chap 20,21, 24,25, 26

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chap 20,21, 24,25, 26
2011-05-13 12:16:15

pharm 3
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  1. Stage 1 hypertension with no cardiovascular risks is treated with lifestyle modifications.
  2. One advantage of using Clonidine-TTS patch is the reduction in variation in action observed when clonidine tablets are used.
  3. One of the primary advantages of irbesartan, one of the newest angiotensin II inhibitors, is that it also is approved as a treatment for diabetic neuropathy.
  4. Hypertension is
    diagnosed on the basis of one blood pressure measurement of at least 140/90.
  5. A potential adverse effect of the use of nitroprusside is cyanide toxicity.
  6. Diuretics are used in the treatment of all the following
    edema, obesity, hypertension
  7. The health care provider prescribes furosemide for a client. The nurse understands that this drug is a(an):
    loop diuretic
  8. The client is a 35-year-old male who was diagnosed with hypertension one year ago. His current drug regime includes enalapril 40 mg by mouth daily. The client confides to the nurse that he is experiencing sexual dysfunction and plans to stop his medication. The nurse’s best response is:
    “Sexual dysfunction can be an adverse effect of this medication, but you shouldn’t stop this medication without discussing it with your doctor. Changes can be made that should eliminate this effect.”
  9. When teaching a client about the risk factors for hypertension, the nurse realizes further instruction is needed when the client identifies which as a risk factor?
  10. low serum cholesterol.
  11. In instructing a client about methyldopa therapy, the nurse stresses that the client should pay particular attention for the development of:
    drowsiness and orthostatic hypotension.
  12. Probably the most common reason that clients stop taking antihypertensive medication is:
    belief that control of blood pressure means cure.
  13. When teaching a client about the adverse effects of thiazide diuretic, the nurse basis instruction on which underlying cause of most adverse effects?
  14. While caring for a hypertensive client, the client’s blood pressure becomes 180/122. After reporting this to the health care provider, the nurse prepares to administer:
  15. Before obtaining the client’s blood pressure the nurse should:
    obtain the appropriate size cuff for taking the blood pressure for this client.
  16. The nurse monitors a 55-year-old man receiving spirolactone for:
  17. The nurse knows that osmotic diuretics are most often used to treat:
    increased intracranial pressure (ICP).
  18. The client is prescribed bumetanide 5 mg by mouth once a day for hypertension and gentamycin 80 mg IV every eight hours for a severe upper respiratory infection. The nurse should monitor this client for:
  19. When monitoring clients receiving thiazide diuretics, the nurse is unlikely to see:
  20. A client is prescribed aldactazide. When preparing to teach the client about the medication, the nurse understands that this agent is a:
    combination potassium-sparing and thiazide diuretics.
  21. The use of carbonic anhydrase inhibitors in treating hypertension has declined. However, they are now used primarily to decrease:
    increased intraocular pressure
  22. The nurse is caring for a client with renal insufficiency. The diuretic of choice for this client is:
  23. When caring for a client receiving reserpine, the nurse should monitor the client for:
    mental depression
  24. Potassium supplements should not be used when a client is receiving:
  25. The nurse caring for an elderly client receiving antihypertensive therapy should:
    protect the client from falls.
  26. Teaching the client receiving antihypertensive therapy to eat a high-protein snack and flex the calf muscle will help decrease the client’s experiencing
    orthostatic hypotension.
  27. When involved in treating a client experiencing a hypertensive emergency, the nurse prepares to administer:
    intravenous sodium nitroprusside.
  28. In caring for hypertensive clients, usually the most important emphasis in the nurse-client relationship is placed on:
    getting the individual to assume responsibility for self-care.
  29. A client has been placed on mild sodium restriction (1500 mg/day) and asks the nurse what this restriction involves. The nurse’s best response is:
    “You should not add salt to cooking and avoid chips and pickles.”
  30. The client the reason for being prescribed triamterene and HCTZ combination agent for hypertension. The nurse’s best reply is:
    “Taking this combination medicine helps decrease the adverse effects of both drugs.”
  31. When evaluating the client’s understanding of antihypertensive therapy, the nurse recognizes which statement indicates client understanding.
