Prazosin and Propranolol
A nurse is teaching a patient about how prazosin works. Which of the following statements best explains the drug’s mechanism of action?
A. “It increases heart rate to improve cardiac output.”
B. “It blocks alpha-1 receptors, causing vasodilation and lower blood pressure.”
C. “It stimulates beta receptors, causing bronchodilation.”
D. “It suppresses the immune system to reduce inflammation.”
Correct Answer: B
Rationale: Prazosin is an alpha-1 adrenergic blocker that causes vasodilation by relaxing vascular smooth muscle, which lowers blood pressure.
1. A nurse is caring for a client newly prescribed hydrochlorothiazide. Which of the following laboratory values should the nurse monitor most closely?
A. Hemoglobin
B. Sodium
C. Glucose
D. Amylase
B. Sodium Rationale: Hydrochlorothiazide can cause hyponatremia, hypokalemia, and other electrolyte imbalances.
A nurse is caring for a client who is receiving isoniazid (INH) for the treatment of tuberculosis. Which of the following adverse effects should the nurse monitor for and report immediately?
A. Constipation
B. Peripheral neuropathy
C. Increased appetite
D. Photosensitivity
Correct Answer: B
Which teaching point is most important when instructing a client about pseudoephedrine?
A. "Take it with grapefruit juice."
B. "It is safe to take with other decongestants."
C. "Avoid taking it at bedtime."
D. "Take a double dose if you miss one."
Answer: C. "Avoid taking it at bedtime."
A nurse is preparing to administer insulin lispro (Humalog) to a client with Type 1 diabetes before breakfast. Based on the characteristics of insulin lispro, the nurse should plan to administer the insulin how many minutes before the client begins eating? A. 5-10 minutes
B. 15-30 minutes
C. 30-60 minutes
D. 60-90 minutes
Rationale: Insulin lispro is a rapid-acting insulin with an onset of action of 15-30 minutes1. To match the insulin's peak effect with the absorption of glucose from a meal, it should be administered shortly before the client eats, ideally within 15 to 30 minutes
A patient taking prazosin reports feeling dizzy and lightheaded when getting out of bed in the morning. What is the most appropriate response by the nurse?
A. “This is a sign of hypertension; you may need a higher dose.”
B. “You should stop taking the medication immediately.”
C. “Take the medication with caffeine to avoid this side effect.”
D. “Change positions slowly and sit on the edge of the bed before standing.”
Correct Answer: D
Rationale: Prazosin can cause orthostatic hypotension, especially after the first dose. Changing positions slowly can help prevent falls or fainting.
A client taking hydrochlorothiazide reports muscle weakness and irregular heartbeat. Which adverse effect is most likely responsible for these symptoms?
A. Hypercalcemia
B. Hyperkalemia
C. Hypokalemia
D. Hypoglycemia
C. Hypokalemia Rationale: Thiazide diuretics can lead to potassium loss, causing muscle weakness and cardiac arrhythmias.
A nurse is providing discharge teaching to a client prescribed isoniazid (INH). Which statement by the client indicates a need for further teaching?
A. "I will avoid alcohol while taking this medication."
B. "I will take the medication on an empty stomach."
C. "I should notify my provider if I notice yellowing of my skin or eyes."
D. "I can stop the medication once I start feeling better."
Correct Answer: D
Which of the following is a common side effect of pseudoephedrine?
A. Diarrhea
B. Hypotension
C. Drowsiness
D. Jitteriness
Answer: D. Jitteriness
Rationale: Pseudoephedrine is a stimulant, so it can cause restlessness, nervousness, and jitteriness
A client received their dose of NPH insulin at 0800. The nurse should monitor the client most closely for signs and symptoms of hypoglycemia during which time frame?
A. 0830 to 0900
B. 1000 to 1200
C. 1200 to 2000
D. 2200 to 0800 the next day
Rationale: NPH insulin is an intermediate-acting insulin with a peak effect occurring 4 to 12 hours after administration
The peak action is when the insulin is working most effectively to lower blood glucose, and thus the risk of hypoglycemia is highest during this time
Administered at 0800, the peak would be expected between 1200 (0800 + 4 hours) and 2000 (0800 + 12 hours)
The nurse is educating a patient newly prescribed prazosin. Which instruction is most important to include?
