Pharm Test 3 Flashcards
The home health nurse is caring for a client diagnosed with heart failure who has been prescribed the cardiac gycoside digoxin (Lanoxin) and the loop diuretic furosemide (Lasix). Which statement by the client indicates the medications are Effective?
A. “I am staying on my diet and I don’t put salt on my foods anymore.”
B. “I have gained weight since my last doctor’s visit.”
C. “I keep my feet propped up as much as I can during the day.”
D. “I am able to walk next door now without being short of breath.”
D. “I am able to walk next door now without being short of breath.”
A symptom of HF is shortness of breath. The fact that the client can ambulate without being short of breath is an improvement of symptoms, which shows that the medications are effective. Keeping the client’s feet propped up and staying within their diet indicates compliance with treatment guidelines, not effectiveness of a medication. Weight gain would indicate that the client is retaining fluid and the medications are not effective.
The client diagnosed with heart failure is prescribed the angiotensin-converting enzyme (ACE) inhibitor lisinopril. Which statement explains the scientific rationale for administering this medication?
A.
ACE inhibitors dilate arteries, reduce blood volume, and prevent pathologic changes in the heart and kidneys, which reduces the workload of the heart.
B.
ACE inhibitors block the intervention of antidiuretic hormone in the kidney.
C.
ACE inhibitors increase the levels of angiotensin II in the blood vessels.
D.
ACE inhibitors decrease the effects of bradykinin in the body.
A.
ACE inhibitors dilate arteries, reduce blood volume, and prevent pathologic changes in the heart and kidneys, which reduces the workload of the heart.
ACE inhibitors decrease the level of angiotensin in the body by blocking the conversion from angiotensin I to angiotensin II. By reducing the levels of angiotensin II, ACE inhibitors dilate blood vessels, reduce blood volume, and prevent or reverse angiotensin II pathological changes in the heart and kidneys. ACE inhibitors increase bradykinin levels. ACE inhibitors have no effect on the intervention of the antidiuretic hormone.
The nurse is providing discharge instructions for a client prescribed the thiazide diuretic hydrochlorothiazide. Which instruction should the nurse include?
A.
It is not important to drink water throughout the day.
B.
Try to sleep in an upright position.
C.
Eat bananas or oranges regularly.
D.
Weigh monthly and report the weight to the health care provider.
C.
Eat bananas or oranges regularly.
The client should drink enough fluid to replace insensible losses (e.g., through perspiration and in feces) or the client will become dehydrated. The medication is being given to reduce the amount of fluid in the body. The client should weigh himself or herself daily in the same amount of clothes and at approximately the same time for accuracy in weight measurement. The client should report a weight gain of 3 pounds within a week. Loop and thiazide diuretics cause the body to excrete potassium in the urine. The client should attempt to replace the potassium by eating potassium-rick foods such as bananas and orange juice. The client does not need to sleep in an upright position if the CHF is being controlled. If the client has to sleep in an upright position to breathe, the HCP should be notified.
The nurse in the health care provider’s office is completing an assessment on a client who has been prescribed the cardiac glycoside digoxin (Lanoxin) for heart failure. Which data indicates the medication has been effective?
A.
The client has 2+ edema of the sacrum.
B.
The client’s sputum is pink and frothy.
C.
The client’s heart rate is 78 beats per minute.
D.
The client has clear breath sounds bilaterally.
D.
The client has clear breath sounds bilaterally.
Pink, frothy sputum indicates that the client’s lungs are filling with fluid. This indicates the client’s condition is becoming worse. Pitting edema of the sacrum would be seen in clients on bed rest. This is a symptom of HF and would only indicate the client is getting better if the client had 3+ or 4+ edema initially. Clear breath sounds bilaterally indicate the treatment is effective. The nurse assesses for the signs and symptoms of the disease for which the medication is being administered. If the symptoms are resolving, then the medication is effective. The client’s heart rate must be 60 or above to administer digoxin safely, but the heart rate does not indicate the client with HF is getting better.
