NR 293 Quiz 3
Student Name
Chamberlain University
NR-293: Pharmacology for Nursing Practice
Prof. Name
Date
Quiz 3 Pharmacology Review
1. Three days after beginning therapy with oral iron tablets, a patient calls the office, saying, “I’m very worried because my bowel movements are black!” What will the nurse do?
Correct Answer: d. Explain to the patient that this is an expected effect of the medication.
Explanation:
Black or dark-colored stools are a common and harmless side effect of oral iron therapy. This occurs because unabsorbed iron is oxidized in the gastrointestinal tract. The nurse should reassure the patient that this is normal and does not indicate internal bleeding unless accompanied by symptoms such as abdominal pain or bloody stools.
2. Connie, age 58 years, is in the hospital because of extreme weakness. She has a history of chronic renal failure, and there is a new order for epoetin alfa (Epogen). What laboratory results are monitored during epoetin therapy, and why?
Answer:
The nurse should regularly monitor hemoglobin levels and hematocrit during epoetin therapy. If hemoglobin levels rise too quickly or exceed 12 g/dL, the patient may be at increased risk for hypertension or seizures. This monitoring ensures safe therapeutic effects without triggering adverse cardiovascular events.
3. When administering angiotensin-converting enzyme (ACE) inhibitors, the nurse keeps in mind that which are possible adverse effects? (Select all that apply.)
Correct Answers: b. Fatigue, d. Headaches, e. A dry cough
Explanation:
ACE inhibitors may cause fatigue, headaches, and a persistent dry cough due to bradykinin accumulation. Other potential adverse effects include dizziness, hyperkalemia, and angioedema.
4. A patient is being treated for a hypertensive emergency. The nurse expects which drug to be used?
Correct Answer: a. Sodium nitroprusside (Nitropress)
Explanation:
Sodium nitroprusside is the drug of choice for hypertensive emergencies because it acts rapidly as a potent vasodilator to immediately lower blood pressure.
5. A beta1 blocker is prescribed for a patient with heart failure and hypertension. Which adverse effects, if present, may indicate a serious problem is developing while the patient is taking this medication? (Select all that apply.)
Correct Answers: a. Edema, c. Shortness of breath
Explanation:
Edema and shortness of breath can indicate worsening heart failure or pulmonary congestion, requiring immediate evaluation and possible adjustment of therapy.
6. Given the nurse’s knowledge of the side effects of alpha blockers, which instruction should the nurse provide to the patient with a new order for an alpha blocker to treat hypertension?
Correct Answer: c. Change positions slowly.
Explanation:
Alpha blockers can cause orthostatic hypotension, leading to dizziness or fainting when standing suddenly. Patients should be instructed to change positions gradually to reduce the risk of falls.
7. Indicate which ACE inhibitor would be best for the following patients. Explain your answers.
| Patient | Best ACE Inhibitor | Reason |
|---|---|---|
| Irene (liver dysfunction, high BP, critically ill) | Captopril | Not a prodrug, so it does not require liver metabolism for activation. |
| Kory (poor adherence history) | Lisinopril or Benazepril | Long half-life allows once-daily dosing, improving adherence. |
8. White and African-American patients are known to respond differently to antihypertensive agents. Which antihypertensives are considered more effective in African-American patients than in white patients?
Answer:
Calcium channel blockers and diuretics have been shown to be more effective in African-American patients compared to ACE inhibitors or beta blockers for initial hypertension management.
9. What is the purpose of antianginal drug therapy?
Correct Answer: c. To increase blood flow to ischemic cardiac muscle
Explanation:
Antianginal medications improve myocardial oxygen supply-demand balance by increasing blood flow to oxygen-deprived cardiac tissue, reducing chest pain and preventing ischemia.
10. A patient with coronary artery spasms will be most effectively treated with which type of antianginal medication?
Correct Answer: b. Calcium channel blockers
Explanation:
Calcium channel blockers relax smooth muscle in coronary arteries, preventing and relieving vasospasms.
11. During his morning walk, a man begins to experience chest pain. He sits down and takes one nitroglycerin sublingual tablet. After 5 minutes, the chest pain is worsening. What action would be the priority in this situation?
Correct Answer: a. Call 911 (emergency medical services)
Explanation:
Worsening chest pain after nitroglycerin could indicate a myocardial infarction. Immediate emergency assistance is critical.
12. As part of treatment for early heart failure, a patient is started on an ACE inhibitor. The nurse will monitor the patient’s laboratory work for which potential effect?
Correct Answer: c. Hyperkalemia
Explanation:
ACE inhibitors reduce aldosterone secretion, leading to potassium retention, which can cause dangerous hyperkalemia.
