Pharmacology Final Exam Review Q&A + NCLEX Study Questions/Open book Quizzes. Covering, Respiratory, Cardiac, Gastrointestinal and Emergency Drugs

Pharmacology Final Exam Review Questions (Open book quizzes & NCLEX Review Questions) Quiz 6 1.) Potassium chloride 10 mEq intravenously has been ordered for a client whose potassium is 2.9 following diuretics. How w ...

Pharmacology Final Exam Review Questions (Open book quizzes & NCLEX Review Questions) Quiz 6 1.) Potassium chloride 10 mEq intravenously has been ordered for a client whose potassium is 2.9 following diuretics. How will the nurse administer the potassium dose? A) Dilute the dose in a 50 ml IV rider and infused over 1 hour B) Push the dose as a rapid IV push because of the patient’s dangerously low potassium level C) Push the dose slowly over 10 minutes D) Ask to give the dose in a large muscle since the intravenously route is too dangerous 2.) A client who has been taking Lisinopril (an ace inhibitor) for 2 weeks complains of a dry cough. How should the nurse respond to this complaint? A) The cough will subside within 5 to 7 days when the body becomes accustomed to the medicine. B) The cough is a sign of impending angioedema. The client should stop the medicine immediately. C) The cough is a result of immune suppression. The client should stop the medicine immediately D) The cough is a common side effect of prils. Sartans may be prescribed instead if it becomes intolerable 3.) A client is experiencing edema. Which over-the-counter medication might be reducing the diuretic effects of her lisinopril? A) St John’s Wort B) Glucosamine C) Vitamin C D) Ibuprofen 4.) A client, who has been seeing multiple doctors, reports that she is taking Lisinopril and another antihypertensive medication, the name of which she can’t recall. What type of antihypertensive is contraindicated when people are taking ACE inhibitors due to risk of compound effects? A) Thiazide diuretics B) Beta blockers C) Potassium-sparing diuretics D) Calcium channel blockers 5.) In preparing discharge education for a client who has just begun hydrochlorothiazide therapy, a nurse reviews the client's lab results. Which finding should the nurse be concerned about in relationship to the discharge prescription? A) blood sugar level of 80 mg/dL B) potassium level of 3.1 mEq/L C) hemoglobin of 15 g/dL D) potassium level of 4.8 mEq/L. 6.) A client has had hypertension for approximately 7 years and now is interested in becoming pregnant. What is the safest anti-hypertensive for a woman in the early stages of pregnancy? A) Amlodipine B) Lisinopril C) Methyldopa D) Valsartan 7.) If a client is taking carvedilol, a beta blocker, which adverse effect should the nurse watch for? A) Hypoventilation B) Sinus tachycardia C) Hypergylcemia D) Dizziness 8.) While preparing to administer a scheduled dose of digoxin, the nurse finds a new lab result showing a digoxin level of 0.7 ng/mL. What action should the nurse take? A) Hold the drug for an hour and reassess the level. B) Withhold the drug and notify the prescriber immediately. C) Administer Digibind to counteract the toxicity. D) Check the patient’s apical pulse, and if it is within a safe range, administer the digoxin. 9.) A client has been taking digoxin 0.25 mg, and furosemide 40 mg, daily. Upon routine assessment by the nurse, the client states, “I see yellow halos around the lights.” The nurse should perform which of the following actions based on this assessment? A) Consult the provider then request a digoxin and potassium level check B) Withhold the next dose of furosemide. C) Continue to monitor the patient for heart failure. D) Document the findings and reassess in 1 hour. 10.) A client with angina is preparing to go home with a prescription for Nifedipine, a calcium channel blocker. What should the client be taught? A) Elevate your feet when you are sitting to avoid edema side effects B) Drink grapefruit juice with breakfast to reduce your risk of plaque. C) Eat cheese regularly to restore calcium and manage loose stools. D) Use salt substitute to replenish your potassium losses due to diuretic effects 11.) A client with stable angina asks why the physician told her to put her nitro patch on at 8am and take it off at 8pm. What explanation should he be given? A) The doctor is trying to reduce your risk of night falls. B) Patch-free intervals are needed to sustain medication effectiveness. C) The patch should be replaced, not removed at bedtime D) You should follow this advice for any patch medications you use. 12.) A client with stable angina as starting treatment with nifedipine a calcium channel blocker. The client’s spouse asks how nifedipine alleviates chest pain. How should the nurse respond? A) “They reduce platelet aggregation.” B) “They reducing the work of the heart by reducing aortic pressure (afterload).” C) “They increase the heart rate and contractility.” D) “They improve cardiac circulation through vasoconstriction.” 13.) The nurse is providing patient education to a patient who has just been given a new prescription for sublingual nitroglycerin tablets. Which statement by the client would indicate a need for additional teaching? A) “I should take the nitro every 2 to 3 minutes until my pain goes away.” B) “I should take one tablet every 5 minutes, up to a total of three tablets if needed.” C) “I should store my nitroglycerin in its original dark bottle to protect it from light.” D) “I should keep the bottle of nitro tightly closed to protect the tablets.” 14.) A client presents to the emergency department with chest pain. On a scale of 1:10 he rates the pain as a 6. His respiratory rate is 22. His blood pressure is 156/92. His heart rate is 110. He is afebrile. What other information should the nurse obtain before administering nitroglycerin? A) Has the patient experienced any dizziness or nausea within the last two weeks? B) Has the patient used any alcohol or drugs for erectile dysfunction recently? C) Has the patient taken any drugs within the past 12 hours? D) Has the patient had a previous heart attack? 15.) A client is being discharged to his home on enoxaparin (Lovenox) injections for treatment of deep vein thrombosis (DVT). Which of the following statements made by the client indicates a need for further discharge teaching by the nurse? A) “I will inject the enoxaparin into the fatty tissue of my abdomen.” B) “I hate needles, but I know enoxaparin doesn’t come in pill form.” C) “I will need to go to my doctor’s office each day to have my enoxaparin blood drawn." D) “I will call my physician if I pass black tarry stools or pink urine.” 