Diuretics
Furosemide is an example of what type of diuretic?
a. Potassium-Sparing Diuretic
b. Thiazide Diuretic
c. Loop Diuretic
d. Sodium-Sparing diuretic
c. Loop Diuretic
Captopril is what type of medication?
a. Beta-1 Antagonist
b. Alpha-2 Agonist
c. ACE Inhibitor
d. Vasodilator
c. ACE Inhibitor
Atorvastatin is what type of Antilipemic medication?
a. Cholesterol Absorption Inhibitor
b. HMG-CoA Reductase Inhibitors
c. Bile Acid Sequestrants
d. LMW Heparin
b. HMG-CoA Reductase Inhibitors
Enoxaparin is what type of medication?
a. LMW Heparin
b. Heparin Sodium
c. Warfarin
d. HMW Heparin
a. LMW Heparin
Alteplase is what type of medication?
a. Acetylsalicylic acid
b. Sildenafil
c. Antiplatelets
d. Thrombolytics
d. Thrombolytics
The nurse is reviewing a new client's medication administration record (MAR). The nurse knows that which of the following medications is most likely to cause hypokalemia?
a. Furosemide
b. Spironolactone
c. triamcinolone
d. amlodipine
a. Furosemide (loop diuretic – which excretes potassium, sodium, and water)
A nurse is preparing to administer a medication to a patient who is receiving a beta-blocker. The nurse assesses the patient’s apical pulse and finds it to be 58 beats per minute. What should the nurse do next?
a) Administer the medication as prescribed.
b) Withhold the medication and notify the healthcare provider.
c) Decrease the dose of the medication and administer it.
d) Recheck the pulse in 30 minutes and then administer the medication.
Correct Answer: b) Withhold the medication and notify the healthcare provider.
Rationale:
The nurse is caring for a client with hyperlipidemia who is prescribed atorvastatin. Which client statement indicates that additional medication teaching is needed?
a. I will take my medication every day with grapefruit juice
b. Eating an oat bran muffin for breakfast will be helpful
c. I scheduled an appointment to have my liver function tested
d. I will start to exercise more regularly by taking walks
a. I will take my medication every day with grapefruit juice
Rationale:
Grapefruit juice can interfere with the metabolism of atorvastatin (and other statins) by inhibiting the enzyme CYP3A4in the liver, which can increase the concentration of the medication in the blood and raise the risk of muscle damage and liver toxicity.
A client is prescribed heparin therapy for treatment of a deep vein thrombosis (DVT). Which laboratory value should the nurse assess prior to administration?
a. Partial thromboplastin time (PTT)
b. White blood cells (WBCs)
c. Red blood cells (RBCs)
d. International normalized ratio (INR)
a. Partial thromboplastin time (PTT)
Rationale:
IV heparin therapy requires close monitoring of frequent partial thromboplastin time (PTT) results to ensure dosage is in therapeutic range and to reduce the risk of overdose with associated bleeding.
The nurse reviews the medication administration record (MAR) for a client reporting angina who is prescribed nitroglycerin. The nurse knows that this medication is contraindicated in which of the following clients?
a. The client with a history of acute renal failure
b. The client taking sildenafil or similar medications for erectile dysfunction in the previous 24 hours
c. The client on diuretic therapy
d. The client with a current diagnosis of heart failure
b. The client taking sildenafil or similar medications for erectile dysfunction in the previous 24 hours.
Rationale:
Sildenafil is a vasodilator and it relaxes smooth muscle. Taking it with nitroglycerin which is also a vasodilator will result to severe hypotension.
A nurse is providing teaching to a patient who has been prescribed hydrochlorothiazide for the management of hypertension. Which of the following instructions is most important for the nurse to include in the teaching?
a. "Take your medication on an empty stomach to increase absorption."
b. "Monitor your blood pressure regularly and notify your healthcare provider if there are significant changes in your weight."
c. "You should avoid drinking fluids while taking this medication to prevent dehydration."
d. "It is safe to take this medication at any time of the day, so long as you remember to take it."
b. "Monitor your blood pressure regularly and notify your healthcare provider if there are significant changes in your weight."
