Diuretics are used to tx:
a. Edema and HTN
b. Ascites and hypotension
c. Edema and hyponatremia
d. HTN and dehydration
A
When a pt is receiving diuretic therapy, which of the following would best reflect the patient's fluid volume status?
a. Blood pressure and pulse
b. Serum K+ and Na+ levels
c. Intake, output and daily weight
d. Measurements of abdominal girth and calf cir
C
A pt is being discharges to home on a single daily dose of diuretic. The health care provider instructs the pt to take the does at which time so it will be least disruptive to the pt daily routine?
a. In the morning
b. At noon
c. With supper
d. At bedtime
A
A pt is started on a diuretic fer ant anti-HTN therapy. The nurse expects that a drug in which of the following classes is likely to be used initially?
a. Loop diuretics
b. Osmotic diuretics
c. Thiazide diuretics
d. Vasodilators
C
A pt in the neurologic ICU is being tx for cerebral edema and is given which type of drug to reduce intracranial pressure?
a. Loop diuretics
b. Osmotic diuretics
c. Thiazide diuretics
d. Vasodilators
B
A 70 yo pt is taking a diuretic for tx of HTN. This pt is very independent and wants to continue to live at home, despite his dx of mild HF. The nurse will know what which teaching point is important for this patient?
a. He should take the diuretic with h
D
A pt on diuretic tharapy calls the clinic because he's had the flu, with "terrible vomiting and diarrhea," and he has not kept anything down for 2 days. He feels weak and extremely tired. What will the nurse advise this patient?
a. "It's important to try
D
When assessing a pt who is receiving a loop diuretic, the nurse looks the the manifestations of K+ deficiency, which would include which Sx? Select all that apply:
a. Constipation
b. Tinnitus
c. Muscle weakness
d. Leg cramps
e. Lethargy
C D E
When monitoring a pt for signs of hypokalemia, the nurse looks for what early sign?
a. Seizures
b. Cardiac dysrhythmias
c. Stomach cramps
d. Muscle weakness
D
A pt is receiving an infusion of fresh frozen plasma. The nurse interprets that this pt has which disorder?
a. Hypovolemic shock
b. Anemia
c. Coagulation disorder
d. Previous transfusion reaction
C
The nurse is preparing to transfuse a pt with a unit of PRBCs. Which IV solution should be used along with the PRBC transfusion?
a. 5% dextrose in water (D5W)
b. 0.9% sodium chloride (NS)
c. 5% dextrose in 0.9% sodium chloride (D5NS)
d. 5% dextrose in lac
B
The nurse is planning to transfuse a pt with a unit of PRBCs. Which patient would be best tx with this transfusion?
a. Pt with coagualtion disorder
b. Pt with severe anemia
c. Pt who has lost a missive amount of blood after emergency surgery
d. Pt who has
B
After a severe auto accident, a pt has been taken to the trauma unit and has an estimated blood loss of more than30% of his blood volume. The nurse prepares to administer which product?
a. Fresh Frozen Plasma
b. Albumin
c. Packed RBCs
d. Whole Blood
D
The nurse understands that mannitol, an osmotic diuretic, may be used to decrease:
a. Peripheral edema
b. HTN
c. Hyperkalemia
d. Increased intracranial pressure
D
A pt with severe CHF has been started on a therapy with a CAI, but the nurse mentions that this med may be stopped in a few days. What is the reason for this short tx?
a. CAIs aren't the first choice for the tx of HF
b. CAIs lose their diuretic effect in
B
Diuretics that result in the dieresis of Na+ and water and the retention of K+; spironolactone is one example.
Potassium Sparing Diuretics
Drugs that induce dieresis by increasing the osmotic pressure of the glomerular filtrate, which results in rapid dieresis; mannitol is an example.
Osmotic Diuretic
Diuretics that act on the distal convoluted tubules where they inhibit sodium and water resorption; HCTZ is one example
Thiazide
Abbreviation for a class of diuretics that inhibit the enzyme carbonic anahydrase; acetazolamide is an exmplae
CAIs
A pt has been taking dig at home but took an accidental overdose and has developed toxicity. HE has been admitted to the telemetry unit where the physician had ordered Digibind. The pt asks the nurse why the medication is ordered. What is the nurse's best
D
A patient has been placed on a milrinone infusion as part of the therapy for end-stage heart failure. What risks involved with this drug will the nurse keep in mind while assessing this patient during the infusion?
a. HTN
b. Hyperkalemia
c. N/V
d. Caridac
D
When reviewing the list of meds taken by a pt who will be receiving a new prescription for Dig, the nurse would be concerned about which med that may interact with Dig?