A. “Take the first dose on an empty stomach in the morning.”
B. “Take the first dose at bedtime to reduce the risk of fainting.”
C. “Avoid protein-rich foods when taking this medication.”
D. “You may drink grapefruit juice with this medication.”
Correct Answer: B
Rationale: Prazosin can cause a first-dose phenomenon, which is a sudden and severe drop in blood pressure. Taking the first dose at bedtime reduces the risk of injury from fainting.
Hydrochlorothiazide is contraindicated in a client with a known allergy to which of the following?
A. Aspirin
B. Penicillin
C. Sulfonamides
D. Macrolides
C. Sulfonamides Rationale: Hydrochlorothiazide is a sulfonamide derivative and may cause a reaction in clients with a sulfa allergy.
Which laboratory test should the nurse expect to monitor regularly for a client receiving long-term isoniazid therapy?
A. Serum potassium
B. Complete blood count (CBC)
C. Liver function tests (LFTs)
D. Serum calcium
Correct Answer: C
A patient asks why pseudoephedrine is kept behind the pharmacy counter. What is the nurse's best response?
A. "It is an over-the-counter narcotic."
B. "It must be refrigerated after opening."
C. "It can be used to make illegal drugs."
D. "It is not FDA-approved for sale."
Answer: C. "It can be used to make illegal drugs."
Rationale: Pseudoephedrine can raise BP and may counteract antihypertensive drugs.
A client with Type 2 diabetes is scheduled for a CT scan with intravenous contrast dye at noon today. The client took their prescribed daily dose of metformin this morning at 0700. Based on the potential interactions of metformin, what is the priority nursing action?
A. Notify the radiology department that the client has taken metformin.
B. Proceed with the procedure as planned, monitoring for adverse effects.
C. Notify the healthcare provider to potentially reschedule the procedure or hold future metformin doses.
D. Administer a rapid-acting insulin dose before the procedure.
Rationale: Metformin is contraindicated when a client receives IV contrast dye because it increases the risk of lactic acidosis or acute renal failure. Metformin should be held 48 hours before and after receiving contrast dye. Since the client took the medication this morning before a noon procedure, the healthcare provider must be notified immediately to evaluate the situation and determine the appropriate plan of action, which will likely involve holding the medication and potentially rescheduling the procedure.
Which of the following patients would most likely benefit from prazosin therapy?
A. A patient with bradycardia
B. A patient with asthma
C. A patient with hypertension and PTSD-related nightmares
D. A patient with chronic kidney disease and edema
Correct Answer: C
Rationale: Prazosin is primarily used for hypertension and off-label for PTSD-related nightmares due to its CNS effects.
Which of the following is an expected outcome of hydrochlorothiazide therapy for a client with hypertension?
A. Decreased peripheral resistance
B. Increased serum potassium levels
C. Decreased blood volume
D. Increased cardiac output
C. Decreased blood volume Rationale: Hydrochlorothiazide promotes diuresis, leading to reduced blood volume and lower blood pressure.
A nurse is preparing to administer isoniazid to a client. Which of the following should the nurse do?
A. Mix the medication in juice to mask the taste
B. Administer with antacids to reduce gastric irritation
C. Give on an empty stomach, 1 hour before or 2 hours after meals
D. Encourage high-protein, high-fat meals for better absorption
Correct Answer: C
A client using oxymetazoline nasal spray reports that their congestion has returned worse than before. What is the nurse’s best response?
A. “Try using more sprays each time.”
B. “You’re experiencing a rebound effect.”
C. “It’s probably a sinus infection.”
D. “Switch to a different oral antihistamine.”
Answer: B. “You’re experiencing a rebound effect.”
Rationale: Oxymetazoline used longer than 3 days can cause rebound nasal congestion.
A nurse is reviewing lab results for a client presenting with symptoms that could indicate diabetes. The client's Hemoglobin A1c (HbA1c) result is 6.2%. Based on the American Diabetic Association (ADA) recommendations cited in the sources, how should the nurse interpret this result?
A. The client does not have diabetes.
B. The client has prediabetes.
C. The client has diabetes mellitus.
D. The client requires immediate insulin therapy.
Rationale: According to the sources, an HbA1c level is used for the diagnosis of diabetes as recommended by the ADA. A HbA1c level of 5% indicates no diabetes, 5.7% to 6.4% indicates prediabetes, and 6.5% or greater indicates diabetes mellitus. A result of 6.2% falls within the range for prediabetes.
