week 6 sherpath Flashcards
A patient who is taking metoprolol questions the nurse regarding the need for liver function tests. Which nursing response is appropriate?
“The drug may not be effective if your liver function is abnormal.”
“Patients with decreased liver function may experience toxic effects from this drug.”
“This drug may damage the liver, so your health care provider needs to monitor liver function.”
“If your liver is not functioning well, the medication may not be absorbed properly.”
“Patients with decreased liver function may experience toxic effects from this drug.”
The nurse administers an oral dose of metoprolol at 0800 to a patient with hypertension. At which time will the nurse anticipate the peak effect?
0815
0830
1000
1400
1000
The charge nurse is teaching a group of new nurses about safe administration of beta blockers. Which statements indicate that further teaching is required?
Select all that apply.
“Metoprolol is commonly prescribed to treat hypertension.”
“Beta blockers increase the heart rate and force of cardiac contraction.”
“Metoprolol can cause liver failure, so laboratory values are required.”
“Beta blockers are only used to treat hypertension.”
“Beta blockers are also called beta-adrenergic antagonists”
“Beta blockers increase the heart rate and force of cardiac contraction.”
“Metoprolol can cause liver failure, so laboratory values are required.”
“Beta blockers are only used to treat hypertension.”
The nurse is teaching Ms. Jones about her new prescription for metoprolol. What teachings will the nurse include?
Select all that apply.
“Sit on the side of the bed for a few moments prior to standing up.”
“If you miss a dose, double your next dose.”
“Stop taking the medication if you experience side effects.”
“Inform all health care providers that you are taking metoprolol.”
“Notify your health care provider if dizziness becomes excessive.”
“Sit on the side of the bed for a few moments prior to standing up.”
“Inform all health care providers that you are taking metoprolol.”
“Notify your health care provider if dizziness becomes excessive.”
The nurse is conducting a health history on a patient who is taking a beta blocker. Which assessment data present contraindications or cautions to beta blocker therapy?
Select all that apply.
History of asthma
Second-degree atrioventricular (AV) block on telemetry monitor
Type 2 diabetes
Blood pressure 168/92 mm Hg
Difficulty with urination due to benign prostatic hypertrophy (BPH)
History of asthma
Second-degree atrioventricular (AV) block on telemetry monitor
Type 2 diabetes
The health care provider prescribes a maintenance dose of metoprolol 250 mg orally twice daily for hypertension. Which action would the nurse take upon receiving the prescription?
Ask the health care provider if the dose should be 500 mg once daily.
Administer the metoprolol as prescribed.
Hold the medication and ask the health care provider about the dose.
Discuss whether the medication should be given intravenously.
Hold the medication and ask the health care provider about the dose.
The charge nurse is teaching a new nurse about beta blockers. Which teaching would the nurse include?
First-generation beta blockers are nonselective and block beta1 and beta2 receptors.
Second-generation beta blockers include carvedilol and labetalol.
Beta blockers are divided into four categories or generations
Beta blockers stimulate beta receptors in the heart.
First-generation beta blockers are nonselective and block beta1 and beta2 receptors.
A patient is admitted to the emergency department with a blood pressure of 222/110 mm Hg. For which reason would the nurse anticipate intravenous (IV) beta blocker administration?
IV forms of beta blockers have immediate effects.
Administering a beta blocker intravenously prolongs the action of the drug.
There are fewer adverse systemic effects when giving IV beta blockers.
IV beta blockers have a slower peak time than other forms of these medications.
IV forms of beta blockers have immediate effects.
A 30-year-old female patient who is taking a beta blocker asks the nurse, “Can I take this drug if I am considering pregnancy?” Which nursing response is appropriate?
“The drug will affect your ability to become pregnant.”
“There is potential risk to the fetus because metoprolol crosses the placental barrier.”
“Being pregnant will alter the effectiveness of the medication.”
“Taking this drug while pregnant increases the risk for bradycardia.”
“There is potential risk to the fetus because metoprolol crosses the placental barrier.”
A patient who has hypertension and asthma asks, “Why can’t I take a beta blocker for my hypertension?” Which nursing response is appropriate?
“Taking a beta blocker with asthma medication increases the risk for toxicity.”
“Most asthma medications reduce the therapeutic effects of beta blocker medications.”
“Beta blocker medications can cause bronchospasm, which can trigger an asthma attack.”