a. Aspirin
b. Tylenol
c. Lasix
d. Vit K
D
In assessing a pt before administration of cardiac glycoside, the nurse knows that which lab result can increase the toxicity of the drug?
a. K+ level of 2.8
b. K+ level 4.9
c. Na+ level 140
d. Ca++ level 10
A
The nurse administering the phosphodiesterase inhibitor inimrinone recognize that this drug should have a positive inotropic effect. This effect will result in increased:
a. Heart rate
b. Blood vessel dilation
c. Force of cardiac contraction
d. Conduction
C
As part of tx for early HF, a pt is started on an ACE inhibitor. The nurse will monitor the patient's lab work for which potential effect?
a. Agranulocytosis
b. Proteinuria
c. Hyperkalemia
d. Hypoglycemia
D
When starting a pt on antidysrhythimic therapy, the nurse should remember that which problem is a potential adverse effect of any antidysrhythmic drug?
a. Deficiency of fat- soluble vits
b. Hyperkalemia
c. Heart failure
d. Dysrhythmias
D
A pt is experiencing a rapid dysrhythmias and the nurse is preparing to administer adenocard. Which is the correct administration procedure?
It should be given fast IV push
ACE inhibitors and other vasodilators are used in the early treatment of CHF. They act to:
a. Cause loss of volume
b. Increase arterial pressure and perfusion
c. Cause pooling blood and decreased venous return to the heart, decreasing ht workload of the h
C
A pt is taking a beta- blocker as part of the tx plan for HF. The nurse knows that the purpose of the beta blocker is to:
a. Increase urine output
b. Prevent stimulation of the heart by catecholamines
c. Increase contractility of heart muscle
d. Cause per
B
A CCB is RX for a pt, and the nurse provides instructions to the pt about the meds. What does the nurse tell the pt?
a. The tab should be chewed for faster release of the med
b. To increase the effect of the drug, take it with grapefruit juice
c. If the A
D
A 74 yo professional golfer has chest pain that occurs toward the end of his golf games. He says the pain usually goes away after 1-2 sL nitroglycerin tabs and rest. What type of angina does he have?
a. Classic
b. Variant
c. Unstable
d. Printzmals
A
When applying transdermal nitroglycerin patches, how ill the nurse instruct the pt?
a. Use any nonhairy are on the body
b. Use only the chest are for application sites
c. Temporarily remove the patch if you go swimming
d. Apply the patch to the same site
A
A pt has been taking a beta- blocker for 4 weeks as part of his antianginal therapy. He also has type II DM and hyperthydoidism. When discussing possible A/Es the nurse should include which info?
a. Watch for unusual weight loss
b. Monitor your pulse for
D
What action is recommended to help reduce the tolerance to transdermal nitroglycerin therapy that commonly develops?
a. Omit a dose once a week
b. Leave the patch on for 2 days at a time
c. Cut the patch in half for a week until the tolerance subsides
d.
D
While assessing a pt who is taking a beta- blocker for angina, the nurse knows to monitor for which a/e?
a. Nervousness
b. HTN
c. Bradycardia
d. Dry cough
C
Sodium channel blockers:
a. Reduce automaticity
b. Slow the impulse conduction
c. Prolong the refractory period
d. Increase the impulse conduction
B
Common side effects of antidysrhythmic meds include:
a. Hypotension
b. Hypertension
c. Dizziness
d. Weakness
e. Panic attacks
A C D
ACE inhibitor on the renin-angiotensin system to prevent the conversion of angiotensin 1 to angiotension II. Because this blocking occurs in the cells in the lung, which is usually the site of this conversion, use of ACE inhibitor often results in:
a. Spo
C
A pt w/ severe liver disease is receiving the ACE inhibitor, Captopril. The nurse is aware that the advantage of this drug for this pt is that captopril:
Is not a prodrug and doesn't need to be metabolized by the liver before becoming active
ACE inhibitors and other vasodilators are used in the early tx of CHF. They act to:
Cause pooling of the blood and decreases venous return to the heart, decreasing the workload of the heart.
pain associated with lack of O2 to the heart muscles
Angina
Nitrates are commonly used antianginal drugs that work to:
Dilate coronary vessels to increase the delivery of O2 through the vessels
Calcium channel blockers are effective in treating angina because they:
Block strong muscle contractions and cause vasodilation, decreasing work of the heart
A spasm of a coronary vessel:
Printzmals Angina
Which of the following parameters determine the regulation of arterial blood pressure?
Cardiac output and vascular resistance
Nurse is creating a plan of care for a pt with a new diagnosis of HTN. Which is a potential nursing diagnosis for the pt taking antihypertensive meds?