Which assessment is most important for the nurse to perform before administering prazosin?
A. Lung auscultation
B. Blood pressure and heart rate
C. Blood glucose level
D. Pupil size and reactivity
Correct Answer: B
Rationale: Because prazosin can cause hypotension, especially after the first dose, it’s critical to assess blood pressure and heart rate prior to administration.
A nurse is teaching a client about taking hydrochlorothiazide. Which statement by the client indicates a need for further teaching?
A. "I will take this medication in the morning."
B. "I need to increase foods high in potassium."
C. "I should weigh myself daily."
D. "I can drink unlimited fluids since it’s a diuretic."
D. "I can drink unlimited fluids since it’s a diuretic." Rationale: Fluid intake should be managed appropriately; excessive intake may counteract the effects of diuretics or worsen fluid retention in some patients.
A nurse is educating a client who has been prescribed rifampin. Which statement by the client indicates understanding of a common side effect of the medication?
A. “I need to wear sunscreen because this drug causes photosensitivity.”
B. “I should call the doctor if my urine turns orange.”
C. “It’s normal if my tears and sweat are orange-colored.”
D. “If I get a dry cough, I should stop taking the medication immediately.”
Correct Answer: C. “It’s normal if my tears and sweat are orange-colored.”
2. Oxymetazoline is contraindicated in which patient?
A. A patient with a history of seasonal allergies
B. A patient with a nasal fracture
C. A patient with chronic hypertension
D. A patient with mild eczema
Answer: C. A patient with chronic hypertension
Rationale: Vasoconstriction from oxymetazoline can worsen hypertension.
A client prescribed empagliflozin (Jardiance), an SGLT2 inhibitor, reports painful urination and increased frequency. The nurse should assess the client further for which potential side effect?
A. Hypoglycemia
B. Volume depletion
C. Genitourinary infection
D. Exacerbation of peripheral vascular disease
Rationale: Empagliflozin is an SGLT2 inhibitor. The sources list genitourinary infections as a side/adverse effect of SGLT2 inhibitors. Painful urination and increased frequency are classic symptoms of a genitourinary infection. Volume depletion is also listed as a side effect, and frequent urination is a symptom, but painful urination strongly suggests an infection.
A nurse is reviewing the action of propranolol with a nursing student. Which statement by the student indicates correct understanding of the drug’s action?
A. “Propranolol blocks alpha-adrenergic receptors to reduce blood pressure.”
B. “Propranolol stimulates beta-1 receptors to increase cardiac output.”
C. “Propranolol blocks beta-adrenergic receptors to decrease heart rate and blood pressure.”
D. “Propranolol increases renin secretion to control hypertension.”
Correct Answer: C
Rationale: Propranolol is a non-selective beta blocker that blocks both beta-1 and beta-2 receptors, leading to decreased heart rate, myocardial contractility, and blood pressure.
What is the primary action of hydrochlorothiazide in the treatment of hypertension?
A. Inhibits angiotensin II receptors
B. Promotes sodium and water excretion
C. Blocks calcium channels in vascular smooth muscle
D. Reduces sympathetic nervous system activity
B. Promotes sodium and water excretion Rationale: Thiazide diuretics act on the distal tubules to promote excretion of sodium and water, reducing blood pressure.
Rifampin is known to interact with several medications. Which of the following should the nurse monitor closely when given concurrently with rifampin?
A. Acetaminophen
B. Warfarin
C. Furosemide
D. Metformin
Correct Answer: B. Warfarin
A nurse is teaching a patient prescribed diphenhydramine for seasonal allergies. Which statement by the patient indicates a need for further teaching?
A. "I will avoid drinking alcohol while taking this medication."
B. "I may feel sleepy after taking this drug."
C. "I should take this medication before operating heavy machinery."
D. "Dry mouth is a possible side effect."
Correct Answer: C
Rationale: Diphenhydramine causes sedation; it is unsafe to operate heavy machinery.
The nurse is teaching a client about newly prescribed liraglutide (Victoza), a GLP-1 agonist administered daily. Which common side effect should the nurse include in the teaching?
