Silvestri Chapter 51mm

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51: Cardiovascular Medications PRACTICE QUESTIONS 1. A nurse reinforces discharge instructions to a postoperative client taking warfarin sodium (Coumadin). Which statement by the client indicates the need for further teaching? 1. “I will take Ecotrin for my headaches because it is coated.” 2. “I will be certain to limit my alcohol consumption.” 3. “I will take my pills every day at the same time.” 4. “I have already called my family to pick up a Medic Alert bracelet.” Answer: 1 Rationale: Ecotrin is an aspirin-containing product and should be avoided. Excessive alcohol consumption should be avoided when taking warfarin sodium. Taking prescribed medication at the same time increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information. Test-Taking Strategy: Use the process of elimination. Note the key words, need for further teaching. These words indicate a false response question and that you need to select the incorrect client statement. Recalling that warfarin sodium is an anticoagulant and that Ecotrin is an aspirin-containing product will direct you to option 1. Review client teaching points related to warfarin sodium if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Evaluation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 1122. 2. A client taking digoxin (Lanoxin) has a serum potassium level of 3.0 mEq/L and is complaining of anorexia. The physician orders a digoxin level to be obtained to rule out digoxin toxicity. The nurse checks the results of the test, knowing that the therapeutic serum level for digoxin is which of the following? 1. 0.1 to 0.5 ng/mL 2. 0.3 to 0.8 ng/mL 3. 0.5 to 2 ng/mL 4. 1 to 3 ng/mL Answer: 3 Rationale: The therapeutic serum digoxin level ranges from 0.5 to 2.0 ng/mL. Test-Taking Strategy: Knowledge of the therapeutic serum digoxin level is necessary to answer the question. Review this level if you had difficulty with this question. Level of Cognitive Ability: Knowledge Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology References: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 477.

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Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 326. 3. Heparin sodium (Liquaemin) by subcutaneous injection is prescribed for a client. When administering the medication, the nurse would: 1. Use a 23- to 25-gauge, 1-inch needle. 2. Aspirate before injection. 3. Apply heat after the injection. 4. Administer with a 25- to 27-gauge, ⅝-inch needle. Answer: 4 Rationale: For subcutaneous heparin sodium injection, a 25- to 27-gauge, ⅜- to ⅝-inch needle is used to prevent tissue trauma and inadvertent intramuscular injection. A 1-inch needle would inject the heparin sodium into the muscle. The application of heat may affect the absorption of the heparin. Aspiration prior to injection is avoided with heparin sodium. Test-Taking Strategy: Use the process of elimination. Recalling the anatomy of muscle and subcutaneous layers of tissue will assist in directing you to option 4. If you had difficulty with this question, review the principles related to heparin administration. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 625. 4. A client is taking hydrochlorothiazide (HydroDIURIL, HCTZ) without taking any form of electrolyte supplement. The nurse would encourage intake of which of the following foods? 1. Canned pears 2. Oranges 3. Cranberry juice 4. Applesauce Answer: 2 Rationale: Hydrochlorothiazide is a potassium-losing diuretic, and clients are at risk for hypokalemia. Potassium is found in many foods, especially unprocessed foods, many vegetables, fruits and fresh meats. Because potassium is very water-soluble, foods that are prepared in water are often lower in potassium than the same foods cooked another way (e.g., boiled versus baked potato). Clients who need potassium added to the diet are encouraged to take in these foods. Many salt substitutes are also high in potassium. Test-Taking Strategy: Focus on the name of the medication to assist in determining that it is a diuretic. Evaluating food choices in terms of their water content and according to how highly processed they are may be a helpful approach for some questions related to potassium. In this question, note that each of the incorrect options is processed to some degree and has a high water content. Review foods high in potassium if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Cardiovascular

