NURS 6521N Week 3 Quiz With Elaborate Responses

NURS 6521N Week 3- Quiz With Elaborate Responses  Question 1 1 out of 1 points A nurse explains to a patient that nitroglycerin patches should be applied in the morning and removed in the evening. This medication ...

NURS 6521N Week 3- Quiz With Elaborate Responses  Question 1 1 out of 1 points A nurse explains to a patient that nitroglycerin patches should be applied in the morning and removed in the evening. This medication schedule reduces the potential for Response Feedback: The nurse will stress that it is important to remove the patch for 10 to 12 hours every 24 hours to prevent nitrate tolerance from developing. If anginal symptoms develop at night, the use of a beta blocker or calcium channel blocker should be considered. Patients who normally have angina only during daytime hours are not at substantial risk for developing nighttime angina with a nightly nitrate-free period. Applying the nitroglycerin patch in the morning and removing it in the evening would not significantly limit the adverse effects from the drug. Dependency does not occur with nitroglycerin, and prescribed dosages should not cause toxic effects.  Question 2 1 out of 1 points A nurse who provides care in a busy clinic is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics in many patients. Treatment of high cholesterol using statins would be contraindicated in which of the following patients? An obese male patient who is a heavy alcohol user and who has cirrhosis of the liver Response Feedback: Active liver disease is a contraindication to the use of statins. As well, heavy alcohol use increases the risk of liver dysfunction. Respiratory disease, recent surgery, and organic cognitive deficits do not preclude the use of statins for high cholesterol.  Question 3 1 out of 1 points A 77-year-old man's chronic heart failure is being treated with a regimen of quinapril (Accupril) and furosemide (Lasix). Which of the following assessment findings would suggest that the loop diuretic is contributing to a therapeutic effect? The man’s chest sounds are clear and his ankle edema is lessened. Response Appropriate diuretic therapy leads to the resolution of pulmonary and peripheralFeedback: edema. Healthy kidney function, cardiac rhythm, and electrolyte levels are all desirable outcomes, but they are not directly indicative of the therapeutic action of diuretics in the treatment of CHF.  Question 4 1 out of 1 points A patient with class-IV CHF has a medication regimen consisting of metoprolol (Lopressor), enalapril (Vasotec), and furosemide (Lasix). In addition to regularly assessing the patient s heart rate, the nurse should prioritize assessment of the patient's blood pressure Response Feedback: Fluid balance, cognition, and exercise tolerance are all affected by CHF and should be regularly assessed as part of thorough nursing care. However, the combination of an ACE inhibitor, a beta blocker, and a diuretic constitutes a significant risk for hypotension and indicates a need for frequent blood pressure monitoring.  Question 5 1 out of 1 points A patient has recently been prescribed a drug that treats his hypertension by blocking the sympathetic receptors in his sympathetic nervous system. This action is characteristic of adrenergic antagonist Response Feedback: Those drugs that stimulate sympathetic receptors are referred to as adrenergic or dopaminergic agonists (stimulators) and those that block are referred to as adrenergic antagonists (blockers). Adrenergic antagonism is not synonymous with the action of a cardiotonic drug.  Question 6 1 out of 1 points A patient is diagnosed with heart failure and is started on digoxin. On the second day of therapy, lab values, the ECG results, and the patient's symptoms indicate that the medication is not producing a therapeutic effect. An appropriate nursing action would be to continue to administer the med Response Feedback: The nurse should continue regular administration of the drug because digoxin requires a loading dose before the drug's therapeutic effect is present. It may take several days for optimal clinical effects to appear. Therefore, seeking an order to increase the dosage, seeking orders to discontinue digoxin and start another drug, or insisting that another drug be ordered would not be necessary at this time.  Question 7 1 out of 1 pointsA 58-year-old man is admitted to the emergency department. A diagnosis of severe digoxin toxicity is made. Bradycardia is present, and an electrocardiogram (ECG) confirms toxicity. The nurse will administer which of the following drugs? Response Feedback: Digoxin immune fab is used as the antidote to digoxin toxicity. The other drugs would not be used to treat digoxin toxicity. The patient could be taking furosemide as part of his drug regimen for heart failure.  Question 8 1 out of 1 points A patient has been prescribed lovastatin for a high cholesterol level. The nurse's teaching plan will include a basic explanation of how the drug produces its therapeutic effect. The nurse will explain that lovastatin lowers cholesterol levels because it Response Feedback: Lovastatin belongs to a group of drugs classified as statins. These drugs work by inhibiting cholesterol synthesis in the liver. Fibric acid derivatives and bile-acid resins also decrease cholesterol levels but they work at different sites. Fibric acid derivatives work on lipoproteins and triglycerides to reduce cholesterol, and bile-acid resins work in the gastrointestinal tract and bind bile salts in the intestine. Lovastatin is not a hormone.  