Multiple Choice Review

Question 1

Which of the following is an expected outcome associated with the administration of digoxin (Lanoxin)?

Answer 1

Decreased heart rate

Digoxin (Lanoxin) has a negative chronotropic effect (decreased heart rate).

Question 2

Which of the following serum digoxin levels does a level of 0.6 nmol/mL indicate?

Answer 2

Below the therapeutic level

Therapeutic serum digoxin levels are 1 to 2.5 nmol/mL; thus, 0.6 nmol/mL is below the therapeutic level.

Question 3

A patient is taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg. When the nurse enters the room, the patient states, “There are nice yellow halos around the lights.” Which of the following would be an appropriate nursing action at this point?

Answer 3

Evaluate the patient for other symptoms of digoxin toxicity
Seeing yellow or green halos around objects is a red flag symptom of digoxin toxicity, and the patient should be evaluated for other symptoms.

Question 4

What is the purpose of a digitalizing dose?

Answer 4

To raise digitalis serum levels to a therapeutic level
“Digitalizing” refers to a loading dose of digoxin (Lanoxin). It is used to quickly bring a patient’s digoxin serum level to the therapeutic range.

Question 5

Which of the following are therapeutic effects of digoxin (Lanoxin)?

Answer 5

Positive inotropic, negative chronotropic, and negative dromotropic
Digoxin (Lanoxin) increases cardiac contractility (positive inotropic effect), decreases heart rate (negative chronotropic effect), and decreases conductivity (negative dromotropic effect)

Question 6

Which of the following would alert the nurse to suspect early digitalis toxicity?

Answer 6

Loss of appetite with slight bradycardia

Early symptoms of digitalis toxicity include anorexia, nausea and vomiting, and bradycardia

Question 7

In addition to a positive inotropic effect in treating heart failure, which of the following advantages do phosphodiesterase inhibitors have?

Answer 7

Vasodilation
Phosphodiesterase inhibitors are also called inodilators because they have both positive inotropic and vasodilator effects

Question 8

Which of the following would the nurse anticipate administering when the laboratory values reveal a digoxin level of 10 and a serum potassium level of 6.2?

Answer 8

digoxin immune Fab (Digibind)
Digoxin immune Fab (Digibind) is indicated for severe digoxin toxicity, as evidenced in this question by a digoxin level of 10 and hyperkalemia

Question 9

Assessment of a patient receiving a positive inotropic drug would include which of the following? (Choose all that apply.)

Answer 9

Apical pulse, daily weights, lung sounds
Assessment of apical pulse, daily weights, lung sounds, and serum electrolytes are appropriate for patients receiving an inotropic drug. Lung sounds and daily weights are appropriate assessments related to the treatment of heart failure with inotropic drugs. The apical pulse and serum electrolytes are important assessments related to potential adverse reactions (bradycardia, toxicity with hypokalemia).

Question 10

Which of the following drugs is used for short-term management of severe heart failure?

Answer 10

Milrinone
Milrinone is a phosphodiesterase inhibitor administered intravenously to treat patients with heart failure not responding adequately to digoxin, diuretics, or other vasodilators

Question 11

Which of the following statements indicates that digoxin (Lanoxin) is working well in a patient with congestive heart failure?

Answer 11

“I have more energy to perform my daily activities.”

A congestive heart failure patient taking digoxin (Lanoxin) should benefit from an increased cardiac output, which in turn reduces dyspnea and edema. The patient reports less fatigue and better sleeping patterns as a result

Question 12

When teaching a patient regarding the administration of digoxin (Lanoxin), the nurse instructs the patient not to take this medication with which of the following foods?

Answer 12

Wheat bran

Large amounts of bran, taken with digoxin (Lanoxin), will decrease and negatively impact the drug’s absorption.

Question 13

Which of the following is an indication for the antidysrhythmic drug lidocaine (Xylocaine)?

Answer 13

Ventricular arrhythmias

Lidocaine (Xylocaine) is a sodium channel blocking agent used specifically to treat ventricular arrhythmias

Question 14

Which of the following is important for the nurse to remember when administering adenosine (Adenocard)?