16.) A client is brought to the emergency department for accidental warfarin (Coumadin) overdose. The nurse determines that the client has no apparent signs of bleeding. Which action should the nurse take next? A) Obtain a stat PTT level. B) Administer protamine sulfate. C) Type and cross-match the patient’s blood. D) Draw a stat blood level for PT or INR. 17.) In which of the following situations should the nurse prepare to administer of protamine sulfate? A) A patient on warfarin with an INR of 4 and tarry stools B) A patient on warfarin with a PT of 12 seconds and bleeding from a laceration C) A patient on a heparin drip with a PTT >120 seconds and active GI bleeding D) A patient on a heparin drip with a PTT of 60 seconds and pink-tinged urine 18.) A client is starting sildenafil (Viagra) for the treatment of pulmonary hypertension. Which of these medications could cause a serious reaction if they are taken with sildenafil? A) nitroglycerin, an antianginal B) clopidigrel, and antiplatelet C) simvastatin, an antilipemic D) CoEnzyme Q, an herbal remedy E) doxazosin, an alpha blocker Table for Individual Question Feedback 19.) Atenolol (Tenormin) has been prescribed for a client who is recovering from a recent heart attack. The nurse would consult the provider before giving the medicine in which of these situations? (Select all that apply.) A) Pulse 52 B) BP 108/86 C) Respirations 32 with wheezes D) Blood glucose 50 E) Tension headache F) Parkinsonian tremors 20.) A client presents in the clinic with concerns of having taken his dabigitran (Pradaxa) twice this morning. Realizing that this is a new oral anticoagulant (NOAC), what should the nurse do next? (Select all that apply.) A) Seek advice from the physician B) Ask the client to share how the overdose happened C) Have the client eat a spinach salad D) Have the lab check a stat INR E) Calm the client by explaining that the medication has a 12 hour half life F) Assess for signs of active bleeding Quiz 7 1.) In preparing to administer albuterol (Proventil) and beclomethasone (Beconase) inhalers to an asthmatic client, what is most important for the nurse to remember? A) Change the schedule, because these medications should not be administered concurrently. B) Administer the albuterol first, wait 5 minutes, and then administer the beclomethasone. C) Call the prescriber, because these medications are the same. D) Administer the beclomethasone before breakfast and the albuterol after breakfast. 2.) A hospitalized patient receives codeine as an antitussive. What type of client could be harmed by cough suppression? A) A client with asthma B) A client with reflux and impaired swallowing who aspirates C) A client with loose stools D) A client who is allergic to bee stings 3.) A patient with a pneumonia-related cough has been advised to add guaifenesin to the regimen of antibiotics. The client asks about the purpose of the drug. How should the nurse’s respond? guaifenesin will A) Guaifenesin will potentiate the antibiotics you are taking to fight the infection.” B) Guaifenesin will relieve any pain associated with your cough.” C) Guaifenesin will help dry your secretions so that you produce less mucus with your cough.” D) Guaifenesin will help stimulate the flow of secretions and help you bring them up.” 4. ) The nurse is providing patient education to an elderly being treated for duodenal ulcers with Carafate (Sucralfate). The client asks the nurse how sucralfate helps heal ulcers. How should the nurse respond? A) “It creates a protective barrier against pepsin and acid.” B) “It suppresses gastric acidity, irreversibly.” C) “It inhibits the enzyme that generates gastric acid.” D) “It enhances prostaglandin production.” 5.) The nurse is providing education to a client who has been prescribed both an antacid and ranitidine (Zantac). Which instruction should the nurse give the client about taking the medications? A) “Take the ranitidine before meals and take the antacid for heartburn if needed after meals.” B) “The antacid and ranitidine should be taken at the same time for better effect.” C) “The antacid should be taken 15 minutes before the ranitidine.” D) “Both medications should be taken on a full stomach.” 6.) The nurse is preparing to give medications to a client taking sucralfate (Carafate) and ciprofloxacin (Cipro). The drugs are ordered for 0900. In what manner should the nurse proceed to administer the drugs? A) The nurse should administer the drugs with a full glass of water. B) The nurse should ask the prescriber to stagger the medication times. C) The nurse should administer the two drugs at same time with food. D) The nurse should administer the ciprofloxacin 15 minutes before the sucralfate. 7.) The nurse who is caring for a post-operative client administers Compazine, a phenothiazine (related to Thorazine). What side effects should the nurse watch for, given this classification? A) Extrapyramidal symptoms B) Hyper-vigilance C) Hiccups D) Drooling 8.) For patients who don’t require PPIs or H2 inhibitors, antacids should be taken A) Routinely before meals B) Routinely after meals C) Whenever heartburn occurs (prn) qid D) At bedtime only 9.) When teaching a client with renal insufficiency how to manage constipation, what teaching point should the nurse convey about laxatives? A) Laxatives containing magnesium are the best remedy for renal patients B) Laxatives should only be given after suppositories or enemas have failed C) Laxatives are an unavoidable fact of life for people over the age of 80 D) Laxatives can be habit forming if taken repeatedly 10.) Which of these teaching points about gastro-esophageal reflux would be helpful to a client with reflux? A) Proton pump inhibitors like Protonix should be taken with every meal B) Reflux is triggered by carbonated beverages C) People who experience reflux at night should eat cheese and crackers before retiring D) Alcohol is a good remedy for reflux because it neutralizes acid 11.) The ventrogluteal site is recommended when intramuscular opiates are ordered to treat abdominal pain. What are the Landmarks for the ventrogluteal site? A) Palm over trochanter, fingertips over anterior & superior ileac crests B) Two finger breadths below the acromium process C) Two inches above or below the umbillicus D) The right lower quadrant of