BP Meds
Some patients who take ACE Inhibitors may develop angioedema. What signs and symptoms will you teach the patient to recognize that can present with this adverse reaction? Select all that apply:
A) Hyperkalemia
B) Persistent, dry cough
C) Swelling in the face
D) Thin and shiny skin in the lower extremities
E) Difficulty breathing
C and E
Angioedema is swelling deep in the skin (dermis and subcutaneous tissue)…..it’s very dangerous! Signs and symptoms include: swelling in face (mouth, eyes, tongue, lips, dyspnea, swelling of extremities). It most commonly occurs in African American patients.
A nurse is providing teaching to a client who is starting simvastatin. Which of the following information should the nurse include in the teaching?
A) Take this medication in the evening
B) Change positions slowly when rising from a chair
C) Maintain a steady intake of green leafy vegetables
D) Consume no more than 1 L/day of fluid
A) Take this medication in the evening
A nurse is providing information to a patient who has a new prescription for hydrochlorothiazide. Which of the following information should the nurse include?
A) Take the medication with food
B) Plan to take the medication at bedtime
C) Expect increased swelling of the ankles
D) Fluid intake should be limited in the morning
A) Take the medication with food
To prevent GI upset
A nurse is caring for a patient who is receiving IV heparin for a DVT. The patient begins vomiting blood. After the heparin has been stopped, which of the following medications should the nurse prepare to administer?
A) Vitamin K
B) Atropine
C) Protamine
D) Calcium gluconate
C) Protamine
A nurse is admitting a toddler to the hospital after an acetaminophen overdose. Which of the following medications should the nurse anticipate administering to this patient?
A) Acetylcysteine
B) Pegfilgrastim
C) Misoprostol
D) Naltrexone
A) Acetylcysteine
A nurse is caring for a patient who has a new prescription for capopril for hypertension. The nurse should monitor the client for which of the following adverse effects of this medication?
A) Hypokalemia
B) Hypernatremia
C) Neutropenia
D) Bradycardia
C) Neutropenia
Neutropenia is a serious adverse effect that can occur with ACE inhibitors. Monitor CBC and teach patient to report indications of infection to PCP.
Which discharge instruction should the nurse include for a patient prescribed an antilipemic medication?
A) "Stop taking the medication if it causes nausea and vomiting."
B) "Continue your exercise program and maintain a low-fat diet."
C) "It is important to take a double dose to make up for a missed dose."
D) "Lifestyle changes are no longer necessary when taking this medication."
B) "Continue your exercise program and maintain a low-fat diet."
A nurse is planning care for a patient who is receiving furosemide IV for peripheral edema. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)
A) Assess for tinnitus
B) Report urine output of 50 mL/hr
C) Monitor serum K+ levels
D) Elevate the HOB slowly before ambulation
E) Recommend eating a banana daily
A) Assess for tinnitus
C) Monitor serum K+ levels
D) Elevate HOB slowly before ambulation
E)Recommend eating a banana daily
A nurse is monitoring a patient who takes aspirin 81 mg PO daily. The nurse should identify which of the following manifestations as adverse effects of daily aspirin therapy? (Select all that apply.)
A) Hypertension
B) Coffee-ground emesis
C) Tinnitus
D) Paresthesias of the extremities
E) Nausea
B) Coffee-ground emesis
C) Tinnitus
E) Nausea
A nurse is taking a history for a patient who reports that he is taking aspirin about four times daily for a sprained wrist. Which of the following prescribed medication taken by the patient is contraindicated with aspirin?
A)Digoxin
B) Metformin
C) Warfarin
D) Nitroglycerin
C) Warfarin
Increased risk for bleeding
You’re providing discharge instructions to a patient that will be taking an ACE Inhibitor at home. Which statements by the patient demonstrate they understood your discharge instructions? (Select all that apply.)
A) “If I feel unwell, it is okay that I miss a dose.”
B) “I will avoid using salt substitutes that contain potassium.”
C) “I will make sure I incorporate a high amount of potatoes, bananas, oranges, and tomatoes into my diet while taking this medication”.