Answer 14

Give it as a fast intravenous push
Adenosine (Adenocard) must be given as rapidly as possible, followed by a 50 mL normal saline flush in order to get all of the medication into the circulation quickly, since the half-life of this drug is less than 10 seconds

Question 15

When planning a continuous intravenous infusion of an antiarrhythmia drug, the nurse understands that the safest delivery system is which of the following

Answer 15

Delivery through an intravenous pump
Antiarrhythmia agents are used to treat cardiac arrhythmias, but they are also capable of producing cardiac arrthymias if not closely monitored. These drugs are potent and need to be delivered in a safe and precise manner; the safest delivery system is an intravenous pump.

Question 16

Which of the following conditions would adenosine (Adenocard) be used to treat?

Answer 16

Paroxysmal supraventricular tachycardia (PSVT)

The only therapeutic indication of use for adenosine (Adenocard) is the treatment of PSVT.

Question 17

Sodium channel blockers are considered to be in which of the following classes of antiarrhythmic drugs?

Answer 17

Class I
Sodium channel blockers are classified as class I antiarrhythmic drugs

Question 18

Which of the following is ibutilide (Corvert), a class III antiarrhythmic drug, used for?

Answer 18

Rapid conversion of atrial fibrillation and flutter

Ibutilide (Corvert) is specifically indicated only for treatment of recent-onset atrial fibrillation and flutter.

Question 19

For which of the following should the nurse assess before administering a dose of an antiarrhythmic drug?

Answer 19

Apical pulse and blood pressure
Antiarrhythmic drugs can cause both hypotension and bradycardia; therefore, it is important to assess blood pressure and apical pulse before administration

Question 20

Which of the following classifications of drugs is used to treat both hypertension and dysrhythmias?

Answer 20

Calcium channel blockers
Calcium channel blockers are effective in treating both hypertension and dysrhythmias secondary to their negative inotropic and chronotropic effects.

Question 21

Calcium channel blockers have which of the following pharmacodynamic effects?

Answer 21

Atrial effect on conduction
Calcium channel blockers interfere with the inward flow of calcium into conduction tissue. The blockage of calcium flow is limited to the atria and AV node, and it has little effect on ventricular tissues. When used to treat dysrhythmia, the drug is effective for irregularities above the ventricles.

Question 22

Amiodarone toxicity is evidenced in which of the following body systems?

Answer 22

Pulmonary
Patients taking amiodarone must have baseline and serial pulmonary function tests in order to monitor for potential pulmonary toxicity.

Question 23

Which of the following drugs frequently interacts with antidysrhythmic drugs?

Answer 23

warfarin (Coumadin)
International Normalized Ratio (INR) levels will need to be monitored closely in the patient receiving warfarin (Coumadin) and antidysrthythmic drugs. The drug–drug interaction can potentiate the coagulation effects of warfarin

Question 24

To prevent the occurrence of cinchonism in a patient prescribed quinidine (Apo-Quin-G), the nurse will highlight the importance of what teaching content?

Answer 24

Avoiding ingestions of antacids
Cinchonism can result from concurrent use of antacids and quinidine (Apo-Quin-G) secondary to blocked renal excretion of the quinidine.

Question 25

Which of the following instructions should be included in the discharge teaching for a patient discharged with a transdermal nitroglycerin patch?

Answer 25

“Apply the patch to a nonhairy area of the upper torso or arms.”

A nitroglycerin patch should be applied to a nonhairy, nonfatty area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and the drug should be continued if headache occurs because tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain

Question 26

Which of the following statements best describes how nitrates impact the heart’s preload?

Answer 26

Reduce the preload by dilating blood vessels
Preload is determined by the amount of blood in the ventricle just before contraction. Nitrates’ primary action is to dilate blood vessels, thereby removing some blood volume out of the heart chambers. This action reduces the pressure on the heart (preload).

Question 27

Which of the following is a common adverse effect of nitroglycerin?