A. Weight gain
B. Increased appetite
C. Constipation
D. Injection site itching
Rationale: Liraglutide is a GLP-1 agonist administered daily. Common side effects of GLP-1 agonists listed in the sources include nausea, vomiting, diarrhea, and constipation. While injection site itching is also listed, constipation is a very common class effect associated with altered GI motility. GLP-1 agonists suppress appetite and can lead to weight loss, not gain or increased appetite.
A client is prescribed propranolol. For which of the following conditions is this medication most commonly prescribed?
A. Asthma
B. Bradycardia
C. Hypertension
D. Hypotension
Correct Answer: C
Rationale: Propranolol is commonly prescribed for hypertension, angina, arrhythmias, and migraine prophylaxis. It is contraindicated in bradycardia and asthma.
A client taking hydrochlorothiazide is scheduled for a follow-up visit. Which symptom should the nurse report to the healthcare provider immediately?
A. Increased urination
B. Lightheadedness when standing
C. Dry mouth
D. Fatigue in the afternoon
B. Lightheadedness when standing Rationale: This may indicate orthostatic hypotension, a potentially serious side effect of diuretic therapy.
A nurse is providing teaching for a client who is starting rifampin. Which of the following should be included in the teaching?
A. “You should avoid dairy products while taking this medication.”
B. “Take this medication with food to improve absorption.”
C. “Use a non-hormonal form of birth control while taking this medication.”
D. “This drug must be taken only once a week.”
Correct Answer: C. “Use a non-hormonal form of birth control while taking this medication.”
A nurse is caring for an older adult taking diphenhydramine for insomnia. Which of the following side effects should the nurse monitor most closely?
A. Nausea
B. Insomnia
C. Confusion
D. Itching
Correct Answer: C
Rationale: Older adults are at higher risk for anticholinergic-induced confusion and delirium.
The nurse is providing instruction to a client with diabetes on storing unopened vials of insulin. Which instruction is correct according to the sources?
A. Store unopened insulin at room temperature.
B. Store unopened insulin in the refrigerator.
C. Store unopened insulin in direct sunlight.
D. Store unopened insulin in a warm place.
Rationale: The sources state, "Keep unopened insulin in refrigerator". Opened insulin may be stored at room temperature or in the refrigerator for a limited time, but unopened vials require refrigeration. Insulin should also avoid direct sunlight or high temperatures.
Which of the following is the most important adverse effect to monitor in a patient taking propranolol?
A. Tachycardia
B. Hyperglycemia
C. Bronchospasm
D. Constipation
Correct Answer: C
Rationale: Because propranolol blocks beta-2 receptors in the lungs, it can cause bronchospasm, especially in patients with asthma or other respiratory conditions.
The nurse should instruct a client taking hydrochlorothiazide to monitor for which common side effect?
A. Constipation
B. Bradycardia
C. Photosensitivity
D. Tinnitus
C. Photosensitivity Rationale: Hydrochlorothiazide can increase sensitivity to sunlight, leading to a higher risk of sunburn.
A client taking isoniazid and rifampin for tuberculosis reports fatigue, dark-colored urine, and yellowing of the skin. What is the nurse's priority action?
A. Document the findings as expected side effects
B. Instruct the client to increase fluid intake
C. Hold the medication and notify the provider
D. Schedule the next dose earlier in the day
Correct Answer: C. Hold the medication and notify the provider
Which condition is a contraindication for diphenhydramine use?
A. Seasonal allergies
B. Narrow-angle glaucoma
C. Pruritus
D. Urticaria
Correct Answer: B
Rationale: Diphenhydramine has anticholinergic effects that may increase intraocular pressure in glaucoma
A client is admitted with symptoms including extreme thirst, polyuria, and a fruity breath odor. A blood glucose check shows a level of 310 mg/dL. The nurse recognizes these findings are consistent with which condition?
A. Hypoglycemic reaction
B. Diabetic ketoacidosis (DKA)
C. Insulin shock
D. Anaphylaxis
Rationale: The course slides contrast the symptoms of Diabetic Ketoacidosis (DKA), also known as a hyperglycemic reaction, and Insulin Shock, or a hypoglycemic reaction. Extreme thirst, polyuria, fruity breath odor, and a blood glucose level greater than 250 mg/dL are listed as symptoms of Diabetic Ketoacidosis. Hypoglycemic symptoms include headache, sweating, confusion, and blood glucose less than 60 mg/dL. Anaphylaxis is an allergic reaction and is not suggested by these symptoms.