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References: Lehne, R. (2004). Pharmacology for nursing care (5th ed.). Philadelphia: W.B. Saunders, p. 409. Nix, S. (2005). Williams basic nutrition and diet therapy (11th ed.). St. Louis: Mosby, p. 137. 5. A 51-year-old client is admitted to the hospital with a diagnosis of myocardial infarction and is started on streptokinase (Streptase) therapy. The nurse determines that the client’s wife understands the purpose of the medication if she states that it is used to: 1. Thin the blood. 2. Slow the clotting of the blood. 3. Dissolve any clots in the coronary arteries. 4. Prevent further clots from forming in the coronary arteries. Answer: 3 Rationale: Streptokinase converts plasminogen in the blood to plasmin. Plasmin is an enzyme that digests or dissolves fibrin clots wherever they exist. Option 1, 2, and 4 describe mechanisms of action of heparin sodium (Liquaemin) and warfarin sodium (Coumadin). Test-Taking Strategy: Focus on the name of the medication, recalling that it is a thrombolytic. Remember that streptokinase dissolves clots. This will direct you to option 3. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 989. 6. A client is being treated for moderate hypertension and has been taking diltiazem (Cardizem) for several months. The client is seen by the physician, and Prinzmetal's angina is diagnosed. The nurse planning care for the client understands that which action of the medication will provide a therapeutic effect for this new diagnosis? 1. Increases oxygen demands within the myocardium 2. Prevents influx of calcium ions in vascular smooth muscle 3. Leads to an increase in calcium absorption in the vascular smooth muscle 4. Increases the force of contraction of ventricular tissues Answer: 2 Rationale: Diltiazem is a calcium channel blockers that inhibits calcium influx through the slow channels of the membrane of smooth muscle cells. Calcium channel blockers decrease myocardial oxygen demands and blocks calcium channels, thereby decreasing the force of contraction of the ventricular tissue. Test-Taking Strategy: Focus on the name of the medication and recall that it is a calcium channel blocker. Note the relation of the medication classification and option 2. Review the action of calcium channel blockers if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005.

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Philadelphia: W.B. Saunders, p.328. 7. A nurse is caring for a client who is taking propranolol (Inderal). Which data would indicate an adverse reaction associated with this medication? 1. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication 2. A baseline resting heart rate of 88 beats per minute followed by a resting heart rate of 72 beats per minute after two doses of the medication 3. The development of audible expiratory wheezes 4. The development of complaints of insomnia Answer: 3 Rationale: Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. Beta blockers may induce this reaction particularly in clients with chronic obstructive pulmonary disease (COPD) or asthma. A normal decrease in blood pressure and heart rate is expected. Insomnia is a frequent mild side effect and should be monitored. Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 2 first because these are expected responses from the medication. From the remaining options, noting the key words, adverse reaction, will assist in directing you to option 3. Review the adverse effects of this medication if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology References: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 903. McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 561. 8. A client is admitted to the emergency department with an acute anterior wall myocardial infarction. Streptokinase (Streptase) therapy is prescribed for the client and the client’s spouse is concerned about the dangers of this treatment. The nurse should make which statement to the client’s spouse? 1. “Your loved one is very ill. The physician has made the best decision for you.” 2. “There is no reason to worry. We use this medication all of the time.” 3. “I'm certain you made the correct decision to use this medication.” 4. “You have concerns about whether this treatment is the best option.” Answer: 4 Rationale: Paraphrasing is restating the client's or family member's own words. Option 1 represents a communication block that denies the person's right to an opinion. Option 2 is offering a false reassurance. In option 3, the nurse is expressing approval, which can be harmful to the client-nurse or family-nurse relationship. Test-Taking Strategy: Use therapeutic communication techniques. Remembering to address client feelings first will direct you to option 4. Review these therapeutic techniques if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity

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Integrated Process: Communication and Documentation Content Area: Pharmacology References: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W. B. Saunders, p. 989. Potter, P., & Perry, A. (2005) Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 437. 9. A physician prescribed digoxin (Lanoxin), 0.25 mg, for a client with atrial fibrillation. The medication is available as 0.125-mg tablets. The nurse calculates that the client will receive two tablets of digoxin. When the nurse administers the medication, the client looks at the medication and states, “Every time I get chest pain, I will take one of these heart pills.” After doublechecking the dosage calculation, the nurse decides to: 1. Not administer the medication as prescribed and calculated. 2. Administer one half-tablet of the medication instead of the dosage calculated. 3. Administer the medication as prescribed and calculated, and monitor for untoward effects such as seizures. 4. Administer the medication as prescribed and calculated and proceed with further client teaching. Answer: 4 Rationale: It is appropriate to treat atrial fibrillation with the prescribed and calculated dose of digoxin, as indicated in the question. The issue of the question is that the client verbalizes inaccurate and unsafe knowledge regarding this medication and the treatment for chest pain. This client needs further teaching regarding the safe administration of medications for episodes of chest pain. Options 1, 2, and 3 are incorrect actions. Test-Taking Strategy: Perform the calculation first and determine that the dose that the nurse is to give is a correct dose. From this point, eliminate options 1 and 2. From the remaining options, note the issue of the question, the need for client teaching. This should direct you to option 4. Review the client teaching points related to digoxin if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Planning Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 325. 10. A nurse is caring for an older client who will be discharged home. Furosemide (Lasix) is prescribed for the client and the nurse reinforces instructions to the client about the medication. Which statement by the client indicates the need for further instructions? 1. “I will take my medication every morning with breakfast.” 2. “I will call my doctor if my ankles swell or my rings get tight.” 3. “I need to drink lots of coffee and tea to keep myself healthy.” 4. “I will sit up slowly before standing each morning.” Answer: 3 Rationale: Tea and coffee are stimulants as well as mild diuretics. These are a poor choice for hydration. Taking the medication at the same time each day improves compliance. Because furosemide is a diuretic, the morning is the best time to take the medication so as not to interrupt