Answer 27

Headache

Common adverse effects of nitroglycerin include flushing, headache, and hypotension. The most common is headache.

Question 28

Which of the following statements by the patient demonstrates a need for further education regarding nitroglycerin?

Answer 28

“I can take up to five tablets at 3-minute intervals for chest pain.”

Patients are taught to take up to three tablets every 5 minutes. If no relief from chest pain is obtained after three tablets, they should seek medical assistance.

Question 29

One of the effects of calcium channel blockers in reducing myocardial oxygen demand includes afterload reduction. Which of the following best describes afterload?

Answer 29

Pressure against which the heart must pump

Afterload is determined by the pressure in the aorta just before systole.

Question 30

Which of the following nitrate preparations or dosage forms has the longest duration of action?

Answer 30

Transdermal nitroglycerin patch
The transdermal patch has a duration of action of 24 hours, compared to 2 to 6 hours for sublingual nitroglycerin, nitroglycerin spray, and transdermal nitroglycerin patches.

Question 31

Which of the following instructions would the nurse give the patient in order to prevent nitroglycerin tolerance development?

Answer 31

Remove the patch for 8 hours a day as directed by the physician
Nitroglycerin tolerance can be prevented by maintaining an 8-hour, nitrate-free period each day

Question 32

Which of the following would be a priority nursing assessment before administering isosorbide mononitrate?

Answer 32

Blood Pressure
Isosorbide mononitrate is a vasodilator, and thus it can cause hypotension. It is important to assess blood pressure before administration.

Question 33

Which of the following would be the nurse’s best response when the patient asks how nitroglycerin should be stored while travelling?

Answer 33

“It’s best to keep it in its original container away from heat and light.”

Although nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest where it could freeze. It should also not be locked up and needs to be kept away from light, not in a clear plastic bag.

Question 34

Patient teaching regarding sublingual nitroglycerin should include which of the following statements?

Answer 34

“Sit or lie down after you take a nitroglycerin tablet to prevent dizziness.”

Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. It should be kept in a readily accessible location for immediate use should chest pain occur. Three tablets may be taken 5 minutes apart. It should be placed under the tongue and allowed to dissolve.

Question 35

Which of the following statements indicates that the patient understands discharge teaching about nitroglycerin?

Answer 35

“I will need to refill my prescription every 3 to 6 months so it doesn’t expire.”

Nitroglycerin will lose potency after 6 months; in order for the patient to have a fresh supply, the prescription should be renewed every 3 to 6 months.

Question 36

Which of the following would be the nurse’s best response to a patient who is taking sublingual nitroglycerin and complaining of flushing?

Answer 36

“This is a common adverse effect of nitroglycerin, and it will subside with continued use.”

Flushing is a common adverse effect of nitroglycerin and will subside with continued use

Question 37

Which of the following actions should the nurse take when applying nitroglycerin ointment?

Answer 37

Apply the ointment to intact skin on the upper torso
Absorption is best over a nonfatty, nonhairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves when applying to prevent transdermal absorption by the applier. Rubbing would increase absorption and risks of adverse effects.

Question 38

For which of the following should the nurse monitor when titrating intravenous nitroglycerin?

Answer 38

Heart rate
Chest pain
Blood pressure
Intravenous nitroglycerin can cause hypotension and tachycardia. Relief of chest pain and/or systolic blood pressure

Question 39

A patient receiving intravenous nitroglycerin at 20 µg/min complains of dizziness. Nursing assessment reveals a blood pressure of 88/46 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse’s best response?

Answer 39

Decrease the intravenous nitroglycerin drip rate
Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 minutes while changing the rate of the intravenous nitroglycerin infusion.

Question 40

Which of the following nitroglycerin effects would the nurse explain during patient teaching?

Answer 40

“The drug decreases the workload of the heart and therefore reduces pain.”

Nitroglycerin reduces the workload of the heart, which decreases oxygen demand, thus bringing the oxygen supply and demand back into equilibrium.