    “I need to take my medicine, even if I don’t have any symptoms.”
  32. The nurse observes for signs and symptoms of anemia and liver dysfunction in clients taking:
  33. A client is prescribed captopril and asks the nurse if this is like the atenolol that a neighbor takes for hypertension. The nurse’s best response would be:
    “No, they both treat hypertension, but work in different ways.”
  34. The nurse exercises good judgment in assigning an appropriate administration schedule for the client’s furosemide 40 mg by mouth daily when the dose is scheduled for:
    8 a.m.
  35. When caring for the client prescribed hydrochlorothiazide (HCTZ) and digoxin, the nurse would monitor the client for:
  36. The nurse instructs the client who takes HCTZ daily that he should consume which of the following foods in his diet?
    bananas and oranges
  37. A client is prescribed HCTZ, 25 mg by mouth daily. The pharmacy sends HCTZ 50 mg/5 mL. The client should receive:
    3 mL.
  38. For the client receiving furosemide, the nurse should monitor for:
    muscle weakness, leg cramps, irregular pulse
  39. Angiotensin II receptor antagonists appear to have fewer adverse effects than other antihypertensive agents and the nurse recognizes which of the following agents are in this classification?
    valsartan, losartan
  40. Dietary modification is an important part of therapy for clients with elevated serum lipids
  41. Constipation is a frequent side effect for clients using exchange resins.
  42. Long-term use of exchange resins is sometimes associated with the development of electrolyte disturbances.
  43. High-density lipoproteins (HDL) contain the highest proportion of cholesterol of all the lipoproteins.
  44. VLDL and LDL play the most important roles in promoting atherosclerosis.
  45. When evaluating a client for risk factors for the development of atherosclerosis, the nurse should be concerned about which of the following?
    low-density lipoprotein 130 mg/dL
  46. The nurse should include which of the following when teaching a client prescribed cholestyramine?
    Mix the drug with a liquid or soft food
  47. When teaching a client about the recommended serum cholesterol level for an adult, the nurse instructs the client to try to achieve:
    cholesterol level of 170 mg/dL.
  48. When teaching a client who is prescribed niacin to decrease triglyceride levels and raise HDL levels, the nurse should instruct the client that:
    in high doses, niacin is very effective in decreasing triglyceride levels and raising HDL levels.
  49. The client asked the nurse about how colesevelam HCl works to decrease serum LDL. The nurse’s best response is:
    “It works by increasing the conversion of cholesterol to bile acids.”
  50. The nurse knows instructs a client prescribed simvastatin single daily dose therapy to schedule the medication
    in the evening, because cholesterol is synthesized between midnight and 3 a.m.
  51. When teaching the client about cholesterol, the nurse should instruct the client that the highest level of cholesterol is found in:
  52. Colestipol HCl is most similar in action to:
  53. When evaluating a client for an end point for therapy with an HMG-CoA reductase inhibitor, the nurse monitors to detect when:
    transaminase levels rise and remain at 3 times the upper limit of normal.
  54. In addition to niacin, the client is on antihypertensive therapy. When caring for this client, the nurse should:
    monitor the client for hypotension.
  55. In teaching a client about hyperlipidemia, the nurse should include:
    Usually, drug therapy is used in conjunction with dietary modification
  56. Which of the following medications, if prescribed to a pregnant woman, would the nurse question
  57. Which of the following should be included in client teaching for clients on lovastatin (Mevacor) therapy?
    Liver function studies should be monitored.
  58. Which of the following is a combination HMG-CoA reductase inhibitor and statin?
  59. When teaching a client about atorvastin, the nurse should include information about when to schedule follow-up visits with the health care provider for lab work. What should the nurse tell the client?
    Liver function tests will need to be done every four-to-six weeks for the first three months.
  60. When teaching a client about niacin therapy, the nurse should tell the client that niacin:
    is the least expensive cholesterol-reducing therapy
  61. When teaching a client prescribed atorvastatin, the nurse should instruct the client that:
    maximal effects occur by four-to-six weeks.
  62. Clients taking antilipidemia agents should be taught:
    to consume one-to-two liters of fluid per day.