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sleep. Notification of the health care provider is appropriate if edema is noted in the hands, feet, or face, or if the client is short of breath. Sitting up slowly prevents postural hypotension. Test-Taking Strategy: Note the key words, need for further instructions. These words indicate a false response question and that you need to select the incorrect client statement. Tea and coffee are stimulants and diuretics can potentially worsening dehydration. Additionally, coffee and tea are not healthy foods. This should alert you that this is the correct option for this question, as stated. Review client teaching points related to this medication if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, pp. 479-480. 11. Isosorbide mononitrate (Imdur) is prescribed for a client with angina pectoris. The client tells the nurse that the medication is causing a chronic headache. The nurse appropriately suggests that the client: 1. Contact the physician. 2. Discontinue the medication. 3. Cut the dose in half. 4. Take the medication with food. Answer: 4 Rationale: Isosorbide mononitrate is an antianginal medication. Headache is a frequent side effect of isosorbide mononitrate and usually disappears during continued therapy. If a headache occurs during therapy, the client should be instructed to take the medication with food or meals. It is not necessary to contact the physician unless the headaches persist with therapy. It is not appropriate to instruct the client to discontinue therapy or adjust the dosages. Test-Taking Strategy: Use the process of elimination. Eliminate options 2 and 3 first because it is not within the scope of nursing practice to instruct a client to discontinue or adjust dosages. From the remaining options, recalling that the headache can be relieved with the administration of food with the medication will assist in directing you to option 4. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Pharmacology References: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, pp. 594-595. McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 679. 12. A client is being discharged with a prescription for propranolol (Inderal). When reinforcing instruction to the client about the medication, the nurse would include which of the following? 1. Gentle exercising will prevent orthostatic hypotension. 2. Hot baths and showers are advised to increase vasodilation.

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3. Medication should be taken on an empty stomach to enhance absorption. 4. Medication should be withheld if the pulse rate drops below 60 beats per minute. Answer: 4 Rationale: Most beta blockers may be administered with food or on an empty stomach but propranolol is best absorbed if taken with meals or directly after eating. Exercise will not prevent orthostatic hypotension. Hot showers and baths are not advised because of their vasodilating effect. The client needs to be instructed how to take his or her pulse rate and to notify the physician if the heart rate falls below 60 beats per minute. Test-Taking Strategy: Focus on the name of the medication and recall that medication names that end with the letters lol are beta blockers. Recalling that bradycardia can occur with the use of beta blockers will direct you to option 4. If you had difficulty with question, review this medication. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 903. 13. Heparin sodium (Liquaemin) is prescribed for the client. The nurse expects that the physician will order which of the following to monitor for a therapeutic effect of the medication? 1. Prothrombin time (PT) 2. Activated partial thromboplastin time (aPTT) 3. Hematocrit level 4. Hemoglobin level Answer: 2 Rationale: The PT will assess for the therapeutic effect of warfarin sodium (Coumadin) and the aPTT will assess the therapeutic effect of heparin sodium. Heparin sodium doses are determined based on these laboratory results. The hemoglobin and hematocrit values assess red blood cell concentrations. Test-Taking Strategy: Use the process of elimination. Eliminate options 3 and 4 because these laboratory values are unrelated to heparin sodium therapy. From the remaining options, knowledge of the appropriate test for monitoring therapeutic values of both heparin sodium and warfarin sodium is required to answer this question. Review this content if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 523. 14. A client has suffered an acute myocardial infarction and is receiving tissue plasminogen activator (t-PA). Which of the following is a priority nursing intervention while caring for the client? 1. Have heparin sodium (Liquaemin) available.