13. Before giving oral digoxin (Lanoxin), the nurse discovers that the patient’s radial pulse is 52 beats/min. What will be the nurse’s next action?
Correct Answer: c. Hold the dose and notify the physician.
Explanation:
A pulse below 60 bpm may indicate digoxin toxicity or bradycardia, requiring medical evaluation before administration.
14. Which statement regarding digoxin therapy and potassium levels is correct?
Correct Answer: a. Low potassium levels increase the chance of digoxin toxicity.
Explanation:
Hypokalemia enhances digoxin binding to cardiac tissue, increasing toxicity risk.
15. While monitoring Mr. F. after oral digoxin (Lanoxin) administration, the nurse notes increased urinary output, decreased dyspnea and fatigue, and constipation. Mr. F. complains that if he were allowed to eat bran as often as he used to, he wouldn’t be constipated. What do the nurse’s findings indicate? How will the nurse respond to Mr. F.?
Answer:
The increased urinary output and reduction in dyspnea and fatigue indicate that digoxin is having its desired therapeutic effect in improving cardiac function. However, constipation is an undesired side effect. The nurse should advise Mr. F. to avoid bran because it can interfere with digoxin absorption, and instead suggest other constipation remedies such as increased fluid intake, dietary fiber from non-bran sources, and possibly stool softeners.
16. Before giving oral digoxin (Lanoxin), the nurse discovers that the patient’s radial pulse is 52 beats/min. What will be the nurse’s next action?
Correct Answer: c. Hold the dose and notify the physician.
Explanation:
A radial pulse below 60 bpm requires withholding digoxin and contacting the healthcare provider to avoid potential toxicity or severe bradycardia.
17. Mr. K., who has been diagnosed with hypertension, is hospitalized after a myocardial infarction (MI).
a. To reduce the risk of sudden cardiac death in Mr. K., the physician prescribes a drug from which class? Why?
Answer:
Class II antidysrhythmics (beta blockers) are prescribed because they reduce myocardial oxygen demand, prevent dysrhythmias, and lower mortality rates after MI.
b. How would a history of asthma in Mr. K. affect the drug choice?
Answer:
A history of asthma would require the use of cardioselective beta blockers such as atenolol or metoprolol to minimize bronchoconstriction risk.
18. Which statement is true regarding enoxaparin (Lovenox) and dalteparin (Fragmin)?
Correct Answer: b. They do not require clotting time monitoring.
Explanation:
These low molecular weight heparins (LMWHs) have predictable anticoagulant effects and typically do not require routine aPTT monitoring, unlike unfractionated heparin.
19. During teaching of a patient who will be taking warfarin sodium (Coumadin) at home, which statement by the nurse is correct regarding over-the-counter drug use?
Correct Answer: b. Aspirin products may result in increased bleeding.
Explanation:
Aspirin has antiplatelet effects that can potentiate the anticoagulant action of warfarin, significantly increasing bleeding risk.
20. A patient is at risk for a stroke. Which drug is recommended to prevent platelet aggregation for stroke prevention by the American Stroke Society?
Correct Answer: a. Aspirin
Explanation:
Aspirin is recommended for certain high-risk individuals to prevent stroke through inhibition of platelet aggregation.
21. During thrombolytic therapy, the nurse monitors for bleeding. Which symptoms may indicate a serious bleeding problem? (Select all that apply.)
Correct Answers: b. Hypotension, c. Decreased level of consciousness, d. Increased pulse rate, e. Restlessness
Explanation:
These signs may indicate internal bleeding or hemorrhagic stroke and require immediate intervention.
22. The nurse is preparing to administer a new order of enoxaparin (Lovenox) to a patient. Upon checking the patient, the nurse notes that the patient has an epidural catheter. What is the priority action of the nurse at this time?
Answer:
Enoxaparin should only be given at least 2 hours after removal of the epidural catheter to avoid the risk of spinal or epidural hematoma, which could lead to paralysis.
23. Patients taking cholestyramine (Questran) may experience which adverse effects?
Correct Answer: d. Belching and bloating
Explanation:
This bile acid sequestrant commonly causes gastrointestinal discomfort, including bloating, belching, and constipation.
24. In reviewing the history of a newly admitted cardiac patient, the nurse knows that the patient would have a contraindication to antilipemic therapy if which condition is present?
Correct Answer: a. Liver disease
Explanation:
Antilipemic drugs, especially statins, can cause hepatotoxicity, so they are contraindicated in patients with active liver disease.
25. A patient who has started taking niacin complains that he “hates the side effects.” Which statement by the nurse is most appropriate?
Correct Answer: d. Try taking a small dose of ibuprofen (Advil) 30 minutes before taking niacin.
