NLEX PHARM

Question 1

The nurse is planning care for a patient taking imipramine (Tofranil). Which findings, if present, would most likely be an adverse effect of this drug?

A. Blood pressure = 160/90 mm Hg
B. Insomnia and diarrhea
C. Sedation and dry mouth
D. Tachypnea and wheezing

Answer 1

C. Sedation and dry mouth

Question 2

The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline. Which question is most important for the nurse to ask the patient?

A. “Have you noticed dry mouth or blurred vision?”
B. “Have you had any changes in your urine function?”
C. “When was your last bowel movement?”
D. “Have you had any changes in your mood or anxiety level?”

Answer 2

D. “Have you had any changes in your mood or anxiety level?”

Rationale: In the early phase of treatment for depression, suicide risk may increase. Patients should be monitored closely for worsening mood, unusual changes in behavior, and suicide risk. The other questions would be useful in assessing the patient for adverse effects of amitriptyline, but assessing suicide risk is the most important.

Question 3

The nurse is caring for a patient receiving fluoxetine (Prozac) for depression. Which adverse effect below is most likely associated with this drug?

A. Sexual dysfunction
B. Dry mouth
C. Orthostatic hypotension
D. Bradycardia

Answer 3

A. Sexual dysfunction

Rationale: Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), does not cause anticholinergic effects, orthostatic hypotension, or cardiotoxicity like the tricyclic antidepressants. The most common adverse effects are sexual dysfunction, nausea, headache, and central nervous system stimulation.

Question 4

The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription of escitalopram (Lexapro). Which is the most likely explanation for these symptoms?

A. Depressive psychosis
B. Serotonin syndrome
C. Escitalopram overdose
D. Cholinergic crisis

Answer 4

B. Serotonin syndrome

Question 5

The nurse is preparing to give phenelzine (Nardil) to a patient with depression. Why is this drug considered a second- or third-line agent in treating depression?

A. It increases the risk of suicide in the early phase.
B. It is less effective than the tricyclic antidepressants.
C. It increases the risk of psychoses and parkinsonism.
D. It has more side effects and drug interactions.

Answer 5

D. It has more side effects and drug interactions.

Rationale: Phenelzine, a monoamine oxidase (MAO) inhibitor, is considered a second- or third-line treatment because of the risk of triggering hypertensive crisis when the patient eats foods high in tyramine, and there is an increased incidence of drug-drug interactions. Phenelzine does not carry an increased risk for suicide, psychoses, or parkinsonism. Phenelzine is as effective as the tricyclic and SSRI antidepressants.

Question 6

A nurse teaches a patient who takes an MAO inhibitor about important dietary restrictions. Which foods will the nurse caution the patient to avoid?

A. Aged cheese and sherry
B. Grapefruit and other citrus juices
C. Coffee, colas, and tea
D. Potato and corn chips

Answer 6

A. Aged cheese and sherry

Rationale: Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAO inhibitor antidepressant medication. Many aged foods contain tyramines.

Question 7

The nurse is caring for a group of patients being treated for depression. Why might an SSRI be chosen over a TCA?

A. To decrease the risk of suicide with overdose
B. To avoid weight gain and other GI effects
C. To help prevent sexual dysfunction
D. To prevent the risk of serotonin syndrome

Answer 7

A. To decrease the risk of suicide with overdose

Rationale: The SSRIs may be chosen because they have fewer side effects and are safer with overdose. However, the SSRIs can cause sexual dysfunction and weight gain, and they carry a risk of serotonin syndrome.

Question 8

The nurse is teaching a patient about a new prescription for citalopram (Celexa). Which statement is appropriate to include in the teaching plan? Select all that apply.

A. “This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs.”

B. “When you stop taking this medication, you should not withdraw it abruptly.”

C. “You will need to move slowly from a sitting to standing position to avoid dizziness from low blood pressure.”

D. “This medication often causes drowsiness. You should take it at bedtime.”

E. “Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety.”

Answer 8

A. This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs.”
B. When you stop taking this medication, you should not withdraw it abruptly.”
E.“Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety.”

Rationale: Citalopram and other SSRIs can cause sexual side effects that patients may be hesitant to report. They should be withdrawn slowly to avoid dizziness, headache, dysphoria, and/or other symptoms of withdrawal. The SSRIs do not generally cause orthostatic hypotension or drowsiness. All antidepressants initially increase the risk of suicide, and patients should be monitored for worsening mood and other signs of suicide risk.

Question 9

The nurse is caring for a patient with bipolar disorder (BPD) who is taking lithium (Lithobid). Which abnormal lab value below is the most essential for the nurse to communicate to the healthcare provider, because this patient is receiving lithium?