  63. The client asks the nurse if he can still drink his six-pack of beer in the evening while on the simvastatin. The nurse’s best reply is:
    Alcohol can cause liver damage that may increase in simvastin, but we can provide you with support to stop drinking
  64. When teaching a client prescribed an antilipidemia drug, the nurse should instruct the client:
    “Compliance with therapy is crucial to success.”
  65. The nurse understands that all HMG-CoA reductase inhibitors do which of the following:
    decrease cholesterol,increase HDL levels, decrease LDL levels.
  66. The nurse should monitor clients taking exchange resins for:
    fat-soluble vitamin deficiencies, nosebleeds (epistaxis), bruising.
  67. Antacid therapy can cause an increase in urinary pH, which may effect the excretion of some drugs.
  68. Cost is an important consideration for many clients using antacid therapy, because most clients will be on long-term therapy.
  69. Research findings have established that antacid therapy facilitates healing of peptic ulcers
  70. GERD may result in esophageal erosion.
  71. Lansoprazole (Prevacid) acts by suppressing gastric acid secretion.
  72. A tense 32-year-old junior executive for a large corporation has had recurrent episodes of abdominal pain, anorexia, and vomiting for the last two years. The client describes his pain as a burning sensation. It is usually most severe just prior to meals and subsides upon ingestion of a meal. The client smokes two packs of cigarettes and drinks about eight cups of coffee each day. The client’s health care provider prescribes diazepam (Valium) 5 mg t.i.d. and Mylanta II Liquid 30 mL hourly.
    The reason the client’s abdominal pain is most severe just prior to mealtime is because:
    stomach acid and pepsin are not being consumed by food.
  73. The client asks the office nurse if his smoking can cause the development of peptic ulcer disease. The nurse’s best response is:
    “Smoking increases the secretion of stomach acid, as well as decreasing the acid-neutralizing capacity within the first part of the small intestines.”
  74. The clients asks the nurse what the difference is between antacids and proton pump inhibitors. The nurse’s best response is:
    “Antacids neutralize gastric acid and proton pump inhibitors prevent the secretion of gastric acid.”
  75. When teaching a client about antacids, which comment by the client indicates further teaching is needed:
    “Taking antacids will not affect my heart medication (digoxin).”
  76. The nurse should teach a client taking an antacid to take it one hour after meals because:
    the antacid has a much longer duration of action.
  77. Which of the following statements is true about antacid therapy?
    Gas released by effervescent antacid solutions may lead to distention and secretion of additional hydrochloric acid.
  78. The client asks the nurse how his ranitidine works to treat his heartburn. The nurse’s best response is:
    “Ranitidine block the histamine-2 receptors in the stomach to decrease gastric acid.”
  79. An example of an antacid that releases carbon dioxide when it neutralizes acid in the stomach is
    calcium carbonate.
  80. An important reason for using this antacid in renal failure clients is that with prolonged use it leads to phosphate depletion.
    aluminum hydroxide
  81. The client says to the nurse that since he started taking an antacid “that distended feeling in my stomach is better.” In explaining this effect, the nurse understands that the antacid probably contained:
  82. For the client taking enteric-coated aspirin for a heart condition, the nurse should instruct the client:
    not to take his antacid within one to two hours of his EC (enteric-coated) aspirin.
  83. Prior to preparing to administer a liquid antacid, the nurse must:
    shake well to mix the liquid prior to pouring.
  84. The nurse understands that antacids absorbed systemically:
    have a rapid onset and a short duration of action.
  85. The ideal antacid does not cause acid rebound. Acid rebound is best described as:
    overproduction of acid when the stomach pH is above the 4-5 range.
  86. Clients sometimes prefer chewable forms of antacids because of their convenience. When this form of antacid is used, the nurse instructs the client to:
    chew the tablet completely before swallowing and follow it with a glass of water.
  87. The client is prescribed cimetidine for treatment of hyperacidity. The nurse should tell the client:
    “Your cigarette smoking may decrease the effectiveness of this drug.”
  88. Acid-neutralizing capacity (ANC) is an important consideration in choice of antacid. The nurse realizes that further client education is necessary when the client expresses which of the following ideas?