Sexual dysfunction
Pt taking antihypertensive drugs for a few months complaining of having persistent dry cough. Nurse knows that this cough is adverse effect of what drug?
ACE inhibitors
Which drug is commonly used for a pregnant pt who is experiencing HTN?
Methyldopa (Aldomet)
Pt diagnosed with pre-HTN has BP reading of _____mm HG systolic and _____mm HG diastolic
120 and 139; over 80 and 89
Pt has HTN along with T1DM and proteinuria. Nurse anticipates that a drug from which class will be order for its renal-protective effects?
ACE inhibitors
Nurse is reviewing orders for pt and notes new order for ACE inhibitor. Nurse checks current med orders, knowing that this drug class may have serious interaction with what other drug class:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Any pt receiving a loop diuretic needs to have regular monitoring of:
Potassium levels
The diuretic of choice for treating hyperaldosteronism would be:
Spironolactone
Pt with severe glaucoma who is about to undergo eye surgery would benefit from a decrease in intraocular fluid. This is often best accomplished by giving the pt:
CAI
During severe exertion, a man may lose up to 4 L of hypotonic sweat per hr. This loss would result in:
Decreased plasma volume
High cholesterol levels are considered to be:
A treatable risk factor for the development of heart disease
The formation of atheromas in blood vessels precedes the signs and symptoms of :
Coronary artery disease
HMG-CoA reductase works in the:
Process of formation of cholesterol within the cell
A pt who has high lipids and cannot take fibrates or HMG-CoA reductase inhibitors may be able to take:
Niacin
Nicotinic acid is prescribed for a pt with elevated lipid levels. Nurse informs the pt that which adverse effect may occur with this med?
Pruritus, cutaneous flushing
Rhabdomyolysis is a very serious adverse effect that can be seen with HMG-CoA reductase inhibitors. To detect it, pts taking these drugs would be monitored for:
Muscle pain and weakness
Coronary artery disease results in:
An imbalance in the supply and demand for O2 in heart muscle
Nitrates are commonly used antianginal drugs that act to:
Dilate coronary vessels to increase the delivery of O2 through those vessesls
Calcium channel blockers are effective in treating angina because:
Block strong muscle contractions and cause vasodilation, decreasing work of the heart
Antidysrhythmic drugs alter the action potential of the cardiac cells. Because they alter the action potential, antidysrhythmic drugs often:
Cause new dysrhythmias
Pts with CHF present clinically with:
Congestion of blood vessels with slowing in delivery of nutrients and removal of waste products
A nurse is about to administer Digoxin to a pt whose apical pulse is 48 beats/min. She should:
Withhold the drug and notify prescriber
Blood pressure is related to heart rate, stroke volume, and the total peripheral resistance. True or False
TRUE
Constricted arterioles lower pressure, dilated arterioles raise pressure. True or False
FALSE
A pt has received too much warfarin. Nurse will prepare to give which antidote for warfarin toxicity?
Vitamin K
Pt will be receiving thrombolytic drug as part of his treatment for acute myocardial infarction. Nurse explains to him that this drug is used to:
Dissolve the clot in his coronary artery
A pt is receiving an IV infusion of heparin. Nurse will monitor which lab studies to adjust and monitor the dose of heparin?
Activated partial thromboplastin time (aPTT)
Pt has had recent prosthetic heart valve surgery and is receiving anticoagulant therapy. While monitoring lab work, nurse understands pt's international normalized ratio (INR) level of 2.5 indicates that the:
Pt's warfarin dose is at therapeutic levels
Physician wants to improve pt's anemia, nurse anticipates the pt will receive which blood product?
Packed red blood cells (PRBCs)
Nurse notes a pts med history that the pt will be taking demopressin. Based on this finding the nurse interprets that the pt has which disorder?
Diabetes insipidus
A 16 yo boy who is taking growth hormone somatropin comes into the office cause he has had an asthma attack during a race at school. Cause of this new development the nurse expects which intervention to occur next?
Dosage may be adjusted
When pt receiving vasopressin, which therapeutic response would the nurse expect to see?
Decreased urinary output
A pituitary drug is prescribed for a pt with hormone deficiency and the nurse provides instructions about the medication. Which statement by the RN indicates for further instruction?
I am looking for a cure for my condition
During a teaching session for pt on antithyroid drugs the RN should discuss which dietary instructions?
Avoid iodine containing foods
A pt has a dx of primary hypothyroidism. which statement accurately describes this problem?
The abnormality is in the thyroid glad itself
RN admin lispro rapid acting insulin and should keep in mind that this insulin will start to have effect whithin which time frame?