A. Sodium = 128 mEq/L
B. Prothrombin time = 8 seconds
C. Blood urea nitrogen = 25 mg/dL
D. Potassium = 5.6 mEq/L

Answer 9

A. Sodium = 128 mEq/L

Rationale: The sodium level given is well below the normal range of 135 to 145 mEq/L. When the serum sodium is reduced, lithium excretion is also reduced, causing lithium accumulation. Since lithium has a narrow therapeutic index, this is a dangerous situation and can result in symptoms of toxicity and even death.

Question 10

The nurse is seeing each of the patients below in the outpatient clinic today. Which patient requires the most immediate attention by the nurse?

A. A female with bipolar disorder receiving valproic acid (Depakene) who reports nausea and vomiting

B. A male with bipolar disorder receiving lithium, with a lithium level of 1.6 mEq/L

C. A male with depression receiving fluoxetine (Prozac), with reports of sexual dysfunction

D. A female with schizophrenia receiving haloperidol (Haldol), with blood pressure of 102/72

Answer 10

B. A male with bipolar disorder receiving lithium, with a lithium level of 1.6 mEq/L

Question 11

The nurse is caring for a patient receiving lithium (Lithobid). The nurse understands that there are many drug interactions with lithium. Which agent is safe to give with lithium?

A. Ibuprofen (Motrin) for muscle pain
B. Hydrochlorothiazide (HCTZ) for edema
C. Aspirin (ASA) for mild headache
D. Diphenhydramine (Benadryl) for cold symptoms

Answer 11

C. Aspirin (ASA) for mild headache

Rationale: Aspirin is safe to use as an analgesic with lithium. Other NSAIDs, such as ibuprofen, can increase lithium levels by as much as 60%. Diuretics increase lithium levels by decreasing serum sodium levels. Diphenhydramine has anticholinergic properties and can aggravate lithium-induced polyuria by causing urinary hesitancy.

Question 12

A nurse assesses a patient who takes a maintenance dose of lithium carbonate (Lithobid) for bipolar disorder. The patient complains of hand tremor, nausea, vomiting, and diarrhea. The patient’s gait is unsteady. What might the nurse suspect in this situation? The patient:

A. may have consumed some foods high in tyramine.
B. has not taken the lithium as directed.
C. has probably developed tolerance to the lithium.
D. may have developed lithium toxicity.

Answer 12

D. may have developed lithium toxicity.

Rationale: Early lithium toxicity is evidenced by diarrhea, anorexia, muscle weakness, nausea, vomiting, tremors, slurred speech, and drowsiness. Later signs include blurred vision, seizures, trembling, confusion, and ataxia.

Question 13

What is the rationale for administering antipsychotics during manic episodes?

A. They help control symptoms during severe manic episodes.
B. They help elevate mood during manic episodes.
C. They are given for their sedating effects during manic episodes.
D. They are given in the presence of psychotic episodes.

Answer 13

A. They help control symptoms during severe manic episodes.

Rationale: Antipsychotic drugs are given to help control symptoms during severe manic episodes, even if psychotic symptoms are absent. Benzodiazepines are given for their sedating effects. Antidepressants help elevate mood during manic episodes.

Question 14

Calcium channel blockers work by decreasing calcium influx into cells of the heart and blood vessels. Calcium channels are coupled to which type of autonomic nervous system receptors?

A. Alpha1
B. Alpha2
C. Beta1
D. Beta2

Answer 14

C. Beta1

Rationale: Calcium channels are coupled to beta1-adrenergic receptors in the heart. For that reason, calcium channel blockers have effects on the heart that are similar to beta blockers. Both drug categories cause decreased force of contraction, decreased heart rate, and decreased cardiac impulse conduction.

Question 15

The nurse is caring for each of the following patients. In which patient would a prescription for nifedipine (Adalat) be the most appropriate?

A. A 60-year-old male with angina and hypertension
B. A 48-year-old female with hypotension
C. A 78-year-old male with atrial fibrillation
D. A 55-year-old female with angina and tachycardia

Answer 15

A. A 60-year-old male with angina and hypertension

Rationale: Nifedipine is a calcium channel blocker from the dihydropyridine family. As such, it blocks calcium channels in the blood vessels, but less in the heart. It is used to treat angina and hypertension, but not cardiac dysrhythmias. It is not used for tachycardia, because dihydropyridines may cause reflex tachycardia.

Question 16

Which agent below is the most likely to cause the side effect of constipation?

A. Nifedipine (Adalat)
B. Amlodipine (Norvasc)
C. Isradipine (DynaCirc)
D. Diltiazem (Cardizem)

Answer 16

D. Diltiazem (Cardizem)

Rationale: Nifedipine, amlodipine, and isradipine are dihydropyridine calcium channel blockers and cause less risk of constipation than diltiazem and verapamil.