the buttocks 12.) A mother brings her 17-year-old daughter to the emergency department and states that the daughter took 40 extended-release acetaminophen tablets. What medication should the nurse procure so it is available when the provider's orders that it should be given. A) flumazenil (Romazicon) B) Solumedrol (methylprednisolone) C) acetylcysteine (Mucomyst) D) protamine sulfate 13.) A spouse is requesting that an alternative for lactulose be given to a constipated client with elevated liver enzymes. How should the nurse respond? A) Explain that Lactulose is the only laxative the Veterans Administration will pay for B) Validate the concern, given the patients liver issues C) Explain that Lactulose binds ammonia in the gut when the impaired liver can't. D) Explain that Lactulose is the final stop. It creates ultimate Laxative dependency 14.) Which antiepileptic medication is considered safer than others in pregnancy A) Lamictal (lamotrigine) B) Dilantin (phenytoin) C) Depakote (valproic acid) D) Neurontin (gabapentin) 15.) Which of these immune modifiers would the nurse question in pregnancy? A) Methotrexate (Trexall) B) Etanercept (Enbrel) C) Infliximab (Remicade) D) Anakinra (Kineret) 16.) A pregnant client is suffering from acid indigestion. The nurse would question giving which of these medicines for epigastric distress to a woman who was pregnant? A) misoprostol (Cytotec) B) metoclopramide (Reglan) C) calcium carbonate (TUMS) D) magnesium calcium combinations (Rolaids) 17.) An asthmatic client comes into the emergency room with rapid pulse, rapid respirations, minimal breath sounds in the bases. Which of these therapies should the nurse anticipate, and have available, pending providers order A) Duoneb (albuterol and ipratropium) via nebulizer B) methylprednisolone (Solumedrol) Intravenous C) oxygen D) diphenhydramine (Benadryl) by mouth E) Codeine syrup to suppress cough 18.) A client has been prescribed Librax (chlordiazepoxide and clidinium), an anticholinergic benzodiazepine, for irritable bowel syndrome. Which of these conditions would constitute a contraindication for Librax? A) History of substance abuse B) Glaucoma C) Attention deficit disorder D) History of migraines E) History of anemia 19.) A spouse of a hospice client wants to know why the sublingual dose of morphine is so much lower than the MS Contin dose that was given orally, and the IM injection dose that was given in the hospital. How should the nurse respond? (Select all that apply) A) The oral dose was a slow delivery dose. Sublingual is rapid, and given more often B) He is losing consciousness, so his need for pain control is less C) The MS Contin was partly metabolized in the liver before it started working D) Sublingual medications enter the bloodstream more quickly than IM doses E) This must be a mistake. He should need more pain control, not less. 20.) A client who is taking Haldol, Aricept, Colace, TUMs and Ampicillin is having loose stools. Which of these may be contributing to the diarrhea? A) Ampicillin B) Haldol (haloperidol) C) Aricept (donepezil) D) Colace (docusate) E) TUMs (calcium carbonate) Mixed Review Questions from Previous Open Book Quizzes (Quizzes 2, 3, 4, 5) 1.) When metronidazole (Flagyl) is a component of the H. pylori treatment regimen, what instructions should the client receive? A) Avoid foods containing tyramine. B) Take the drug with food. C) Take the drug on an empty stomach. D) Avoid any alcoholic beverages. 2.) What advice should the nurse offer a client who is being started on a significant amount of Prednisone? Select all that apply. A) Consult your doctor if nausea prevents you from taking this drug. Don’t stop it abruptly * B) Take the medication on an empty stomach. This will help assure full absorption C) Snack often on simple starches and comfort foods. This will help you avoid hypoglycemia D) Use table salt. Avoid salt substitute because steroids cause potassium retention & sodium losses 3.) In which of these situations would the nurse question the administration of steroid eye drops? A) During an eye infection B) After cataract surgery C) After a corneal abrasion D) After a chemical eye splash 4.) Lantus Insulin (glargine) is prescribed for a hospitalized patient who is diabetic. When will the nurse administer this drug? A) Approximately 15 to 30 minutes before each meal B) In the morning and at 4 PM C) Once daily at bedtime D) After meals and at bedtime 5.) A client in ketoacidosis needs intravenous insulin. What should the nurse understand before giving IV insulin? A) Either aspart or glargine insulin can be administered IV, so the nurse should ask which one to give B) It is customary to administer the same dose IV that would be given subcutaneously per sliding scale C) Insulin should never be given IV, so this order should be questioned. D) Only regular insulin can be administered IV. It is given in smaller increments. 6.) A client calls from home to report that his lispro (Humalog) insulin appears cloudy. What would be the nurse’s best response? A) “Agitate the solution, and the granules should disperse.” B) “Discard the vial. The solution should be clear.” C) “Proceed with the injection. Drawing the solution into the syringe will mix the particles.” D) “Lispro is always cloudy. Proceed with the injection.” 7.) A client with type I diabetes who takes insulin reports taking propranolol for hypertension. Why would this cause the nurse to be concerned? A) the beta blocker can cause insulin resistance and hyperglycemia. B) using the two agents together increases the risk of ketoacidosis. C) propranolol increases insulin requirements because of receptor blocking. D) the beta blocker can mask the symptoms of hypoglycemia. 8.) The nurse manages care for a client with diabetes who takes metformin (Glucophage). Which laboratory result would cause the nurse to question the prescription? A) Elevated creatinine B) Decreased hemoglobin C) Decreased platelets D) Increased iron 9.) The nurse is providing client education after laboratory findings reveal am elevated thyroid-stimulating hormone (TSH). How would the nurse best explain the implications of the laboratory finding to the client? A) “Hypothyroidism causes a decrease in TSH.” B) “The test probably is erroneous, because you don’t have a goiter.” C) “TSH is not a good screening test for thyroid disease.” D) “The low TSH is consistent with hyperthyroidism.” 