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2. Monitor for renal failure. 3. Monitor for signs of bleeding. 4. Monitor psychosocial status. Answer: 3 Rationale: t-PA is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client should be monitored for bleeding. Monitoring for renal failure and the client's psychosocial status is important; however, they are not the priority. Heparin sodium is given following thrombolytic therapy, but the question is not asking for the associated medications following t-PA therapy. Test-Taking Strategy: Use the process of elimination and note the key word, priority. Use the principles of prioritizing and knowledge regarding this medication to direct you to option 3. Additionally, remember that bleeding is a priority. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Lehne, R. (2004). Pharmacology for nursing care (5th ed.). Philadelphia: W.B. Saunders, p. 560. 15. A nurse is reinforcing instructions to the client about the use of a nitrate patch for the treatment of angina pectoris. Which of the following will the nurse include in the instructions to prevent client tolerance to nitrates? 1. Do not remove the patches. 2. Have a 12-hour “no-nitrate” time. 3. Have a 24-hour “no-nitrate” time. 4. Keep nitrates on 24 hours, then off 24 hours. Answer: 2 Rationale: To help prevent tolerance, clients need a 12-hour “no-nitrate” time. In addition to having a 12-hour no-nitrate time, the client must rotate the nitrate patch and wash his or her hands to prevent topical absorption through the fingers. Options 1, 3, and 4 are incorrect. Test-Taking Strategy: Use the process of elimination. Option 1 can be easily eliminated based on the issue of the question. Eliminate options 3 and 4 next because they are similar. Review the administration of nitrate patches if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, pp. 779. 16. A hypertensive client who has been taking metoprolol (Lopressor) has been ordered to decrease the dose of the medication. The client asks the nurse why this must be done over a period of 1 to 2 weeks. In formulating a response, the nurse incorporates the understanding that abrupt withdrawal could: 1. Give the client insomnia,

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2. Cause enhanced side effects of other prescribed medications, 3. Result in hypoglycemia, 4. Precipitate rebound hypertension, Answer: 4 Rationale: Beta-adrenergic blocking agents should be tapered slowly. This will avoid abrupt withdrawal syndrome, characterized by headache, malaise, palpitations, tremors, sweating, rebound hypertension, dysrhythmias, and possibly myocardial infarction (in clients with cardiac disorders, including angina pectoris). Options 1, 2, and 3 are incorrect. Test-Taking Strategy: Focus on the name of the medication and recall that medication names that end with the letters “lol” are beta blockers. Next, recall that all beta-adrenergic blocking agents should be tapered slowly to prevent withdrawal symptoms, as well as to prevent return of the symptoms for which the medication was prescribed. Also, note that the question guides you to the correct option by telling you that the client was taking this medication for hypertension. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Cardiovascular Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 705. 17. A client with a diagnosis of congestive heart failure is seen in the clinic. The client is being treated with a variety of medications, including digoxin (Lanoxin) and furosemide (Lasix). Which findings on data collection would lead the nurse to suspect that the client is hypokalemic? 1. Constipation 2. Intermittent intestinal colic 3. Muscle weakness and leg cramps 4. Tingling of fingers and toes Answer: 3 Rationale: Clients on potassium-wasting diuretics are at high risk of hypokalemia. Clinical manifestations of hypokalemia include fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps, decreased bowel motility, paresthesias, and dysrhythmias. Diarrhea and intestinal colic are signs of hyperkalemia. Tingling of the fingers and toes are signs of hypocalcemia. Test-Taking Strategy: Knowledge regarding the signs of hypokalemia is required to answer the question. Remember, muscle weakness and leg cramps are associated with hypokalemia. If you had difficulty with this question, review the signs of this electrolyte imbalance. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W. B. Saunders, p. 480. 18. A nurse is reinforcing dietary instructions to a client who is taking triamterene (Dyrenium). The nurse instructs the client that it is appropriate to consume which of the following food items daily?