Which medication should the nurse question administering?
A.
Verapamil (Calan), a calcium channel blocker, to a client with angina.
B.
Furosemide (Lasix), a loop diuretic, to a client complaining of leg cramps.
C.
Lisinopril (Zestril), an ACE inhibitor, to a client with a BP of 118/84.
D.
Carvedilol (Coreg), a beta blocker, to a client with an apical pulse of 62.
B.
Furosemide (Lasix), a loop diuretic, to a client complaining of leg cramps.
The blood pressure is above 90/60; there is no reason for the nurse to question administering an ACE inhibitor in this situation. The apical pulse is 60, so the nurse would not question administering a beta blocker in this situation. Calcium channel blockers are prescribed to treat angina, so there is no reason for the nurse to question the medication. Leg cramps may indicate a low blood potassium level; the nurse should hold the medication until the potassium level can be checked. Loop diuretics cause the kidneys to excrete potassium. Hypokalemia can cause life-threatening dysrhythmias.
The healthcare provider prescribed an angiotensin-converting enzyme (ACE) inhibitor for a client diagnosed with heart failure. Which instruction should the nurse provide?
A.
Eat a banana or drink orange juice at lease twice a day.
B.
Notify the healthcare provider if you develop localized edematous areas that itch.
C.
A dry cough is expected early in the morning on arising.
D.
The symptoms of heart failure should improve rapidly.
B.
Notify the healthcare provider if you develop localized edematous areas that itch.
ACE inhibitors have a side effect of hyperkalemia. The client should not be encouraged to eat potassium-rich foods. A condition in which there are localized edematous areas (wheals), accompanied by intense itching of the skin and mucous membranes, is called angioedema. This is an adverse reintervention to an ACE inhibitor and should be reported to the healthcare provider. An intractable dry cough is a reason for discontinuing the ACE inhibitor and should be reported to the healthcare provider. Symptomatic improvement may take weeks to months to develop for a client diagnosed with heart failure.
The nurse is administering digoxin (Lanoxin), a cardiac glycoside, to a client diagnosed with heart failure. Which interventions should the nurse implement? Select All That Apply?
A. Assess the client’s carotid pulse for 1 full minute.
B. Check the client’s current potassium level.
C. Ask the client if he or she is seeing a yellow haze around objects.
D. Have the client squeeze the nurse’s fingers.
B. Check the client’s current potassium level.
C. Ask the client if he or she is seeing a yellow haze around objects.
The client’s apical pulse, not carotid pulse, should be assessed. The client’s potassium level, as well as the digoxin level, is monitored because high levels of potassium impair therapeutic response to digoxin and low levels can cause toxicity. The most common cause of dysrhythmias in clients receiving digoxin is hypokalemia from diuretics that are usually given simultaneously. Yellow haze indicates the client may have high serum digoxin levels. The therapeutic range for digoxin is relatively small and levels of 2.0 or greater are considered toxic. Having a client squeeze the nurse’s fingers is part of a neurological assessment and not needed for digoxin.
A client with essential hypertension is prescribed the beta blocker metoprolol (Lopressor). Which assessment data should make the nurse question administering this medication?
A. The client has an occipital headache.
B. The client’s blood pressure is 112/90.
C. The client’s apical pulse is 56.
D. The client is complaining of a yellow haze.
C. The client’s apical pulse is 56.
The nurse would question administering a beta blocker if the client’s blood pressure was less than 90/60 because this medication would further lower the blood pressure. The nurse would question administering a beta blocker if the client’s apical pulse was less than 60 because this medication decreases the heart rate. An occipital headache could be a sign of high blood pressure; therefore, the nurse would administer the medication. A yellow haze is a common symptom of a client who is exhibiting digoxin (a cardiac glycoside) toxicity.
