Cardiovascular System
A patient on the unit is recieving intravenous heparin therapy. Which of the following medications should be available on the nursing unit?
a. Protamine sulfate
b. Potassium chloride
c. Aminocaproic acid (amicar)
d. Vitamin K
a. Protamine Sulfate
Rationale: The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrahge should occur. Vitamin K is an antidote for warfarin sodium. Amniocaproic acid is the antidote for thrombolytic therapy. Potassium chloride is administered for a potassium diet.
After a period of unsuccessful treatments with varying antidepressants, a woman diagnosed with severe depression is switched to phenelzine (Nardil). Which statement by the client indicates the client understands the side effects of MOAI's?
a. “I must refrain from eating bacon or other purine rich foods”
b. “I must refrain from strenuous exercise for the first 4-5 weeks of treatment”
c. “I must refrain from eating aged cheese or other tyramine rich foods”
d. “I should decrease my intake of foods containing sugar”
c. “I must refrain from eating aged cheese or other tyramine rich foods”
Rationale: Nardil is an MAO inhibitor. Patients taking MAO inhibitors should avoid tyramine-rich foods which cause a negative reaction when mixed.
What condition/drugs avoid high purine foods?
The client with Type 2 diabetes mellitus is taught to take Humalog with each meal each day. The client should be instructed that if they do not eat with Humalog, hypoglycemia could occur how long after taking this medication?
a. 60 - 90 minutes
b. 5 - 15 minutes
c. 1 - 2 hours
d. 30 minutes
b. 5 - 15 minutes
Rationale: Humalog is rapid acting with an onset of 5-15 minutes and must be taken with food to avoid hypoglycemia.
A client with nasal congestion is instructed on the correct way for using oxymetazoline. Which of the following statements would demonstrate to the nurse that the client understands the instructions?
A. "I should limit the use to early morning and bedtime"
B."It is important to not shake the bottle because the particulates in the bottle can settle."
C. "I should only use this medication for a short period of time to avoid complications"
D. "The bottle tip should be inserted into the nostril and pointed towards the inside nostril wall."
C. "I should only use this medication for a short period of time to avoid complications"
Rationale: Nasal decongestant medications like Afrin should be used as directed and for typically no more the BID x3 days to avoid rebound congestion.
While assessing the medication history of an older adult client, the nurse notes the client takes acetaminophen daily. The nurse will further question the client to determine how much and how often to ensure the client is not exceeding what daily amount?
a. 1-2 gram
b. 3-4 grams
c. 5-6 grams
d. 7-8 grams
b. 3-4 grams
Rationale: Patients should not exceed 3g - 4g a day. Typically 3g in health care settings.
What complication are we worried about if exceeded?
A client with atrial fibrillation is receiving coumadin. The nurse would determine that the client is receiving a therapeutic effect based on which of the following results?
a. Prothrombin time (PT) of 12.5 sec
b. Internationalized Ratio (INR) between 2 - 3
c. Internationalized Ratio (INR) less than 1.1
d. Platelet level of 150 - 450
b. Internationalized Ratio (INR) between 2 - 3
Rationale: In healthy people an INR of 1.1 or below is considered normal. An INR range of 2.0 to 3.0 is generally an effective therapeutic range for people taking warfarin for certain disorders.
The client states to the nurse, “I take citalopram (Celexa) 40 mg every day like my physician prescribed. I have also been taking St. John’s Wort 750 mg daily for the past 2 weeks”. Which of the following is this client at risk for?
a. Decreased absorption of the Celexa due to the St. Johns Wort
b. Gastric ulcers
c. Serotonin syndrome
d. Pulmonary edema
c. Serotonin syndrome
Rationale: Serotonin syndrome can occur when multiple antidepressants are taken concurrently including St. Johns Wort. Symptoms include mental status changes such as confusion, restlessness or agitation, headache, diaphoresis, ataxia, myoclonus, shivering, tremor, diarrhea, nausea, abdominal cramps and hyperreflexia.
A client has diabetes insipidus and receives desmopressin (DDAVP). The nurse completes medication education and evaluates that learning has occurred when the client makes which statement?
a. "This medication is a potent vasodilator which could cause my blood pressure to decrease."
b. "This medication promotes diuresis in my body which could cause my blood pressure to decrease."
c. "This medication increases water reabsorption in my kidneys, decreasing my urine output."
d. "This medication suppresses hormone secretion from my posterior pituitary gland."
c. "This medication increases water reabsorption in my kidneys, decreasing my urine output."
Rationale: DI causes large volumes of dilute urine resulting in fluid and electrolyte loss and imbalances. Desmopressin is synthetic ADH, which results in fluid retention therefore decreased urine output.
A nurse is teaching a client about taking antihistamines. Which of the following instructions should the nurse include in the teaching plan? Select all that apply.