Question 9 1 out of 1 points An expected outcome for a patient who has just taken sublingual nitroglycerin should be increased heart rate and decreased blood pressure Response Feedback: Nitroglycerin relaxes vascular smooth muscle and dilates both arterial and venous vessels. Dilation of veins is more predominant than dilation of arteries, resulting in peripheral pooling of blood and decreased preload. Blood pressure will usually decrease as a result of the venous dilation. Reflex tachycardia usually follows the drop in blood pressure.  Question 10 1 out of 1 points A nurse has been following a male patient who is taking hydralazine, clonidine, and a diuretic for hypertension. After 2 weeks of medication therapy, the patient begins to complain of numbness and tingling in his hands and feet. The nurse suspects that these signs or symptoms are Response The nurse will evaluate the numbness and tingling in the patient's hands and feet as signs of peripheral neuritis, which is an adverse effect of the hydralazine. If a diagnosisFeedback: is made to confirm the nurse's suspicion, pyridoxine should be administered because the neuritis may be caused by the antipyridoxine effect of the drug therapy. The numbness and tingling are not associated with clonidine and a diuretic. An increased risk of diabetes has not been identified as being related to this combination of medications.  Question 11 1 out of 1 points A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which of the following actions should the nurse do first when he complains of chest pain? Response Feedback: The initial action by the nurse should be sublingual administration of the drug by placing one tablet under the patient's tongue and repeating the action in 5 and 10 minutes if necessary. Asking the patient to relax is important and should be done, but administering the tablets would need to be done first. The nurse would not call the physician if the pain has subsided by the third tablet. If the pain has not subsided, the patient is considered to be having an acute MI, and it would be urgent to call the physician. Nitroglycerin does not come in oral form; therefore, it would not be swallowed.  Question 12 1 out of 1 points A 39-year-old African-American male is 25 pounds overweight and has been diagnosed with hypertension after three consecutive above-normal blood pressure readings. The most likely initial drug therapy for this patient will be Response Feedback: The patient would most likely be prescribed a diuretic in combination with diet and other lifestyle changes. African-American men are at increased risk for developing hypertension and tend to respond differently to antihypertensive therapy. The research shows that African-American men are most responsive to single-drug therapy and diuretics. The use of a calcium channel blocker and/or alpha-adrenergic blocker would follow if he is unresponsive to the diuretic in combination with diet and other lifestyle changes. African Americans tend to be less responsive to ACE inhibitors and beta blockers.  Question 13 1 out of 1 points A patient is brought to the emergency department in hypertensive crisis. Nitroprusside is administered intravenously. The patient experiences diaphoresis and dizziness. Which of the following is theappropriate action by the nurse? Slow the rate of infusion Response Feedback: Administering nitroprusside too quickly can result in abdominal pain, apprehension, diaphoresis, dizziness, headache, muscle twitching, nausea, palpitations, restlessness, retching, and retrosternal discomfort. The nurse should quickly inform the prescriber and slow the infusion. Symptoms quickly subside when the nitroprusside infusion is slowed or stopped, and usually do not return when the infusion resumes at a slower rate. Consulting the prescriber for a dose change would not help; the rate of drug administration is the issue. Continuing to give the nitroprusside at the ordered rate could be fatal.  Question 14 1 out of 1 points A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by Response Feedback: Verapamil acts by inhibiting the movement of calcium ions across the cardiac and arterial muscle cell membrane. It works preferentially in “slow response” myocardial tissue, such as the SA and AV nodes. Beta blockers inhibit adrenergic receptors and Class IB antiarrhythmics are among the drugs that decrease sodium and potassium conduction. Lidocaine weakens phase 4 diastolic depolarization and decreases the action potential duration and the effective refractory period of Purkinje fibers and ventricular muscle.  Question 15 1 out of 1 points A nurse is caring for a patient who is admitted into the cardiac care unit with acute, decompensated heart failure. Nesiritide (Natrecor) has been ordered. When preparing for administration of the drug, the nurse will administer the intial bolus over approximately 60 seconds Response Feedback: Nesiritide must be reconstituted and then further diluted for infusion. Reconstitute one vial by adding 5 mL of diluent that has been removed from a 250-mL plastic IV bag. Do not shake the vial. Rock the vial gently so that all surfaces, including the stopper, are in contact with the diluent. Add the entire contents of the reconstituted vial back to the 250-mL plastic IV bag and invert the bag several times to ensure complete mixing. Use the reconstituted nesiritide solution within 24 hours. The initial IV bolus must be drawn from the prepared infusion bag and administered over approximately 60 seconds through an IV port.  Question 16 1 out of 1 pointsThe nurse is performing patient education for a woman who will soon begin treatment of hyperlipidemia with simvastatin (Zocor). The patient has asked the nurse if there are any “bad side effects” that she should be aware of. Which of the following statements should underlie the nurse's response? Statins are generally well tolerated, but minor aches and pains are the most common side effect Response Feedback: Adverse effects of lovastatin are usually mild and transient; the drug is generally well tolerated. A fairly common complaint with all statins, including lovastatin, is nonspecific muscle aches or joint aches, weakness, and/or cramps (myalgias), which are not associated with any signs of muscle damage. GI upset and cough are not associated with the use of statins. Renal disease may contraindicate the use of statins, but frequent analysis of kidney function is not necessary for patients with no preexisting indications.  