Rationale:
Monitoring blood pressure and notifying the healthcare provider about significant weight changes are essential for patients on hydrochlorothiazide. Weight changes can indicate fluid retention or loss, which could be important for adjusting treatment. Blood pressure monitoring is crucial for evaluating the effectiveness of the medication in managing hypertension.
Which medication blocks angiotensin II in the RAAS to produce vasodilation?
a. Lisinopril
b. Metropolol
c. Losartan
d. Hydralazine
c. Losartan
Rationale:
Losartan is an angiotensin II receptor blocker; therefore, it blocks angiotensin II in the renin-angiotensin-aldosterone system to produce vasodilation.
A nurse is providing education to a patient prescribed cholestyramine for the management of hyperlipidemia. Which of the following statements best explains the indication for use of this medication?
a) Cholestyramine inhibits the synthesis of triglycerides, leading to decreased cholesterol and triglyceride levels.
b) Cholestyramine binds to bile acids in the intestines, preventing their reabsorption and promoting their excretion, which helps reduce cholesterol levels.
c) Cholestyramine increases the production of bile acids from cholesterol, leading to lower cholesterol levels.
d) Cholestyramine prevents the absorption of dietary cholesterol, leading to a significant reduction in blood cholesterol levels.
b) Cholestyramine binds to bile acids in the intestines, preventing their reabsorption and promoting their excretion, which helps reduce cholesterol levels.
Rationale:
b) Correct. Cholestyramine, a bile acid sequestrant, works by binding to bile acids in the intestines, preventing their reabsorption and promoting their excretion. This process reduces the amount of bile acids available to the liver for cholesterol synthesis, thereby lowering cholesterol levels.
The nurse is caring for a patient on heparin therapy. What would be the PRIORITY nursing assessment in the care of this patient?
a. Assess lung sounds
b. Monitor weight daily
c. Assess for bruising
d. Monitor electrolytes
c. Assess for bruising
Rationale: Heparin is an anticoagulant, and one of the main risks associated with this therapy is bleeding. Bruising is a sign of bleeding, and since heparin increases the risk of bleeding, it is crucial for the nurse to assess the patient for signs of bruising or any other signs of hemorrhage. This makes it the priority assessment in a patient on heparin therapy.
The nurse is educating a client who has been prescribed aspirin for secondary prevention of myocardial infarction (MI). Which of the following statements by the client indicates the need for further teaching about the action of this medication?
a) "Aspirin works by making my blood platelets less sticky and prevents clots from forming."
b) "I will need to stop taking aspirin for a few days before any surgery or dental procedures to reduce my risk of bleeding."
c) "Aspirin will help reduce the risk of another MI by blocking the pain caused by chest discomfort."
d) "The effect of aspirin lasts the entire lifespan of my platelets, about 7-10 days."
c) "Aspirin will help reduce the risk of another MI by blocking the pain caused by chest discomfort."
Rationale: Aspirin prevents the activation and aggregation of platelets, which helps reduce the risk of blood clots leading to an MI or stroke. However, it does not block the pain associated with chest discomfort. The correct mechanism of action is related to platelet inhibition, not pain relief.
A 58-year-old male with heart failure is prescribed spironolactone to help manage his condition. During a follow-up visit, the nurse observes that the patient’s potassium level is 5.2 mEq/L. The patient reports feeling lightheaded and has a history of poor adherence to his diet.
Which of the following actions should the nurse take first?
a) Instruct the patient to decrease his intake of potassium-rich foods.
b) Educate the patient on the importance of avoiding foods that are high in potassium.
c) Assess the patient for signs of hyperkalemia, such as muscle weakness or irregular heartbeats.
d) Administer the spironolactone dose as scheduled, since the patient’s potassium is only slightly elevated.
c) Assess the patient for signs of hyperkalemia, such as muscle weakness or palpitations, and notify the healthcare provider if necessary.
Rationale:
While the patient's potassium level is only slightly elevated, spironolactone is a potassium-sparing diuretic, which can increase the risk of hyperkalemia. While it is important to educate patients to decrease their potassium intake, it is not the priority action. The nurse should first assess for signs of hyperkalemia, such as muscle weakness, palpitations, or arrhythmias, and then notify the healthcare provider as appropriate to adjust her regimen.