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1. Avocado 2. Banana 3. Baked potato 4. Apple Answer: 4 Rationale: Triamterene is a potassium-sparing diuretic, which means that the client must avoid the intake of foods high in potassium. Options 1, 2, and 3 are high-potassium food items. Test-Taking Strategy: Focus on the name of the medication and recall that triamterene is a potassium-sparing diuretic. Next, recalling the food items high in potassium will direct you to option 4. If you are unfamiliar with this medication and those foods high in potassium, review this content. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Teaching/Learning Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 1075. 19. Hydrochlorothiazide (HydroDIURIL) is prescribed for the client. The nurse checks the client’s record for documentation of which of the following before administering the medication? 1. Penicillin allergy 2. Hyperkalemia 3. Sulfa allergy 4. History of osteoporosis Answer: 3 Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Options 1, 2, and 4 are not associated with the use of this medication. Test-Taking Strategy: Knowledge of the chemical make-up of thiazide diuretics is necessary to answer this question. Recalling that these medications contain a sulfa ring in their structure will direct you to option 3. Review the contraindications associated with the thiazide diuretics if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology References: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 530. Skidmore-Roth, L. (2005). Mosby’s drug guide for nurses (6th ed.). St. Louis: Mosby, p. 419. 20. Cholestyramine resin (Questran) is prescribed for a client with an elevated triglyceride level and a serum cholesterol level of 398 mg/dL. The nurse reinforces instructions to the client about the medication. Which statement by the client indicates the need for further instructions? 1. “Constipation and bloating might be a problem.” 2. “I'll continue to watch my diet and reduce my fats.” 3. “I'll continue my nicotinic acid from the health food store.”

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4. “Walking a mile each day will help the whole process.” Answer: 3 Rationale: Nicotinic acid should be avoided because it may lead to liver abnormalities. All lipid-lowering medications can also cause liver abnormalities, so a combination of nicotinic acid and cholestyramine is to be avoided. Constipation and bloating are the two most common side effects. Both walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels. Test-Taking Strategy: Note the key words, need for further instructions. These words indicate a false response question and that you need to select the incorrect client statement. Recalling that over-the-counter medications should be avoided when a client is taking a prescription medication will direct you to option 3. Review client teaching points related to this medication if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Evaluation Content Area: Pharmacology Reference: Skidmore-Roth, L. (2005). Mosby’s drug guide for nurses (6th ed.). St. Louis: Mosby, pp. 186-187. 21. A client is experiencing impotence after taking guanfacine (Tenex). The client states, “I would sooner have a stroke than keep living with the side effects of this medication.” The nurse makes which appropriate response to the client? 1. “I can understand completely.” 2. “That doctor should change your prescription.” 3. “You wouldn't really want to have a stroke.” 4. “You are concerned about the side effects of your medication.” Answer: 4 Rationale: Reflection of the client's own comment lets the client know that you are hearing his or her concerns without judging. The nurse cannot understand what the client is experiencing (option 1). Option 2 devalues the physician’s judgement. Option 3 is confrontative and unsupportive. Test-Taking Strategy: Use therapeutic communication techniques. Select nonjudgmental responses that reflect the fact you are listening to the client's concerns. Review these techniques if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Pharmacology Reference: Potter, P., & Perry, A. (2005) Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 437. 22. A physician tells the nurse that a potassium-sparing diuretic is being prescribed for the client with congestive heart failure. The nurse reviews the physician’s orders, expecting that which of the following medications will be prescribed? 1. Spironolactone (Aldactone) 2. Furosemide (Lasix)

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3. Ethacrynic acid (Edecrin) 4. Hydrochlorothiazide (HydroDIURIL) Answer: 1 Rationale: Spironolactone is a potassium-sparing diuretic that promotes sodium excretion while conserving potassium. Options 2, 3, and 4 identify diuretics that do not conserve potassium. Test-Taking Strategy: Knowledge that spironolactone is a potassium-sparing diuretic is required to answer this question. Review the potassium-sparing diuretics if you are unfamiliar with them and had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 985. 23. A client with coronary artery disease complains of substernal chest pain. After checking the client's heart rate and blood pressure, the nurse administers nitroglycerin, 0.4 mg sublingually. After 5 minutes, the client states, “My chest still hurts.” If the vital signs have remained stable, the nurse should: 1. Wait another 10 minutes and then administer a second nitroglycerin tablet 2. Apply 10 L of oxygen via nasal cannula 3. Administer another nitroglycerin tablet 4. Call the resuscitation team immediately Answer: 3 Rationale: Nitroglycerin tablets are usually ordered one every 5 minutes PRN for chest pain, for a total dose of three tablets. Waiting 10 minutes is inappropriate if the client is having chest pain. Oxygen at 10 L is an unsafe dose. There is no need to call the resuscitation team at this time. Test-Taking Strategy: Focus on the information provided in the question and use knowledge regarding the administration of nitroglycerin for chest pain. Recalling that a nitroglycerin tablet can be administered for three doses 5 minutes apart if the vital signs remain stable will direct you to option 3. Review the administration of nitroglycerin if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 780. 24. A nurse is caring for the client with history of mild heart failure who is receiving diltiazem (Cardizem) for hypertension. The nurse would check the client for: 1. Tachycardia and rebound hypertension 2. Wheezing and shortness of breath 3. Bradycardia, weight gain, and peripheral edema 4. Chest pain and tachycardia Answer: 3 Rationale: Calcium channel blocking agents, such as diltiazem, are used cautiously in clients