10.) A steroid dependent client has a blood glucose level of 249 mg/dL. Her blood pressure is 178/99 and she is complaining of muscle aches and weakness. Her face appears very round and puffy.” What would the nurse suspect? What type of advocacy does the client need? A) Advocacy for a TSH level is needed because these symptoms indicate Graves’ disease B) Advocacy for fludrocortisone is needed because these symptoms are consistent with Addison’s disease C) Diuretics and glucose control may be needed. Cushing’s syndrome presents this way D) Diabetic ketoacidosis is causing the clients sodium pump to shut down. An IV insulin drip is needed. 11.) A client being followed for latent tuberculosis has been on isoniazid therapy for 2 months. The nurse notes that the liver function test results have become grossly abnormal during that interval. What should the nurse do? A) Continue the drug unless jaundice, nausea, or itching develops. B) Continue the drug and have liver function tests repeated weekly. C) Hold the medication, and seek an alternative medication from the prescriber. D) Stop the drug and restart it when liver function returns to normal. 12.) A client, who is taking rifampin, telephones the nurse to say, “My urine and saliva have looked orange-red for the past 2 days.” Select the nurse’s best response. A) “This is consistent with an allergic response, and the drug should be stopped.” B) “Continue the drug for another week to see if the color returns to normal.” C) “Stop the drug, because it is likely that hepatitis has developed.” D) “This is a normal effect of the drug and is harmless.” 13.) A client with persistent pain due to cancer is brought to the emergency department by his spouse. Upon assessment, the nurse notes pinpoint pupils and a respiratory rate of 6 breaths per minute. The nurse should immediately prepare for administration of which medication? A) Naloxone (Narcan) B) Flumazenil (Romazicon) C) Methamphetamine hydrochloride (Desoxyn) D) Acetylcysteine (Mucomyst) 14.) A client taking amitriptyline (Elavil) complains of having blurred vision and dry mouth, and he states that he hasn’t had a bowel movement in 3 days, whereas he normally has one daily. His vital signs are temperature 97.6° F, pulse 90/minute, blood pressure 130/79 mm Hg, and respirations 20/minute. Based on this assessment, the nurse should suspect which of the following causes? A) Medication incompatibilities B) Sympatholytic effects C) Dehydration D) Anticholinergic effects 15.) The nurse is preparing to administer lithium (Eskalith), to a client with bipolar disorder whose lithium level is 2.0 mEq/L. What symptoms might the nurse expect to see? (Select all that apply.) A) Irregular heart rate B) Hunger C) Slurred speech D) Unsteady gate E) Pacing F) Drooling 16.) A client who has been taking an antiepileptic medication with a narrow therapeutic window for 2 weeks seems confused and forgetful. What should be the priority action of the nurse? A) Call the prescriber and have them change the seizure medication changed. B) Give an antihistamine like diphenhydramine under house protocol for a suspected allergy. C) Seek a plasma drug level from the client’s physician. D) Set up oxygen and obtain an order for activated charcoal. 17.) A nurse in the emergency department is caring for a client whose family reports that she had taken an overdose of diazepam. Which of the following medications should the nurse have available to reverse the CNS depression caused by this drug? A) Ondasteron (Zofran) B) Magnesium sulfate C) Flumazanil (Romazicon) D) Protamine sulfate 18.) A nurse is reviewing a client’s list of medications and notices that he is taking two anticholinergics. Which of his recent symptoms could be caused by his anticholinergic medications? (Select all that apply) A) Epigastric distress B) Tachycardia C) Dry mouth D) Frequent loose stools E) Blurred vision 19.) A client is using a prn scopolamine patch for motion sickness. Knowing that the medication has anticholinergic side effects, the client should be taught to anticipate which side effects? (Select all that apply!) A) Urine retention B) Blurred vision C) Dry mouth D) Diarrhea E) Wheezes 20.) A nurse recognizes that the actions of benzodiazepines include which of the following benefits? (Select all that apply.) A) Sleep facilitation B) Relief of general anxiety C) Suppression of seizures and/or seizure activity D) Reversal of Parkinsonism E) Improvement of muscle coordination 21.) A 68 year old male has a history of seizures and has been taking phenytoin (Dilantin) for years. His last seizure occurred 2 years ago, so he has decided that he no longer needs the medication. What would be the best action of the nurse? (Select all that apply.) A) Recommend that he start cutting his pills in half, and see how it goes B) Affirm his plan to stop taking it, but advise that he should restart it if tremors occur C) Recommend that he develop a withdrawal plan with his prescriber D) Educate the client that suddenly stopping the drug could precipitate seizures. E) Advise the client that once a medication for seizures is started it can never be stopped. NCLEX Study Questions from textbook Respiratory 1.) A patient tells the nurse that he has started to take an over-the-counter (OTC) antihistamine, diphenhydramine (Benadryl). In teaching about side effects, what is most important for the nurse to tell the patient? A. Do not to take this drug at bedtime to avoid insomnia. B. Avoid driving a motor vehicle until stabilized on the drug. C. Nightmares and nervousness are more likely in an adult. D. Medication may cause him to have excessive secretions. 2.) A patient complains of a sore throat and has been told it is due to beta-hemolytic streptococcal infection. The nurse anticipates that the patient has which acute condition? A. Rhinitis B. Sinusitis C. Pharyngitis D. Rhinorrhea 3.) A patient is prescribed the decongestant oxymetazoline (Afrin) nasal spray. What will the nurse teach the patient? A. Take this drug at bedtime because it may cause drowsiness. B. Directly spray the medication away from the nasal septum, and gently sniff. C. This drug may be used in maintenance treatment for asthma. D. Limit use of the drug to 5 to 7 days to prevent rebound nasal congestion. 4.) A patient has been prescribed guaifenesin (Robitussin). The nurse understands that the purpose of the drug is to accomplish what? A. Treat allergic rhinitis and prevent motion sickness. B. Loosen bronchial secretions so coughing can eliminate them. C. Compete with histamine for receptor sites, thus preventing a histamine response. D. Stimulate alpha-adrenergic receptors, thus producing vascular constriction of capillaries in nasal mucosa. 