The client diagnosed with arterial hypertension is receiving furosemide (Lasix), a loop diuretic. Which data indicates the medication is Effective?
A. The client reports occasional light-headedness and dizziness.
B. The client’s 8-hour intake is 1800 mL and the output is 2300 mL.
C. The client’s blood pressure went from 144/88 to 154/96.
D. The client has had a weight gain of 2.2 lbs in 7 days.
B. The client’s 8-hour intake is 1800 mL and the output is 2300 mL.
The client has had 500 mL (2300 - 1800 = 500) excess urinary output. This indicates the medication is effective - the diuretic is causing an increase in urinary ouput. 144/88 to 154/96 indicates the blood pressure has increased; therefore, the medication is not effective. A weight gain of 2.2 lbs in 7 days would indicate fluid retention. Signs of orthostatic hypotension does not indicate the medication is effective.
The client diagnosed with high blood pressure is ordered the angiotensin-converting enzyme inhibitor lisinopril. Which statements by the client indicate to the nurse the discharge teaching has been Effective? Select all that apply.
A. “I should get up slowly when I am getting out of my bed.”
B. “I should check and record my blood pressure once a day.”
C. “If I forget to take my medication, I will take two doses the next day.”
D. “If I get leg cramps, I should increase my potassium supplements.”
A. “I should get up slowly when I am getting out of my bed.”
B. “I should check and record my blood pressure once a day.”
Antihypertensive medications in general cause orthostatic hypotension. Therefore, the client should be taught to get up slowly from lying to sitting and sitting to standing position to help prevent dizziness and light-headedness. The blood pressure must be checked daily. ACE inhibitors can cause hyperkalemia and do not require potassium supplements. The client should never make up doses of medication missed; that may cause hypotension.
The nurse is preparing to administer the following medications. Which medication should the nurse question administering?
A. The loop diuretic furosemide (Lasix) to the client with a serum potassium level of 3.1 mEq/L.
B. The calcium channel blocker diltiazem (Cardizem) to the client with a glucose level of 280 mEq/L.
C. The vasodilator hydralazine (Apresoline) to the client with a blood pressure of 168/94.
D. The alpha blocker prazosin (Minipress) to the client with a serum sodium level of 137 mEq/L.
A. The loop diuretic furosemide (Lasix) to the client with a serum potassium level of 3.1 mEq/L.
The blood pressure (168/94) is elevated; therefore, the nurse should administer this medication without questioning it. The normal serum sodium level is 135-145 mEq/L. Therefore, the nurse should administer this medication without questioning. The glucose level is not pertinent when administering this medication. Although the glucose level is elevated (70-110 mg/dL is normal), it would not cause the nurse to question administering this medication. The serum potassium level is low (normal 3.5-5.0 mEq/L). Therefore, because a loop diuretic will cause further potassium loss, the nurse should question administering this medication and obtain a potassium supplement for the client.
The healthcare provider prescribed a beta blocker for the client diagnosed with arterial hypertension. Which statement is the scientific rationale for administering this medication?
A. This medication prevents the calcium from entering the cell, which helps decrease the client’s blood pressure.
B. This medication prevents the release of aldosterone, which decreases absorption of sodium and water, which, in turn, decreases blood pressure.
C. This medication decreases the sympathetic stimulation to the heart, thereby decreasing the client’s heart rate and blood pressure.
D. This medication will cause an increased excretion of water from the vascular system, which will decrease the blood pressure.
C. This medication decreases the sympathetic stimulation to the heart, thereby decreasing the client’s heart rate and blood pressure.
The nurse is preparing to administer a cardiac glycoside, a loop diuretic, and a beta blocker to a client diagnosed with heart failure. Which intervention should the nurse implement?