Question 41

Which of the following patient statements indicates that additional patient teaching regarding antihypertensive treatment is required?

Answer 41

“I will check my blood pressure every day and take my medication when it is over 140/90.”

Antihypertensive medications need to be taken routinely in order to maintain a normotensive state and prevent occurrence of complications. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, but they experience adverse effects from the medication. Patient teaching is essential

Question 42

Which of the following troublesome adverse effects of angiotensin-converting enzyme (ACE) inhibitors may be minimized by switching to an angiotensin receptor blocking agent?

Answer 42

A dry, nonproductive cough
ACE inhibitors prevent the breakdown of bradykinin, frequently causing a nonproductive cough. Angiotensin receptor blocking agents do not block this breakdown, thus minimizing this annoying adverse effect.

Question 43

Which of the following medications should not be taken concurrently with ACE inhibitors?

Answer 43

Potassium
ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion; decreased aldosterone can result in increased serum potassium.

Question 44

Direct-acting vasodilators have which of the following effects on the heart rate?

Answer 44

HR increases

Heart rate increases in response to decreased blood pressure caused by vasodilation

Question 45

The nurse would plan to administer which of the following calcium channel blocking agents to a patient with cerebral arterial spasms following a subarachnoid hemorrhage?

Answer 45

nimodipine (Nimotop)
Nimodipine (Nimotop) crosses the blood–brain barrier and has a greater effect on the cerebral arteries than on other arteries in the body; thus, it is indicated for the treatment of cerebral arterial spasm following subarachnoid hemorrhage

Question 46

Which of the following conditions would cause the nurse to question an antihypertensive medication order?

Answer 46

Hypotension
All antihypertensive medications are designed to lower blood pressure. They are contraindicated in the presence of hypotension.

Question 47

Which of the following statements would be appropriate during discharge teaching for a patient receiving clonidine (Catapres)?

Answer 47

“Increasing fluid and fibre in your diet can help prevent the adverse effect of constipation.”

Constipation is a controllable adverse effect of clonidine (Catapres). The patient’s blood pressure should be checked more frequently than once a year. Prolonged standing can cause venous pooling and hypotension. Drooling is not a common adverse effect of clonidine.

Question 48

It would be accurate to state that Blacks generally respond best to which combination of medications to treat hypertension?

Answer 48

Diuretics and calcium antagonists
Research has demonstrated that Blacks do not typically respond therapeutically to β-blockers or ACE inhibitors; they respond better to diuretics and calcium antagonists

Question 49

To which of the following classifications does carvedilol belong?

Answer 49

Combined α- and β-blocking drugs

Carvedilol blocks both the α- and β-receptors of the adrenergic nervous system.

Question 50

Which of the following would the nurse ensure when administering sodium nitroprusside (Nipride) intravenously?

Answer 50

Infuse through a volumetric intravenous pump
Due to the possible severe hypotensive response, sodium nitroprusside (Nipride) should be delivered precisely, via infusion through a volumetric intravenous pump

Question 51

A patient who does not have a history of hypertension is prescribed an α-blocking agent (prazosin [Minipress]). The nurse knows that this drug can also be used for which of the following medical conditions?

Answer 51

BPH
α1-blocking agents have been useful in treating obstructive benign prostatic hyperplasia. The blocking of α-adrenergic receptors decreases the urine outflow obstruction related to benign prostatic hyperplasia

Question 52

By which of the following actions do both ACE inhibitors and angiotensin receptor blockers work to decrease blood pressure?

Answer 52

Inhibit aldosterone secretion
ACE inhibitors block the formation of angiotensin II, whereas angiotensin receptor blockers allow the formation of angiotensin II but block its effect at the receptors. Without the receptors stimulated (because of either drug), aldosterone is not produced, diminishing the reabsorption of sodium and water.

Question 53

Which of the following is a priority nursing diagnosis for patients taking an antihypertensive medication?

Answer 53

Alteration in cardiac output related to effects on the sympathetic nervous system
Circulation is always a priority over fatigue, pain, and/or knowledge deficit.