Explanation:
Ibuprofen or aspirin can reduce flushing, a common side effect of niacin.
NR 293 Quiz 3
26. A patient asks, “What is considered the ‘good cholesterol?’”
Correct Answer: c. HDL
Explanation:
High-density lipoprotein (HDL) removes cholesterol from the bloodstream, transporting it to the liver for excretion.
29. A patient taking a statin calls the office to report an increase in muscle pain. Which information takes priority as the nurse communicates with the patient?
Correct Answer: a. This could be the sign of a serious side effect, stop taking the medication immediately.
Explanation:
Muscle pain could indicate rhabdomyolysis, a potentially life-threatening complication of statins.
30. The nurse is preparing to administer a newly ordered statin drug to a patient and is reviewing the patient’s list of current medications. Which medications may cause an interaction with the statin drug? (Select all that apply.)
Correct Answers: a. Warfarin, c. Erythromycin, d. Cyclosporine, e. Gemfibrozil
31. Which are indications for the use of diuretics? (Select all that apply.)
Correct Answers: a. To increase urine output, c. To treat hypertension, d. To treat open-angle glaucoma, e. To treat edema associated with heart failure
32. When providing patient teaching to a patient who is taking a potassium-sparing diuretic such as spironolactone (Aldactone), the nurse will include which dietary guidelines?
Correct Answer: c. The patient needs to avoid excessive intake of foods high in potassium.
33. When teaching a patient about diuretic therapy, which would the nurse indicate as the best time of day to take these medications?
Correct Answer: a. Morning
34. The greatest volume of diuresis is produced by which class of diuretics?
Correct Answer: a. Loop
35. A nurse is administering octreotide (Sandostatin) to a patient who has a metastatic carcinoid tumor. The patient asks about the purpose of this drug.
Correct Answer: c. This drug helps to control the flushing and diarrhea that you are experiencing.
36. The nurse will instruct a patient taking desmopressin acetate as a nasal spray for the treatment of diabetes insipidus to perform which action to obtain maximum benefit from the drug?
Correct Answer: a. Clear the nasal passages before spraying the medication.
37. When assessing a patient who is receiving octreotide (Sandostatin) therapy, the nurse will closely monitor which assessment finding?
Correct Answer: a. Blood glucose levels
38. When monitoring for the therapeutic effects of intranasal desmopressin (DDAVP) in a patient who has diabetes insipidus, which assessment finding will the nurse look for as an indication that the medication therapy is successful?
Correct Answer: d. Decreased urine output
39. A patient who is beginning therapy with levothyroxine (Synthroid) asks the nurse when the medication will start working.
Correct Answer: c. Within a few weeks
40. A patient wants to switch brands of levothyroxine (Synthroid). What is the nurse’s best response?
Correct Answer: d. You should check with your provider before switching brands.
41. When administering insulin, the nurse must keep in mind that which is the most immediate and serious adverse effect of insulin therapy?
Correct Answer: b. Hypoglycemia
42. While monitoring a patient who is receiving insulin therapy, the nurse observes for which signs of hypoglycemia?
Correct Answer: c. Irritability, sweating, and confusion
43. The nurse is reviewing the use of oral glucocorticoids. Which of these is the preferred oral glucocorticoid for anti-inflammatory or immunosuppressant purposes?
Correct Answer: c. Prednisone
44. A patient has Cushing’s syndrome. The nurse expects which drug to be used to inhibit the function of the adrenal cortex in the treatment of this syndrome?
Correct Answer: b. Aminoglutethimide
45. The nurse would recognize which of the following as a potential side effect of glucocorticoid therapy in young children?
Correct Answer: b. Growth suppression
46. What patient teaching is appropriate for a patient taking alendronate (Fosamax)? (Select all that apply.)
Correct Answers: c. Take with an 8-oz glass of water, e. Take first thing in the morning upon arising, f. Do not lie down for at least 30 minutes after taking
47. A patient asks the nurse about the newer antihistamines. He wants one that does not cause drowsiness. Which of these drugs is appropriate?
Correct Answer: a. Loratadine (Claritin)
48. Which outcome would the nurse recognize as a positive response to guaifenesin?
Correct Answer: c. Increase in sputum production
References
National Institutes of Health. (2023). Medication safety and patient education. https://www.nih.gov
Lilley, L. L., Collins, S. R., & Snyder, J. S. (2023). Pharmacology and the nursing process (10th ed.). Elsevier.
NR 293 Quiz 3
Rosenthal, L., & Burchum, J. (2021). Lehne’s pharmacology for nursing care (11th ed.). Elsevier.
American Heart Association. (2024). Hypertension treatment guidelines. https://www.heart.org