Question 17

The nurse is caring for a patient with hypertension receiving verapamil (Calan). The patient has a healthy heart. What pharmacodynamic effects does the nurse expect from this drug? Select all that apply

  A. Peripheral vasoconstriction
  B. Peripheral vasodilation
  C. Coronary vasodilation
  D. Increased heart rate
  E. Increased force of contraction

Answer 17

B. Peripheral vasodilation
C. Coronary vasodilation

Rationale: Verapamil causes peripheral and cardiac vasodilation, which leads to decreased blood pressure and improved coronary perfusion. It does not cause vasoconstriction and usually has little effect on heart rate or contractility in healthy hearts.

Question 18

The nurse is teaching an elderly patient with hypertension about his new prescription for verapamil (Calan). Which statement(s) made by the patient indicate(s) the teaching was effective? Select all that apply.

A. “I will increase my intake of fluid and foods high in fiber.”
B. “I will avoid exposing my skin to the sun.”
C. “I will call my physician if I notice swelling in my ankles.”
D. “I will avoid salt substitutes and potassium supplements.”
E. “I may notice easy bruising and bleeding with this drug.”

Answer 18

A. “I will increase my intake of fluid and foods high in fiber.”
C. “I will call my physician if I notice swelling in my ankles.”

Rationale: Verapamil often causes constipation and can also cause peripheral edema. Patients should take measures to prevent constipation and should call about new symptoms of peripheral edema. Patients should not experience photosensitivity, hyperkalemia, or increased bruising and bleeding.

Question 19

The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement made by the patient indicates the teaching was effective?

A. “ I will take this medication in the morning to decrease nighttime urination.”
B. “ I will rise slowly when standing up from a sitting position.”
C. “ My heart rate may slow down with this drug. I will call if my pulse is below 60.”
D. “ I will increase my intake of fluids and foods that are high in fiber.”

Answer 19

B. “ I will rise slowly when standing up from a sitting position.”

Rationale: Vasodilators may cause postural hypotension and reflex tachycardia. Patients should be taught to move slowly when changing positions to avoid dizziness.

Question 20

Before the administration of hydralazine (Apresoline), it is most important for the nurse to obtain which assessment?

A. Peripheral pulses
B. Homans’ sign
C. Blood pressure
D. Capillary refill

Answer 20

C. Blood pressure

Rationale: Hydralazine is a vasodilator causing arteriolar dilation, decreased resistance, and decreased blood pressure. Monitoring blood pressure and heart rate would receive the highest priority for assessment.

Question 21

The nurse is caring for a patient receiving hydralazine (Apresoline). The primary care provider prescribes propranolol (Inderal). Why is a drug such as propranolol often combined with hydralazine?

A. To decrease the risk of headache
B. To improve hypotensive effects
C. To prevent heart failure
D. To protect against reflex tachycardia

Answer 21

D. To protect against reflex tachycardia

Ratioanle: Hydralazine is a vasodilator that lowers blood pressure, but can trigger reflex tachycardia. Beta blockers, such as propranolol, are added to the regimen to normalize the heart rate.

Question 22

Which is the only cardiovascular indication for minoxidil (Rogaine)?

A. Heart failure
B. Myocardial infarction
C. Mild hypertension
D. Severe hypertension

Answer 22

D. Severe hypertension

Rationale: Because of its serious adverse effects, minoxidil is reserved for patients who have failed to respond to safer drugs. The only cardiovascular indication for minoxidil is severe hypertension.

Question 23

The nurse is caring for a patient receiving a nitroprusside (Nipride) intravenous infusion. The patient’s wife asks why furosemide (Lasix) is being prescribed along with this drug. The nurse’s response is based on which concept?

A. Furosemide will help decrease reflex tachycardia.
B. Many vasodilators cause retention of sodium and water.
C. Thiocyanate may accumulate in patients receiving nitroprusside.
D. Vasodilators can cause serious orthostatic hypotension.

Answer 23

B. Many vasodilators cause retention of sodium and water.

Rationale: Nitroprusside is a potent vasodilator that can cause retention of sodium and water. Furosemide, a diuretic, is often combined with nitroprusside to decrease the risk of edema and fluid retention. Furosemide does not decrease reflex tachycardia. Thiocyanate can accumulate in patients receiving nitroprusside, but furosemide does not help prevent or treat that. Vasodilators can cause serious orthostatic hypotension, but that is not the rationale for adding furosemide to the regimen.

Question 24

The nurse is teaching a patient with hypertension about appropriate lifestyle changes. This patient is a 60-year-old male with body mass index of 30 kg/ m2 who smokes 1 pack per day. Which statement is appropriate to include in the teaching plan?