“Asthma medications act to potentiate the effects of beta blockers, increasing the risk for toxicity.”
“Beta blocker medications can cause bronchospasm, which can trigger an asthma attack.”
A patient has been taking metoprolol IR for 6 weeks. Current assessment data includes a heart rate of 72 beats per minute and blood pressure of 126/74 mm Hg. The patient reports occasional dizziness, insomnia, and fatigue. Which recommendation will the nurse provide for this patient?
“You should stop the drug immediately.”
“It is important to discuss these symptoms with the health care provider.”
“You should go to an emergency department for evaluation.”
“These symptoms are common, harmless side effects.”
“It is important to discuss these symptoms with the health care provider.”
The nurse is caring for a patient with newly diagnosed hypertension who has been prescribed metoprolol. Which teaching would the nurse include?
Change positions slowly.
Avoid foods high in sugar.
Report a heart rate less than 80 beats per minute.
Stop taking the medication if the systolic blood pressure is less than 95 mm Hg.
Change positions slowly.
The nurse is teaching a patient who is being discharged with a prescription for metoprolol. Which patient statement indicates understanding of the teaching?
“I will take an antacid with the medication to prevent upset stomach.”
“I should begin to feel better right away.”
“I will not drive until I know how this medication affects me.”
“If I miss a dose of my medication, I will double the next dose.”
“I will not drive until I know how this medication affects me.”
When is atorvastatin expected to achieve its peak concentration?
0.25 to 0.5 hr
1 to 2 hr
3 to 6 hr
4 to 8 hr
1 to 2 hr
Which phrase accurately describes a statin’s mechanism of action?
Increase in apolipoprotein B-100 production
Reduction of cholesterol removal from circulation
Inhibition of the enzyme hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase
Reduction in the number of low-density lipoprotein (LDL) receptors on the hepatocytes
Inhibition of the enzyme hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase
Which statement regarding the pharmacokinetics of statins is accurate?
Statins have a bioavailability of 50%.
Statins are largely excreted in the urine.
Statins, except for pravastatin, are minimally protein bound.
Statins undergo first-pass metabolism through the liver, the primary site of statin activity.
Statins undergo first-pass metabolism through the liver, the primary site of statin activity.
Which medication that Mrs. Harrison is currently taking may cause a potential drug interaction with simvastatin?
Metformin
Ranitidine
Metoprolol
Amlodipine
Amlodipine
Which laboratory values will a nurse ensure are ordered for a patient before initiation of a statin?
Select all that apply.
Potassium
Lipid panel
Liver enzymes
Serum creatinine
Creatine kinase (CK)
Lipid panel
Liver enzymes
Creatine kinase (CK)
Which administration information will a nurse provide to a patient who is newly prescribed immediate-release lovastatin 20 mg?
Take it in the morning with a meal.
Take it in the evening with a meal.
Take it in the morning without a meal.
Take it in the evening without a meal.
Take it in the evening with a meal.
Which statins are significantly metabolized by CYP3A4?
Select all that apply.
Lovastatin
Fluvastatin
Pitavastatin
Simvastatin
Atorvastatin
Rosuvastatin
Lovastatin
Simvastatin
Atorvastatin
Which parameters are expected to decrease with statins?
Select all that apply.
Triglycerides
Total cholesterol
Apolipoprotein B-100
Low-density lipoprotein (LDL) cholesterol
High-density lipoprotein (HDL) cholesterol
Triglycerides
Total cholesterol
Apolipoprotein B-100
Low-density lipoprotein (LDL) cholesterol
Which statements regarding pharmacodynamics and pharmacokinetics of statins are accurate?
Select all that apply.
In general, statins undergo significant urinary excretion.
All statins except for simvastatin are highly protein bound.
Statins increase apolipoprotein B-100 production to decrease very low–density lipoprotein (VLDL) synthesis.
Statins reduce cholesterol production through inhibition of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase.
Hepatocytes increase the number of low-density lipoprotein (LDL) receptors in response to decreased cholesterol synthesis by statins to remove cholesterol from circulation.
Statins reduce cholesterol production through inhibition of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase.
Hepatocytes increase the number of low-density lipoprotein (LDL) receptors in response to decreased cholesterol synthesis by statins to remove cholesterol from circulation.
Which patients would a nurse determine can safely receive treatment with a statin in the absence of any other factors?
Select all that apply.