Question 54

Medication compliance associated with the adverse effect of impotence is related to which of the following drug classifications?

Answer 54

Adrenergic drugs
Sexual dysfunction (impotence) is a common adverse effect of the adrenergic drug classification.

Question 55

Which of the following laboratory values should the nurse assess to identify an adverse response to hydrochlorothiazide?

Answer 55

Glucose levels

Hydrochlorothiazide can cause hyperglycemia.

Question 56

Which of the following principles would the nurse use in teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together?

Answer 56

This combination promotes diuresis but decreases the risk of hypokalemia
Spironolactone (Aldactone) is a potassium-sparing diuretic; furosemide (Lasix) is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.

Question 57

For which of the following adverse effects will the nurse check the laboratory values of a patient who has started on furosemide (Lasix)?

Answer 57

Hypokalemia

Furosemide (Lasix) is a potent loop diuretic, resulting in the loss of potassium as well as water, sodium, and chloride

Question 58

A patient admitted to the hospital with pneumonia and a history of chronic renal insufficiency is ordered furosemide (Lasix) 40 mg twice a day. Which of the following rationales explains the reason for the furosemide order?

Answer 58

Is effective in treating persons with renal insufficiency

Furosemide (Lasix) is effective in patients with creatinine clearance as low as 25 L/min (normal 125 L/min).

Question 59

Which of the following dietary recommendations would the nurse make to a patient taking spironolactone (Aldactone)?

Answer 59

Avoid foods high in potassium, such as bananas
Spironolactone (Aldactone) is a potassium-sparing diuretic that could potentially cause hyperkalemia. Bananas are high in potassium and thus should be avoided.

Question 60

The nurse would question the use of mannitol (Osmitrol) in which of the following patients?

Answer 60

47-year-old patient with anuria
Mannitol (Osmitrol) is not metabolized but is excreted unchanged by the kidneys. Potential water intoxication could occur if mannitol is given to a patient without urine output and thus renal function

Question 61

Acetazolamide (Acetazolam) therapy is contraindicated for which of the following medical conditions?

Answer 61

Metabolic Acidosis
Acetazolamide (Acetazolam) causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat metabolic alkalosis, edema, seizures, and acute glaucoma.

Question 62

Which of the following symptoms is directly related to hyporkalemia?

Answer 62

Abdominal cramps

Muscle-related symptoms, such as abdominal cramps, are associated with hypokalemia.

Question 63

Which of the following would be the nurse’s best response when a patient asks about taking potassium supplements while taking spironalactone (Aldactone)?

Answer 63

“You are on a diuretic that is potassium sparing, so there is no need for extra potassium.”

Spironalactone (Aldactone) is a potassium-sparing diuretic, and additional potassium ingestion would put the patient at risk for hyperkalemia.

Question 64

The nurse would expect to administer which of the following diuretics to treat a patient diagnosed with primary hyperaldosteronism?

Answer 64

spironolactone (Aldactone)

Spironolactone (Aldactone) is the direct antagonist for aldosterone.

Question 65

The nurse prepares to administer which of the following diuretics to treat a patient suffering from acute pulmonary edema?

Answer 65

Furosemide (Lasix)
Furosemide (Lasix) is a potent, rapid-acting diuretic that would be the drug of choice to treat acute pulmonary edema. Amiloride, triamterene, and spironolactone are not potent enough to cause the strong diuresis necessary to treat acute pulmonary edema.

Question 66

Which of the following therapeutic effects of mannitol (Osmitrol) would the nurse anticipate?

Answer 66

Decreased intracranial pressure
Mannitol (Osmitrol) is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This will decrease intracranial pressure caused by cerebral edema.

Question 67

Which of the following adverse effects of triamterene would the nurse specifically monitor for?

Answer 67

Hyperkalemia

Triamterene is a potassium-sparing diuretic.

Question 68

Which of the following responses best explains why a patient is prescribed the diuretic acetazolamide (Acetazolam) to treat glaucoma?

