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Chapter 42 - Cardiac Glycosides, Antianginals, and Antidysrhythmics 1. A client is to be discharged home with a transdermal nitroglycerin patch.

Which instruction will the nurse include in the client's teaching plan? A) a. Apply the patch to a nonhairy area of the upper torso or arm. B) b. Apply the patch to the same site each day. C) c. If you have a headache, remove the patch for 4 hours and then reapply. D) d. If you have chest pain, apply a second patch next to the first patch. 2. A nurse is monitoring a client with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective? A) a. Blood pressure 120/80 mm Hg B) b. Heart rate 70 beats per minute C) c. ECG without evidence of ST changes D) d. Client stating that pain is 0 out of 10 3. The nurse is monitoring a client during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action? A) a. Blood pressure 110/90 mm Hg B) b. Flushing C) c. Headache D) d. Chest pain 4. Which statement made by the client demonstrates a need for further instruction regarding the use of nitroglycerin? A) a. If I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief. B) b. I should keep my nitroglycerin in a cool, dry place. C) c. I should change positions slowly to avoid getting dizzy. D) d. I can take up to five tablets at 3-minute intervals for chest pain if necessary. 5. Which client assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker? A) a. Client states that she has no chest pain. B) b. Client states that the swelling in her feet is reduced. C) c. Client states the she does not feel dizzy. D) d. Client states that she feels stronger.

6. What statement is the most important for the nurse to include in the teaching plan for a client who has started on a transdermal nitroglycerin patch? A) a. This medication works faster than sublingual nitroglycerin works. B) b. This medication is the strongest of any nitroglycerin preparation available. C) c. This medication should be used only when you are experiencing chest pain. D) d. This medication will work for 24 hours and you will need to change the patch daily. 7. What will the nurse instruct the client to do to prevent the development of tolerance to nitroglycerin? A) a. Apply the nitroglycerin patch every other day. B) b. Switch to sublingual nitroglycerin when the clients systolic blood pressure elevates to more than 140 mm Hg. C) c. Apply the nitroglycerin patch for 14 hours and remove it for 10 hours at night. D) d. Use the nitroglycerin patch for acute episodes of angina only. 8. Before the nurse administers isosorbide mononitrate (Imdur), what is a priority nursing assessment? A) a. Assess serum electrolytes. B) b. Measure blood urea nitrogen and creatinine. C) c. Assess blood pressure. D) d. Monitor level of consciousness. 9. The client asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response? A) a. You can protect it from heat by placing the bottle in an ice chest. B) b. Its best to keep it in its original container away from heat and light. C) c. You can put a few tablets in a resealable bag and carry it in your pocket. D) d. Its best to lock them in the glove compartment to keep them away from heat and light. 10. Which statement indicates to the nurse that the client understands sublingual nitroglycerin medication instructions? A) a. I will take up to five doses every 3 minutes for chest pain. B) b. I can chew the tablet for the quickest effect. C) c. I will keep the tablets locked in a safe place until I need them. D) d. I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness.

11. What instruction should the nurse provide to the client who needs to apply nitroglycerin ointment? A) a. Use the fingers to spread the ointment evenly over a 3-inch area. B) b. Apply the ointment to a nonhairy part of the upper torso. C) c. Massage the ointment into the skin. D) d. Cover the application paper with ointment before use. 12. A client receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's priority action? A) a. Assess the clients lung sounds. B) b. Decrease the intravenous nitroglycerin by 10 mcg/min. C) c. Stop the nitroglycerin infusion for 1 hour, and then restart. D) d. Recheck the clients vital signs in 15 minutes but continue the infusion. 13. The nurse is monitoring a client taking digoxin (Lanoxin) for treatment of heart failure. Which assessment finding indicates a therapeutic effect of the drug? A) a. Heart rate 110 beats per minute B) b. Heart rate 58 beats per minute C) c. Urinary output 40 mL/hr D) d. Blood pressure 90/50 mm Hg 14. A client's serum digoxin level is drawn, and it is 0.4 ng/mL. What is the nurse's priority action? A) a. Administer ordered dose of digoxin. B) b. Hold future digoxin doses. C) c. Administer potassium. D) d. Call the health care provider. 15. A client is taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg. When the nurse enters the room, the client states, "There are yellow halos around the lights." Which action will the nurse take? A) a. Evaluate digoxin levels. B) b. Withhold the furosemide C) c. Administer potassium. D) d. Document the findings and reassess in 1 hour.