5.) Beclomethasone (Beconase) has been prescribed for a patient with allergic rhinitis. What should the nurse teach the patient regarding this medication? A. This may be used for an acute attack. B. An oral form is available if the patient prefers to use it. C. Avoid large amounts of caffeine intake because an increased heart rate may occur. D. With continuous use, dryness of the nasal mucosa/lining may occur. 6.) The nurse is teaching a patient about diphenhydramine (Benadryl). Which instructions should the nurse include in the patient's teaching plan? (Select all that apply.) A. Take medication on an empty stomach to facilitate absorption. B. Avoid alcohol and other central nervous system depressants. C. Notify the health care provider if confusion or hypotension occurs. D. Use sugarless candy, gum, or ice chips for temporary relief of dry mouth. E. Avoid handling dangerous equipment or performing dangerous activities until stabilized on the medication. Respiratory 1.) An Advair Diskus, fluticasone propionate (Flonase) and salmeterol (Serevent) 100 mcg/50 mcg, is ordered for a patient with COPD. What does the nurse know about this medication? (Select all that apply.) A. It can be used to treat an acute attack. B. It is delivered as a dry powdered inhaler. C. It contains a beta1 agonist and Cromolyn. D. It is taken as one puff two times a day. E. It promotes bronchodilation. 2.) A patient with COPD has an acute bronchospasm. The nurse anticipates that the health care provider will prescribe which medication? A. zafirlukast (Accolate) B. epinephrine (Adrenalin) C. dexamethasone (Decadron) D. oxtriphylline-theophyllinate 3.) A patient is prescribed aminophylline–theophylline. For what adverse effect should the nurse monitor the patient? A. Drowsiness B. Hypoglycemia C. Increased heart rate D. Decreased white blood cell count 4.) A patient is receiving IV aminophylline. The nurse checks the patient's lab values. The serum theophylline level is 32 mcg/mL. What action should the nurse take? A. Assess the patient's breath sounds for improvement. B. Increase the dosage per sliding scale directions. C. Notify the health care provider of the level. D. Have the laboratory collect another sample to verify the results. 5.) A patient with COPD is taking a leukotriene antagonist, montelukast (Singulair). The nurse is aware that this medication is given for which purpose? A. Maintenance treatment of asthma B. Treatment of acute asthmatic attack C. Reversing bronchospasm associated with COPD D. Treatment of inflammation in chronic bronchitis Cardiac 1.) The patient is receiving digoxin for treatment of heart failure. Which finding would suggest to the nurse that heart failure is improving? A. Pale and cool extremities B. Absence of peripheral edema C. Urine output of 60 mL/4 h D. Complaints of increasing dyspnea 2.) The patient's serum digoxin level is 3.0 ng/mL. What does the nurse know about this serum digoxin level? A. It is in the high (elevated) range. B. It is in the low (decreased) range. C. It is within the normal range. D. It is in the low average range. 3.) The nurse is assessing a patient for possible evidence of digitalis toxicity. The nurse acknowledges that which is included in the signs and symptoms for digitalis toxicity? A. Apical pulse rate of 100 beats/min B. Apical pulse of 72 beats/min with an irregular rate C. Apical pulse of 90 beats/min and an irregular rate D. Apical pulse of 48 beats/min and irregular rate 4.) A patient is taking a potassium-depleting diuretic and digoxin. The nurse expects that a low potassium level (hypokalemia) could have what effect on digoxin (Lanoxin)? A. Increase serum digoxin sensitivity level B. Decrease serum digoxin sensitivity level C. Have no effect on serum digoxin sensitivity level D. Cause a low average serum digoxin sensitivity level 5.) A patient takes an initial dose of a nitrate. Which symptom(s) will the nurse expect to occur? A. Nausea and vomiting B. Headaches C. Stomach cramps D. Irregular pulse rate 6.) A patient is prescribed a beta blocker. The nurse acknowledges that beta blockers are as effective as antianginals because they do what? A. Increase oxygen to the systemic circulation B. Maintain heart rate and blood pressure C. Decrease heart rate and decrease myocardial contractility D. Decrease heart rate and increase myocardial contractility 7.) The health care provider is planning to discontinue a patient's beta blocker. Which instruction will the nurse give the patient regarding the beta blocker? A. The beta blocker should be abruptly stopped when another cardiac drug is prescribed. B. The beta blocker should not be abruptly stopped; the dose should be tapered down. C. The beta blocker dose should be maintained while taking another antianginal drug. D. Half the beta blocker dose should be taken for the next several weeks. 8.) The beta blocker acebutolol (Sectral) is prescribed for dysrhythmias. The nurse knows that what is the primary purpose of the drug? A. Increase beta1 and beta2 receptors in cardiac tissues B. Increase the flow of oxygen to cardiac tissues C. Block beta1-adrenergic receptors in cardiac tissues D. Block beta2-adrenergic receptors in cardiac tissues 9.) A patient who has angina is prescribed nitroglycerin. Which are appropriate nursing interventions for nitroglycerin? (Select all that apply.) A. Have patient sit or lie down when taking a nitroglycerin sublingual tablet. B. Teach patient who has taken a tablet to call 911 in 5 minutes if chest pain persists. C. Apply Transderm-Nitro patch to a hairy area to protect skin from burning. D. Call the health care provider after taking five tablets if chest pain persists. E. Warn patient against ingesting alcohol while taking nitroglycerin. Cardiac 1.) A patient is taking hydrochlorothiazide (HCTZ) 50 mg/day and digoxin (Lanoxin) 0.25 mg/day. The nurse plans to monitor the patient for which potential electrolyte imbalance? A. Hypocalcemia B. Hypokalemia C. Hyperkalemia D. Hypermagnesemia 2.) The nurse knows that which statement is correct regarding nursing care of a patient receiving hydrochlorothiazide (HCTZ)? (Select all that apply.) A. Monitor patient for signs of hypoglycemia. B. Administer ordered potassium supplements. C. Monitor serum potassium and uric acid levels. D. Assess blood pressure before administration. E. Notify health care provider if patient has had oliguria for 24 hours. F. Assess for decreased cholesterol and triglyceride levels. 