Answer 68

Increase the outflow of aqueous humour
Acetazolamide (Acetazolam) is used effectively in the treatment of open angle glaucoma by increasing the outflow of aqueous humour. As a result, intraocular pressure is decreased.

Question 69

The “ALLHAT” research study found that one diuretic had fewer cardiovascular adverse effects as well as lowered systolic blood pressure better than other diuretics. Which of the following drugs were suggested by the researchers to be the first-line drug in the treatment of hypertension?

Answer 69

chlorthialidone
Researchers, based on the “ALLHAT” study, suggested chlorthialidone as the first-line drug in the treatment of hypertension.

Question 70

Gwen, 90, lives in a long-term care facility. She is ambulatory and continent but requires direction for her activities of daily living. Her medical diagnoses include congestive heart failure and Alzheimer’s disease. Gwen has a number of medications to treat her conditions, including digoxin (Lanoxin), furosemide (Lasix), and potassium supplements.
What potassium serum level result indicates that Gwen’s potassium supplement may not be adequate?

Answer 70

2.2 mmol/L

Serum potassium levels less than 3.0 mmol/L indicate that additional potassium supplements are required.

Question 71

Gwen, 90, lives in a long-term care facility. She is ambulatory and continent but requires direction for her activities of daily living. Her medical diagnoses include congestive heart failure and Alzheimer’s disease. Gwen has a number of medications to treat her conditions, including digoxin (Lanoxin), furosemide (Lasix), and potassium supplements.
How often should Gwen be weighed?

Answer 71

Daily

Patients should be weighed daily, at the same time of day. Fluctuations in weight indicate fluid retention or loss.

Question 72

Gwen, 90, lives in a long-term care facility. She is ambulatory and continent but requires direction for her activities of daily living. Her medical diagnoses include congestive heart failure and Alzheimer’s disease. Gwen has a number of medications to treat her conditions, including digoxin (Lanoxin), furosemide (Lasix), and potassium supplements.
What nursing action recognizes that Gwen is at risk for falls related to her diuretic therapy?

Answer 72

Place a commode at Gwen’s bedside at night

To minimize Gwen’s risk for falling at night, a commode should be placed at her bedside.

Question 73

Which of the following laboratory values would the nurse assess to determine the effectiveness of intravenous heparin?

Answer 73

Activated partial thromboplastin time (aPTT)

Heparin dosing is based on aPTT results.

Question 74

Which of the following would the nurse anticipate administering to a patient who has been anticoagulated with warfarin (Coumadin) and is admitted with gastrointestinal bleeding?

Answer 74

Vitamin K

Vitamin K is the antagonist for warfarin (Coumadin).

Question 75

Which of the following best explains a patient’s INR value of 2.5?

Answer 75

The client’s warfarin (Coumadin) dose is therapeutic

A therapeutic INR is 2-3

Question 76

Which of the following patient statements identifies a knowledge deficit regarding warfarin (Coumadin)?

Answer 76

“I will increase the dark green leafy vegetables in my diet.”

Dark green leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin (Coumadin). Rather than increase the intake of these, it is important to maintain a consistent daily intake of vitamin K.

Question 77

Which of the following medications has antiplatelet properties?

Answer 77

acetylsalicylic acid (aspirin) 
Acetylsalicylic acid (aspirin) is the prototype for antiplatelet medications. Enoxaparin and heparin are anticoagulants. Alteplase is a thrombolytic drug.

Question 78

While preparing a patient with acute chest pain for an emergency angioplasty, the nurse would anticipate administering which of the following medications to prevent platelet aggregation?

Answer 78

eptifibatide (Integrilin)
Eptifibatide (Integrilin) is a glycoprotein IIb/IIIa inhibitor that blocks the enzyme essential for platelet aggregation. This is given to prevent the formation of further clots and is faster acting than warfarin (Coumadin)

Question 79

Enoxaparin sodium (Lovenox) is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. Enoxaparin belongs to which drug group?

Answer 79

Low-molecular-weight heparin

Enoxaparin (Lovenox) is a low-molecular-weight heparin.