15 min
When teaching about hypoglycemia the RN should make sure the pt is aware of the early signs of hypoglycemia including:
irritability and confusion
The RN is teaching group of pts about a self admin of insulin. Which teaching is import to include?
When mixing insulins clear before cloudy
A 75 yo women with type 2 DM has a recently been placed on glyburise a sufonylurea drug 10 mg daily. She asks wen best time to take med?
Take in the morn 30 min before breakfast
Pt with T2DM is scheduled for a colonoscopy and has been NPO since midnight. She is concerned cause her meds are being held. What is the best action regarding admin of her oral antidiabetic drug?
Contacting her prescriber for further orders
RN is reviewing instructions for a pt with T2DM who also gives herself insulin injections as part of the therapy. The nurse asks the pt what should you do if your fasting blood glucose is 47 mg/dl?
Take oral form of glucose
The nurse is admin rapid acting Insulin. Which statement is true regarding its admin?
Should be given w/in 15 m in of a meal
After starting treatment for type 2 DM 6 mo earlier, a pt is in the office for a follow up examination. Which lab test will best reflect pts adherence to the antidiabetic therapy over the past few months?
Hemoglobin A1C level
A pt in the emergency depart was showing signs of hypoglycemia and a finger stick glucose level of 34 mg/dl. He has just become unconscious. What is RN first action?
Give him IV glucose
Nurse preparing to admin insulin IV. Which statement about IV insulin is true?
Only regular can be admin IV
A pt with hx of COPD and T2DM has been treated for pneumonia for the past week. He has been receiving IV corticosteroids as well as antibiotics as part of his therapy/ his pneumonia has resolved but wen monitoring his blood glucose levels the nurse notice
Corticosteroids may cause increase in glucose levels
The RN knows to admin acarbose (precose) an alpha glucosidase inhibitor at which time?
Within the first bite of each main meal
A 48 yo is dx with T2DM and is started on metaformin (glucaphage) a biguanide. The purpose of the metaformin in this situation is:
to decrease insulin resistance
When admin morning meds to a new admitted pt the RN notes that the pt has an allergy to sulfa drugs. There is order for sulfonylurea glipizide. What RNs best action?
Hold drug and check with perscriber
The nurse is reviewing a pts medication list and notes that incretin mimetic Sitaglipitin (Januvia) is ordered. Nurse should question for additional order for which drug/drug class?
Insulin
Insulin order reads check blood glucose levels before meals and bed. For every 5 mg over 100 give 1 unit of R insulin subq. Pt level before lunch is was 150. How many units will nurse give?
10
When starting a pts drug therapy with corticosteroids the RN is aware that some drugs classes can have an adverse interaction with corticosteroids such as:
NSAIDs
A pt Is concerned about body changes that have resulted from lg term prednisone therapy for the treatment of lupus erythematous. Which effect of this drug therapy would be present to support the nursing dx of disturbed body image?
Weight Gain
A pt is taking fludrocortisone of addisons disease and his wife is concerned about all the probs that may occur with this therapy. When teaching them about therapy with this drug the RN should include which info?
Should be taken with milk/food to minimize GI upset.
Pt receiving aminoglutethimide an adrenal steroid inhibitor therapy. The nurse knows that this med if for which condition.
Cushing's syndrome
When monitoring a pt who is taking systematically administered glucocorticoid, the nurse should monitor for signs of which condition?
Hypoglycemia
A pt who has been on lg term corticosteroid therapy has had surgery to correct an abdominal hernia. Nurse keeps in mind that which potential effect of this med may have the most impact on the pts recovery?
Delayed wound healing
The nurse notes in the pts med orders that the pt is taking the tocolytic drugs terbutaline (Brethine). Based on this finding the RN interprets that the drug has been ordered for which prob?
Prevention of preterm labor in the 22nd week of pregnancy
A female pt who lives in NY city is preparing to take a plan to Austria she has been taking SERM raloxifene. The nurse will provide which instructions?
Stop the drug 72 hrs before the trip
A pt who is taking bisphosphonate alendronate (Flomax) has been instructed to lie flat in bed for 2 days after having plastic surgery. Which intervention is appropriate at this time?
Don't take alendronate till she can sit up for 30 min
While discussing options for osteoporosis prevention a pt asks if she will be using estrogen patches. What is RN response?
Patches are associated with high risk of CV probs and are not the first choice
Nurse is preparing to admin the contraceptive form of medroxyprogesterone (depo provera). Which administration technique is appropriate?
route is IM
When couples are treated for infertility with ovulation inducing drugs the nurse will instruct about the likely hood of:
multiple births
The nurse is reviewing the med list of pt who will be starting androgen therapy. Which drug classes if taken with androgens may interact with them?