3.) A patient has heart failure, and a high dose of furosemide (Lasix) is ordered. What suggests a favorable response to Lasix? A. Decrease in level of consciousness and sleeping more B. Respiratory rate decreases from 28/min to 20/min and the depth increases. C. Increased congestion heard in breath sounds and complains of shortness of breath D. Urine output of 50 mL/4 h and intake of 200 mL 4.) What does the nurse know to be correct concerning the use of mannitol (Osmitrol) in patients? A. Decreases intracranial pressure B. Increases intraocular pressure C. Causes sodium and potassium retention D. Causes diuresis in several days 5.) What should the nurse do when a patient is taking furosemide (Lasix)? A. Instruct patient to change positions quickly when getting out of bed. B. Assess blood pressure before administration. C. Administer at bedtime for maximum effectiveness D. Teach to avoid fruits to prevent hyperkalemia. 6.) For the patient taking a diuretic, a combination such as triamterene and hydrochlorothiazide may be prescribed. The nurse realizes that this combination is ordered for which purpose? A. To decrease serum potassium level B. To increase serum potassium level C. To decrease glucose level D. To increase glucose level 7.) The patient has been receiving spironolactone (Aldactone) 50 mg/day for heart failure. The nurse should closely monitor the patient for which condition? A. Hypokalemia B. Hyperkalemia C. Hypoglycemia D. Hypermagnesemia 1.) A patient's blood pressure (BP) is 130/84. The health care provider plans to suggest nonpharmacologic methods for the patient. Which should the nurse include in teaching? (Select all that apply.) A. Stress-reduction techniques B. Starting an exercise program C. Salt restriction D. Smoking cessation E. Diet with increased protein 2.) A patient has developed mild hypertension. The nurse acknowledges that the first-line drug for treating this patient's blood pressure might be which drug? A. Diuretic B. Alpha blocker C. ACE inhibitor D. Alpha/beta blocker 3.) An African-American patient has developed hypertension. The nurse is aware that which group(s) of antihypertensive drugs are less effective in African-American patients? A. Diuretics B. Calcium channel blockers and vasodilators C. Beta blockers and ACE inhibitors D. Alpha blockers 4.) The nurse knows that which diuretic is most frequently combined with an antihypertensive drug? A. chlorthalidone B. hydrochlorothiazide C. bendroflumethiazide D. potassium-sparing diuretic 5.) The nurse is administering a beta blocker to a patient. Which is an important assessment to perform before administration? A. Urine output B. Apical pulse C. Potassium level D. Serum level of medication 6.) Captopril (Capoten) has been ordered for a patient. The nurse teaches the patient that angiotensin-converting enzyme (ACE) inhibitors have which common side effects? A. Nausea and vomiting B. Dizziness and headaches C. Upset stomach D. Constant, irritating cough 7.) A patient is prescribed losartan (Cozaar). The nurse teaches the patient that an angiotensin II receptor blocker (ARB) acts by doing what? A. Inhibiting angiotensin-converting enzyme B. Blocking angiotensin II from AT1 receptors C. Preventing the release of angiotensin I D. Promoting the release of aldosterone 8.) During an admission assessment, a patient states that she takes amlodipine (Norvasc). The nurse wishes to determine whether the patient has any common side effects of a calcium channel blocker. The nurse asks the patient if she has which signs and symptoms? (Select all that apply.) A. Insomnia B. Dizziness C. Headache D. Angioedema E. Ankle edema F. Hacking cough 1.) A patient is placed on heparin, and the nurse acknowledges that heparin is effective for preventing clot formation in patients who have which disorder(s)? (Select all that apply.) A. Coronary thrombosis B. Acute myocardial infarction C. Deep vein thrombosis D. Hemorrhagic cerebrovascular accident (stroke) E. Disseminated intravascular coagulation 2.) A patient who received heparin begins to bleed. The nurse anticipates that the health care provider will order which antidote? A. protamine sulfate B. vitamin K1 (Mephyton) C. aminocaproic acid (Amicar) D. potassium chloride (KCl) 3.) A patient is prescribed enoxaparin (Lovenox). The nurse knows that low–molecular-weight heparin has what kind of half-life? A. A longer half-life than heparin B. A shorter half-life than heparin C. The same half-life as heparin D. A four times shorter half-life than heparin 4.) The nurse is teaching a patient about clopidogrel (Plavix). Which information will the nurse include in the patient's teaching plan? A. Constipation may occur. B. Hypotension may occur. C. Bleeding may increase when taken with aspirin. D. Normal dose is 25 mg tablet per day. 5.) A patient had an orthopedic surgery and is prescribed dalteparin (Fragmin). What would the nurse teach the patient and/or family about this low–molecular-weight heparin (LMWH) before discharge? A. How to administer the medication intramuscularly B. PT and INR monitoring will be done weekly. C. Avoidance of green leafy vegetables is recommended. D. Watch for bleeding or excessive bruising. 6.) A patient is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally? A. enoxaparin sodium (Lovenox) B. warfarin (Coumadin) C. bivalirudin (Angiomax) D. lepirudin (Refludan) 7.) A patient is taking warfarin 5 mg/day for atrial fibrillation. The patient's international normalized ratio (INR) is 3.8. The nurse would consider the INR to be what? A. Within normal range B. Elevated range C. Low range D. Low-average range 8.) Cilostazol (Pletal) is being prescribed for a patient with coronary artery disease. The nurse understands that which is the major purpose for antiplatelet drug therapy? A. Dissolve the blood clot B. Decrease tissue necrosis C. Inhibit hepatic synthesis of vitamin K D. Suppress platelet aggregation 9.) A patient is to undergo a coronary angioplasty. The nurse acknowledges that which drug is used primarily for preventing reocclusion of coronary arteries following coronary angioplasty? A. clopidogrel (Plavix) B. abciximab (ReoPro) C. warfarin (Coumadin) D. cilostazol (Pletal) 10.) A patient is admitted to the emergency department with an acute myocardial