A. Assess the client’s blood pressure and heart rate.
B. Contact the pharmacist to discuss the medication.
C. Double-check the healthcare provider’s orders.
D. Hold the medications and notify the healthcare provider on rounds.
A. Assess the client’s blood pressure and heart rate.
Many clients with heart failure are prescribed multiple medications to help decrease the workload of the heart and increase contractility. There is no need to hold the medication and notify the healthcare provider. These medications all work in different parts of the body to help increase contractility of the heart, improve cardiac output, and decrease the workload on the heart. Multiple medications used to treat heart failure are prescribed to help control the client’s symptoms; therefore, there is no need for the nurse to contact the pharmacist. The nurse should not question administering multiple medications to treat heart failure that work on different parts of the body; this is an accepted standard of care, unless the client’s vital signs are in a non-therapeutic range.
The nurse is preparing to administer warfarin (Coumadin), an anticoagulant. The client’s current laboratory values are as follows: PT: 38; aPTT: 39; INR: 6.0. Which intervention should the nurse implement?
A. Administer the medication as ordered.
B. Discontinue the intravenous bag immediately.
C. Prepare to administer AquaMEPHYTON (vitamin K).
D. Notify the healthcare provider to increase the dose.
C. Prepare to administer AquaMEPHYTON (vitamin K).
Coumadin is administered orally. There is no reason to discontinue an IV. Vitamin K is the antidote for Coumadin toxicity. The therapeutic range for INR is 2-3. With an INR of 6.0, this client is at great risk for hemorrhage adn should be given the vitamin K. The dose should not be administered because it is above the therapeutic range. The dose should be held until the therapeutic range is obtained. Administering this medication is a medication error that could possibly result in the death of the client.
The nurse is discharging the female client diagnosed with deep vein thrombosis (DVT) who is prescribed the anticoagulant warfarin (Coumadin). Which statement indicates the client needs MORE teaching concerning this medication?
A. “If I get cut, I will apply pressure for at least 5 minutes.”
B. “I will increase the amount of green, leafy vegetables I eat.”
C. “I will have to see my healthcare provider regularly while taking this medication.”
D. “I should wear a MedicAlert bracelet in case of an emergency.”
B. “I will increase the amount of green, leafy vegetables I eat.”
The client is a risk of bleeding and should wear a medical alert bracelet to notify healthcare providers about the anticoagulant; therefore, the client understands the medication teaching. If the client cuts himself or herself, the client should apply direct pressure for 5 minutes without peeking at the cut. If the cut is still bleeding after this time, the client should continue to apply pressure and seek medical attention. This statement indicates the client understands the medication teaching. Green, leafy vegetables are high in vitamin K, which is the antidote for Coumadin toxicity. Green leafy vegetables would interfere with the therapeutic effects of coumadin. This statement indicates the client does not understand the medication teaching. The client’s PT/INR is monitored at routine intervals to determine if the medication is within the therapeutic range: an INR of 2-3 should be maintained. The client should regularly see the healthcare provider. This statement indicates the client understands the medication teaching.
The client diagnosed with a deep vein thrombosis (DVT) asks the nurse, “Why do I have to take my Coumadin in the evening?” Which statement is the nurse’s best response?”
A. “This allows for a more accurate INR level when we draw your morning labs.”
B. “The medicine should be given with the largest meal of the day.”
C. “The side effects of the Coumadin are less if you take it in the evening.”
D. “The medication works more effectively while you are sleeping.”
A. “This allows for a more accurate INR level when we draw your morning labs.”
Coumadin does not work better during the night and can be taken on an empty stomach or with food. There are not any side effects of Coumadin that would be decreased by taking the medication in the evening. Routine laboratory tests are drawn in the morning. If Coumadin is administered in the morning, the INR will be lower as a result of the medication’s effects wearing off. If the Coumadinis taken in the evening, then the INR level will reflect more accurately the peak blood level.
The client on strict bed rest is prescribed subcutaneous heparin. Which data indicates the medication is effective?