Oral anticoagulants
A 63 yo male is scheduled for PE and he tells the nurse that he wants to start taking vitamin formula that includes saw palmetto:
the doc will have to draw some blood and do a DIG exam first
Which of the following ?s should the nurse ask prior to admin of sildenafil (Viagra)?
Are you currently taking meds for angina
Thyroid replacement is indicated for the treatment of:
myxedema
Assessing a pt knowledge of his or her thyroid replacement therapy would show good understanding if the pt stated:
I should call if I experience unusual sweating, weight gain, and chills and fever
Currently the pharmological management of DM is aimed at:
tightly regulating blood sugar levels
Insulin is available in several forms or suspensions which differ in their:
onset, peak, and duration
Treatment of DM may include replacement therapy with insulin. True or false
TRUE
Treatment of DM may include control of glucose absorption through GI tract. True or false
TRUE
Treatment of DM may include drugs that stimulate insulin release or increase sensitivity of insulin receptor cites. True or false
TRUE
Treatment of DM may include surgical clearing of the basal cell membrane. True or false
FALSE
Treatment of DM may include slowing gastric emptying. True or false
TRUE
Treatment of DM may include diet and exercise programs. True or false
TRUE
If I have to take an antibiotic while I'm on the pill should take double pills on those days that I am using the antibiotic. True or false
FALSE
I shouldn't smoke for the first month I am on the birth control pill to make sure I don't react severely to them. True or false
FALSE
Testosterone is an approved for use in treatment:
of breast cancers
Lg illegal doses of anabolic steroids to enhance performance is associated with:
liver peliosis
Anabolic steroids would be indicated for the treatment of:
debilitation and sever weight loss
Levothyroxine is classified as a:
thyroid replacement hormone
The nurse is preparing insulin for subq admin. Which is correct:
always have another licensed nurse check insulin drawn into syringe before admin
The highest priority intervention associated with adverse effects of insulin is related to the need to monitor the client for receiving insulin for:
hypoglycemia
The nurse is reviewing the hx of a pt who will be taken the amylin mimetic drug Pramlintide (symlin). Which condition is contraindicated with the use of this drug?
Gastroparesis
Nurse is admin octreotide (sandostatin) to a pt who has metastatic carcinoid tumor. The pt asks about the purpose of the drug. What is RN best response?
This drugs helps to control the flushing and diarrhea you are experiencing
The most commonly prescribed synthetic thyroid hormone:
is levothyroxine
A drug used to treat hyperthyroidism is:
propylthiouracil (PTU)
The type of hypothyroidism that results from insufficient secreation of thyroid stimulating hormone from the pituitary gland is called:
secondary
The type of hypothyroidism that is dysfunction within the thyroid gland is called:
primary
Pt beginning therapy with levothyroxine asks the RN wen the med will start working:
within a few weeks
It is important to take a thyroid preparations at the same time each day. True or false
TRUE
After thyroidectomy as a treatment of thyroid tumor life long replacement therapy is normally required. True or false
TRUE
A 38 yo teacher has come to the clinic complaining OF NO ENERGY AND APPETITE and yet her weight has increased by 15 lbs in the last month. Her hair is thin and skin is dull. Lab work reveals an elevated level of TSH. She has:
hypothyroid state
When admin insulin the nurse keep in mind that which is the most immediate an serious AE of insulin therapy?
Hypoglycemia
Pt placed on insulin drip to control bl gucose levels. Which one can be admin IV:
regular
A pt taking rosiglitazone a thiazolidinedione/glitazone, tells the nurse there is my insulin pill, which info will nurse provide regarding the MOA or the drug:
it inhibits hepatic glucose production
50 yo man taking prednisone following severe reaction to poison ivy. He notices that the dosage of the med decreases. During follow up he asks the nurse why he must continue med and not just stop it now that the rash is better. The nurse says:
sudden discontinuation of this med may result in adrenal insufficiency.
Because corticosteroids may cause sodium retention the nurse should closely monitor pts with which condition wen admin corticosteroids:
heart failure
When combination of oral contraceptives are given postcoital emergency contraception, the nurse should remember they are not affective:
when the woman is already pregnant.
Terbutaline a beta adrengergic uterine relaxant use to prevent contractions during which time frame:
between 20-37th weeks
Pt taking finasteride for the treatment of benign prostatic hyperplasia. His wife who is 3 mo preg is worried about effects of the drug. What should the nurse say?
This drug should not even be handled by preg women cause it could harm the fetus