infarction. Which drug does the nurse anticipate the health care provider to order for prevention of tissue necrosis following blood clot blockage in a coronary artery? A. heparin sodium B. clopidogrel (Plavix) C. alteplase (rPA, Activase) D. aminocaproic acid (Amicar) 1.) A patient has a serum cholesterol level of 265 mg/dL, triglyceride level of 235 mg/dL, and LDL of 180 mg/dL. What do these serum levels indicate? A. Hypolipidemia B. Normolipidemia C. Hyperlipidemia D. Alipidemia 2.) The nurse knows that a patient's total cholesterol level should be within which range? A. 150 to 200 mg/dL B. 200 to 225 mg/dL C. 225 to 250 mg/dL D. >250 mg/dL 3.) A patient has a low-density lipoprotein (LDL) of 175 mg/dL and a high-density lipoprotein (HDL) of 30 mg/dL. What teaching should the nurse implement for this patient? A. Discuss medications ordered, dietary changes, and exercise. B. No changes in lifestyle are needed and continue with current plan. C. Discuss how to have fat intake be 40% of caloric intake. D. Begin keeping a food diary and schedule lab work to be repeated in 6 months. 4.) Which laboratory test value does the nurse realize can contribute to the development of cardiovascular disease and stroke? A. Decreased antidiuretic hormone B. Increased homocysteine level C. Decreased triglycerides D. Increased HDL level 5.) A patient is taking lovastatin (Mevacor). Which serum level is most important for the nurse to monitor? A. Blood urea nitrogen B. blood count C. Cardiac enzymes D. Liver enzymes 6.) For what severe skeletal muscle adverse reaction should the nurse observe in a patient taking rosuvastatin (Crestor)? A. Myasthenia gravis B. Rhabdomyolysis C. Dyskinesia D. Agranulocytosis 7.) A patient is taking ezetimibe (Zetia) and asks the nurse how it works. The nurse should explain that ezetimibe does what? A. Inhibits absorption of dietary cholesterol in the intestines. B. Binds with bile acids in the intestines to reduce LDL levels. C. Inhibits HMG-CoA reductase, which is necessary for cholesterol production in the liver. D. Forms insoluble complexes and reduces circulating cholesterol in the blood. 8.) A patient is diagnosed with peripheral arterial disease. He is prescribed pentoxifylline (Trental). What does the nurse realize are the effects of pentoxifylline? (Select all that apply.) A. May lead to hypertension and bradycardia B. Improves microcirculation and tissue perfusion C. Decreases blood viscosity and improves flexibility of erythrocytes D. Alleviates intermittent claudication E. Commonly causes an adverse effect of rhabdomyolysis F. Allows vasodilation of arteries in skeletal muscles Gastrointestinal 1.) A patient complains of constipation and requires a laxative. In providing teaching for this patient, the nurse reviews the common causes of constipation, including which cause? A. Motion sickness B. Poor dietary habits C. Food intolerance D. Bacteria (Escherichia coli) 2.) A patient with nausea is taking ondansetron (Zofran). She asks the nurse how this drug works. The nurse is aware that this medication has which action? A. Enhances histamine1 receptor sites B. Blocks serotonin receptors in the CTZ C. Blocks dopamine receptors in the CTZ D. Stimulates anticholinergic receptor sites 3.) A patient who has constipation is prescribed a bisacodyl (Dulcolax) suppository. Which explanation will the nurse use to explain the action of bisacodyl? A. Acts on smooth intestinal muscle to gently increase peristalsis B. Absorbs water into the intestines to increase bulk and peristalsis C. Lowers surface tension and increases water accumulation in the intestines D. Pulls salts into the colon and increases water in the feces to increase bulk 4.) A patient is using scopolamine (Transderm-Scōp) to prevent motion sickness. About which common side effect should the nurse teach the patient? A. Diarrhea B. Vomiting C. Insomnia D. Dry mouth 5.) When metoclopramide (Reglan) is given for nausea, the nurse plans to caution the patient to avoid which substance? A. Milk B. Coffee C. Alcohol D. Carbonated beverages 6.) The nurse is administering diphenoxylate with atropine (Lomotil) to a patient. Which should be included in the patient teaching regarding this medication? (Select all that apply.) A. Caution the patient to avoid laxative abuse. B. Record the frequency of bowel movements. C. Caution the patient against taking sedatives concurrently. D. Encourage the patient to increase fluids. E. Instruct the patient to avoid this drug if he or she has narrow-angle glaucoma. F. Teach the patient that the drug acts by drawing water into the intestine. 1.) A patient is diagnosed with peptic ulcer disease. The nurse realizes that which factor is a predisposing factor for this condition? A. Helicobacter pylori B. Hyposecretion of pepsin C. Decreased hydrochloric acid D. Escherichia coli 2.) A student nurse is preparing to administer sucralfate (Carafate) to a patient. Which statement by the student nurse demonstrates understanding of sucralfate's mode of action? A. “Sucralfate neutralizes gastric acidity.” B. “Gastric acid secretion is decreased by inhibiting histamine at H2 receptors in parietal cells.” C. “Gastric acid secretion is suppressed by inhibiting the hydrogen/potassium ATPase enzyme.” D. “Sucralfate combines with protein to form a viscous substance that forms a protective covering of ulcer.” 3.) A patient is taking ranitidine (Zantac). What information should the nurse teach the patient about this drug? (Select all that apply.) A. Drug-induced impotence is irreversible. B. The drug must be administered 30 minutes before meals. C. The drug must be administered separately from an antacid by at least 1 hour. D The drug must always be administered with magnesium hydroxide. E. Smoking should be avoided while taking this drug. F. Foods high in vitamin B12 should be increased in diet. 4.) When a patient complains of pain accompanying a peptic ulcer, why should the nurse give an antacid? A. Antacids decrease GI motility. B. Antacids decrease gastric acid secretion. C. Antacids strengthen the lower esophageal sphincter's action. D. Antacids neutralize HCl and reduce pepsin activity. 