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with conditions that could be worsened by the medication, such as aortic stenosis, bradycardia, heart failure, acute myocardial infarction, and hypotension. The nurse would assess for signs and symptoms that indicate worsening of these underlying disorders. In this question, the nurse assesses for signs and symptoms indicating heart failure. Test-Taking Strategy: Focus on the medication name to determine that diltiazem is a calcium channel blocker, and recall that these medications decrease the rate and force of cardiac contraction. This helps you to eliminate options 1 and 4, because bradycardia is expected. Option 2 is eliminated next, because these signs could indicate bronchoconstriction, which does not occur with calcium channel blockers but does occur with some beta-adrenergic blockers. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Cardiovascular Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 330. 25. A client receiving nifedipine (Procardia) for angina complains of feeling listless, with generalized weakness and no energy. To support the client most effectively, the nurse must understand that these symptoms: 1. Are unrelated to taking the medication 2. Are an expected effect of the medication 3. Indicate toxic reaction to the medication 4. Indicate underdosing of the medication Answer: 2 Rationale: The client receiving a calcium channel blocking agent such as nifedipine may develop weakness and lethargy as expected effects of the medication. Options 1, 3, and 4 are incorrect. Test-Taking Strategy: Focus on the name of the medication. Recall that nifedipine is a calcium channel blocking agent, and that this medication decreases the rate and force of cardiac contraction, lowering the oxygen demand and also the cardiac output. By thinking through this process, you can reach the conclusion that decreased energy would then be an expected effect of the medication. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Cardiovascular Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 772. 26. A nurse has an order to administer a dose of nitroglycerin ointment (Nitro-Bid, Nitrostat) to a client. The nurse would avoid doing which of the following in preparing the medication for administration? 1. Using the manufacturer’s papers 2. Using the fingers to spread the ointment 3. Applying the dose in an even layer

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4. Washing off the previous application Answer: 2 Rationale: The ointment is readily absorbed through the skin, so using the fingers will result in the nurse becoming hypotensive. Proper administration of nitroglycerin ointment involves the use of the dose-measuring applicator paper supplied by the manufacturer and application in a thin, uniform even layer to a nonhairy area of the chest, abdomen, anterior thigh, or forearm. The previous dose is removed before applying, and sites are rotated to avoid inflammation. Test-Taking Strategy: Use the process of elimination and note the key word, avoid. This word indicates a false response question and that you need to select the incorrect action. This question tests fundamental principles of medication administration for nitroglycerin ointment. Visualizing each action will direct you to the correct option. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Cardiovascular Reference: Lehne, R. (2004). Pharmacology for nursing care (5th ed.). Philadelphia: W.B. Saunders, p. 534. 27. A 66-year-old client is seen in the clinic complaining of not feeling well. The client is taking several medications for the control of heart disease and hypertension. These medications include atenolol (Tenormin), digoxin (Lanoxin), and chlorothiazide (Diuril). A tentative diagnosis of digoxin toxicity is made. The nurse collects data from the client, knowing that which of the following would support this diagnosis? 1. Chest pain, hypotension, and paresthesia 2. Constipation, dry mouth, and sleep disorder 3. Double vision, loss of appetite, and nausea 4. Dyspnea, edema, and palpitations Answer: 3 Rationale: Double vision, loss of appetite, and nausea are signs of digoxin toxicity. Additional signs of digoxin toxicity include bradycardia, difficulty reading, visual alterations such as green and yellow vision, seeing spots or halos, confusion, vomiting, diarrhea, decreased libido, and impotence. Test-Taking Strategy: Knowledge regarding the signs of digoxin toxicity is required to answer the question. Remembering that gastrointestinal and visual disturbances are signs of toxicity will direct you to option 3. If you had difficulty with this question, review the signs of digoxin toxicity. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, pp. 218, 326, 373. 28. A 79-year-old client is being treated for congestive heart failure with bumetanide (Bumex). The client’s vital signs are blood pressure, 100/60 mm Hg , pulse, 96 beats per minute, and