16. Which assessment finding will alert the nurse to suspect early digitalis toxicity? A) a. Loss of appetite with slight bradycardia B) b. Blood pressure 90/60 mm Hg C) c. Heart rate 110 beats per minute D) d. Confusion and diarrhea 17. The nurse reviews a client's laboratory values and finds a digoxin level of 10 ng/mL and a serum potassium level of 5.9 mEq/L. What is the nurse's primary intervention? A) a. To administer atropine B) b. To administer digoxin immune FAB C) c. To administer epinephrine D) d. To administer Kayexalate 18. A client is to begin treatment for short-term management of heart failure with milrinone lactate (Primacor). What is the priority nursing action? A) a. Administer digoxin via IV infusion with the Primacor. B) b. Administer Lasix (furosemide) via IV infusion after the Primacor. C) c. Monitor blood pressure continuously. D) d. Maintain an infusion of lactated Ringers with Primacor infusion. 19. A client's recently drawn serum lidocaine drug level is 3.0 mcg/mL. What is the nurse's priority intervention? A) a. Increase the lidocaine infusion. B) b. Decrease the lidocaine infusion. C) c. Continue to monitor the client. D) d. Stop the IV drip for 1 hour. 20. A client is admitted to the emergency department with paroxysmal supraventricular tachycardia. What intervention is the nurse's priority? A) a. Administration of digoxin IV push B) b. Administration of oxygen, 2 lpm C) c. Rapid IV bolus of Adenosine (Adenocard) D) d. Instructing client to bear down

21. A nurse is caring for a client who has been started on ibutilide (Corvert). Which assessment is a priority for this client? A) a. Blood pressure measurement B) b. BUN and creatinine C) c. ECG D) d. Lung sounds 22. Which assessment finding will alert the nurse to possible toxic effects of amiodarone? A) a. Heart rate 100 beats per minute B) b. Crackles in the lungs C) c. Elevated blood urea nitrogen D) d. Decreased hemoglobin 23. What must the nurse monitor when titrating intravenous nitroglycerin for a client? (Select all that apply.) A) a. Continuous oxygen saturation B) b. Continuous blood pressures C) c. Hourly ECGs D) d. Presence of chest pain E) e. Serum nitroglycerin levels F) f. Visual acuity Chapter 43 Diuretics 1. Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide (HydroDIURIL)? A) a. Sodium level of 140 mEq/L B) b. Fasting blood glucose level of 140 mg/dL C) c. Calcium level of 9 mg/dL D) d. Chloride level of 100 mEq/L

2. What is the best information for the nurse to provide to the client who is receiving spironolactone (Aldactone) and furosemide (Lasix) therapy? A) a. Moderate doses of two different diuretics are more effective than a large dose of one. B) b. This combination promotes diuresis but decreases the risk of hypokalemia. C) c. This combination prevents dehydration and hypovolemia. D) d. Using two drugs increases the osmolality of plasma and the glomerular filtration rate. 3. The nurse is assessing a client who is taking furosemide (Lasix). The client's potassium level is 3.4 mEq/L, chloride is 90 mmol/L, and sodium is 140 mEq/L. What is the nurse's primary intervention? A) a. Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly. B) b. Administer Kayexalate. C) c. Administer 2 mEq potassium chloride per kilogram per day IV. D) d. Administer PhosLo, two tablets three times per day. 4. A nurse admits a client diagnosed with pneumonia. The client has a history of chronic renal insufficiency, and the health care provider orders furosemide (Lasix) 40 mg twice a day. What is most important to include in the teaching plan for this client? A) a. That the medication will have to be monitored very carefully owing to the clients diagnosis of pneumonia. B) b. The fact that Lasix has been proven to decrease symptoms with pneumonia. C) c. The fact that Lasix has shown efficacy in treating persons with renal insufficiency. D) d. That the medication will need to be given at a higher than normal dose owing to the clients medical problems. 5. A client taking spironolactone (Aldactone) has been taught about the therapy. Which menu selection indicates that the client understands teaching related to this medication? A) a. Apricots B) b. Bananas C) c. Fish D) d. Strawberries 6. Which client would the nurse need to assess first if the client is receiving mannitol (Osmitrol)? A) a. A 67-year-old client with type 1 diabetes mellitus B) b. A 21-year-old client with a head injury C) c. A 47-year-old client with anuria D) d. A 55-year-old client receiving cisplatin to treat ovarian cancer

7. A nurse is caring for a client receiving acetazolamide (Diamox). Which assessment finding will require immediate nursing intervention? A) a. A decrease in bicarbonate level B) b. An increase in urinary output C) c. A decrease in arterial pH D) d. An increase in PaO2 8. A client is ordered furosemide (Lasix) to be given via intravenous push. What interventions should the nurse perform? (Select all that apply.) A) a. Administer at a rate no faster than 20 mg/min. B) b. Assess lung sounds before and after administration. C) c. Assess blood pressure before and after administration. D) d. Maintain accurate intake and output record. E) e. Monitor ECG continuously. F) f. Insert an arterial line for continuous blood pressure monitoring. 9. A client is prescribed Thalitone (chlorthalidone). What is the most important information the nurse should teach the client? A) a. Do not drink more than 10 ounces of fluid a day while on this medication. B) b. Take this medication on an empty stomach. C) c. Take this medication before bed each night. D) d. Wear protective clothing and sunscreen while on this medication. 10. A client with hyperaldosteronism is prescribed spironolactone (Aldactone). What assessment finding would the nurse evaluate as a positive outcome? A) a. Decreased potassium level B) b. Decreased crackles in the lung bases C) c. Decreased aldosterone D) d. Decreased ankle edema