A. The client’s calves are normal size, are normal skin color, and are nontender.
B. The client performs active range-of-motion exercises every 4 hours.
C. The client’s varicose veins have reduced in size and appearance.
D. The client’s current PT is 22; the INR is 2.4; and the aPTT is 70.
D. The client’s current PT is 22; the INR is 2.4; and the aPTT is 70.
Heparin has a very short half-life, and to achieve a therapeutic level it must be administered intravenously. Subcutaneous heparin is used prophylactically to prevent deep vein thrombosis (DVT). Laboratory tests are not monitored for this route. Subcutaneous heparin is used prophylactically to prevent deep vein thrombosis. Symptoms of a DVT include calf edema, redness, warmth, and pain on dorsiflexion. Lack of these symptoms indicates the client does not have a DVT and that, therefore, the medication is effective. ROM exercise is an intervention and does not indicate the medication is effective. In most people, the appearance of varicose veins will improve when the legs are elevated. Remember, however, that varicose veins are superficial veins and that subcutaneous heparin is not used to treat this condition.
The client complaining of “acid” when lying down at night asks the nurse if there are any medications that might help? Which statement is the nurse’s best response?
A. “There are several over-the-counter and prescription medications available to treat this. You should discuss this with the healthcare provider.”
B. “There are no medications to treat this problem, but losing weight will sometimes help the symptoms.”
C. “Have you had any x-rays or other tests to determine if you have cancer or some other serious illness.”
D. “Acid reflux at night can lead to serious complications. You need to have tests done to determine the cause.”
A. “There are several over-the-counter and prescription medications available to treat this. You should discuss this with the healthcare provider.”
There are several classifications of medications used to treat acid reflux problems. Sometimes losing weight will help relieve symptoms, but the client did not ask about lifestyle modifications. Proton-pump inhibitors, histamine2 blockers, and antacids all treat the symptoms of acid reflux. The nurse should encourage the client to discuss which medication is best with the HCP. The symptoms do not indicate cancer. The nurse should not scare the client. Acid reflux can lead to complications, including adult-onset asthma, that should be treated, but most HCPs will empirically treat the symptoms of acid reflux before ordering tests to determine the cause or possible complications.
Which statement is an advantage to administering a histamine-2 (H2) blocker rather than an antacid to a client diagnosed with gastroesophageal reflux disease (GERD)?
A. H2 blockers require less frequent dosing than antacids.
B. H2 blockers are less expensive than antacids.
C. H2 blockers have more side effects than antacids.
D. Antacids are more potent than H2 blockers in relieving the symptoms of GERD.
A. H2 blockers require less frequent dosing than antacids.
H2 blockers actually block the production of gastric acid; they have a longer effect than an antacid. An increase in side effects would not be an advantage. Antacids are usually less expensive than H2 blockers. H2 blockers require less frequent administration than do antacids, which require frequent administration, seven or more times a day, for the therapeutic effects. The fewer times a client is expected to take a medication, the more likely the client is to comply with a medication regimen.
The nurse is discharging a client diagnosed with gastroesophageal reflux disease (GERD). Which information should the nurse include in the teaching?
A. If any discomfort is noted, take an NSAID for the pain.
B. Notify the healthcare provider if the medication does not resolve the symptoms.
C. Immediately after a meal, lie down for at least 45 minutes.
D. There are no complications of GERD as long as the client takes the medications.
B. Notify the healthcare provider if the medication does not resolve the symptoms.
There may be several complications of GERD. Adult-onset asthma and Barrett’s esophagus leading to cancer of the esophagus are two complications of GERD. The chance of developing these problems is less if GERD is adequately treated, but there are no guarantees. The client should always be informed of what symptoms to report to the HCP. The client should be instructed to sit upright for at least 60 minutes following a meal to prevent reflux from occurring. NSAIDs can increase gastric distress. Ulcers caused by NSAID use may be asymptomatic, or the symptoms may be attributed to the GERD. The client should use the prescribed H2 receptor blocker, proton-pump inhibitor, or an antacid to relieve the discomfort associated with GERD.