5.) A patient is taking famotidine (Pepcid) to inhibit gastric secretions. Which side effects of famotidine will the nurse teach the patient? (Select all that apply.) A. Diarrhea B. Dizziness C. Dry mouth D. Headaches E. Blurred vision F. Decreased libido 6.) The patient is taking esomeprazole magnesium (Nexium) for an erosive GERD. Which should the nurse include in patient teaching? A. Take with breakfast daily. B. Healing should occur in one week. C. This medication decreases stomach acid secretion. D. Blood test to check kidney function should be done. Emergency Drugs 1.) The nurse is administering atropine 0.3 mg IV to a 75-year-old patient with a heart rate of 45, and his heart rate decreases to 38. What is the most likely explanation? A. Atropine exerts its effects by stimulating the vagus nerve. B. The ordered dose was too low. C. Adenosine was indicated, not atropine. D. Atropine typically slows heart rate first and then increases it. 2.) An 80-year-old woman with a hip fracture received morphine 3 mg IV 20 minutes ago. The patient's son runs to the nurses' station and says that his mother is no longer responding to him. What actions should the nurse take? A. Assess the patient; call for additional assistance; support breathing with a bag-valve-mask device as indicated, and prepare to administer flumazenil. B. Call the physician and report that the patient most likely suffered a stroke and now has elevated intracranial pressure; prepare to administer mannitol. C. Assess the patient; call for additional assistance; support breathing with a bag-valve-mask device as indicated, and prepare to administer naloxone. D. Explain to the patient's son that the morphine is taking effect and that unresponsiveness is the desired outcome to best manage her pain. 3.) The nurse is caring for a 21-year-old woman with a closed head injury. Her intracranial pressure is 35 (normal <20). Her serum osmolality is 330. The nurse should anticipate which action? A. Administer mannitol. B. Withhold mannitol at this time, but take other measures to reduce intracranial pressure. C. Administer sodium nitroprusside. D. Take no action at this time because the patient has a serum osmolality of 330, which will offset the effects of the elevated intracranial pressure. 4.) A dopamine infusion was started in a patient's antecubital vein during resuscitation after cardiac arrest. The electronic infusion device is now sounding an alert for an occlusion. What is the most important immediate concern for the nurse? A. Infiltration with phentolamine will be necessary if there is extravasation. B. An interruption in the infusion can produce hypotension in the patient. C. The device will need to be reported to the hospital's clinical engineering department for service. D. The patient could develop hypertension as a result of the alarm. 5.) Adenosine is ordered for a patient in the emergency department. Immediately after intravenous administration, the nurse observes a short period of asystole on the cardiac monitor that resolves spontaneously. What is the most appropriate initial action for the nurse? A. Call for the doctor. B. Prepare epinephrine and atropine for intravenous administration. C. Initiate CPR. D. Closely observe the patient and the cardiac monitor. 6.) A patient on the medical-surgical unit has suffered an acute anaphylactic reaction during infusion of an IV antibiotic with hives and bronchospasm. The nurse practitioner has written a number of stat medication orders. What is the priority medication to administer first? A. steroid dose pack B. dopamine C. epinephrine D. diphenhydramine 7.) The nurse receives a stat order to administer 50% dextrose solution intravenously to a 1-year-old child with hypoglycemia. How should this medication best be prepared for safe administration to the child? A. Use a filter needle. B. Draw the medication into a tuberculin syringe. C. Dilute 1:1 with sterile water to produce dextrose 25%. D. Shake the solution vigorously before injection. 8.) A 51-year-old woman has been reportedly taking Xanax for a severe anxiety disorder following her mother's death. She was brought into the emergency department because she became unresponsive while at work in an insurance office. Knowing her history, what should the nurse anticipate administering? A. mannitol B. naloxone C. activated charcoal D. flumazenil 9.) A 25-year-old woman was admitted to the emergency department after a successful prehospital resuscitation from cardiac arrest owing to an asthma attack. On arrival, her pulse oximeter reading is 85%. Given her condition, what is the most important initial medication to administer as ordered? A. epinephrine B. sodium bicarbonate C. albuterol D. oxygen 10.) The nurse practitioner orders epinephrine 0.3 mg IM for a severe allergic reaction to a bee sting in an adult patient. Which concentration of epinephrine should the nurse select to administer this particular dose? A. 1 :10,000 B. 1 : 1000 C. 1 : 100 D. 1 : 10 11.) The emergency physician orders activated charcoal for a teenage girl who took an intentional overdose of aspirin and several unknown drugs from her parent's medicine cabinet. Upon preparing to administer the activated charcoal by mouth, the nurse notes that the patient has become very somnolent and opens her eyes only to a noxious stimulus. Which action by the nurse is most appropriate at this point? A. Immediately discuss the change in the patient's mental status with the physician so that the plan of care can be reevaluated. B. Immediately insert a nasogastric tube, and administer the activated charcoal. C. Immediately elevate the head of the patient's stretcher, and coax her to drink the activated charcoal while applying noxious stimuli as necessary to keep her awake. D. Give only half the dose now, and wait until her mental status improves before giving the remainder of the dose. 12.) While getting dressed to go home after minor outpatient surgery on his leg for removal of a mole, a 62-year-old patient notifies the nurse that he has severe chest pain. He is also diaphoretic and complains of shortness of breath. The surgeon is notified and orders administration of aspirin 325 mg PO while quickly making arrangements to transfer the patient to the emergency department. Which is the best course of action by the nurse? A. Question the aspirin order because the patient just had a surgical procedure and might have bleeding complications. B. After checking for drug allergies, first instruct the patient to chew the aspirin tablet and then administer the aspirin. C. After checking for drug allergies, instruct the patient to swallow the aspirin tablet whole. D. Suggest to the surgeon that the enteric-coated form of aspirin might be better tolerated by the patient to avoid GI distress.