Question 17 1 out of 1 points A nurse is caring for a patient who is taking digoxin and a loop diuretic. Which of the following would be most important for the nurse to monitor? Response Feedback: Although it is important to monitor the patient's ECG, it is more important to closely monitor potassium levels when the patient is taking a drug that promotes the loss of potassium, such as thiazide or loop diuretics. Hypokalemia increases the effect of digoxin and increases the risk for digoxin toxicity. The patient's sodium levels and liver enzyme levels may need to be monitored periodically, but not as closely as potassium levels.  Question 18 1 out of 1 points A nurse is caring for a patient who is diabetic and has been diagnosed with hypertension. An angiotensin-converting enzyme inhibitor, captopril, has been prescribed for her. Which of the following should the nurse assess before beginning drug therapy? Response Feedback: Captopril inhibits the angiotensin-converting enzyme that is needed to change the inactive angiotensin I to the active form, angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, preventing sodium and water retention. This action decreases peripheral vascular resistance and lowers blood pressure. Serum potassium levels may increase as a result of decreased aldosterone levels. It would be helpful to have a baseline level at the beginning of the drug therapy to monitor the possible effect of hyperkalemia. There is no need to monitor calcium and magnesium levels. While it is important to always know a diabetic's blood glucose level, captopril does not alter the level during therapy. Question 19 1 out of 1 points A patient is admitted to the emergency department with severe chest pain. The emergency department physician orders intravenous nitroglycerin 5 mcg/min, titrate dose by 5 mcg/min every 3 to 5 minutes per infusion pump as needed. Before administering the nitroglycerin, the nurse should prioritize which of the following assessments? Response Feedback: Before administering IV nitroglycerin, the nurse should first assess blood pressure to make sure that the patient does not have hypotension and to establish a baseline blood pressure. It is also important to assess the heart rate and urinary function (urinary output and BUN). However, in the case of administering intravenous nitroglycerin, the nurse would first assess the blood pressure.  Question 20 1 out of 1 points A 45-year-old man who is a construction worker has been diagnosed with hyperlipidemia and has been prescribed lovastatin. The nurse will advise the patient to Response Feedback: Since the patient works outdoors most of the time, the nurse should advise him to avoid prolonged exposure to sunlight by wearing protective gear. Advising the patient regarding the use of OTC drugs and drug changes would be better handled by the prescriber. The patient should not drink moderate amounts of alcohol, but should avoid alcohol altogether while taking lovastatin.  Question 21 1 out of 1 points A 62-year-old man has been prescribed extended-release lovastatin. The nurse will instruct the patient to take the medication Response Feedback: Patients who are prescribed extended-release lovastatin should take the medication at bedtime, without food, to be most effective. This is because most cholesterol synthesis occurs during this time. Immediate-release lovastatin should be taken after the evening meal. It would not be appropriate to take lovastatin in the afternoon or the early morning.  Question 22 1 out of 1 points A nurse is caring for a male patient who has a diagnosis of coronary artery disease (CAD). His drug therapy includes lovastatin. Because the patient has a history of severe renal disease, the nurse willassess for which of the following? Response Feedback: Patients with severe renal disease may have an increased plasma concentration of lovastatin because 10% of the drug is eliminated in the urine. Patients with renal disorders are not likely to experience a decrease in LDL or an increase in the statin tolerance level.  Question 23 1 out of 1 points Several months of treatment with a statin accompanied by lifestyle modifications have failed to appreciably improve a patient's cholesterol levels. Consequently, the patient has been prescribed cholestyramine. The nurse should recognize that this drugs achieves its therapeutic effect by oxidizing cholesterol to bile acids Response Feedback: Unlike statins, which work by decreasing the synthesis of cholesterol, the bile acid sequestrants such as cholestyramine promote the oxidation of cholesterol to bile acids. Bile acid sequestrants do not promote vasodilation or bind HDL to LDL.  Question 24 1 out of 1 points A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the nurse should perform and document what assessments? Response Feedback: Metoprolol has a profound effect on both blood pressure and heart rate. Consequently, the nurse should assess these parameters prior to administering the drug. Assessments related to pain, respiratory status, cognition, and temperature are not central to the administration of a beta blocker.  Question 25 1 out of 1 points A nurse is providing patient education to a 35-year-old man who has been prescribed clonidine (Catapres) as part of step 2 antihypertensive therapy. The nurse should anticipate that the drug will be administered Response Feedback: Clonidine may be administered orally or parenterally but is most frequently administered transdermally