The nurse is conducting triage over the phone for a client who reports a persistent, severe, dry cough. Which class of medication does the nurse know can cause this adverse effect?
a. Angiotensin-converting enzyme (ACE) inhibitor
b. Diuretic
c. Calcium channel blocker (CCB)
d. Beta-Blocker
a. Angiotensin-converting enzyme (ACE) inhibitor
A nurse is educating a patient who has been prescribed ezetimibe for hyperlipidemia. Which of the following statements by the nurse correctly explains the mechanism of action of this medication?
a) Ezetimibe works by increasing the production of cholesterol in the liver, leading to a decrease in LDL levels.
b) Ezetimibe blocks the absorption of cholesterol in the small intestines, leading to reduced LDL levels.
c) Ezetimibe inhibits the synthesis of bile acids, thereby decreasing cholesterol levels in the blood.
d) Ezetimibe promotes the excretion of cholesterol through the kidneys, resulting in a decrease in cholesterol levels.
b) Ezetimibe blocks the absorption of cholesterol in the small intestines, leading to reduced LDL levels.
Rationale:
Ezetimibe is a cholesterol absorption inhibitor.
True or False: The antidote for a client receiving warfarin is protamine sulfate.
False. Vitamin K is the antidote for protamine sulfate.
A nurse is reviewing health teaching with a client prescribed both aspirin and clopidogrel for secondary prevention of stroke. Which of the following health promotion measures should the nurse emphasize to reduce the risk of adverse effects?
a) "Avoid consuming grapefruit juice while on both medications."
b) "You should take the medications at the same time each day to ensure maximum effectiveness."
c) "Limit alcohol intake and monitor for signs of unusual bruising or bleeding, such as blood in your stool."
d) "Since aspirin can cause gastrointestinal irritation, you should take it on an empty stomach for better absorption."
c) "Limit alcohol intake and monitor for signs of unusual bruising or bleeding, such as blood in your stool."
Rationale:
Both aspirin and clopidogrel increase the risk of bleeding, so it is essential to monitor for signs of bleeding (e.g., unusual bruising, blood in stool). Limiting alcohol intake is important because it can further irritate the gastrointestinal tract, increasing the risk of bleeding.
A nurse is reviewing the medication list of a patient prescribed mannitol (osmotic diuretic). Which of the following are potential side effects of mannitol that the nurse should educate the patient about? (Select all that apply.)
a) Dehydration
b) Electrolyte balance
c) Increased appetite
d) Kidney dysfunction
e) Headaches
f) Increased blood pressure
g) Nausea and vomiting
a, d, e, & g.
What should the nurse place as a priority when caring for a client who is being treated for hypertension with a vasodilator?
a. Instructing the client to report any headaches
b. Instructing the patient to rise slowly
c. Monitoring the client for tachycardia
d. Monitoring the client for an increase in urinary frequency
b. Instructing the patient to rise slowly
Rationale:
Vasodilators work by relaxing and dilating blood vessels, which can lead to hypotension (low blood pressure), particularly when moving from a sitting or lying position to standing. This may cause dizziness or lightheadedness, a condition known as orthostatic hypotension. Rising slowly helps prevent this from happening and reduces the risk of falls.
A nurse is educating a patient who has been prescribed niacin for hyperlipidemia. Which of the following client teaching points is most important for the nurse to emphasize?
a) Take niacin on an empty stomach for maximum effectiveness.
b) Avoid hot beverages or alcohol, as these can worsen flushing.
c) Niacin should be taken with vitamin C to reduce side effects.
d) Monitor blood pressure regularly, as niacin may cause hypotension.
b) Avoid hot beverages or alcohol, as these can worsen flushing.
Rationale:
Niacin causes an adverse effect such as flushing. Hot beverages or alcohol can exacerbate this effect, so clients should avoid them to minimize the flushing symptoms.