A. “Getting regular aerobic activity will help you maintain your current healthy weight.”
B. “Reading food labels will help you limit your sodium intake to 4 gm/day.”
C. “Losing weight has been shown to reduce blood pressure in a majority of patients.”
D. “The DASH diet encourages fruits and vegetables and limits potassium and dairy.”

Answer 24

C. “Losing weight has been shown to reduce blood pressure in a majority of patients.”

Rationale: Getting regular aerobic activity is important, but this patient’s current weight is not a healthy one. Reading food labels is important, but the recommended sodium intake is 2.4 gm/day or less. Weight loss is a very effective nonpharmacologic means of lower blood pressure. The DASH eating plan encourages fruits, vegetables, and low-fat dairy. The diet is rich in potassium, magnesium, and calcium and low in sodium.

Question 25

An adult male has taken medication for management of hypertension for 3 years. He says to the nurse, “I’m not going to take these drugs anymore because they are interfering with my sex life.” Which response by the nurse will be most helpful?

A. “It is unfortunate that these drugs can cause erectile dysfunction, but managing your blood pressure is more important than your sexual performance.”

B. “I understand how discouraging it must be to live with this adverse effect, but you could have a stroke if you do not take your blood pressure medicines.”

C. “Let’s discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not produce the same adverse effect.”

D. “I am glad you told me about your experience with this adverse effect. Sexual performance can be a difficult subject to discuss.”

Answer 25

C. “Let’s discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not produce the same adverse effect.”

Rationale: Many antihypertensive medications can produce adverse sexual effects, including impotence. It is important for the nurse to listen to the patient’s concerns and to avoid making value judgments. Other antihypertensive medications may manage this patient’s blood pressure without causing adverse sexual effects. Reducing undesired effects with antihypertensive medication will improve patient adherence.

Question 26

The nurse is caring for a pregnant female who is experiencing a new episode of hypertension. Which agent does the nurse anticipate will be prescribed for this patient?

A. Methyldopa (Aldomet)
B. Propranolol (Inderal)
C. Captopril (Capoten)
D. Captopril (Capoten)

Answer 26

A. Methyldopa (Aldomet)

Rationale: Hypertension is the most common complication of pregnancy, occurring in about 10% of pregnant women. When drug therapy is initiated during pregnancy, methyldopa is the traditional agent of choice because of its limited effects on the fetus. Women with pre-existing hypertension can typically continue taking antihypertensives they were previously prescribed except for angiotensin-converting enzyme (ACE) inhibitors, such as captopril; angiotensin II receptor blockers (ARBs), such as valsartan; and direct renin inhibitors, such as aliskiren.

Question 27

The nurse is caring for a patient who has diabetes and hypertension. Which agent is most likely to be prescribed to treat this patient’s hypertension?

A. Hydrochlorothiazide (HCTZ)
B. Enalapril (Vasotec)
C. Propranolol (Inderal)
D. Methyldopa (Aldomet)

Answer 27

B. Enalapril (Vasotec)

Rationale: Preferred antihypertensives for patients with diabetes include angiotensin-converting enzyme (ACE) inhibitors (enalapril), angiotensin II receptor blockers (ARBs), and calcium channel blockers. ACE inhibitors are particularly useful since they slow progression of diabetic nephropathy in addition to lowering blood pressure. Thiazide diuretics promote hyperglycemia and are used with caution.

Question 28

The Seventh Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7 report), released in 2003, is the guiding document for treatment of hypertension in the United States. Which principles are included in these guidelines? Select all that apply.

A. People with blood pressure above 120 to 139 systolic and 80 to 89 diastolic should receive medication treatment.

B. In people over 50 years of age, an elevated diastolic blood pressure is more dangerous than an elevated systolic one.

C. Thiazide diuretics should be used as initial medication therapy for hypertension for most patients.

D. Blood pressure should be measured twice at a clinic visit with the patient seated in a chair with feet on the floor.

E. Diagnosis of hypertension is typically made after several elevated readings at more than one clinic visit.

Answer 28

C. Thiazide diuretics should be used as initial medication therapy for hypertension for most patients.

D. Blood pressure should be measured twice at a clinic visit with the patient seated in a chair with feet on the floor.

E. Diagnosis of hypertension is typically made after several elevated readings at more than one clinic visit.

Ratioanle: Patients with prehypertension (120 to 139/80 to 89) should adopt lifestyle changes. Medication therapy is not indicated until blood pressure (BP) is greater than 140 systolic or 90 diastolic. In people over age 50 years, an elevated systolic BP is more dangerous than an elevated diastolic BP. Thiazide diuretics lower BP by reducing blood volume and arterial resistance. They are considered initial first-line therapy for most patients. Hypertension is generally diagnosed after repeated elevated measures. The BP should be measure twice, 5 minutes apart, with the patient seated in a chair with feet on the floor.