A 36-year-old pregnant patient
A 41-year-old breastfeeding patient
A 48-year-old patient with hyperthyroidism
A 69-year-old patient with alcoholic cirrhosis
A 55-year-old patient with type 2 diabetes mellitus
A 48-year-old patient with hyperthyroidism
A 55-year-old patient with type 2 diabetes mellitus
A 51-year-old male patient has been prescribed lovastatin 40 mg PO each evening to help lower his low-density lipoprotein (LDL) cholesterol. In addition to lovastatin, this patient also takes pantoprazole for gastroesophageal reflux disease (GERD), amiodarone for atrial fibrillation, tamsulosin for benign prostatic hyperplasia, and lisinopril for hypertension. Which medication could cause a potential drug interaction with lovastatin?
Lisinopril
Tamsulosin
Amiodarone
Pantoprazole
Amiodarone
A patient taking atorvastatin is experiencing the adverse effect of myositis. Which manifestations would a nurse expect to see in this patient?
Select all that apply.
Creatine kinase (CK) elevation
Muscle breakdown
Muscle inflammation
Muscle pain
Myoglobin in urine
Creatine kinase (CK) elevation
Muscle inflammation
Muscle pain
Which teaching points would a nurse share with a 33-year-old female patient who was prescribed statin therapy?
Select all that apply.
The patient should avoid pregnancy while receiving therapy with a statin.
Once the patient’s cholesterol parameters are reduced, she can expect to stop taking the - statin.
Gastrointestinal distress can be minimized by taking with food and/or with at least 6 to 8 oz of water.
Ensure she is getting plenty of exercise and a diet rich in vegetables, fruits, and fiber to help lower cholesterol levels.
Lipid levels are expected to maximally decrease in 2 to 3 weeks after initiation, and she should plan to have the lipid panel assessed around that time frame.
The patient should avoid pregnancy while receiving therapy with a statin.
Gastrointestinal distress can be minimized by taking with food and/or with at least 6 to 8 oz of water.
Ensure she is getting plenty of exercise and a diet rich in vegetables, fruits, and fiber to help lower cholesterol levels.
An obese 84-year-old patient is taking simvastatin 10 mg PO each evening. In addition to dyslipidemia, the patient has hypertension, diabetes, and hypothyroidism. Which factors increase this patient’s risk for rhabdomyolysis?
Select all that apply.
Obesity
Hypertension
Advanced age-
Hypothyroidism
High dose of statin
Advanced age-
Hypothyroidism
A patient who has received a prescription for lovastatin asks the nurse why grapefruit and grapefruit juice should ideally be avoided. Which explanation would the nurse provide?
Delays absorption of lovastatin
Decreases efficacy of lovastatin
Increases risk for rhabdomyolysis
Increases risk for myocardial infarction
Increases risk for rhabdomyolysis
An insurance company is requiring a patient receiving pitavastatin 2 mg to switch to another statin to receive coverage. Which statins and doses are therapeutically equivalent to pitavastatin 2 mg?
Select all that apply.
Lovastatin 20 mg
Pravastatin 40 mg
Simvastatin 20 mg
Rosuvastatin 5 mg
Atorvastatin 40 mg
Pravastatin 40 mg
Simvastatin 20 mg
Rosuvastatin 5 mg
Match the class of diuretic with the drug most commonly prescribed from that class.
Potassium-sparing diuretic
Loop diuretic
Thiazide diuretic
Answer choices
Furosemide
Spironolactone
Hydrochlorothiazide
Potassium-sparing diuretic
Spironolactone
Loop diuretic
Furosemide
Thiazide diuretic
Hydrochlorothiazide
The nurse is caring for a patient who is hypotensive after receiving a dose of furosemide. Which action of furosemide can cause hypotension?
Tubular reabsorption of sodium and chloride
Water retention and potassium-sparing
Excess fluid loss and dehydration
Decreased blood volume and cardiac output
Decreased blood volume and cardiac output
The nurse is caring for a patient who has heart failure and has developed bilateral crackles in the lungs. Based on onset of action, which diuretic would the nurse anticipate to be prescribed to quickly decrease the fluid?
Furosemide
Hydrochlorothiazide
Spironolactone
Amiloride
Furosemide
The nurse is teaching Ms. Adams about loop diuretics. Which teaching will the nurse include?
A loop diuretic causes high blood potassium levels.
Get a childproof cap for the diuretic.
Herbal supplements will not affect the diuretic.