Question 80

Which of the following is the nurse’s best response when the patient asks what the difference is between enoxaparin (Lovenox) and heparin?

Answer 80

“Enoxaparin is more predictable in its effect and has a lower risk of bleeding.”

Enoxaparin (Lovenox), a low-molecular-weight heparin, is more predictable in its effect than regular heparin.

Question 81

Before emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin?

Answer 81

protamine sulphate

Protamine sulphate binds with heparin in the bloodstream to inactivate it, thus reversing its effect.

Question 82

Alteplase (Activase) is indicated for which of the following medical conditions?

Answer 82

Arterial thrombosis
Alteplase (Alteplase), a thrombolytic drug, is used to lyse thrombi, especially when the thrombus is occluding blood vessels, causing ischemia to the distal tissues.

Question 83

Which of the following would be the nurse’s best response to a patient who is taking an anticoagulant and requests an aspirin for headache relief?

Answer 83

Explain to the client that aspirin is contraindicated, and call the doctor for an alternate analgesic
Patients taking an anticoagulant should not use medications that would further increase the risk of bleeding. The nurse still needs to advocate for the patient’s pain relief, and an alternate order, such as ibuprofen (Advil), should be sought.

Question 84

Which of the following is the nurse’s best response when a patient is started on oral anticoagulant therapy while still receiving intravenous heparin and is concerned about risk for bleeding?

Answer 84

“It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued to help prevent blood clots until the warfarin is working up to speed.”

Warfarin (Coumadin) works by decreasing the production of clotting factors. However, it takes approximately 3 days for the body to use up present clotting factors and thus achieve a therapeutic anticoagulant effect. Because of this, heparin is continued until this is achieved.

Question 85

Which of the following patient statements would confirm understanding of discharge instructions regarding warfarin (Coumadin)?

Answer 85

“I should use a soft toothbrush for dental hygiene.”

The client should reduce the risk of bleeding, such as using a soft toothbrush. Doubling a forgotten dose, taking ibuprofen, and decreasing the dose as a result of bruising are inaccurate choices

Question 86

Which of the following actions would the nurse do before administering streptokinase (Streptase)?

Answer 86

Perform all necessary venipunctures
Streptokinase (Streptase) is a thrombolytic agent that can interfere with the body’s clotting ability. Therefore, all invasive procedures should be completed before administering this drug.

Question 87

The nurse formulates a plan of care for a patient receiving heparin based upon which of the following nursing diagnoses?

Answer 87

Risk for injury

The patient receiving heparin is at risk for injury secondary to increased risk of bleeding

Question 88

Which of the following patient statements would demonstrate understanding of discharge instructions regarding cholestyramine (Novo-Cholamine)?

Answer 88

“I will increase fibre in my diet.”

Cholestyramine (Novo-Cholamine) can cause constipation; thus, increasing dietary fibre is appropriate. All other drugs should be taken 1 hour before or 4 hours after cholestyramine to facilitate proper absorption.

Question 89

The nurse plans which of the following interventions to decrease the flushing reaction of nicotinic acid (Niacin)?

Answer 89

Administer acetylsalicylic acid (aspirin) 30 minutes before nicotinic acid
Administration of an anti-inflammatory agent such as aspirin has been shown to decrease the flushing reaction associated with nicotinic acid.

Question 90

Which of the following are common adverse effects of gemfibrozil (Lopid), a fibric acid derivative?

Answer 90

Anorexia, nausea and vomiting, diarrhea
Increase in gallstone formation, gastritis
Impotence, decreased libido, gynecomastia
Anorexia, nausea and vomiting, diarrhea, increase in gallstone formation, gastritis, impotence, decreased libido, and gynecomastia can occur with gemfibrozil (Lopid).

Question 91

Which of the following would the nurse include in discharge teaching for a patient receiving an antilipemic medication?

Answer 91

“You should continue your exercise program in order to increase your high-density lipoprotein (HDL) serum levels.”