A client is prescribed low molecular weight heparin (LMW heparin) for the prevention of deep vein thrombosis (DVT). The nurse provides education regarding the medication. Which statement by the client indicates the need for further clarification?
a. "I will avoid activities that may cause injury, as I am at an increased risk for bleeding while on this medication."
b. "I should avoid consuming alcohol, as it may increase my risk for bleeding while on this medication."
c. "It’s important to monitor my blood pressure regularly to ensure it remains normal while on this medication."
d. "I will notify my healthcare provider immediately if I notice any unexplained bruising, bleeding, or swelling."
c. "It’s important to monitor my blood pressure regularly to ensure it remains normal while on this medication."
Rationale:
Monitoring blood pressure is important in general, but it is not a primary concern specific to low molecular weight heparin (LMW heparin) therapy. The primary concern with LMW heparin is bleeding risks, and the focus should be on signs and symptoms of bleeding or bruising rather than blood pressure. This statement indicates that the client may not be fully understanding the key risks of the medication.
The nurse is preparing to administer alteplase (tPA) to a client with an acute ischemic stroke. Which of the following actions is the priority before administering the medication?
a) Assess the client's blood pressure to ensure it is within normal limits.
b) Perform a neurological assessment to evaluate the client’s stroke symptoms.
c) Obtain a CT scan of the head to rule out hemorrhagic stroke or brain tumors.
d) Verify the client's weight to determine the correct dose of alteplase.
c) Obtain a CT scan of the head to rule out hemorrhagic stroke or brain tumors.
Rationale:
A CT scan of the head is crucial before administering alteplase to rule out hemorrhagic stroke or other contraindications such as brain tumors. Alteplase can cause life-threatening bleeding, and these conditions increase the risk of complications from thrombolytic therapy.
A nurse is caring for a patient who has been prescribed spironolactone to manage heart failure. The nurse is teaching the patient about the use of this medication. Which of the following statements by the patient indicates an accurate understanding of the indication for spironolactone?
a) “This medication will help treat my heart failure by helping my body retain more potassium.”
b) “I will take this medication to help lower my blood pressure and manage my fluid retention.”
c) “This medication is given to treat high blood sugar levels related to diabetes.”
d) “Spironolactone will prevent my kidney function from worsening and control the swelling in my legs."
Correct Answer: b) “I will take this medication to help lower my blood pressure and manage my fluid retention.”
A nurse is reviewing the medical record of a client who asks about using propanolol to treat hypertension. The nurse should recognize which of the following conditions is a contraindication for taking metoprolol?
a. Asthma
b. Glaucoma
c. Hypertension
d. Tachycardia
a. Asthma
Rationale:
Metoprolol, especially in higher doses, can also block Beta-2 receptors in the lungs, causing bronchoconstriction, so it is contraindicated in clients who have asthma.
A nurse is reviewing the discharge instructions with a patient who has been prescribed atorvastatin for hyperlipidemia. Which of the following statements by the patient would require further clarification?
Select all that apply:
a) I can consume grapefruit juice as long as I take it in moderation.
b) It’s okay if I notice some tea-colored urine; it will pass on its own.
c) Atorvastatin increases LDL levels which will help prevent heart attacks.
d) I should report any unexplained muscle tenderness, pain, or weakness to my healthcare provider right away.
a, b, & c.
A nurse is educating a client who is prescribed warfarin. Which of the following client statements indicates an accurate understanding of how warfarin works to prevent clot formation?
a. "Warfarin works by increasing the synthesis of vitamin K-dependent clotting factors."
b. "Warfarin prevents clot formation by inhibiting the synthesis of vitamin K-dependent clotting factors."
c. "Warfarin promotes the activation of clotting factors in the bloodstream to prevent bleeding."
b. "Warfarin prevents clot formation by inhibiting the synthesis of vitamin K-dependent clotting factors."
Rationale:
Warfarin works by inhibiting the synthesis of vitamin K-dependent clotting factors (such as Factor II, VII, IX, and X) in the liver. Since vitamin K is necessary for the synthesis of these clotting factors, warfarin interferes with this process, ultimately decreasing the blood’s ability to clot and preventing clot formation.