A loop diuretic will increase urinary frequency.
A loop diuretic will increase urinary frequency.
When teaching Ms. Adams regarding loop diuretics, what will the nurse recommend regarding administration?
“Take your diuretic at 8 a.m.”
“Take your diuretic at 9 p.m.”
“Don’t eat foods that have potassium.”
“Over time, you may learn to like bananas.”
Take your diuretic at 8 a.m.”
The nurse is reviewing the medications for a patient who has just been prescribed a thiazide diuretic. Which medication history requires nursing intervention?
Furosemide
Spironolactone
Digoxin
Propranolol
Digoxin
Match the type of diuretic with its mechanism of action.
Block sodium and water reabsorption in the distal tubule
Block sodium and chloride reabsorption in the loop of Henle
Block sodium-potassium exchange in the collecting tubules
Answer choices
Loop diuretics
Potassium-sparing diuretics
Thiazide diuretics
Block sodium and water reabsorption in the distal tubule
Thiazide diuretics
Block sodium and chloride reabsorption in the loop of Henle
Loop diuretics
Block sodium-potassium exchange in the collecting tubules
Potassium-sparing diuretics
A patient recently prescribed a diuretic states, “I have heart failure and hypertension; I think I need a medication for each.” Which nursing response is appropriate?
“If we treat the heart failure with diuretics, then the hypertension will go away.”
“Diuretics can be used to treat both heart failure and hypertension.”
“We can call the health care provider to get a separate medication prescribed.”
“That is probably true, but it is common to start with one medication first.”
“Diuretics can be used to treat both heart failure and hypertension.”
Within which time frame would the nurse anticipate diuresis following the administration of oral furosemide?
10 to 20 minutes
60 minutes
1.5 to 2 hours
2.5 to 3 hours
60 minutes
The nurse is teaching a patient how thiazide diuretics reduce blood pressure. Which teaching will the nurse include?
Thiazide diuretics act directly on the smallest blood vessels, which causes vasodilation and lowers blood pressure.
Thiazide diuretics produce a rapid fluid loss, which decreases the overall amount of blood pumped through the heart each minute, thus lowering blood pressure.
Thiazide diuretics promote sodium and water removal and potassium retention, which lowers blood pressure.
Thiazide diuretics prevent the effects of aldosterone, a steroid hormone that causes water retention, which can lower blood pressure quickly.
Thiazide diuretics act directly on the smallest blood vessels, which causes vasodilation and lowers blood pressure.
A patient who began taking furosemide 24 hours ago reports increased frequency of urination. Which nursing response is appropriate?
“Increased frequency of urination is a side effect of this medication, and there is not much we can do about it.”
“Frequency of urination will decrease 6 to 8 hours after you take this medication. You should take it in the morning.”
“It is okay to skip a dose of your medication occasionally if frequent urination is bothering you.”
“I can provide a bedpan or urinal to prevent frequent visits to the bathroom.”
Frequency of urination will decrease 6 to 8 hours after you take this medication. You should take it in the morning.”
The nurse is caring for a patient who asks, “Is it safe for me to take spironolactone while I am pregnant?” Which nursing response is appropriate?
“Yes. This medication is safe to use during pregnancy.”
“I think so. Let me ask the pharmacy if a dosage reduction is required.”
“No. This medication is not recommended in pregnancy. Are you currently pregnant?”
“It’s more important to treat the heart failure.”
No. This medication is not recommended in pregnancy. Are you currently pregnant?”
A patient taking a thiazide diuretic has been admitted to the hospital. Which laboratory finding will the nurse associate with thiazide diuretics?
Hyperuricemia
Hyperkalemia
Hypoglycemia
Hyperammonemia
Hyperuricemia
Which patient statement demonstrates understanding of nursing education regarding the use of furosemide?
“I will lower myself slowly into bed.”
“I will weigh myself daily on the same scale.”
“I will take this medication an hour before eating breakfast.”
“I don’t need to use sunscreen while I am taking this medication.”
“I will weigh myself daily on the same scale.”
The nurse is teaching a patient about side effects of spironolactone. Which patient statement indicates that the teaching has been effective?
“I will use Mylanta if I get an upset stomach.”
“I will continue using a salt substitute on my eggs every morning.”
“I will stop taking this medication if I experience side effects.”
“I will do my gardening in the evening after the sun has gone down.”
“I will do my gardening in the evening after the sun has gone down.”
