Exam 2

Question 1

Hydrochlorothiazide should not be given to patients with what?

Answer 1

severe renal impairment; therefore, an decreased creatinine clearance

Question 2

A client is taking an aminoglycoside ABX and furosemide. What symptom should the nurse teach the client to report?

Answer 2

ringing in the ears

Question 3

A pt on dig has been Rx furosemide. VS- BP 132/84 HR irreg 87 bpm RR 23. Crackles are present. What lab is concerning?

Answer 3

potassium levels that are not within range

Question 4

What symptoms would the nurse monitor for in a patient with suspected hypokalemia caused by diuretic use?

Answer 4

muscle weakness and lethargy

Question 5

A nurse assesses dyspnea, bilat crackles, & pitting edema in a pt RX spironolactone. Which intervention is appropriate?

Answer 5

request an order for furosemide

Question 6

A pt has 2+ pitting edema of BLE. The nurse hears crackles. The serum K+ level is 6. Which drug would the nurse question

Answer 6

spironolactone

Question 7

A pt is taking furosemide 4 HTN & CHF. The dr has just added dig. What other drug does the nurse suspect will be added?

Answer 7

spironolactone

Question 8

A pt w/ CHF has been taking dig&HCTZ. Spironolactone has just been added. What statement indicates teach’g is effective?

Answer 8

“I need to stop taking potassium supplements.”

Question 9

What time of day would the nurse teach a client that it is best to take their diuretic medication?

Answer 9

morning

Question 10

What time of day would the nurse teach a client that it is best to take their diuretic medication?

Answer 10

reduces intracranial pressure.

Question 11

What electrolyte imbalances might occur in a pt taking 40 mg furosemide daily?

Answer 11

low serum potassium, sodium, magnesium, and calcium

Question 12

What kind of drug is aspirin/NSAIDs/ASA (acetylsalicylic)?

Answer 12

antiplatelets

Question 13

What kind of drugs are P2Y12 ADP Receptor Blockers (clopidogrel/prasugrel)?

Answer 13

antiplatelets

Question 14

When are antiplatelet medications used?

Answer 14

treatment of acute MI, reinfarction prevention, ischemic strokes/TIAs, and acute coronary symptoms (they prevent clots in arteries by suppressing platelet aggregation)

Question 15

What are the adverse effects of clopidogrel/prasugrel and aspirin?

Answer 15

bleeding and GI effects

Question 16

What are the effects of aspirin/NSAIDs/ASAs?

Answer 16

gastric bleeding, hemorrhagic stroke, thrombocytopenia, tinnitus/hearing loss(aspirin overdose)

Question 17

What is the antidote for for heparin?

Answer 17

protamine sulfate

Question 18

What lab is prevalent for heparin? What range is considered therapeutic?

Answer 18

PTT (120-140 secs)
aPTT (60-80 secs)

Question 19

Describe heparin subcutaneous injection administration.

Answer 19

Get accurate weight. Use a 1/2-5/8 in; 25-26 G needle. Give in abdomen, 2in from umbilicus. Don’t rub site

Question 20

Describe heparin IV administration.

Answer 20

aPTT before initiating/changing rate. Accurate weight. verify with second nurse. Use pump. No IVPB, must have separate line.

Question 21

What is the antidote for warfarin?

Answer 21

Vitamin K

Question 22

What is warfarin used for?

Answer 22

treat DVT, prevent thrombus formation in those with A-fib or prosthetic heart valves, prevent MI/ TIA/ PE/ DVT

Question 23

What labs are prevalent to warfarin?

Answer 23

PT (18-24 secs) and INR (2-3: <2 indicates it is not working)

Question 24

What patient education should be provided by the nurse for a patient starting warfarin?

Answer 24

inform dentist before operations, smoking cessation (it can increase warfarin metabolism), avoid aspirin, wear medical alert bracelet, and eat consistent vitamin K foods

Question 25

What pregnancy category is warfarin?

Answer 25

category X

Question 26

What are effects of erythropoietin meds (ex. epoetin alfa)?

Answer 26

HTN, risk for thrombotic events, DVT, headache, and body aches

Question 27

What are the indications for oprelvekin (thrombopoietic growth factors)?

Answer 27

thrombocytopenia (low platelet) and decreases need for platelet transfusion following chemo

Question 28

How is effectiveness of oprelvekin determined?

Answer 28

platelet level of 50,000, so CBC should be done before and after

Question 29

What are the side effects of filgrastim (leukopoietic growth factors)?

Answer 29

bone pain, leukocytosis, splenomegaly, and risk of splenic rupture with long-term usage

Question 30

What some examples of thiazide diuretics?

Answer 30

HCTZ (hydrochlorothiazide), Chlorthalidone, and Metolazone

Question 31

What are the contraindications for thiazide diuretics?

Answer 31

renal failure, pregnancy, allegry to sulfonamides, and anuria (no urine production)

Question 32

What lab interactions can be expected with a patient on a thiazide diuretic?