Antilipemic medications are an addition to, not a replacement of, the therapeutic regimen used to decrease serum cholesterol.

Question 92

Which of the following describes the action for ezetimibe (Ezetrol)?

Answer 92

Inhibiting absorption of cholesterol in the small intestine
Ezetimibe (Ezetrol) is the newest type of antilipemic medication that works by inhibiting the absorption of cholesterol in the small intestine.

Question 93

By which of the following actions does cholestyramine (Novo-Cholamine) decrease lipid levels?

Answer 93

By binding to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces
Cholestyramine (Novo-Cholamine) is an anion exchange resin that binds to bile to form an insoluble complex that is excreted in the feces. The liver must then use cholesterol to synthesize more bile.

Question 94

Which of the following patient statements demonstrates a knowledge deficit regarding colestipol (Colestid)?

Answer 94

“I should mix and stir the powder in as small an amount of fluid as possible in order to maintain potency of the medication.”

Colestipol (Colestid) is a powder that must be well diluted in fluids before administration to avoid esophageal irritation or obstruction and intestinal obstruction. The powder should not be stirred because it may clump—it should be left to dissolve slowly for a least 1 minute.

Question 95

Which of the following describes the action of lovastatin (Advicor)?

Answer 95

Inhibits HMG-CoA reductase, the enzyme responsible for the biosynthesis of cholesterol in the liver
Lovastatin (Advicor) is an HMG-CoA reductase inhibitor, decreasing the synthesis of cholesterol in the liver.

Question 96

Which of the following laboratory tests would the nurse monitor for adverse reactions to HMG-CoA reductase inhibitors?

Answer 96

Liver function tests
HMG-CoA reductase inhibitors can cause hepatic toxicity; thus, it is necessary to monitor liver function tests every 3 months for the first year of treatment

Question 97

Which of the following symptoms might indicate a serious adverse reaction to the drug simvastatin (Zocor)?

Answer 97

Muscle pain
Muscle pain must be reported when taking simvastatin (Zocor) because it could signify an uncommon but serious adverse effect of rhabdomyolysis associated with statin drugs.

Question 98

The nurse will question a lovastatin (Advicor) order for which of the following patient conditions?

Answer 98

Hepatic disease
Lovastatin (Advicor) can cause an increase in liver enzymes, and thus it should not be used in patients with pre-existing liver disease

Question 99

Which of the following drugs would most likely be prescribed for a patient with elevated triglyceride levels unresponsive to HMG-CoA reductase inhibitors?

Answer 99

gemfibrozil (Lopid)

Gemfibrozil (Lopid), a fibric acid derivative, promotes catabolism of triglyceride-rich lipoproteins

Question 100

For which of the following conditions would the nurse question an order for cholestyramine (Novo-Cholamine)?

Answer 100

Complete bowel obstruction Correct
Cholestyramine (Novo-Cholamine) binds with bile in the intestinal tract to form an insoluble complex. It can also bind to other substances and lead to intestinal obstruction

Question 101

The nurse is alert for which adverse event in a patient receiving the drugs bezafibrate (PMS-Bezafibrate) and warfarin (Coumadin)?

Answer 101

Increased risk of bleeding
Bezafibrate (PMS-Bezafibrate) can bind with vitamin K in the intestinal tract, reducing vitamin K absorption. Since vitamin K is the antidote for warfarin (Coumadin), a lack of vitamin K increases the anticoagulant effect of warfarin and thus the risk for bleeding

Question 102

Which of the following lab results indicates that a high-risk patient’s antilipemic agents are working?

Answer 102

LDL-C 1.9 mmol/L
Canadian dyslipedimia guidelines for the lower density lipid cholesterial LDL-C are targeted below 2.0 mmol/L for high-risk people.

Question 103

Which of the following statements indicates an understanding of drug action from a patient new to statin therapy?

Answer 103

“It may take several months to reach target blood levels.”

Patient education should reinforce that statin therapy will take several weeks before therapeutic results are realized. Reinforcement of this educational piece will enhance compliance rates.