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NSG 3032 Pharmacotherapeutics II EXAM
1 LATEST 2024/2025 SOUTH UNIVERSITY
WITH RATIONALE
- A patient is diagnosed with heart failure (HF), and the prescriber has ordered digoxin. What lifestyle changes will help in the management of this condition? c. Consuming 2 teaspoons or less of salt every day Reducing salt intake helps manage fluid retention and blood pressure.
- A patient with chronic obstructive pulmonary disease (COPD) has increasing dyspnea and is being evaluated for HF. Which test will be ordered to help differentiate between dyspnea due to lung dysfunction and dyspnea due to HF? b. Brain natriuretic peptide (BNP) level Elevated BNP levels are indicative of heart failure.
- Phosphodiesterase inhibitors promote which actions in treating heart failure? c. Promote positive inotropic action These inhibitors increase the force of heart contractions.
- A client with a history of atrial flutter is prescribed quinidine. What is the nurse's best response when answering a patient who asks how the drug helps the heart? d. "It will slow down the speed of your heart so that it will work more effectively." Quinidine helps by slowing down the heart rate and stabilizing the rhythm.
- Which is more effective when other drugs are ineffective in treating ventricular fibrillation? a. Amiodarone Amiodarone is effective in managing ventricular fibrillation when other treatments fail.
- What is lidocaine primarily used to treat? d. Ventricular dysrhythmias Lidocaine is used to treat ventricular arrhythmias.
- A client with angina has been prescribed verapamil. Which priority teaching point(s) will the nurse include regarding this drug? (Select all that apply.) a. "Eat lots of fiber to avoid constipation." c. "This drug is taken three times per day." Verapamil can cause constipation, and it's typically taken multiple times a day.
- A client has been prescribed amlodipine to help control hypertension. Which laboratory values must be monitored carefully when on amlodipine? d. Liver enzymes Amlodipine can affect liver function, so monitoring liver enzymes is important.
- What is the antidote for digitalis toxicity? b. Digoxin immune Fab This antidote helps neutralize digoxin in cases of toxicity. The nurse is reviewing the patient's medication administration record (MAR). Which drug(s) on the MAR will concern the nurse, given that the patient is taking digitalis? (Select all that apply.)
This range is considered therapeutic for digoxin. Which priority teaching should the nurse provide to a client who has just started taking acebutolol? a. "Do not abruptly stop this drug, or you risk your heart rate beating very fast or irregularly." Abrupt discontinuation can lead to rebound effects. What is the duration of action of a nitroglycerin transdermal patch? c. 18-24 hours Nitroglycerin patches typically have this duration of action. Which priority health teaching should be given to a client taking sublingual (SL) nitroglycerin (NTG)? (Select all that apply.) b. NTG should be stored in its original container and away from light. d. Call your health care provider if chest pain is not relieved after three tablets. e. Clients should not take vitamin C supplements while taking NTG. Proper storage and use of nitroglycerin are crucial for effectiveness. The nurse is providing health teaching to a client prescribed digoxin for heart failure. Which food(s) will the nurse tell the client to avoid? (Select all that apply.) c. Hot dogs e. Potatoes Foods high in sodium and potassium should be monitored in clients taking digoxin. Which herbal preparation(s) must be avoided when taking digitalis preparations? (Select all that apply.) a. Aloe d. Ginseng
e. Ma-huang These herbs can interact negatively with digitalis. Which condition(s) can directly lead to cardiac dysrhythmias? (Select all that apply.) a. Electrolyte imbalances b. Excess catecholamines d. Hypocapnia e. Hypoxia These conditions can contribute to the development of dysrhythmias. Which client would be most suited for treatment with a nonselective alpha- adrenergic blocker? b. A client with hypertension associated with pheochromocytoma Nonselective alpha-blockers are used for specific conditions like pheochromocytoma. Where in the body do direct-acting vasodilators act to decrease blood pressure? d. Smooth muscles of the blood vessels Direct-acting vasodilators target smooth muscle in blood vessels. With use of direct-acting vasodilators, sodium and water are retained and peripheral edema occurs. Which category of drugs should be given to avoid fluid retention? d. Diuretics Diuretics help manage fluid retention caused by vasodilators. Which is/are action(s) of angiotensin II-receptor blockers (ARBs)? (Select all that apply.) a. Block angiotensin II