The nurse is reviewing a patient’s medical history before administering propranolol. Which condition is a contraindication for this medication?
A. Hypertension
B. Migraine headaches
C. Asthma
D. Atrial fibrillation
Correct Answer: C
Rationale: Propranolol is contraindicated in asthma due to its bronchoconstrictive effects via beta-2 receptor blockade.
A client with type 2 diabetes is prescribed hydrochlorothiazide. What is a priority nursing action?
A. Monitor for signs of hypoglycemia
B. Encourage salt substitutes containing potassium
C. Monitor blood glucose levels closely
D. Administer before bedtime
C. Monitor blood glucose levels closely Rationale: Thiazide diuretics can increase blood glucose levels, so diabetic clients require close monitoring.
A nurse is instructing a client about taking rifampin for tuberculosis. Which instruction is appropriate?
A. “Take rifampin with antacids to prevent stomach upset.”
B. “Avoid taking this medication with food for best absorption.”
C. “Crush the tablet and mix it in applesauce if swallowing is difficult.”
D. “Take the medication only when symptoms are present.”
Correct Answer: B. “Avoid taking this medication with food for best absorption.”
The nurse administers diphenhydramine to a child with a severe allergic reaction. Which of the following is the priority assessment?
A. Nausea
B. Respiratory status
C. Temperature
D. Sleep pattern
Correct Answer: B
Rationale: In allergic reactions, airway and breathing are the priority.
A client has an order for sliding-scale insulin coverage based on point-of-care blood glucose readings. Based on the sources, which type of insulin is typically used for a sliding scale?
A. Long-acting insulin
B. Intermediate-acting insulin
C. Rapid-acting or short-acting insulin
D. Combination insulin
Rationale: Sliding-scale insulin regimens are typically administered before meals and at bedtime based on current blood glucose levels. Sliding-scale insulin usually uses rapid or short-acting insulin. An example is insulin lispro, which is a rapid-acting insulin.
A nurse is preparing to administer propranolol to a patient. Which vital sign should be assessed prior to administration?
A. Oxygen saturation
B. Respiratory rate
C. Heart rate and blood pressure
D. Temperature
Correct Answer: C
Rationale: Beta blockers can cause bradycardia and hypotension. Always check HR and BP before administration; withhold if HR is below 60 bpm or BP is too low, and notify the provider.
The nurse is reviewing the medication list for a client who is prescribed hydrochlorothiazide. Which medication, if also prescribed, should raise concern?
A. Potassium chloride
B. Lisinopril
C. Digoxin
D. Acetaminophen
C. Digoxin Rationale: Hypokalemia from hydrochlorothiazide increases the risk of digoxin toxicity.
A client with nasal congestion is prescribed pseudoephedrine. Which of the following conditions would require the nurse to question this order?
A. Allergic rhinitis
B. Type 2 diabetes
C. Nasal polyps
D. Viral pharyngitis
Answer: B. Type 2 diabetes
Rationale: Pseudoephedrine can raise blood sugar and blood pressure, so it's used cautiously in diabetics
Which patient should the nurse monitor most closely when prescribed loratadine?
A. A 40-year-old with allergic rhinitis
B. A 30-year-old with seasonal allergies
C. A 60-year-old with renal impairment
D. A teenager with eczema
Rationale: Loratadine is excreted renally, and caution is needed in renal impairment.
A client with Type 2 diabetes is taking glipizide (a sulfonylurea) daily. The nurse notes in the client's medication history that they also take a beta blocker for hypertension. Based on the potential drug interactions, the nurse should monitor the client for an increased risk of which complication?
A. Hyperglycemia
B. Hypoglycemia
C. Lactic acidosis
D. Thyroid tumor
Rationale: Glipizide is a sulfonylurea which works by stimulating pancreatic beta cells to secrete more insulin, thus decreasing blood glucose. The course slides list beta blockers as an interaction with sulfonylureas like glipizide. Beta blockers can enhance the hypoglycemic effect of antidiabetic agents or mask the symptoms of hypoglycemia, particularly adrenergic signs like tachycardia. Therefore, the combination increases the risk of hypoglycemia. Lactic acidosis is associated with metformin3, and thyroid tumors with some GLP-1 agonists.