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respirations, 24 breaths per minute. The nurse checks which priority item before administering the medication? 1. Blood pressure 2. Weight 3. Urine output 4. Temperature Answer: 1 Rationale: Hypotension is a common side effect with this medication, and an increased risk exists in an elderly client. Options 2 and 3 will also require monitoring but are not the priority. The temperature is unrelated to administering this medication. Test-Taking Strategy: Use the process of elimination and focus on the key word, priority. Use the ABCs—airway, breathing, and circulation. Blood pressure reflects circulation. Review the side effects of this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 143. 29. Atorvastatin (Lipitor) has been prescribed for a client with an elevated cholesterol level. The nurse collects a health history from the client, knowing that the medication is contraindicated in which of the following conditions? 1. Cirrhosis 2. Coronary artery disease 3. Diabetes mellitus 4. Hypothyroidism Answer: 1 Rationale: Atorvastin is an antihyperlipidemic medication. It is contraindicated in pregnancy, lactation, liver disease, biliary cirrhosis or obstruction, and severe renal dysfunction, and in clients who are hypersensitive to the medication. Options 2, 3, and 4 are not contraindications to the use of this medication. Test-Taking Strategy: Knowledge regarding the contraindications associated with use of this medication is required to answer this question. Remember, atorvastin is contraindicated in the client with liver disease. Review these contraindications if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 93. 30. Warfarin sodium (Coumadin) is prescribed for the client. The nurse expects that the physician will order which of the following to monitor for a therapeutic effect of the medication? 1. Prothrombin time (PT) 2. Activated partial thromboplastin time (aPTT)

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3. Red blood cell (RBC) count 4. Platelet count Answer: 1 Rationale: The PT will assess for the therapeutic effect of warfarin sodium (Coumadin) and the aPTT will assess the therapeutic effect of heparin sodium. The RBC and platelet counts will assess red blood cell concentration and the client’s potential for bleeding, respectively. Warfarin sodium doses are determined based the results of the PT. Test-Taking Strategy: Use the process of elimination. Eliminate options 3 and 4 first, because these laboratory values are unrelated to warfarin sodium therapy. From the remaining options, knowledge of the appropriate test for monitoring the therapeutic values of both heparin sodium and warfarin sodium is required to answer this question. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 1122. 31. A client with coronary artery disease complains of substernal chest pain. After assessing the client's heart rate and blood pressure, a nurse administers nitroglycerin, 0.4 mg, sublingually. After 5 minutes, the client states, "My chest still hurts." Select the appropriate actions that the nurse should take. ____Assess the client’s pain level. ____Check the client's blood pressure. ____Contact the physician. ____Call a code blue. ____Administer a second nitroglycerin, 0.4 mg, sublingually. Answers: Assess the client’s pain level. Check the client's blood pressure. Administer a second nitroglycerin, 0.4 mg, sublingually. Rationale: The usual guidelines for administering nitroglycerin tablets for chest pain is to administer one tablet every 5 minutes PRN for chest pain, for a total dose of three tablets. If the client does not obtain relief after taking a third dose of nitroglycerin, the physician is notified. Because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would assess the client’s pain level and check the client’s blood pressure before administering each nitroglycerin dose. There is no data in the question that indicates the need to call a code blue. Test-Taking Strategy: Focus on the data in the question. Use the steps of the clinical problemsolving process (nursing process) to determine that assessing the client’s pain level and checking the client's blood pressure are appropriate actions. Next recalling the usual guidelines for administering nitroglycerin tablets will assist in determining that an appropriate action is to administer a second nitroglycerin, 0.4 mg, sublingually. Review care of the client with chest pain and the guidelines for the administration of nitroglycerin if you had difficulty with this question.

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Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Kee, J., & Hayes, E. (2003). Pharmacology: A nursing process approach (4th ed.). Philadelphia: W.B. Saunders, p. 576.