    “Antacids with a high ANC can only be obtained by prescription.
  89. Cimetidine is not as commonly used as often in adults as other drugs in its class. The nurse understands that this is because cimetidine:
    has more drug-to-drug interactions.
  90. Which of the following statements by the client indicates that further teaching about proton pump inhibitor therapy is warranted?
    These are just more expensive versions of the histamine-2 antagonists.”
  91. In addition to treating duodenal ulcer disease, lansoprazole and omeprazole also are approved in the treatment of:
    H. pylori infections
  92. The client asks the nurse why her health care provider prescribed esomeprazole for her. The nurse’s best response is:
    “This drug is used to treat the inflammation in your esophagus caused by GERD.”
  93. A hospitalized client has been prescribed sucralfate. The nurse understands that this drug is used because it:
    forms a protective complex over duodenal ulcers.
  94. The nurse realizes that which of the following clients is most likely to experience pancreatic enzyme deficiency?
    a client with multiple sclerosis
  95. The nurse recognizes that which of the following is not a histamine H2-receptor antagonist?
  96. A client taking ranitidine tells the nurse that he frequently experiences headaches. The best response by the nurse is:
    “Though headaches can occur, can you describe these headaches for me?”
  97. A client taking nonsteroidal anti-inflammatory agents (NSAIDs) for arthritis is experiencing gastric irritation. The nurse anticipates the health care provider will prescribe:
    discontinued use of NSAIDs.
  98. A client is prescribed esomeprazole and metoclopramide for GERD. The client approaches the nurse saying, “I understand why he prescribed Nexium, but why the laxative?” The nurse’s best response is:
    “Metoclopramide is a gastric stimulant, not a laxative.”
  99. The nurse admitting a client with GERD is planning the client’s care and determines that the priority nursing diagnosis for this client is:
    Risk for injury related to development of complications of GERD.
  100. The nurse would question a prescription for metoclopramide for which of the following clients?
    a child under six years of age
  101. A client is experiencing constipation secondary to the use of calcium carbonate. The nurse’s most appropriate response to this client is:
    “Alternating the calcium carbonate with magnesium hydroxide will help prevent this.”
  102. A client asks the nurse if drinking coffee might make her peptic ulcer disease worse. The nurse’s best response is:
    “Both caffeinated and decaffeinated coffees are ulcerogenic and must be avoided.”
  103. The nurse understands that which of these clients is the most appropriate candidate for metoclopramide therapy?
    a client debilitated by a stroke
  104. A young child being treated with metoclopramide for gastroesophageal reflux develops an acute dystonic reaction. The nurse anticipates administering
    parenteral diphenhydramine.
  105. For the client taking omeprazole, the nurse understands that this drug:
    decreases the metabolism of warfarin,increases plasma levels of phenytoin, increases plasma levels of diazepam.
  106. In scheduling medications, the nurse does not schedule sucralfate administration simultaneously with:
    digoxin, warfarin, phenytoin, tetracycline
  107. Promethazine is used to treat motion sickness
  108. A major concern in care of clients with emesis is the risk of aspiration.
  109. Emetics are indicated for treatment of clients who ingest gasoline.
  110. Anticholinergic antiemetics are not agents of choice for management of nausea and vomiting in clients with benign prostatic hypertrophy.
  111. The use of emetics has declined, as safer methods of removal of poisons develop.
  112. During a well-baby check-up, a mother of an infant says to the nurse, “I have ipecac syrup at home just like my mother did for me.” The nurse’s best response is:
    “Ipecac syrup should not be around infants, and we don’t use it in infants, because of the risk of aspiration
  113. The mother of a small child asks the nurse if she should keep ipecac syrup handy in case her three-year-old “swallows something he shouldn’t.” The nurse’s best response is:
    “No, ipecac syrup should only be given under medical supervision
  114. An adolescent is admitted for an ipecac overdose. The nurse’s first intervention should be to:
    place the child on a cardiac monitor.
