (Capoten) to treat hypertension calls a clinic to report a persistent cough. The nurse will perform which action? | Schedule an appointment with the provider to discuss changing to an angiotensin II receptor blocker (ARB). |
| The nurse is preparing to administer an (ACE) inhibitor to a patient who has hypertension. The nurse notes peripheral edema and swelling of the patients lips. The patient has a bp of 160/80 mm Hg and HR of 76 bpm. What is the nurses next action? | Hold the dose and notify the provider of a hypersensitivity reaction. |
| The nurse is caring for a patient who will begin taking captopril (Capoten) for hypertension. The nurse reviews the patients laboratory test results and notes increased BUN and creatinine. Which action will the nurse take? | Contact the provider to discuss changing to fosinopril (Monopril). |
| The nurse is caring for a patient who experiences a rapid rise in blood pressure. The nurse will contact the provider to discuss administering which medication? | Nifedipine (Procardia) |
| The nurse is caring for a 70-year-old who recently begun taking amlodipine (Norvasc) 5 mg/day to control hypertension. The nurse notes mild edema of the patients ankles, bp of 130/70 mm Hg, and HR of 80 bpm. PT reports flushing and dizziness. The nurse | ask to decrease the dose to 2.5 mg/day. |
| The nurse teaches a patient about antihypertensive medication. Which statements by the patient indicate understanding of the teaching? (Select all that apply.) | I should be careful when I stand up from a chair. I should not add extra salt to my foods. I may need to take a combination of drugs, including diuretics. |
| A patient who has atrial fibrillation is taking digoxin. The nurse expects which medication to be given concurrently to treat this condition? | Warfarin (Coumadin) |
| A patient is diagnosed with heart failure, and the prescriber has ordered digoxin. The patient asks what lifestyle changes will help in the management of this condition. The nurse will recommend which changes? | Having no more than one alcoholic beverage per day |
| A patient with chronic obstructive pulmonary disease (COPD) has increasing dyspnea and is being evaluated for heart failure (HF). Which test will be ordered to help differentiate between dyspnea due to lung dysfunction and dyspnea due to HF? | Brain natriuretic peptide (BNP) level |
| The nurse is preparing to administer digoxin to a patient who has heart failure. patient reports nausea, vomiting, and a headache. The nurse notes a respiratory rate of 18, a HR of 58 bpm, and a blood pressure of 120/78 mm Hg. What will the nurse do next? | Hold the dose and notify the provider of possible digoxin toxicity. |
| The nurse is caring for a patient who is taking digoxin to treat heart failure. The patients electrocardiogram shows a ventricular dysrhythmia. The nurse will notify the provider and will anticipate an order for which medication? | Phenytoin (Dilantin) |
| A patient who takes digoxin to treat heart failure will begin taking a vasodilator. The patient asks the nurse why this new drug has been ordered. The nurse will explain that the vasodilator is used to | decrease ventricular stretching. |
| The nurse performs a medication history and learns that the patient takes a thiazide diuretic and digoxin (Lanoxin). The nurse will question the patient to ensure that the patient is also taking which medication? | Potassium |
| The nurse administers a dose of digoxin (Lanoxin) to a patient who has heart failure and returns to the room later to reassess the patient. Which finding indicates that the medication is effective? | Decreased dyspnea |
| A patient who has heart failure receives digoxin (Lanoxin) and an (ACE) inhibitor. The patient will begin taking spironolactone (Aldactone). The patient asks why the new drug is necessary. The nurse will tell the patient that spironolactone will | provide cardioprotective effects |
| A patient who has stable angina pectoris is given nitroglycerin to use as needed. In addition to pharmacotherapy, the nurse will give the patient which instruction? | Avoid extremes in weather. |
| The nurse is teaching a patient about the use of a transdermal nitroglycerin patch. Which statement by the patient indicates understanding of the teaching? | I should rotate sites when changing the patch to prevent skin irritation. |
| The nurse is teaching a patient about sublingual nitroglycerin administration. What information will the nurse include when teaching this patient? | Take the first tablet while sitting or lying down. |
| A patient who uses transdermal nitroglycerin reports having headaches. The nurse will counsel the patient to perform which action? | Take acetaminophen as needed. |
| A patient is ordered to receive a nitrate to relieve stable angina. What side effect(s) will the nurse anticipate in a patient receiving this medication? | Pounding headache |