D) “I will regularly check my blood pressure and pulse rate while taking this medication and report any significant changes to my doctor.”
B and D
It is very important a patient does not miss a dose of this medication (even if they are unwell) because this medication can cause rebound hypertension. Also, the patient should avoid salt substitutes with potassium and AVOID consuming foods high in potassium (like the foods in option C) because this medication causes the kidneys to retain potassium. The patient should monitor their blood pressure and pulse rate regularly and report any significant changes to their doctor.
The nurse is providing discharge teaching for a patient about potential serious adverse effects to simvastatin (Zocor). Which symptom may indicate the patient is experiencing a serious adverse effect to this medication?
A) Itching
B) Headache
C) Muscle pain
D) Weight loss
C) Muscle pain
Unexplained muscle pain and soreness are symptoms of a relatively uncommon but serious adverse effect of rhabdomyolysis associated with statin drugs and must be immediately reported to the health care provider.
A nurse is monitoring a patient who is receiving spironolactone. Which of the following findings should the nurse report for the provider?
A) Serum sodium 144 mEq/L
B) Urine output 120 mL in 4 hr
C) Serum potassium 5.2 mEq/L
D) BP 140/90 mm Hg
C) Serum potassium 5.2 mEq/L
You’re educating a patient’s family member about Warfarin and how it is used to treat blood clots. Which statements by the family member require you to re-educate them about how this medication works? Select all that apply:
A) “This medication will help dissolve the blood clot.”
B) “This medication will prevent another blood clot from forming.”
C) “This medication will help prevent the blood clot from becoming bigger in size.”
D) “This medication starts working immediately after the first dose.”
A and D
Warfarin does NOT dissolve blood clots. It prevents blood clots from forming, and if one is present, it will help prevent it from becoming bigger. If the blood clot becomes bigger it may break off and travel in blood circulation. This can lead to a pulmonary embolism, heart attack, or stroke.
Warfarin does NOT start working immediately. It takes about 3-5 days of scheduled doses to start achieving a therapeutic INR level. It is very common that a patient will be on Heparin while taking Warfarin until INR levels are therapeutic.
When caring for a patient who is receiving epidural morphine, which information obtained by the nurse indicates that the patient may be experiencing a side effect of the medication?
A) The patient has cramping abdominal pain.
B) The patient becomes restless and agitated.
C) The patient has not voided for over 10 hours.
D) The patient complains of a "pounding" headache.
C) The patient has not voided for over 10 hours.
Urinary retention is a common side effect of epidural opioids. Headache is not an anticipated side effect of morphine, although if there is a cerebrospinal fluid leak, the patient may develop a "spinal" headache. Sedation (rather than restlessness or agitation) would be a possible side effect. Hypotonic bowel sounds and constipation (rather than abdominal cramping) are concerns.
A patient with diabetes and hypertension is being discharged home. The patient will be taking Sotalol and insulin per sliding scale. Which statement by the patient demonstrates they did NOT understand your discharge instructions about the side effects of Sotalol?
A) “This medication can affect my blood glucose levels.”
B) “I will monitor my heart rate and blood pressure everyday while taking this medication.”
C) “While taking this medication I will monitor for a fast heart rate because this is an early indication that my blood glucose level is low.”
D) “I will report to my physician if I develop shortness of breath, weight gain, or swelling in my feet.”
C
Beta blockers can prevent tachycardia (increased heart rate). An increased heart rate is a sign for most diabetics that they are experiencing a low blood glucose level. Therefore, the patient who is taking beta blocker (especially a nonselective type) needs to be re-educated that a fast heart rate is NOT a reliable way of determining hypoglycemia and should check their blood glucose regularly.
To assess for a potentially serious adverse effect to HMG-CoA reductase inhibitors, the nurse should monitor which laboratory results?
A) PT/INR
B) CBC
C) AST
D) Hemoglobin A1C
C) AST
HMG-CoA reductase inhibitors can cause hepatic toxicity; thus, liver function tests are often measured every 6 to 8 weeks for the first 6 months of statin therapy and then every 3 to 6 months, depending on the prescriber and the patient situation.
The nurse is providing education to a patient prescribed spironolactone and furosemide. What information does the nurse explain to the patient?