  115. The nurse understands that which of the following clients would be the most likely to misuse the drug ipecac?
    an adolescent with bulimia
  116. A client is being seen by the health care provider for a prescription medication for motion sickness. The nurse anticipates the client will be prescribed:
  117. A pregnant client is admitted with excessive nausea and vomiting. Proactively, the nurse will place the client in what position?
    side lying
  118. A client is receiving antiemetic therapy for a history of frequent nausea and vomiting. In caring for this client the nurse should:
    monitor for fluid and electrolyte imbalances
  119. Prescribed is ondansetron 4 mg IV for a client with a central venous access. The pharmacy provides ondansetron 4 mg in 50 mL of D5W to infuse over 15 minutes. The nurse will program the volumetric infusion pump at
    200 mL/hr.
  120. The nurse should question administering promethazine to a client with a history of:
    benign prostatic hypertrophy (BPH).
  121. A client is receiving chlorpromazine HCl. The nurse understands that this medication is classified as a/an:
  122. A client receiving emetogenic chemotherapy should receive which of the following medications as a premedication?
  123. The nurse is aware of a special warning on the label of droperidol about the risk of:
    sudden cardiac death.
  124. A client on chemotherapy asks the nurse why he is now prescribed aprepitant as one of his premeds. The nurse’s best response is:
    “This drug is combined with your other premeds for better control of nausea.”
  125. A client is receiving a serotonin antagonist and a corticosteroid as premedications for chemotherapy. The nurse understands these agents are used in this circumstance to:
    prevent acute and delayed nausea and vomiting caused by chemotherapy.
  126. A postoperative client is prescribed IV promethazine to treat his nausea. The nurse understands that this agent:
    is not compatible with lactated Ringer’s IV solution.
  127. A client is prescribed IV palonosetron HCl. The nurse understands the action of this agent is to:
    prevent delayed nausea and vomiting related to chemotherapy
  128. When planning care for a client receiving treatment for vomiting, the nurse’s highest priority nursing diagnosis is:
    risk for aspiration related to vomiting
  129. Prior to administering IV palonosetron, the nurse should:
    flush the IV line with 0.9% saline.
  130. The nurse is caring for a client with urinary retention secondary to benign prostatic hypertrophy experiencing nausea. The nurse would question which of the following prescriptions written by the health care provider for this client?
    promethazine 25 mg IV now
  131. A client receiving chemotherapy is prescribed dolasetron mesylate 100 mg IV. The nurse plans to administer the dolasetron mesylate
    30 minutes prior to chemotherapy.
  132. Ondansetron IV is prescribed for a client. The recommended safe dose for IV ondansetron is 0.15 mg/kg/dose. What is the safe dose for a client who weighs 132 pounds?
    9 mg
  133. A child weighing 21 pounds is prescribed diphenhydramine by mouth to prevent nausea associated with receiving immunizations. The recommended safe dose for diphenhydramine is 5 mg/kg/day in 4 divided doses. This child’s individual dose should not exceed:
    12 mg/dose.
  134. When teaching mothers of infants and small children about vomiting and diarrhea in their children, which statement by one of the mothers indicates and understanding of the teaching?
    “I will take him to the pediatrician if his vomiting lasts more than 24 hours.”
  135. The nurse is caring for a client who is to receive chemotherapy. When the nurse notes the client does not have a prescription for premedication prior to chemotherapy he or she should:
    collaborate with the health care provider for a premedication prescription.
  136. The client receiving a neuroleptic agent for nausea should be instructed to:
    rise slowly from a reclined or sitting position.
  137. The nurse’s priority focus when a client begins to vomit is to:
    maintain a patent airway
  138. For the client receiving droperidol, the nurse should monitor for:
    orthostatic hypotension, sedation ,tardive dyskinesia
  139. Overuse of laxatives by the elderly is a common problem
  140. Prolonged use of laxatives will decrease the need and the dose of laxatives needed to obtain a response.
  141. Magnesium citrate is a saline laxative.
  142. Clients typically use GoLYTELY as a bowel prep prior to a gastrointestinal diagnostic procedure.
  143. The nurse understands that clients taking which of the following classifications of laxatives are most likely to experience laxative-dependence?
    stimulant laxatives
  144. The nurse teaching the client receiving diphenoxylate HCl (Lomotil) knows the client needs further teaching when the client responds with which of the following?