A client who is experiencing a massive pulmonary embolism (PE) is being considered for alteplase (tPA) therapy. The nurse knows that alteplase is contraindicated in which of the following conditions?
a) The client has a history of chronic hypertension, but blood pressure is well-controlled with antihypertensive medication.
b) The client has a history of a recent ischemic stroke two weeks ago, and a large clot is seen in the pulmonary artery on imaging.
c) The client has been diagnosed with a deep vein thrombosis (DVT) and has no prior history of stroke or cardiovascular disease.
b. The client has a history of a recent ischemic stroke two weeks ago, and a large clot is seen in the pulmonary artery on imaging.
Rationale: Alteplase (tPA) is contraindicated in clients who have had a recent stroke (within three months) due to the risk of significant bleeding. This includes any ischemic stroke, which can increase the likelihood of hemorrhagic complications when alteplase is administered. The other conditions listed are not contraindications based on the information provided.
The nursing students asks the instructor why it is important to administer Furosemide slowly when given IV.What is the best response by the instructor?
a. Furosemide decreases the amount of fluid loss.
b. Slow IV administration is less painful to the client.
c. The client may become hypertension.
d. IV administration of furosemide may cause ototoxicity if administered too quickly.
d. IV administration of furosemide may cause ototoxicity if administered too quickly.
A nurse is educating a patient who has been prescribed clonidine, an alpha-2 agonist, for the management of hypertension. Which of the following statements made by the patient indicates an understanding of the necessary client teaching regarding this medication?
a) “I should stop taking this medication if I feel fine to avoid any side effects.”
b) “I need to make sure I drink plenty of fluids to avoid dry mouth and dry eyes.”
c) “It is okay to consume alcohol occasionally while taking this medication as long as I don’t drink too much.”
d) “I should change positions slowly because this medication can cause dizziness or lightheadedness.”
d) “I should change positions slowly because this medication can cause dizziness or lightheadedness.”
Rationale:
d) Correct. Clonidine, an alpha-2 agonist, can cause orthostatic hypotension (dizziness or lightheadedness when changing positions), so it is important for the patient to change positions slowly to avoid falls and injury.
a) Incorrect. Clonidine should not be stopped abruptly because it can cause rebound hypertension, a dangerous increase in blood pressure. The patient should be advised to gradually reduce the medication under healthcare provider supervision.
b) Partially correct, but not the best choice. While dry mouth and dry eyes are common side effects of clonidine, increasing fluid intake may help alleviate the dry mouth. However, the priority teaching point is to focus on the risk of orthostatic hypotension, which could be more immediate and hazardous.
c) Incorrect. Alcohol and CNS depressants should be avoided because they can increase the sedative effects of clonidine, leading to excessive drowsiness, dizziness, or further hypotension.
A nurse is providing education to a patient who has been prescribed atorvastatin for hyperlipidemia. The nurse should instruct the patient to report which of the following symptoms that could indicate a serious adverse effect of the medication? (Select all that apply)
a) Muscle pain or weakness
b) Tea-colored urine
c) Abdominal discomfort or bloating
d) Irregular heartbeat
e) Increased appetite and weight gain
a, b, & d
A nurse is caring for a patient on warfarin therapy. The patient requires urgent reversal of warfarin's anticoagulant effects due to active bleeding. Which of the following actions is most appropriate for the nurse to take?
a. Administer vitamin K slowly over a 24-hour period to reverse the anticoagulant effects of warfarin.
b. Administer fresh frozen plasma (FFP) if rapid reversal is required, as it contains clotting factors.
c. Increase the warfarin dose to counteract the bleeding effects.
d. Monitor the patient’s prothrombin time (PT) and international normalized ratio (INR) every 12 hours for the next 48 hours.
b. Administer fresh frozen plasma (FFP) if rapid reversal is required, as it contains clotting factors.
A nurse is preparing to administer alteplase (tPA) to a client with a suspected ischemic stroke. The nurse is aware of the contraindications for alteplase therapy. Which of the following conditions in the client would require the nurse to withhold the administration of alteplase? (Select all that apply.)
a) The client has active internal bleeding.
b) The client has a history of a stroke three months ago.
c) The client has a current diagnosis of severe uncontrolled hypertension (BP 190/100 mmHg).
d) The client has a recent intracranial surgery within the last two months.
e) The client has a known brain tumor as confirmed by recent imaging.
f) The client has a history of serious head trauma within the last three months.
ALL OF THEM. :)