Answer 32

HYPO- kalemia, magnesemia, natremia HYPER- calcemia, glycemia, lipidemia, uricemia

Question 33

What patient teaching should be provided for thiazide diuretics?

Answer 33

Take in the AM, monitor blood glucose (hyperglycemia), potassium-rich foods, take daily weight, sunblock, change positions slowly

Question 34

What kind of medication is furosemide (potassium-wasting) ?

Answer 34

loop diuretics

Question 35

What are reasons that loop diuretics are given?

Answer 35

CHF, edema, HTN, acute renal failure, acute pulmonary edema, and hypertensive crisis

Question 36

What are the contraindications of loop diuretics (furosemide)?

Answer 36

sulfonamides/sulfa allergies and uncorrected hypokalemia

Question 37

A client on lovastatin complains of muscle pain, what condition may the nurse suspect?

Answer 37

rhabdomyolysis

Question 38

What is a very common side-effect of nicotinic acid (aka Niacin or Vitamin B3)?

Answer 38

flushing ( red face, neck, ears and face)

Question 39

What kind of medications end in -pril?

Answer 39

ACE inhibitors

Question 40

What kind of drugs end in -sartan?

Answer 40

ARBs (angiotensin II-receptor blockers)

Question 41

What class is valsartan?

Answer 41

ARB

Question 42

If the dry cough caused by lisinopril becomes too severe for the patient to handle, what type of medication may be taken into consideration for them to switch to?

Answer 42

ARBs (valsartan)

Question 43

What should individuals on an ACE inhibitor avoid?

Answer 43

high K= foods (salt substitutes, bananas, prunes)

Question 44

What type of antihypertensives are effective for diabetics? Why?

Answer 44

ACE no glucose effect and less effect on kidneys (diabetes damages kidneys)

Question 45

What type of diuretic should be avoided for a patient on an ACE inhibitor? Why?

Answer 45

potassium sparing (spironolactone), because ACE inhibitors can cause elevated potassium (hyperkalemia)

Question 46

What are the black box warnings for lisinopril?

Answer 46

angioedema and pregnancy

Question 47

Clonidine is an antihypertensive medication that causes anticholinergic effect. Name a few.

Answer 47

dry mouth, constipation, sedation, drowsiness

Question 48

Hypotension, bradycardia, dry mouth, constipation, sedation, drowsiness, and peripheral edema are all effects that could be caused by which antihypertensive medications?

Answer 48

clonidine

Question 49

Diltiazem, verapamil and drugs ending in -dipine are what class of medication, and used for what?

Answer 49

calcium channel blockers and antihypertensives

Question 50

What are the intended effects of calcium channel blockers?

Answer 50

decease hypertension, vasodilation

Question 50

What are the indications for calcium channel blockers (verapamil, diltiazem and -dipine drugs?

Answer 50

arrythmias, angina and hypertension

Question 50

What are some side effects of calcium channel blockers?

Answer 50

edema (peripheral), chronic heart failure, syncope, hypotension, and bradycardia

Question 51

What patient teaching should be provided from individuals taking a calcium channel blocker?

Answer 51

avoid grapefruit juice and statins, report chest pain/SOB, taper dose, and change positions slowly

Question 52

How are beta blockers recognized?

Answer 52

-olol

Question 53

In which patients should beta blockers not be used as initial treatment or monotherapy?

Answer 53

African American

Question 54

In which ethnic group should lower dosages of beta blockers be considered, due to their sensitivity to antihypertensives?

Answer 54

Asian individuals

Question 55

What are the contraindications for thiazide diuretics?

Answer 55

renal failure, pregnancy, allergy to sulfonamides, and anuria (no urine production)

Question 56

What lab interactions are expected to occur with thiazide diuretics?

Answer 56

HYPER (GLUC) HYPO (KMN) hyper (glycemia, lipidemia, uricemia, and calcemia) hypo (kalemia, magnesemia, and natremia)

Question 57

What is the antidote for warfarin?

Answer 57

Vitamin K

Question 58

What are some effects of warfarin?

Answer 58

bleeding, hemorrhage, and hepatitis

Question 59

What class of drug is warfarin?

Answer 59

anticoagulant

Question 60

What is the mechanism of action for anticoagulants (heparin/warfarin)?

Answer 60

don't dissolve clots, but prevent new ones forming/growing

Question 61

What are the indications for warfarin?

Answer 61

DVT, prevent thrombus formation in those with A-fib or prosthetic heart valves, prevent MI, TIA, PE, and DVT

Question 62

What should individuals wear who are on warfarin?

Answer 62

medical alert bracelet

Question 63

What should be avoided while taking warfarin?

Answer 63

aspirin and smoking

Question 64

Which food type should be eaten at a consistent level for those on warfarin?

Answer 64

Vitamin K

Question 65

In what cases should warfarin not be given?

Answer 65

pregnancy, active bleeding, hemorrhagic stroke and used in caution with other highly protein bound drugs

Question 66

What is the antidote for heparin?

Answer 66

protamine sulfate