A. Operating machinery and driving may be dangerous when taking antihistamines.
B. Continue taking antihistamines even if nasal infection develops.
C. The effect of antihistamines is not felt until a day later.
D. Do not use alcohol with antihistamines
E. Increase fluid intake to 2,000ml/day
A,D,E.
Rationale: Antihistamines have an anticholinergic action and a drying effect. They reduce nasal, salivary, and lacrimal gland hypersecretions (runny nose, tearing, and itchy eyes). An adverse effect is drowsiness, so operating machinery and driving are not recommended. There is also an additive depressant effect when alcohol is combined with antihistamines, so alcohol should be avoided during use. The client should ensure adequate fluid intake of atleast 8 glasses per day due to the drying effect of this drug.
A client with peptic ulcer disease is taking famotidine (Pepcid). What is the expected outcome of this drug?
A. Heal the ulcer
B. Protect the ulcer surface from acids
C. Limit gastric acid secretion
D. Reduce acid concentration
C. Limit gastric acid secretion
Rationale: famotidine is a Histamine-2 receptor antagonist, meaning that is reduces gastric acid secretion. Anti-secretory or proton-pump inhibitors such as Prilosec, help ulcers heal quickly in 4-8 weeks. Cytoprotective drugs such as Carafate protect the ulcer surface against acid, bile and pepsin. Antacids are responsible for reducing acid concentration and helping to reduce symptoms.
A 66-year-old client complaining of not feeling well is seen in a clinic. The client is taking several meds for the control of heart disease and hypertension. These medications include atenolol, digoxin, and hydrochlorothiazide. A tentative diagnosis of digoxin toxicity is made. Which of the following assessment data would support this diagnosis?
a. Dyspnea, edema, and tachycardia
b. Chest pain, hypotension, and paresthesia
c. Visual disturbances, loss of appetite, and nausea
d. Constipation, dry mouth, and trouble sleeping
c. Visual disturbances, loss of appetite, and nausea
Rationale: These are early signs of toxicity. Additional signs of toxicity are bradycardia, difficulty reading, other visual disturbances such as green and yellow vision or seeing spots or halos, confusion, vomiting, diarrhea, and decreased libido and impotence.
A patient on the unit is receiving intravenous lorazepam for seizures. Which of the following medications should be available on the nursing unit?
a. Narcan (naloxone)
b. Romazicon (flumazenil)
c. Atropen (atropine)
d. Activated Charcoal
b. Romazicon (flumazenil)
Rationale: Romazicon (flumazenil) is the antidote for benzodiazepines.
What are the others antidotes for?
When do we give this?
A client with Grave Disease is treated with radioactive iodine (RAI) in the form of sodium iodide 131I. Which of the following statements by the nurse will explain to the client how the drug works?
a. “The radioactive iodine stabilizes the thyroid hormone levels before a thyroidectomy.”
b. “The radioactive iodine reduces uptake of thyroxine and thereby improving your condition”
c. “The radioactive iodine lowers the levels of thyroid hormones by slowing your body’s production of them”
d. “The radioactive iodine destroys thyroid tissue so that the thyroid hormones are no longer produced.”
d. “The radioactive iodine destroys thyroid tissue so that the thyroid hormones are no longer produced.”
Rationale: RAI is frequently given to patients with Grave Disease, it is described as a “medical thyroidectomy” as it is given in lieu of surgery. It is frequently given in the elderly.
The nurse should include which of the following instructions when developing a teaching plan for a client who is receiving isoniazid (INH) and rifampin (Rifamate)?
A. Take the medication with antacids
B. Double the dosage if a drug dose is missed
C. Increase intake of dairy products
D. Limit alcohol intake
D. Limit alcohol intake
Rationale: INH and Rifamate are hepatotoxic drugs. The client should be warned to limit the intake of alcohol during drug therapy. These drugs should be taken on an empty stomach. If antacids are needed for GI distress, they should be taken 1 hour before or 2 hours after drug administration. The client should not double the dose due to potential toxicity. Clients taking these drugs should avoid foods rich in tyramine, such as cheese and dairy products, to avoid development of hypertension.
A patient has been diagnosed with infectious diarrhea caused by C.Diff. Which antibiotic do you anticipate this patient will be prescribed for the treatment of this disorder?
Vancomycin
A hospitalized patient is receiving the diuretic spironolactone (Aldactone). A consulting physician sees the patient and orders an Ace Inhibitor called Enalapril (Vasotec). Which electrolyte imbalance will the nurse be concerned about in this patient?
a. Hypernatremia
b. Hypokalemia
c. Hypocalcemia
d. Hyperkalemia
d. Hyperkalemia
Rationale: Sprionalactone is a K sparring diuretic. While not classically considered potassium-sparing diuretics, ACE inhibitors (ACEis) and angiotensin receptor blockers (ARBs) are anti-hypertensive drugs with diuretic effects that decrease renal excretion of potassium.