These combinations can enhance the blood pressure-lowering effect. Which drug-herb interaction can occur when ma-huang (ephedra) is taken concomitantly with an antihypertensive drug? a. A decrease or counteraction of the effects of the antihypertensive drug Ma-huang can reduce the effectiveness of antihypertensive medications. A African American client presents to a health care provider for continued high blood pressure. Which group of drugs would be more effective for this client? c. Calcium blockers Calcium channel blockers are often more effective for African American clients with hypertension. A nurse would be concerned about administering an ACE inhibitor as mono- therapy to which client? d. An African American client Rationale: ACE inhibitors are often less effective as mono-therapy in African American patients compared to other racial groups. They may respond better when combined with a calcium channel blocker or a diuretic. What is the protein-binding power of amlodipine? b. Moderately to highly protein-bound Rationale: Amlodipine is approximately 93-98% protein-bound. What will the nurse assess in a client experiencing side effects from metoprolol? (Select all that apply.) a. Dizziness b. Headache d. Nausea
Rationale: Metoprolol, a beta-blocker, can cause dizziness, headache, and nausea. Increased blood pressure is not a typical side effect, and paranoia is not commonly associated with metoprolol. Which statement best describes the direct renin inhibitor aliskiren? b. It can be combined with another antihypertensive drug. Rationale: Aliskiren can be used in combination with other antihypertensive agents to enhance effectiveness. A client taking amlodipine complains of swelling in the ankles. What is the nurse's best response to the client's concern? b. "Swelling may occur with amlodipine. I will contact your health care provider to determine if the drug should be changed." Rationale: Swelling of the ankles is a known side effect of amlodipine, but it is important to consult with the healthcare provider for further evaluation and possible adjustment of medication. What is/are the advantage(s) of using cardioselective beta-adrenergic blockers as an antihypertensive? (Select all that apply.) d. They maintain renal blood flow. e. They minimize the hypoglycemic effect. Rationale: Cardioselective beta-blockers are less likely to affect the lungs and are generally safer for diabetic patients. They can help maintain renal blood flow and reduce the risk of hypoglycemia. A client on warfarin for a deep vein thrombosis asks the nurse how warfarin works. What is the nurse's best response? c. "Warfarin prevents new clots from forming." Rationale: Warfarin is an anticoagulant that prevents the formation of new blood clots but does not dissolve existing clots. The nurse has several clients receiving warfarin. Which INR(s) would concern the nurse? (Select all that apply.)
Rationale: Monitoring INR is crucial for clients on warfarin to ensure the drug is within the therapeutic range and to prevent complications. Which statement best describes clopidogrel? d. It can be used together with aspirin after myocardial infarction (MI) or cerebrovascular accident (CVA) to prevent platelet aggregation. Rationale: Clopidogrel is often used in combination with aspirin to reduce the risk of further thrombotic events. A client weighs 168 pounds and is going to receive abciximab for unstable angina. What is the correct dosage for a continuous infusion? a. 9.5 mcg/min Rationale: For a typical dosing regimen, the continuous infusion rate of abciximab is 0.125 mcg/kg/min, which approximates to about 9.5 mcg/min for this client’s weight. The client is given heparin for early treatment of deep vein thrombosis. Later, warfarin is prescribed. If the client is also taking fluoxetine, which is highly protein-bound, which drug-drug interaction can occur? b. Drug displacement of warfarin Rationale: Fluoxetine can displace warfarin from protein-binding sites, increasing the risk of bleeding. A client, who has been on fondaparinux at home, presents to the emergency department with complaints of gastrointestinal bleeding. What does the nurse anticipate is occurring? a. Adverse reaction Rationale: Gastrointestinal bleeding is a known adverse effect of fondaparinux. Which client(s) would be a candidate(s) for anticoagulant? (Select all that apply.) a. A client with deep vein thrombosis (DVT)
b. A client with an artificial heart valve e. A client with a cerebrovascular accident (CVA) Rationale: Anticoagulants are used for DVT, artificial heart valves, and CVA to prevent clot formation and recurrence. A client who received alteplase for treatment of a cerebrovascular accident (CVA) begins to hemorrhage. Which drug will the nurse anticipate administering? b. Aminocaproic acid Rationale: Aminocaproic acid is an antifibrinolytic agent used to control bleeding complications following thrombolytic therapy. Which action(s) will the nurse perform when caring for a client who is receiving tenecteplase? (Select all that apply.) a. Assess for reperfusion arrhythmias. c. Observe for signs and symptoms of bleeding. e. Record vital signs and report changes. Rationale: Monitoring for arrhythmias, bleeding, and vital signs are important in the care of clients receiving thrombolytics like tenecteplase. Which elevated apolipoprotein can be an indication of risk for coronary artery disease (CAD)? c. apoB- 100 Rationale: Elevated levels of apoB-100 are associated with an increased risk of CAD. A client who was prescribed atorvastatin 80 mg/day presented to the emergency department feeling weak and complaining of muscle pain. What severe side effect of statins does the nurse suspect? d. Rhabdomyolysis Rationale: Muscle pain and weakness in patients taking statins can be indicative of rhabdomyolysis, a serious side effect.