    “I will take a laxative, if I do not have a bowel movement every day.”
  145. The nurse applies which of the following principles when teaching clients about absorbent agents such as kaolin?
    Do not take these agents within several hours of other drugs.
  146. All of the following are characteristics of the “ideal laxative,” except:
    works for several days after administration.
  147. The nurse understands that saline laxatives work by:
    increasing fluid in the stool by osmosis.
  148. A client with cardiovascular disease is prescribed a laxative. Which of the following prescriptions would the nurse question for this client?
    magnesium citrate 240 mL
  149. The nurse is caring for a 71-year-old who underwent a total hip replacement and then developed constipation from lack of activity. What action by the nurse could have prevented constipation in this client?
    collaborating with the health care provider about prophylactic use of stool softeners
  150. For pregnant women, which type of laxative usually is recommended?
    bulk-forming laxatives
  151. Saline laxatives generally should be avoided by clients who are:
    experiencing renal insufficiency
  152. The nurse who is teaching a client about how to use OTC methylcellulose should include
    “Follow the laxative with at least 8 ounces of water
  153. The nurse explains to the client taking psyllium that:
    “It frequently takes at least 12 hours before you experience a bowel movement.”
  154. The nurse understands that lactulose is most commonly prescribed for the client experiencing
    portal systemic encephalopathy.
  155. The nurse instructing a client about laxatives uses which of the following examples to illustrate the type of laxative most likely to result in laxative dependence?
  156. For the client with an elevated ammonia level, the nurse anticipates administering:
  157. Polyethylene glycol-electrolyte solution mixtures are commonly employed as:
    bowel-cleansing products
  158. When teaching a client about how loperamide HCl works, the nurse should include,
    It acts by decreasing gastrointestinal motility.”
  159. The nurse understands that which of the following medications is generally prescribed for treatment of antibiotic-induced diarrhea?
    lactobacillus product
  160. In providing education about maintaining optimal bowel function, the nurse instructs the client to:
    increase fluid intake.
  161. When administering a rectal suppository to a client, the nurse should:
    insert tapered end of the suppository first
  162. When administering a rectal suppository, the nurse should insert the suppository
    above the internal sphincter.
  163. Prior to administering an enema, the nurse should:
    warm solution to 99-102 degrees F.
  164. During administration of a nonretention enema, the nurse should
    hang the solution 12-18 inches above the level of the client’s anus.
  165. A client who has been treated with cephalexin for 14 days asks the nurse why his doctor prescribed lactobacillus. The nurse’s best response is:
    “Your antibiotic destroyed all the normal bacteria in your intestines, causing your diarrhea. This medication will help replace that bacteria.”
  166. The nurse questions when a laxative is prescribed for which of the following clients?
    abdominal pain
  167. The best indication of the effectiveness of a laxative taken by a client would be which of the following statements by the client?
    “I have been passing a lot of gas, but haven’t moved my bowels yet.”
  168. The nurse understands that which of the following factors is necessary in the treatment of both diarrhea and constipation?
    increased fluid intake
  169. The client with diarrhea comments to the nurse, “I drink about five cups of hot tea a day.” The nurse’s best response to this client would be:
    “Drinking hot beverages can actually make your diarrhea worse.”
  170. The nurse should instruct clients about health-related measures that promote elimination and discourage laxative overuse, including which of the following:
    exercise and activity, adequate fluid intake.
  171. When teaching clients about laxatives appropriate comment(s) by the nurse would be”
    “They can be habit-forming so don’t overuse them.”, “Some laxatives can take up to three days to work.”
  172. Mr. Jones is a 40-year-old disabled man who lives alone since his wife died six months ago. Which factors would the nurse consider place Mr. Jones at risk for developing constipation?
    that he lives alone, that he is disabled, that his wife died so recently
  173. An 80-year-old woman lives with her husband of 50 years. Even though she has a heart condition, she attends an exercise class for seniors twice a week. She and her husband make sure they drink 4 ounces of juice at all three of their daily meals. What factors would place this woman at risk for constipation.
    her age, her fluid intake