What are our K+ wasting diuretics?
A client has been taking only levodopa for the treatment of Parkinson’s disease. What additional two medications added to their regimen will prevent the enzymatic breakdown of levodopa allowing it to reach the brain and decrease “wearing off” symptoms? Select all that apply.
a. haloperidol
b. carbidopa
c. entacapone
d. donepezil
e. olanzapine
b. carbidopa
c. entacapone
Rationale: levodopa is broken down quickly by gastric enzymes, by taking with carbidopa this aides in getting the dopamine to the brain. entacapone assists with decreasing wearing off symptoms.
The client with Addison’s disease is taking glucocorticoids at home. Which of the following statements indicates that the client understands how to take the medication?
a. “I must take a dose every 6 hours to ensure consistent blood levels of glucocorticoids”
b. “My need for glucocorticoids will stabilize and I will be able to take a predetermined dose once a day.”
c. “Glucocorticoids are cumulative, so I will take a dose every third day”
d. “I must never stop taking this medication abruptly”.
a. “I must never stop taking this medication abruptly”.
Rationale: Glucocorticoids must never be stopped abruptly because the patient will be at risk for adrenal crisis where the adrenals stop producing glucocorticoids.
A client is prescribed beta agonist medication via a metered-dose inhaler. The nurse instructs the client to report adverse effects. Which of the following are potential adverse effects of albuterol?
A. Drowsiness
B. Bradycardia
C. Constipation
D. Tachycardia
D. Tachycardia
Rationale: Albuterol is a beta agonist medication and stimulates the SNS. Adverse Effects – headaches, throat irritation, nervousness, restlessness, tachycardia, chest pain, allergic reactions, hypertension, insomnia
The nurse designs a plan of care for the client with peptic ulcer disease (PUD) who is taking omeprazole for the management of his illness. What will the best plan by the nurse include?
a. Omeprazole is best taken with yogurt.
b. Omeprazole is recommended for long-term treatment of peptic ulcer disease (PUD).
c. Omeprazole should be taken for no longer then 4-8 weeks.
d. Omeprazole should be administered after meals.
c. Omeprazole should be taken for no longer then 4-8 weeks.
Rationale: Anti-secretory or proton-pump inhibitors such as Prilosec, help ulcers heal quickly in 4-8 weeks.
A nurse is monitoring a client who is taking metoprolol. Which assessment data would indicate a potential serious complication associated with metoprolol?
a. The development of complaints of insomnia
b. The development of audible expiratory wheezes
c. A baseline blood pressure of 150/80 mmHg followed by a blood pressure of 138/72
d. A baseline resting heart rate of 88 beats/min followed by a resting heart rate of 65 beats/min after two doses of the medication
b. The development of audible expiratory wheezes
Rationale: Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. Beta blockers may induce this reaction, particularly in clients with COPD, or asthma. Normal decreases in BP and HR are expected.
The patient is receiving zolpidem (Ambien) for treatment of short-term insomnia. What is the primary safety concern of the nurse when the patient takes this medication?
a. Dizziness and daytime sedation
b. Nausea
c. Diarrhea
d. Sleepwalking
d. Sleepwalking
Rationale: The sleep aide zolpidem has an adverse effect of Neuro-psychiatric reactions such as hallucinations, sensory distortion, sleepwalking, nocturnal eating
A client with diabetes mellitus visits a health care clinic. The client’s diabetes previously had been well controlled with metformin, but recently his fasting blood glucose level has been between 180 to 200 mg/dL. Which new medication from the patient’s medication list is likely contributing to his hyperglycemia?
a. fluticasone
b. albuterol
c. isoniazid
d. allopurinol
a. fluticasone
Rationale: fluticasone is a glucocorticoid steroid inhaler, glucocorticoids increase a diabetic patient's risk for hyperglycemic events.
The nurse is preparing to administer an antitussive to a client. Which assessments will the nurse prioritize in the pre-administration assessment? Select all that apply.
a. Temperature
b. Sputum presence
c. Type of cough
d. Pain assessment
e. Heart sounds
a. Temperature
b. Sputum presence
c. Type of cough
Rationales: Antitussives should not be given to patients with a productive cough or a suspected infection.
What type of drug class could be given a patient with these three things?
An 80-year-old client with rheumatoid arthritis reveals to the nurse that they have been using ibuprofen multiple times a day. Which of the following disorders is this patient potentially at risk for when taking NSAIDs regularly? Select all that apply.
a. Peptic ulcer disease
b. Thrombotic events (ex. MI)
c. Hyperglycemia
d. Blindness
e. Kidney damage
a. Peptic ulcer disease
b. Thrombotic events (ex. MI)
e. Kidney damage
Rationale: Patients taking ibuprofen are at increased risk for PUD, MI, Stroke and kidney damage especially if taking more the the recommended daily dose.