11. A client with acute pulmonary edema receives furosemide (Lasix). What assessment finding indicates that the intervention is working? A) a. Potassium level decreased from 4.5 to 3.5 mEq/L. B) b. Crackles auscultated in the bases. C) c. Lungs clear. D) d. Output 30 mL/hr. 12. Which assessment indicates a therapeutic effect of mannitol (Osmitrol)? A) a. Decreased intracranial pressure B) b. Decreased potassium C) c. Increased urine osmolality D) d. Decreased serum osmolality 13. Which intervention will the nurse perform when monitoring a client receiving triamterene (Dyrenium)? A) a. Assess urinary output hourly. B) b. Monitor for side effect of hypoglycemia. C) c. Assess potassium levels. D) d. Monitor for Hypernatremia. 14. The client asks the nurse why the health care provider prescribed acetazolamide (Diamox), a diuretic, to treat gout. What is the nurse's best response? A) a. It causes an alkaline urine, which facilitates the elimination of uric acid. B) b. It increases alkalinity of urine, thus decreasing the formation of uric acid. C) c. It causes an acid urine, which facilitates the elimination of uric acid. D) d. It decreases alkalinity of urine, thus decreasing the formation of uric acid. Chapter 44 Antihypertensives 1. Which statement indicates that the client needs additional instruction about antihypertensive treatment? A) a. I will check my blood pressure daily and take my medication when it is over 140/90. B) b. I will include rest periods during the day to help me tolerate the fatigue my medicine may cause. C) c. I will change my position slowly to prevent feeling dizzy. D) d. I will not mow my lawn until I see how this medication makes me feel.

2. A nurse is caring for a client who is taking an angiotensin-converting enzyme inhibitor and develops a dry, nonproductive cough. What is the nurse's priority action? A) a. Call the health care provider to switch the medication. B) b. Assess the client for other symptoms of upper respiratory infection. C) c. Instruct the client to take antitussive medication until the symptoms subside. D) d. Tell the client that the cough will subside in a few days. 3. The nurse is reviewing a medication history on a client taking an ACE inhibitor. The nurse plans to contact the health care provider if the client is also taking which medication? A) a. docusate sodium (Colace) B) b. furosemide (Lasix) C) c. morphine sulfate D) d. spironolactone (Aldactone) 4. A client is prescribed a noncardioselective beta1 blocker. What nursing intervention is a priority for this client? A) a. Assessment of blood glucose levels B) b. Respiratory assessment C) c. Orthostatic blood pressure assessment D) d. Teaching about potential tachycardia 5. Which client will the nurse assess first? A) a. The client who has been on beta blockers for 1 day. B) b. The client who is on a beta blocker and a thiazide diuretic. C) c. The client who has stopped taking a beta blocker due to cost. D) d. The client who is taking a beta blocker and Lasix (furosemide). 6. The nurse is caring for a client with hypertension who is prescribed Clonidine transdermal preparation. What is the correct information to teach this client? A) a. Change the patch daily at the same time. B) b. Remove the patch before taking a shower or bath. C) c. Do not take other antihypertensive medications while on this patch. D) d. Get up slowly from a sitting to a standing position.

7. The client taking Methyldopa (Aldomet) has elevated liver function tests. What is the nurse's best action? A) a. Document the finding and continue care. B) b. Notify the health care provider. C) c. Immediately stop the medication. D) d. Change the clients diet. 8. A client taking prazosin has a blood pressure of 140/90. The client is complaining of swollen feet. What is the nurse's best action? A) a. Hold the medication. B) b. Call the health care provider. C) c. Determine the clients history. D) d. Weigh the client. 9. A calcium channel blocker has been ordered for a client. Which condition in the client's history is a contraindication to this medication? A) a. Hypokalemia B) b. Dysrhythmias C) c. Hypotension D) d. Increased intracranial pressure 10. A client who takes clonidine (Catapres) is to be discharged to home. Which instruction will the nurse include when teaching this client? A) a. Your blood pressure should be checked by a health care provider at least once a year. B) b. Increasing fluid and fiber in your diet can help prevent the side effect of constipation. C) c. Intense exercise or prolonged standing is not a problem with clonidine as it can be with other antihypertensive agents. D) d. If you are having difficulty with the common side effect of drooling, notify your health care provider so your dosage can be adjusted. 11. During assessment of a client diagnosed with pheochromocytoma, the nurse auscultates a blood pressure of 210/110 mm Hg. What is the nurse's best action? A) a. To ask the client to lie down and rest B) b. To assess the client?s dietary intake of sodium and fluid C) c. To administer phentolamine (Regitine) D) d. To administer nitroprusside (Nipride)

12. Which is a priority nursing diagnosis for a client taking an antihypertensive medication? A) a. Alteration in cardiac output related to effects on the sympathetic nervous system B) b. Knowledge deficit related to medication regimen C) c. Fatigue related to side effects of medication D) d. Alteration in comfort related to nonproductive cough