| A patient asks the nurse why nitroglycerin is given sublingually. The nurse will explain that nitroglycerin is administered by this route for which reason? | To increase absorption |
| A patient who has been taking nitroglycerin for angina has developed variant angina, and the provider has added verapamil (Calan) to the patients regimen. The nurse will explain that verapamil is given for which purpose? | To relax coronary arteries |
| A patient who has begun taking nifedipine (Procardia) to treat variant angina has had a recurrent blood pressure of 90/60 mm Hg or less. The nurse will anticipate that the provider will | switch to diltiazem (Cardizem). |
| The nurse is preparing to administer digoxin to a patient who has a serum digoxin level of 2.5 ng/mL. The patient takes 0.25 mg of digoxin per day. What action will the nurse take? | Notify the provider of digoxin toxicity. |
| A patient who has Wolff-Parkinson-White syndrome is given intravenous adenosine (Adenocard). The nurse will explain that the medication is effective because it | prolongs repolarization. |
| The nurse provides teaching for a patient who has a ventricular dysrhythmia who is prescribed acebutolol (Spectral) 200 mg twice daily. Which statement by the patient indicates understanding of the teaching? | I should not stop taking this drug abruptly to avoid palpitations. |
| A patient has congestive heart failure and has been taking digoxin (Lanoxin) for 9 years. The patient is admitted with signs and symptoms of digoxin toxicity. Which signs and symptoms are associated with digoxin toxicity? (Select all that apply.) | Vomiting. Yellow haloes in the visual field. Diarrhea |
| A f. patient has serum lipid levels performed, which reveal a total cholesterol of 285 mg/dL, triglycerides of 188 mg/dL, a low-density lipoprotein (LDL) of 175 mg/dL, and a (HDL) of 40 mg/dL. BP is 138/72. The nurse may expect the provider to order | Niacin and lovastatin (Advicor) |
| A patient has a serum cholesterol level of 270 mg/dL. The patient asks the nurse what this level means. Which response by the nurse is correct? | You have a high risk for coronary artery disease. |
| A patient begins taking cholestyramine (Questran) to treat hyperlipidemia. The patient reports abdominal discomfort and constipation. The nurse will provide which instruction to the patient? | Increase fluid and slowly increase fiber intake. |
| The provider changes the medication to colesevelam HCl (Welchol).The patient asks the nurse why the medication was changed, and the nurse will explain that colesevelam HCl is ordered for which reason? | It has fewer side effects. |
| A patient is admitted to the hospital, and the provider orders gemfibrozil (Lopid) 600 mg twice daily, 30 minutes prior to meals. The nurse learns that the patient takes warfarin (Coumadin) once daily. The nurse will contact the provider to discuss | ordering frequent INR levels. |
| A patient begins taking nicotinic acid (Niacin) and reports dizziness and flushing of the skin. The nurse will perform which action? | Contact the provider to discuss decreasing the dose. |
| A patient has been taking atorvastatin (Lipitor) for several months to treat hyperlipidemia. The patient reports muscle weakness and tenderness. The nurse will counsel the patient to | contact the provider to report these symptoms. |
| The nurse provides teaching to a patient who will begin taking simvastatin (Zocor) to treat hyperlipidemia. Which statement by the patient indicates understanding of the teaching? | I will need an annual eye examination while taking this medication. |
| A patient, who has intermittent claudication, has been taking 400 mg of pentoxifylline (Trental) TID with meals for 2 weeks. The patient reports mild flushing, occasional GI upset, and continued pain in both legs. How will the nurse advise the patient? | Expect side effects to diminish as drug effects increase in several weeks. |
| A patient will begin taking simvastatin (Zocor) to decrease serum cholesterol. When teaching the patient about this medication, the nurse will counsel the patient to take which action? | Take the medication in the evening for best effect. |
| A patient will begin taking rosuvastatin calcium (Crestor) to treat hyperlipidemia. The patient asks the nurse how to take the medication for best effect. Which statement by the nurse is correct? | Increase your fluid intake while taking this medication. |
| A patient with high cholesterol is ordered to take atorvastatin (Lipitor). What information will be included in the patient teaching? (Select all that apply.) | The medicine should be taken with a full glass of water. The patient should watch for body aches or gastrointestinal upset as side effects. The patient should have liver function tests frequently. |
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