A) Using two drugs increases blood osmolality and the glomerular filtration rate.
B) This combination promotes diuresis but decreases the risk of low levels of potassium.
C) The lowest dose of two different types of diuretics are more effective than a large dose of one type.
D) This combination maintains water balance to protect against dehydration and electrolyte imbalance.
B) This combination promotes diuresis but decreases the risk of low levels of potassium.
Which patients below are NOT candidates for Warfarin? (Select all that apply.)
A) A 45-year-old male patient with alcoholism and an active GI ulcer.
B) A 55-year-old female with a heart valve replacement.
C) A 36-year-old female with a deep vein thrombosis.
D) A 52-year-old male who needs a liver transplant.
A and D
Option A is NOT a candidate because active ulcer disease places the patient at risk for bleeding while taking Warfarin. In addition, patients should NOT drink alcohol while taking Warfarin because it majorly affects how the drug works.
Option D is NOT a candidate because of the liver disease. Warfarin affects the liver’s clotting factors. Option B and D would benefit because both are at risk for a blood clots (especially option B). While Option C already has a blood clot, Warfarin would help prevent it from becoming larger and new clots from forming.
The nurse assesses a postoperative patient who is receiving morphine through patient-controlled analgesia (PCA). Which information is most important to report to the health care provider?
A) The patient complains of nausea after eating.
B) The patient's respiratory rate is 10 breaths/minute.
C) The patient has not had a bowel movement for 3 days.
D) The patient has a distended bladder and has not voided.
B) The patient's respiratory rate is 10 breaths/minute.
The patient's respiratory rate indicates a need to decrease the PCA dose or change the medication in order to avoid further respiratory depression. The other information also may require intervention, but is not as urgent to report as the respiratory rate.
A patient is admitted with a dysrhythmia. The physician prescribes Propranolol. Which statement by the patient requires the nurse to hold the ordered dose and notify the physician for further orders?
A) “I use an inhaler at home for asthma.”
B) “My heart feels like it is racing, and I feel very weak.”
C) “I had caffeine this morning with breakfast.”
D) “I smoke 2 packs of cigarettes per day.”
A
Propranolol is a nonselective beta blocker. Therefore, it affects beta 1 and beta 2 receptors. Beta 2 receptors are found in the lungs (specifically the bronchioles). This medication could cause bronchoconstriction in patients with asthma or COPD and should be avoided. Selective beta blockers (Atenolol, Esmolol, Metorprolol) block only beta 1 (which are found in the heart and kidneys). Therefore, they are less likely to cause bronchoconstriction.
Statins should not be taken with which liquid?
A) Carbonated beverages
B) Milk
C) Grapefruit juice
D) Orange juice
C) Grapefruit juice
Grapefruit juice can increase the levels of statins
When teaching a patient about symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which symptom occurs?
A) Diaphoresis
B) Constipation
C) Blurred vision
D) Muscle weakness
D) Muscle weakness
Other symptoms include: Paresthesia, anxiety, lethargy, confusion, SOB, diminished breath sounds, thready/weak/irregular pulses, N/V/D/C, deep tendon hyporeflexia
Your patient was started on Warfarin (Coumadin) a week ago for the treatment of a DVT. Which findings below would indicate an adverse reaction to this medication? (Select all that apply.)
A) Patient reports a severe and sudden headache
B) Melena
C) Chvostek’s Sign
D) Hematuria
E) Coffee ground emesis
F) Bleeding gums
A, B, D, E, and F
Sudden/severe headache (represents intracranial bleed), melena (dark, tarry stools…represent blood), hematuria (urine reddish or pink), coffee ground emesis (bleeding in the stomach), or bleeding gums….along with tachycardia, hypotension, nosebleeds, or bruising for no reason. Chvostek’s Sign is associated with a low calcium level (hypocalcemia).
A patient is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal?
A) Fever
B) Nausea
C) Diaphoresis
D) Abdominal cramps
C
Diaphoresis is one of the early signs that occur between 6 and 12 hours. Fever, nausea, and abdominal cramps are late signs that occur between 48 and 72 hours.